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ON THE

FUNCTIONAL DISEASES

URINARY AND REPRODUCTIVE ORGANS

ON THK

FUNCTIONAL DISEASES

UKINARY AND REPUODUCTLVE ORGANS

D. CAMPBELL ^ACK, M.D., LRC.S. EniN.

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SRCOXn KDITION, RKVISKD

LONDON
J. ife A. CnUKCHILL, NKW BURLINGTON STUKIVr

PREFACE

A SECOND edition of my work " On the Functional
Diseases of the Renal, Urinary, and Reproductive
Organs " being required, I have dissociated, for several
reasons, the portion referring to the kidney, reserving
it for a special work, and have in the following pages
revised and amplified that relating to the latter portion
of the subject, adding a chapter on allied female
diseases.

What may be termed a metaphysical objection is
sometimes taken to the term functional The time
may come when a more exact knowledge of the che-
mical changes which take place in the living organism
may obviate the use of this word, but it has certainly
not yet arrived. The sense in which I regard it in
conjunction with the term disease, is as indicating
simply physiological, in contradistinction to structural
or pathological aberrations from the normal state. It
is, no doubt, somewhat difficult to draw a clear dis-
tinction, but as nearly as possible this position is held
in view in the following pages.

VI PREFACE.

In the English language there is no special work in
which male sexual derangements are treated in a
sufficiently scientific spirit, and consequently on their
merits, or without digressing largely into matters which
have no conceivable professional relationship. The
subject is thus not yet emancipated from the tenacious
grasp of the most rampant charlatanism. Strangely
enough, corresponding diseases in the female have suf-
fered rather from a nimia dUigentia. This deficiency
I have again endeavoured to supply, and I would fain
hope that my present attempt may be found more
worthy of the reception accorded to the former edition
both at home and abroad.

It consists with my experience, both in public and
in private practice, that sexual derangements, real or
imaginary, are productive of evils whose magnitude is
not sufficiently appreciated; or if so, then the reticence
of physicians on these subjects, more especially in this
country, must be held as inimical to the best interests
of society.

In the presence of that unfortunate confusion — ^the
result of imperfect education — between the moral and
the physical, it is extremely difficult to examine or
discuss certain questions relating to sexual matters, in
such a manner that the conventional and the absolute
may not confiict; hence the greater portion of the
wretchedness and quackery associated with generative
derangements, more particularly in the male.

It appears to me, however, that one thing should be
paramount in the mind of the physician, equally with
the physiologist, viz., that he should know neither

PREFACE. VU

restraint nor impulse but that of truth, and the con-
sciousness that under this guidance neither science nor
human well-being will ever be prejudicially assailed.

As in the former edition, I assimie in the present
the responsibility of giving expression to what / beUeve
to be fact.

To succeed in elevating the Uterature of the subjects
herein treated, from the mire in which it has been per-
mitted too long to remain, would have been a no
unworthy triumph — ^to hasten the accomplishment of
this end, ample reward for the trouble which the
present undertaking has entailed.

D. C. B.

29 Montague Place, Russell Square,
London.

CONTENTS.

CHAPTER I.

RETENTION OF URINE; ITS VARIETIES, CAUSES, AND
TREATMENT.

PAGR

Physiology of Micturition, ..... 1

Stracture of the Bladder, and Nervous Supply, ... 2

Nature of the Mucous Coat of the Bladder, ... 4
Budge's experiments on Dogs relatively to Nervous Centre of the

Bladder, ....... 5

Sokoronin's conclusions relatively to Nervous Centre of the

Bladder, ....... 6

Special Functions of the Sympathetic, .... 7

Importance of Bernard's physiological experiments, . 8

Dr Meryon on Secretion, ......

Faradisation of the Bladder; effects o^ &c, 10

Dr Decimus Hogson on the Prostate, ... 10

Sir Charles Bell's views of the iS^Ttcter Fenca?, . . 11
Kupressow on Vesical Innervation, .13

Varieties of Retention of Urine tabulated, ... 14

PhTSIOLOOICAL liETENTION, . .15

Spasm OF THE Bladder, . .15

Symptoms and Treatment, .16

Retention of Urine from Mental Emotion, 17

Spasm OF THE Urethra, . .17

RETENTION FROM VESICAL PARALYSIS.

Normal Function of the Bladder; on what dependent, . 11)

Ischuria; how caused, ...... 19

Bhiddation of Retention by Nerve Distribution, ... 20

Valentin's experiments on the Sympathetic and Spiral Nerves, . 21

Pathology of Priapism, ...... 23

Vaso-Motor Nerves of the Penis, . .24

Distinction of the Splanchnic from other Sympathetic Nerves, 24

Paralysis of the Abdominal Muscles in its relation to Retention, . 25

Vesical Paralysis from affections of the Brain and Spinal Cord, . 25

Treatment of Vesical aralysis, ..... 26

Mr Hutchinson's views as to Catheterism, ... 26

Cystitis in cases of Paraplegia, .... 27

CONTENTS.

PAOX

29
29

30
30

Benzoic Acid as a preventive of Ammoniacal Decomposition,
Tincture of Steel, Strychnine, Ergot of Rye, Phosphoras, and

Electricity in treatment of Vesical Paralysis, .
Dr Wemich of Berlin on Ergot of Bye, ....
Mode of applying Electricity, .....
Dr Althaus on Galvanism^ .....

RETENTION FROM OLD AGE.

Anaesthesia and Acinesis contrasted, . .31

Vesical Debility, ....... 31

Retention from Paralysis, how distinguished from Retention from
Obstruction, . . . . . .32

Prognosis and Treatment of Retention from old age, 33

RETENTION FROM REFLEX IRRITATION.

Causes of this variety of Retention, .... 34

Case of Retention from Operation for Hseraorrhoids, 35

Treatment of Retention from Reflex Irritation, ... 36

RETENTION OF URINE FROM SHOCK.

Shock ; how acting on the Bladder, .36

Diagnosis and Treatment, . .37

CHAPTER ir.

IRRITABLE BLADDER AND STRANGURY.

Functional Diseases defined,

Causes of Irritable Bladder, and Effects, .

Irritable Bladder associated with ** Nervous " conditions.

Relation of the Lithic, and Oxalic Acid Diathesis to Irritable

Bladder,
Treatment of Irritable Bladder, .
Btranodrt — Varieties,

Mason Gk>od's varieties of Strangury,
Differentiation of Strangury from Spasm,
Vermiculous and Polypose Strangury,
Strangury from Application of Blisters,
Treatment of Strangury, Percival on,
Worms in the Bladder,

Dr Barry of Dublin on Worms in the Bladder,
Mr Lawrence's case of Worms in the Bladder,
Symptoms and Treatment of Vesical Worms,

3d
38
39

40
40
il
41
41
43
42
42
43
43
4.'>

C'ONTKNTS.

CHAPTER III.

ON THE PATHOLOGY AND TREATMENT OF NOCTURNAL ENURESIS,
AND SPERMATIC INCONTINENCE.

Physiology and Pathological Relations of these conditions,
Causes of Functional Diseases twofold, Psychical and Somatic,
Functions of the Sensory, Motor, and Sympathetic Nerves,
Emotional Stimulation, .....

Organic Functions, .....

Hysteria, illustrative of Functional Diseases,

Charcot on preventive treatment of Hysteria,

Metromania, a Psychical Aberration,

Effects of HypersBsthesia on Muscular Fibre,

Enuresis in Children more frequently due to Somatic disturbance,

Desault on Involuntary Micturition,

Enuresis from Debility and Sexual Excesses,

Spermorrhagia (axf^^*, seed, fiypvfit, to break forth),

Seminal Emission exclusively a Reflex Act ; Micturition different.

Do the Testicles constantly Secrete Semen ? . . .

Opinion of Eirkes on the Seminal Fluid, ....

Analysis of Vanquelin, ......

Physical Constituents of the Seminal Fluid,

MM. Prevost and Dumas on the relation of the Voml Defferentia

and Ureters in Frogs, ......

Views of Hunter, Bransby Cooper, and others, on Seminal Fluid,
Casx>ei^s Cases relating to Seminal Secretion in advanced life.
Analysis of Dr Davy's Cases, .....

Dr Davy's inferences regarding the Functions of the Vesiculoe, .

Hunter on the Fluid in the Vasa Deffermtiay

Inferences, .......

First discoveiy of Spermatozoa, .....

Pliny, Savonarola, and Felix Platerus, on the Procreati"

Climacteric, .......

Can the peculiar Secretion of the Prostate, Cowpei^s Glands, and

the Vesiculse occur independently of one another, or of the

Secretion of the Testicles ? . . . .

Sir Astley Cooper's Case of Castration, .
Gosselin's Experiments on Animals,
Krahmei^s similar Case, .....
Godard on Seminal Secretion in cases of Epididymitis, .
Lieg^ois and Hirtz on Seminal Secretion in Epididymitis,
John Hunter on Secretion from the Prostate,
Herodotus on the Seminal Fluid of the Ethiopians,

PAOk

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66
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69
09

CONTENTS.

Kraus on the Physical Properties of the Seminal Fluid,

Prout on the Prostatic Secretion,

Nature of the Fluid dischai^ged from the Urethra at Stool

Trousseau's Views,

Benjamin Phillips on the Fluid dischai^ged at Stool

Cullerier on Gonorrhoea,

Morgagni on Involuntary Seminal Evacuation,

Is Semen discharged with the Urine in health ?

Clemens on Semenin the Urine, .

Is Semen reabsorbed into the System ?

Lallemand on Spermatic Discharges,

M. Oosselin on Seminal Reabsorption,

Haller on Seminal Reabsorption, .

Kolliker on Seminal Reabsorption,

Dr Hake of Brighton on Seminal Reabsorption,

Mr Acton on Seminal Reabsorption,

Hippocrates on Humid Tabes,

Pickford on Seminal Evacuation,

Non-Reabsorption of Semen defended,

Effects of Castration on Animals, .

Budge's experiments on the Cerebellum of a Cat, showing the

relations of the Cerebellum and Testicles,
Roubaud on Priapism,
Burdach on the relations of Uterine Ulcerations to the Occiput,
Larry's Case ; Atrophy of the Genitals from Injury to the Occiput,
Lallemand's <TJ'T»'l*^y Case, ....

M. Chauffard's Case of Satyriasis from injury to the Head,
Seminal Secretion constant in health.
Preternatural Excitation stimulates Seminal Secretion, .
Normal Seminal Secretion may lapse into a Pathological State,
Period of Puberty ; its characteristics,
Feuchtersleben and Cabanis on Characteristics of Puberty,
Mason Good on Puberty, .....
Lucretius on Nocturnal Enuresis and Seminal Incontinence,
Psychical impressions; their Influence on Organic Functions,
Physiology of Sleep and Dreams, ....
Certain otubr Circumstances which Influence the Develop-

KENT OF the REPRODUCTIVE FACULTY,

Constitution — Temperament,
Moral Faculties — Passions,
Habit, ....
Climatic Influences,
Seasons, ....

PACK

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91
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93
94
94
95

CONTENTS.

XIU

FAOB

Excessive Seminal Emission a Pathological State, . 95

Its Manifestations — Constitutional ; Local, ... 96

Dr Barclay on the Symptoms Pathognomonic of so-called Sperma-
torrhoea, ....... 97

Scarpa and Rognetta on Amaurosis firom Spermorrfaagia, 97

Pickford and Trousseau on Seminal Emission, ... 98

Hippocrates on Excessive Venery, .99

Dr Bradbury's Case of Locomotor Ataxy, ... 99

Immediate Effects of Prbternatfbal Sexual Excitation, 99

Psychical and Somatic Excitation, .... 100

Mr Solly's case of Spermorrhagia from Spinal Injury, 101

Urethritis as a Cause of Seminal Incontinence, . .102

Chronic Inflammation of the Prostate a cause of Spermorrhagia, . 103
Coarctation of the Urethra from Prostatic Hypersesthesia ; case, . 104
Irritation of the Testicle ; its Influence on Seminal Secretion, 105

Varicocele, an alleged effect of Masturbation, 106

Diagnosis of Varicocele, . . .107

Circocele, ........ 107

Anaemia from Sexual Excesses, .108

Mauriac on Epididymitis, ..... 108

Irritable Testes ; Symptoms, .108

SEMINAL INCONTINENCE IN ITS RELATION TO MENTAL STATES.

Alleged Relationship, .....

Mental Aberration often due to suggestion,

Dr Hassall on the Symptoms of Spermatic Incontinence,

Erotomania in the Male, .....

Relation of Mental Affections to Sexual Aberrations,
Dr Maudsley on Mental Aberration at Puberty, .
Dr Maudsley on Mental Aberration due to Self- Abuse, .
Moral Character of Eunuchs, ....

Dr Crichton Browne on Senile Dementia,

Esquirol on Insanity from Masturbation, .

Dr Ritchie on Insanity from Masturbation,

Mr Solly on Masturbation as a Cause of Epilepsy,

Dr Mapother on Quacks, .....

Dr Smith on Phthisis from Excessive Seminal Emission,

Affections of the Heart in Relation to Genital Excesses, .

Dr Sayre's Cases of Reflex Paralysis, 119, 120, 121, 122, 123,

Analogies of Reflex Paralysis with Epilepsy,

Dr Mackenzie Bacon on Castration as a Remedy for Epilepsy,

Clitoridectomy, ......

Dubois on Clitoridectomy, ....

109
110
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116
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124, 125
125
126
187
127

XIV

CONTENTS.

rAOz
Qraefe of Berlin on Glitoridectomy, .128

Richerand on Clitoridectomj, . . .129

Correlation of Stmptoms as arising from Sexual Excesses and
Masturbation, . . .129

Coitus or Masturbation ; which most injurious, .130

Deslandes on this subject, .130

Hunter's opinions criticised by Jesse Foote, .131

Trousseau's views, ...... 132

Varieties and Causes of Spermorrhagia, .... 132
Preternatural Glandular Excitation, .133

Hyperesthesia of the Prostate and Testicles, . 1 34

Varieties of Spermorrhagia, . .135*

Roubaud on " Pollution" and */ Spermatorrhoea,'' 135

Dr Kxag Chambers on ** Spermatorrhoea," .136

Mr Teevan on '* True Spermatorrhoea," .... 136
Causes of Spermorrhagia, . .136

Morbid Conditions of the VesicuUe SeininaleSf .138

Howship on Morbid Conditions of the Vesiculse, . .139

Hydrocele of the VesiculcB Seminales, .... 140
Affections of the Prepuce as a cause of Seminal Incontinence, 141

Affections of the Rectum as a cause of Seminal Incontinence, . 142
Erichsen on Prolonged Continence, .... 142

Lehmann's case of Seminal Incontinence from Blistering, 143

The Analogies and Relations of Nocturnal Enuresis and
Seminal Incontinence, ...... 143

Retrospect, .... 143, 144, 145, 146, 147, 148

Diagnosis, ........ 148

Prognosis, ....... 149

Treatment, . . ' . 150

Meinhinzen's Experiments as to Spinal Reflex Excitation, and

Influence thereon of Medicinal Agents, . 151

Agents which diminish Sensibility; their modus operandi, 152

Motor Tonics, ....... 163

Effects of Iron on the Nervous System, .... 153

Moral Treatment of Enuresis, . . .154

Extension of Gonorrhoeal Inflammation to the Bladder, . 154

Vesical Injections, . . . .154

Vesical Absorption, Sir Heury Thompson on, . .155

Dr Campbell Black's case of, . . .155

MM. Seglas, Demarquay, Russ, and Susini, on Vesical Absorption, 158
Dr Braxton Hicks, and Dr Tilt, on Vesical Absorption, . 159

Employment of Vesical Injections in Diseased States of the

Organ, ........ 160

CONTENTS.

Qoelicke on Incontinence of urine firom Hair in the Bladder,
Sir Hans Sloane's Case, .....

Mr Powell's Case, .....

Treatment, ......

Diet suitable in cases of Enuresis,

Incontinence from Affections of the Spinal Cord,

Treatment of Spermatic Incontinence,

First indication to allay Irritability,

Application of Nitrate of Silver to the Prostate,

Mr Courtenay*s opinions, .....

Mr James Douglas on Prostatic Cauterisation,

Civiale on Prostatic Cauterisation,

Modus Medendi of Caustic, ....

Dr Bradbury on Treatment of Seminal Incontinence,
Digitalis as an Anaphrodisiac, ....

Bromide of Camphor, its Therapeutical Properties,
Preparations of Lead, their Action,
Bromide of Potassium, its Effect on the' Genital System,
Phosphorus, Lupulin, &c., ....

Steel, Strychnine, and Ergot of Rye,

Psychical Impressions, how removed.

Circumcision in Treatment of Spermorrhagia,

Galvanism in Treatment of Spermorrhagia,

Sexual Congress, its Influence on Sexual Aberrations discussed,

Cicero, Stewart, and Strauss, on the Appetites, . .

PHTSIOLOaiCAL RELATIONS OF CoNTINENCB AND INCONTINENCE,

Arguments in fiEivour of Sexual Congress,

Civiale on Continence, .....

Sanctorius on Continence, ....

Analogy of the Sexual with other Appetites,
Galen on Continence, . . * .

" Editorial'* of The Lancet on Sexual Congress, .
Deslandes on Sexual Congress, ....

Seminal Plethora, ......

Lallemand on Gymnastic Exercise to diminish Seminal Secretion,
Trousseau's Rectal Pessary as a Cure for Seminal Incontinence,
General Treatment, .....

PAOB

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CHACTErv IV.
STERILITY IN THE MALE.

Definition of Sterility,

Procreative Capacity, on what Dependent,

191
191

XVI

CONTENTS.

PAOB

Malformations of the Male Genital Organs, .192

Retained Testes, Cases of, ..... 193

Hunter and Follin's Views as to Procreative Capacity of Cryps-
orchids, ....... 195

Cases by Jarjavay, Caspar, and Blandin, . .197

Procreative Capacity of Monorchids, . . 197

Procreative Capacity of Hypospadias and Epispadias, . 197

Various Malformations of the Penis, . . . 198, 199

Stbriuty from Diseased Conditions of the Beproductive Organs, 199
Sterility from Epididymitis, ..... 200

Prognosis, ....... 201

Treatment of Sterility from Epididymitis, . 202

Sterility from UrethrcU Stricture, .... 202

Tubercular Affections of the Testicles, .... 203

Influence of Disease on Fecundation, * . . 204

Cancer and other Morbid Growths of the Testicles, 204

Excessive Venery, its Effects on Seminal Secretion, 205

Effects of Hydrocele on the Spermatic Function, . 206

Sterility from Diminished Reflex Paresis, 206

" Entonic Impotency," ...... 207

Epileptic Misemission, ...... 208

Idiopathic Azoospermia, ...... 209

Relative Sterility, . .210

CHAPTER V.

MALE IMPOTENCY,

Definition of Impotency, .....

212

Physiology of Erection,

213

Psychical Causes of Impotency,

214

Objective Causes of Impotency,

215

Montaigne's Method of Cure,

216

Subjective Causes of Impotency,

217

Treatment, .

218

Physical Causes of Impotency,

218

Cases of Foed^r^, Schenck, Cattier, Nelaton, &c.,

219

Abnormal Development of the Penis,

220

Bifurcation of the Penis, .....

221

Vicious Directions of the Penis, ....

221

Petit on their Pathology, .....

221,222

Malformations of the Prepuce, ....

223

Malformations of the Bladder,

224,225

CONTENTS.

XVll

Idiopathic ImpoUncy from Defect of Energy,
Satyriasis, ......

Priapism, .......

Stmptomatic Impotbnct, .....

FAQK

226
227
227
228

From Pathological States, ....

From Obesity, ......

Treatment, ......

228
228
229

From Marasmus, ......

229

From Tabes Dorsalis, .....

229

From Obstinate Spermatic Discharges,

From Chlorosis, ......

229
229

Koubaud's Case, .......

230

Impotency from Diabetes, . ....
Impotenct from Affections of the Prostate, Neck of the

231, 232

Bladder, and Vasa Deferentia, ....

233

Anticipating Misemission, ....
Impotency from Affections of the Nervoos System,
Treatment, ......

233, 234
235
236

Impotency from Diseased Conditions of the Nerves,

237

Impotency from Orgamc Neuroses,
Impotenct from Toxjsmia, .....

237
237

Impotency from Lead Poisoning, ....

Seat and Symptoms, .....

Impotenct from Antimonial and Arsenical Poisoning, .

237
238
239

Symptoms, ......

Impotenct from the Toxic Effects of Iodine and Bromine,

239
240

Epitome of the Treatment of Impotency, .
JSIale Preoocitt, ......

240
241

Cases 0^

241,242

Treatment, ......

242

CHAPTER VI.

ANOMALOUS URETHRAL DISCHARGES.

Definition of Anomalous Urethral Discharges,
Diagnosis of Leucorrhoea and Gronorrhcea,
Professor Euss on Leucorrhoea and Gonorrhoea,
Causes of Urethritis,
Case of Simple Urethritis,
Fluid Dischaiged at Stool,
Symptoms of Prostatitis, .
Acute Epididtmitis, as a cause of Urethral Discharge,

244
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246
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248
249,250
261

X\111

CONTENTS.

Constitutional Causes of Simple Urethritis,

Skin Diseases, ......

Carbuncular Diathesis, .....

Long-sustained Intellectual application as a cause of Urethial
Discharges, ......

Diseases of the Rectum as causes of PhaUoirhcea,
Haemorrhoids as a cause of Phallorrhoca, .
Alcoholic Drinks, &c., causes of Phalloirhoea,
Cantharides as a cause of PhaUorrhcea,

PAOB

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252

253
253
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253
254

CHAPTER VII.
IMPOTENCY AND STERILITY m THE FEMALE.

Limits of Procreative Capacity in the Female,

Impotencj, Infecundity, Sterility,
Impotbnct, or Inaptitude for Copulation,

From Congenita], Accidental, and Pathological Conditions,

Varieties, .....

Amussat's Case of Absence of the Vagina,
Stricture of the Vagina, .

Congenital Atresia of the Vagina,

Pathological Conditions of the Uterus, Vagina, &c., as causes of
Impotency, ....

Vaginismus, ....

Neuralgia of the Vagina, .
Inpecunditt, or Inaptitude for Impregnation,

Cases, .....

Imperforation of the Uterine Canal, &c., .

Hypertrophy of the Uterine Neck, and Tumours,

Treatment, ....

Stricture of the Cervical Canal, .

Obstruction froDi False Membranes,

Treatment, ....

Other Varieties of Uterine Stricture,

Spasm of the Uterus,

Position of the Uterus in Pelvic Cavity, .

Vital Displacements,
Uterine Displacements Independent op Coitus,

Exaggerated Elevation of the Uterus^

Prolapsus of the Uterus, .

Versions of the Vterns,

Degrees of Uterine Displacement,

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256, 257
258
259
260

261
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270
270
271

CONTENTS.

XIX

FAOB

Indications of Treatment, ...... 272

Pessaries and other Remedial Agencies, .... 273

Vt^ine Fleocions, ....... 274

Inversion of the Uterus, ...... 274

Treatment of Uterine Inversion, .... 275, 276

Uterine Polypi, ....... 277

Fibrous Tumours, ....... 277

Congestion of the Uterus, ...... 277

Metritis, ........ 278

False Membranes, ...... 278

Morbid Secretions, ...... 278

Indications of Treatment of this Form of Infecundity, . 279

Idiopathetic Uterine Haemorrhages, .^ . . . 279

Treatment, ....... 280

Passive Uterine Haemorrhage, ..... 280

Treatment, . . . . .281

Abnormalities of Ovulation (Sterility proper), 282

Congenital Absence of the Ovaries, .... 283

General Symptoms, ...... 283

Vital Lesions of the Ovart as a Cause of Sterility, 284

Evolution of Normal Ovariaj^ Function, 286

Malposition of the Ovary, ..... 286

Simple or Complicated, ...... 287

Hernia of the Ovary, ...... 288

Percival Pott's Case, ...... 288

General Causes of Female Sterility, .... 289

Temperament, Hereditariness, &c. &c., .... 290
Premature Abortion due to Venereal Excesses, . .291

Relationship of Menstruation with Stbriuty, . 292

Pouchet's Conclusions, ...... 293

Courty's Conclusions, ...... 294

Venereal Excesses as a cause of Sterility, 294

Peculiar Affections of the Grenitals due to Excessive Coitus, . 295

Affections of the Mucous Membrane from, . 296

Influence of Frigidity on Fecundation, .... 297

Roubaud's Varieties of Frigidity, .... 297

Parent — ^Duch&telet on, . 298

Malformations of the Clitoris as perverting the Grenital Sense, 299

Artificial Impregnation, ...... 300

;(apcroyXoxr(rcik ^t fioi"

" We live iii a world which in full of misery and ignorance, and the plain
duty of each and all of na, is to try and make the little comer he can influ-
ence somewhat less miserable, and somewhat less ignorant, than it was before
he entered it" — Huxley,

" Licet omnibus, licet etiam mihi, dignitatem Artis medicinro tueri ; potes-
tas modo veniendi in publicum sit, dicendi periculum non recuso." — Cicero.

" Lou^ par ceux-ci, blam^ par ceox-la, me moquant des sots, bravant len
m^hants, je me hate de rii^ de tout . . . de peur d'etre oblig^ <rempleurer."
— Beaumarchais,

'' La sincerity scientifique ne connait pas les mensonges prudents. II n'est
pas en ce monde uu motif assez fort pour qu'un savant se contraigne dims
Texpression de ce qu*il croit la v^rite.'* — Kenan.

" Wenn deine schrift dem kenner nicht gefallt,
So ist es schon ein bdses zeicheu :
Doch wenn sie gar des narren lob erhiiU,
So ist es zeit, sie ausgustreichen."
-^GclUrt.

THE

FUNCTIONAL DISEASES

OF THE

URINARY AND REPRODUCTIVE ORGANS.

CHAPTER I.

KETENTION OF URINE : ITS VARIETIES, CAUSES, AND
TREATMENT.

Stnoktms,— Reteutio Urinas {Lnf.); Eetention d'Hrino {Frmch);
HarHYerlmltung {6Vr); lieteiiiione d'Orina {IlaL).

CoNTBNTs: — Physiology of Mictrnition— Structure of the Bladder —
Relations of Spinal Cord to Vesical Eunervation — ^ Varieties of
Urinary Retention — Phjsiolo^cal Retention — Spasm of the
Bladder — Spasm of the Urethra — Retention from Vesical Paralyaia
— Pathology of Priapism — Retention from Old Age — Retention
from Reflex IrritiUioii — Retention of Urino from Shock.

Strictly speaking, the urinary eanal may be said to
extend from the pehds of the kidney to the meatus
urinarius of the penis; the bladder being simply a
reservoir conveniently sitnatcd, and admirably adapted,
from the perfection of its mechanism, to meet the
varied exigencies of our state.

The passage of mine from the kidney to the bladder
is a purely involuntary act; its expulsion from the
bladder is a reflex act, which may be performed inde-
pendently of the will, but over which volition has to
a considerable degree a regulating and controlling

ON THE FUNCTIONAL DISEASES OF THE

influence. Between the purely organic or involuntary
and the purely voluntary actions of the body, that
of micturition consequently occupies a middle posi*
tion. These facts, therefore, imply the existence of a
muscular mechanism, partly independent and partly
dependent on the cerebro-spinal system* Hence, in
common with the other portions of the ureter, the
pelvis of the kidney and the greater portion of the
calyces consist of three coats,— externally, a strong
fibro-areolar one, which becomes continuous at the
bases of the papilh^ with the portion of the proper
coat of the kidney, which is continued inwards to the
sinus ; intermediately a strong muscular coat, consist-
ing, as in all canals of the body having like functions
to perform, of longitudinal and circular fibres ; and
Internally, a thin mucous coat, which is reflected over
the summit of each papilla. The special function of
the ureter being beyond the control of the will, its
nerves are derived exclusively from the inferior mesen-
teric, spermatic, and liypogastric plexuses of the sympa-
thetic. The bladder, in like manner, is composed of
three coats,^ — outermost, a serous, partial in extent,
and derived from the peritoneum ; intermediately, a
muscular ; and innermost, a mucous coat. The mus-
cular coat of the bladder, which more immediately
regulates the expulsion and retention of m^ine, is
composed of pale involuntary muscular fibres, in the
anatomical sense of the description. These fibres are
so arranged as to form three layers; the external fibres
taking a longitudinal course, the intermediate being
circularly arranged, and the third, or mnermost, follow-
ing the same com-se as the superficial layer. The
longitudinal fibres are most apparent on the anterior

URINARY AND REPRODUCTIVE ORGANS. 3

and posterior aspects of the bladder. In front their
commencement is traced to the surface of the prostate
gland in the male, and to a corresponding region of
the vagina in the female ; and from this they pass, on
the one hand, over the anterior surface of the bladder
towards its summit, and posteriorly, in like manner,
towards the base of the viscus, on the lateral aspects
of which they run obliquely, and not unfrequently
intersect one another. From the part which these
muscular fibres perform in the act of micturition, they
are collectively termed the detrusor urince muscle.
In the upper and back portion of the bladder the
middle or circular coat does not follow the regularity
of the arrangement which the term implies, for in this
portion of the bladder the arrangement of this part of
the muscular coat is rather oblique than circular ; but
as the vesical orifice is approximated, the layers become
more dense and more circular in disposition, and
aroimd the neck of the bladder constitute dense mus-
cular fibres, termed the sphincter vesicce, which, how-
ever, is not anatomically distinct from the common
middle coat. The difference in the disposition of the
fibres of the middle coat, in the regions mentioned,
is an interesting anatomical fact, and has, no doubt, a
physiological significance, to which reference will be
made in the sequel.

The most deeply situated or sub-mucous coat, very
delicate in structure, is disposed in a longitudinal
manner throughout the surface of the bladder, and,
doubtless, co-operates with the external coat in the
performance of a common function.

Between the mucous membrane of the bladder and
the muscular coat, a layer of areolar tissue, termed the

ON THE FUNCTIONAL DISKA?^)

cellular or Tcisciilar coat, exists. Tl»
smooth, soft, and of a pale rose cului.
tended condition of the bladder it i.^ ,
but becomes smooth or even in sni l
the degree of distension. At the v»i
it forms a small projection tenutv.
In a liypertrophied condition of i^
tlie bladder, in particular, two mu-
seen converjjinjj from the orifices • :
the urethral orifice. At their },-
they cross each other, fomiing t '
tlie urula vesicce, and then buri-
tlie h^ngitudinal muscular fibro
their oflice to occlude the orili*
to open tliat of the urethra
tlie muscles of the ureters,
remarked that pamlysis of th(
tril)utes to several states of rei

The mucous coat of the bh-
stratified epithelium, in varic*'
the columnar and squamoii?^
alkaline, and is said to cov*
pliosphates.

Partaking of an intermed'
tary and involuntary muscv
bladder are derived, con.s«»'
pathetic and cerebro-spiv
the hypogastric plexus, ■
plexus. It is interest It '
logical point of view. ■
is distributed to the
the spinal nerves ni'
base. Through the \

nCittitfior tbrtrs ±':ai

^^^m ^iM^efii^ :u pass

c>jiik v^Mfimcduns of

ijiM^ liscstacua of

URINARY .IND REPRODUCTIVE ORG^VNS.

nerve, a connection between the cerebro-spinal neiVes
of the bladder and prostate is established with the
sjTnpathetic, by the junction of the farmer with the
hypogastric plexus; and by means of the muscular
branch of the same nerve, distributed to the levator
ani and coccygeus, intimate pathological connections
between the bladder, llie rectum, and adjacent textures
are well known to exist.

With reference to the nervous distribution of the
bladder, Budge, of Griefs wald,"^ has recently perfoi^ied
some very interesting experiments on dogs, from which
the folloT\ing conclusions have been drawn :— The
tracing of the vesical nerves from their origin to their
peripherte being, at present impracticable, Budge
resorted to faradisation of the nervous centres, to deter-
mine the relative interdependence between the bladtler
and the brain, and spinal cord. By faradising the
central hemispheres, the corpora striata and the thalami
optici, no effect was produced upon the bladder ; but
no sooner wxre the electrodes made to touch the
peduncuhis cerel>ri and the restiforme body than the
bladder contracted, and urine was voided. It w as thus
made manifest that this portion of the cerebro-spinal
centre furnishes its motor power to the bladder. In
order further to determine the medium of communica-
tion, the sympathetic and pncumogastric were divided,
but witliout producing any modification of the mani-
festations previously observed ; but after sect mi of the
cord, faradisation had no effect. It was further demon-
stmted that the vesical motor fibres proceeded from
the peduncuhis and restiforme body, tlirough the

♦ Zeitachr. f, nU. Hcilk. xxL pp. 3 hs\A 174. Uvl>er die Eeizbarkeit der
vonleren Ruckeimiarksatriiijge (FHugetg AicHiv. fur PhyaioL, Bd, ii p. 51)-

ON THE FUNCTIONAL DISEASES OF THE

anterior columns of the cord, to the anterior roots of
the third and fourth sacral nerves, and that their func-
tion may be excited through the cerebrum, and by
means of reflex action conveyed through the posterior
roots of the sacral nerves. Further, it is alleged that
there is another nervous centre for the bladder in the
lower part of the lumbar region, from which, tlirough
the hj^ogastric plexus, motor fibres are sent to the
bladder ; and we are assm^od that excitibihty persists
in this region longer, after death, than in any other
portion of the nervous system exercising any control
over the bladder. The centripetal nerves of tliis region
are the sensory nerves which run in the posterior roots
of the third, fourth, and fifth sacral nerves.

More recently, N. Sokoronin* arrived at the following
conclusions, confirmatory of Budge's views. He agrees
with Afonasieff that the contractions of the bladder
observed after irritation of the pedmmuli cerebri are
essentially due to irritation of the vaso-motor system,
for the application of a ligature to the aorta prevented
the contractions. He believes that there is a motor
centre for the bladder in the brain, the motor fibres from
which enter the spinal cord and emerge with the first,
second, and third roots of the sacral nerves, to pass
into the hypogastric plexus. Reflex contractions of
the bladder can be made to take place by excitation of
such nerves as the sciatic and crural, and the sensory
nerves of the body generally, as well as the splanchnics,
but not by the pneumogastric, and by excitation of
the proper sensory nerves of the bladder itself. These,
as already remarked, are partly continued in the sacral
nerves, and partly in connecting branches between the

♦ Pflijger*8 Arcliiv. (Band viii. Heft, xii).

URINARY AND REPRODUCTIVE ORGANS. 7

hypogastric plexus, and the inferior mesenteric plexus.
Pain must be felt by the animal in the former case be-
fore the reflex actions occur, since they do not take
place if the hemispheres have been previously removed,
or if the spinal cord be divided in the cervical region.
But in the second case, the proper sensory nerves of
the bladder, which run in the sacral nerves, have as
their centre some point in the vicinity of the fourth
lumbar vertebra, and those movements which are ex-
cited through the sensory sympathetic fibres have as
their centre the superior mesentric ganglion.

To what extent do the results of these experiments
accord with what is known of the relative functions of
the sympathetic, sensory, and motor portions of the
nervous system ? As this subject bears equally upon
the phenomena of retention, and upon other questions
to be discussed in subsequent sections of our under-
taking, a review of them here may obviate unnecessary
recapitulation.

An examination of the sympathetic ganglia discloses
a connection with motor and sensory nerves. With
the spinal cord each ganglion is connected by means
of (a) white nerve fibres proceeding from the spinal
cord to the ganglia, and (6) grey nuclear fibres (fibres
of Remak) proceeding from the ganglion to the cord ;
and it may be incidentally remarked that the opinion
is generally entertained by physiologists that every
ganglion possesses in itself the properties of a nervous
centre, being capable of originating, transmitting, and
regulating impressions on the structures to which its
branches are distributed.*

♦ Vide Dr Andrew Buchanan's pamphlet " On the Classification of the
Functions of the Human Body."

ON THE FUNCTIONAL DISEASES OP THE

In tlie lij^ogastric plexus these communications
aboimd, the hmibar gaiigha ha\ang each two communi-
cating branches from the spinal nerves. At the lower
end the hj^iogastric plexus divides into two parts, one
on each side of the pelvic viscera (pelvic plexuses),
from which numerous branches are sent to the rectum,
bladder, vas deferens, vesicula? seminales, prostate, and
cavernous portion of the penis, in the male ; and the
ovary, vagina, and uterus in the female.

Seeing that so httle exists, w^ithout manifest design,
in the very perfect mechanism of the human body, the
fact of this intimate connection of the synn>athetic with
the ccrebro-spinal system lias naturally led physiologists
to infer that pecuUar properties were developed l}y this
interchange of nerve fibres, and to Claude Bernard, to
whom scientific medicine and physiology owe so much,
is duo the credit of advancing our knowledge on this
abstruse question, as weU as on so many kindred sub-
jects. It has been long known that the nervous supply
of the vascular system is derived from the sjmpathetic,
and we are familiar with the efiect profkiced 1)y the
withdrawal of the influence of this portion of the ner-
vous system from minute blood vessels. In addition
to such experiments of Bernard's as we have akeady
adverted to, he found that division of the sympathetic
in the upper part of the dorsal region in the horse was
follow^ed, as in the experiment on the rabl>it, by greatly
increased vascularity, and that the corresponding sur-
face was bathed in perspiration.

By fai* the most important experiment, however, with
which we are acquainted, as elucidating the respective
properties of the three portions of the nervous system,
is the following one, likewise performed first by

URINARY AND REPRODUCTIVE ORGANS. 9

Bernard * and which Dr Merypn informs me he has
also performed with similar results. Bernard exposed
in a dog the gustatory nerve, the chordae tympani
(before they receive communicating branches from the
lingual nerve), and the submaxillary ganglion. By this
means a motor nerve (the chorda tympani), a sensory
nerve (the lingual), and a ganglionic centre were ex-
posed to view. Thereupon he divided the gustatory
nerve before its junction with the tympanic nei-ve, and
immediately the secretion from the gland was arrested,
because, as Dr Meryon believes, the vital sense of the
gland was destroyed. He then pricked the centripetal
end of the divided nerve, and a large quantity of saliva
was secreted, while the ducts of the parotid and sublin-
gual remained dry. The experiment was subsequently
varied by section of the common nerve, the insertion
of a tube into the Whartonian duct, and by a weak
current being communicated to the peripheric end of
the divided nerve. Whenever this was done, a drop of
saliva was seen to fall from the tube. Thus secretion
was arrested by division of the gustatory, and repro-
duced by pinching its centripetal end. It was arrested
by division of the compound nerve, but likewise restored
by the stimulus of electricity applied to the centri-
fugal end — when applied to the centripetal end of the
divided nerve no effect was produced. As the sensory
nerve is centripetal in function, it could not affect
secretion except by reflex action through the motor;
it is obvious, therefore, that it is upon the motor
nerve that the supply of blood for increased secretion
depends.t

♦ Comptes RenduB, voL xxxiv. p. 474.

t Vide Dr Meryon's excellent lectures in the " Lancet," vol. ii. 1871.

ON THE FUNCTIONAL DISEASES OF THE

I have always entertained the beHef that the fimetioii
of an organ 18 maintained in its normal state hy a cer-
tain potential equililirinm or correlation of the various
nerves by which it is supplied* Thns impressions upon
tlie sjmpathetic (fibres of Keniak), which correspond-
ingly diminish its inhibitory power, exalt motor influ-
ence, by accelerating the circulation ; of which exanij jIcs
are furnislied in the increased force and frequency of
the heart s action,"^ caused by mental impressions, and
augmented glandidar secretion, likewise occasioned by
mental impressions, if not originating in, being at
least ilirected towards particular parts of tlie ganglicmic
system. This disturbance of the nutritive balance is
the psychic4il ; while Bernard s experiments, just re-
ferred to, demonstrate how sematic influences (reflex
irritation, etc.) upon the sensory nerves may be produc-
tive of like results.

Reverting, after this apparent digression to Budge s
experiments, we are solicited to disbelieve— not for the
first time, however — in the existence of a special s^phtnC'
ter ve^icm^f on the following grounds. | " Faradisation

♦ It ift dematiflttvble in tbe frog and other animala, ttiat by commtinicating
electric shocks to the pneuuiogaatric nerve the action of the heart u arrestecL
AHera little time the mflucnce paaaea off, aod the heart re^iuueg iu action.

t For the information of recent writers, who seem to think that Budge*a
Tiewf regarding the circular fibres in the neck of the bladder are novel, it maj
b«? mentioned that ponae years ago, Dr Decinuis HiKlgson, of Ghisgow, puli-
Utht?'l a Bnmll volume, ** On the Pttietate Gland, and its Enlargement in Old
Age," in which the following pftasage occur*. lo treating of " Healthy Mic-
turition," Dr Hodgson reniarka "that the proulatic urethra and the neck of
iht* blftiidtr, with the neck of the canal » are kept dosed during the intervala
of micturitinn by means of the elaMic tijwue of their waUe, quite in the flune
marnier ae» the? bladder ie kept in apposition with its contained urine ; and the
uiuiuiubir fibref of the bladder and urethra are gimply employed in expelling
tJie urine at internals,"

t Dt Althan^a Brit, Med Jour. 1876,

■i

URINARY AND REPRODUCTIVE ORGANS. 11

of any portion of the bladder caused urine to be voided ;
and when Budge caused a column of water to flow in
an uninterrupted stream out of the bladder, faradisa-
tion of the anatomical sphincter had no influence in
arresting the flow. This was, however, immediately
checked when the electrodes were directed to the mem-
branous portion of the urethra acting upon the con-
strictor urethrce and htdho-cavernosus muscles ^'^ which,
it is contended, performed the part of sphincter to the
bladder. Now, it must be urged, that this experiment
is insuflScient to overthrow the opinions first enimciated,
we believe, by Sir Charles Bell, and accepted by so
many competent observers after him. It is, indeed, at
variance with experience, and opposed to what we be-
Keve to be the normal physiological functions of adja-
cent organs. In the first place, this experiment simply
demonstrates, looking at the question from an anatomi-
cal point of view, what w ovldiy prima facie y be expected
fi'om their size, that the constrictor urethse and bulbo-
cavemosus muscles are endowed with more potent
muscular contractibility, on the one hand, than the
detrusor urince muscle, and, on the other, than the com-
paratively slender portion of the middle coat which con-
stitutes the anatomical sphincter. This view (that of
Budge) is further negatived by the facts, that in opera-
tions which involve the cutting of these muscles, incon-
tinence of urine does not necessarily follow, that neither
the bulbo-cavernosus nor the constrictor urethrse passes
sufficiently far back to prevent the presence of urine in
the prostatic portion of the urethra — an occurrence, it
need hardly be remarked, at variance with the most
moderate experience of the use of the catheter. More-
over, it is the special action of these muscles to evacuate

14 ON THE FUNCTIONAL DISEASES OF THE

(a) Physiological Retention of Urine,
Spasm

of ureter, of bladder, of urethra,

From mental emotion.
Retention from shock.

(b) Pathological Retention of Urine,
Paralysis.

Permanent. Transient,

(a) From affections of the head. (a) From affections of the head.
(5) „ „ of the cord. „ „ of the cord.

„ old age.
„ over distension of the

bladder.
„ reflex irritation.
Retention from vesical ioflammation.
„ „ strangulated hernia.

,, „ hernia of the bladder.

„ „ prolapsus of the bladder.

„ ,, vesical tumours.

„ „ certain uterine conditions, comprising —

(a) retained menses.
ip) pressure of impregnated uterus.
„ pressure from conditions of the rectum.
„ traumatic haemorrhage into the bladder.
„ rupture of the bladder.
„ inflammation of the urethra — (a) specific.
»i n %9 (^) non-specific.

„ laceration of the urethra.
„ tumours in the scrotum, penis, perinaeum.
„ enlarged prostate.
„ diseased prostate.
„ permanent or organic stricture.
„ spasmodic stricture.

„ phimosis, and other abnormal conditions of
the prepuce.

URINARY AND REPRODUCTIVE ORGANS. 15

Physiological Retention. — Spasm — The possible
existence of spasm of the ureter, and retention of
urine arising therefrom, is based upon the fact, that
the mooters manifest contractility on the application of
stimuli ; that irritation of the roots of the spinal nerves,
and of the sympathetic, which contains fibres of these,
produce powerful peristaltic action of the ureters
proceeding towards the bladder, and that pain, accom-
panied with the symptoms of obstruction, is referred
to this region ; and that these are capable of removal
by narcotics and antispasmodics. I beUeve there is
no such thing, strictly speaking, as idiopathic spasm ;
some exciting cause must be invariably present. But
even as spasm of the bowels and other involuntary
muscles, such as the diaphragm, takes place imder
particular circumstances, there is no apparent reason
why spasm of the ureter should not likewise occur
under analogous conditions ; and it is assuredly within
the range of possibility, that spasm of the ureter may
at least contribute towards the condition of retention.
As has been indicated, warm baths, narcotics, and
antispasmodics should afford the best results in the
treatment of this condition.

Accumulation of flatus in the bowels, by pressing
upon the ureter, has been assigned a place in the
etiology of retention ; but this alleged cause is less
worthy of serious consideration than the foregoing.

Spasm of the bladder is of occasional occurrence, and
the contraction of the organ may take place to such a
degree as to effect complete closure of the orifices of
the ureters, and thus give rise to a species of reten-
tion, whereby the urine is retained in the ureters and
pelvis of the kidney. This may be artificially produced

ON THE FUNCTIOiNAL DISEASES OF THE

by irritation of tlie inferior portion of the abdominal

sympathetic.

ASi/mptoms, — ^Tlie bladder is contracted into a hard
ball ; intense pain is complained of, extending to the
penis, sometimes causing erection of the organ, and to
the bowel, occasioning painful tenesmus. In the lum-
bar region, the spnptoms are those of calculous neph-
ralgia — cold perspirations, paleness of surface, weak
and frequent pulse, and general irritability. From
cystitis, spasm of the bladder is to be distinguished
by the history of the case, presenting, as it does, the
feature of snddenness of attack, absence of fever, and
of pain on pressure (this causing, as in colic, rather
relief), by the paroxysmal nature of the pain, and the
previously normal condition of the mine* Indepen-
dently of idiopathic spasms of the bladder, symptomatic
spasm may be due to stone, morbid conditions of the
urine, morbid secretions from the bladder itself in
certain diseased states, irritating diuretics, such as
turpentine, cantharides, and sympathetic irritation
from gout, hysteria, cold, and injuries of the rectum*

Treatment, — The treatment of spasm of the bladder
should be based on the presumed cause. If due to
foreign bodies, fissured anus, or other forms of peri-
pheral irritation, these conditions will necessitate at-
tention. Idiopathic spasm will demand attention to the
state of the urine, and, if necessary, in addition to the
administration of such agents as chloral, hyoscyanuis,
and camphor, the exhibition of alkalies. Antispasmo-
dics, from which there is a sufficient variety to select,
are indicated; and if the case be sufficiently urgent, the
inhalation of chloroform or ether may be resorted to.
Diseased conditions of the mucous membrane of the

URINARY AND REPRODUCTIVE ORGANS. 17

bladder, when diagnosed, must be treated according to
the particular indications which each case presents.

Retention from mental emotion is a manifestation of
urinary disorder occasionally met with, though it is of
such a nature as not to have merited attention in
medical works. It is well, however, that its existence
should be recognised, as it may lapse into the variety
of vesical paralysis due to over-distension of the blad-
der. It is usually, indeed almost invariably, met with
in persons of a highly nervous temperament, happen-
ing to be placed in circumstances where a feeling of
shame, or other mental emotion, is such that the
co-ordination of nervous power between the sympa-
thetic and motor nerves is disturbed to such a degree
as to occasion temporary paralysis. Usually this state
passes away rapidly; it is analogous to what occurs in
very sensitive people losing to such an extent the power
of the muscles of the fore-arm, as in writing in presence
of on-lookers, or other unusual circumstances. If it
remain so long that the bladder becomes too ftdl, cathe-
terism may be required.

Spasm of the Urethra. — Like the lu^eters and bladder,
the urethra is sometimes the seat of idiopathic spasm.
In such cases coitus is often followed by a greater
facility of micturition, as in cases of retention from
organic stricture. If too frequently repeated, the
result is rather retention. Civiale records the follow-
ing case of this natm^e : —

Captain B., aged 36, of a robust constitution, had
suffered from many attacks of gonorrhoea, of which he
was perfectly cured. His health was excellent; he
suffered neither from fatigues of the campaign nor
venereal excesses. Meanwhile, following sexual in-

ON THE FUNCTIONAL DISEASES OF THE

dulgeiice on one occasion, he experienced an impossi-
Inlity of mictnrating. All the usual means of relief
proved ineflectuai. The introduction of an instrument
gave issue to three pints of urine, and terminated
patient's agonies. The function of the bladder was im-
mediately re-establislied. Some months after that the
patient was threatened with a simihir affection. After
having explored the bladtler, I satisfied myself, says
Civiale, that the urethia was much more h ritable above
the sf/mphisis puhis than in heaUh; the introduction of
bougies removed this preternatural irrital >ility. On his
own part, the patient found the necessity of having
recourse more moderately to sexual intercom^se, and
since then he experienced no inconvenience.

Somewhat analogous to the foregoing is the follomng
case from the same author : — M. N., a Portuguese, a^t.
30, had had many gonorrhoeas treated by autiphlogis-
tics. There remained a slight discharge, which the
least change of diet aggravated. Moderate coitus caused
only a slight embarrassment of micturition during some
hours. But whenever it was repeated, it was preceded
by a condition of prolonged erection, which caused a
complete retention of urine. This occasioned, twice
the most aUirming symptoms^ removed by catheterism.
From that time M. N. abstained from venereal excesses,
and his urine was made in a full stream.

The etiology of the foregoing condition is doubtless
spasm of the perineal muscles, due to a h}^>er£esthetic
condition of the pelvic nerves, especially of the pudic*

Spasm of the urethra has, however, been caused by
sudden exposure to cold, moral emotion (as above),
fright, &c., &c.

URINARY AND REPRODUCTIVE 0RGANJ5. 19

RETENTION FROM VESICAL PARALYSIS.

The performance of its normal function by the
bladder depends on the four following conditions : —
1st, A normal reciprocal action between the motor
nerves of the viscus and the brain ; 2d, a healthy con-
dition of the sensory nerves ; Sdly, a perfect potential
co-ordination between the three sets of nerves sup-
plied to the bladder — the motor, the sensory, and the
sympathetic; and 4<A/y, an unimpaired state of the
muscular fibres of the bladder.

Of the first variety, familiar instances are furnished
in typhus and other fevers, where possibly, fi'om tem-
porary congestion, aberrant impressions are made upon
the pedunculus and the restiforme body ; in cases of
paraplegia from organic disease of the nervous centres,
and in other instances where the nerves themselves
are imfitted, from structural derangement, for the
transmission of motor power to the muscular fibres.
Violent twists of the spinal cord, blows, and shocks,
may cause, in like manner, retention, more or less per-
manent, as the cause is aggravated. Effusion into the
ventricles of the brain is sometimes characterised by
like consequences.

Retention and incontinence occur at times appar-
ently in a very capricious manner ; but we think the
anomaly is capable of explanation by a consideration
of the physiological facts already submitted.

We accept the fact that section of the cord above
the sacral plexus invariably sets up ischuria and dilata-
tion of the bladder, but never incontinence; for, in the
first place, the motor influence of the vesical nerves
is at once completely withdrawn, by their connection

ON THE FUNCTIONAL DISEASES OF THE

with the brain being thus severed. It must be assumed
in this case that motor paralysis of tlie entire mus-
cular structure of the bladder is induced, the circular
as well as the l<mifUaduuil; and why should retention
exist? From the fact of the ischuria, whieli admits
of a sutticieutly palpable explanation, and the absence
of incontinence, it is inferred by Bndge and Ids dis-
ciples that there is an increased reHex irritability,
according to which assumption there is estabUslicd a
heightened reflex tone of the urethral muscles, whereby
the retention is occasioned. But supposing it be ad-
mitted causa arijamfmii tliat an increased reflex exci-
tation is thus induced, of what can it avail when the
motor power of the nerte suppfj/imf the urethral muscles
{tfis pudic) ftimt be destroped bf/ section of the cord, as
wefl as that of the tesical nerves ? Tlie pndic is a branch
of the sacral j)lexus ; and if the motor power of this
plexus be destroyed l>y section of the cord in respect
of the vesical muscular fibres, it is somewhat difficult
to conceive how the same thing should not occur with
respect to the urethral muscles. But incontinence does
set in as a secondary event; and to reconcile tins un-
fortunate occurrence with the fragile theory at issue,
we are informed that the event is due to hydrostatic
pressure. Thus hycbostatic pressure, from accnnuda*
tion of urine in a l>Iadder deprived of motor power,
overcomes the power of muscles of no insignificant
propoitions, whose potency is augmented by reflex
excitation ! It is a somewhat unf*u innate circum-
stance for not a few patients and surgeons, that canine
and human bladders present very diverse phenomena.
An explanation more in accordance with physiology
is desiderated, and tlie following is confidently sug-

■

URINARY AND REPRODUCTIVE ORGANS. 21

gested : — In a distended condition, the prostatic portion
of the urethra is the most spacious portion of the canal,
but, except during the act of micturition, it is closed
by means of the action of its muscular fibres. This
object is achieved, as in the case of the proper sphinc-
ters, by means of the sympathetic. If the cord be
divided above the sacral plexus, motor power will cer-
tainly be withdrawn from the muscular fibres of the
entire bladder; but the prostatic and the urethral
branches of the hypogastric are so intimately connected
with the aortic and solar plexuses, that section of the
cord in this region -will not necessarily interfere with
their function. But the influence which the sympa-
thetic thus exercises over the urethra is necessarily not
potent; and it is perfectly intelligible that hydrostatic
pressure would overcome it, when it could not possibly
have any such effect on the muscles alluded to, and
under the circumstances quoted. That incontinence
is occasioned in dogs after section of the cmteriar roots
of the three sacral nerves, admits of an easy explana-
tion, independently of Budge's theory; for we have
seen that the motor fibres are largely supplied to the
neck of the bladder, and the division of a limited num-
ber of the sacral nerves might cause paralysis of the
sphincter; sensation, and the motor power of the
longitudinal ^bres remaining imimpaired.

Valentin has long ago demonstrated that imtation
of the roots of the spinal nerves, and of the sympa-
thetic, which contains the fibres of these, produced
powerful peristaltic action of the ureter proceeding to-
wards the bladder. Irritation of the inferior portion
of the abdominal sympathetic excited strong contrac-
tions of the bladder; this effect was occasioned more

ON THE FUNCTIONAL DISEASES OF THE

particularly by iiTitatiiig the sacral portions of the
sympathetic. The same result was produced by irri-
tation of the roots of the midtlle and inferior abdominal
nerves of the spine, but no effect was produced uniess
ike portkm of the sympathetic distributed to the particU'
lar part was e?ittre. Contractions of the vas deferens
and vesieuliB seminales were likewise produced by irri-
tation of the inferior lumbar and highest sacral portions-
of the sjanpathetic ; and in like manner, conti^actions
of the Fallopian tubes and of the uterus, from the fundus
to the neck, mav be excited by iiTitation of the same
nerves as those which excite the rectum, viz., the lower
lumbar and fii'st sacral nerves of the spine. From his
experiments Valentin di^ew the following inferences : —

1. That all parts which exhibit involuntary movement
are excited to action, like voluntary muscles, by stimuli
applied to the nerves with which they are endowed.

2, That fi'om whatever pait of the sjTnpathetic system
their neiwes arise their actions are governed by the
same laws. 3. That the sjinpathetic system has the
following relations witli other nerves :—{u) its motor
fibres are distributed to remoter parts of the body ;
(A) still throughout their long course there is no connec-
tion between them, so that definite contractions are
excited according to the fibres kritated, as in other
nerves ; (e) that these motor fibres originally proceed
from the cerebro-spinal system, and that irritation of
thoir origins acts through the sympathetic trunks."^

This view of the influence of the sympathetic affords
a rational explanation, besides, of certain other pheno-
mena attendant on spinal injuries which would be
otherwise perplexing.

♦ Vfllentin on tlie Functioiii of the Cere>n*ai Nen'e* and the Sympathetic,

URINARY AND REPRODUCTIVE ORGANS. 23

According to the particular region of the cord
injured, certain aflTections of the genito-urinary system
are developed.

In cases of injury of the lower portion of the spinal
cord, proportionate to the severity, paralysis more or
less complete of the sphincter and detrusor fibres
ensues, and the urine accumulates in the viscus accord-
ing to gravitation, as the position of the body permits,
and overflows therefrom by hydrostatic pressure.
Intestinal paralysis is in likQ maimer induced, and as
a consequence, troublesome constipation. Should the
injury exist, however, in any part of the dorsal region
above the tenth vertebra, priapism is a frequent mani-
festation of the disorder. Associated with this peculiar
feature, the temperature of the body below the seat of
injury is markedly increased, and as a matter of course
paraplegia, more or less complete, is invariably present.
Further, it must be noted that as a symptom of spinal
injury, priapism does not occur when the cord is injured
in the cervical region, or from aflections of the cerebro-
spinal axis. It is the function, as we have seen, of the
sympathetic system to regulate nutrition and exercise
an inhibitory influence over the blood-vessels; let this
influence be withdrawn, and increased vascularity and
consequent elevation of temperature result, as Ber-
nard's experiments and others of a similar kind so.
amply demonstrate. Priapism is as much an indication
of debility as palpitation of the heart, and, as'we have
seen, it is never associated with injmies of the lower
portion of the spine though there be vesical paralysis,
because the sympathetic is independent of its rela-
tions with the cord in this region; and the explana-
tion of its occurrence in the region of the spinal cord.

ON THE FUNCTIONAL DISEASES OK THE

which we have indicated, fq^pears to be tlie t'oUowiiig,
Notwithstaiicling the connect ion of the sympathetic
with the cord in the hinil>ar and i^acral regions^ hijnry
of this portion of tlie spine does not effect it owing to
its intimate, or rather preponderating, connection with
the aortic and sokr plexuses; but occuning in any part
of the cord from the fifth to the tenth dorsal vertebrae
incln^5ive, the abdominal portion of the sympathetic is
severed entirely from the influence of tlie cord, by the
impression on the greater and lesser splanchnic nerves*
From the other branches of the Hympathetic it is signifi-
cant to note that the splanclniic nerves arc contradis-
tinguished by their whiteness and general tirmuess,
owmg to the preponderance of spinal nerves in their
sheaths ; and consequently, no doubt, to tlieir posses-
sion of a more intimate physiological connection with
the cord than any other of the abdominal branches of
the* same system. There is every reason to infer that
it is fi'om this region that the vaso-motor nerves of the
penis originate. In this case, therefore, the inhibitory
influence of the sympathetic is removed from the blood-
vessels of the penis, tlie heart continues to beat with
unabated vigour, and blood is pumped into the cellular
structure of the organ, occasioning enlargement simj>ly
by mechanical dihition. Should the sjiinal injury be
still higher paralytic myosis is of not uncommon occur-
rence.

It is probable, therefore, that in cases of paralytic
retention the spnpathetic is more immediately con-
cerned than usually supposed to be, and that the
apparently capricious occiuTence of retention and
incontinence thus admit of intelligible explanation.

The inability to pass urine is only absolutely com-

URINARY AND REPRODUCTIVE ORGANS. 25

plete when there exists paralysis of the abdominal
muscles, for as long as they admit of being exerted
the urine can be forced out in a slow current, though
in small quantities. In complete paralysis of the
bladder contraction of the viscus does not occur though
the urine be entirely withdrawn ; and in these cases,
inasmuch as there is sensorial as well as motor para-
lysis, the accumulation of urine causes no pain, and
the attention of the surgeon is not unfrequently directed
to this state by the supposition of an abdominal
tumour, dropsy, or presumed incontinence of urine.

Paralysis due to aflfections of the brain and spinal
cord are immistakably recognised by the antecedent
history of the case ; such as injury from indirect
violence, or the gradual development of cerebral and
spinal symptoms characteristic of organic lesions;
under all circumstances a careful examination of the
abdomen should be instituted. Keflex irritation may
undoubtedly occasion disease of the nerves; and some-
times morbid processes seem to originate in the mem-
branes of cord and bony canal. In his " Observations
in Surgery and Morbid Anatomy," Mr Howship nar-
rates a case in which the origins of all the nerves on
the basis of the brain, as well as those of the medulla
spinalis, were enveloped in a puriform fluid ; and this
condition he foimd in one instance associated with other
effects of progressive paralysis, due to disease of the
joint between the atlas and odontoid. The capsule of
the joint was exceedingly thickened, and the process,
therefore, forced backwards, inducing a fatal compres-
sion of the spinal marrow.

Treatment — Paralysis of the bladder, when due to
affections of the head or spine, must be treated accord-

26 ox THE FUNCTIONAL DISEASES OF THE

ing to the imlicatioiis presented by the supposed
cause.

As to the propriety of catheterism, upon this as
upon every other question which engages the attention
of sublunary intelligence, opinion conflicts. Thus, ]VIr
Jonathan Hutchinson observes, " There is, I think,
room for much doubt as to whether the usual practice
of relieving the bladder by the catheter is judicious.
In a few cases, where the fracture is in a certain part
of the lumUir region, the bladder is involved in hyper-
a?sthesia, and the pain caused by its detention necessi-
tates interference. These, however, are very rare, and,
in almost all cases, the Wadder fills without causing
any discomfort, and when full runs over.

" After a few days it regains a certain amount of
tone and empties itself verj* frequently. At this stage
we have troublesome incontinence, and but little reten-
tion. Now, if the catheter be used fix)m the first,
inflammation of the urethra and bladder is, I think,
almost certain to occur, and the urine will become
loaded with pus and mucus. I suspect that cystitis
is, in some cases, one of the influences which brings
about the j^atient's death by exhaustion. Not imfre-
quontly ulcerations of the mucous membrane of the
bhuUlor occur. Thei^e is a specimen in the museum
fnnii a fractured spine case, in which a fistula passes
from the membranous urethra into the rectum, no
iUnxht in connection with the use of catheters. Why
should cystitis thus constantly follow the use of cathe-
ters i Seeing that there is no impediment to the intro-
ihiction of instruments, that they give the patient no
jmiu, and are used with the greatest ease, why should
they produce so much more irritation than we usually

URINARY AND REPRODUCTIVE ORGANS. 27

observe when they are employed for other reasons?
I thmk we mnst admit that it is probable that the
mucous membrane of the bladder when paralysed is
in a state especially prone to inflame, just as the eye
is after paralysis of the fifth nerve. The practical
question before us is, whether to permit the retention
to continue until overflow takes place is less likely to
cause this cystitis than the use of instruments. My
own experience has been in favour of non-interference,
and I quite intend in the future to make a full trial of
the plan."

Upon Mr Hutchinson's views the following remarks
may be made, and against his theory some weighty
objections may be urged : —

In cases of paraplegia there is an undoubted depres-
sion of vital function, and, consequently, a remarkable
proneness to the occurrence of bed sores. When the
influence of the sympathetic is removed from the
blood-vessels, as we have seen, two factors of the in-
flammatory process, viz., increased vascularity and
elevation of temperature, are immediately induced.
Hence, from the vascular debility, prominent parts of
the body, which would, in health resist a certain pres-
sure, break down under the conditions of paraplegia;
and further, it is perfectly conceivable that the tissues
in this state are less tolerant of irritation than in a
healthy condition; but given two causes of irritation, it
is expedient to eliminate the one from which the most
danger is likely to result. I cannot help thinking,
basing my opinion confessedly on a much more limited
experience than that of the author quoted, that the
tendency to cystitis in this state is somewhat over-
rated. In cases of paraplegia, it must be borne in

ON THE FUNCTIONAL DISEASES OF TBE

mind tliat urine retained in the bladder is particularly
liable to decomposition, containing as it does so fre-
(|uently an abundance of litliates, earthy pho.sphates,
mid other organic ingredients. This state of tiie nrine
is primarily due no doubt to the depressed state of the
nervous system, and again to the condition of the
bladder wliich favours decomposition; thus the two
ctmditions mutually react on one another. If the
bladder be not carefully emptied in these cases, expe-
rience amply testifies that decomposition of retained
urine is very apt to induce structural disorganisation
of the viscus.

Besides, urine which has become amnioniacal in the
bladder may seriously react on the health of the pa-
tient, particularly if it l>e absorbed by a solution of
continuity^ for carbonate of ammonia exercises a toxic
influence over the organism. To prevent this, a free
acid should be introduced into the circulation through
tlie stonuich. For this purpose, benzoic acid, which is
rapidly transformed in the system into uric acid, may
be used to prevent the amnioniacal decomposition.

But, 8up]}osing Mr Hutchinson's treatment to be
adopted, what is Hkely to happen? That only the
supernatant fluid in the bladder, in all prol)ability, will
be voided, wlnle the lower stratum of urine will remain
indefinitely, and occasion tliose comi>lications which it
is so expedient to avoid. Moreover, Mr Ilutcliinson's
treatment could only apply to certaui cases, for assur-
edly there are others where the power of micturition
is completely lost. Further, nuiscular contractility is
more apt to occur, beyond question, when the muscular
fibres of the bladder are kept as much as possible in
the condition of physiological rest, which it need hardly

URINARY AND REPRODUCTIVE ORGANS. 29

be mentioned, is not the distended state of the bladder.
Indeed, such treatment, instead of predisposing to the
restoration of muscular energy, is particularly apt to
cause atony — a fact with which we are so familiar in
the cases of debility of the detrusor fibres, which the
occasional over-distension of the bladder so frequently
induces.

Instead, therefore, of viewing tliis laissez /aire treat-
ment with favour, it is, in my opinion, to be strongly
reprehended. Its risks and inconveniences are incom-
parably greater than the alleged complications ascribed
to judicious catheterism. The bladder should, in cases
of paraplegia, never be allowed to suflFer great disten-
sion; and should there be any evidence of any aflfection
of the mucous membrane as arising from decomposition
of the urine, washing, by means of the double catheter,
with a weak solution of permanganate of potash, or
oxygenated water, is to be enjoined.

Of internal remedies, tincture of steel, strychnine,
ergot of rye, and phosphorus, may be carefully ad-
ministered; but should there exist decided evidences
of organic lesion, the prospect of much benefit from
these or any other means is very remote.

Dr Wemich of Berlin ^ has directed attention to the
distension of the bladder so often observed in cases of
poisoning by ergot of rye. This he ascribes to the
tonic power which the ergot exercises over the sphincter
vesicae, and indicating its therapeutic value in the
treatment of paralysis, as it frequently exists after
typhus fever, in the nocturnal enuresis of children,
and the senile incontinuence of general weakness.
During chQdbirth care should be taken that, after the

♦ Centralblatt fiir die Medizinisclien Wissenschaften.

ON THE FUNCTIONAL DISEASES OF THE

administration of ergot, labour is not impeded by a

distended bladder.

Should the vesical aflfection be presumably due to
shock fixim direct violence to the cord, or to the cerebro-
spinal system, and likely to be transient^ the electro-
magnetic current promises good results. This may
be exercised by the introduction of a vesical sound,
isolated to within a short distanee of its extremity, into
the bladder, connecting it with one pole of a battery;
with the other pole are attached the ordinary handle
and moist si>onge, which may be applied from above
the pubis to the perineum, or over the lumbar vertebra^.
The application may be daily or twice daily, and should
last for fi^om three to five minutes.

On this subject Dr Althaus remarks : — " Expei'ience
lias shown me that it is neither necessary nor expedient
to apply the current directly to the tissue of the bladder
itself, as we might do by means of an insulated sound,
w^ith a free metallic knob introduced into that organ.
Duect galvanism of the fnll bladder is ol>jectionable,
because a powerfid chemical decomposition of the urine
is the consequence of such a proceeding, giving rise to
symptoms of fainting, owing to the sudden distension of
the viscus by the gases which are set free; while direct
galvanism of the empty bladder app€*ars to produce an
iiTitating eflect upon its mucous membrane. External
galvanism produces none of these inconveniences, and
is thoroughly effective, so that it should in all cases
be employed in lieu of direct internal galvanism. The
position of the electrodes should vary according to
the seat of the affection. Where we have reason to
believe that it is due to disease involving the pedun-
culus cerebri, one director connected with the negative

URINARY AND REPRODUCTIVE ORGANS. 31

pole should be placed to the back of the head, and
another connected with the positive pole above the
OS pubis. The latter electrode should have a large
surface. In cases of disease of the lumbar portion of
the spinal cord, the negative pole is placed to the lower
part of the lumbar spine, and the positive in the same
position as above. Finally, in local paralysis of the
bladder, we may either use the same arrangement of
the electrodes as in spinal disease, or both directors
may be placed above the os pubis."

Dr Althaus further recommends that the current be
intermittent rather than continuative, an application
of from three to four minutes sufficing in respect to
time.

RETENTION FROM OLD AGE.

Muscular paralysis occurs under the three following
conditions: — 1^^, When centripetal impressions are
incapable of transmission to the central nervous system
in consequence of disorganisation or lesion of the
sensory nerves, a condition to which the term anaes-
thesia (a ala-drjais) is familiary applied ; 2dlt/, when
motor or centrifugal impressions are similarly influ-
enced, a state in contradistinction to the former indi-
cated by the term acinesis (a klptjo-ls) ; and, 3d/j/, when
the muscular fibres are themselves incompetent for
the performance of their function from structural
changes.

One of the most notable manifestations of the in-
sidious incursion of the phenomena of declining years,
is that of vesical debility. This may occur in common
with a general atony of the muscular structure of the
body, without any apparent connection with, or depend-

s-i

ON THE FITNCTIONAL DISEASES OF THE

euco upon, affectioos of the nervous systeni, or it may
be associated with them. We recognise the latter
condition if due to cerebral affections by tlieir charac-
teristic mental alienations, and the manifestations of
local paralysis. If associated with spinal affections,
impaired power of locomotion, diminished sensibility
in the hjwer extremities- and the fact that while the
bhidder may be enormcnisly distended the patient is
unconscious of his condition, mil tend to ehicidate the
diagnosis. Retention from paralysis is to be distin-
guished from retention from obstniction by the absence
of the sulijective symptom of pain, by the fticility
with which an instrument can be introduced into the
bladder, and tliat when so mtroduced the urine flows
from the viscus in a slow stream, just according to the
degree of paralysis and the extent to wliich the abdo-
minal muscles are eapalile of co-operating in the act
of micturition. The power of expelling urine in the
ordinary debility of old age is not usually lost. The
patient simply finds that the act of micturition occupies
a longer time, that a greater exertion is recjuired in its
performance, that the stream is less full, and that a
feeling of imperfect evacuation is more or less expe-
rienced. Should a residuum of urine remain in the
bladder, under these circumstances, as we have seen
above, it is apt to become putrid, and consequently
occasion mflammation of the bladder, and other com-
plications.

According to the degi^ee of muscular power, or to
the causes which occasion its impairment, so will be
the efiicacy of remedial agents, and other therapeutical
appliances. If due to marked organic disease of the
nervous centres, a condition almost invariably progres-

URINARY AND REPRODUCTIVE ORGANS. 33

sive, the prognosis must necessarily be unfavourable;
if due to temporary over-distention, or to transient
impression on the nervous centres in an otherwise
healthy subject, the case will present a more promising
aspect In treatment it is of primary importance that
undue accumulation of urine be prevented, that all
sources of irritation \^e removed, more particularly as
occurring in the bladder itself, and that tone be im-
parted to its muscular fibres by the judicious selection of
internal medicines, blistering to the region of the spine
more presumably aflfected, or antiphlogistic measures
if required in the early stages, and by the use of gal-
vanism as referred to in the foregoing section.

We have seen that the bladder is abimdantly supplied
with nerves from each of the three divisions of the ner-
vous system, each class subserving according to their
distribution the performance of a special part in the act
of micturition. That certain remedial agents act speci-
fically upon the different nerves has been satisfactorily
demonstrated; according, therefore, to the particular
fibres of the bladder at fault the selection of remedies
becomes a question of scientific precision. If there be
paralysis of the detrusor fibres we employ tincture of
steel, ergot of rye, strychnine, &c. (for though the
sympathetic is distributed to the upper and back por-
tion of the bladder, and regulates in all probability the
action of the detrusor fibres, it contains motor branches
derived from the spine). If there be hypersesthesia
of the detrusor fibres, as in enuresis, a condition due
presumably to certain states of the sympathetic, chloral,
belladonna, camphor, &c., are indicated. With respect
to opium in small doses, it is to be remarked, that it is
a motor excitant, an effect, indicated in its acting as a

ON THE FUNCTIONAL DISEASES OF THE

cardiac stimulant^ and may, therefore, be beneficially
conjoined with pure geni to-urinary stimulants.

It is in such cases that Retention from over-disien-
tion is most apt to occur, though it may take place in
peifectly healtliy individuals. Its causes are, primarily
neglect to empty the viscus when desire exists ; while
exposure to cold predisposes to ii^^uscular debility in the
aged, and in like manner inordinate indulgence in alco-
holic liquors, which, in addition to stimulating the kid-
ney to augmented secretion, superinduces tlie narcotic
effects of alcohol on an already weakened organ, Cathe-
terism will be demanded, in the first place, and then
general treatment if the exigencies of the case so de-
manded. To this section also belong certain cases of
retention after childbirth, the pressure of the child's
head in the pelvis obstructing the urinary canal in
the mother, tOl accumulation of urine has taken place
to such a degree as to occasion temporary paralysis ;
while others may be due to nerve compression, a fact
indicated by the frequency with which pains extend-
ing down the thigh are complained of, when the head
is engaged in the pelvis.

RETENTION FROM REFLEX IRRITATION.

We have seen that an intimate nervous intercom-
munication takes place between the nerves of the
pelvic vicera, we have descanted upon the interesting
fact that the motor nerves proper of the bladder are
chieHy distriliuted to the region of the sphincter vesica?,
and, accordingly, the pathological significance of reflex
U'ritation in its bearings on retention, will be obvious.
In addition, therefore, to the irritation, and, possibly,

URINARY AND REPRODUCTIVE ORGANS. 36

to the mechanical obstruction to the passage of mine
exercised by the presence of adventitious growths,
irritation from certam conditions of the prepuce and
rectum may occasion spasm of the sphincter, and
consequent retention. If the irritation be of a mild
description, as due to the presence of ascarides, &c.,
irritability of the bladder and enuresis are induced;
but if of a more violent nature, as from operations
on the prepuce and rectum, for the removal of haemor-
rhoids, &c., retention from spasm is the result. A
case of the latter description occurred recently in my
practice. On the 29th November last, by the advice

of a surgical friend, I operated on Mr O , for

external haemorrhoids by means of the ligature — the
pedunculated nature of the tumours and the patient's
abhorrence of a cutting operation dictating this pro-
cedure. Nothing worthy of note occurred during the
transfixing and tying of the tumours. On the evening
of the same day considerable difficulty was experienced
in voiding urine, an occurrence which the adminis-
tration of a sedative draught containing opium and
hyoscyamus to a great extent removed. On the 2d
December, during an examination of the haemorrhoids,
with a view to ascertain the condition of the ligatures,
a considerable amount of irritation was thereby caused.
Subsequently, this local irritation became more intense,
and occasioned a return of the retention. For fully
two hours, as I was informed, patient could not pass
urine, though making the greatest efforts to do so.
The cause being clear, the application of hot fomenta-
tions to the pained part, and the administration of
opium and hyoscyamus, remedied this condition. A
short time afterwards the piles were removed by the

ON THE FUNCTIONAL DISEASES OF THE

scissors, and the retention did not recur. The treat-
ment of this form of retention will ob\ionsly resolve
itself into a recofjnition of the cause, and its removal
according to the principles enunciated.

RETENTION OF URINE FROM SHOCK.

Independently of stmctuial lesion, simple shock,
affecting the portion of the neiTous system by which
the bladder is supplied, may be followed by temporary
retention. This effect is of the same nature as the
famihar influence on the respiratoiy muscles caused by
blows over the epigastric region, the shock to the
pneumogajstric for the time being suspending its vital
function. If the violence be sufficiently severe^ the
heart may be similarly affected, and the impression so
long continued that death results.

Retention of urine, of the variety mider considera-
tion, is usually observed in cases when a fiill upon the
back has been sustained, or from violent compression
of the lower part of the body, as in the cases of rail-
way accidents, known as " buffer " accidents- Of this
variety I saw one, with a highly intelligent countiy i
practitioner, in February last. In this case there was fl
considerable ecchymosis over the lower part of the
abdomen; the penis, particularly the glans, presented
a similar appearance of greater intensity, and the
scrotum was similarly affected. The catheter was
passed with ease; the urine withdrawn was perfectly
nonnal, but the power of mictmition was in perfect
abeyance. From eases presenting analogous features,
but complicated with the existence of laceration of the
urethm, cases of retention fiom shock are to be dis-

URINARY AND REPRODUCTIVE ORGANS. 37

tinguished by the facility with which catheterism is
eflTected, the perfect continuity of the urethral surface
as judged by the passage of the catheter, the absence
of blood in the urine, and the evidence afforded by the
tactus eruditus of the characteristic difference in the
sensation communicated by infiltration of urine in the
cellular tissue, and simple ecchymosis.

The treatment of this condition will mainly consist
in judicious catheterism.

The consideration of the remaining causes of reten-
tion of urine, chiefly pathological, do not come within
the intended scope of the present undertaking.*

* Vidt Classification, i»age 14.

ON THE FTNCTIONAL BLSKASES OF THE

CHAPTER II.

IRRITABLE BLADDER ; STRANGURY.

CoNTEirre : — "Fimctionar' Diseaae^ — Irritable Bladder; ite Yarietitia
The Rektion of the Litliic and Oxalic Acid Diathesis to *' Irritable
Bladder ** — Period of Life at which *' Irritable Bladder " occara —
Treatment^Strangury ; its Varieties — Treafcment of Strangury —
Wonas in the Bladder — Varieties of Vesical Worms ; SymptomB
and Treatment of Worms in the Bladder.

Conformably with that property of living textures,
wliicli we have termed the law of material congelation,
on which normal f miction essentially depends, and
through the opeiation of which aD rational cm'ative
efforts must be made, we have seen how its violations
are associated with functional or organic derangements
of a corresponding nature.

By the term '* functional " as applied to departures
fiom health, an imperfection of knowledge is confessedly
conveyed, for it is impossible to conceive the slightest
somatic disturl>ance of the normal equilibrium regulat-
ing the integrity of the living body without some ante-
cedent molecular cacogenesis, unrecognisable though it
be. Perhaps it is not too much to anticipate that the
time may come when a genuine scientific advancement
in knowlege will render the use of this probationary
term purposeless*

IiTitable bladder, in the strict signification of the
term, comes essentially under the category of functional

URINARY AND REPRODUCTIVE ORGANS. 39

diseases, and it should be consequently restricted to
those states in which the viscus manifests an extreme
sensitiveness to. the presence of fiealthy urine j in the
absence of any recognisable disease of its own structure,
or any other organ capable of sympathetically acting
upon it. In the course of these remarks, we have
adverted suflficiently to the intimate nervous commimi-
cation between the bladder and the circumjacent organs,
and to enumerate the diseases of which irritability of
the bladder constitutes a symptom, would be to repeat
much of what has already been said, and enumerate,
indeed, almost all the diseases of the pelvic viscera.

The most typical variety of irritable bladder is as-
sociated with the condition to which the vague term
"nervous" is applied; where, generally from some
mental emotion of a transient nature, hyperaesthesia
of the sensory nerves is occasioned. Of this nature is
hysteria: in other cases the phenomenon is associated
with general debility, neuralgia, and irritation of the
brain and spinal marrow, though, when so arising, the
condition can hardly be denoininated functional, the
cause being recognisable.

Nor can it be so considered when it is manifestly
due to dyspepsia and the lithic acid, or the oxalic acid
diathesis, as the acrid nature of the urine in these
states affords palpable explanation; neither can the con-
dition be said to be functional in the very opposite state
of the urine, viz., when it is too alkaline, for departures
from the normal composition of the urine in either way
heightens alike the sensibility of the bladder.*

♦ Kaupp, " Archiv. f. Phys. Heilk.," 1856, has demonstrated that, with in-
creased frequency of inicturition, there is an absolute increase in the quantity
of urine and urea discharged in twenty-four hours.

40 ON THK KUNfrriONAL DISEASES OF THE

Iiritablo bladder is a disease, as a rule, of early or
niiddlo life, and occurs with equal frequency in both
sexcjH. It is characterised, as the name implies, by
frcKiucnicy of micturition, tenesmus, and a feeling of
und(^finabh5 uneasiness in the loins and region of the
blad<l(^r. The health becomes manifestly undermined,
th(^ patient becoming weak, emaciated, and irritable;
but this applies more particularly to those cases in
which organic changes in the viscus are superinduced,
wh(ui the urine is generally of a greenish whey colour,
of (*()nHidenible specific gravity, often serous, and de-
positing ph(\sphates and lithates, and micturition is
attt^ndtul with scalding pain along the urethra.

Tht^ tiratment of inutuble bladder will be based upon
th(^ proHumod cause. If purely nervous, or associated
with noumlgia, nervine tonics are indicated; such as
t h(^ pivpumtions of inm, of which the tinct. ferri mur.
ol t ho Kdinbuixh Pharmacopana is to be preferred,* also
tiuiuino, uux vomica, &x\ If the affection be sympto-
nmtio of tho gmity, and rheumatic, or oxalic acid
diathosiv'i. tho tn^Umeut ahvady referred to will be
tlu^ most appi\>priate: while h)-steria, irritation of the
uorvou8 ooutrtv^, v^i\» will demiuid the special treat-
n\out appn^priuto to thonu

Sh\iHii^fi\¥ \dysuria ditMoilis et dolorosica, s^Eepiens
anlou5i, uriuiv inuuiv^o- i^am-uges) (urinae parce, gut-
tata* t\\Hpious, doK^r\vs;u mioturitio — Linmeus) may in
lik\^ mauuor K^ siud to In* rather a sjTiiptom than a
divM\^sM\ th\n^::)\ autiquitY has presoriptively conferred
upou it tho t\^ht of tho hutor rocoj^iition. It is very
av\uriUol\ d^v^oriKnl in the brief terms of Sauvages

URINARY AND REPKUDUCTIVK OlUJANS. 41

and LinnteuSy and it difiers mainly fn)ni tlio ordinary
forms of enuresis in presenting the syinptoin of
pain, due to a transient iiritation of the })roxiiiiate
cause.

Mason Good describes no less than the six followinj;
varieties of strangury : —

Spasmodica, . . Spasinodic strai»j,^ury.

Ardens, Scahliiij,^ slranj^ury.

Callosa, . Calhnis stran^niry.

Mucosa, . . Mucous sliaiij;uiy.

Helnienthica, . Vornnculnus slranj^uiT.

Polyposa, . . . Polyp* )us stranj^auy.

Tlie most cursory glance at the varieties of stiaiigury
thus tabulated will suflice to exhibit the faiicifuhiess
of its nature, for without sjiasm and scalding micturition,
strangury could not be said to exist ; again the vesical
irritability due to stricture, which Mastni (iood terms
callous strangury, has been already exi)lained, and j)re-
sents no feature to justify its classification under this
section; and of nmcous stmngury so-called, it nmst be
said that it shnply indicates a consequential affection
of the bladder, if the cause of the irritation has been
sufficiently prolonged.

Strangury differs essentially from the other spasmo-
dic affections of the bladder which we have been con-
sidering in this r(»gard, viz., that in strangury, there is
a consentaneous, instead of an alternate si)asmodic
affection of the nmscular fibres of tlu* bhulder, compli-
cated with the effects of irritation, which, if sufficiently
prolonged or repeated, may result in inflannnation of
the organ.

The vermiculous and polypose strangury of the

ON THE FUNCTIONAL DISEASES OF THE

learned author alluded to, cannot with propriety be
considered forms of this affection; but as the former
is both rare and interesting, brief allusion will be made
to it immediately.

Tlie most characteristic and frequent form of stran-
gury is that due to the absorption of cantharadin from
the application of fly blisters, and its eHmination by the
urine. It may, in like manner, be occasioned by the
internal administration of turpentine and other stimulat-
ing diuretics in excessive doses, and also by acrid articles
of diet, and stimuhiting vegetables, as asparagus, &c.

The treatmeut of stningurji may be considered al-
most entirely prophylactic. When blisters are applied
over a large surface with active absorptive powers,
owing to cutaneous tenderness or to anatomical pecu-
liarity, the patient should be made to drink copiously
of mucilaginous fluids, by means of which the irritant,
if absorbed, is correspondingly diluted, so as to render
it proportionately innocuous. Camphor has long been
held in high estimation for its efficacy in the treatment
of strangury, either given internally, or applied to the
skin in conjunction mth the blister. The following
testimony to its efficacy in the latter respect is given
by Percival i — " In three instances blisters sprinkled
with camphor were repeatedly applied without stran-
giury, and as uniformly, when the camphor was
omitted, with the occmTence of that symptom. I will
not say that in all constitutions camphor will obviate
strangury, nor in all constitutions will cantharides
without camphor produce it/*

So painful an affection is strangury, from the ab-
sorption of cantharadin, that its avoidance is urgently
desiderated. I have seen the agony of such intensity

URINARY AND REPRODUCTIVE ORGANS. 43

that perspiration flowed copiously from the forehead,
the features pinched, and presenting a sardonic expres-
sion very significant of suffering. In such cases warm
baths, full doses of opium, and copious libations of
such mucilaginous drinks as barley water, linseed tea,
&c., afford the most reUef

The presence of worms in the Madder gives rise to a
form of vesical irritation to which allusion has not
hitherto been made. In some cases they are discovered
in the organ after death, and in others discharged from
the urethra during life. They occur in various forms,
sometimes like the larvae of insects, in other instances
of the fluke or gourd variety; and in some cases soU-
tary — an example of the last variety being recorded
by Dr Barry of Dublin, in the case of a man, aged
fifty, who discharged from his urethra a solitary worm
"above an inch in length, of the thickness of the
smallest sort of eel, and not unlike it in shape, ending
in a sharp-pointed tail." It was discharged dead,
though death had evidently been of recent date. For
several years the man suffered from the following
symptoms : — He discharged urine frequently, and
mingled with blood, although the act was unaccom-
panied with pain in the urinary canal. His health
had become impaired; he was feverish, troubled with
anorexia, and his strength diminished. From all these
symptoms he recovered on the discharge of the worm.

Mr Lawrence, in the second volume of the " Medico-
Chirurgical Transactions," likewise contributes the fol-
lowing very interesting particulars to the literature of
this subject. The patient, a female of twenty-four
years of age, had long laboured under symptoms of
vesical irritation, which had been pronounced of a cal-

THE FUNCTIONAL DISEASES OF THE

ciilous nature. Ultimately she discliargcd three or four
worms of a peculiar variety from the urethra; tliis con-
tinued more or less for some time, more especially
when their discharge was facilitated by the use of
injections, or the use of the catheter in the bladder
during a night. This discharge of worms continued
for the period of a year. At one time so many as
twenty-two were passed, and altogether not less tlian
from eight hmidied to a thousand were thus voided!
They varied in size, being sometimes small, and at
other times measuring from four to eight inches ui
length, and were usually discharged dead. Their pre-
sence in the bladder has been accounted for on the
supposition that their ova are first introduced into the
body with food, and that they transude through the
arteries of the bkidder, as the white corpuscles of the
blood sometimes do.

Instances of worms in the bladder are mentioned
by some of the ohler writers, as Rhodins, Bonnetus,
Bartholin, Tulpius, Barry, Henlcel, and Acrel But
two varieties of vesical worms have been discovered ;
the one by Lawrence, as mentioned, the other by Mr
Curling, The one described by Lawrence is the
Spiropfera, They were remarkably slender in the
middle, from which they gradually increased towards
the extremeties, wliich were small and tapering. One
of the surfixces of the body was marked by a double
row of small protuberances, while the other was marked
by a groove with two rising edges. When first voided
they were soft and of a yellowish colour. Under the
microscope the body seemed homugeneous, and with
no distinct organisation. The smaller variety were
semitransparent, and of a rounded form with pointed

URINARY AND REPRODUCTIVE ORGANS. 45

ends. The worm discovered by Mr Curling has been
named by him the Dactylus aculeatuSj owing to its
peculiar ring-like appearance. (Med. Chir. Trans,
vol. ii. page 274).

The Symptoms caused by the presence of worms in
the bladder are equivocal. Pain is complained of;
micturition is frequent; spasm is occasional; and there
is usually derangement of the digestive functions. On
passing a sound, contact with a soft mass is elicited.
The treatment will consist in evacuation; the injection
of small quantities of carbolic acid, or vinegar suf-
ficiently diluted, and the internal administration of
turpentine, and other diuretics.

ON THE FUNCTIONAL DISEASES OF THE

CHAPTER IIL

ON THE PATHOLOGY AND TREATMENT OF NOCTURNAL
ENURESIS AND SPERMATIC INCONTINENCE.

Synonyms.— (^Efov^ccu) ; IncontincBtia urinsB (Latin); Incontinence
d^arine (French) ; Incontmentia iirinfiB (Cfer.) ; Ennresi (Ital.) —
Sperm at orrh tea (27r€/>/ia, pctu). — Spennorrhagia (prjyw^t. Author) ;
Spermatorrh^e (Fnmch) ; Samenfluss (fr^r,); Spermatoirea (//t*i^).

Contents : — Or^mic Functions— Hysteria, Metromania, and ttieir Allied
Diseases — Pathology of Enuresis, and of Spermorrhagia — ^Secretion
of SeTDen — Functions of the Vesiculte Seminales — Limits of Pro-
creative Capacity — Secretion of Cowper^a Glandsr— Ta Semen Dis-
charged with the Urine in Health ? — Is Semen Keahaorhed into the
System? — Tabes Dorsalis — Relatiuos of Cerebellum and Sexual
Functions — -Puberty — ^C ire urn stances which influence the Develop-
ment of the Reproductive Faculty — Excessive Seminal Emission a
Pathological SUte— Seminal incontinence in its relation to Mental
States — Reflex Spinal Paralysis and Epilepsy; their connection with
Genito-LTrinary Irritation — Conflation of Symjitoms a^ arising
from Sexual Excesses and Masturbation — Varietiea and Causes of
Spermonhagia— The Analogies and Relations of Nocturnal Enuresis
and Seminal Incontinence — Diagnosis and Prognosis of Spermor-
rhagia — ^Treatmen t.

Normal function essentially consists in a due equili-
brium of nervous influence. It is regulated from two
poles, so to speak, tlie psycliical and the somatic; and
when undue elevation or depression occurs on either
side, functional or organic changes may be the result
The machinery whereby nervous influence is regulated
are the sensory or afterent nerves, and the motor or
[efferent nerves. Performing functions subsidiary to
the former, are the inhibitory nerves, or those which
restrain or diminish action, and to the hitter the secre-

URINARY AND REPRODUCTIVE ORGANS. 47

tory and trophic. This distinction is, however, not
yet satisfactorily established.

The sensory nerves, under the influence of stimuli,
transmit, probably by molecular action, impressions to
the central organ, the brain, through the medium of
which they are commimicated to the motor. In this
'manner abnormal peripheral irritation may occasion
functional disease, quite apart from the local patholo-
gical changes it may induce. This may be termed the
somatic side of the balance; on the other hand, the very
converse of this may happen through the medium of.
the mind — ^the psychical side of the balance.

That the various secretions of the body, and many
of the involuntary or muscular movements, are power-
fully influenced by mental emotions, is a fundamental
principle in physiology. We find examples of this
influence in profuse lachrymation from grief, the arrest
of the secretion of milk from strong mental impression,
the manifestation of blushing, the accelerated action of
the heart, or the depression of its action, from diflBdence,
anger, fear, &c. This law, that of emotional stimulation,
as it may be termed, finds expression in the old aphor-
ism, '' ubi stimulus, ibi humerorum uberior adfluxus."

Reverting to our subject, the close relationship be-
tween the functional aberrations of the genito-urinary
system and the brain, and consequently their interde-
pendence, is clearly demonstrated by the distribution
of the sympathetic nerve. It is through this nerve in
a peculiar manner, that the conditions enumerated in-
fluence secretion. As the nerve of common feeling
(coensesthesis, kolvo^ ala-drfa-i^), and regulator of organic
functions, the sympathetic is to a great extent inde-
pendent of the brain and spinal marrow. Its sensa-
tions have been resolved into three separate foci, — {a)

ON THE FUNCTIONAL DISEASES OF THE

the focus of generation, (/>) the phrenic focus, and (r)
the pfe,ru.9 soitiris,

** The focus of generation forms opposite to the brain,
as it were, the other pole of the organisation. The more
complete the stnictures belonging to this focus are
developed, the less so is the cerebrum (for the con-
trary is affirmed of the cerebellum) and conversely."*
The phrenic focus regulates the actions of the heart,
diaphragm, and the stomach, in conjunction with tlie
pneumogastric nerve. Tlie plexus Solaris is formed by
two semi-lunar arcs of tlie abdominal plexus, and of the
superior mesenteric plexus ; it also receives tlie greater
and lesser splanchnic nei^v^es, the termination of the right
pneumogastric, and filaments from the right phrenic
nerve. From this centre, accompanying the various
branches of the aorta as *' goveniors," to cany out our
analogy, the sympathetic distributes branches. In addi-
tion, therefore, to the diaphragmatic, gastric, hepatic,
splenic, supra-renal, renal, mesenteric, and aortic, we
have spermatic plexuses. Besides these branches, the
pelvic organs derive branches from the lumbar and sacral
portions of the parent nerve. Hence there are described
the h^emonhoidal, vesical, prostatic, vaginal, and ovarian
plexuses. ** By the co^na^sthesis, states of our body are
revealed to us, which liave their seat m the sphere of
vegetative life, wherein tlie nerves which belong to it
spread themselves. These states are (a) general— cor-
poreal heaviness and buoyancy, atony, tbniety; (fj)
special — hunger, thirst, sexual instinct," &c.t

Our position, therefore, is as follows : — That func-
tional diseases, i.e. aberrations of organic muscular^
movements, glands, &c., may be due to either psychiccal
or somatic causes, in other words, to peripheral, or

♦ FcuchUjr8ltil>en*fi Psychology. f 0]i, cit

URINARY AND REPRODUCTn^'E ORGANS. 49

central irritation, or to a combination of both, and that
consequently the explanation thereof, and their rational
treatment, must be resolved into psychical and so-
matic.

I am thus a firm believer in the theory which asso-
ciates hysteria with some disturbance of ovarian, vagi-
nal, or uterine coenaesthesis. For instance, but recently
M. Charcot had under his care at the Salp^trifere four
or five cases in which hysteria and epileptiform attacks
were associated with ovarian irritation and unilateral
anaesthesia. One of these was a healthy-looking girl
of nineteen, who suffered from pain in the right ovarian
region, an*d had been the subject of hysterical attacks
of an epileptiform character for some time. At the
time of visit, on one occasion, she was in one of her fits,
with violent convulsive movements of her limbs. M.
Charcot immediately applied firm pressure with both
hands deeply towards the right side of the pelvis, and
the convulsions were at once checked, the patient
became quiet and sensible, and sat up as if wakening
from a dream. The attack returned, but a repetition
of the same treatment speedily removed it. A similar
affection occurred in a half-witted girl of eighteen.
She was subject to hysteria simulating epilepsy, pain
in the left ovarian region, irregular menstruation, and
complete anaesthesia of the left half of the body. There
were other cases of a kindred nature in the hospital at
the same time. All presented the following marked
features, — pain in the neighbourhood of the ovary,
attacks of epileptiform hysteria, relieved or checked by
pressure in the ovarian region, unilateral anaesthesia
generally of the same side, and affecting the whole of
the lateral half of the body, and limited exactly to the

60 ON THE FUNCTIONAL DISEASES OF THE

middle line, and spinal hyperaesthesia or " spinal irri-
tation." In most of the cases there was irregularity of
menstruation, but the seizures did not correspond to
the catamenial period. The sight of one eye was
usually affected. The anaesthesia was perfect and
unmistakable, as patients bore with indifference having
large hair-pins run through folds of the skin. M.
Charcot considers this a special form of hysteria, and
the prognosis as regards cure to be very unfavourabla
I^)uyer-Villermay relates the case of a young lady
resident in a convent, who had such a violent attack of
motromania, that she died in the midst of an extra-
ordinary convulsion. After death the left ovary was
found much enlarged, and full of thickened matter. The
Fallopian tube was in a like condition. Helwich speaks
of a female who during many years manifested an ex-
treme repugnance to marital relations, but who, at an
advanced period of life, had venereal appetites so pro-
nounced as to make her abandon herself to all manner
of obscenities. Post-mortem examination disclosed on
the right side of the uterus four reniform •tumours ;
and the ovary of the same side presented vesicles,
which, on being incised, gave vent to about 30 grammes
of black matter. To modified impressions of this nature
— a i)aralysing influence being made on the splanchnic
— must be ascribed the abundant secretion of urine so
pathognomic of the Protean malady, the circulation of
blood through the kidney lacing accelerated by the
extent to which the inhibitory power of the sympathetic
is withdrawn. On the other hand, the influence of a
strong mental emotion may either remove or prevent
the hysterical paroxysm. With respect to enuresis,
the disturbing agency is, in the great majority of in-

URINARY AND REPRODUCTIVE ORGANS. 51

stances, of a somatic nature, while in the case of sper-
matic incontinence, its prototype, it may be either
somatic or psychical, or a combination of both. Enu-
resis more frequently occurs at the periods of infancy
and of declining years, and according as it may so occur,
it receives a different pathological explanation. In
childhood, it is almost invariably due to the irritation
of worms (muscular branch of the fourth sacral nerve),
congenital phimosis (pudic, and hypogastric plexus of
the sympathetic), the prepuce being often adherent to a
greater or less extent to the glands penis, vesical cal-
culi, unusual density and consequent acridity of urine ;
while, in some cases there may be absolutely a super-
abundant secretion of urine. The presence of stone is
indicated, in children, often by prolapsus of the rectum
and pain in the point of the penis, while in adults the
pain is usually felt over the hypogastric region. These
causes being removed, the normal nervous equilibrium
is restored, and the complaint remedied, as a rule.
But if the hyperaesthesia has been of long continuation,
debility of muscular fibre, or atony may have ensued,
and tonic treatment is indicated in addition. In
advanced life, the conditions alluded to are generally
absent, and the cause of the enuresis is found in diseased
prostate, vesical catarrh, atony of the sphincter and
bladder generally, — a condition most frequently asso-
ciated with general muscular atrophy, or affections of
the spinal cord.

Of the two sets of muscular fibres of which the
bladder is composed, it is a disputed point which set is
more immediately under the influence of the will. In
the act of micturition, it is only when the detrusor
muscles cease to overpower the sphincter, that the

ON THE FUNCTIONAL DISEASES OF THE

bladder is closed ; and the attempt to explain the
occurence of eianresis by the fact that muscular relaxa-
tion occurs during repose, and is participated in by
the spMimter teskWj I look upon as fiiUacious and
untenable. It is indeed a wise provision that it should
be otherwise.

But while enuresis in childien is in the vast majority
of instances due to somatic disturbance, in some cases
a psychical cause is present* That is to say, involun-
tary dischai-ge of urine may be due to a stute of dream-
ing, in which the necessity of mictiurition as arising
fi'om the normal stimulus Ls present to the mind. The
detrusor muscles are thus l)rought into action precisely
as in voluntary micturition. Desault (now a consider*
able time since) refers the occuiTcnce of involuntary
micturition rather to imjiaired sensation. Thus, he
ol)serves : — ^' La sensation qui met en jeu la contrac-
tilite de la vessie, et accompagne rejection des urines,
est si foible, que cette fonctiou se fait sans un acte
formel de la volontd, sans exciter mSme une impression
assez vive pour interrompre le sommcil." Though his
mode of cure indicates a psychical impression — '*La
erainte les rend plus attcntifs au besoin d'uriner, et fait
quails epieut, en quelque sort, le premier aiguillon (jui
aimonce ce besoin, Cest k cette nianifere d'agir, que
Ton doit rappr»rter les guerisons qn'ont produit une
foule de moyens plus elTrayans les uns que les autres;
c'est ainsi qu'on a vii des enfans 6tre pour toujours
d^livr^s de cette incommodit^, en leur faisant 6craser
des somis vivantes dans les mains, en les faisant assister
au lit d*un mouiant,'' &c.

Putting out of consideration the causes of enuresis
in infancy, it may occur in the adult from yet another

irRINARY AND REPRODUCTIVE ORGANS.

cause, viz,, debility due to sexual excesses or ODanism.
The repeated stimuli to the spinal cord and sjmpa-
thetic being, according to a well-known law of nervous
excitability, followed by muscular relaxation— ra^to^
vara 7nmget With respect to enlargement of the
prostate as a cause of enm^esis, cases of overflowing
must be distinguished from those of incontinence.
Mistakes in diagnosis are of frequent occurrence from
disregard of this precaution. Incontinence of urine
has also been known to occur from the passing of too
hirge bougies and catheters, likewise from the gi^adual
dilatation of the female urethra for the removal of stone.
With the patholog)'^ of nocturnal or diurnal enuresis is
intimately associated that of spermatic incontinence,
an affliction which lias long proved, and continues to
prove, a potent instrument of imposition and misery
in the hands of quacks both iu and out of the pro-
fession.

While spermorrhagia (to coin a convenient term)*
presents iu many respects striking analogies to enuresis,
^ut diflers in some essential and, pathologically and
^■targiologically speaking, important respects. In the
^^rmer case we have to deal with a functional aberra-
tion of a glandular secretory apparatus (excito-motor),
in the latter simply with a muscular derangement of
the reserv^oir of the urine. * Seminal emission is a reflex
act, and not immediately under the influence of the
will; expulsion of urine, as we have seen, bears a dif-
ferent relation to volition.

It is in the cases of enm^esis in which the sphincter

♦ In the last editioB I suggested the iise of this word (3ir/p^a, pnymt^Li)^ iis
eing, hy analogy, more correct than the term ftpenuatoTrhoea. Exception has,
■ course, beeu taken to it. I retain it, my opinion l)eing atill michangiKl,

ON THE FUNCTIONAL DISEASES OF THE

is at fault that these complaints can be more appro-
priately compared. The spfiiueter vesiem is, eciually
with the muscular fibres of the vasa deferentia and
vesicula?, and the accessory muscles, an inAoluntary
muscle. But again, while the act of mictmition de-
pends on the quantity of urine secreted, so also must
seminal emission depend on the normal function of the
testicles; and it is thus only by a correct appreciation
of the function of the testicles in health, as in the case
of all other organs, that wc cau prouomice where
liealth ends and disease begins. This essential preli-
minary investigation it devolves upon us, as briefly as
possible, to consider.

The organs by which the seminal fluid is secreted
are the testicles, the vesicular seminales, the prostate,
and Co^vi^er's glands, each organ contributing its quota
to the perfect semen. At the threshold of this part of
our subject the following questions present themselves.
Do the testicles continually secrete semen, as other
glands constantly elaborate their pecuUar secretions ?
Can the discharge of the peculiar secretion of the vesi-
culaj seminales, the prostate, and Cowper's glands take
place indcpeudently of one another ? Are the vesicuhu
seminales merely the reservoirs of the seminal fluid %

Do THE Testicles const^\j^tly secrete Semen ? Judg-
ing from analogy, no one would hesitate to answer
this question ui the affirmative ; but, like many other
secretions, that of semen is regidatcd by certain con-
ditions, so far as the rapidity and quantity of the
secretion are conceiTied. It is the opinion of Khkcs
that '* the seminal fluid is probably after the period of
puberty secreted constantly, though, except under excite-
vient, very slowly, m the tubxdes of the testicles. From

URINARY AND REPRODUCTIVE ORGANS, 55

these it passes along the vasa deferentia into the
vesiculoB seminaleSy whence, if not expelled in emissioH,
it may be discharged, as slowly as it enters them,
either with tlie urine, which may remove minute quan-
tities mingled with the mucus of the bladder and the
secretion of the prostate, or from the urethra in the
act of defaecation." To the proposition that the secre-
tion of semen is influenced by mental excitement I as-
sent; from the assertion that in health semen is removed
from the vesiculse seminales during defsecation, or
micturition, I unhesitatingly differ. To this we shall
revert in the proper time and place. Assuming in the
mean time, what the present state of our knowledge
on the subject justifies us in doing, that seminal fluid
is constantly secreted, subject to variation from certain
mental and physical conditions, one of three things it
follows must happen; it must be excreted from the
system in the form of an involuntary emission, be dis-
charged with the urine with certain effete elements
of tissue, or it must be reabsorbed into the system.
It will be remarked in the above quotation from
ELirkes, that he supports the generally received opinion
that the vesiculce seminales act as reservoirs.

Further, this physiologist remarks, "The seminal
fluid* secreted by the testicle is one of those secretions
in which a process of development is combined after
its formation by the secreting cells, and its discharge
from them into the tubes. The principal part of this
development consists in the formation of the peculiar

♦ Vanquelin gives the following as the chemical composition of semen: —
Water, .... 900
Animal mucilage, . . 60
Soda, .... 10

Phosphate of lime, . 30

ON THE FUNCTIONAL DISEASES OF THE

bodies named spermatozoids, seminal ^laments, or sper-
matozoa, the complete development of which m their
full proportion of number is not achieved till the
semen has reached the vesicular seminales. Earlieiv
after its first secretion, the semen contains none of
these bodies, but grannies, and round corpuscles, hke
large nuclei, enclosed within parent cells. These
round corpuscles ai'e the 'vesicles of evolution/ in the
interior of wliich the spermatozoa are formed. They
present a well-defined outline. They are usually em-
bedded in granulai' mutter. Tlie parent cells some-
times contain but one vesicle of evolution. At other
times more than one. They vary much in size, doubt-
less according to the stage of development, and are
not usually found in conjunction with perfectly fomied
spermatozoa ; their presence, consequently, in the
seminal fluid indicates that the fluid has not remained
long in the vesicular, and as a corollary may point to
excessive coitus or sperm orrhagia. To the vesicular
seminales a double function may be assigned ; for they
both secrete some fluid to be added to that of the
testicles, and scrv^e as resen^oirs for the seminal fluid.
The former is their most constant and probably most
important office; for in the horse, bear, and guinea pig,
and several animals in which the vesicul^ seminales
are large and of apparently active function, they do not
communicate with the vasa defercntia, but pour their
secretion separately, though it may be simultaneously,
into the urethra. In like manner, MM, Prevost and
Dimias have obseiTed that the vam de/erentia in frogs
oj>en into the ureters, and that they form a lateral
pouch, which enlarges much at the period of their
rutting, and thus the urine contains true semen. In

URINARY AND RErRODUCTITE ORGANS.

man, also, when one testicle is lost, the corresponding

■vesicula seminalis suffers no atrophy, though its fvmc-
tion M a reservoir is abrogated. But how the vesicuke
seminalis act as secreting organs is unknown; the
peculiar brownish fluid which they contain after death
does not properly represent their secretion, for it is
different in appearance from anything discliarged dur-
mg life, and is mixed with semen. It is nearly certain,
however, that this secretion contributes to the proper
composition of the impregnating fluid; for in aE animals

Hin which they exist, and in which the generative func-
tions are exercised at only one season of the year, the
vesiculiB seminales, whether they comnninicate with
the vasa deferentia or not, enlarge commensurately
with the testicles at the approach of that season.
That the vesiculse are also reservoirs, yi which tlie
seminal fluid may lie for a time previons to its dis-
charge, is shown by their commonly containing the
seminal filaments in larger abundance than any portion
of the seminal ducts themselves do. The fluiddike
mucus ako, which is dischai'ged from the vesicular in
straining dming defiiecation, commonly contains seminal

[filaments/'

^ While the foregoing views express pretty accu-
rately the most generally received opinions on the
points at issue, are more in accordance with the physi-
ological functions of other organs and the manifest
purposes of adaptation, inasmuch as in animals which
have no vesicula3 seminales a dilatation of the vas
deferens fulfils the same object, different views have
been entertained by Hunter, Bransby, Cooj)er, and
foUowmg them by even recent WTiters. Let us examine
the e\idence for and against the views that the vesicular

ON THE FUNCTIONAL DISEASES OF THE

seminales are reservoirs of semen, for the inquiiy has a
highly important practical bearing.

Against the opinion that the vesicnl^e act as reser-
voirs for the seminal flnid, it is urged that, even in
castrated persons, the vesicukii seminales are full ; and
Mr Milton considers the fact of his liaving examined
the l)ody of a pauper, eighty-fonr years old, and liaving
found the seminal vesicles **as full of fluid as in a
young person," when the testicles, as ho thinks, must
long have ceased to secret, likewise fatal to this \iew.

To my mind, the finding of fluid in tlie vesicular of
castrated persons simply shows that, independently of
the testicles, the vesicuke continue to secrete their owTi
special secretion. Again, it is not a fact that the tes-
ticles cease to secrete semen even at the advanced age
of eighty-fourj and if it be assumed solely on account
of the advanced age that the contents of the vesicular
m Ml* Milton's case were not seminal, the assumption
is unwarrantable, for Casper relates the case of an
hivaUd,^ aged ninety-siw, who died under the care of a
trustwortliy observer, Dr Abel, who had the remark-
able oppoilnnity of observing a nitmher of spennatozoa
in the vesicles. Hence the finding of fluid in the
vesiculte at an age under ninety-six cannot invalidate
the opinion that the vesicuke act as seminal recep-
tacles.t To show that at very advanced ages the tes-
ticles secrete semen, the following cases, likewise
related by Casper, may be mentioned ;^ — A carriage
vamisher, aged sixty-five, who killed himself by sUt-
ting up his belly, had nmnerous zoosperms in his

♦ Valentin'a Physiology,

t Dupky found thai tUe semen contained 8ix!nnaiozoa in thirty-fieven caaea
out of fifty-one oH men, nine of whom were more tliaii eighty years old.

UEINARY AUB REPRODUCTIVE ORGANS.

les. An invalid, aged sixty- eight, whose death
wits occasioned by fracture of the pelvis, had a large
numljer of zoosperms in his vesicles. Case seven may
be quoted ui Casper's own words — "A vigorous natura-
list, dwtp t/ears of age^ a married man, and father of a
large family, and accustomed to the use of the micros-
cope, whom I had interested in this question^ examined
with me for some time continuously his own semen
after coitus. Here we found the greatest variations^
which were accurately noted by both of us together.
After coitus on the third day, reckoning from the last
performance of the act, there was a farge number of
very small spermatozoa ; after renewed coitus on the
fourth day, few and small; after a pause of only two
days, none ; after a pause of only one day there was
only a watery spenna, in which no zoosperms were
found. At another time, on the fifth day after the last
coitus, the zoosperms were very numerous; another time,
after a pause of six days, they were few but large in
mze; four months after the last examination, and seventy-
two hours after tlie last act, the zoosperms were ami-
paratitelp very small; and at another time, on tlie third
day after the last act, they were mnumeral)le. Imme-
diately after coitus, and before emptying the bladder,
the urethra was twice examined. Twenty-four hours
after the last act, a drop pressed out of the urethra
exhibited m^/«^^/w/^ ^w/r^// zoosperms; at another time,
after a three days' interval, there was not a single
zoo.sperm." It may be contended against Casper's
cases that the individuals examined were in a most
favourable state for post mortem ejaculation, an occur-
rence not imfi*equent even after natural death, for with
the exception of two subjects dead, the one fi'om

ON THE FUNCTIONAL DISEASES OF THE

pyaemia the other from pneumonia, the others were
asphyxiated, hanged, or drowned; circumstances under
which ejaculation is nearly constant. Casper further
relates thirteen cases in wliich zoosperms were found
in the vesicul^, but as they pcDssess no peculiar interest,
I shall content myself with referring to the original
work; but he also relates eleven cases in which no
zoosperms were found in the vesicular, and the conchi-
sion at which he arrives is that *Hhese observations
prove, not only that the human seminal fluid does not
always contain sperniatoza, but also, that even in the
same individual they are not always to be found.
Whether, as it seems, long illness or excess in reners ,
has an influence upon the origin and reproduction of
tliese animalculie, must remain for future and more
extended observations to decide,"

The important observations of Dr Davy, F.E..S.,
Assistant-Inspector of Army Hospitals, published in
the ** Edinlnu^gh Medical and Surgical Journal " for
1838, confiiin these views, and an outline of the cases
examined is presented on p. 60.

In all these cases Dr Davy states that the testes
were examined along with their associated organs, and
tliat, except in the 18th and 20th cases, no animalcules
could be discovered in the fluid expressed fix>m the
substance of the gland. "Wlien obtained in suflicient
quantity for accurate observation the fluid secured was
transparent, generally contained globules about the size
of blood corpuscles, and invariably dense particles,
from twelve to fifteen times smaller than the glolmles,
and which, it has been surmised, are the ova of the
spermatic entozoa. In the two instances Dr Davy
remarks, in which spermatic animalcules were fountl

URINARY AND REPRODUCTIVE ORGANS.

^siT

s & s ^ ss ^

n c^ ^ h-
Wi m Si ^

SI K s. ^

S 3 ^

^ 9« «i3 «# 14 «&

•-

« A Q 1-*

n 4' <« e

S S g

ON THE FUNCTIONAL DISEASES OF THE

in the fluid of the tubuli, the quantity of the fluid was

greater than in the others. From this table Dr Davy
justly di^aws the inferences that the resiridaf are semi-
nal reservoirs, but that they also secrete a peculiar
fluid of their own for admixture with the semen. Tlie
first inference is supported l>y the general resemblance,
in several cases, of the fluid in the vasa dcferentia and
the vesicuht% and of the existence of the characteristic
spermatic animalcules in the fluid of the vesiculte in
every instance in which they were detected in the fluid
of the vasa dcferentia. The second inference is sup-
ported by there being a certain difierence in almost
every case between the fluid of the vesicular and that
of the vasa dcferentia, and especially by the ciiTuni-
stance that the difference of the quality is most per-
ceptible in the fluid of the fundus, — being most out
of the way of being readily mixed with the fluid of the
testes. The fluid in the vesicula3, Dr Davy thinks, will
be found more dilute than that in the vasa dcferentia.
With respect to the colour of the fluid in the venicuhe.
Hunter was of opinion that it was naturally of a
browTiish hue. Thin appears questional >le; and Dr
Davy is disposed to think that coloration is a post
mortem eflect, as the fluid partakes less of this hue
the sooner it is examined after death. In Dr Davy's
cases, instances occurred iu which it was colourless;
and Hunter himself, relating his examination of the
vesicula of two men suddenly deprived of life, the one
killed by a cannon ball, the other by falling from a
height, remarks that in the former *'the fluid in the
vasa dcferentia was of a lighter colour than is usually
found in men who have been dead a considerable
time; but it was by no means like the semen either

URINARY AND REPRODUCTIVE ORGANS. 63

in colour or smell." With respect to the latter, he
remarks, " I inspected the body soon after the acci-
dent, and found the contents of the vesiculse of a
lightish whey-colour, having nothing of the smell of
semen, and in so fluid a state as to run out on cutting
into them." *

Conformably with the generally received opinion, Dr
Davy looks upon the vesiculse as performing a purpose
similar to the gall bladder in the case of bile, and the
urinary bladder for that of urine. He believes that in
health semen is constantly secreted, and to pass as it
is formed into its reservoir, from which in continent
persons it is voided during defsecation, or in part ab-
sorbed. Dr Davy further remarks, "Mr Hunter, in
accordance with the opinion which he had formed of
the use of the vesiculse, did not admit this. He be-
lieved that the fluid rather accumulated in the testes,
and gave rise there to annoyance, requiring its evacua-
tion by a disturbing act — a dangerous doctrine, and
one for which there is, to modern science, no sufficient
evidence. In opposition to the doctrine of Hunter, I
may further state, that I have frequently examined
microscopically the fluid from the urethra, following
the alvine evacuations, and I have always found it,
in a healthy person, abounding in animalcules, the
majority of which have always been dead ; and thus,
perhaps, seeming to indicate that the vesiculse are
cloaccc as well as reservoirs, and are essentially designed
for man to enable him to control and to exercise that
moral check on the passions by which he should be

♦ Observations on Certain Parts of the Animal Economy, 1786, page 28 ;
vide also,. Manuel d'Anatomie G^n6rale, Descriptive, et Pathologique. Par
J. F. Meckel, traduit par A. Jounlon et G. Buschet, tom. iii. p. 643

ON THE FUNCTIONAL DISEASES OF THE

distinguished from brute animals, and without which
no considerable advance can be made in civilisation
or in elevation of individual condition and char-
acter/'

When the contents of the vesicular scminales are
examined shortly after death, the spermatozoa are
sometimes found alive. My impression, from the ex-
aniination of the tenacious fluid passed at stool, is
that if the spermatozoa have lain too long in the
vesiculiB they die and shrivel up* Their activity is
diminished, or even entirely destroyed, by cold, heat,
discharge of electricity, hj'drocyanic acid, strychnine,
a too acid condition of the vaginal mucus, and a too
alkaline condition of the uterine mucus {Donne). On
the other hand, ordinary mucus, pus, milk, saliva, and
urine exercise no influence on this mobility.

Spermatozoa were first observed in 1677, by Leeun*
wenhoeck. The Journal des Sarants contains the first
account of them by Hartsteker. Tliey ai'e usually
desciibed as consisting of a body, or head and tail.
The head is ovoid and flattened. The head presents
a cavity, which I have seen diminish and enlarge l)y
alternate contraction and dilation of the suiTounding
structure. Their total length is about Tj^jth of a mil-
limetre, and the diameter of the head from ^Jcfth to
^^th of a milUmctre. Certain authors (Valentin,
Schwann, Pouchet) have asserted their discovery of
organs of generation in spermatozoa. This is cer-
tainly an error. What then are the additional infer-
ences that may be adduced with reference to the
fimctions of the vesicular ? We have seen that, in

♦ After writing the above, I ftrid thiit this oljfiervatioii lias dim Ix-t'ii made
by Dr Hnxy.

URINARY AND REPRODUCTIVE ORGANS. 65

arriving at any conclusion, the factor of age up to
ninety-six must be dismissed; not only that, but if
more ancient authority may be relied upon, Pliny
relates that Masinissa had a son bom to him after
he was eighty-six years of age, showing fecundating
property of the spermatozoa at this advanced period
of life ; and Cato, the Roman senator, had a child born
to him at the age of eighty. Alexander Benedictus
knew a German who had one in his ninetieth year;
and Lemnius mentions another, who, at the age of an
hundred, married a woman of thirty, by whom he had
a numerous offspring. Felix Platerus, a celebrated
physician, who died at Basle in 1614, records that his
father married at seventy-two years of age, and had
six sons ; at eighty-two years of age his wife bore him
a daughter. I have the most direct testimony myself
to the fact of the marriage of a man of ninety-six, who
lived for ten years afterwards, and had a family of four
by his wife. Old Parr is alleged to have possessed
sexual capacity at one hundred and forty years of age !
According to Palmorius, he was tried for his life at the
age of one hundred, ob vim illatum virginL

Does the presence of spermatozoa in the fluid prove
it to be seminal ? Then seminal fluid has been found
in the vesiculse in the majority of Casper's cases. Does
the absence of spermatozoa in the fluid found in the
vesiculse show that the fluid is not seminal? It does
not. Then surely Casper's and Davy's cases prove
conclusively that the vesiculae seminales act as seminal
reservoirs. Casper's " case seven " further shows, what
will be very generally conceded, that venereal excesses
diminish the consistency of the semen — render it more
fluid ; that the seminal fluid requires time for its per-

ON THE FrXC

^AL DISEASES OF THE

feet maturation in the vesiculte, and consequently,
that repeated coitus also diminishes the number of
spermatozoa by preventing their growth ; for as sexual
congress was frequent, the spermatozoa were smaller,
till ultimately the fluid ejaculated was reduced to a
watery sperma w ith no zoosperms. The dense particles
refen-ed to by Dr Davy, as being found in the tiuid of
the testes, are probal>ly formed into perfect sperma-
tozoa in the vesicukie. After repeated ctjitus the secre-
tion of the vesiculte alone may be ejaculated, or no
discharge at all may take place. All these circum-
stances must be held as conclusively proving, that in
addition to their secreting a fluid peculiar to them-
selves, the vesiculae act as seminal reservoirs.

Can the peculiar secretion of the prostate, Cowpefs
Giands, and the vesicular occur indepeudenttf/ of one
another, or of the secretion of the testirlef

So far as the secretion of the testicle is concerned,
castration will decide the question. The possession of
testicles, or indeed a testicle, presumes procreative
power, and the absence of both would bo necessarily
presumptive of sterility ; but procreative ability must
not be infeiTed from the fact that the power of grati-
fying sexual desire exists, even though the act be
attended with tyaculation. Thus Sir Astley Cowper
relates the case of a man in whom the testicles had
been extirpated for twenty-nine years. For the first
twelve months he was capable of sexual congress, and
had ejaculations, or at least the same feeluig as if these
had occuri'cd. Subsequently his erections became less
frequent, and the act of coitus wasunattended with
the feeling of ejaculation. Ten years after the per-
formance of the operation he told Sir Astley that

UKIXAKV AND REPRODUCTIVE ORGANS.

during the past year he had only on one occasion had
sexual intercourse. Twenty-eight years afterwards he
had imperfect erections. Sexual desire gi^adually di-
minished, but on rare occasions he indulged in sexual
intercourse, though without result, aud only once or
twice he had libidinous dreams, without any ejaculation.
Krahmer relates a confirmatory case, that of a young
man, twenty -two years of age, who cut oft' his testicles
and epididjTuis with a razor. Between the eleventh
and twelfth day he had an involuntaiy seminal emis-
sion, but during eighteen years afterw^ards the sexual
power had entirely ceased.

Dr L. Gosselin has published in the ''Archives G^n6-
rales de M^d^cine," for Sept 1853, the result of ex-
periments on animals for the determination of this
point, and of the obser\'ation of nineteen patients suf-
fering from double induration of the epididymis follow-
ing gonorrhoea. The spermatic cord of one side being
exposed in two dogs, the vas deferens w^as detached
from the other portions of the cord and a portion uf it
excised. After several months the animals were killed,
and examination disclosed the testicles subjected to
the experiment in all respects nonnal, and differing
from that of the opposite testicle in that the convolu-
tions of the epididymis of the former were distended
with fluid contaijihig abundance of spermatozoa. The
isolation of the testicle, therefore, in dogs at all events,
does not interfere with the nutrition of the testicle, or
its power of secreting semen. Of the nineteen cases
in the human subject under the care of Gosselin, some
occurred in private, and the rest at the Hfipital du
Midi. The period of induration, to that of observation
by Dr Gosselin, extended from a few weeks to ten years.

«H

ON THE FUNCTTUNAL DISEASES OF THE

III all of them the indiiratioii was seated at the lower

portion of the epididymis. There was no variation
fi'oni the normal state in size, nor tenderness on pres-
sure ; none of them had their sexual powers impaired,
and therti was conijjlete ejaenhxtion unattended with
pain. The semen seemed normal, but subjected to
microHC'opical examination it wrts foimd to he enlire/j/
(iesiitnte f>/ spennatuzoa. The accuracy of the micro-
scopic examination was confirmed by Robin, Verneuil,
and others. In two of the cases, treatment being con-
tinued, resolution of the induration took place, in one
in three, in the other in nine mouths, and coincidently
spermatozoa wore found in the urine.

The inference is therefore inevitable, that while
the testicles secrete the fecundating portion of the
semen, the accessory organs, the prostate, vesicular,
and Cowper's glands likewise secrete a portion of per-
fect semen, and that their contents may be discliarged
independently of the testicular portion of the semen,
Gosselin concludes that to the portion of the semen
derived frum the latter organs is due the colom\, smell,
and other chemical pecuKarities, and this upiniun is
confirmed, as we shall presently see, by Dr Kraiis,
editor of the *' Vienna Medical Times." M. Godard
has confirmed Gosselin 's observations in more tlian
thirty cases of double epididymitis. In every instance
spermatozoa were absent.

Venereal excesses diminish the quantity of spenna-
tozoa. Thus M. Liegeois, of the Hopital du Midi,
Paris, relates the following case: — **A student, after
having had three to four connections daily for ten suc-
cessive days, asked me to examine his semen. Out of
seven or eight preparations which I made I could not

URINARY AND REPRODUCTIVE ORGANS. 69

discover any spermatozoa. There existed no lesion of
the testicle. Some months later the same person
brought me a new sample of spermatic fluid, but this
time after three weeks of sexual abstinence. I then
found spermatozoa in enormous quantity, covering
nearly the whole field of the instrument." And it is sug-
gested by M. Lieg^ois that the cases of idiopathic " as-
permatozie " mentioned by Hirtz are explicable on the
ground of sexual excesses. Hence it is inferred that in-
fecundity is due to excesses, and moderation of the con-
jugal relations is enjoined for the begetting of offspring.

We are not even authorised to affirm that the pre-
sence of spermatozoa in the semen implies the power
of procreation, for these spermatozoa must be endowed
with motion, and even if endowed with motion, an
abnormal molecular arrangement may destroy the
fecimdating property of the semen.

It is not so easy to determine whether the secretion
of the prostate can be discharged independently of that
of Cowper's glands, and the vesiculse, or vice versa.
This must necessarily be conjectural, as on account of
the anatomical relationships the one cannot be sepa-
rated from the other. I incline to think, however, that
the prostatic fluid is at times separately discharged,
and this brings us to consider the nature of the fluid
discharged at stool, when the bowels are costive, and
during relaxed states of the body generally. The argu-
ment that it is not seminal when spermatozoa cannot
be discovered in it, we have seen to be valueless. In
supporting the assertion that it is not semen, John
Hunter contended that it is not of the same colour.*

♦ Herodotus (Thalia, c. 101) makes a cunous statement. Referring to a
tribe of Indians called Padaei, he observes : — ** The communication between

ON THE FUNCTIONAL DISEASES OF THE

What is the value of this argument? Gosselio believes
that the semen owes its colour, odour, and chemical
reactions to the vesicuke, and his cases fnlly warrant
this belief. More recently, Kraus of Vienna, to whom
we have already referred as corroborating these opinions,
asserts, that seminal fluid, as long as it remains within
the testes, vesicuke, and other seminal passages, is
colourless and scentless, being in appearance exactly
like fresh honey while deposited in the comb ; and in
its reactions it is neutral Only when it has quitted
the passages and arrived in the urethra does it acquire
its white colour, and its peculiar foint smell. This
smeU has been compared to that arising from an egg
in the first stages of decomposition.

Dr Kraus fmlher adds, that it is during its passage
tlirough the prostatic portion of the urethra that the
secretion of this gland imparts its white colour to the
semen, and confers upon it the property of coagulating
when exposed to the air (alkaline reaction),

Prout has remarked that the prostatic secretion is
precipitated by acetic acid, A careful examination
has not enabled me to confirm this observation, solution
rather than precipitation, according to my experience,
being the result of the addition of strong acetic acid.

What, tlien, is this fluid ? Is it seminal ? While
these arguments do uoi prove that it is not seminal, I
am satisfied that whde it may in some cases be seminal,
in the great majority of instances it is not so,

the Beiea is like that of the beasts, open ajid unrestniiiied. They are all of
ihe same complexion, and mucli resembling the Kthinpiana. The semen
which their miiles emit is not, like that of other men, white, but black, like
their bodieii, which is ako the csae with the Ethiopiani I"

Semen ai probe concoctum fucrit, colore album et splendent esse opporfct,
lU vel hinc {^lateat quam parum vere Herodotus sen bat semen nigrum Ethjope^
pr(»mere, (K<>dericue a Ca-^tro de uuivLTaa miilierum medic in a.)

URINARY AND REPRODUCTIVE ORGANS. 71

I have said in the majority of instances it is not so,
for cases have come under my notice where sperma-
tozoa did exist in this fluid, proving it to be seminal.
This I have seen in perfectly healthy individuals, the
bowels being confined.* Other cases have come under
my notice at the Royal Infirmary of Glasgow, where
semen was passed at stool, the bowels being quite
relaxed, and where coitus could not be accomplished
owing to premature seminal ejaculation. Rayer also
states that he attended two patients who passed pure
semen at stool, recognisable by the large quantity of
spermatozoa which the fluid contained. A person
passing semen at stool would a priori be expected to
present appearances of debilitated health, and I am
bound to express myself less decidedly than I did in
the former edition against the frequency of this occur-
rence. No doubt in the great majority of instances it
is the prostatic secretion that is voided, the cause
being the pressure of foecal accumulation in the lower
bowel against the rectum.

A glance at the relative anatomical position of the
parts will corroborate this belief. The situation at
which accumulation of faeces in the rectum will press
with greatest force antero-posteriorly, is at a point
corresponding to a line drawn between the prostate
gland and tip of the coccyx. Higher up, the capacity
of the pelvis is greater ; the vesiculse are placed as it

♦ Subsequent to the writing of the above I noticed the following in
Trousseau's work on Clinical Medicine. After referring to the two classes of
cases he remarks : — " It is otherwise in respect of spermatorrhocal patients
having habitual seminal emissions not only in the act of defecaetion, but also
during micturition. In the first referred to class of cases the seminal flux
only takes place in small quantity, and under the influence of a violent efibrt,
while, in the latter, it supervenes when there is no straining — when the
motions are diarrhoeal — as well as when they are hard and solid."

ON THE FUNCTIONAL DISEASES OF THE

might seem designedly on either side of the base of
the bladder, and thns removed from the ordinary con-
tents of the bowels. That the faeces do so press is
demonstrated by the fact that when the liowels are
costive, and during deftecation^ the bladder full, the
flow of nrine is temporarily arrested by the pressure,
from behind, on the pi'ostatic i)ortinn of the urethra.
Again, the fluid thus discharged is much thinner than
normal seminal fluid. While, therefore, it is my con-
viction tliat in the majoHty of instanreii tliis discharge
— the somxe of much uneasiness to patients^ — is from
the prostate, I am bound to conclude that facts are
wanting to prove that involuntary seminal emission
may not so occur; nay, that my experience proves the
contrary.

Referring to this portion of our sul>ject, Mr Benjamin
Philips, F.K.S., observes: — *'At one time 1 doubted
whether this fluid were spermatic, it is usually so
smooth, transparent, and homogeneous ; but if it be
examined under the microscope, spermatozoa can
usually be observed in it. Its thin fluid character has
induced people to think that it was a depraved secre-
tion become watery by exhaustion of the secretory
organ ; and sometimes it may be so ; for if a person
who complains of the constant escape of the thinner
fluid has an ejaculation, the fluid wiU be thick and
grnmous. It is, therefore, most probable that the
more fluid portion of the secretion which Alls the
seminal vesicles is most easily pressed out; and tliis is
a reasonable explanation of this feature of seminal
discharges."*

Finally, CuUerier, comprehending under the term

♦ Med. Gazette, 1B45.

URINARY AND REPRODUCTIVE ORGANS. 73

gonorrhoea in the proper sense of the term, the evacu-
ation of spermatic fluid, admits two kinds ; the one
occurring during straining at stool, and which dis-
appears with the removal of the constipation, the other
which resembles the diurnal pollution of Wichmann,
simply the prostatic secretion.*

Morgagnit observes that in men enfeebled by
debauch, semen is evacuated without pleasurable feel-
ing, or venereal excitation, by too hot baths, or when
the bowels are loaded with hardened faeces.

The occurrence of any such discharge, while easily
remedied, is not to be considered a manifestation of
health.

In conformity with our plan, the next question which
presents itself is. Is semen discharged with the urine in
hecUthf — to which the brief answer may be made,
assuredly not, Neubauer and Vogel show that sper-
matozoa are found in the urine after coitus, and that
they have been frequently noticed in the urine of
patients suffering from typhus, and they detail their
mode of examination and the influence of certain
forms of urine on the behaviour of the spermatozoa.
Lehmann remarks that urine containing spermatozoa
very soon becomes alkaline.

Clemens has frequently noticed the passing away
with the urine of imperfectly formed semen ; the sper-
matozoa lying in the cells, and adhering by their head
and tail to the envelope ; the tails seldom showed any
signs of motion, which only takes place in perfectly
formed semen. Besides these spermatic cells, Clemens
often observed in the urine of patients suffering from

♦ De Causis et Bed. Morb., epist 44, art. 16.

t Diction, des Sciences Med., Art Gk)norrh(£a, t. xix. pp. 4 and 5.

ON THE FimCTlONAL DISEASES OF THE

speimatorrhcea loimclish cells of 0033 to 005"'
diameter, filled with fine gi^aniiles, which lay for the
most part on the side of the cell These cells are in
reality the mother cells of the spermatozoa. Such ele-
mentary bodies are generally found in the last drop of
the urine of patients wiio have been much depressed
by loss of semen, and also in tj^^hus fever patients:*

From a careful examination of tlie urine of healthy
indi\idual8, the same authurity infers that the urine is
never seminiferous excepting after pollution or sexual
intercourse. This accords with universal experience.
The presence of semen in urine must be regarded then
as a pathological condition save under the circum-
stances noted.

Is semen re-absorbed into the sj/siem? In a very able
review of M. Lallemand s well-known and mischievous
work on " Spermatic Discharges/* in the first number
of the Medico-Chirurgical Review (1848), the following
passage occm*s : — " M, Lallemand, in our opinion,
attributes far too great an importance to prolonged
eonthumce as a direct cause of .spennatoiTha^a. That
a moderate ejcercise of the genital organs is the eoudi'
lion most fatourable to the maintenance of their health ff
condition, and the general weU-being of the emnomy^ is
a fact which requires no proof; but we conceive that
M. Lallemand gi^eatly exaggerates the ill consequences
which ensue ui>i*n the withholding such exercise. In
the first place, the condition of spermatic plethora, or
distension of the vesicula*, is not such a necessary
consequence as he states it to be, and may be said to
be in a great degree under the control of the iudiviiluak
Even if the secretion of semen is of constant occur-

♦ CaiisUtt'R Jabresl^rkht 1860, p. 285.

URINARY AND REPRODUCTIVE ORGANS. 75

rence, the amount is much infltienced [the italics are
mine] by the mental state operating through the
nervous system, and by the demand made upon the
gland. Thus, if an individual has frequent recourse
to coitus, or without this, indulges in erotic thoughts,
libidinous reading and conversation, or analagous prac-
tices, a large quantity of semen will be secreted ; and
in the latter case, not finding a natural ejection, it may
lay the foimdation of obstinate nocturnal pollution.
This, indeed, may occur in any person without prior
excitement of sensual ideas; but then it is usually
both rare and moderate. And indeed the testicles
and their secretion seem to possess a far greater power
of accommodation to the exigencies of the economy
than M. Lallemand is disposed to allow; and we
imagine the instances of atrophy from mere disuse,
unaccompanied by prior disease, to he of very rare
occurrence. Certain it is, that many men, who have
maintained a complete continence long after full man-
hood, have yet proved effective progenitors of children;
while the number of cases of premature impotence,
brought on by too early or excessive intercourse, would
lead us to suspect that this is the more formidable of
the two."

With the reservation that atrophy of the testicles in
very rare cases may be produced by excess of venery
or masturbation, we give to the foregoing our im-
qualified adherence, believing, as we do, that these
opinions are in perfect harmony with physiology.

Of the authorities who maintain the reabsorption of
semen may first be noticed Gosselin. Certain of his
statements are not a little strange, nor wanting in the
elements of powerful fancy. He says — "All physi-

ON THE FUNCTIONAL DISEASES OF THE

ologists (?) acknowledge that of all the secreted fluids,
semen most easily admits of al>sor])tion. In fact, in
the best organised snbjeets, its excretion is neither
continuous or regular. It is tnie that the vesiculie
are organs of reception ; but their capacity is small,
and their power of distension slight. Now, if these
organs do not admit of a large accumulation of the
fluid, and yet, on the other hand, n^ithing arrests or
suspends its secretion, it is by means of a gradual and
proportionate abs()q>tion that nature supplies this
a|il)arent dtriciency in the anatomical arrangements.

Need I allude to the fact tliat such absorption of
semen is regarded by all i>bysiologists as of utility for
the regular mainteinince of om^ organs, auil the exer-
cise of all our functions. (Sic ! !). Observe what takes
place when the t(\stes are absent, disappear, or arc
imperfectly develojied. The semen is then absorbed in
insuHicient rpiantity, and all the organism suffers from
this; the constitution continues feeble, wliile the body
does not take on, or loses a portion of its masculine
characters. Nature endeavours to provide for the
resndar conservation of tlie indivithiaL by means of the
absorjition of the siime ]irnducts where excretion serves
for the preservation of the species. ^Tien an oblitera-
tion takes place, the latter and most capital of these
uses is suspended ; but the other persists, the absorp-
tion of tlie semen throughout the spermatic passages
prevents a distension of part^ w^hich might end in local
mischief, while the beneficial iiiHnence of the secreted
semen is imparted to the entire economy/' It is l>y
such argmnents as these, phuisible no doubt, that
Gosselin, Ilaller, and others, support their view.

Human experience has alauidantly shown that the

ITTtlXARV AND REPRODUCTIVE 0UUAN8.

antife of absurilities in medical science, as in every-
thing else, is not narrow, and, accordingly, Haller is
afliliateil with the following opiiiiouH : — '* The greater
part of the semen — that which is the most valuat>le
and the strongest smeUing, that which has most force
^is pnmped back again into the blood, and tliere pro-
duces, as soon as it reaches the circulation, changes
the most marveUous^ — the beard, the hair, the horn; it
changes the voice and the manners ; for age does not
I»rodnce these changes in animals, it is the seminal
tluid alone which can effect this. As we never re-
mai'ked these changes in eunnchs," (Haller.)

Statements still more extravagant are fonnd in certain
books, but it is hoped that these will be taken at their
proper estimate, and a reference to them in this place
olniated. How the growth of beard in certain females
can be reconciled with the above theory may well
excite surprise, the more so that this abnormality has
been regarded as a sign of female sterility, especially
when coinciding with the absence of certain other
feminine characteristics.

In defence of the opposite opinion KoUiker contends
that ** there are no certain facts in favour of an
aljsorption of semen when formed, which could only
take |)lace in tlie vam de/ereniia and re^iruiw semimties,
for what is observed in animals after the rutting season
is over has no reference to this point; and the very
circumstance that in the situations above mentioned
no traces of a disintegi^ation of semen are ever found,
apfjears to be very much opposed to such a suj^positiou.
At the same time, however, it is perhaps unquestion-
al)le that, without seminal evacuation, a formation of
semen may be possible; for it is sufliciently established

ON TICK FITNCTIONAL DISEASES OF THE

tlie reabsorptiou of the semen into the organism can
do auy good, or produce any increase of l}oJily strength
and spirit*"

Again, if the power of the voice and growth of the
beard depend on seminal reabsorption, it is not nar-
rated that in cases where castration has been per-
formed, in cases of occlusion of the vas deferens, or
induration of the epididymis, that any suck influence
had been thus manifested. Indeed, in Sir Astley
Cooper's case the patient ** was in the liabit of shaving
once and sometimes twice a week/' Twenty-eight
years after the the operation his voice^ natmuUy feeble,
remained as at the time of the operation.

I have been charged by the re\dewer of the foimer
edition of this work, in the " Lancet," with having
assumed the non-absorption of semen on insutlicient
evidence. I am still unshaken in my opinion, I
regard the resmdfe seininales as fulfilHng like purposes
to the gall-bhidder and urinary bladder in relation to
their special contents; and while it is not denied that
bile and urine are capable of reabsorptiou, it is con-
tended that this is not normal Further, analogy is
opposed to the view. The reabsorptiou of the corres-
ponding secretion of the female, viz., the menstrual
fluid with its contained ovum or ova, is not regarded
as normal. Where would realtsorption take place ?
Has the presence of absorbents ever been traced to
the ms deferens or ecmctdfB semimdes? There is then
not the slightest evidence that reabsorptiou of semen
takes phice, while, on the other hand, suflieient grounds
exist to justify a contrary belief By one class of mdi-
vidnals — Charlatans — this theory is propounded for the
purpose of terrorism ; by another, a well-meaning class,

URINARY AND REPRODUCTIVE ORGANS. 81

perhaps, in order to reconcile physiology with conven-
tional ethics.

That there is a diflference between castrated and
non-castrated animals we are not prepared to deny;
the cause we are disposed to ascribe first, possibly to
the shock, and secondly, to the removal of organs so
intimately associated with the medulla oblongata; thus
disturbing by their removal a co-ordinating pole of
nervous equilibrium, and diminishing muscular vigour
by some impression on the medulla oblongata.

The influence of the cerebellum on the nutrition and
vigour of the body is indisputable, and the intimate
relationship between the sexual organs and this portion
of the nervous system is equally incontestable. This
is well indicated by the following observations. Budge
remarks : — '* By a lucky coincidence I made the grati-
fying observation that in an old cat, whose testicles
lay in the abdominal cavity, those organs, imme-
diately after death, moved, whenever the cerebellum
was irritated by the scapel or with caustic potash.
The effect was such, that whenever the right lobe of
the cerebellum, and the right half of the vermiform
process were irritated, movement of the left testes
ensued, and the reverse. Mere superficial irritation
sufficed to produce the result. The movement of the
testicles soon became so palpable in the animal that
there could be no doubt as to its reality. I hastened
to open the entire skull, and the abdominal cavity,
and found the testicles lying perfectly still, without
any trace of movement. On irritating one side of the
cerebellum the testicle of the opposite side swelled,
quitted its position, and rose up so as to form a right
angle with the spermatic cord, one side of the angle

ON THE FUNCTIONAL DISEASES OF THE

being directed forwards. If I desisted from the irrita-
tion the testicle returned to its position, and the move-
ment was renewed on renewing the irritation. The
experiment was repeated during half an hour with
inivaiyiiig results. . . , . In the ductus deferens the
movements were alternately those of elevation and
depression, an entire portion being distended and
collapsing/' &c. &c,

Koubaud afhrms that he has frequently allayed
obstinate priapism by the application of cold to the
nape of the neck; and M. SeiTes has remarked in a
series of cases, that an effusion of blood on the cere-
bellum is accomiianied with a turgescence of the
genitals, sometimes attended with seminal discharge,
and persisting even after death, Burdach'' mauitains
that uterine ulcerations occasion pains in the occiput,
and spasm in the cervical region.

Larrey reconls the following interesting case bearing
on the subject. A soldier wounded in the occipital
region was attacked with all the sjTnptoms of hiflamed
cerebellum, which, despite treatment, wore dissipated
only on the appearance of an abscess which opened
spontaneously on the nape of the neck. Three months
afterwards he rejoined his regiment, and many years
elapsed before he again came under Larrey*s notice.
His appearance was then so altered that Larrey mistook
him for a youug conscript exhausted by some asthenic
disease. He was thirty-two years of age, of middle
size, but thin and pale; his eyes were depressed, his
lips blanched, his hau% more especially that which
covered his occiput, was thin aud bristled, and a feel-
ing of pain and coldness was always felt in the back

* Bau und L^ben dea Oeliirns, t iii p, 76.

REPKODlf

GAT

portion of his head. Being beardless, and possessing
a feminine voice, a suspicion of his sex arose among
his comrades, and an examination disclosed the follow-
ing condition : — '' To our great surprise," says Larrey,
** we found his genital organs reduced to the size of
those of an infant some months old. His penis was
not more than five or six lines long, and two or three
lines thick ; it never exhibited any degree of erection ;
and liis testicles were so wasted as scarcely to equal
in size a small bean."*

Lallemand refers to the case of a man who received
in the neck a sabre-cut, in consequence of wliich the
testicles atrophied, and venereal desires diminished.
He also cites another case in which the discoveiy, that
a stroke on a particular part of the occiput produced
voluptuous sensations, was followed by repeated per-
cussion on the same part to produce similar eflects.

M. Chaulfard mentions the case of a man of eighty-
three years of age, in whom a blow on the nape of the
neck produced violent satyriasis. It is not at all un-
frequent to encounter men in whom sexual intercourse
is followed by pain in the nape of the neck, and some-
times even during the act.

So far, then, we have adduced reasons for the follow-
ing opinions :■— that the secretion of semen is constant
m health, its quantity and rapidity of secretion being
subject to certain mental states; that while sperma-
tozoa may be found in the epididymis and vas deferens,
the vesiculse seniinales act as seminal reseiTou's; that
independently of the testicular secretion, fluid may be
extruded from the vesiculte, prostate, and Cowper's
glands conjointly, and probably singly; that the pre-

* Clinique Cliirurgicale, 1830.

OK THE FUNCTIONAL DISEASES OF THE

sence of spermatozoa in a fluid from the nrethi*a gives
only an affiiinative proof that such fluid is seminal, for
their absence does not prove that the fluid is jwt
senimal, that semen is not discharged in health with
the urine^ and that seminal fluid is not reabsorbed. We
may be supposed to have landed om'selves on the horns
of a dilemma, inasmuch as the only means remaining
for the disposal of semen is that of seminal emission.
To this conclusion the facts we have submitted force
us; but we must qualify this belief by asserting our
con\iction that a power of accommodation is inherent
in the organism, so far as all the secretions are con-
cerned; for the quantity of all secretions is relative
to the requirements, and glands are stimulated to in-
creased secretion, each by its own special stinmlus.
Thus, saliva is secreted in greatest abundance during
mast i cat ion, and the gastric and biliary secretions are
in Hke manner more abmidantly secreted dufing diges-
tion; ami hence, in the case of the seminal secretion,
where a mechanical imperfection seems to some to
exist, a regulating influence of the nervous system
meets the supposed want. Therefore semen, it would
appear, is secreted but very slowly when the vasa de-
ferentia and vesicuhe seminales are full^ but no sooner
are they emptied than the testicles and associated
organs supply the want created, for it seems to be
the noiTnal condition of the vasa deferentia and the
vesicular to be full, thu8 enalJing human beings, in con-
tradistinction to animals, to have sexual congi^ess at
any time. But should physical or jisychical causes
determine secretorj' stimulation, the vis a tergo, in
continent individuals, occasions involuntary seminal
emission, an occurrence in healthy individuals audcr

UPJXAUY ANH lIEPliUDUCTIVK OKCANS.

circunistanecs, between the period of puberty
and the advanced age of even sixty, as my experience
has shown, inseparable from our present organisation.
Hence I contend that seminal emissions, in continent
indi\iduals withm given limits, are rather significant of
health, and that their absence under these circum-
stances would be calculated more to surprise than
their presence to excite ahmiL While it is in perfect
harmony with sound physiology to mfer that somatic
or psychical irritation detennines an increased glandu-
lar secretion, it w^ould seem equally uureasonable to
infer that the secretion of any glandular body is exclu-
sively under the infiuence of physical or emotion causes;
accordingly, whdo preternatural secretion may be in-
duced on the one hand, there must, on the othcr^ be
such a condition as independent normal secretion; and
to the extent that uivohmtary seminal emissions are
due to this vis a tergo from normal secretion, the idea
of treating tliem as manifestations of disease, I look
upon as too absurd to merit grave attention.

Reverting more particularly to our subject, it is not
contended that, while involuntary seminal emission
within certain limits, and under the circumstances re-
ferred to, must be looked upon as normal, that exag-
gerated seminal emission may not constitute a patho-
logical condition demanding the ullention of the pby si-
man or stirgeon. To draw the line of demarcatii^n in
these cases requires the exercise of sound judgment,
uninfluenced necessaiily by preconceived prejudice,
and a consideration of the general symptoms which a
given case may be present; for obviously much will
depend on the natural vigour of the patient, and there-
fore a robust person will tolerate with impunity a

ON THE FUNCTIONAL DISEASES OF THE

drain upon the system from which a weaker one might
8Hffer dangerous consequences. As we have seen that
secretion of semen may bo stimulated by psychical or
somatic causes, we proceed to inquire the natme and
variety of these causes. On the psychical side, that
occurring during the transition from adolescence to
mankind, is peculiarly striking and dominant. At the
period of pul jcrty the l)odily and mental functions attain
their complete development,— ^the development of the
former coinciding with a noraial excitation of the
latter.

On the physical side, the voice becomes abruptly
changed;^ it is fuller, deeper, and more sonorous, the
sexual organs become fully developed, and incipient
beard makes its appeamnce, along with growth of hair
on other parts of the V)ody; psychically, with the in-
creased cerebral development corresponding mental
emotions manifest themselves. As Fenchtersleben re-
marks, — " The mind of the young man is poweifuUy
impelled in the direction of the will, that of the mmden

♦ ** Le veritable ^pauotuMineat dc k p^ode morale s'opire lurtout 1^ k
pubcrilu L'ln^lmct sexxiel apparalt et il donrnie retre cozntue un l>'iun«
Lliomme devient irraiment hoiimie, la fenune vraiment femme. Chez l*un
et rautre, rimpredsionnabilit^ morale acqttiert tine sensibility exquiee. De
foTtc« impressionB niotale*, fr^|ueiieiiinient rtp^t^es, provojuent la genem-
lion des d^Kir^ durables, on eflt apte k k poMton. Alora, dn moins cliez r^tre
normalement doue, le« be«oiiiA nutritifo et lensiiiia sont compli^tement piiiu^
ptt7 tei benoins mnmux. Aniour 0<;xitel pooaioiiji^ amour rajretitjuc, non motna
fort, d^vouenieiit d^^intdrenad, pour Ftoc mmi rM on fictif, fli>leiideur« de
ritnigi nation, ivruHsijij ou tortuiea dee tootions momle-s, noua voua avoua torn
ccmiiua; maia jien k pen, chez certaimi hommea du in(nsi% ches oettx qui
puroourent l« cycle comptet, voua devenez moiiiB TtTHcea) ehoihb iInp4neu]^
TOO! cMez k pkce au d^sir de k fortune, k Fambition chez beaucoup, chex
quelquea— unfi que je coDnid^re lea ^hantinons les pltia oompleta de Fef^tece,
k IVmour du travail intellectual i|ii(^l que soit eoiibiit» »cienci^s propn!iiient
dite% 4tti4a0 8ociolo|^uet ou morales ''^Letoumeau, Physiologic da Pamons,
1808.

tfRINARY AND REPRODUCTIVE^

in the direction of feeling; images of ondcfiiied delight
float before their minds ; the enchantress Fancy reigns
in all her loveliness ; soothing and rapturous emotions
alternate in a constant tnmnit of ecstasy; and love as
a passion, with flattering but despotic hand^fortunate
those who ai^e able calmly to guide it — seizes the
sceptra When happily controlled, whether designedly,
through education and self-reflection, or undesignedly,
by an harmonious proportion of the desires in the
natural disposition, love becomes the source of the
most beautiful psychical developments; and he who
never loved is or will become egotistical, mean, nan'ow-
minded, covetous, timid, and but too often an imnatu-
ral sensualist."

The new want, says Cabanis * produces in the young
man a mixture of audacity and timidity, — of audacity,
because he knows that all his organs are animated with
an unknown vigour; of timidity, because the nature of
his desires astonish him, as defiance to them discon-
certs him. In the young girl this want gives rise to a
sentiment of modesty or virgin shame, of which she
was heretofore ignorant, which may be regarded as the
hidden expression of her desires, or the involuntary
signs of her secret impressions.

The period of puberty is thus a highly critical one,
and amid the phantasmagoria which take possession of
the mind, man's relation to the opposite sex occupies a
prominent phice. If, accordingly, there happen at
this period, in the normal state, this mental condition,
can it be a matter of surprise if it manifest itself
in correspomhng physiological aberrations 1 Hence
we infer that involuntary seminal emission at puberty

♦ Rapport du Physiriue et Moml de I' Homme.

ON THE FUNCTIONAL DISEASES OF THE

Semen ubi ipsa dies membris natum creavii,

Conveniuiit simulacra forls e corpore quoque,

Nuntise pnectari vultus, palchriqiie coloris,

Qui ciet iiritans loca turgida semine nmlto,

Ut, quasi transactis s^pe omnibus rebus, profundant

Fluminis ingenteis fluctus vestem quo crueiiteut." *

Pichont iiai'rates that a female of 48, who had ceased
to menstruate four years previously, in assisting at a
protracted and painful accouchement of one of her
sisters, was taken with pains resembling those of
labour ; tliat some hours ailerwards haemorrhage from
the genitals occurred, which lasted for several days,
and that three days after the cessation of that dis-
charge, the breast became tumefied, and furnished a
secretion of milk.

It is a legitimate and interesting subject of specula-
tion, vvhether it is the genital functional commotion, or
in pathological conditions, the uTitation which, acting
on the brain, determines the dream, and in consequence
the reflex action ; or whether the dream is primary, and
the functional impulse secondary. In nocturnal enuresis
the physiological sequence is of the fii*st order; in

* Manj meet cleatlj ; moijy, as if tumbling down from high pi-ecipices to
tlie ground with tbeir whole hody, are ucarecl T^ilh terror, and, after flleep, as
if they were out uf tlitfij jiul^fmeiit^ pcarce come to tbejiL*ielveB agiiin, quite
diBordered liy tbeir ImkIv'h turmoil. Af,tiin, a tbirsty man sits down beside a
river, or a i>lejisiLnt spri]ti,% and gidplifl ib>vvu w ell-ni^li till tlie etretim. Cleanly
l^eople iiftf 11, wbuii asleep, btlifviii^ that tbey are lifting their dreHij beside a
urinrd or the puldic vesselsi, pour forth the filtered fluid of their whole Iwxly,
and the Baby Ionian coverletfl of 8urp!i>«ing brilliaoey are drenclied. Then, too,
tbui5e into the boiling carreut of whose age seed is for the first time passing,
when the ripe fnlncfis of days has produced it in their linil)«, idcik eneounler
from without from what body eoever, harbingers of a glorioas face ar»d a
Wiiutiful bloom, which atir and excite the a]ipropriate portions of the frame,
and often oceaaion fruitles3 anticipations of the pleftsures of love.

t Arch- General de Med., t ivii. p. 125.

URINARY AND UEPRODUCTI\^ ORGANS.

aeminal incontinence, I believe it to be sometimes of
the one, and at other times of the opposite variety-
During sleep the influence of the sympathetic over tlie
organic ftmctions seems to be diminished ; hence the
frequency of erections in this state ; motor influence
predominates. I believe it to bo the reverse in respect
of the l>raiu, and that an anfcmic condition is thus
determined, which, in proportion to its degree, induces
sleep. We have seen that a most intimate nerv^ous con-
nection exists between the ccrebellimi and the genital
organs. Functional activity of the latter determines
passive congestion — an increased afflux of blood — in
the former. Genital, and even gastric irritation, during
sleep will accompHsh the same, and the distui-bance
of the circulation thus induce dreams conesponding
to the seat of irritation, and to the relative point in the
brain. On the other hand, ungratified sexual excite-
ment may leave impressions on the brain, which during
sleep, when the regulating power of the sympathetic is
lowered, will be expressed in correlative functional
action.

What is normal, then, both psychically and pliysi-
cally, may lapse into that which is abnomial, and while
at puberty and the change of life {in females) there is
a proneness to mental aberration, physical infirmities,
as associated with and arising from sexual excesses,
have been recognised by the earliest cultivators of
medical science.

Certain other circumstmires tvhich mfluence the De-
tehpment of the lieprodfictire Facnilf/, — Irrespective of
puberty and age, certain indi\idual peculiarities or
idiosyncrasies exercise a dh-ect influence over the
generative faculty. Those inherent to the individual

ON THE FUNCTIO!

OF TIIK

may l)e rej?anled as constitution, temperament, pas*
sioiis, habit, regimen, modes of life; those extrinsieally
operative, climate, seasons, periods uf life.

Constitution — Tempera ment, — Tl i e t erm s con sti tut ion
ant] temperament are frequently and improperly used
synonymously; by the former is to be understood the
general relative development of all the organs; by the
latter, a preponderance of the inHuence of a given
portion of the organism over all the rest. In propor-
tion as the constitution is robust, so will be the energy
of the generative function, the earlier will be its
development, and the greater the chances of a healthy
progeny. With respect to persons of delicate constitu-
tion, in whom desire is frerpiently urgent, the copula-
tive act is performed with less vigour, it might almost
be said perfunctorily, but is not frerpiently followed by
conception. By temperament is understuod a given
combination of psychical and physitflogical manifesta-
tions, usually distinguished by peculiarity of exterior
hal)it. The ancients recognised fom* temperaments —
viz., the biiiou^ or choloric, the miHgnim^thQ melaneholir^
and t\\^plde<jmatie. It is seldom that there is a marked
I)reilominance of the one in any given person; nic^re
frequently a twofold or treble combination exists. Tlie
lymphatic temperament is marked by a relaxed condi-
tion of body, and is not favoui:al>le to procreative vigour.
The bilious temperament, on the other, is characterised
by exactly opposite manifestaticms, sexual ardour, and
procreative energy. "The temperament is so hot and
80 amorous that even with saintly virtues, nature
gives a constant proneness towards the opposite
sex. One might as well extinguish a great fire with
a drop of water, or compel a hirge river to return

nclNAUY AND Ul' PRODUCTIVE OliOANS.

towards its source, as to correct the mcliiuitions of that
person."*

Moral Fae ill ties — Pasdous. — To a greater extent
tlxan any other of the bodily fmictions, that of genera-
tion is influenced by the morah The more Uvely the
ima^nation, the more directly is the influence over the
genital sense, while mental torpor produces the opposite
effect. Intellectual applicatitni of a protracted nature,
on the other hand, diminishes sexual vigour, and may
even cause inipotency and sterihty.t

The sentiment of love exercises, perhaps of all others,
the most powerful iuflnence over the generative func-
tion, heightening its power and activity, wliile its
opposite, that of repulsion, strikes it with diminished
vigour, or even impotency.

Exceptional circumstances, though they do exist,
but pruve the rule. Thus, w^hen ardent desire has been
long repressed, or if it exceed the normal hmit, a like
inHuence may be induced over the generative function
as that caused by a feeling of repulsion. The excess
of desire may cause temporary impotency, and in order
that the natural consensus between body and mind and
its attendant physiological manifestations be developed,
the normal sur-excitation must have ceased, or at least
retunietl to its proper standard. Montaigne accord-
ingly remarks, *' J en sais, que j'aurai plus dune fois
occasion ile citer ^ quil il a scrvi dV ajiporter le corps
m^mc, demirassasie, d ailleurs, pour endormir I'ardenr
de cette fureur, et qui, \rAT Tage, se trouve nioins
impuissant de ce qu'il est moins puissant." :[:

* Vennttt*. TiiUt^au <le raiaour conjitgal, 2«» partie, cliap, iv. ^rt. V*.
"t Physiulogie et liygi^tie cle^ bominea livr^a aux tiuvaus dt; I'esprit, |tar le
Docteur RtvcilU-Pari*?. Paris, 1843.
X EAsais, t i. p. 104. Pari^, 1743.

ON THE FUNCTIONAL DISEASES OF THE

HabiL — As in other portions of tlio body, as we
shall see in the seqiiol, hal»it exercises a strong influ-
ence over the faculty of {generation. Exercise of the
genital fimction is not attended with the same con-
seqiieuees in all persons. In some it engenders satiety,
and is conducive to sexual vigour; in others the want
of normal excitation is followed by impotence. Modes
of life, as they react on the system generally, will react
correspondingly on the sexual functions.

Clinmik Iffjfnemx's,— In hot climates, both in the
male and female, the sexual functions and capacity are
developed at a much earlier period than in cold.

jMonteHquieu ascriljcs to this fact the polygamy of
these countries. *' Fenuiles,'' he remarks, "are mariiage-
able in hot climates at eight, nine, and ten years of age;
thus infancy and marriage ai'e almost coincident; they
are old at twenty years. Reason never exists with
them coincideutly w ith beauty. When beauty demands
the empire of reason, reason refuses it; when reason is
able to obtain it, there is no beauty. Females become
dependent, for reason is not alile to procure them in
age a supremacy w hich beauty lias not given them m
youth. It is thus ajjparent that wdiile religion inter-
poses no obstacle, the husband quits his w ife, takes
another, and polygamy is introduced." *

The opinion of iVIontesipiieu is warmly contested by
Chervin,t who shows that in hot climates puberty is
equally early among males as among females, and that
in such climates, as in the Levant, nothing is more
common than to find impotency in men of thirty, and

^ Esprit ties lots, 17M, liv, svL chap. iL

t Rechcrcbes MMieo — Fliiloeophiques sor les Caa»e« Phjriquea de Ia
Polygamic iIaqb Icb pays cbautk. PiLiis^ 1812.

URINARY A^B KErKODUCTIVE ORGANS,

who frequently demand of Enropeans Madjoun, or
aphrodisiac pills.*

Seasons, — Considering what obtains in hot countries,
it might natm^lly be inferred that the procreative
facnlty is more active (luring hot than cold weather.
Tills, however, is not the case; for as the rut in animals
has l>een compared with certain phenomena in the
human species, so is the generative funetiou more active
in spring than in summer. The investigations of M,
Villemic%t in France, and of MM. Qneteletif and Smits,
in Belgium, have placed this fact on a scientific basis.

The furmer lias made the following classification of
the months of the year in the order of fecundity: —

May.

Febraaiy.

August

June.

March and

November.

April

Ilecember.

September,

July.

January.

OctoboL

Addressing himself to the question, whether the
periodic influence was confined to fecundity or extended
in like manner to desire, M, Villenn^, by investigating
the records of justice, found that while in spring there
was a greater number of conceptions, there were Uke-
wise at this period the greatest number of criminal
assaults and rape. This influence is not confined to
temperate climates, but is universal ; and man may be
said, hke animals, to a certain extent to have a nitting
season. But even as the phenomena of rut cease when
wild animals live a domestic life, so in the human being,
no doubt owing to artificial modes of Hfe, is the influence
refen'ed to less marked in cities than in the country,

♦ Histoire Me*lical<3 Je rami^e <rOrietit. PariB, 1802.
t Animles d'Uygifene, t viii. p. 459» Paris, li*32,
X Ibid, t ix. p. 300. Paris, 1833.

ON THE FUNCTIONAL DISEASES OF THE

Excessim Seminal Emission ^ a Pathological State —
Sj/mptoms. — Few medical subjects have suffered more
from too hasty and uujiistifiable geuerahsation than
the one under consideration. This is well evinced in
the wi'itings of Dalmas, Albers, Faye, Lallemand and
his followers* On the other hand, the very existence
of seminal incontinence as a pathological condition has
been more than once disputed by men whose position
and reputation entitled them to consideration. As in
most other cases, the truth will be found here also, we
beheve, between the two extremes. The manifestxi-
tions of preternatural seminal emission are patlio-
logically divisiljle into (a) constitutional, (b) local.
The question will engage oiu* attention in the sequel,
whether the symptoms arising from excessive coitus
are analogous to those caused by preternatural excite-
ment of the genitals.

The prominent feature in the first order of symptoms
is general enfeeblement of health. Patient has fre-
quently a sallow look ; pulse soft and feeble, with
clammy skin. The intimate physiological relation of
the genitals with the brain and nervous system develops
unquestionably sjiaiptoms relating to the latter, which,
taken in conjunction with the symptums of enfeebled
health, rivet the attention of the experienced physician,
and point too frequently to an accurate diagnosis. Of
the latter are evident depression, or melancholy, some-
times restlessness, trembhng, at first confined to parti-
cular parts of the body, but ultimately becoming general.
Manifest disorders of digestion frequently exist ; the
toncrue is coated, the bowels confined, tiatulcncy and
ha3moiTlioids are often complained of. There is not
unfrequently a marked dilatation of the pupils, the

URINARY AND REFHODUCTlVE ORGANS.

eyeEds being siirroimded by a dark ring. Emaciation
in certain cases becomes extreme ; muscular activity
and power arc impaired. A form of anaesthesia,
comparal>lo to tliat noticed in lij^>ochondriacal and
hysterical patients, is often noted. Transitory sensa-
tions of heat, burning, or cold, are complained of. The
sense of hearing is perverted ; it loses its delicacy and
precision ; singing noises exist, which may proceed to
complete deafness.

Memory is often impaired, and there exists an
inability to fix the attention for any length of time on
a given subject Added to these, there are functional
derangements of the heart's action, as mainicsted in
palpitation, shortness of breath, giddiness, «fec. In
other cases, respirations are slow, few in nimibcr, and
not deep. In extreme cases epilepsy may be induced,
and complete impotency.

Dr Barclay, wdiom no one can accuse of exaggera-
tion, and who justly reprehends the '* obscene fami-
liarities," in which some writers on this subject have
indulged, obscn^es—^' Painful as the inquiiy must be
to every right-feeling man, w^e must not neglect the
suggestions of the wan aspect, and the slninking eye
of the young man, who has brought upon himself, as
the fniit of his vices, the penalty of a constant sper-
matorrhoea."

Scarpa remarks, and in this he is confii^med by
Rognetta, that masturbation is a frequent cause of
amam^osis. The prognt}sis he considers highly un-
favourable, as ill all other cases which have been
preceded by great and protracted incitement of the
whole nervous system.

As to the frequency of involuntary emission neces-

OK THE FUNCTIONAL DISEASES OF THE

sary to constitute a disease, it will be obvious that no
general rule can be laid down. Every case must be
taken on its own merits, for seminal emission may be
normal in one, to an extent that it would l)e abnormal
in anotlier. I regard the statement made by certain
authors,'*^ that more than one seminal emission in a
month, in continent persons, constitute spermatoiThoea,
as decidedly extravagant.

On the other hand, it is remarked by Piclvford that,
shoidd invohint<ary emissions occur more frequently
than once a week, tliey certainly demand attention,
not because the quantity of semen emitted can of itself
do any harm to an otlierwise healthy young man, but
because such frequency indicates an abnormally excit-
able condition of the generative organs,

Trousseau^t referring to the same subject, remarks
that in chaste persons involimtary emissions take place
less frequently than is generally supposed, and that a
very vigorous man may abstain for months from sexual
intercourse, without having nocturnal pollutions, and
that, speaking generally, they ought to be of rare
occurrence, save during early manhood. " Should they
take place," he further remarks, ''every month, still
more, should they occur eveiy fortnight, or every
week, should the loss of semen happen in this way,
even less frequently than in those who resort in mode-
ration to coitus, there will nevertheless be some bad
effect produced."

From the intimate connection, with regard to nervous
supply, subsisting between the spine and the genital
organs, it will be as apparent, as it is indisputaljle, that
preternatural sexual stimulation frequently operates as

♦ Mr Miltm on SpermAtorrhaja. + Clinical Meiiicine.

URINARY ASm^PRODUCTTVE ORGANJi.

a powerful cause in the production of tabes dorsalis,
and progressive locomotor ataxy (a priv. ra^ty, order).
In addition to the obseiTation of Hippocrates, akeady
referred to {page 79), Celsus is no less explicit on tliis
point. He remarks, " Est etiam, circa natmaha vitium,
quod sine venere, sme noctiirnis imaginibns sic fertur,
ut interposito spatio, tabe hominen consumat/**

I fiave oliscrvcd, conformably with the physiological
relationship already referred to, that preternatural
sexual excitation is frequently associated with a dull
aching pain, or feeling of weakness over the lower
portion of the spinal column.

Dr Bradbmy of Cambridge records (Brit. Med*
Journal, Oct 28th, 1871) a case of locomotor ataxy,
due, evidently, to excessive onanism, of wliich the
following is an outline : — ^A young man of eigliteen
was admitted into Addenbrokcs hospital, suffer-
ing from the following condition :■ — Three years prior
to May 1871, he first complained of pain and weak-
ness in the small of the back, which became aggiu-
vated by cold. Nine months ago he began to lose
conti'ol over his legs ; when he walked he staggered
as if intoxicated — his legs were thi'own out at ran-
dom, and he brought his heels heavily to the ground.
He could not walk when his eyes were closed without
falling on the floor, and he fell to the ground when he
stood upright, blindftjlded, with his feet together.
The conjunctivae were injected, but the eyes were other-
wise natural. He was deaf in the left ear. He com-
plained of frontal and occipital headache, with vertigo.
Sensation was not impaired, and the muscles of his
legs were not wasted. When first admitted there was

♦ De Medici na, lib. iv, wc, 2L

100

ON THE FUNCTIONAL DISEASES OF THE

some slight loss of power in the left arm, which even-
tually passed away. Pains of short duration shot down
the legs. There was no loss of coutiiil over the
sphincters, except occasional dril^lilin^tj of urine. He
confessed to ha\ing practised masturbation to a great
extent since the age of nine yeai*s, and at this time he
was troubled with spennatorrhfca. A brother who
came to see him had a pccuUar gait, and Dr Bradbury
was of opinion that, while tlie exciting cause was
excessive onanism, there was an hereditary predisposi-
tion to this neurosis in the family. This is only the
fourth case of locomotor ataxy published as occmTing
uuiler the age of twenty.

On the other hand, locomotor-ataxy reacts on the
genito-urinary organs. These cflects consist of fre-
quent micturitiou, attended with pain; and Trousseau
has much insisted on the occnrrence of sat}Tiasis, as
manifested in frequent imperfect erections, with pre-
mature ejaculation of semen. Similar phenomena have
l>een observed in the female l>y Bouchard and Bourne-
ville. In the rectum lancinating pains are felt; and
painful spasm is not unfreqnently siiperinchiced.

Of the local s}Tnptoms of spennorrhagia may be
mentioned discharge of true seminal fluid at stool, or
with the urine, varicocele, and impotency.

We pass now to investigate the immediate ^ects of
preWrnaturul seruai excitation.

In treating of the physiology of normal function we
have seen that impressions on the sjTnpathetic deter-
mined h)^ier4emia and increased glandular secret ion, and
that the same thing is occasioned reflexly through the
gensory nerves. A distinction was thus established
between psychical and somatic excitation. Should the

URINARY AND REPRODUCTIVE ORGANS.

lUl

exciting cause be of too long duration, or too Intense,
preteraatoral secretion is the result, in confomiity mtli
the law, iibi stimnhis ibi hitmerorum uberiot adjfuxiis;
and the converse law is equally true,^ uhi ad/luxus ibi

♦ The iBtimate connection exiattng between epltial complttlnta and llie
function of tlie test idea is illustrated in the subjoined ca-se, which occurred in
the practice of the late Mr Solly. The subject of it {lidc Mr Solly's Surgical
Experiences) was a fine yoiiiig man, alMjut 23 years of agr. About two years
arid a hull previous to hia couHulting Mr Solly, he fell fi'om a height of sixteen
or seventeen feet with hid back Hat on a hard gnivcl walk. He waa stunned
at the timCr though he did not strike bis head ilirectly. He received imme-
diately the beat advice ; was bled from the arm, and leeched over the hip.
He was very sore, and bad severe headaches for some days aftenvanls, and was

I not able to walk until seven or eight weelcs had elapseil from the time of the
injury. He was then examinetl by several medical men, and pronouneeti
sound. After this he went abroad, and lived rather freely. Just ten months
before consulting Mr Solly he began to suffer from involuntary seminal emia-
aions, accompained with great feeling of weakuef^s in the back. About two
mouths id^ter these first appeared he renieml>era fiuding a swelling on the left
dde of the loins, but this inconveideuced him m little that be did not even
mention it to his medical attendant, who treated him for dyspepsia, ordering

I liim plenty of horse and pedestrian exercise, with tonics; but he continued to

rget worse, and was obliged to return to England. On Ids arrival he applied
to an enunent surgeon, who treated him for sj^ennatoirhcra w^lb the C4iustic
catheter. He remained mider biii ti-eatuient for two months^ but without

r improvement, when Mr Solly was consulted. Aa the result of this gentle-
man's exaiiunation, he concluded that the spei-maton hci^a had a wpiual, and
not a generative origin. On stripping patient, an ehistic, eloogated swelling,
about foiu" inches in length, was found un the left gide of the JumUir vertebrae.
On rapping the spine in this region, patient felt a thrilling pain shooting
down Ma legs, with some numbness. Walking, riding, &c., caused the «ame
paim Weakness complained of in lx>th legs, more especially nght He

Ldragged \Mb leg in walking, and could not balance hiniself naturally. Coun-
ace aimoua, and he looked out of health. The nocturnal emissions
occurred frequently, without erection or pleasurable sensations. Spermatozoa
in urine.

Putting the factfl of the case together, Mr Solly inferred that the spine had
been injured about hvo and a half j^eara previously. At first be feared there
was an abscess^ but hoped the case was not so flerioua, m presaure and rapping
on the spine were so well Ixirna He had no doubt, however, ob to there being
chronic inllammation of the ligaments of the vertebrie and theca vertebralis.
With a view to this state he oidered complete rest, a lar^ge moxa to be made
over the swellings and quinine with eulphflt-e of magneeia. Subeequentlji

102

ON THE FUNCTIONAL DISEASES OF THE

irritatio, Hoiice genital irritatiou, preternaturally in-
tense or prolonged, occasions urethritis, inflammation of
the prostate, inflammation of tlie vas deferens, chronic
phlegnuisia of the testicle, inflammation of the vesi-
cuh\i seminales, varicocele or circoeele {Kipm^;, a ring,
KTikf}, a tumour), haemorrhoids, &c. These conditions,
again, react on the seminal secretion, rendering it more
abundant, and its evacuation more frequent.

Urethritis from this cause presents the same features
as that arising from specific ctJiitagion, On August
14th, 1873, I was consulted regarding a case of this
nature. I find from my notes that patient had nut
had connection with a female for more than a yean
There was a punilent discharge from the urethra in all
respects hke a gonoiThteal discharge. Seminal emis-
sions took place to the extent of two a night, twice or
thrice weekly. Patient was in tlie habit of resorting
to masturliation, whicli within Imt a week or two
previously he had abandoned. On passing an instill-
nient there was considerable tenderness throughout
the greater portion of the urethra. The discharge was
obstinate, ami wtis not completely removed when the
patient passed from under my notice.* Civiale has

UiiB medicine was changed to carb. feni with pU. tiloet c, myrrlL Six weeks
afl«rwarUs the retult m thiu detailed : —

" V, T. \A going on OA Cavounibly as when you law hinL The issue di»chaiget
welL He has not any nnmhneM on tupping the spine, nor any disagreeable
•ensation. He hat had fleyeral emiesiom;, but they have been attended with
nAtural feelingly and have not left him in the weak, nenroua state aa when
they oectined lome months ago," &c.

The ttliove Wain date 22d October IS51 Oii 4tli December, ** The swelling
has Ijeen butixcly absorbed, and on Inith sides the loins ore exactly the same
site and shape. The nocturnal emisaioiis have ceased ; the urine is free from
upermatozoA.'*

* A Jiimilar case is reported in 7^ Limut^ toL ii., IS39-40.

URINARy AND REPRODUCTIVE ORGANS.

103

noticed a similai- occurrence. He obsen^es that the
practitioner ought not to overlook the fact, that in men
who have never had connection, and who are not in
any way exposed to contagion, masturbation, inde-
pendently of its ordinary consequences, provokes a
blenorrhagic discharge.

In a large number of cases in which sexu«al excesses
have been practised, chronic intiamniation of the pros-
tate is found. The prominent symptoms of this state
are unmistakeably elicited on passing a bougie or
catheter, which on passing over the prostatic surface
occasions pain, sometimes so acute as to cause syncope.
Over the prostate, in the perineum, tenderness on
pressure is ehcited. There is frequent tenesmus; fi'e*
quency of micturition, with more or less pain, reaching
its maximum intensity as the last few drops of mine
are expelled. Involuntary seminal evacuations are
frequent, attended with deep-seated pain. The same
happens on coitus being resorted to; the pain, the
malaise, and anxiety thereby occasioned sometimes
remaining for days. Sometimes a discharge of fluid
both from the prostate and vesicul^e seminales takes
place^ under those circumstances, even without erec-
tion. Should the prostate be in a state of enlargement,
the superficial veins of the penis may be remarked as
being full, and the organ more or less enlarged in
consequence.

As in the case of urethritis, prostatic h}"penesthesia
in certain cases induces coarctation of the urethra in-
dependently of gonorrhoea, as exemplified in the fol-
lowing case which recently came under my notice:—
A young gentleman, for a year prior to consulting me,
confessed to practising masturbation. His passions,

104

ON THE FUNCTIONAL DISEASES OF TBE

he alleged, had been first excited by reading Boccacio's
Decameron. He had been engaged to be married
within a month of the time I had .seen him fiist, and
fearing sexual incapacity, he consulted nie. On pass-
ing an ordinarysized bougie great temlerness and nar-
rowing of the canal were discovered in the prostatic
region. Bougies were passed within given periods,
alkaUes and sedatives prescribed, and in a forttiight
afterwards a number ten couhi be passed without the
slightest difficuhy or the production of pain. Patient
never had gunorrhaa; lie married at the appointed
time. His health and spirits have continued excellent.
A similar case came under the notice of my friend
J. B, Hislop^ Esq., FJi.CS, (of Glasgow). A young
gentleman who considted him regarding the occurrence
of seminal emissions to such an extent as to aftect his
health, and consequently occasion mental annoyance.
Mr Hislop advised marriage. His patient got married ;
his wife became pregnant; but still the emissions per-
sisted. An examination of the nretha was thereupon
instituted, when intense tenderness was found to exist
in tlie back part of the urethra; so intolerant was the
prostatic region of the passage of the catheter that
considerable haemorrhage ensued. Patient acknow-
ledged an iuilnlgence, for a short time, in the practice
of masturl>ation, in which ho was uiitiated by no one,
but, like Rousseau, ascril)ed the feeUngs which origin-
ally prompted to its performance to maternal chastise-
ment administereil nd pof^ttTiareirh ** Qui croiri>it ([uo
CO chatiment d'enfant, reyu a huit ans \mr les mains
d'une fillo de trente, a ddcidd de mes gotits, de mes
ddsii*s, de mes passions, de moi pour le reste de ma
vie, et cela prc5cis(5ment dans le sens contiaire h ce qui

URIHARY ANB REPRODUCTiyB OROANa

105

devoit arriver naturelleinent ? En m6me temps que
mes sens furent alliim^s, mes dtisirs prirent si bien le
change, que, bomes a ce que j*avais ijprouvd, ils ne
s'avis^rent point de chercher autre chose. Avec un
sang brfilant de sensuality presqne des ma naissance,
je me conservai pur de toute souillure jnsqn'a Fage oil
les temperaments les plus froids et les plus tardifs se
developpent. Tommente long-temps, sans savoir de
quoi, je dt^vorois d'un a^il ardent les belles personnes,
mon imagination me les rappeloit sans cessej nnique-
ment pour les mettre en oeuvre a ma mode, et en faire
autant de demoiselle Lambercier '* (Rousseau, " Con-
fessions," partie I livTO l p. 1039).*

The sjTiiptoms presented by sympathetic irritation
of the testicle are mainly in a less degree similar to
those arising from regular inflammation of the organ.
The testicles are swollen, there is more or less dull
deep-seated pain and general uneasiness ; and a feeling
of weight exists in connection with the organ. The
diagnosis of affections of the vesiculos seminales and
vasa deferentia is more equivocal. By rectal examina-
tion tenderness or enlargement may be discovered, or
a too precipitate ejaculation of semen may indicate

* Who would Ijclieve tliat the cliaatisement of mfancTj received at the age
of eight l>y the hands of a womun of thirty, had given an up pulse to my tastes,
my desires, and my pasaionB^ for the rest of my life, and that in a sense con-
tmty to that wluch might to arrive naturally. At the same time that my
senses were kindled^ my desires appreciated so well the chan^je, that, impelled
to that which I hud eir^riiiiiced, they diil not oldige me to think of anything
else. With my Hutxl boiling with sensuality almost from my l>jrtb, I kept
myaelf free from every stain to an af^e when the temj>eramenta of the coldest
and the mont backward begin to develop themselves. Tormented long, with*
out knowing why, I devoured with an ardent eye beautiful persons, my
imagination recalled them to me without ceasing, only to ftgHTQ them after my
own fashion, and to make of them aa much bh of Madame LambeTcier*

106

ON THE FLTNCTIONAL DISEASES OF THE

vesicular hj^era^sthesia* In many cases pAin following
eJEiculation, and general malaise remaining for days,
indicate the condition in c[uestion,

Shonld infliimmation occur in the testicle, it may
resnlt in atrophy of the organ. I am persuaded that
I have seen atrophy of the testicles and penis, as the
result of excessive seminal emission. Cases of epidy-
mitis from masturbation have come under my personal
notice.

Considerable prominence lias been given to vari-
cocele as one of the effects of masturbation, or exces-
sive coitus. In the vast majority of cases where this
condition is suspected, it has no actual existence* It
is suggested to the mind by a perusal of those vile
productions which the press of our country manifests
such a desire to disseminate. Notwithstanding this, I
am persuaded that in many cases varicocele does stand
in the relation of eftcct, to excessive excitation of the
genitals, and this is to be ascribed to exhaustion of
the nervous centres; for, as we have seen, stinmli which
are relatively too violent, may, by too frequent repeti-
tion, exhaust muscular tension. Hence the dilatation
of the spermatic veins from debility of their muscular
coat The veins }>ecome enlarged, are valveless, and
a rdmora is thus induced, which by retrogressive pres-
sure obstructs the due supply of arterial blood, and
consequently, after a time, shrinking of the testicle*
That the shrinking of the organ is due to diminished
supply of ai'terial blood is furtliei" demonstrated by the
fiict that obliteration of the aflected veins, the circu-
lation being thus accelemted, is usually followed by
increased nutrition and heaUhy growth of the testicle.
The pathology of this condition is exactly the same

URINARY AND REPRODUCTIVE ORG.\NS.

as that which obtains in the case of varicose ulcers
of the legs.

The left testicle, in liealth, suspends lower than the
right ; and while dread of varicocele is not unfreqnently
inspired by this normal condition, it is still true that
the left testicle is more subject to varicocele than its
opposite fellow. Why this should happen will be dis-
closed by an examination of tlie vascular distribution
of the parts. The right spermatic vein opens by an
acute angle into the vena cava, while the left opens
almost at a right angle with the left renal vein, and
discharges its contents almost at a right angle mto the
left renal vein Kence the greater obstacle to the
return of blood in the left spermatic vein is of a two-
fold nature : it has to overcome a greater amount of
force of gravitation as it empties itself into the venous
system much higher than the right, and its insertion
into the receiving vessel being at a right angle, a greater
propelling force is requhed. Fm*thermore, the left
spei^iatic vein passes behmd the sigmoid flexm^e of
the colon, a position in which it is liable to be pressed
upon l)y faecal accumulations, and a further obstacle to
the circulation of its blood is thus created.

The diagnosis of varicocele is important. From
hernia it may be thus distinguished : — Place the patient
on the back, elevate and press the tumour, w^hen, if a
hernia, it suddenly disappears; then place the finger
on the abdominal ring, let the patient resume the erect
position, and, if varicocele, the tumour will reappear,
a thing not possible with hernia under the same con-
ditions. Again, the physical characteristics are so
different as of themselves to prevent error.

The term circocele (w-tpKos, KTjkrj) more accm^ately

108

ON THE FUNCTIONAL DISl

THE

ricocele implyi

applies to this conditioo, that of
in addition enlargement of the superficial veins of the
scrotmn, in which the two corpora pmirpiniformia are
frequently connected together; and in this case a
modification of the usual operation would be required
to eflFect a cure.

It has been suggested that the anaemic condition of
persons guilty of sexual excesses may be accounted for
in this manner, viz., that local initation, by producing
gub- acute orchitis and varicose veins^ causes an inter-
ruption to the progressive perfection of blood cells.
The opinion that the depressing effects of inordinate
sexual indulgence bears a relative proportion to the
quantity of semen emitted has been now all but aban-
doned, and in its stead the more natural explanation
offered, that they are due to the excessive succession
of nei'if^ous shocks, and expenditure of nerve force, as
like\\is0 the moral influences of degrading practices*
" But," as suggested recently by the reviewer of my
friend M. Mauriac's work, in the '^ Practitioner,*' '* if
sub-acute inflammation of the testes or epididjanis be a
necessary step in the train of evils, it at once accounts
for that immunity from the effects of the vice, which it
cannot be doubted that many persons possess; and on
the other hand (as the inflammatory affection is apt to
pass unnoticed), it suggests that a sufficient search
may frequently not be made into the causes of an[emic
neuralgia, especially when the pain is manifested in
quite a distant part of the body.'* Irritable testes,
therefore, in addition to varicocele, may in certain cases
be one of the results of disturbed sexual conaisthesis.
It is characterised by paroxysmal or shooting pains
along the cremaster muscle and spermatic cord. In

LRY AND REPRODUCrm: OBOANS.

109

addition to which tliere is also actual orchitic hyper-
algia, as shown by the great tenderness on pressiu^e,
the slightest touch of the clothes causing intense pain.
Vomiting and a certain amount of fever may be thus
induced; the pain is best relieved by support, and the
administration of narcotics.

This condition must he distinguished from neuralgic
pains extending from the perineum down the thigh, and
which will frequently be found to bo due to unsuspected
stricture.

Seminal hicontinenee in its rehition to Mental States.
— One of the most important, and not unfrcquently
the most painfid of the alleged effects of seminal incon-
tinence, is that upon mind. I have a strong belief that
the alleged relationship has been wantonly exagger-
ated. It is not denied that, physiologically, an inti-
mate connection exists between the brain and the focus
of generation, indeed the contrary has been established
in the foregoing; but it is contended that indepen-
dently of this there are other circimistances which pre-
dispose to insanity in these melancholy cases ; and that
in the greater number of recorded cases in which sexual
aberrations and insanity are regarded as cause and
effect, the conclusions are not based on a sufficiently
wide induction. I confidently affirm, that not the least
of the predisposing causes is the suggestion of insanity,
in conjunction with a functional disturbance to which
I believe the majority of continent young persons are
more or less liable. When this comes from beyond
the pale of the profession, and in the form of literary
garbage too long tolerated and circulated with strange
impunity in our country, it ought to be treated as any
other fonn of villany; when it receives countenance

110

ON THB FUNCTIONAL DISEASES OF THE

and encouragement from qualified members of the
profession^ it cannot be siifticiently deplored**

Supposing a thoughtless youth, who may have in-
herited the insane neurosis^ to have been addicted in
early hfe to the not uncommon pmctice of masturba-
tion. He may have long abandoned the practice. He
leads a continent hfe; and he finds in the literature of
our profession that more than one seminal emission
in a month is a disease^ painted too frequently in the
most ghastly manner, then I ask, Is the preparation for
suicide or an asylum not the refinement of malevolence?
How often is the physician placed hi the position of
haviug to witness the struggle wdiich the confession of
a trifling functional irregidarity, or still worse, of a con-
fessedly pernicious practice during thoughtless years,
entails. Frequently men in a position to marry, and
desirous of being so, are deterred from tlie matrimonial
alliance because of au occasional seminal emission, and
the dread of being unable to perform the marital obli-
gations, and be obliged to confess to the cause of their,
in many cases, imaginary ailment. I have kno^\ii a
case of this description where sonietimes seminal emis-

* It is to be reffTutled that a gentlenum of Dr Has&oirs reputntiun fibould
be fotm<l <|Uijliiig ruljlJsh from one or tAvo authors who biivo \vrittt:ii exlruva-
gant noijBeiiBe on thie suhject, and jj^viiig expression to sutli ,'^taLemf at^ as
that " unilt-r the tenri Bpenimtorrha*a aix? to be includetl all lossifs of the
semiiial fluid not ot^cnrring as Itie re-svilt of iutLTcounn?/' **Wh<.*u several
emij^ioiia nccitx iii quick succession on llie recovery from au ilUiesH, they ore
termesd critical /" ** The consequmcr^ of epenuatorrhtca are even more nume-
rous than the cau&ea, and among them may 1j^ enuniemted tlehility, disinclina-
tion to exertion of body or mind, lijuidily, want of memor>', confusion of
ideas, antl despondency/' These, t]iere tannot he a doubt, are occa^iomilly
due to tills cause ; Vait the height of extravagance ia reaijhe<l in the a^sei-tion^
that " phtliisif?, cerebral congestion, epilepsy, general paralvftis^ antl insanity,'*
are to l»e regardtid aa coiiftet|uences save in Hm ligiit we have endeavoured t^
explain.

ITRTNARY AND REPRODUCTTYE ORGANS.

ttt

sion took place but once in six weeks, yet the iiidi-
Aidiial at tlie age of 40 never had connection with a
female, and tlioiigh desirous of marrjing, was deterred
by the fli*ead referred to. Cases of this description
require at the hands of tlie medical man the most deli-
cate and considerate treatment. I am persuaded^ as
the result of not a little experience, that many of the
suicides anil cases of insanity now so frequent, have
their origin in quack literature, and the pnirient intel-
lectual food so lavishly supplied by the low press.

It is perfectly indisputable that certain mental aflec-
tions have a close relationsliip with sexual aberrations,
and that tliese are particulai'ly apt to occur at pul)orty.

Erotomania in the male, and satyriasis in the female,
may be regarded simply as more exalted mental con-
ditions of a normal state. It is to tl/is cause, and not
to sexual excesses, that the extravagant rhapsodies of
J. J, Kousseau are to be ascribed.""" In a word, Rous-
seau was mad- That he was so is shown by his being
the subject of other delusions, such as being persecuted
by all the world ; and the idea of associating his rav-
ings on sexual sulyects mtli an infirmity to which he
confessed, is wholly untenable.

While it is contended that, as a rule, these mental
aberrations ai-e purely psychical, we confess that peri-
pheral irritation, or disease of the central organs, may
contribute to their development, or independently occa-
sion them. Cases of erotomama ai'e recorded, in which
tumours or other affections of the cerebellum have
been discovered poi^^l-mortem. In females, on the other
hand, certain forms of recurrent mania are apt to

♦ For a refutation of L^JlemaQd's opinions regarding Rouasean, Bee Expli-
cation de k Malatlie fie J. J. Eou?s<fau, \^t le Dr L. A, Mercier. Ptu-isj 1859,

112

ON THE FUNCTIONAL DISEASES OF THE

occur during the menstrual period; and in parturient
females, the occurreuce of puerperal mania is no donbt
due to the important physical distnihances incident to
those critical periods of female life.

Excess of coitus is often followed by cephalalgia,
vertigo, hallucinations, degenerations of the cerebellum,
especially suppuration and induration.

Compression of the testicles may occasion a fatal
stupor, a circumstance taken advantage of in subduing
fierce animals. Burdach * asserts that imperfect de-
relopment of the genitals has been occasioned by
chronic dropsy of the cerebral ventricles.

Common observation has noted a relationship be-
tween a highly developed cerebclhmi and massive
neck, and sexual potentiality.

Cases of priapism are common enough from injuries
to the spinal cord. These, it is worthy of remark,
occur only when the injury is sustained near the sixth
dorsal vertebra, at which point the sacral plexus com-
bines with the cord.t That part of the cord between
this situation and the brain may be looked upon as the
inhibitory portion of the nervous system in respect of
the genito-urinary organs ; and, ejt passant, it may be
remarked that this might seem the proper situation
for blistering (the region of the sixth dorsal) in cases
of genito-urinary deljility*

On the subject of insanity, turning from these paren-
thetical remarks, we find Dr Maudsley remarking —
" The develoi>ment of puberty may lead indirectly to
insanity, by becoming the occasion of the vicious habit
of self-abuse in men ; and it is not always easy to say,
in such cases, how much of the evil is due to pube-

* Vom Bau und Leben des Gehiras, t. iii. jx 7b, t Vid. p. 86 of 1 at Ed

URINARY AND REPRODUCTIVE ORGANS.

scence, and how much to self-abuse. But the form of
mental derangement directly traceable to self-abuse (the
italics are mine) has certainly characteristic features.
There are no acute sjanptoms, the onset of the disease
being most gradual The patient becomes offensively
egotistical and impracticable; he is full of self-feeling
and self-conceit; insensible to the claims of others upon
him, and of his duties to them; interested only in hypo-
chondriacally watching his morbid sensations, and
attending to his morbid feeUngs. His mental energy
is sapped ; and though he has extravagant pretensions,
and often speaks of the gi^eat projects engendered by
his conceit, he never works systematically for any aim,
but exhibits an incredible vacillation of conduct, and
spends his days in indolent and suspicious selfbrood-
ing," and so on. In another place the same authority
remarks—'* We know that alcohol and opium do affect
the brain by their actual presence there, and through
the brain the mind, just as strychnia affects the spinal
cord and its functions; and we know also that in the
natural order of events, that continuance of perverted
function should lead to organic disease. In the case
of opium or alcohol, then, as in the case of a blow
on the head, we believe the effect to 'be physical
We are further strengthened in this conviction when
we take note of the decided effects of such a vice as
self-abuse upon the moral character, or of such a
sexual mutilation as eunuchs have undergone. Long
before self-abuse destroys the mind, it destroys moral
energy and feehng, this effect being the precursor of
the intellectual impairment which goes on to utter
dementia in the worst cases. Of the moral character
of eunuchs, all that we can briefly say is, that in most

114

ON THE FUNCTIONAL DISEASES OF THE

cases they have no moral character — ^their minds are
mutilated like their bodies; with the deprivation of
sexual feeling, they are deprived of all the mental
growth and energy which it directly or remotely in«
spires,"

While, on the one hand, it is evident that Dr Mauds-
ley has satisfied himself tliat there is a s])eri(fl form
of insanity directly traceable to self-abuse; in another
place ho observes — ** This is a form of insanity which
certainly has its special exciting cause, and its charac-
teristic features; nevertheless, I think that self-abuse
seldom, if ever, produces it without the co-operation of
the inmne neurosis.'* It seems to me that it is difiicult
to reconcile the statement that there is a form of
insanity ''dii-eetly traceable to self-abuse/' with the
allegation that it is seldom, if ever, produced '* without
the co-operation of the insane neurosis/' Is the "insane
neurosis of itself not suflScient to account for the
insanitv, and does not the fact of an abandonment to
the jiractice of self- abuse presuppose a depraved moral
and intellectual organisation?

Referring to senile dementia, Dr Crichton Browne*
remarks, regarding the morbid propensities of advanced
life, •* Just as old people are either crusty or genial, so
are senile flemciits, and, of course, the prevailing
temper of the man comes to the surface in the diseased
condition. Then morbid propensities occasionally dis-
play themselves, and of these, perversions of the sexual
appetite are most frequently met with. Old fatuous
men, m whom passion might be supposed to be dead,
contract foolish marriages*" * , , . Dr Carpenter has
been made acquainted with six cases in which an

t Brit Mec!, Jour. May 9, 1874

URINARY AND REPRODUCTIVE ORGANS. 115

extraordinary salacity developed itself at an advanced
period of life, whilst concurrently with this, or fol-
lowing upon it, there was a kind of unsteadiness of
gait, which may be held as indicating chronic disease
of the cerebellum.

Esquirol, in his work "Des Maladies Mentales,"
remarks, — "La masturbation, ce flfeau de Tespfece
humaine, est plus souvent qu'on ne pense, surtout

chez les riches La masturbation, dont nous

avons parl6 sous un autre rapport, est signal^e, dans
tons les pays, comme une des causes fr^quentes de
folic; quelque fois est le prelude de la manie de la
d^mence, et m6me de la d^mence senile; elle jette
dans la melancholic, conduit au suicide. Elle est plus
fimeste aux hommes qu'aux femmes." He also re-
marks that imbeciles and cretins specially abandon
themselves to onanism. Deslandes* notes that the
impotent and masturbator fall into a profound melan-
choly, become timid and enfeebled, manifest an indif-
ference for everything, and cherish a bitter distaste
for life.t Richerand remarks that those who have
been subjected to amputation of the penis are apt to
fall into melancholy, which eminently disposes them to
fever of a malignant character, and frequently termi-
nates in death. Some years ago, Dr Ritchie of Edin-
burgh, then resident physician in Bethnal House
Asylum, contributed a series of able articles to the
" Lancet" on this subject.

Dr Ritchie there states that in 119 cases which were
recognised, after admission into Bethnal House Asy-
lum, to be due to this melancholy cause, in only six

♦ De Fonanisme et des autrea abus ven^riens. 1835. p. 133.
t Dicton. des Sciences M^caLes, t xL p. 193.

116

ON THE FUNCTIONAL DISEASES OF THE

was, what he calls the true cause, understood prenoiis
to admission. To those more particularly interested in
this part of our subject I woukl recommend a perusal
of Dr Ritchie *s able papers. I have read them with
the care wliich they merit ; I am willing to admit the
undoubted honesty whicli they display; but I am of
opinion that Dr Ritchie has failed to prove his case.
I attacli far less importance to the statements of
Esquirol, for sexual vice of every description is in
France so prevalent that it might be made to prove
anything. Instead of showing a cause of insanity in
young men, Dr Ritchie has demonstrated mther the
frequency of the vice in question. I believe the fact
to be, that it prevails in puldic schools, and boaiding-
schools, to the extent of the relative frequency of in-
sanity.

Mr Solly, referrmg to this subject, is veiy decided.
Speaking of Dr Ritchie s papers, he remarks, — ** He
(Dr Ritchie) has called attention to a subject in which
the profession feel the deepest interest* I for one am
grateful to him for having had the courage to attack
a vice, the existence of which is ignored l>y many
schoolmasters and some medical men; nevertheless, it
is practised to a feaifnl extent. I am suiprised that
he has doul>ts whether it is also the cause of epilepsy;
I liave none,"

In taking leave of this portion of our subject, I am
not to be understood as denying the intimate relation-
ship between the genito-nriuary organs and the brain,
and the consequent inteitlepcndenco of healthy func-
tion as well as relative intluence on morbid jjrocesses.
Should aflections of the brain be called into existence
through abnormal processes occurring in the genito-

rARY AND ItEPRODUCTIVE ORGANS.

117

urinary organs, mental aberration is likely to follow,
and vice rers(t But I contend that the existence of a
special form of insanity as due to sexual excesses or to
masturbatiun, has not been proved to exist ; and I am
unshaken in my belief that where mental abenations
do occur in this conjunction, there is usually an inherit-
ance of the insane neurosis; and that the mggestion of
insanity, the morbid shame, and the enforced secrecy
imposed by sexual derangements, are strongly operative
in the disturbance of the mental balance. Psychologists
cannot, therefore, be too careful in avoiding overdra^Ti
pictures, which are no sooner called into existence,
bearing the stamp of authority, than they are made the
instruments of tortme to fill the cofiers of the char-
latan, or the gloomy wards of an asylum. By all
means let the physician co-operate with the psycho-
logist in arresting, by calling attention to the effects of
a debasing and pernicious \ice ; but it behoves him as
well to guard against the contingency of the means
employed directly defeating the objects intended**

♦ Apropos of this eubject, Dr MaiJother of Dublm, in an address ** On
American Medidne," delivered at St Vincent'a Hospital, in opening the
Besffion 1670-71 J reioarka, *' I have elsewhere contended that the e|>read of the
knowledge of the functions of the human Wly was the efficient remedy
against ijuackeiy. • . - . Quacks are largely supported by those wretched
peraona whoae diaeaeea have been deemed incurable. The quacks who are
most det€5table are those who profess to prevent and cure sexu&l diseases.
Their indecent OALlvertiHenienls have caused the minds of the young to dwell on
Ittscivicms suhjectfl, encoumged inftsturhation, and nmde hypochondriasis com-
mon. They have had muih to do with the origin and spread of such scarcely
conceivahle mixtures of hist and JunaeVi as MoiTJioniJsm.iUKl Free Love;" and
though not l»earinR intimately on the suliject under cnnyideration, I c[Uote the
following from Dr Mapother as strongly corrolxirative of the \^eW9 I have
advanced in my addresti "On the Kelations of PreBcril>er to Dispenser," and
commented on in an eilitorial article in the "Britif^h Medical Journal" for April
22p 1871 : — **The prevalence of quackeiy^ and the generally low state of the
profeMion (in America), depend greatly on the general combination of drug

118

ON THE FUNCTIONAL DISEASES OF THE

Among the consequences of preternatural sexual
indulgence phthisis has also been ranked. In 1862
Dr Smith read a paper before the IMedico-ChiiTirgical
Society, entitled " A Statistical Inquiry into the Pre-
valence of Numerous Conditions affecting the Con-
stitution in One Thousand Phthisical Persons when in
Health," Dr Smith asserts that 11 '6 per cent, of the
males liad committed sexual excesses ; 18^2 per cent,
had been addicted to masturbation, and 22 per cent,
had suffered from involuntary emissions. To this tho
objections urged aheady as to insanity apply with
equal cogency. All conditions which weaken the-
system predispose to phthisis, particularly in cases of
the tu1>ercular diathesis, and if sexual excesses de-
bilitate, as it must be confessed they do, they may to
that extent induce phthisis; there can be no closer
connection as cause and effect. Taking Dr Smith s
statistics just quoted, I believe they would apply with
equal force to the entire human race as to the one
thousand cases on which his inquiry is based. An
ingeuious winter has discovered that cler^tpmin's throat
is likewise to be ascribed to spermatorrhcea. Doubt-
less there are many men suflering from affections of
this nature, of whom it is not improbable that a con-
siderable proportion may have transgi^essed in youth,
and finding authority for recognising sore throat as a
symptom of spermatorrha^a will beheve it, as people
will believe in almost any absurdity ; and what is
physically wanting, an excited imagination is too ready
to siqiply.

selling witb the curatiTe art; and their total fiepiiration, while greatly elevating
medicine, wmikl atimukl^i the s^cientific study of pbarniaev — a i-einark et^imlly
applicable to tliese coimtriiiB."— Fw/« tlie mithor^s atitljiesa in the **Pbiiriiia-
ceutical Joumar' for 1871.

URINARY AND REPRODUCTIVE ORGANS. 119

Affections of the heart, as due to spermatorrhoea,
have as little foundation in reality. Disorders of the
heart, as of all other parts of the body, are apt to
occur in proportion as the constitutional vigour is
impaired, and only in this wise can they be said to have
any connection with genito-urinary affections.

Disturbance of the genito-urinary co-ordination of
nervous influence is intimately associated with certain
other pathological states, to which brief reference may
be made in this place. These admit of natural
division, as we have seen into those in which psychical
disturbance is the preponderating cause, and those
whose sole factor of production is of a somatic nature.
As we have above indicated, to the former class
belong nocturnal enuresis, spermatic incontinence, and
hysteria ; to the latter, reflex paralysis of the spinal
cord, epilepsy, tetanus, and some others.

Of the most interesting of the former cases are those
recorded by Dr Sayre of New York; they merit
examination in detail. Dr Sayre describes his first
patient as " a beautiful little boy of five years of age,
but exceedingly white and delicate in his appearance,
unable to walk without assistance or stand erect, his
knees being fixed about an angle of 45"*." Dr Sayre,
who was sent for to perform tenotomy on the hamstring
tendons of his little patient, soon satisfied himself
" that the deformity was due to paralysis and not con-
traction, and it was therefore necessary to restore
vitality to the partially paralysed extensor muscles,
rather than to cut the apparently contracted fiexors."
Proceeding to this by means of galvanism, this gentle-
man accidentally discovered a peculiar condition of
the penis, which is thus described: — '*The body of the

120

ON THE FUNCTIUNAL DISEASES OF THE

penis was well developed, but the glans was very small
and pointed, tightly imprisoned in the contracted fore-
skin, and in its efforts to escape, the meatus minaiius
had become so puffed out and red as in a case of
severe granular urethritis; upon touching the orifice of
the lu^etlira, he was extremely convulsed, and had a
regular orgasm. This was repeated for a number of
times, and always with the same result. The nurse
stated that this was his condition most of the time, and
that be frequently awoke in the night crying, because
his " pee pee " hmt him, and the same thing had often
occurred when riding in the stage or cai" ; the friction
of his clothes exciting his penis would cause erections."
Dr Sayre, naturally associating this abnormal condi-
tion with the paralysis, performed circumcision, which
operation he fully describes. He adds, " No untoward
sjTUptoms occurred, and in less than two weeks the
wound had entirely healed, and the penis was immensely
increased in size. The prepuce was sufficiently long
to cover the glans, and could be readily glided over it
without any in^itation whatever. *' From the day of
the operation the child began to improve in his general
health, slept quietly at night, improved in his appetite,
and, although confined to the house all the time, yet
at the end of three weeks he had recovered quite a
rosy colour in his cheeks, and was able to extend his
limbs perfectly straight while lying upon his back.
From this time on he improved most rapidly, and in
less than a fortnight he was able to walk alone with
his limbs quite straight.'' A short time afterwards this
little patient is described as quite recovered, without
the use of any other remedy whatever. If there were
but one case of this description, it might be alleged

URINARY AND REPRODUCTIVE ORGANa

121

tlaat the recovery and the performance of the operation
were simply coincident ; but Dr SajTe relates two
other cases of a similar nature- His second case is as
follows :—" Mr T. N.^ one of the first lawyers in our
city, called on me at the very time the little fellow
above described was making his farewell \isit, to speak
to me ill reference to his son, a lad of fourteen years,
that I had attended some months before for paralysis
of his legs. He stated that he was not improving, and
that he looked so badly in the morning, that he feared
he was guilty of masturbation, and was very anxious
that I should talk to him seriously upon the subject,
and point out to him its dangers. As the Httle fellow,
then running round the office, had just recovered from
a paralysis that was evidently due to genital irritation,
it occurred to me that the pai-alysis in the son of Mr
N., for which I formerly had been consulted, might
possibly be due to the same cause. He was sent to
me on the following day, and after questioning him
very closely, I found him unusually inteUigent on the
subject, strictly truthful and honest in his statements,
and perfectly free from the vice of mastmbation.
Upon examining his penis I found it unusually large
at the root and body, but very short; and the prepuce
terminating in an opening scarcely large enough to
admit a small probe. He stated that it always took
him a long time to make his water, and he could never
do so without gieat straining. His penis would become
erected several times in the night, and always with
great pain, ami this difficulty was increasing as he
grew older/* The patient was chloroformed, and, as
in the former case, circumcision wiis perfoniied on the
23d Mmch 1870, and on the 27 th April he walked a

122

ON THE FUNCTIONAL DISEASES OF THE

distance of more than a mile without fatigue, and witli
no evident signs of paralysis. A year previously, Dr
Sayre attended this boy for paralysis of his lower
extremities for about four months. In his own words,
he " apijlied galvanism and electricity twice and thi^ee
times a week, injected strj^chnine into the paralysed
muscles every tenth day, put him on iron and other
tonics, and applied India rubber muscles as assistants
to the paralysed ones during all that time, in order
that he might take exercise, and aU without any
benefit, because I had not ascertained the cause of his
paralysis. And now, at the end of six weeks, the cause
having been removed, he is entirely recovered without
any special treatment whatever." And Dr SajTC adds
in a footnote,—" Jime \hth^ 1870.— This boy has gained
nine pounds in weight since the 23d of March, is
rol>ust and ruddy cheeked, and has no symptom of
paralysis whatever."

Of Case III, the following is an outline :—*' F. G.,West
Eleventh Street, aged fifteen, a tall, slender, pale-faced
ghostly-looking boy, was scut to me for ^nervousness'
and fainting fits. He liad been under homteopathic
treatment for some montlis for neuralgia and weak-
ness of the legs, which caused him to trip easily and
fall^ in fact, he described himself as having 'falling
fits, because his legs would not hold him up.' He liad
all the appearance of a masturbator, but denied having
been one, but stated tliat he was troubled every night
with painful erections and Sequent emissions. Said it
took him a long time to make water, and sometimes
it would stop entirely, and the end of his penis ' would
swell up like an orange,' and when he squeezed it,
• a little wliite chunk would come out of the hole, and

URINARY AND REPRODUCTIVE ORGANS. 123

then the bag of water on the end of his penis would all
run out.' This swelling up on the end with what he
called ' a bag of water/ had happened quite frequently.
He had a very redundant prepuce, which could be
pulled at least an inch from the extremity of the glans
penis, was not adherent to it, and terminated in a rigid,
inelastic ring-like orifice, scarcely large enough to admit
of an ordinary knitting needle. The slightest irritation
of the extremity of his penis produced the most painful
erections, and this he stated was his condition most of
the time." As formerly, Dr Sayre circumcised with
the following result: — "It is now six weeks since the
operation, and he has not had a single fit in that time,
although he used to have one or two almost every day.
He sleeps quietly all night, has had only two nocturnal
emissions, has increased in flesh and strength, has be-
come buoyant in spirits, and in fact is, as his father
says, ' a perfectly changed boy.' "

Further, Dr Sayre relates three remarkable cases of
hip-joint disease evidently due to reflex preputial irri-
tation. " On the 7th April 1870, three cases of hip-
joint disease came to my office within a few minutes
of each other, one from Dover, N.J., one was sent
me by Dr Walser of Staten Island, and one by Dr
M'Sweeney of Grand Street, N.Y. The two latter
were little boys about seven and nine years of age,
rather delicate in appearance, and each of them in the
second stage of hip disease. After questioning in the
most careful manner, I could find no local cause for
the complaint. They had received no injury, fall, blow,
or wrench of the joint that I could get any information
about, and I was somewhat annoyed, as in the immense
majority of these cases I have always been able to trace

124

ON THE FUNCTIONAL DISEASE

the disease to some local origin, rather than to a con-
stituti^mal dyscrasia. Wliile my assistant, Dr Ynle,
was making dra^vings of them, and taking notes of
their eases, I examined the third case, the little boy
from Dover^ who was tliirteen years old, and to mj
suri>rise I found, like the other two cases, that I could
not trace the disease to any distinct recognised injury
that he had ever received. He never had any severe
fall, wrench, blow, bruise, or other injury of the joint
which the father could call to mind.

'* When examining his hips my thumb came in contact
with his penis, which became erect almost immediately,
and presented an exceedingly curious appearance. The
penis was quite large, but very short, and had a long
worm-like projecting prepuce, with an exceedingly
small orifice, which admitted a small probe for nearly
half-an-inch before the ghins was reached. Anxious to
know whether this condition of the genitals was con-
nected with any loss of muscular power in the lower
extremities similar to the case of Dr Sims, I asked
the father wliether he was active and spiy on his feet
previous to his getting lame, and he replied that he was
the clumsiest boy he ever saw, in fact he was tumbling
down all the time. That he had always to hold his
hand when lie walked in the streets, or he would be
almost sure to tumble on the curbstone at every comer.
His father said he had scolded liira about his laUing
a hundred times, as he thought ' his clumsiness was
owing to his carelessness/"

In the light of his former cases, Dr Sayre argues
that the starting-point of the local mischief might
be ascribed to a fall, owing to the muscular debility
induced reflexly, and the initial lesion becoming aggra-

TTRINABY ANT> BEPRODUCTITE ORGANS.

125

by a succession of falls. On making the dis-
covery of the preputial irritation in this case, he pro-
ceeded to examine the other two, and to his surprise
" found them almost counterparts of the one just de-
scribed, both in their history and in the appeai^ance
of their genital organs, except that the prepuce, in-
stead of having a worm Hke elongation, was unusually
short and attached to the glans, nearly to the orifice
of the urethra, which was reddened, and its mucous
membrane swelled like a granular lU'cthritis. The
least irritation would produce an almost instantaneous
erection. In these two latter cases the prepuce was
easUy torn back with the thumb and finger nails, and
the concreted smegma, which was impacted behind the
corona, carefully removed. This slight operation, to-
gether with cleanliness, and frequent moving of the
parts to prevent adhesions, answered all the purposes
of circumcision, and at once quieted the nervous iiTi-
tability,"

I offer no apology for thus giving considerable pro-
minence to the foregoing cases, I attach to them im-
mense importance, as disclosing, possibly, a frequent
source of infantile paralysis, and other numerous indi*
cations of nervous irritability in childhood, while, so far
as known to me, Dr Sayi*e's cases are unique in medical
literature.

The analogies presented by Dr Sayre's first cases,
with those of genuine epilepsy, are remarkably strik-
ing. I am persuaded that due importance is not
attached to peripheral imtation in these cases, as an
element of nervous disturbance. What may be called
sjinpathetic cases of epilepsy are frequent enough in
medical practice. How frequently is the connection

126

ON THE FUNCTIONAL DISEASES OP THE

between gastric and hepatic irritation and epilepsy un-
mistakable.

Looking at Dr Sawe's cases, and the closely analo-
gous functional al)errations of the geuito-uriuary organs,
it is not at all improbable that unsuspected irritation
of the pelvic organs may be more frequently a factor
in the production of epik^jisy than generally surmised.
It accords with my own observation that epilepsy is
more apt to occur during and shortly after the period
of puberty. Esquirol's experience has shown that mas-
turbation has caused epilepsy, and Petit records a case
of St Vitus's dance from the same cause.

This view of the pathology of epilepsy in certain
cases receives confirmation from the beneficial results
which have followed castration as a cure for epilepsy.
On one occasion, Dr Mackenzie Bacon removed both
testes fi'om a lad, believing that epileptic fits from which
lie was suffering were to a great extent kept up by
sexual excitement. Before the operation the patient
had a great number of fits, and was seldom more than
two or three days without a series of them. Dr Mac-
kenzie Bacon tabulates the number of fits patient had
after the operation. It is unnecessary to reproduce
this table; suffice it to state, that ^'the fits have been
greatly diminished in frequency by the operation^ and
the general condition of the patient has also much
improved. His intelligence has increased, he is lively
and better behaved, and able to be employed usefully.
Ho is probably now as well as his mental condition
will ever permit him to be, and I think no one can
refuse the conclusion that he has benefited by what
has been done for him."

M. Goupil records an extraordinary case of mas-

turbation in an inCutt of ogiisacfi imfxzhs cd ft^e. Az
first the parents attached no impTS&aieie' m* tie CLr*%jit-
stance, bat at two rears of age e^oepoc £is cuifr lo.
Haying recoorse to mechanical meuts tie b&xc: ^9:a$
conqnered, and at the age of ten the chiU vas in pier-
feet health.

But wherein, I would ask, d«je§ the peri:«iz2ar>ei? of
this operation differ from cIitorid£ct«:<nT in the •: f -f •:«s:e
sex ? Is satyriasis a mental disease ! Is 6f:<>rp^ in
females due to masturbation, as is \.*cheTed to be the
case in males ? To mj mind there is n«> difference in
the operation relatirelr, and if castrax^:^ in the male
is, under peculiar circumstances, justifiable, excision of
the clitoris in the female under like circumstances must
be equaUy justifiable. The conditions being parallel,
there is a parallelism in the operation. If the fact be
admitted that the proximate cause of certain fcffms of
epilepsy — the immediate cause being cerebral anapmi^ —
is peripheral irritation, and that it is irremediable by
the ordinary resources of om- art, it becomes a momen-
tous question whether it is not preferable entirely to
emasculate the unfortunate victim of epilepsy in the male
sex, rather than to allow progressive mental miseries,
leading possibly to dementia, to go on unchecked; or
in the female to remove an organ which exerts no in-
fluence over procreation; and if Mr Kroun had selected
his cases with a due regard to the indications justifying
such a procedure, the odium medicorum alone could
explain the harsh and unfeeling treatment to which he
had been subjected, and which clouded his last days.

But the operation of clitoridectomy did not originate
with Mr Baker Brown. As early at least as 1822, it
was recommended by Dubois as a remedy in cases of

128

ON THE FUNCTIONAL DISEASES OF THE

nymphomania; and it was resorted to with success by
Dr Graefe of BerHn, in that year, under the following
circumstances. Tlie patient was born in the year 1807,
and was a strong healthy child imtil the age of 14
months. At this time she was attacked with vomiting
and fever; after recovering from the acute symptoms,
she still continued weak and sickly; she could not waUc
until she was four years of age; she was unable to talk,
and, in short, exhil >ited unequivocal sjTnptons of idiocy.
All the remedies which were employed were miavail-
ing; and as she advanced in years, her imbecility and
her brutal propensities became more marked. She
deUghted in swallowing dirt and ordiu^e; and she would
stand for hours together in a fixed position with her
tongue hanging out of her mouth, from which the saliva
flowed in copious streams. She was fourteen years of
age when the physician who published this case first
aaw her* He soon perceived that the girl had an
insatiable propensity for self-pollution, which she per-
formed either by rubbing her extremities on a chair,
or by the reciprocal friction of her thighs. Since this
time there could be no doubt as to the principal object
to be aimed at in the treatment of the case. A bandage
was applied capable of preventing friction in the sitting
position, in w^hich attitude she chiefly indulged her
prurient propensities ; a straight waistcoat was put on
her at bed-time, and counter-irritation by the applica*
tion of a hot iron in the neighbourhood of the part
affected, wms resorted to. These moans, with the use
of tartar emetic, the dose of which was gradually in-
creased to a scruple, produced little effect. At the
end of about a twelvemonth the excision of the clitoris
was determined upon, and this operation was performed

URINARY AND REPRODUCTIVE ORGANS.

129

by Dr Graefe, on the 2()tli of June 1822. After the

cicatrisation of the wound, a niaiked amelioration of
the symptoms was observed. The propensity to self-
polhition was nearly eradicated; a few suspicious mo-
tions, the remains of a h^ng-con tinned habit, were
occasionally observed, but these were at length discon-
tinued. The intellectual faculties of tlie patient began
to develope themselves, and her education coidd now^
be commenced. She can at this time talk, read, reckon
accounts, execute several kinds of needle- work, and a
few easy pieces on the pianoforte.

It is a remarkable circumstance that this young girb
on emei"ging from the normal lethargy in which she had
been sunk from iuftmcy, assumed at once, without any
intervening gradations, the character and tastes of
adolescence,*

Again, Richerand relates the case of a young woman
so violently affected with this disease (nymphomania)
as to have recourse to masturbation, whicli she repeated
so frequently as to reduce herself to the last stage of
marasmus. Though sensible of the danger of her
situation, she was not possessed of self-command
enough to resist the orgastic urgency. Her parents
took her to Professor Dubois, w^ho proposed an amputa-
tion of the clitoris, which was readily assented to. Tlie
organ w^as removed by a single stroke of the bistoiu'y,
and all haemorrhage prevented by an ap]>lication of the
cautery. The wound healed easily, and the patient
obtained a radical cure of her distressing aftiiction.t

Correlation of Symptoms as arising from Sexual Ex-
cesses and Masturbation, — The question lias been much
debated by physicians, whether the effects arising from

♦ Revue M^tlicale. t No«ographie Chirur^cale.

132

ON THE FUNCTIONAL DISEASES OF THE

and let the indifference for tliat natural propensity

which youth is prompted to gratify with woman by an
irresistible imjudse, when not tamed by this detestable
vice, be also referred to,— and then let those who
choose to doubt, doubt on if they dare, that this pas-
sion can be indulged to excess without harm. For
although there may be a remaining desire fur the
enjoyment of a woman, yet there will be an incapacity
to fulfil it; for the constitution being deliihtated, and
the limbs trembling, the very wish for enjoyment mil
be disappointed, the animal spirits will be confused,
and the very doubt of success will take away the hope,
whenever the gratification is attempted. lu the natu-
ral enjoyment of a woman the calls of nature are fair;
that which is indulged is concurred in by the agree-
ment of the parts to participate in the important act.
It cannot take effect without universal conseut,^ — the
penis must be erect, and the semen secreted* lu this
instance nature limits the indulgence, and if the penis
bo not erect, the desire is considered out of season.
But this is not the case in self-pollution; the penis is,
in that instance, often worked up to aji erection, and
that which couhi not otherwise be excited is excited
beyond the limits of constitutional power, when solely
left to its natural exertion/*

Notwithstanding what has just been advanced, it is
proper to remark that the high authority of Trousseau
inclines to the opinion, that to the mere loss of semen
is to be ascribed the subsequent prostration following
seminal emission, and he bases this opinion on the
abihty of the female to engage in sexual intercourse
within a shorter intcn^al, and more frequently than
the male, while the orgasm to which her system has

URINARY AJTD REPRODUCTIVE ORGANa

133

been subjected is not less violent than that of the male.
It is likewise maintained by the same authority, that
the debility consequent on passive polhitions or unat-
tended with erotic dreams and erethism, is much
greater than when accompanied with cynic spasm. It
must be remembered, however, that the occurrence of
seminal emission in this mamicr absohitely presupposes
both an advanced debility, constitutional as well as local.
The preponderance of evil consequences as arising
from mastui'bation being admitted, the causes seem to
be the following :— Masturbation is frequently indulged
in at such an early period, that the genital organs have
not attained their complete development, the system
has not acquired its full energy^ and both the h^cal and
general powers are less able to resist preternatural
excitation. Again, masturbation is often more fre-
quently indulged in than coitus, erection is stimulated,
does not occur naturally, and doubtless the moral de-
basement is infinitely more potent than in tlie normal
indulgence. Other circumstances, such as relative
vigour, temperament, &c., combine to present a difter-
ence in the symptoms thus arising. I incline, there-
fore, to the opinion that, other things being equal, the
local and constitutional sequences attendant on exces-
sive coitus and masturbation must be analogous*

VarieMes and Causes of Spermorrhagia. — Preter-
natund excitation of a gland,'' in obedience to the law

* Supposoiis que renc^i*liftle &cnt fatigu^ pir le travail intellectnel, par Ot s
pr^(K-capatioBa incftsaantea, des paasioiis. .... (ajoutoiiB tlea ^motiona) ;
aiipjxiaonB que rinner^^ation <le la moele s'use pur les alma sexuek ; dans ^§
divcis cas, les centres c^r^bro-rncbidienfi sepuifteut d^iia leur acti'in, uu point
de siiLir nne eorte de jiaralysie ; ila i<e tronv^fnt pour uni^i dire f^piuds dos nerfs
periphorique^, qui, de« lors, Bont priv^is de leurs foyers de nutrition ; cea nerfs
ansi isoles de leurs sources &e d%radenl> winon dan^ leur texture, au moina
daus leuT fonctione. Que cettc degradation vienne k oiteiiidre les nerfa

134

ON THE FUNCTIONAL DISEASES OF TBE

of reflex action, will lead to dimiuislied nervous tone,
chronic initatton, and exaggerated secretion. This
condition is expressed in the hiw ah*eady refeiTed to,
nhi stimnlus ibi humerorum uherior adftuxus, and the
equally true and converse one, nM adjfuxus ibi irntafio.
The greater the amount of blood in a part the more is
sensation hebjhtened^ and mve versd; hence coincidently
with, or rather preceding the orgasm in both sexes, the
genital organs become highly charged mth arterial
bloikL This is due to a paralysing influence on the
sympathetic system, and a heightened motor tone,
Shoidd the excitation bo inordinately repeated sjtu-
pathetic exhaustion may become permanent; dilatation
of the minute bloodvessels of the sexual organs ensues,
there is an exaggerated amount of blood in the parts,
sensation is consequently unnaturally excited, and
preternatural secretion results. This is undoubtedly
the pathology of the abnormal hj^^era^sthesia of the
prostate, testicles, and resiruke seminales^ attendant
upon sexual excesses. But this condition does not
necessarily remain stationary; it may proceed to atony
and atrophy of the organs involved. Hence two
varieties of spermonhagia may exist, according to the
particular condition which the abnormal excitation
has induced. The first variety attended with sthenic
phenomena, hypen^stliesia, profuse secretion, and gene-
rally exaggerated functional activity; the other, with
asthenic manifestations, atrophy, depraved secretion,
and more or less sexual incapacity.

pyijipatlietiques et pneiimogrtstriiiues, toutea les gmndes fonctions de la vie
v«mt se moJifer; le cocur et le pounuin cesaenl d^agir selon le lytbme nonunl ;
la circulation ^pnmve, des stages daiii* lea glandcs vaBculaireB^ et la foniiatitin
des globuJca devient del'ecfcueuse, el.c, (G. see, Du Song et des An^mien,
186<j.)

UKTNARY ANB REPRODUCTIVE ORGANS,

In the former there exist prostatic h)T)erfesthesia, a
condition made very manifest by passing an instru-
ment, or by rectal examination, imtation of the vesi-
cukie seminales, and of the testicles^ The emissions
occur at night, and are attended with erotic sensations ;
seminal emission is sometimes followed by pain hi the
prostate, and the semen may be streaked with blood ;
and in coitus there is premature ejacidation of semen.
This is remarked sul>ject to the reserve, that occasional
premature ejaculation is not necessarily a pathological
condition, but the result of congestion of the genital
vascular system and preternatmal hypen^sthesia, as
akeady indicated.

In the second variety ^ loss of semen takes place
without venereal orgasm, is not necessarily attended
%vitli erection of the penis, takes pkace unconsciously
during sleep, during the day, and with* or without the
shghtest excitement, pliysical or mental; semen is
passed at stool, and the condition lapses into impo-
tency. Such cases, I have reason to believe, are not
so rare as I conceived on ^vTiting the first edition of this
work. Ceitain authors have drawn a distinction be-
tween pollutions and spermatoiThoea, embracing under
the first the loss of semen which is accompanied by
venereal orgasm, and under the latter all such losses as
are unaccompanied by any venereal desire whatever.
Hence Roubaud observes, that impotency does not
necessarily coexist with ''pollutions/* whilst it is an
invariable accompaniment of ''spermatorrhoea; and
that '* pollution," to constitute a pathological state, must
take place independently of vohtion and the natural
sexual excitants. But, as we have seen, pollutions in
the sense in which most authors regard the term, do

136

ON THE FUNCTIONAL DISEASES OF THE

take place in, and are compatible with perfect health,
and consequently this classification must be held as
faulty.

Mr Benjamin Phihps, in Ms papers on this subject,
relates the case of a young man whose sexual organs
were so debilitated, that on every occasion of receiving
a letter from a former mistress emissions of semen took
place, and the mental emotion occasioned by writing
to her in return had a similar effect.

A medical friend informs me that he had a patient
under his care whose sexual organs were so debihtated
that he could ejaculate semen by a mere effort of the
will Again, semen may pass away unconsciously in
the urine, and thus affect the health, I do not know
whether Dr Kmg Chambers still holds the opinion
expressed in 1861, that this may go for years without
any physical or mental impairment unless the patient's
mind is directed to the suljject. If he does so, I think
he will find himself in a very small minority of the pro-
fession, Mr Teovan, on the other hand, considers this
" tme spermatorrhos^a," and alleges that it is not usually
due to debauchery, but to indigestion (!), *'for in that
complaint the semen becomes attenuated (?), and the
bowels constipated; hence spermatozoa are pressed
out by the pow^erful contraction of the levator ani. , . .
Micx'oscopical examination alone could determine the
existence of true spermatorrhoea, and for that purpose
the lowest stratum of urine passed during or after
defecation ought to be examined." jVIi* Teevau would
have some dilliculty, I think, in pio\dng his extraordi-
nary argument.

Holding first rank among the causes of spermor-
rbagia must be classed masturbation and inordinate

URINARY AND REPRODUCTIVE ORGANS.

sexual congress. Tlie former is too often practised at a
tender age, and to an extent that is appalling, in board-
ing scliools — more particularly on the Continent — and
in ignorance of the pernicious and debasing effects of
the vice. For the prevention of this, as well as the pre-
servation of health in other respects, the teaching at
least of the elenjents of human physiology, as a branch
of a Uberal education, is imperatively demanded. The
mysteries of life, and the laws which regulate health,
cannnot be regarded as holding a position in the
mental cultivation of youth, second to a knowledge of
the obsolete and frequently debasing customs of Greece
and Rome.

" Ssevior armis,
Luxuria incubuit victumque uldsitur orbem/*

All conditions which heighten reflex excitability in

the sexual organs, conformably with w^liat has been
already advanced^ will determine augmented secretion,
and frequently lay the foundation of obstinate sper-
morrhagia. Of this nature are the following :— While
we have seen that excessive coitus or masturbation
may occasion orchitis, inflammation of the testicle may
become the cause of preternatural seminal emission.
All varieties of urethritis predispose to this condition;
in this relationship gonorrhoea is commonly met with.
La chaiidepisse tombee dans les bourses, as the common
people say in France. This inflammation may be
occasioned either by simple contiginty, or through the
medium of the nervous system. In these cases the
emission of semen is attended with pain, and is followed
by considerable malaise and feebleness. On the other
hand, I have freiiuently noticed coarctation of the
urethra supervene on masturbation, as in the following

140

ON THE FUNCTIONAL DISEASES OP THE

that of the testicles; thus as the testicles are deficient
or absent, corresponding conditions are found in the
vesicular ; while, on the other hand, in those rare cases
in which supernumerary testicles exist, the vesiculm are
said to be increased in number.

The vesicul^ siminales are also sometimes the seat
t)f hydrocele, a circumstance which should be kept in
view in the examination of the sexual system in con-
junction with its morbid states. Simulating as it does
so many other conditions requiring operative inter-
ference, it is highly expedient that hydrocele of the
visicnla3 be satisiactorily diagnosed, A most instruc-
tive case of this kind is recorded by Dr Smith of
Baltimore."** After stating that a considerable tumour
occupied the liy|>ogastric region, Dr Smith remarks—
** I was greatly surprised then when, on introducing a
long catheter faiiij into the bladder, there flowed only
an ounce of perfectly healthy urine. On placing my
hand on the tumour, I found it not in the least reduced
in size, and as I moved the catheter, I distinctly felt
the instrument gliding about in close contact Avith the
w^alls of the belly, being pressed forwards by the pyri-
form tumour. Here for a moment we were completely
at fault The tumour was not the ilistended bladder,
but was manifestly a cyst containing a fluid. It was
posterior to the bladder, and displaced that organ
forward. After another careful exploration externally,
I introduced my linger into the rectum, and found the
prostate normal ; but on carrying the finger deeply
and to the left of it, I at once encountered an elastic
tuniom", communicating the sensation of a sac tensely
distended with fluid. On palpating with the other

* Lan^€i, Oft. 1872.

URINARY AND REPRODUCTIVE 0RGAN8.

141

hand on the abdomen, the vibratory motion of the
fluid was manifest. The matter was now clear. Wo
had a hytlrocele of the left seminal venicle. We at
imce resolved on tapping thnmgli the rectnm. This I
effected with an ordinary straight trocar. On with-
(h'awiug the stylet, the Hnid issued with force, and in
a few niinntc^s wl^ drew off ten pints of a brown serons
fluid, bearing no reseml»laucc to urine. No nnpk^asant
s}Tni>toms folluwed; but in some four weeks it again
filled, and was tapped by my colleague in the case.
After this there w^as no recurrence/*

Certain affections of the prepuce, even as they react
on the spine, exercise an iuHuence on the secretion of
semen, augmenting its quantity, and from the plethora
that they cause, determining its frequent discharge.
Of this nature are pricputial irritation, intiammation
of the prepuce and gUms, erysipehis, eczeinatous and
other eru|itions, and congenital phimosis^ Urethral
discharges so occasioned are extremely obstinate, and
require for their cure the removal of the primary
affection.

In the cases of spermatic incontinence, constituting
a pathological state, wdiich have come under my notice,
I beheve I am safe in asserting that in three-fourths
of them a preternaturally tight prepuce existed, with
sebaceous accumulation in many of them. The con-
dition of the prepuce presents four varieties — 1st, A
preternatural length ; 2d, Abnormal tightness of the
pra^putial canal ; 3d, Partial or general adherence of
the {jrepuce to the glans ; 4th, Inflammation of the
balanO'pr*ceputial mucous memlnvane, with abnormal
secretion ; ijth, Abnormal relation of the orifice of the
urethra with that of the praeputial canal ; 7th, Warts

142

ON THE FUNCTIONAL DISEASES OF TWE

of the prepuce ; 8th, Pra^putml calculi. In new-bom
infanta complete occlusioa of the preputial orifice
sometimes exists.

Certain afl'ections of the rectum coincide with, and
are the occasional cause of sexual aberrations, such as
haemorrhoids, ascarides, fissure, in the same relation as
in nocturnal urinary incontinence. The irritation so
caused luis in chihlren determined the practice of
niasturlmtion» To the intimate connection, through
the medium of the nervous system, which exists
between the rectum and the urinary and sexual organs,
detailed reference has aheady been made. Strange as
it may appear to some, continence has been enumerated
by authors as one of the causes of spermorrhagia. Mr
Erichsen believes that '* spermatorrhrea may be in-
duceil by coutiniud efforts to repress the natural sexual
desires by a life of enforced or nnavoidal>Ie continence."
Civiale states that he has been consulted by patients
who, during many years having observed an absolute
continence, became affected with giave diseases of the
seminal apparatus ; ahnost all his cases, however,
coincided with the tubercular diathesis.

Speniionhagia indicates active secretion of the
semen, owing to the abnormal phlegmasia of the parts,
and it may doulttless happen that in continent persons
of an excitable tempemment ungratified sexual piU5sion
may so impress tiio imagination as to react in this
manner on the genital system. It must follow, then,
that the emtrerse will he equaUtf true, a eoncluhiou to
which wo shall in the secpiel refer. On the other
hajid, excess of continence has been alleged to be a
cause of impotency; and here a condition different
from tlie foregoing has existence. The one, however.

URINARY AND REPRODUCTIVE ORGANS.

143

maybe but a stage of the other. Further considera-
tion of this subject, under impotency, will engage our
attention.

It has been alleged that excessive smoking is an
occasional cause of spennatic incontinence. That it
may so act upon the genitals, through its influence on
the eerebelkmi, cannot be contested. It has been
stated, on the other hand, that in countries where
ergot of rye exists that the males have a remarkable
salacity, and that the females are peculiarly liable to
abortion.

Lehmann records the case of a man of thirty, to
whose arm the appUcation of a fly-blister had occa-
sioned, the following night, repeated pollutions. The
very smell of cantharides produced the same effect,
and it sufficed almost to hear it even spoken of to be
tlireatened with an invohintary ejaculation. The
genital organs of the man were healthy, but in youth
he had been addicted to excessive masturbation.

In other cases, doubtless where there preexisted
debility, trivial circinnstances have been known to
determine emission,^

The Analogies and Mela t ions of Nocturnal EmireMS
and Seminal Ineontinenee, — Looking in retrospect on
what has been advanced in the foreg*>ii)g, we find that
noctmiial enm*esis and its prototype, .spermatic incon-
tinence, have occupied our attention, as likewise
hysteria, reflex or traumatic epilepsy, and the very
interesting sulyect of reflex paralysis, as illustrated by
the important cases narrated by Dr Sayi'c of New
York, and other kindred subjects. We have seen that
in each of these diseases a disturbance of nervous co-

* Vid^ page 133.

144

ON THE FUxNCTlONAL DISEASES OF TIIE

ordination is the immediate factor in their production
—the remote being different in each. We liave Hke-
wise shown that the balance of nerve force, or equipoise,
may be disturbed from two poles — the somatic and
the psychical. And it has been made manifest that,
m the case of tlie disease which first engaged oiu*
attention, enm^esis, it is of a twofold variety, — the one
clue to invohmtary spasm of the detrusor fibres of the
bhidder, of centripetab or centrifugal origin — what
might indeed be called sthenic enm^esis. This Trous-
seau regards as an erethism of the detrusor fibres,
similar to erection of the penis ; the other, a variety of
this affection due to stmctural changes in the sphincter
vesicae, whereby any considerable accumulation of
urine is incapable of being retained in the viscus, and
w^hat might, in contra-distinction to the other, be
termed the asthenic variety. In considering the etio-
logy of the first vaiiety, its causes have been ascribed
to the presence of ascarides, stone, preputial iiTitation,
and those cases where, probably from hyperassthesia
of the bladder, or acrimony of the urine from nial-
assimilatioE, an impression is made upon the brain,
whereby the functional necessity of micturition is pre-
sented to the central organ, and in which the act may
then be considered rather voluntary than involuntary,
though occurring during sleep. It will be obvious,
therefore, tliat according to the cause diagnosed, so
will the treatment be reguhited.

Generally speaking, the enuresis is of the variety
due to lij^ierexeitation of the detrusor fibres— the
erethism of Trousseau ; and the cause Ijeing removed, the
viscus is functionally restored. But if the malady have
been of long duration, as in tlie case of seminal incon-

URINARY AND REPHODUCTn^ ORGANS.

145

tinence and the corresponding generative organs, atony
of the sphincter supervenes, a circumstance which must
Ije held in \iew in treatment. Again, temporaiy incon-
tinence of ui-ine is a manifestation of various nervous
affections, such as hysteria, hypochontlriasis, or nervous
excitement fiom whatever cause produced, even as in
excitable persons mere nervous excitation is sufficient,
ocmsiomiih/, to cause invohmtary seminal ejaculation.

In cases of hysteria, it has been attempted to explain
the incontinence of urine and profuse secretion on the
supposition that spasm of the cutaneous capillaries
takes place, and that the blood is tlms driven to the
internal organs, and more work therefore imposed upon
the kidney. This is not so. An impression, as we have
already seen, is made upon the s}Tiipatbetic, its influ-
ence is withdrawn from the minute vessels and the
heart, the blood circulates more freely, visceral conges-
tions ensue, increased secretion of ui iue, and, by the
same influence, diminished tone of the sphincter vesicw.
The diabetes insipidus of some writers is purely of this
nature, is not necessarily associated with any organic
change in the bladder, and may be regarded but as an
interesting physiological occurrence.

Turning now to the analogous aftbction — spermatic
incontinence — we have arrived, it will be remembered,
at the conclusion that, like enuresis, its disturbing
element may be either somatic or psychical We con-
fine om selves, in the meantime, to the former. Nervous
distribution to the bladder and the reproductive organs
is so intimate that it will readily be conceived that
what disturbs the one is most likely to distm'b the
other, and, while this holds good pathologically, it is
equally time hi a therapeutical point of view. Hence

14f]

ON THE FUNCTIONAL DISEASES OF THE

the observation that children who have been liable to
nocturnal enuresis are more liable than others to
seminal incontinence during adolescence, A little
reflection on the anatomical relations of the parts in
question will show how this should be. EUis regards
the prostate as '' essentially a muscular body, consisting
of circular or orbicular involuntary fibres, with one large
central hole for the passage of the urethra," The
circular muscular tiljies of the prostate are continuous
behind with the middle or detnisor fibres of the bladder.
These fibres Ellis proposes to call the orhicularis vet
sphinrter nrelhrw. Again, the external or detrusor
urinw fibres of the bladder spread out upon the surface
of the prostate gland, forming its external muscular
coat, while the longitudinal fibres of the bladder con>
etitute an internal muscular coat of the prostate. The
anatomical connection is thus most intimate. Again,
we have seen how intimate the connection of these
parts is with the brain, through the abundant distribu*
tion of the branches of the sympathetic and sacral
plexus.

Trousseau has referred to the relationship between
enuresis, epilepsy, liypochondriasis, insanity, and loco-
motor ataxy. '* Could we but penetrate/' he remarks,
''into the family secrets, we should often find that
among the predecessors of our patients there were
brothers or sisters who had had serious diseases of the

neiTous system We should thus find as an

explanation of the spermatorrhcea, as an explanation
of the nocturnal incontinence of urine, hereditary and
personal predisposing causes ; and should therefore
have no right to attribute the nervous symptoms to the
spermatorrlKea. It is far more reasonable to think

URINAKY AND BEPR0DI7CTIVE OllGANS,

147

and say that the nocturnal incontinence of urine and
the spermatorrhrca are consequences of an unliealthy
state of the encephah>n, and particuhirly of the spinal
marrow, a state the nature of whicli it is not easy to
specifJ^"

Tripier considers that seminal incontinence is allied
to a ncrvopathy of the nature of cerebral paralysis, and
that the varied aftections of the genito-urinary organs,
whieli are usually regarded as causes thereof, can be
regarded only in the light of occasional fiictors in the
production of reflex action.

It is higWy probable that in the initial part of
seminal ejaculation involuntary spasm of the prostate,
the erethism passing back through the ejacuhitory
ilucts to the ras dsferens and resirulw semimiles, takes
place. This is analogous to the erethism of the detrusor
fibres in nocturnal eniu'csis.

We have relened al>ove to that property of the law
of reflex irritation, whereby the vaso-motor nerves of
a part are influenced through the nervous centres,
causing first, temporarily, partial nervous paralysis,
congestion, and ultimately, if preternatiu*ally protracted,
inflammation, which is more likely to become chronic in
vascidar Ijodies, The emission of semen, we have
seen, is a reflex act. Irritation, beginning at the glans
penis, is transmitted through the spinal cord and brain
to the prostate, vesiculas seminales, vas deferens, and
the testicle. In the nonnal condition of the paits a
certain interval elapses before reflex action is estab-
lished, but given a certain amount of irritation in any
of the organs mentioned, and in a direct ratio is reflex
action anticipated, for the gi^cater the amount of blood
in a part, so is its speeial sensibility heightened, and

148

ON THfi FUNCTIONAL DISEASES OF THE

mce "cersd, and with more faciKty is reflex action
iuduced. Of this we shall have more to say in the
sequel Abuse of the genital functions will^ in obedi-
ence to the law of reflex excitation, give rise to irrita-
tion, the result of a sub-acute or chi-onic inflammation
in the organs thus preternaturally excited ; hence, in
the vast majority of instances of spermatic incontinence,
there exists chronic phlegmasia of one or more of the
genital organs.

Diaffnosis.~The diagnosis of nocturnal enm*esis will
present no difficulty ; it is otherwise in those cases in
which spennatic incontinence really occurs to such
a degree as to constitute a pathological state. The
characteristic manifestations of this condition resolve
themselves into such as are constitutional and those
of a local nature. Prominent in the former rank are
the several mental aberrations; hypochondriasis, failure
of memory, defective vision^ taking the form of ambly-
opia or diplopia, perversion of the sense of hearing,
emiui, insomnia, general enfeeblement, derangements
uf the digestive functions, and local nervous disorders
of the spine, cerebellum, &c. It must be borne in mind,
however, that in many cases the nervous symptoms are
due to groundless fears and reproaches of conscience.
Of the local symptoms, indications of locahsed or
general phlegmasia of the genital system exist; pro-
static irritation, orchitic hypersesthesia, irritation of
the vesicuhe seminales; of these the most frequent
manifestations are, in addition to the subjective symp-
toms, frequent seminal emission, nocturnal or diurnal,
according to the gravity of the case> and correspond-
ingly attended with more or less sexual erethism ; pre-

4
4

URINAKy AND REPRODUCTIVE ORGANS.

149

cipitMe ejaculation and subsequent dull pain are more
pathognomonic of chronic irritation of the vesiculae.
The testicles and penis are in some cases diminished
in size. With regai'd to the seminal fluid itself, it is
thin and watery, and contains few or no spermatozoa.
When it does contain spermatozoa, they are diminished
in size and vigour ; sometimes they are dead, or they
assume a spherical form. The urine may contain semen,
passed either with the first drops of the urine, or more
frequently coincidently with the contractions of the peri-
neal muscles which expel the last drops of the urine; and
finally, semen may imquestionably be passed at stool,
either when the bowels are confined, or perfectly lax.

Froffnosis\~^\e prognosis in cases of nocturnal
enuresis is decidedly favourable. In like manner it is
favourable in the majority of cases of seminal incoU'
tinence. ^lucli will olniously depend on the extent
to which, and the period at which the sexual organs
have been subjected to undue excitation, and the stage
at which patients come under treatment. I have seen
cases, however, in which the most varied treatment
was attended with httle benefit Of these, I was spe-
cially and ginevously disappointed in the case of a
gentleman of whom I have lost sight. lie was twice
cauterised, and with but very temporary if any benefit.
He himself describes his case as being a '^ sufferer from
spermatorrhoea for the last thirteen years — was initi-
ated into the habit of self-abuse by a school companion
-^-and continued till nocturnal emissions came on,
which were very frequent at first, every second or third
night for aliout six weeks." His appearance, he states,
was miserable; there was great emaciation, with loss

150 ON TOE FUNCTIONAL DISEASES OF THE

of strength, and also great aversion to society. He
seemed to me preniatiirely aged looking, had a peculiar
salltjw appearance, and suflered from loss of memory,
and other mental perversions. I liave no doubt what-
ever that the cause of his condition was sexual, and I
regretted and was disappointed at the little benefit
which resulted from treatment, when he passed beyond
my observation. Such cases, however, are rare, but
there can be no reasonable doubt of their occasional
existence.

Treatment — Tlie rational treatment of all diseases
must Ije based on a correct appreciation of their etio-
logy, and an intelligent and well-founded knowledge of
the properties of the remedial agents or accessory means
employed for their cure. With regard to enuresis,
the error loci may be either of two conditions, — an
erethism of the detrusor fibres, of peripheral or central
origin, or an atonic state of the ^pfiincter msicm. It
will be obvious that^ according to the diagnosis, treat-
ment, to be deemed rational, must be based on the
particular necessity. The pelvic visceroe, as we have
seen, are supplied by nerves from the sympathetic and
cerebro-spinal system. It is the function of the former
to communicate and appreciate, so to speak, the special
sensilnlil^ of the given parts to which it is furnished.
All oi'ganic movements are independent of the will,
and have consequently an independent nerve or nerves
of sensation, while tho ordinary nenx\s of sensation
subserve the purposes of volition. It has l>ccn satis-
fectorily demonstrated that a certain chiss of remedial
agents^' act by influencing the cliemieal changes which

♦ Vid€ Author's paiupUet " On Tbertiiientic« ajul Ditn^nse/' CburclxUl.

URINARY AND REPRODUCTIVE ORGANS.

151

occur in the body^ and that another class seem to act
primarily by causing certain impressions on particular
portions of the nervous system. Hence a rational
and intelligent classification and selection of remedies
can be made* We are at present concerned, espe-
cially, with an abnoiTiial condition of spinal reflex-
excitability. On this subject, Meiidiinzen's* experi-
ments are pecuUarly instinctive. Operating on ani-
mals — chiefly frogs- — the disturbing iuflnence of the
brain being removed by section of the cord below the
medulla oblongata, he arrived at the following con-
clusions. The test of the degree of excitability of the
spinal cord was in most instances very dilute (I per
cent.),^sulphuric acid, which was applied to the sur-
face of the skin at intervals of a quarter of an hour,
and the time before contraction occurred noted. Mein-
hinzen found that bromide of potassium rapidly de-
pressed the excitabUity of the cord, and ultimately
entirely abolished it; and he gives experiments to show
that this action is due not to any effect on the peri-
jjhery^ or on the nerre eords^ but oit the sjnnal cord itselj.
The salts of zinc he found to have a simUar action.
He considers the acetate might be regarded as a nar-
cotic. Chloral hydrate lowers the reflex-excitability,
and its action is also central Experiments with strych-
nine brought out the curious fact, that whilst the nerves
and muscles become highly sensitive to mechanical irri-
tation, there is no mateiial increase upon the appUca-
tion of chemical stimuli. Quinine, even in moderate
doses, rapidly dtniinishes, and ultimately extinguishes,
the reflex-activity of the cord ; but this action is appa-
rently not direct, but in great measure indirect, through

*^ Pflijger'H ArcMv. (Baiid. vii- HefL 4 and 6.)

152

ON THE FUNCTIONAL DISEASES OF THE

disturbance of the circulation and arrest of the heart's
action. Alcohol (10 per cent.) first, and for a long
time, greatly lowered, and tlien exalted the irritability
of the spinal cord. Caft'ein lowered it (^ c. e* of 10
per cent.), almost entu*ely abolishing it in four hours.
Morphia first depressed, then exalted, and finally abo-
lished the excitabihty of the cord. Digitalis has no
influence on the spinal cord as a centre, but it acts as
a depressant upon it, tlirough its action on the vaso-
motor system.

How far do these obsen-ations harmonise with em-
pirical success? The enuresis of children is, generally
speaking, of the variety in which erethism of the de-
trussor fibres is the immediate cause. Local sources
of irritation being first removed, the bad habit, so to
speak, on the part of the bladder may still remain, and
for the cure of this condition chloral hydrate has been
eminently successful, the modus medeudi being made
manifest by the experiments above detailed. Kot
second in efficacy to chloral hydrate, if not superior to
it in the variety of enuresis under consideration, is
belladonna, or its active principle atropia. Recurring
to the toxic effects of belladonna, w^o find that it causes
dryness of the fauces, of the tonguei extending to the
phaiynx and larynx, huskiness of the voice, difficulty
of deglutition, thirst, drpiess of the lips and sometimes
of the nose and eyes, dilatation of the pupils, and occa-
sionally an erythematous eruption. Grouping these
sjonptoms together, in conjunction with what we know
of the influence of the sympathetic over the minute
blood-vessels, is it not obvious that here we have a
stimulation of the fibres of Remak ? now we have pos*
tulated above that the sensibility of a part is m a direct

URINARY AND REPRODUCTIVE ORGANS.

153

ratio to the amoimt of blood which it contains; if this
be so, and the fact is indisputable, that belladonna and
atropia act as sedatires by sthmilating the fibres of
Rcmak, aiid thus diminuhing the nmount of blood in
the part so wfluenced. Camphor and hyocyamns
have probably a like influence, but not opium, which
is so frequently given in these cases, as it acts, after
its stimulating influence has subsided, rather by para-
lysing the fibres of Kemak, and consequently increas-
ing the heat of the body.

In the opposite variety of enuresis, where atony of
the sphincter has supervened on long-continued hyper-
festhesia, it will be obvious that a directly opposite line
of treatment is demanded. In these eases, prepai^-
tions of strychnine, nux- vomica, ergot of rye (of which
the watery extract may be beneficiaUy combined with
nux-vomica), are indicated. We are in possession, in
my opinion, of few agents which possess a more power-
fully specific influence over the pelvic viscera as a tonic
than the tincture of the muriate of iron judiciously
administered, and I am under the conviction that the
formula of the Edinburgh Phannacopccia* is preferable
to tliat at present followed. The rationale of its influ-
ence seems to be thus* The withtlrawal of blood, by
diminishing to a corresponding extent the amount of
red corpuscles, lowers the innervation of the nervous
centres. Supposing a drain made upon the system by
any chronic discharge, the blood becomes, in popular
phraseologj, 'Hhin;" i.^., deficient in iron, and there
is, consequently, diminished nervous power, a fact indi-
cated by the dropsies attendant on leucocythaemic

• That of the Brit. Phar. decomposes readily owing to tlie nitric acid
employtyl in its preparation, oxide of iron being precipitated.

[54

ON THE FUNCTIONAL DISEASES OF THE

conditions. Iron fm nisbes, or stimulates the formation
of refl corpuscles, and acts correspondingly as a nervous
stimulant. Pressure by means of bougies fixed in the
urethra, and other mechanical means, for the cure of
enm^esis, though anciently held in high esteem, are now,
as a rule, properly discarded. What may be termed
the moral treatment of enuresis is not to be overlooked.
The tendency to spasmodic contraction of tho bladder
is to be obviated by desiring the patient to resist as
much as possible the urgency of mictuiition, whereby
the spasmodic action may be corrected by moderate
distension. Water should be passed before going to
bed, and if necessary the patient should be wakened
during the night and compelled to pass water volun-
tarily. Much benefit \vill be derived from cold- bathing,
general or local. Galvanism is occasionally used with
signal benefit.

In some cases, especially in the adult, enuresis may
be occasioned by cataixb of the bladder, independently
of the presence of stone, as from the extension of
gonorrhceal inflammation by continuity, or the forcible
introduction of too strong injections into the bladder,
as likewise from prostatitis from the incautious use of
instruments. In cases of catarrh of the bladder, great
benefit is to be derived from tho careful washing of the
bladder"*^ with tepid water simply, or ui conjunction
with small quantities of the permanganate of potash, a
weak solution of tho bichloride of mercur}% or chlorate
of potash, &c. Both the permanganate and the bichlo-
ride smart very severely, and the precaution to use
them sufficiently diluted is a very necessary one. Seda-

♦ An elegftut iimtniment fi>r tMa puipoae U supplied by Maw^ Sun, ^
Tljuinpeon, of LontluiL

mUNAUY AND REPRODUCTIVE ORGANS.

155

tives may in certain cases be beneficially combined,
tbougli it is a mistake to believe tbat any quantity of
a powerful narcotic may be introduced into the bladder,
relying upon its non-absorptive power. And this brings
us to a subject which possesses sufficient interest to
merit somewhat detailed examination. I have cer-
tainly seen the coustitutional effects of mercury thus
induced; and as my case, on its publication in *' The
British Medical Journal/' excited a good deal of inte-
rest, it may not be out of place to reproduce it here,
with some other matters which appeared in the same
journal relative thereto. I quote it as it occurs in vol
i. of " The British Medical Journal " for 1869:—

In one of the lectiu^es recently dehvered and pub-
lished by Sir Henry Thompson, '* On affections of the
urinary oi'gans/' the following passage occurs:— ** In
cncumstances of gi'eat pain you may inject anodynes
into the bladder if you please, but they are of little
value. And you need not be afraid of the quantity,
for the mucous membrane of the bladder appears to
have no absorbing power, unlike the neighbouring
tissues which lino the rectum,"

The fullowing case, which has just occurred in my
practice, so thoroughly substantiates the fallaciousness
of this doctrine, that I am induced to place it on
record :—

M. M. C, a female, had been under my care for a
short time in consequence of chronic cystitis. Having
employed the usual constitutional treatment in the first
place, but with no very decided benefit, I adopted the
topical treatment recommended so strongly by the dis-
tinguished surgeon referred to, injecting acetate of
lead and nitrate of silver after hia method. My

156

ON THE FUNCTIONAL DISEASES OF TDE

expectations not l>eing realised, at least so promptly
as I aiiticipatetl, I resolved upon injecting a weak
solution of the bichloride of mercury, from which I
have olitained the best results in other chronic inflam-
matory affections. Accordingly, I injected, on January
27th, about three ounces of a solution containing * as
I firmly lielieve^ little more than a quarter of a gmin of
the bichloride. The patient then left my house, being
desired to retain the solution in the bladder as long as
possible. I was requested to visit her on the succeed-
ing day, when, to my annoyance, she com])lained
bitterly of the pain the last injection had occasioned
her. It was not retnimd in ike biadder/or over twentp
minutes. She stated that she had a most unpleasant
taste in her mouth, *' wersh," as she termed it, or, in
more familiar terms, a brassy taste: thatt her gums
were painful; and on examination, there was at least
evident tenderness, and for two or three days after-
wards she passed very little water, and then with very
consideral)Ie pain. I need not say the statement of
the subjective symptoms w^as voluntarily tendered, and
that the patient had not the remotest idea that the
symptoms complained of were due to the treatment
employed. The internal administratiou of anodjues
relieved the i)ain, and I am hopeful that, notwithstand-
ing the disagreeable consequences, improvement will
ensue. With such a case as this in view, indicating as
it does the great absorptive powa^r of the bladder, I
would be exceedingly chaiy of indiscriminately inject-

* I am now somewhat sospidotLB that, as the result of on acdcknt, the
quintity of the hichloride was greater than above m^iiitioned^

f The views here ejcpt^eeaed have been T«cenilj confirmed by the reaearchea
of M. E. Aning.

URINARY AND REPRODUCTIVE ORGANS.

157

ing anodynes into this organ. From this circumstance
it will be obvious certain raedicO'legal questions might
arise, and it is desirable that until Sir Henry Thomp-
son s views are more conclusively estabhshed in respect
to anodynes, his statements at all events should be
received with reservation.

Such is my case as published in " The British Medi-
cal Journal," and the only comment I have now to
make upon it is, that behoving the solution to have
been stronger than I then imagined, I must modify my
belief as to the great ahmrptwe power of this viscus, to
one that it has absolutely absorptive power.

A cun'espondent of the same jcjui-nal, with reference
to the above case, communicated the following inter-
esting note: —

*'That the bladder is able, under special eircum-
stances» to absorb the water from the urine contained
in it I have no doubt, from an observation made in
my own person. Some years ago I started for a walk
of many miles along the sea-coast, and when near my
destination I was about to pass urine, when I dis-
covered to my consternation that my progress further
was arrested by the jutting rocks. My attention was
immediately diverted to my novel position, and for
some time I was engaged in various schemes for my
extrication. As none were feasible, I was forced to
remain an exile on the shore until the morrow allowed
me to retrace my steps. It was near midnight when I
suddenly recollected that I had been arrested almost
in the act of micturition, and I thereupon emptied my
l>ladder, but it was more from the idea of fulfilling a
forgotten engagement than from necessity* My sur-
prise was then great when I remarked that the quantity

ON THE FUNCTIONAL DISEASES OF THE

of urine was small; as I was sure^ from my own feelings,
that the bladder had some hours before been full. The
physiological ftict of the absoqjtion of the urine, or at
least of its aqueous portion, forced itself upon my con-
viction, and I have not the slightest doubt that this did
take place, I should state that, having no food, my
hunger was gi'eat and my thirst painfully distressing.
Now, if the sense of tliirst be due to the want of water
in the system, its requirements were considerable in
my case. Of comse I cannot prove to a demonstration
what amount of urine my bladder held at three o'clock,
and what amount at eleven, but I know that the
quantity was small at the latter time, and at the foi'mcr
my desire to micturate was as usual, after having had
no rehef since the early morning. I believe also, that
I was the subject of another interesting physiological
experiment — ^that my thirst was subsequently much
alleviated by absorption of water from my wet clothes."

This seems conclusive proof of the absorption of the
watery portion of the urine even by a healthy bladder.

In the ^'Gazette do HOpitaux '* of March 7, 18G8,
M. Seglas admits the absorptive power of the l>ladder,
as proved by experiments on animals ; M* Demarquay,
as finding it very feeble; and MM. Buss and Susini,
on the other hand, as denying it altogether, from
experiments on healthy men.

Apropos of the controversy in " The British Medical
Journal/' the editor observes,^" A good deal of interest
has been excited on the question of vesical absorption
as a physiological phenomenon and therapeutical means,
l>y the notes on the subject which have recently ap-
pearetl in ** The British Medical Journal" On Wednes-
day Sir Henry Thompson read Dr Black's recent note

URINARY AND KEPRODUCTIVE ORGANS.

159

in the Journal to liis class, io which ho (Dr Black) calls
in question the accuracy of his previous statement in
puljlic lectui'es, that there is practically no power of
absorption resident in the hving membrane of the
bladder. To Uhistrate the fact, Sir Henry injected
half a fluid ounce of liquor opii into the bladder of a
patient. An hour afterwards there was not the least
sign of narcotism,"

Dr Braxton Hicks contributed his views on the
question at issue, at the same time, in the following
manner: — "That absorption into the system of mate-
rials injected into the bladder does take place, was well
seen in a case reported in my lectures on the subject,
in * The Lancet/ where eight grains of morphia were
injected by mistake at one time, with marked symp-
toms belonging to the drug, but wondei'fully out of
proportion to the quantity employed. But this does
not in any Avay militate against the use of injections
into the bladder, because these are intended to be
applied diiectly to the mucous membrane to restore
its functions. In cases of over-sensitiveness, or of
abrasion, &c., then the effect of morphia injections is
well marked; but the quantity of the fluid should be
small, and the dose of morphia not less than one grain.
If more than an ounce of the solution be employed,
the uritable bladder shortly expels it, and its effect is
lost," &c.

My view of the matter received fm ther corroboration
from Dr Tilt, who wrote as follows: — *^The result of
Sir Hemy Thompson's experiments on vesical absorp-
tion are so unexpected, that it would be desirable to
know whether the liquor opii was injected mto a healthy
or a diseased bladder "^a difference which I previously

160

ON THE FUNCTIONAL DISEASES OF THE

suggest Gil IB a brief reference to Sir Henry's experi-
ment ill the following manner; — *^ What I contend for
is, that my case clearlif illustrated the absorption by a
diseased bladder of a mineral solution. In the case on
which Sir Henry Thompsun experimenteii, notliing
being saifl to the coiitraiy, I snppose the bladder was
one in a healthy condition. To reccmcile the diHerencea
of opinion on this very interesting solyeet, I think it
very probable that the absorption may be determined
by certain pathological conditions, such as abrasion^
c&c. It is clearly manifest that the 1 (ladder does or
does not absorb ; and the observation and experience
(jf such men as Dr Hicks cannot be questioned no far
as accuracy is concerned, and cannot be reconciled save
on some such assumi>tion as I have made,"

Not only does the J)ladder absorb, under special
circumstances, some of its contained water, Ijut acconl-
ing to Kaupp, some of the solids also j after the water,
in order, come the phosphates, the chlorides, the siil-
idiates, and, finally, the uiea*

I am convinced, Sir Henry Thompson's opinion not-
withstanding, that the bladder does absorb, and that
tlie degree of absorption may be influenced on the one
hand by the condition of the viscus itself, and on the
other by the nature of the fluid so injected. I am per-
suaded that the injection of anodynes into the bladder
is beneficial, while I maintain that their injudicious or
reckless enii>loyment in diseased conditions of the organ
is not without risk, and that it is not necessary that they
should be absorbed in order to act as local sedatives.

We Imve hazarded, as may be remembered, the belief
that in certain cases of enuresis, so dehcate is the adjust-
ment between the two sets of muscles, that imtatiim of

URINARY AND REPRODUCTIVE ORGANS. 161

the detrusor set is apt to be followed by atony of the
sphincter, and we have referred to the efficacy of the
tincture of steel in these cases; in addition, the employ-
mentof the constant galvanic current — though it is more
applicable to cases of paralysis of the viscus generally,
occasioning retention — may be enjoined; as likewise
blistering to the sacrum and perineum, or to the region
of the sixth dorsal, for reasons to which we have
referred above. Small doses of tincture of cantha-
rides, failing other remedies, may be tried, with the
prospect of benefit.

According to Goelicke, in a dissertation de Trichosis,
published in Frankfort in 1724, there is a species of
incontinence of urine due to the growth of hair in the
bladder; the same species is described by Scultetus
xmder the head Trichiasis. Sir Hans Sloane likewise
mentions several instances of this nature, — one that of
a-brewer who voided long hairs from the urethra, with-
out the attachment of little or any calculous matter. In
vol. xii. of the "Philos. Trans." Mr PoweU relates a
similar case in a lady. In several of these cases it has
been surmised that the hairs grew from calculi in the
bladder, from the fact that resistance had been offered
to their extraction in cases where they suspended from
the urethra. These, cases, it need not be observed, are
extremely rare, but the possibility of their occurrence
should be known, as when least anticipated the curio-
sities of medical or surgical practice not unfrequently
turn up. Should the presence of any such source of
irritation be suspected, frequent washing of the bladder,
possibly with some antiseptic preparation, will yield the
best results.

With respect to diet, it may be laid down as a general

162

ON THE FUNCTIONAL DISEASES OF THE

rule that any diet calculated to siircharge the urine
with solid matter, irritate the kidney, or stimulate it to
preternatinal secretion, should be avoided. Conse-
quently the diet should be plain, solid, and nutritious,
nuxking up in quahty what is wanting in ciuantity, duo
care being taken that a tendency to an excessive forma-
tion of oxaHc or uric acid be prevente<l by the judicious
blending of vegetable with the animal portions of the
food. Ardent spii'its are, in my experience, injuriouSp
as likewise malt liquors, and for the obvious rcasou
that their contained aicoliol paralyses the sympathetic
centres, causes visceml congestion, and diuresis.

That species of incontinence which is associated
with affections of the sjiinal cord, and which is more
frequently seen in patients who have resided in tropical
climates, is less amenable to treatment, and must be
treated according to the indications of the existing
case in hand.

As in the case of enuresis the pathological conditions
existing in cases of real spermatic incontinence, dif-
ferentiate themselves into phlegmasia, with its attend-
ant hyi)era^sthesia on the one hand, and relaxation from
nervous exhaustion, chietly motor, with or without
atrophy, on the other.

Having satisfied ourselves in the cases under con-
sideration, that spermatic incontinence actually occurs
to such an extent as to constitute a pathological state,
we naturally proceed to investigate its cause. It will
be the chity of the physician to inquire into the habits
of his patient. Sliould the practice of masturbation be
indulged in, it will be obviously futile to resort to
remedial measures until it be discontinued, and this it
need scarcely be remarked lies with the patient him-

URINARY AND REPRODUCTIVE ORGANS. 163

self. It is a mistake to suppose that this pernicious
practice is confined to youth; as men at the middle
periods of life have confessed to me an unfortunate
propensity to its indulgence, particularly under the
influence of drink. In cases in which an almost irre-
sistible propensity to it occurs, the penis must be freely
blistered, so that the habit may be broken off; and
moral means must necessarily be conjoined with the
surgical treatment.

But if the exciting cause have been abandoned, and
the emissions still persist to an injurious extent, an ex-
amination of the urethra should be instituted. For this
purpose a catheter or bougie is passed, when in the
large majority of cases, intense prostatic hypersesthesia
is found to exist. In the remaining proportion of cases
the irritation is not so acute; or little or no pain is felt,
and we infer the existence of some other cause, or that
a relaxed condition of the prostate has supervened
upon the long continued irritation. This is peculiarly
characteristic of chronic, and more aggravated cases,
and is most likely to be accompanied with diurnal
pollutions. These conditions satisfactorily proved to
exist, the indications of treatment are obvious, viz., to
allay irritation, and restore their pristine tone to the
affected parts. In the cases of extreme prostatic irri-
tation, there unquestionably exists the condition we
denominate inflammatory. There is more or less con-
gestion of the prostate, probably effusion of fibrine in
the gland and consequent enlargement; and ample ex-
perience has shown that the physiological eflTect we call
into operation by the process of blistering, is the most
efficacious for the removal of such states ; and it is also
admitted that blistering is more efficacious applied to,

164

ON THB FUNCTIONAL DISEASES OF THE

than remotely from the affected part. But the prostate ^
is beyond the reach of blistering in the ordinary H
acceptation of the term, and we consequently resort to "
the introduction of a convenient agent into the urethra
for this purpose. Reasoning from anah>gy, it was in-
ferred from the beneficial effect of nitrate of silver in
chronic conjuncti^dtis, that it might with equal benefit
be employed in Hke conditions of the prostate, and
hence its general adoption for this puipose. Its intro-
duction is due to Lallemand, and confessedly not a ^
little diversity of opinion still exists as to its efficacyi or H
propriety as thus employed. Like every other novelty, "
it is undoubted that cauterisation of the prostate has
been pushed by its advocates to a mischievous extent.
That its injudicious and reckless emplojTiient has fre-
ciuently laid the foundation of stricture of the ui'etln^,
has been incontestably shown by Mr Courtenay and
others. But it does not follow, granting even these
consequences, that in certain cases its judicious em-
ployment is not to be enjoined. This question must
therefore be left to the judgment of the medical atten*
dant.

The following case in point may be quoted. So long
ago as October 1837,* Mr James Douglas, lecturer on

♦ As I am not aware that the ptiper of iJii.^ accompliflbed eurgeon was ever i
piinted^ it niay he iritereBtiiig to proBeiit an outline of it in tliis place, taken 1
from Mr Douglas's monnecript The paper is enlitle*!^ "On SpenaatoirbcBft i
or Involuntary Seminal Einiesions, by James Douglas, A.M.^ Mem^>er of the
Faculty of Phyaiciaiisi and SargeonB of GIflHgcjw, and Lecturer on Auatoujy/*
and bears date 1837. Mr Douglas begins his subject, just as the erile mmpant j
in oui* midst comfH?! one to refer to the subject at present.

"The subject of profuse »eniinal evaeuatious, is one which liaa too little
occujned the attention of me»<iical practitionera, partly from a false delicacy^
deterring them from its investigation, and partly from a fear of identifying ]
themselves with those ahanieless qiiack% whoM puffs diaflgure bo disgracefuUy
so many columns of *jur fidvprti^injj papers. That there is mich a disease the

UKINARY AND BEPIIODUCTIVE OHOANS.

165

^
P

anatomy in the Portland School of Medicine, Glasgow,
read a paper before the Glasgow Medical Society, on
spermatoiTh<x'a, giving an account of Lalleniand's
opuiions, and the history of a case which occurred to
himself. The patient, who was a medical man, was so
impressed with tlie truth of M. Lallemand's doctrine,

existeiice of tlie.'it; ([uack lucubralious aiifliciently proves ; jiintl that Ui« un-
happy 8uifer<;frs are ton often tempted to seek from their authora thiit relief
wkich hau not been obt4iine<l elsewhere, is «utViciently evitlent from their exten-
sive circiLlatiun, and the uIVeiLsivc way in which they are couMtantly ohtrutled
upon the pQl>lie eye. AV'hy then ahonJd the regukr surgeon or physician
hesilute to make himseiJ' acf|iMinted with the symptoms, causes, and pathology
of thid diaeatve, and give hh patients the benefit of rational treatment founded
upon this knowledge, inateml of aliandoning them to the misdirected efi'ort-a of
unprinciple<] empirics I

*' It has iK'en long well-known that indulgence in venereal exceaeeH produce*
direct debility, both from the actual aliatfaction of the seminal fluid, and trom
the nervous exhjiustion foOowitjg the excitement of ejiiculation. It has wXso
lieeii known that \\ hen endBsiona have been excited by matiturbation, the
effects have been much more serious, partly from the lUiiiatural way in which
the excitement ha« been applied^ and partly from the age of tlie sulvjecta who
have been addicted to it, enabling them less easily to bear the ahock pro-
duced upon the neiToua system. It has been long known too that Buch
habitual irritation of the genital system has caused tn>i*iitaneuus erections and
emissiona during nleep, which tended much to the weakemng of the unfortu-
nate subject ; but only lately has attention beeii called to the fact, that it may
induce frec|uent evticualioui* of semen along with the urine, or when at stool
to such an extent aa to <leitroy completely^ oaid even to conipromii*e the life.
Slight hints of the nature of this lUsejiae are to be found in the w ritinga of
Hippocrates and of several other practitioners in later periods, under the name
of Tabea Doraalis, but tlie absurd notion of a wasting of the spinid marrow
letl to an erroneous mode of treatment, and rendered the emotive ef ecta
ineifectuaL

*' Wicknian, a German, published a sfmall tract about twenty yeara ago>
which attracted scarcely any notice, and it \m\» left for the celebrated Lal3e-
luand of MontpelLier to investigate ita nalure with accuracy, and to jdan its
cure with success.

** About eighteen months ago, I obacrved in the * Revue Medicale * a notice
of LaHemand'shook, 'Dea Pertes Seminales Involuntaircs/ then just published,
and was struck with a description of a malady of which I had never heard
before. I recommended the work for the Faculty Library. I very soon luul
occasiou to discover tlie symptoms of the disease in a very intimate friend, a
me<licai man, whose case I watched for some months, and wbo this summer

166

ON THE FUNCTIONAL DISEASES OP THE

that he visited Montpellier, and was operated on by
Lallemaud himself. By this operation he Wiis gi'eatly
benefited, the discharge from wliich he suffered having
become much less fi equcnt. He persuaded Mr Douglas
some months afterwards to repeat the operation, which
he did, when renewed improvomeut ensued, although

visited Montpellier, and was treated by the ProfesBor himself,

The essential of the epenualorrhcBa then is, the evacnaticm of the fleminal
fluid fret|uently, involuntarily, and even nnconsciously, without erection or
pleasurable feeling; the v&sicuiw sevimates acting in concert with the bladder
on the one hand, and the rectimi on the other. The proxiniate cause of their
contraction may be actual inflammation or ulceration of the oriticea of the
iHWrt d^ferentiaf inftanimation, or an irritable state of the mucous membrane
of the prostatic portion of the uielhra^ or neck of the bladder, or a similar
state of the mucous membrane of the rectum, aided by the direct pressure of
hardened feeces. The more remote causes are more varie^L Thus the urethral
irritation may depend on venereal excesBeSj masturbation, repeated gonorrhasus,
and stricture, and in most cases the history of the patient leads back to some
of these, occasionally of pretty ancient date. Sometimes it may depend on
sudden and severe exposure to cold, and sometimes on the co-existence or
retrocession of cutaneous diseases The irritation of the rectum again jir^v
ducing violent contractions which are readily connuunicated to the vesiculfo
lying in front of the gut, may depend on constipation, hajuiorrhoids, mecha-
nical obetructio)!, or eveu on the presence of asca rides,

" The symptoms which reaUj constitute the disease are frei|uently unob-
ftcrvod by the patient ; and the me^iical man is consulted on account of symp-
toms denoting indigestion, derangenicBt of the liver, hyi>oehondriaais, or even
serious Bdfectioirs of the brain. This last simulation appears to be the most
common, and indeed Ltillemand declares that must of the patients in whom
he recognised diurnal pollutions were reconiniended to him for advice on
supposed cerebral diseases, on account of the celebrity he Iiad obtainetl by
the publication of his work, ' On the Pathology of the Brain and its De»
pendencies.'

** The patient generally appears exceedingly feeble and emaciated, his skin
dry, wi'inkled, and dirty-looking, his colour gone. Km eyes dull, simken, and
surrounded by a dark areola, while his manner and address imply great anxiety*
He complainri, prolirtldy, of derangement of the stomach and Imwels^ ituibility
to take strong food or drink, habitual ronstipation, and distension of the
Ixiwelft with flatus. He informs you that coitus has become impossible with
him, erections being very rare and imperfect, and the semen being almost im-
nie^liat4*ly expellecL His mind broods constantly over his malatly, he 1»ecome«
peevish and mon^se, flies from society, and falls into a deep melancholy. He
coiuplaiiis finsUly of mental weakness, iualiility to direct hfs thoughts,' h»3« of

URINARY AND REPRODUCTIVE ORGANS. 167

Mr Douglas adds, the discharges have never entirely
ceased Mr Douglas, in this paper, further advised
the injection of opium and acetate of lead into the back
part of the urethra.

The solid caustic is to be recommended only in the
most aggravated cases of spermatic incontinence; and
just as they are removed from this condition, nitrate of
silver in solution, of varying strength, may be applied
to the prostate by means of a prostatic syringe. Yet
in a considerable number of cases even these measures
are not demanded, it being sufficient simply to pass a
bougie or catheter at given intervals. This treatment
is to be employed in those cases where hyperaesthesia
alone is believed to be the origo mali.

It must be remarked that too frequent repetition of
the caustic is apt to defeat the end aimed at, for as
Civiale remarks, it may stimulate the testicle to in-
creased secretion, and even prevent the power of erec-
tion. '^ J'avais ddj^ observe que des malades soumis
k Temploi prolong^ du caustique, perdaient la faculty
d'entrer un erection."

The modus medendi of the caustic solution is ana-
logous to what happens in cases of enuresis when
stimulants of the sympathetic are administered. The
minute vessels are contracted by an impression of a

memoiy, ringing in his ears, dazzling of the eyes, and musca volitantes,
fiednting fits, and flowings of blood to the head, resembling apoplexy, but
differing from it, not being benefited by measures of depletion.''

Mr Douglas then proceeds to the consideration of treatment, and after
general remarks recommends Lallemand's method. He quotes cases from
Lallemand's book, illustrating the efficacy of the treatment The most in-
teresting case in the paper, however, is that of his medical friend W. C, aged
28, who markedly improved under the treatment of caustic The account is
given by the patient himself, and possesses more interest^ inasmuch as it is
the case of an intelligent medical man.

168

QN THE FUNCTIONAL DISEASES OF THE

Stimulating nature upon their nerves, and abnormal
sensibility is consequently diminished. Hence the
agents which are given in the sthenic form of enuresis
are equally applicable in the cases under consideration.
Chloral hydrate is therefore given with benefit in sper-
matic incontinence.

Dr Bradbury, of Cam]>ridge, referring to this subject,
remarks — "Whenever, therefore, there is reason to
believe that nocturnal urinary and seminal incontinence
are due to spasm (not the result of reflex irritation
reflected from a fissured anus, worms, m inary calculi,
congenital phimosis, or of structural disease of the
walls of the bladder, &c,), hydrate of chloral will be
found a most serviceable drag in their treatment, in
consequence of the acknowledged efficacy of this drug
in allaying spasm, as observed in tetanus and other
spasmodic disorders." My belief is that no abnormal
spasm ever takes place without some primary irrita-
tion. Is there no irritation in tetanus? Does the
removal of the testicles in certain cases of epilepsy,
by the improvement that ensues, not indicate the
removal of at least a factor in the production of the
disease ? Is epilepsy not sometimes ascribed to mas-
turbation? Is hysteria not associated with peripheral
irntatitni ?

Digitalis is used in France as an anaplnrodisiac. It
diminishes seminal secretion. This accords with its
therapeutic property of stuunlating the spnpathetic
(fil>res of Remak). The employment of camphor for a
similar purpose is a custom of great antiquity. It was
an axiom at the school of Salermun, " Campkora per-
uares easirat odoix's 7nares.'* Camphor may be bene-
ficially combined with hyoscyamus and l)elladonna, both

URINARY AND REPRODUCTIVE ORGANS. 169

agents which act as anaphrodisiacs, m the maimer
mdicated.

Bromide of camphor (CioHi^OBr) promises to rank
among the most valuable of the medicinal agents of this
class. Attention was first directed to it by M. Deneffe
(de Gand)* as an excellent sedative of the nervous
system. It has been successfully used by Hammond
of New York in hysteria; DeneflTe has found it bene-
ficial in deUrium tremens; Charcot, at the Saltp^trifere,
has had good results from its employment. It di-
minishes temperature by acting on the minute vessels,
as the other agents of this class, and its use is thus indi-
cated in nocturnal enuresis and seminal incontinence.
It may be given in doses of from two to five grains in
form of pill, with a simple excipient, or in combination
with belladonna or hyoscyamus. It has been used by
subcutaneous injection. For this purpose the fol-
lowing formula may be followed i—Monobromide of
camphor, 3 grammes; alcohol, 35 grammes; glycerine,
22 grammes.

The preparations of lead have been given in the
treatment of the afiection at issue. Their use is to be
reprehended. Fredric Hoflftnann cites the case of a
young man who had recourse to acetate of lead to
arrest nocturnal pollutions, and who died after fifteen
days of anguish, from an obstinate constipation thus
induced which nothing was able to remedy. Nitrate
of potash is not beneficial. Large doses are apt to
cause suppression of urine.

Bromide of potassium, which is held in high repute
as an anaphrodisiac, and unquestionably exercises a

♦ Du Camphore Monobrom^ et de ses applications a la Therapeutique
M^icale. (Press. M6d. Belg. 1871, p. 405.)

170 ON THE FCNCnONAL DISEASES OF THE

powerfully sedative influence over the genital organs,
is specially indicated when the emissions are supposed
to depend on conditions of the spinal cord or brain^

Phosphorus has likewise been recommended, on the
theoretical presumption that there may exist defective
nutrition of the nervous system. I have known it dis-
agree with the stomach so as seriously to interfere
with digestion. It may be tried, however, in the form
of pill made up with crumb of bread, in doses of from
gr, i to gr. j. The following is Magendie's foi-mula for
its administration:^ —

BL Phosplioras, 5j

Olcd Amygi DuL, Jij
Sig. Solva

Sumat ^L x. — i

I am in the habit of prescribing bromide of iron, and
I have seen much benefit result from its use* It may
be given in doses, beginning from five to ten gi'ains,
made into pill with extract of eucalyptus globulus,

Lupulin has been strongly recommended by Sigmund'
of Vienna. It may form a conveuient and useful ex-
cipient for a pill

In the opposite class of cases, where there is nei'vous
exhaustion and muscidar relaxation, there are few
agents which possess such a powerfully tonic influence
over the genital oi-gans as the old tincture of steel.
In tlie following case, where the patieut wiis entangled
in the meshes of a London charlatan, the benefit was
most marked; —

Dec. 28th, 1867, patient WTites: — '*I have emissions
almost every night; sometimes twice a night. It is
iibout two years since I suffered fiom them." Patient
had been addicted to masturbation, which, liowever,

URINARY AND REPRODUCTIVE ORGANS. 171

he had at this tune abandoned. I put him under the
above treatment^ advising that the dose of the tincture
of steel should be increased gradually to ninety drops
thrice daily. On the 28th March he writes — "I
have had only one emission during the last thirty-three
days. I am at 120 drops (of the tincture) now, and
am quite cheerful at present."

It may be observed with respect to the employment
of the tincture of steel as a genito-urinary tonic, that
the dose as usually prescribed is much too small.
Where smaller doses have failed, I have seen such
large doses as the above productive of benefit. Of
course it is not to be given in a concentrated form; and
it must be sufficiently diluted with water. It is well to
use precautions against the efiect on the teeth, such as
sucking the fluid through a glass tube, &c. ; and again,
though at the commencement, constipation, which may
be obviated however by the administration of an ordi-
naiy aperient pill, is apt to happen, when the system
becomes saturated with the tincture, the bowels be-
come rather loose than confined, and the flow of urine
is much augmented. Theoretically it has been urged
that large doses of tincture of steel are useless, as so
much of it passes off* by the bowels. This theory is
assuredly not borne out by practical experience.

Strychnine as a nervine (motor) tonic is highly bene-
ficial. It may be judiciously combined with the tinc-
ture of steel. From its action in the uterus, it has been
inferred that ergot of rye would similarly influence its
analogue in the male. The inference is confirmed by the
result of its administration in these cases. I have seen
unquestionable benefit fi'om its use. Of the use of co-
paiba and cubebs in this affection I have no experience.

172

ON THE FUNCTIONAL DISEASES OF THE

As seminal emissions so frequently take place when
the patient is lying on the back — congestion of the
cord being thns induced — certain mechanical means
have been devised to prevent the patient s so sleeping.
Contrivances have also been resorted to to cause the
patient to waken coincidently \iith the accession of
erection of the penis. A leather ring armed with
sharp points, and encircling the penis, so that on its
enlarging the oigau may be pricked, has been thus
used. The procedure is unscientific^ and of most ques-
tionable utiUty.

It is remarkable to what an extent mental impres-
sions may exercise a curative influence, and how
sematic disturbance, primarily due to psychical causes,
may be removed by antagonistic impressions of the
latter nature.

In his highly interesting work " On the Intellectual
Powers," Dr Abercromlue relates tliat Dr Reid cured
himself in like manner of a tendency to frightful
dreams, with which he had been annoyed from his
early years. Ho did so by endeavouring to fix strongly
on his mind the impression that all such dangei"s in
dreams are purely imaginary, and determined when-
ever, in a dream, he found himself on the brink of a
precipice, to throw himself over, and so dissipate the
vision. By persevering in this metluxl, it is alleged
that for nearly forty years he was never sensible of
dreaming.

Tissot makes a similar observation. He remarks,
" Comme riiabitude a ici unc tres-grande inflneuce, et
cju'il iniporte de la rompre, robservation suivante pourra
fournir un moyen d'y r^ussir. Je la tiens d\in Itahen,
respectable par ses vertus, et Tun des plus excellents

URINARY AND REPRODUCTIVE ORGANS. 173

hommes que je me rappelle d'avoir vus. H me con-
sultait pour une maladie tr^s differente : mais afin de
mieux m'instruire, il me fit toute I'histoire de sa sant^.
II avait 6t6 incommode, cinq ans auparavant^ de pollu-
tions &^quentes qui I'^puissaient totalement. II r^solut
fortement le soir de se r^veiller au premier moment oh
une femme frapperait son imagination, et s'occupa long-
temps de cette id^e avant que de s'endormir. Le
remMe eut le plus heureux succfes: Tid^e du danger,
et la volenti de se reveiUer, imies ^troitement la veiUe
k I'id^e d'une femme, se produisirent, au milieu du
sommeil, en m6me temps que cette demifere; il se
r^veilla a temps, et cette precaution, r^it^r^e pendant
quolques soirs, dissipa le mal." By a strong resolution
of the will the patient thus wakened in time to prevent
seminal emission, and thus the habit was ultimately
overcome.

When there is a tendency to self-pollution during
sleep, the penis should be blistered.

Sedative suppositories, such as belladonna and
opium, may be beneficially employed in some cases.

The perineum may in obstinate cases be blistered.

The very extreme measure of transfixing the prostate
by means of accucumpture needles is one which cannot
be sufficiently reprobated.*

In cases of very tight prepuce, or congenital phi-
mosis, the propriety of resorting to the operation of
circumcision cannot be too strongly recommended. If

♦ The first reference to accucumpture occurs in Ovid's writings : —

Num mea Thessalioo languent devota veneno
Corpora ? Num misero carmen et herba nocent ?
Sagave Punlce& defixit nomina cer&,
£t medium ienues injecur egit acus ?

{AmoreM^ lib. iii. eleg. 7.)

174

OK THE FUNCnOKAL DISEASES OF THE

at the juncture of the mucous membrane with the skin
the foreskin is thick or gristly, circumcision proper is .
advisable. To accomplish this, the foreskin is drawn
slightly out, grasped in an ordinary dressing forceps^
and removed with one sweep of the bistoury. Care
must be taken not to remove too much, as the prepuce
retracts greatly. The cut surface should be drawn
together to facilitate adhesion. There are other
methods of removing preputial irritation — modifica-
tions of circumcision — such as slitting the prepuce on
its upper surface, forcible dilatation, &c,, but perfect
circumcision is to be preferred.

En passant, the operation of circumcision is one of
great antiquity, and whose performance is attended
with many beneficial consequences. Thus, it has been
clearly shown that among the Jews, who perform this
operation as a religious rite, venereal diseases are much
less frequently witnessed than among individuals with
long prepuces. Circumcision was not originally per-
formed as a sacred rite. Its commencement with the
Jews originated unquestionably with Abraham; and
Marsham is of opinion that the Hebrews borrowed the
practice from the Egyf^tians. Among the Jews it was
performed on the eighth day, with the Egjqjtians not
until the thirteenth year, and then on ffiris* as well as
on boys! In Otalieite it is performed by slitting the
prepuce on its upper aspect. Herodotus (book ii. c.
liW) refers to the operation in the following terms : —
" The inhabitants of Colchos, Egjpt, and Etiiiopia are
the only people who from time immemorial have used

♦ Wliat thiA circumcision on girls be I cannot divine, unless it be the bur-
iMiroiifl operation practised hy the Nubian women on yoimg girls* For a brief
account of it vuk " I^ncct^ Augtiijt 10, 1867.

URINARY AND REPRODUCTIVE ORGANS. 175

circumcision. The Phoenicians and the Syrians of
Palestine acknowledge that they borrowed the custom
from Egypt. Those Syrians who live near the river
Thermodon and Parthenius, and their neighbours the
Macrones, confess that they learned it — and that, too,
recently — ^from the Colchians. These are the only
people who use circumcision, and who use it precisely
like the Egyptians. As this practice can be traced
both in Egypt and Ethiopia to the remotest antiquity^
it is not possible to say who first introduced it. The
Egyptians certainly communicated it to the other
nations by means of their commercial intercourse.
The Phoenicians, who are connected with Greece, do
not any longer imitate the Egyptians in this particular,
their male children not being circumcised." Again,
Gregory the Abyssinian priest remarks, " ivf antes cir-
cumddunt oh consuetudinem non oh Judaismiim'' Of
the great antiquity of the operation there cannot there-
fore be a doubt, and it is very questionable whether it
does not constitute one of the good ancient customs
unfortunately become obsolete.

Galvanism has also its advocates in the treatment of
spermatic incontinence, and upon the well-founded
belief in its efficacy is based the imposition which takes
the form of the " The Self-adjusting Curative Belt,"
which is so extensively advertised in metropolitan
and provincial journals. It is hardly necessary to
observe that these belts are simply an imposition.

With respect to the employment of galvanism, it has
been found that the induction current is of little use,
while the constant current is highly beneficial. It
should be transmitted along the vertebral column for
one or two minutes, and repeated twice or thrice weekly.

176

ON THE FUNCTrONAL DISEASES OF THE

In Other cases faradisation may be practised by
means of an urethral and a rectal exciter. The con-
stant cuiTcnt has been successfiilly employed also, by
means of an isolated urethral exciter (positive), the
circuit being closed on tlie thigh. This may be prac-
tised for five minutes.

We come now to the delicate and vexed question of
sexual congress as a remedy for spermatic incon*
tinence — a question the discussion of which, and the
physiological issues involved therein, are apt to end in
serious conflict with social ethics. There is nothing
easier than to hound down an individual who, foUow-
ing the guidance of truth and sincerity, is led to form
opinions possibly at variance witli those of the multi-
tude; or an unmanly reticence on the part of others.
The \iilgarity of so doing is on a par with its facility.
How often is conventional " respectal>ility " the mask
of the cheat ! And does not the experience of the
most obseiTant of mankind amply testify that re-
ligious parade and personal integrity, in every relation
of life, are almost invariably in an inverse ratio?
With respect to the difficult sul)Ject which now pre*
seuts for discussion, there is a class of men who seem
to think it a duty, at whatever sacrifice, to reconcile
physiology and conventionality. Respecting as I do,
in common with most others, the endeavours of these
amiable individuals, I must assert that, as physicians
and physiologists, we have nothing whatever to do with
so-called morality, and should not allow ourselves to
be diverted from an honest examination of this sub-
ject in the interests of truth, tlie light of physiology^
and the equally sacred claims of science.

If morality conflict with physiology, I apprehend

URINARY AND REPRODUCTIVE ORGANa 177

that the fault rests with the former and not the
latter.

That in the treatment of spermatic incontinence,
sexual congress hag been recommended by Lallemand,
Benjamin Philips, Erichsen, and many others, consti-
tutes a claim to an impartial examination of the sub-
ject. It is true that in certain countries the subject
involves grave moral considerations; but morality is
not a thing on which all nations tliink alike.* Simple
fornication, for instance, is not regarded as sinful by
even the Greek Church, not to speak of customs that
obtain elsewhere.

It will be conceded in the first place, at least, I
maintain and believe, that there is such a thing as
sexual appetite or instinct in the properly organised
human being. The other senses are called into exer-
cise by external impressions, such as light, odour,
sound, &c. ; the one under consideration, like hunger
and thirst, is prompted by an internal excitation, viz.,
venereal desire.

Am I singular in this belief, as some of the critics
of my former work would seem to regard me ? Cicero

* The subjoined dififerentation of crime, in an age of refinement, might
not be accepted in more barbarous times : —

** Dwell not in thy memory
The words wherein thy ethic page describes
Three dispositioiis adverse to Heaven's will —
Incontinence, malice, and mad bnitishness.
And how incontinence the least offends
God, and least guilt occurs ? If well thou note
This judgment, and remember who they are,
Without these walls to vain repentance doomed.
Thou shalt discern why they apart are plac'd
From these fell spirits, and less dreadful pours
Justice divine on them its vengeance down." - DaiUe.

*' Mcra i^ ravra Xticr^or AWrir iroiriaafi4rovs itpx^i^t trirStv irtpi rh ^^ ptvtcr&y
rpia iffrlr cY8i9, Koicfa, ijcpwria^ BnpiimisJ* — AristoUe's Ethics.

178

ON THE FUNCTIONAL DISEASES OF THE

remarks — **Motus animorimi duplicis sunt; alteri, cogi-
tationis; alteri, appetitiis. Cognitatio in vero exqiiir-
endo maximo versatur ; appetitus impcllit ad agen-
dum/' But Cicero may be called a heatlieii, and his i
testimony held in con'cspondiug esteem ! ^|

"Our appetites/* says Dngald Stewart, ''are three in ^
number— hunger, thirst, and the appetite of sex. Of
tliese, two were intended for the preseiTation of the
indiWdualj the third for the continuance of the species^
and without them reason would have been insufficient

for these important purposes Our appetites can

with no propriety be called selfish, for they are directed
to their respective objects as idtimate ends; and they
must all have operated, in the first instance, prior to
any experience of the pleasiure arising from their grati
fication. .... Our occasional propensities to action
and to repose are in many respects analogous to our
appetites." " According to the old Hebrew narrative/'
says Strauss, "Adam and Eve when still in Paradise
wore also to beget children and multiply ; but this,
according to the fathers of the Church, was to be with
out desire or gi\atification, in which case mankind must
have died out, even as it would starve, if eating were

not pleasant nor hunger painful These sensuous

impulses lie in the normal disposition of human nature,
because, in fact, they are comprised within the laws of
animal hfe to which man belongs. Only that with
man they should not, as with the bmte, constitute the
whole of the stimulus, but be humanly ennol:)led." H

Like all the other appetites, the powder of the sexual ^
appetite varies in different individuals. *' It is well
known" (Ed. ''Lancet,'* Nov. 11, 1871) *Ho be espe-
cially powerful in large classes who are called religious,

URINARY AND REPRODUCTIVE ORGANS. 179

but whose religion consists in submission to excited
feelings, rather than a striving after purity and holiness
of life. It has been very active in many men of great
experience and of the highest reason, and seems, in-
deed, to bear some relation to the general force and
vigour of the nervous system. It is quite true that
men and women are under no necessity of sinning,
and here and there a few may entirely control even
strong sexual passions; but, as a matter of fact, the
great majority of men do not so control them, and
large numbers of continent women,* both widows and
unmarried, suflfer seriously in health from the forced
suppression of an important function."

Schenck speaks of a lady of twenty-five, who observ-
ing a vigorous continence, fell into a state of mental
alienation ; she roamed the fields and forests soUciting
the peasants to have intercourse with her. A peasant,
it is alleged, acceded to her soUcitations, and her
health became perfectly established. Esquirol relates
cases of a similar nature.

Physiological Relation of Continence and Incon-
tinence. — Having arrived at the conclusion that there
is such a thing as the sexual instinct, the question pre-
sents, whether is it or is it not conducive to the well-
being of the individual that its gratification be in-
dulged in? A priori argument and analogy would
decide in favour of the affirmative answer; it may

* Professor Frank of Vienna relates the case of a lady of his acquaintance,
of a wann and amorous constitution, who was unfortunately married to a
very debilitated and impotent man, and w^ho, although she often betrayed
unawares, by her looks and gestures, the secret fire that consumed her, yet,
from a strong moral principle, resisted all criminal gratification. After a
long struggle her health at length gave way ; a slow fever seized her, and
released her from her suffering.

180

ON THE FUNCTIONAL DISEASES OF THE

confidently be asserted, that the moderate giatification
of all natmal appetites is conducive to bodily and
mental sanity, and while it is equally true that all our
appetites are liable to editeafum, the tendency to ex-
cess of every description so lialjle to be proiliiced by
indnlgence is to be guarded against by that faculty of
mind, to wliich the term manliness applies in its best
and widest sense.*

We i>reniise our examination of the argnment, for
and against continence, first by disposing of prema-
ture excesses, in gi\ing our unqualified adherence to
the opimon that sexual excitation before puberty, and
even during early puberty, is fraught with the worst
consequences.

Of the immediate etFects of coitus, Fenchtersleben
makes the following remarks: — "The act of coition
itself has a decided psychical effect. If exercised
with moderation at full maturity, and at the right
moment, it leaves {notwithstandhig the ofnne animal
post eoitum triste)^ a pleasural>le feeling. Nay, it in-
vigorates the powers of thought, as shoT^ii by the
example of the ingenious voluptuary Cassonova, who
at such moments solved the most tlifficult mathematical
problems. If not gratified when urgent desire exista,
it may indeed occasion psychical uneasiness, and espe-
cially distract the attention."

Another argument adduced in favour of sexual con-

♦ Omnia Biquidem onimfilia, cupidiuis a?8tro percita, ferociimt * et nisi m
invic^m trmmtiir, phiriiQuni t;iinleui a cousuetia inoribue recedunt, ItA
mulieres ijutedam in&tniiiiiiL prte desiileriij Lonsciiescendi cum viris; et in
noiiTitiUiH iif=Mjuo iiilen Biivit hoc malum ; \\\ vel veneficio attiatur, vel Biderat«Q,
uul a laciMlDcmone uV^easa? jiulicentur. Idque saipiua conttiij^eret, nisi probn
educjitio^ IxinsG famai revtreiilia, et iiitiata liuic sexui venicujidia, inordin
hoisce Rtiiuii iiiij)*'tu« compeacsereiit. — Harvty.

TSBJLEs: Ufa j^Ficanrmn LjBLbxj& ISl

greas k, liitt ix 11^ & mir if vnr oesbubbouh. ^snc if hit

are apt id ocaar. Oil "iJifr lois '«»"*f n i^ i^aHBrii!^
that Ae iiftittkik^.. l&i- ^se^ TitmnTTtii- hiet ymmn inur >
tkmalhr qnipfiOQiiL and yt tshom. ^[ u^ia. a^ cjrcsnif
stances mar deifBrnmn.

The ibnncr cfiitfttKr vqnmitm m ntiaxCKniitc ry ^rrireR
of muxDpeaciyilde nsifdCUilidniT. T^m^ Crviioe txat-
tends, thai it k^ridi Vbt u^nau, jtsoa, ki Ji ^ iriih
the <MherorgM^ cf i^todr. :iiac ixfrtdse scrcs^ri^keflas
them, thax maakai €Bker«iC£s i^ioD^ lita: i^^
them and nlriinairfT descrcn*^ tLfnr fiEikc3>:«a2 r»: ver.
This, he eonicxMk. k ilfaifiKiviied
he dedooes thercfrvjm tfe octtdc^iii. thai ii i^ ih^^
in fnDctioDal deEmgeBKBi& Vj endeaToixr to regulate
the per^ertad fimetkuL When the oigans hare become
enfeebled, and fatigued br abode, repose tecomes the
first requisite; after that the most natinal excitation is
the exercise of the sexual function, but moderated, and
graduated in proporticA to what remains of eneigv.
Hence it is essential, from this point of view, in the first
place, to determine the actual condition of the organs.*
Sanctorius maintains that coitus is useful when solicited
by nature; but when excitation is from the imagina-
tion, that it enfeebles all the mental faculties, especially
that of memory. It is easy to understand why. In
the state of health, he contends, that the sexual instinct
is inspired only when the resiculw ^miiuUes are dis-
tended with properly matured seminal fluid, and that
then its evacuation is not followed by bodily enfeeblo-

♦ Quoted by TissoL

182

ON THE FUNCTIONAL DISEASES OF THE

ment. But such is the organisation of the genital parts,
tliat their activity is roused not only by the presence of
semen, but, as we have already seen, by mental impres-
sions ; when so produced, seminal emission is more
hurtful, even as it is less necessary.

Thirst and hunger indicate the necessity of taking
food and drink ; if more is taken than the want seems
to indicate, the surplus enfeebles the body ; so it is
with the sexual appetite. The necessity of defaecation
and micturition is presented to the mind by certain
physical phenomena, but perverted habit is able so to
modify the organic constitution of the organs, that the
urgency of the function ceases to be dependent on the
quantity of the excreta. This is the case with mastur-
bators. It is the imagination, the habit, and not a
natural appetite, which impels them. The irritation, as
we have seen, prematurely stimulates seminal secretion,
Rouband remarks, that the genital sense, as all other
functions of the economy, is intended to fulfil a mission,
which, save in some exceptional cases, it is impossible
to control without eWl consequences. There can be
no doubt that protracted continence is attended with
deep gnawing pain, and swelltug of the testicles, in
certain cases.

Now, are we boimd to concede that in continent indi-
viduals the fimction of the testicles is thus abrogated^
and that necessarily atroi>hy of the organs takes place ?
1 think not. Galen, it is true, had remarked that the
smgers and athletes of his time, who observed chastity,
had their genital parts exilia et imgosa as those of old
men One of his friends^ he remai ks, came to consult
him on account of an obstinate priapism, in conse*
quence of a prolonged continence, and was stniek with

4
I

UKINARY AND REPRODUCTIVE ORGANS. 183

the fact that athletes were in an opposite condition.
" MiroVy inquit^ quod^ hinc {athletum indicayis) ob con-
tinentiam nigosus^ collapsusque penis erasent. Mihi
vera ex quo continentiam servare studui, evenerit con-
tr avium.'' Gralen adds, that those who in youth aban-
doned themselves to sexual pleasures* had the genital
parts abnormally developed. The question is one
on which, I think, it impossible to formulate a law.
Possibly in some cases, as the highest authorities do
testify, continence has caused impotency and atrophy
of the genitals. It may likewise be true that moderate
exercise of the genitals develops and strengthens them;
but it by no means follows, 1 think, that continence
is attended with functional inactivity and atrophy, as a
rule. My own experience indicates quite the con-
trary. Of course, in these cases in which continence
has been observed until late in Ufe,t comparatively
speaking, the function of the testicle continues to be
interruptedly performed, as we have already inferred.
On the other hand, the analogy between the testes and
the mamm8e cannot be admitted; the testes are the
analogues of the ovaries, and corresponding physiolo-
gically we naturally infer a functional correspondence,
and this really obtains. With or without sexual con-

♦Mt Wilson (On the Urinary and Qenital Organs) mentions the case of a
man of twenty-six years or age, in whom the penis and testes remained the
same size as in childhood. At this age he married, and at twenty-eight the
organs had reached their natural size. Roubaud mentions a similar case.

t Dr Gall remarked in his Lectures that such clergymen of the Roman
Catholic Church as were considered in the odour of sanctity, were remarkable
for atrophy of the genital organs. Buffon remarks, " The natural state of man
after puljerty is marriage." The ancient Germans did not marry till the
twenty-fourth or twenty-fifth year, previous to which they observed the most
rigid chastity, and in conseriuence of which, according to Caesar, they acquired
a size and strength which astonished Europe.

ON TUE FUNCTIONAL DISEASES OF THE

grrait, ova are discharged with the meustnial fluid every
month. The absence of menstruation shows an abnor-
mal condition of the system; continence in the female
does not cause amenorrhcea,any more than continence in
the male prevents seminal secretion; but preternatural
genital UTitation in the female wiU cause menorrhagia,
even as the same cause in the male will occasion what
I have ventured to term spermoiThagia. The too fre-
quent or too copious flow of the menstrual fluid con-
stitutes a disease ; and an excessive discharge of seminal
fluid, in the male, must be regarded sumlarly. The
entire absence of either, in either sex, would lead to the
supposition that some sexual derangement must exist.
lie verting finally to the articles which appeared in
*' The Lancet/'* apropos of my letter in the same jour-
nal {ride Appendix), the following ^irgument against
sexual congress, as a cure for spermatic incontinence,
as recommended by certain wTiters, is indulged in : —
** Seminal secretion is prompted by the presence of its
[)roper stimulus, and the secretion prompts to the per-

foT'Tnauce of the sexual act The physiological

remedy is the constant presence of the woman; and
her occasional presence only increases the evU it was
designed to cure/* It is implied in these propositions
that the presence of the female is the stimulus to seminal,
secretitin, and conversely that in the absence of the
female there woidd be no seminal secretion, and con-
seciuently no sexual ui'gency. Now, we know that this
ill puint of fact is nut correct It must be admitted
tliitt in unmarried as well as in married men — in the
virtuous as well as in the profligate — secretion of semen
proceeds in a normal ratio on the one hand, and preter-

♦" llic LATica," 1M7IJ.

URINARY AND REPRODUCTIVE ORGANS. 186

naturally, just according to the degree of irritation,
psychical or physical by which the testicles are influ-
enced, on the other; and again, that if the presence of
semen prompts to the performance of the act, it must
do so alike in the married and unmarried, and that con-
tinence, as the term implies, cannot be maintained with-
out an effort at the suppression of a normal function,
which effort, in the opinion of men of acknowledged
eminence, is apt to be attended with psychical as well
as bodily disturbance, and if overcome^ must be relieved
by involuntary seminal emission.

Again, the writer in "The Lancet," referring to
marital excesses, remarks — "The sexual intercourse
which follows legitimately on marriage is not unfre-
quently pushed to excess; but, even then, the evil
works its own cure. In ordinary cases the physio-
logical powers of the husband, and the nature of his
employments in life, set from the first their appropriate
limits to his indulgence. Nocturnal emissions cease at
once [it consists with my knowlege that they occur
even with married men] ; because they are superseded

by the legitimate use of the sexual organs

Now, intercourse with prostitutes, regarded simply as
occasional sexual intercourse, has no effect of the kind.
A man who cannot marry, and who is worried by
emissions, should endeavour to diminish secretion I
By seeking women occasionally he only increases it,
and feeds a craving which grows in proportion as it

is fed Physiology is completely on the same

side as morality; and the advice to seek irregular
sexual intercouse as a remedy for emissions is alto-
gether unsound in principle, and, if followed, would be
unsuccessful in practice."

186

ON THE FUNCTIONAL DISEASES OF THE

Now, I designate this aii iUogical and unphysiological
argument; and maintain, without fear of cuntradiction
or dread of difference of opinion, that neither science
nor human welfare can ever be advanced by compro-
mising the truth in this manner. Dissected, the philo-
sophy of this compromising physiologist will be found
to resolve itself into the performance or non-perfornmnce
of a canonical rite. If in the married state it is alleged ,
'* noctiu-nal emissions cease at once, because they are
superseded by the legitimate use of the sexual organs,"
how does it happen that ilUcit intercourse simply "feeda|
a craving which grows in proportion as it is fed? "

Deslandes takes a very different view of it. He
contends that coitus, when reduced to its most simple
terms (a ses plus simple termes), is neither more nor
less than an excretion of semen, and causes less in-
juiy to the system in proportion as it is attended with
diminished excitement. " Aussi lo commerce avec les
fiUes pubhque et gt5n^ralement femmes qui n'inspirent
point de vifs transports, a-t-il g^n^ralement des incon-
veniens moindres, ainsi que l*a remarque Hunter,"'
que celui qui s'accompagne d'une violente passion/*
Granted that intercourse with prostitutes is only occa-
sional, and that " the physiological remedy is the con-
stant presence of the woman,** which by the way it
not, what does this amount to ? It is admitted that^
marital excesses occur, " but the evil works its own
cure. The physiological powers of the husband, and
the nature of his emploifment in life {sic), set from the
first their appropriate limits to his indulgence." It
follows that sexual congress can only be of occasional
occurrence, to be compatible with health, and if occa-
sional intercourse in the married state supersede

URINARY AND REPRODUCTIVE ORGANS.

187

nocturnal eraissions, why not in the unmarried state ?
If the presence of the female stimulate the secretion of
semen, and seminal plethora i>romi)t the sexual act, how
can the physiological remedy be the constant presence
of the woman? Agiiin, by a strange perversity of
argimient, the writer adds, *' her occasional presence
only increases the e>il it was designed to cure,"
Would ''physiology be completely on the side of
morality " if her presence were constant, withmit tho
l>erformance of the matrimonial rite ?

Patliological or therapeutical considerations based on
such reasoning as this, it need liardly be said, cannot
be regarded as meriting intelligent criticism. What is
the normal condition of the vesicute seminales and
testes ? It is their normal condition to be full. When
in tins state, and under the influence of neither mental
nor bodily excitement, secretion of semen proceeds
very slowly, but it is accelerated according to the
degree of either variety of excitement. Augmented
thus, seminal plethora occurs, and if the natural
appetite which this state creates be not indulged,
psycliical uneasiness is apt to take place, and involun-
tary seminal emission to occur.

How might the natural use, then, of the sexual
organs supersede noctm^nal emission 1 In the first
place, by removing seminal plethora, and, what is not
of less consequence, by obviatiog psychical uneasiness
from ungratified passion. Patients who are tormented
with nocturnal emissions and cannot marry are seri-
ously advised to diminish seminal secretion ! and, to
accomphsh this result, writers of the nineteenth century
have advised them, I can hardly think in earnest, to
invoke the aid of religion !

188

ON THE FUNCTIONAL DISEASES OF THE

I have never denied, nay, I have maintained, that the
diverting of the mind from sexual subjects is calcu-
lated to moderate the amount of seminal secretion, and
reHgion may act in this respect just as it influences the
particular individual and no further. I do not believe
that mere exercise will diminish the amount of seminal
secretion, any more than it will diminish any of the
other secretions of the body. The ^vriter in '^The
Lancet'' above commented upon remarks — and here I
am in harmony with him — " We shall find, in the first
place, that the power of physical exertion and of
mental apphcation, in a degree sufficient to extinguish
animalism, is not a common endowment soon after
the age of puberty."

It is amusing to what extremes individuals will go
when a pet theory has to be bolstered up. Thus,
Lallemand says—'* The urgent necessity of recruiting
eacli day, the great w^aste occasioned by varied pro-
gressive gjTnnastic exercise, diminishes in an equal
proportion tlie secretion of the semen; for the
economy only occupies itself with the reproduction of
the species when it has provided for the construction
of the individual" This novel theory is assmedly more
ingenious than correct It is rather a good example of
Lallemand 's bad physiolog}^ and the excellent develop-
ment of his luxuriant fancy* That it is visionary, is
clearly shown by the remarkable procreative capacity
of patients far advanced in phthisis. Again, by an un-
fortunate forgetfulness, Lallemand states, that '* from
the moment that the evolution of the generative organs
commences, the testicles, if the texture is not acci-
dentally destroyed, will continue to secrete up to a
very advanced age."

4
I

URINARY AKD REPRODUCTIVE ORGANS.

189

There is yet one remedy whieli is said to have been
successfully employed in the treatment of spermatic
incontinence ; I mean the rectal pessary to which
Trousseau refers. He narrates the case of a young
Irishman thus cured. I have no experience of this
method of cure, — it is, however, recommended on such
high authority, that it merits a trial in suitable cases.

In those cases in which psycMcal states keep up
spermatic incontinence, by augmenting seminal secre-
tion, moral treatment must be resorted to^ such as in-
teresting reading, change of scene, &c,

* ' Venus otia aiimt. Qui fiueni quaerifl amoria,
Cedit amor rebua j tea iige, tutus erit."

As accessory to the more direct medical treatment,
much benefit will be derived, in suitable cases, from
cold bathing ; where circumstances permit, in the sea ;
and otherwise by means of sponge, or plunge and
shower baths at home. The bowels should bo kept
free, and by suitable diet alone, if possible. Heavy
suppers should be avoided; trovot, inna, woroLf virvos,
a<f>poSL<Tia fierpta. Avoiding soft beds, and early rising,
should be inculcated.

In closing the consideration of this portion of my
subject, I fervently trust that in endeavouring to
avoid Seylla, I liavo nowhere fallen into Charybdis, and
that I have scrnpulously followed the behests of truth
and science, which must rise paramount to all other
considerations ! The subject is said to be a disagree-
able one. Perhaps so. The question is, Are these
diseases human infirmities or are they not ? If so, are
they, real or imaginary, the instruments of extensive
robbery and mental torture, if not insanity, to an
enormous extent ? Can nothing be done for their

190 ON THE FUNCTIONAL DISEASES OF THE

cure ? Have the several issues therein involved not
been grossly exaggerated by certain legitimate practi-
tioners 1 Can their importance not be diflFerentiated
compatibly with the most perfect honour ? Is not our
profession outraged, and the low press befouled by
vampires, who feed on our culpable negligence or ill-
advised silence ? Why should sexual matters in the
male be more disagreeable than in the female? And
why should the seal of silence be imposed on legitimate
practitioners regarding them ? Simply, I fear, because
of a state of things, inseparable from an unequal, and
in a preponderate degree, an imperfect education, viz.,
puerile attempts to reconcile prurient hypocrisy and
eternal truth.

URDfARY AXD REPRODrCTITE ORGANS. 191

CHAPTER IV.

STERILITY IX THE MALE.

Contents — Sterflity from Congeniul Defects and Malfonnations — from
Disease — Sterility frt-m Stricture — from Tubercular AffectioDs of the
Testicles — Influence of Disease on Fecundation — Effects of Hydro-
cele on the Spermatic Function — Sterility from Diminished Reflex
Paresis — Epileptic Misemission — Idiopathic Azoospermia.

By the term sterility, in contradistinction to that of
impotency, with which it is frequently confounded, is
to be understood procreatire incapacity ^ and not sexual
incapacity. These affections, says an accomplished
writer,* " are subjects of greater importance than has
been conceived by many, and often involve the happi-
ness and perpetuation of families. Yet have they, by
a sort of professional prudery, been either entirely
overlooked by medical writers, or very imperfectly dis-
cussed, and thereby relinquished to the irregular prac-
titioner, or to the entirely unqualified empiric."

In order to the possession of procreative capacity in
the male, the following are indispensable requisites,
viz., power of intromission of the penis, and the dis-
charge into the vagina of properly matured' and healthy
seminal fluid. Incapacity of erection comes properly
under the consideration of impotency, and its discus-
sion must be referred to that section. It is the inability

♦ Copland.

I9S )!r T'^ny wcjfrnDBJkL. dissa;s^ or the

2; --inr^y *Mo iie rrajina hi^dthg jmicm that specially
couisilLjie^^ iTdmiiy. The '^aicie^ of this state may be
oott^rHuemiv r^aerr-il uj — I^, Congoiital drfects and
amlfi^madua jc riie jgnenirrve organs^ ix either of
:±jtfni: aiui i//jf. ro :ie eiEfcis of tiiseajse. Of the con-
gynrnil iefects^ :iie mo^ impoituii: are ncMi-^lescent of
che r^fsdeufs inro liie scxtjumi. whiai the patients are
soiii ro be vrrypfi^onihiiis ^.icpmrnis; huMen^ and ^x^^' ^
K^eLe* aescenc of bm one uesczcle. monocehids (/u^io9),
ckses jf aypoi^piuiiii^ \ mri. and <rir«Scnru7)4a» a tearing),
and vnk^es of epispadia terC. acn^phy of the testicles.
I^ b> >cill a ii2^pIII:ed pocac vhecher crypsorchids are
ab^uu::eiy scerile. azbi we shall briefly ecnsider the
e^iiieace beta pn^ and ^vi^ Civiale mamtains that
enrp»?t^n:aipis are <tertle. bat chat they are not impotent,
aa«i ia a^liiriocL that they are Tery lascirionsw Until
the cinie of Hunter it was thoo^^t that the presence of
tescivie:> waa; a»x aece:?sary to pcocreatiTe capacity, as
invlmduals in whom they were wanting not only mani-
fe;^ted Tenereal des?tre. but begot children. Cabrol*
relates a case of this desertpcion. His adTice was asked
in the case of a yoong man of twenty-two, as to whethw
he might marry and would be likely to beget children,
or whether his con»iition did not render him more
suited for the service of the Churvh. Cabrol counselled
marriage* and his patient became the &ther of two
children. It was John Honter s opinion, that when
one or both testicles remained through life in the belly,
they are exceedin^y imperfect* and probably incapable

* I hMve aeen aome excellent specimens of cheise conditions at the Mus^
Unpotynm, PahA. In the magnificent Anatomical Mu^um of fiok^zna I have
tXMtn'mefl nrailar pTeparations.

t AlphaM Anatomiqae, p. ST.

URINARY AND REPRODUCTIVE ORGANS.

1D3

of perfomiing their natuiul functions. In this opinion
Hunter is confirmed by the observations of Mr Curhng,
It is assumed, as a matter of course, in these cases
that semen, to be fertile, must contain zoosperms, Mr
Curling, in a paper which he read before the Medico-
CUiirurgical Society of London, in 1863, gave details
of two cases of double retained testicles in mamed
men, without children, and other two cases of single
retained testicle, the second testicle in one case being
completely atrophied, while the other had been re-
moved by operation. In the four cases there was per-
fect ririfitp, though the ejaculated fluid was perfectly
destitute of spermatozoa. To these cases Mr Curling
added three cases described by Godart, one by Pench,
and one by Mr Partridge, in all of which the fluid
ejaculated was destitute of spermatozoa. The parti-
culars of Mr Partridge s case are as follow :^A gentle-
man, aged thirty-four, had been married eight years to
a healthy wife. He had strong sexual desire, and fie-
quent intercourse, but no family. He died of tumoui*
in the groin, which was found after death to have been
due to encephaloid disease of a retained testis. The
other testis, which w^as also retained, was of the natural
size, but did not contain any spermatozoa. The disease
having extended to the bladder, the condition of the
vesiculte was not determined, Mr Partridge was cog-
nizant of another case of retained testes, where inter ►
course was frequent, but the fluid ejaculated was
transparent, and did not contain spermatozoa. In this
case, Ukewise, intercoiurse was frequent. A like occur-
rence was observed in another gentleman, aged thirty^
four, wdio had frequent intercourse, and who consulted
Ml' Partridge as to the propriety of getting manied.

194

ON THE FUNCTIONAL DISEASES OF THE

>pical

microscopical examination of the fluid in this case
also having revealed the absence of spermatozoa, an
opinion adverse to his intentions was expressed, on
the gi'ound that there wonld be no offspring. At
the meeting at which Mr Cuding read his paper, Mr
Webster expressed his opinion that sterility was more
frequent in 'males than in fenmles. In the horse it has
been observed, in like manner, that if the testicles be
retained in the abdomen, the animal, though capable
of sexual intercourse, is sterile.

Non-descent of the testicles is of such rare occur-
rence, that Mr Marshall met with but one case of nou-
descent of one testicle in 1000 recruits, and non-descent
of both once in 10,000. There are three preparations
of this condition at Guy's ; one of them taken from a
gentleman, who, fi^om despondency caused by his con-
dition, shot himself

From such cases as the foregoing, it has been inferred
that crypsorchids are necessarily sterile, but other eases
are also recorded which do not bear out this opinion.
Two cases of fertile crj7>sorchids occurred in the prac*
tice of Mr Cock, late surgeon to Guy's. One of them
had been twice married before the age of thirty, and
had children by each wife, besides illegitimate children
which had been affiliated upon him, Mr Poland relates
in Guy's Hospital Beports, the case of a cr}^}sorchid,
aged twenty-nine, in w hom there w^as not the shghtest
trace of a scotum. This man married at twenty; he
had two children by his first wife, and at the date of
admission into hospital was married a second time.

In 1862 a patient came under Mr Durham at Guy*s,
in whom the testicles were lodged in the inguinal

canal. This man presented no signs of sterility; had

4
4

I
I

URINARY AND REPRODUCTIVE ORGANS.

195

two children by his ^vife, and since puberty (he was
then thirty-two years of age) had been always sexually
perfeetly competent, A similar case is described by Dr
Debron of Orleans* This man had a son by liis wife.

It was Hunter's opinion that the testicles retained
in the abdomen became atrophied. This opinion has
been combated by Owen. At least, that this does not
invariably take place, is shown by persons having this
malfi)rmation liaving become frequently the fathers of
children.

FoUin suppoits Hunter's view in the following man-
ner :^ — '*I have had from a distingiushed veterinary
surgeon interesting details on the structure of testicles
retained in the lielly of liox'ses. Beyond alterations
in volume, and in the appearance of the structure of
the gland, M, Goubaux has remarked that the semen
contained in the seminal vesicle, corresponding to the
side in which the testicle was retained, contained no
spermatozoa, I have in three cases examined the
semen contained in the seminal vesicle corresponding
to the side in which a testicle was retained in the
abdominal ring, and on every occasion I foimd a com-
plete absence of spermatozoa. On the other hand,
spermatozoa existed in the opposite vesicula. In a
fourth case, there were spermatozoa on neither side.
This was in tlie case of a man who died of an affection
of the nervous centres, of old date. But that which
was observed constantly in the liquid, devoid of sper*
matozoa, was a yellowish latty matter in round globules,
and having some of the properties of fat"*

Cloquet has found in the abdomen a testicle of equal
volume with one which existed in the scrotum. Tlie

* Archiv, G^n. de Mddeciiie, 1854, t. xxvi. p, 264.

196

ON THE FUNCTIONAL DISEASES OF THE

case of Sir Astley Cooper's pupil is notorious. la
despondency at the evid:jnt want of testicles, the young
man committed suicide* On post mortem examination
two testicles, almost normal, were found engaged in the
internal abdomuial ring. M. Jarjavay"' relates a similar
case~^' I have seen, he says, this year, at the CharitiS,
a man of fifty-five years of age, in whom the right testicle
was not lodged in the scrotum. Just beyond the ex-
ternal orifice of the inguinal canal, it was found above
Poupart s aponeurotic arch, towards the middle line.
The movements of flexion of the thigh on the abdomen
had apparently gi'aduaUy embedded the gland in the
snl^cutaneous cellular tissue. This testicle was always
as large as that in the scrotum." This patient hatl per-
fect sexual capacity.

Caspar is of opinion that erypsorchids are perfectly
capable of procreation, and he cites a case related by
Mahon, in which a most licentious criminal Avas dis-
covered, on dissection, to be a crj^isorchid. He ftuther
relates a case of a crypsorchid in whom microscopical
examination revealed the presence of spermatozoa.
This was the case of a bt ly fourteen and a half years old,
who had been guilty of unnatural conduct rewards a
boy eight years of age. Sixteen days after the criminal
assault, Caspar discovered the spermatozoa in stains
on the boy's shirt. As this is a question on which the
physician or surgeon is apt to be consulted at any
time, and one which may involve grave medico-legal
considerations, it will be apparent that the opinion of
Mr Cuiiing could not be substantiated in a court of
law, as it is absolutely negatived liy the cases just
referred to. It certainly does not follow that in cer-

* Troite J*Anatoraie Chinirj<icale, t. i. p. 276.

URINARY AXD REPR0DU(*T1VE ORGANS.

197

tain cases of cryi>sorchids sterility must exist; and the
question of fecundity in suspicious eases can only be
determined by microscopical examination of the fluid
emitted in coitu.

One testicle may be congeHitaUy absent Thus
Bkndin^^ cites a case, where in one side neither testicle,
vas deferens, nor seminal vesicle existed. And
Velpeaut relates a similar case, in which the spermatic
artery and vein were absent in like manner. If this
malformation be confined to the one side, it need
hardly be remarked, it does not necessarily impair the
power of fecundation.

Congenital absence of two testicles would necessaiily
cause impotency. This condition would be indicated
by feminine characteristics, and the absence of sper-
matozoa in the fluid emitted in eoitu, if impotency did
not exist.

Monorchids, it need scarcely be remarked, are not
necessarily sterile* The condition termed hypospadia,
in which the urethra opens by a slit on the under
suiface of the penis, in some situation between the
glans and the perineum, is, in its aggravated forms, an
extremely rare condition. Epispadia, the correspond-
ing condition on the upper surface, is still more rare.
The aperture may be situated near or at a distance
from the glans, and may consist of a mere slit, or
involve part, or all the urethra. When the latter con-
dition exists, it is usuaHy complicated with eversion of
the bladder, and approaches the condition of herma-
phroditism. With respect to the procreative power of
hypospadias and epispadias, it will be obvious that

^ Anatomie topographifjue, p. -143.
t Anatomie Climirgictdej p. 192.

198

ON THE FUNCTIONAL DISEASliS OF TtlE

much will depend on the degree to whicli a departure
from the normal cdntlition exists. If the aperture be
situated near the glans, this condition is of no conse-
quence; nay, impregnation seems possible when hypos-
padia exists to a very extreme degree; and Schenek
and Simeon describe cases of hereditary hypospadia.
Frank records an instance of the transmission of tliis
deformity to three generations. Hypospadia and
ei>ispadia can be regarded as causes of sterility only in
cases where the orifice of the urethra is so situated
that the seminal fluid cannot be projected into the
vaginal canal. Tn fact, animals may be artificially
impregnated. Valentin thus observes- — " Coitus is not
a necessary condition for impregnation. It is merely
an expedient selected by nature for bringing together
the two different kinds of germs in many animals.

The rigidity of the organ is not a necessary

condition for the ejaculation of semen, or for impreg-
nation. It only materially favours the act of copulation
...... since the seminal stream may describe a

tcderably large arc, it may force its way into the vagina,
though only the point of the glans be introduced
lietween the lips of the vulva, or, if these be separated,
in any other manner. And the spontaneous movements
uf the spermatozoa make it possible for them subse-
quently to reach tlic cavity of the uterus through its os."
John Hunter was considtcd in a case in which the
seminal Huid escaped in the perineum, and having in
view the experiments of 8|)allanzani, ho recommended
the patient to collect the seminal Huid which thus
escai>od, and inject it into the vagina. This 1 icing done
imprt'gnation Uyok \ili\vi\ and a h(*althy chiM was l>orn
in nine montlis.

URINARY AND REPRODUCTIVE ORGANS.

199

Among the other congenital mall'ormations, there
may be complete absence of the vasa deferentia ; but
this is so rare an occurrence as simply to merit being
mentioned. There is yet another singular malformation
on whose occnrrence Eokitansky throws doul>t. I refer
to the occnn*ence of t^vo penes placed side by side.*
Of this malfomiation there is no doubt. (For an accoimt
of a remarkable case of this kind ride '* Lancet/' July
29th, 1865.) The genital functions were perfect.

Foder^ saw a young soldier, in whom there was a
fleshy excrescence in place of a penis, and in which the
lu-eters terminated. The testicles were normal. Belloc
relates a remarkable case in which the ureters ter-
minated at the bottom of the fra^num. The subject of
the malfonnation had four children; two of whmn had
the same maf/ormatitm. Similar cases are related by
Zacehias, and Francis of New York. Sometimes the
urethra opens by more than one orifice, Fabricius of
HUder refers to a case in such a manner as to convey
the idea that two urethrae existed; De duplici ductu
urhmrioA Haller speaks of three openings; Tna
Oi^tia in una glaHdo,\ and Vidal states that he observed
a similar circumstance. This condition is simply a
variety of hypo- or epispadias, as the apertures may
happen to be placed.

Age in its relation to sterility has already been
referred to {mde Chapter iii,).

Sterility from Diseased Conditions of the Ke-
PRODUCTivE Okgans.— But semen may be naturally

* SohuTiek (Obsen'. lib, iv. 2, 8) rtlnteet the caae of a double penia, and alao
Weikard, BiuIInger, Mark, aTjtl RichenmcL
t OljstrvatioiiH Chirurgicales.
t Elementa Phywiologiar, t, vii. lilf. xxvii, p. 47u.

200

ON THE FUNCTIONAL DISEASES OF THE

formed, aud sterility be occasioned by obstruction to
its commnnication witli the vc^icnlai and urethra.
Thus, in cases of gonorrhtxal epididymitis the vas
deferens may become occluded. And if double,
sterility inevitably ensues, while this condition lasts,
though in such cases fluid may be discharged from the
prostate and vesiculce in eoilu. Semen may be perfectly
formed iu such cases, but it remains imprisoned* As
the result of interesting experiments on dogs, M.
Gosselin found that, after ligature of the vas deferens,
spermatic secretion persisted for sixteen months; and
that the obliteration of the epididymis is capable of
being removed. This result, of comse, cannot be
predicted in all cases»

M. Gosselin has collected seventy cases of this
nature. In fifteen, the epidiilymitis dated from a few
weeks to a few months, and in all of them the indura-
tion was permanent. There was no modification of
the genital functions in any respect whatever, save the
absence of spermatozoa. In two cases the sperma-
tozoa reappeared — in the one at the end of eight
mouths, after a second epididymitis, the first occurring
six years previously; in the other after tiix mouths
time, likewise after the appearance of a second epi-
didymitis, the first occuiring eleven months before.
Of these fifteen cases, thirteen were lost sight of.
Of the remaining five, of the twenty, they were cases
of double epididymitis. The disease in one had been
contracted twenty years before; the induration per*
sisted in the one side Imt was absent in the utiier, and
the fiuid ejaculated therefore contained spermatozoa.
In the remaining four the imimiition persisteil, and the
spermatic filaments were consequently absent.

URINARY AND REPRODUCTm: ORGANS.

In his edition of Curling's work, Gosselin adds five
more cases. In two the spermatozoa reappeared after
the absence of many months. In a third, where the
patient was under observation for three months, the
semen contained no spermatozoa. The two remaining
were cases of bihxteral epididymitis contracted in early
youth, and spermatic filaments were absent in the ejacu*
hited fluid. Patients were married for several yeai's,
but had no issue. Godart. has observed the removal of
the induration of the epididymis in cases in which,
however, fecundation was not restored. The indura-
tion, he asserts, may be seated in the loose cellular
tissue surrounding the epididymis, and the commence-
ment of the vas deferens, or it may exist between the
coats of the canal itself; rarely, if ever in its interior.
Godart believes that the deposition of the phosphate
of lime in the convolutions of the epididymis may, by
obUterating the vas deferens at its origin, gave rise to
spermatocele, the same as if caused by plastic exuda-
tion from an inflammatory state of the parts. It is
therefore concluded, that while the induration conse-
quent on doul.>le epididymitis may be removed, and
full procreativo powers be restored, in certain other
cases the arrest of the function prevents the reappear-
ance of spennatozoa.

According to M. Liegeois, a more favourable prog-
nosis may be formed, with respect to the return of
spermatozoa, in non-blenorrhagic than in the epididy-
mitis following gonorrhcea. Of eighty eases of epididy-
mitis, spermatozoa reappeared as follows :—

G(j8fielio, 25 cases, 5 returns of BpH^rniatozoa,
Godart, 35 „ 1 „ ,»

Liegeoin, 23 „ 2! „

202

ON THE FUNCTIONAL DISEASES OF THE

It is interesting to notice that, contrary to what obtains

in the case of other donble organs of the body, an affec-
tion of one testicle is apt to react upon the other, and
instead of the energy of the sound one being redoubled,
the very reverse occurs ; even atrophy may ensue.

The Treatment of induration of the epididymis will
consist in the inunction of mercurial preparations into
the part, and the internal administration of bicldoride
of mercury with large doses of the iodide of potassium ;
of which certainly not less than ten grains should be
administered thrice daily. Godart, by the aid of pur-
gatives and iodide of potassium, has succeeded in
removing these indurations after the lapse of ten years.
The most chronic case may, therefore, be taken in hand
with the prospect of success.

Sterility from Stricture comes properly under
this section, and not under impotency, where it is
usually placed. This constitutes the misemisifio re-
JInens of Mason Good, and is a more frequent cause of
male sterility than usually supposed* A stricture
w^hich offers little or no impediment to the passage of
urine, may, in the erect condition of the penis, where
the cahbre of the canal becomes so much diminished,
offer such resistance to the discharge of semen, that it
is forced back into the bladder^ and becomes mixed
with the urine. Deidier relates a case of a somewhat
similar nature, in which a fistulous communication
existed between tlie vesicula* seminales and the rectum.
In consequence of this condition, during intercourse,
no semen was emitted from the penis, but nearly all
passed into the bowel

UNARY Al

Sductive OHC

203

The cure of sterility from stricture will necessarily
1)e that of stricture itself; and of the last conLlition,
if ever found to exist, the usual treatment of fistula.

Tubercular Affections of the Testicles. — The
testicle, in common witli so many other glandular
structures of tlie body, is liable to tubercular deposit,
occurring more frequently in the epididymis. From
this, it is apt to extend backwards to the accessory
organs, the vasa deferentia, the vesicular, and the pro-
state. With respect to the bearing of orchitic tuber-
cular deposits on fecundation, ditferent opinions are
entertained. Godart is of opinion, that an individual
mth even one tubercular testicle is barren. In this
\iew, he is supported by Gosselin. Mantegazza like-
wise details the case of an individual suflering from
tubercular softening of the epididymis of one side, in
whom no spermatozoa were found in the opposite
testicle, though peifectly free from disease. In oppo-
sition to the conclusions, borne out by these observers,
M. Liegeois narrates the following case: — **A man
twenty-eight years old came to me," he remarks, '*with a
fistulous opening in the left scrotum. The probe intro-
duced here leads to the indurated and deformed epidi-
djmis. The aff'ection dates back five or six years.
This man, of apparent good constitution, presents none
of the signs of pulmunary consumption. His virile
faculties have notably diminished since the develop-
ment of the tumour. His semen, 1*50 giamme^ con-
tains frtjnr five to ten spermatozoa, under each prepara-
tion." This observation proves that the presence of
tubercles in one testicle does not al>oUsh the spermatic
secretion of the opposite side, but it also shows, that

204

ON THE FUNCTIONAL DISEASES OF THE

wlieo this secretion persists, it only does so in relatively
small limits.

Even one case invalidates an absolnte rule; and
while it may more frequently obtain that tobercnlar
deposit in one testicle abrogates the function of the
other, it cannot positively be asserted that steriUty
inevitably follows.

Influence of Disease on Fecundation.— Godart
has found spennatic filaments in the vesicles of patients
dead from pneumonia, Bright s disease, gangi*ene of
the lungs, typhoid fever, and peritonitis. Often in
cases of indi\iduals who had been ill from pneumonia,
variola, pleurisy, and scarlatina, and examined by him,
no change whatever was found in the spermatic secre-
tion. It is inferred the azoospermia, in consequence
of acute disease, if occurring in early life is only tem-
porary, while it is othenvise in advanced life.

With respect to the influences of chronic diseases on
the seminal secretion, very diverse views are hkewise
entertained. With regard to phthisis pulmonalis, I
have myself seen numerous cases, which have impressed
me with the conviction, that in these cases fecundation
is not impaired; nay, I should say the very reverse.

Godart tliinks that in cases of phthisis, occuiTing at
an age corresponding to the estal>lishment of the sper-
matic secretion, spermatozoa are absent; while he
admits that after puberty they are not. He believes,
further, with respect to tubercular orchitis, that sterihty
precedes the development of the local lesion by a year
or two.

Cancer, and other Morbid Growths, mav occur

TTRTNAllY AND REPRODUCTIVE ORGANS.

205

in the testicle, but with these diseases, in the present
instance, we are not particularly concernetl

There is yet another cireumstauce, which in perfectly
healthy individuals unquestionably causes azoospermia
and consequent sterility, viz., excessive coitus,''* Cases
are recorded in which seminal fluid has been examined
after a close succession of sexual indulgences, in which
the spermatozoa were diminished in proportion to the
demands made upon the testicle. It woidd appear,
therefore, tliat spermatozoa are not secreted as such —
at least in the form by which we recognise them — but
require a certain time for maturation. This may
certainly be a cause of sterility; and hence. Mason
Good remarks that ''abstinence by consent, for many
months, has, however, proved a more fi'equent remedy
than any other, and especially when the mtercourse has
been so incessantly repeated as to break do\\Ti the
staminal {sk) strength ; and hence the separation pro-
duced by a voyage to India has often proved successful."

It is from this cause that the Dysspermatismus
Serosm of Sauvages occm*s, His definition of it is,
*' Ejaculatio seminis aquosioris, adeoque ad genesim
inepti, qua? species est frequentissimum sterihtatis
vhihs prmcipium/'

It must be borne in mind that the sterility in many
of these cases is relative, as too frequent coition on the
part of the female may give rise to an irritable con-
dition of the ovaries and u terns, for contractions of the
Fallopian tubes and uterus, from the fundus to the neck,
may be excited by irritation of tlie lower lumbar and
first sacral ner\' es of the spine. This is no doulH the
cause of sterility in the majority of prostitutes.

♦ Vidi page 178,

206

ON THE FU

itf 31

Effects of Hydroc
Lannelongue* states
twenty-three cases i
spermatozoa were ft
seminales, although
healthy. In 1856 I
in five cases of hydro
observations made on
years old. One had
goose's egg; a second
as a fowl's egg. No
seminal fluid of eithi
teresting observation,
hydrocele, and whose
the spermatozoa reapp'
ture had been perfonin
sac refilling.

Atrophy of the test
mation of the organ \ u
by pressure, as from he

Sterility from DI^
Sterility from this caus*
currence. I have known
paresis, occasioning pr^ s
seminal emission. It exi-
suffering from morbus coj^
manner affected the pelvic i
tem. B. Schulz relates a *
twenty-eight years of age coul-
had been continued for an hoi
a case of aspomiatism in a maii

ft the end of vUdi ume the kii]y
i^ added eforyw to her femflj
r^cTOchildraL In a profesaonal
^I]^i;doi the father made it appear
(taetothecaoseamier

4 :iB loime are d ercry^if

■^

URINARY AND REPRODUCTIVE ORGANS.

207

liad never been able to ejeculate during coitus^ althougli
he had perfect erections. Semmal emissions occnned
duriog sleep in both cases.

The treatment of such cases must be based on the
particuhxr indications presented.

Somewhat akin to the foregoing condition is that to
which the old authors apphed the term entonic im-
potency. In this condition ejaculation of semen does not
take place during coitus, though seminal emissions may
occur during sleep. There is a siurexcitation of some
portion of the sexual system. Dr Cockburn relates a
case of this description. The patient w^as a Venetian of
noble family, who, thougli married to a fine and
healthy young lady, ha<l no seminal emission in the act
of sexual congi^ess, notwithstanding that there was
igorous erection, and involuntary seminal discharge
during sleep. He was greatly afflicted, as were also
his family, by such a misfortune; and failing beneficial
treatment at home, the Venetian ambassadors at the
difterent courts of Europe were requested to consult
the most eminent physicians in their respective
quarters. Under these circnmstances, Dr Cockburn
was consnltedp and divining the condition to be due to
excessive plethora of the vessels of the penis, and con-
sequent coarctation of the uretlu-a during coitus, which
possibly caused a seminal refluence into the bladder,
a condition he surmised not occurring during sleep,
he recommended lowering treatment, purgative medi-
cine, slender diet, &c., which were soon followed by
the desired issue.

Mason Good relates a case of a somew^hat similar
nature, which came under his ow^n notice, A young
hcMLlthy couple were married for seven or eight years

208 ON THE FtJKCTIONAL DISEASES OF THE

without offspring, at the end of which time the lady
became pregiuuit, and added every year to her family
until she had six or seven children. In a professional
couversation with Dr Good, the father made it appear
tliat the temporary sterility was due to the cause under
consideration. Cases of tliis nature are of every-day
occurrence.

That priapism, by which is to be imderstood persis-
tent erection due to disease, prevents seminal emission,
is known by the fact that in these painful cases, mas-
turbation has been actually resorted to for the removal
of the distressing malady, and in vain.

In the cases in which seminal emission does not
take place during coitus, the immediate cause is, doubt-
less, a spasmodic affection of the ejaculatory passages,
the prostate, and the perineal muscles. The treatment
is sufficiently indicated by this view of their etiology.

Epileptic Misemission occurs when, in persons pre-
disposed to epilepsy, or of a very sensitive nervous
organisation, a fit is occasioned by sexual congress. It
is said of several eminent men that epilepsy was thus
induced. Its treatment will essentially be that of
epilepsy.*

♦ Sauvttges, in his " NoBolagia Methodica, bou classes morborum '* (p» 230),
relates the case of aii individual who was for twelve yeara attacked, in the act
of copulation, with a spasm which extended throughout hifl whole \kk\}\ with
k>sa of feeling and eotificiousneas:— " Ita ut ilhuii pree oneri.s impotentia, in
alteram lecti partem i. xcutcre cot>eretiLr uator, et evacuatio BiH-muitia lenla
Uaccidoqufe veretro demiLai 8iiccedel)at, remittents corporis rigiditate." Tiasot
statea that he knew many analogona casea ; and Haller, ia his ol>8ervfltionB on
Boerhaave'ii InstituteaT refers to »eveTal Buch ca^ne^. Vidt^ also Didier, Quest
Meilic. an Epilepis Mercurius \^ta) ; Galen, De kicis aifectis. L v, c. vi. ; Henri
van Heers, Oh»er\'atioiiefl Metlicai oppido rtu-ae, Obi 8 ; Roerhaave, de MorU
Nerv. p, 462.

URINARY AND REPRODUCTIVE ORGANS.

209

Idiopathic Azoospermia. — ^There are cases in which,
independent entirely of structural or other disease,
there is an unaccountable absence of spermatozoa in
the ejaculated fluid* In the work of Hirtz of Stras-
burg, published in 1861, entitled " De la Sterilitie chez
rhomme," there ai'e narrated the cases of two robust
men, several years married, childless^ and presenting
no abnormaHty of the genital organs. Coition was in
these cases performed not only normally, but with
imusual vigour; yet, in both cases there was a complete
absence of spermatozoa* Hhlz observes, ^' A remark*
able thing, and upon which both have insisted, is, that
the ejaculations are never followed by the sense of fa-
tigue so generally ea^periencedm the physiological state,''

Notwithstanding the most nourishing dietary, and
the administration of the oil of phosphor, neither one
nor other had children. M* Mantegazza, professor of
General Pathology in Pavia^o-ef erring to the absence of
spermatozoa in the nriniferous tubes inspected after
death, states, that in 100 subjects of different ages, he
finds spermatozoa absent in nine times in one testicle,
and twenty times in both. The absence is, in some of
his cases, explained by material lesions, such as tuber-
cles of the epididymis and testes, and fatty and fibrous
inflammation of the epithelium of the seminal ducts, and
these cases, of course, cannot be regarded as cases of
idiopathic azoospei'mia; but in certain eases Mantegazza
was unable to discover any physical alteration, and he
arrives at the conclusion, that in " certain obscure cases
of steriUty during marriage, the fault may be in the
man, even though the development of his genital
organs should cause us to look to his wife for the cause
of infecundity/*

212 UN THE FUNCTIONAL DISEASES OF THE

CHAPTER V.

MALE IM POTENCY.

STNONTMa.— 'Ai/a<^i>SMna (Gr); AnapliroJisia (Lai); Impuissonce,
(Fr.); Olinmacbt (Ger,); Impotenxa {Ital.)»
Contents ; — Physiology of Erectiun — Psychical Caiises of I m potency —
Objective Causes of Impotency — Subjective CauBes of ImpoteBcy
— Treatment— Phy 81 cal Causes of Impot-ency — Bifurcation of the
Penia^Vicioua Directioina of the Penis— ilalfurmationa of the
Prepuce^— Malformations of the Bladder — Idiopathic Impotency
from Defect of Energy — Satyriasia— -Priapism — Symptomatic Im-
potency, (a) from Physiological Conditions; (b) from Pathological
States; Perverted Nutrition; Marasmus, Phthisis Pulmonalia ;
Obstinate Spermatic Discharges ; Chlorosis — Impotency from
Diabetes — ^Impotency from Affections of the Prostate, Keck of the
Bladder, and Yasa Deferentia — ^Anticipating Misemission — Impo-
tency from Affections of the Nervons System*- Impotency from
Toxoemia-^Epitome of the Treatment of Impotency.

The subject of consideration in the foregoing chapter,
sterility, was examined conformably to our definition
of procn?atim, in contradistinction to sexual incapacity.
In pui'suance of our plan, the latter now presents for
examination and discussion. It were an aflfectation
unworthy of cultivators of medical science to ignore
the comparative frequency of this troublesome affec-
tion, entailing a^ it does on the patient so much mental
suffering, and so calculated to compromise domestic
and social relationships. In the dominion of the
organic functions, sexual capacity, as we have seen in
the foregoing, is prompted by a stimulus apart from the
will, and to the extent that it is so, so is it apt to be per*

URINARY AKD KEPRODUCTIYE ORGANS.

213

verted by mental impressions, the temporary influences
of which may be mistaken for cases of genuine impo*
tency. Of this, however, more in the sequel

In order to conceive the bearings of pathological
conditions on this function, and to stablish the treat-
ment on a rational basis conformably thereto, it were
desirable to glance at the physiological processes
involved in the normal performance of the sexual act.

Physiologif of ErectiofL— 'Erection has for its point of
departure either a spontaneous incitation, instinctive
or voluntary, originating in that portion of the brain
in connection with the nerves of organic life, and the
organs of generation, or a direct excitation of the
generative organs, the glans penis, or the clitoris, and
thus transmitted by the nerves of sensation to the brain,
which influence in turn reacts on the erectile tissue
through the organic muscular fibres so abundant in all
erectile tissue. Under this influence the veins at the
root of the penis contract, and the arterial blood
accumulates in the cavernous body, the bulb and the
glans, occasioning the phenomena of erection. The
impediment to the return of the venous blood is
materially aided by the action of the ischio-cavemous,
and bulbo-cavernous muscles, which are so situated as,
under genital excitement, to compress the penis at the
root. When the penis is erect and introduced into the
vagina of the female, friction of the glans causes an
excitation of the sensory nerves, which is transmitted
to the cerebellum. Keflex action is thus called into
action, the semen flows into the urethra, the perineal
muscles, and Wilson's muscle in particular, spasmodi-
cally contract. Tlie semen in the urethra being
imprisoned behind by the verunwniammi^ Wilson*s,

214 ON THE FUNCTIONAL DISEASES OF THE

and the other perineal muscles relax through exhaus-
tion, being composed of striated muscular fibre, and,
consentaneous with each relaxation, the semen escapes
from the urethra per mitum. Such being briefly the
mechanism of erection and emission, it will be obvious
that the causes of impotency will vary according as par-
ticular portions of the sexual system may be individu-
ally influenced. These influences may be conveniently
examined in their psychical and physical relatimn.

Psychical Causes of Impotency, — Idiopathic im-
potency, which is more closely allied to the psychical
than to any other variety of impotency, and comes
properly under it, is a condition of extreme rarity.
Planqne quotes a case of this nature from the German.*
*' One would not have succeeded so well/* he remarks,
** with that impotent pei^on of whom Hartmann speaks.
He was strong and robust. Had large testicles, a
short and flabby penis, he neter had the power of
erection nor secreted semen, and had never experi-
enced the sentiment of love."

The various emotional causes of temporary impotency
(those of permanent impotency may be said to be
exclusively physical) may be classified as excess of
desire, an extreme respect for the object thereof,
antipathy, timidity, di^ead, or shame.t Hence Zacchias

♦ Epk Ger dec 3j an 4, obs. 85, p. 184.

t It IB mainkdued by some wrileni, that in order to proUfic marriages ft
psychical correapondeoce must exiat hetween the Dialeiux! femala M. \wj
accordingly remarks, ** There should be a certAin harmony between the sexes,
both moral and psychic-al j and this is manifeF't^d in the sympathies of inutinct
which, indci^endcntly uf beauty, makea u» pix'fer one person to another. The
sexes Bectetly wish tlieir union by a natural impulse which cannot he cx-
jdnined, and which in a mixed sociely rendera us more attentive to one peraon
than all the refit; and nature ina^pires m l>etter in thia respect ihim reason.

URINARY AND REPROBUCTmi ORGANS.

215

remarks, " Pudor quoque ejus rei catisa esse potest,
nam si mr erubescat coram spousa^ fiumquam cum ea
coibit" A fuither subdivision of these influences may
be made into sueh as are objeeAhey and such as are siib-
jecHve, and in this light a brief epitome of them will be
passed in review.

Objective Causes of Impotenct/. — By these influences
are understood influences originating in a condition
apart from the individual ; by the subjective^ influences
originating in, and felt by the indi\d€lual hmiself.
Thus, a man at the moment of attempting coitus finds
himself suddenly incapacitated; the one imder the
belief that he is under the influence of witchcraft, the
other finding that the female is at the menstrual
period, and the disgust thus occasioned gives rise to
his temporary incapacity. In the former the impotency
arises from a delusion^ in the latter it is based on
reality; in the one, the imagination is imposed upon by
a myth; in the other, reason has succumbed to the
weight of truth.

Of these, the first, are incontestably the most fre-
quent causes of impotency, embracing as they do such
a wide range, and are more frequently met with among
individuals of culture and intelligence. Montaigne, of
whom it may well be said, Tetegit fiihU quod non
ornamt, relates an example in point* A friend of his,
on being married, conceived the idea that he was under
the influence of sorcery, and thus impotent. He relates

This harmony coDmste less in similitude of temp-arament, age, &c, than in
diversity ; for if we remark, we observe a violent bilious man prefer a mild
and modeat companion, while a poafiionale impetuous woman fmda nvos^t
charma in a moderate, tranquil man ; ao that oue may he temj>ered hy the
other, whether they be too cold or too hot." CaBes of relative Rterility may
receive some elucidation in this maiuier.

♦ Fjuuli. I. I. ck XX. ed. ; de 1743 %, u p, li*5 et lOa

216

ON THE FUNCTIONAL DISEASES OF THE

the manner of cure as follows: — '* I had luckily in my
possession a piece of gold plate on which were engraven
some celestial figures against snn -stroke, and to remove
headache, being placed over the opper and front portion
of the head, and to hold it in this position it had attached
to it a ribbon to be tied under the chin. I advised the
Count to put this in use, that he would have the same
success as others, but that he ought boldly to go to
sleep. I would make him a friendly tuin, and spare
no effort to work the miracle which was in my power;
while, upon his honour, he promised me to hold the
matter absolutely secret. But when they brought him
his midnight draught, if he had not accomplished
sexual intercourse, he would indicate the same to me
by a sign. He had had his mind and ears so disturbed,
that his imagination was troubled, and he made me the
sign at the appointed hour. I whispered to him that
he should get up under the pretext of sending us away,
and he should remove my night dress and put it upon
himself, as soon as he had done my bidding, that it
would be necessary, when we were away, that he should
micturate, and at the same time repeat certain words
and make certain movements* That at each of these
three times, that he would encircle himself in a ribbon
which I put in his hands, and put carefuEy down
the medalion which was attached to it — the face in a
certain posture. That being done, having at th€ last
time tightened the ribbon, in order that it would not
untie, nor move fiom its place, and that in all assur-
ance he might return to his marital duties, not forget*
ting to thiow my robe upon his bed, in such a manner
as to cover both. These devices were the principal
means of cure, our thoughts not being able to free

URINARY AKD REPRODUCTIVE ORGANS.

themselves, this jugglery gave them weight and con-
fidence in the means employed," In short they were
attended with the desired effect.

One influence is thus to be counterbalanced by
another of a more agreeable nature, and by impartingj
with assurance, the certainty of success, to the patient.

SuwEcrrvE Causes of Impotency. — These causes
may be based on a purely imaginary beUef, or upon an
erroneous conclusion based upon the existence of a
real fact, refemng either to a remote date, or existing
simultaneously with the functional abeiTation.

Under the first category come most frequently
affections of the genito-urinary organs, a dread of
spermatorrhoea, varicocele, diseases of the prostate, &c.
Masturbation and excessive venereal indulgences fre-
quently inspu^e the belief. Roubaud mentions that he
had treated a case in which the alleged causes of
impotency existed hereditarily in three generations.
His patient affirmed that at the age of thirty, during
three generations, his family were affected with an
unfortunate affection of the genitals; nothing in the
extenial conditions of the organs indicated that con-
dition, and it was reqiusite to pay close attention to
appreciate a few painful symptoms. The principal
sign, and that which manifested itself first, was a
gradual enfeeblement of virility; my grandfather,
continued the patient, experienced the same some
months before his thutieth year; my father some
months after the same age, and I fifteen days before
my thirtieth biithday. Notwithstanding, as with his
gi^andfather, and father, the patient had not lost his
venereal desires, nor the power of erection; but the

218

ON THE FUNCTIONAL DISEASES OF THE

erections and ejaculation occurred only in solitude
either under the form of pollutions^ or brought about
by masturbation. The recollection of this supposed
hereditary malady inspired in the patient such a
feeling of shame, that the terror replaced the natural
desu*e, and abolished his generative energy. As may
be readily conceived, the range of the hnagination is
sufficiently extensive, and groundless dreads are con-
jured up according to the temperament of the indi-
vidual In the other variety of cases, sexual incapacity
is referred to conditions actually existing at the time,
or sensations thus experienced. Among the former
may be noted actual cases of varicocele, and in the
same category neuralgia of the testicles, vesiculce, and
prostate.

The treatmsnt of these cases is not without consi-
derable difficulty. If there be a condition apart
from the sexual organs, to which the impotency is
ascribed, then by directing treatment ostensibly to-
wards it, the confidence of the patient may be secured,
and improvement thus accompUshed. The cases in
which real or imaginary conditions of the sexnal
organs are alone believed to be at fault, present
greater difficulties. If the condition be purely imagi-
nary, it is useless, according to the opinions of the
most experienced, to insist at the outset upon pressing
this assurance on the patient; it is better by kindness
and tact to obtam his confidence, and secure his cure
through the instrumentahty of treatment, even if it be
subordinate to the psychical operations involved. Of
2ourse, actual disease, and the neuralgic affections to
which reference has just been made, must be treated
on general principles.

URINARY AND REPRODUCTIVE ORGANS.

219

Physical Causes of Impotency.— In the first rank
among the physical causes of impotency, is to be noted
entire absence of the penis. This abiiormaKty is very
rare, but some such cases are related by medical jurists
and others* Thus, Foed^r^"^ relates the case of a yoimg
soldier, in whom a fleshy excrescence existed in place
of a penis, and in which the ureters terminated. The
testicles were healthy. The excrescence enlarged under
erotic excitement ; and a white fluid escaped from it on
its being subjected to friction, Schenckt and Cattier|
have recorded similar cases. Belloc relates a singular
case in which the ureters terminated at the bottom of
the frtenum. The subject of this malformation was not
impotent; and strange to say, he had four children
resembling him, ttvo o/ivhom had tfie same malformation,
Zacchias, and Francis of New York, have related
similar cases, in which the individuals had offspring.

The following singular case came under the obsei'va-
tion of Nelaton.§ A midwife presented herself before
Nelatou, desiring his opinion as to the sex of a child,
which she carried, as she felt embarrassed as to the
declaration of sex to the authorities.

The child, born ten days previously, was perfectly
well formed in body, and sucked well A scrotum
existed in the usual situation, but there was a complete
absence of penis; its place being occupied simply by a
cicatrix. There was difficulty in determining at first
whether the scrotum contained the bladder, or testicles*
After an exhaustive examination, Nelaton found that
the scrotum contained testicles, and that on the left

♦ M^ecine legale t L p. 364. t Obaerv. Med. L iv. <x ix.

X laaaci Cattieri oba, Med. Borello Commiimcat obs. xix,
§ Gazette des Hopitaux, 1854,

220

ON THE FUNCTIONAL DISEASES OF THE

side there existed a hydrocele. The infant did not
appear to suffer in any way, and the question presented
itself,as to the manner in which micturition was affected.

Examination of the umbilicus revealed nothing
abnormal' and the only passage remaining for the
urine was the rectum. The midwife in being ques-
tioned regarding the dejecta, affimied that they were
always fluid, and seemed to contain urine. There was
thus a species of cloaca where the urine and fieces
combined prior to excretion.

Extreme size, and imperfect dsmlopment of the penis
have been described by writers as occasional causes
of impotency. Incapacity for sexual intercourse
from the former condition rarely happens; and then
the impotency must rather be regarded as relative
than absolute ; and from the latter condition equally
rare. Roubaud relates the case of a patient in whom
the penis was almost imperceptible (la grosseur d'un
piquant ordinaire de poc-epic), but which, by means of
a mechanical contrivance, and the normal exercise of
the organ, had acquired moderate dimensions,

M. Suedy saw at The Charite, in 1868, an individual
suffering from Addison*s disease so-called, and pre-
senting a remarkable arrested development of the
genital organs. At the age of twenty-eight, the penis
was not larger than that of an infant of four years
old. It measured, comprising an hj'pertrophied pre-
puce, but five centimetres in length. The scrotum
was very small and empty. A few silken hairs
covered the pubis. Venereal desires existed; the
>enis was capable of erection. Formerly, the patient
lad been addicted to masturbation; he never attempted
sexual intercourse, and ho never ejaculated.

UttlNARY AND REPROBUCTIVE ORGANS. 221

Bifurcation of the Penis* — This abnormality is
regarded by writers as causing sometimes impotency,
and at other times sterility. It is frequently compli-
cated with other bias of conformation. In an uncom-
plicated example of this condition which I saw in the
Anatomical Museum of Parma, the bifurcation was
confined to the root of the penis, and no physical
impediments to the performance of the sexual act
appeared to exist*

Vicious Directions of the Penis.— Abnormal direc-
tions of the penis, congenitalj or the result of accident,
may sometimes abrogate sexual capacity. The penis
may be curved upwards, downwards, or laterally. As
the result of accident the injury is usually confined to
the cavernous body or urethra. By Petit these affec-
tions are considered as usually beyond the resources of
medical or surgical art, and he gives the foUowmg
explanation of the morbid condition. The cellules of
the concave surface of the penis are smaller than
those of the convex ; the former, bound down by a
fibrous band, cannot assume dimensions equal to those
on the opposite side at the moment of the afflux of
blood; besides, the cavernous body of the concave
side is always shorter than that of the opposite side-
Whence it results, that operation cannot in any case
give to the caveraous body an equal length; there
is always then a deviation of the organ during erec-
tion.

Petit* gives the following post mortem examination
in support of his opinion. '' I have had occasion to
convince myself of the reaUty of this fact, by the

♦ (Eiivre» completefi 6tlit. l^aT n 7J7-7ia

222

ON THE .FUNCTIONAL DISEASES OF THE

examination of the body of an infant which I saw on
the day of its birth, and on which I did not wish to
operate. The infant was brought to me on many
occasions during Life, in the expectation that I might
be able to devise some means to cure the hypospodiaa,
and accompanying cmr\atnre, I always said to the
parent that the deformity was irreparable. The child
died of inflammation of the lungs at the age of from
ten to twelve years. I desired to make an examina-
tion of the body. I discovered at the outset one of
the cavernous bodies; I opened it, introduced into it
a tube by which I inflated it; the penis enlarged
and cuned itself downwards; in order to maintaia
that conformation, I applied a hgature to retain the
air, dissected the penis, and found the urethra verj'
short; it was ligamentous, incapable thus of extension,
containing as it did no cellular tissue. I then carefully
separated the two cavernous bodies; notwithstanding
this separation, the cavenions body enlarged very
httle; the penis remained curved, and I judged, c<m-
sequent ly, that the condition of the urethra alone was
not the sole cause of the malformation, but that the
cavernous body participated in its production. IlaviBg
entirely separated the cavernous body, I found, on
dnxwing each extremity, that I was unable to elongate
the body ; and inflating it anew by the first aperture
that I had made, it assumed, as before, the curved
form, vhat I had before attributed to a ligamentous
band, which existed at the situation in wliich I had
separated the uretlmi, I separated this band to the
extent that I was able, without opening the cavernous
body; and even cut transversely the fibres which I
had been able to raise; in spite of all that, and not-

URINARY AND REPRODUCTIVK ORGANS. 228

withstanding that I forcibly inflated the cavernous
body, it retained its curved form. Having finally
inflated it, I retained the air by means of a ligature,
and allowed the specimen to dry. Some time after-
wards, I cut the cavernous bodies, the one longitudi-
nally, the other transversely. I found that the curved
figure of the cavernous body was due to the fact that
its cellules were almost blocked up in the concave
surface, and that gradually they enlarged on to the
convex jpart, where they were larger, or that the
cellules had been originally of this form, but that the
one portion of them being bound down by the urethra
and ligamentous band, they were thus prevented
distending as the others."

Congenital curvatures of the penis, to such an extent
as to prevent sexual intercourse, are incurable, and the
impotency thus occasioned absolute.

Malformations of the Prepuce. — It is not usual
that malformations of the prepuce exist to such an
extent as to cause impotency. Congenital imperfora-
tion of the prepuce is occasionally met with, and will
require at once surgical interference. Pathological
conditions may occasion temporary impotency, such as
syphilitic condylomata, oedema, erysipelas, &c.

Phimosis, and its complication, adherence of the
prepuce to the glans, may sometimes, in like manner,
occasion temporary impotency, as likewise, fungous
enlargement of the cavernous body, scirrhus of the
prostate, enlargement of the verunumtanum^ and
diseases, or congenital defects of the fi:'8enum. All
these conditions must be treated on general principles
conformably with the indications presented.

224

ON THE FUNCTIONAL DISEASES OF THE

Malformations of the Bladder. — ^As a rule, cases of
ectroversion of the bladder are attended with complete
impoteiicy, and not unfrequently mth some variety of
epi- or hyposijadias. An exception to this rule came
under the notice of M, Huguier at la Ckanid,^ " That
organ (the penis) has the appearance of a long tubercle
of about an inch in length; it is furnished with an
imperforate glans, and the urethra is wanting entirely.
The bulk of the penis is formed by cavernous bodies
rudimentarily developed. The patient asserts that his
sexual capacity is perfect, and that the venereal orgasm
is followed by seminal ejaculation."

A somewhat similar case came imder my notice
lately, for the second time, having seen the patient
first while studying at the University of Glasgow*
A M'D., set. 32, has complete ectroversion of the
bladder. The bladder, occupying the pubic region,
presents the appearance of a red tumour, on both sides
of which the ureter opens, and urine escapes in jets^
at short intervals; more urine escapes on the right
side. On the under surface of the bladder a rudi-
mentary penis exists; there is no urethra. The glans
resembles somewhat a chestnut, is flattened, and larger
transversly than longitudinally. There is a perfectly
formed testicle in each side of the scrotum, and patient
has sexual desires. Involuntary seminal emissions
take place, in the waking and sleeping state, two or
three times weekly, the fluid coming from the junction
of the base of the penis and protruded bladder, and are
attended with sexual orgasm. Under sexual excite-
ment the penis elongates and becomes erect, to the
extent of an inch and a-half The testicles, patient

♦Gazette de« llopitaux, IH40, N*>. 117, p. 467.

4
I

URINAKY AND REPKODIICTIVE OUGANS.

225

iwell under excitement, and the semen is quite
narmal In fifty-five seconds ingredients taken into
the mouth appear in the urine.

Sometimes the penis presents on its superior surface
simply the lower portion of the urethra, bridged over
by a narrow band, as in a tyi>ical case of this variety
which I have seen at The Musee Dujniytren, Paris.*
A somewhat similar case to this one is reported by
Chopart.t " A man about thirty years of age died at
the C/iante, of malignant fever. His generative
organs presented the following peculiarities: — From
the sjmphisis of the pubis the length of the penis was
but one inch, and from the root of the scrotum two
inches. The penis was flat on its superior aspect^ and
convex on tlie under. The superior surface presented
an elongated gutter, extending from the point of the
glans to a red body situated between the pubic bones,
whence the urine from the posterior wall of the bladder.
The gutter was larger at its origin ; and in the middle
portion of it was seen the rerumontaimmf and the
orifices of the ejaculatory canals and prostatic ducts.
The glans penis was divided in two parts. Each
cavernous body, instead of being incorporated together,
was simply applied the one to the other, and they were
not united save at their anterior extremity at the base
of the glans. So incomplete was the union that air

♦The description appended to this case is as foUows:^ — '* Homme de
Tingt-aijt ana. La verge f|ui eat aasez bifeii devi^!opi>i^e, quant au volume pre-
sente, a aa parte superieare une gonitis conime creua^e entr^ les deux corps
cavertieaux ; Fextromit-e po^fterieure s'eiigage uu-deanousa de ai'cade du pubis,
jjonr ga^uer la vessie ; k 2 centimetres de rextremitd anterieure Ba trauve
line bride de 2 millinieLre« de lari^^e, qui relie en ce point lea deux cotea de la
gouttiere. (M. Blandin, 1848.)

t Traits des Maladies dea Tuiea Urinaires> Paris. 1830,

2*26

ON THE FUNCTIONAL DISEASES OF THE

Ibrced into the cavemoiis body did not pass into the
other."

All example even more reniarkal4e tlian the fore-
going is reported by Devilleneuve.* In thii* ease,]
in addition to the malformations, there was a per-
fect absence of venereal desires. FoUouing the do-
scription of the ectro version, the subjoined account
occm's: — "Immediately under the tumour wa.s an
unformed penis, short* and slit on its upper surface
for'its entire length. The glans W4us easily recognised.
Its colour and its spongy substance were natural;
it contained some small sebaceous lacuna?; the penis j
seemed as if inversed, for un it^ sui»erior surface the!
traces, of an open urethra existed. Some observersi
alleged to have seen at the commissure of the penis and
of the tumour, a superior portion of the urethra which
was not cleft as the other portion of the urinary canaL ,
It was not easy to verify this allegation, on account of j
the obscurity and of the pain which the examination [
caused to the patient. The remaining portion of the
urethra was never explored; only the small portion
the anterior part of the cavernous body was visible,
the rest being hidden in the hypogjistrium. There
a complete absence of carnal desires."

Such infirmities, it need hardly l)e remarked, must
be deemed incunible. ^d

Idiopathic /wjfotencj/ in conaeqnenre of Defect fl^^
Enetyp^ has been separately described by Ron baud*
There does not seem any reason for this ditferentiation^
a^ the condition in question is either due to some of th€
psychical causes already referred to, or to some of the'
physic4il ones above dise^ntiMj upon, or to be refeired

URINARY AND REPRODUCTIVE ORGANS.

227

to in the sequel On the other hand, ewcess of energy
may lead to, if not be the direct occasion of inipotency;
and this brings us to examine cursorily these psychi co-
physical sexual abenations denominated saiyriams,
erotomania^ and prhfpmiL

Salj/ria.<is, — (Efthenis, impudensque veneris cnpidi-
tas libidinosa penis tentigine, — Sanraffes). (Desiderium
Veneris enorrae. — Limuem). (Est morbus proprius
viris, cujns prtccipuuni syniptuma est eifrmnis inipu-
densque Veneris cupiditas, cum lil^idinosa penis tenti-
gine; priapismus caret cnpiditate libidinosa. — Sognrt),
Satyriasis, it will at once occur, cannot strictly be
regarded as an immediate, but rather a determining
cause of impotency, even as sexual excesses act simi-
larly. It is an exceedingly rare affection in cold and
temperate climates, and is as frequently a cause of
death itself as of impotency. This state must not be
conf(jun<led witli erotomauhi, whicli is purely a psychi-
cal aberratii>n characterised by morbid sexual desires,
but miattended irith ereetioiL It is common to l)oth
sexes. Most frequently the genital syncope, as it may
be termed, exists only in the presence of the object of
desire. Erotomania is consequently one of the forms of
relative impotency. In the female, the malady is usually
determined by local conditions, such as plethora of the
ovaries, and associated organs, from ungratified instinct
or disease. It was regardeil by the Greeks as a punish-
ment on females who neglected the rites due to Venua'^

Priaphm is a longsustained and painful erection of
the penis, and without venereal desires. From the
existing pain, and the attendant sequences, it may

♦ Vidt Es^uirol det* Maladies MenUlee, 1838 ; Tardieu, Eiudt Medico-
leyah, 18«S ; Marc, De la/ofie, 1840.

ON THE FUNCTIONAL DISEASES OF THE

properly enough be regarded as an occasional cause of
impotency. Reference has already been made (pp. 81,
82, 112, &c.) to the etiological considerations relating
to this state. The causes of priapism are numerous;
accidents to the spinal cord and brain, the employ-
ment of genitourinary excitants, gononhoea, vesical
calculi, herpetic eruptions of the penis, &c., and its
treatment will correspondingly vary. Should the
inflammatory symptoms be of an aggravated charac-
ter, gaugi-ene ought to be guai^ded against by local
blood-letting, and the application of evaporating lotions.
In some cases not only is seminal emission not possible,
but there is likewise retention of urine.

SvMProMATic Im POTENCY may be conveniently ex-
amined, 1st, in its relation to certain physiological con-
ditions; and 2d, relatively to certain pathological states.

Foremost under the first category comes the question
of age. Tliis has been sufficiently discussed in Chap* III.
(page 65, et pamm)^ so far as the latter period of life is
concerned, and for other relative information, the reader
is referred to the section treating of Male Precocity.
For tlie relations of constitution and temperament to
the subject at issue reference is also made to Chap. III.

From Patholo(jira! States, the first Miriety of impo-
tency claiming attention is that due to perverted
nutrition; and of this nature the first species to which
reference must be made is Obesity. This condition
operates in relation to the subject under consideration
in a twofold manner. There can be no doubt that an
abnormal accumulation of fat is due to perverted tissue
change, and that this condition in turn, or operating
in conjunction with its immediate cause, reacts pre-
judicially on the nervous system, and as experience

miNARY AND REPRODUCTIVE ORGANS.

229

amply demonstrates, on the intellectual factilties and
the organic fiinctions. From this cause alone, im-
potency is a common expression of the dyscrasia in
question. On the other hand, it may oppose a physical
obstacle to the performance of the sexual act

Of the treatnmnt of this variety of impotency little
need be said. It will be the treatment of the constitu-
tional, rather than the local derangement which will
claim consideration.

Marasmus, in contradistinction to the foregoing con-
dition, has been described by authors as a cause of
impotency ; but marasmus being itself a symptom, it is
more scientific to regard its causes in the light men-
tioned. It should be premised, however, that all
conditions which induce marasmus do not in like
degree inipare procreative capacity, for notably in cases
oi phthisis pulmmialu the contrary obtains.

In tabes dorsalis there is usually a complete sexual
debility. The penis is flaccid, the testicles atrophied,
and neither psychical nor physical stimulants move
the genital sense.

Obstinate Sperinatie DischargeSj it need hardly be
necessary to remark, are a frequent and distressing
cause of impotency.

Chlorosis. — In considering the treatment of ^^-
morrhagia {Chap. III.) we endeavoured to indicate the
modus medendi of iron preparations in that disease ;
and agreeably with the opinions therein expressed, we
now find that chlorosis is to be regarded as one of the
causes of impotency. That chlorosis is a disease
peculiar to females is an opinion long grown obsolete.*

* Noureftux ^l^ments cle patliologie, Parie, 1844 ; R^portoire g^n^ral des
Sciences Metlicales, d^xi . CMqtosu^ Pam, 1844 ; Prefise M^«de, No. 54,
1837 \ (Uzac), Be la chlorose chei rkomme, Paris, 1853.

ON THE FUNCTIONAL DISEASES OF THE

Of the successful employment of the tonic, and ferini-
ginous treatment in this state, and attended with inipo-
tency, Koubaud relates the fullowitig case: — ** A young
man, twenty-five years of age, a native of Poland, lean,
pale, and with impaired locomotive power, presented
himself to nie on account of impotency. He com-
plained for some time prior of derangements of the
digestive organs, of such an aggravated nature, that
normal digestion had almost become impossilile; consti-
pation was constant, bnt there existed no pain in the
region of the stomach or abdomen. The nervous func-
tions w*ere still more manifestly impaired; j)hysical sen-
si!>ility had become so exaggerated that the least change
of temperature or the least movement affected him in
a painful manner. The moral sensibility was no less
affected, for the patient was unable to read, without
weeping and being profoundly affected, not only a
novel, but the ordinary news]>apers; sleeplessness
existed, and opium was impotent to remove it,

*' In the midst of all these disorders, the intellectual
{acuities were affected, the patient being possessed
of a profound hypochondriasis, incessantly impelhng
towards suicide. To these symptoms were added those
peculiar to chlorosis, such as blanching of the skin,
Haccidity of tlie muscles; and, with the sole exception of
an absence of a carotid fjmiij there existed all the sjTUp-
toms characteristic of chlorosis.

'*The genital organs pi-esented externally nothing
pecubar. The penis and testicles were of the natural
size^ and the skin of the scrotum contracted under the
excitation of toucli and cokl Venereal desires were
absent, and sexual ideals inspired not quite disgust, but
an indifference not far removed from actual repulsion.

URINARY AND REPRODUCTIVE ORGANS. 231

There were no erections, under any form of excitation.
At distant intervals, and under the influence of lascivi-
ous dreams or amorous imaginings, ejaculations took
place, sometimes in the state of waking, and at other
times during sleep, occasioning a certain orgastic feel-
ing, but leaving, in consequence, a general lassitude
which lasted during several succeeding days. All the
perversions of the genital apparatus came on simul-
taneously with those associated with the digestive
derangements, and the constitutional enervation. Prior
to the accession of the latter, coitus was accomplished,
if not with energy, at least with regularity, and without
any dread.

" In presence of all these cirumstances," says Rou-
baud, ** I did not doubt that I had to do with a case
of impotency from chlorosis, and the treatment was
accordingly determined. Quinine was at first given* in
order to give tone to the digestive functions, and
following this medicine, ferruginous preparations were
prescribed along with the general treatment appro-
priate to chlorosis, and a residence in the countay.
No special treatment was applied to the genital
organs; under the influence of the general treatment
of chlorosis, their energy was nevertheless restored,
the venereal desires returned, and in proportion, the
melancholy and the suicidal tendencies disappeared.
Two years afterwards the cure was permanent, and
the patient enjoyed in perfection all his functions."

Ricord has described a syphilitic chlorosis. The
bearings of such an affection on treatment will be
sufficiently obvious.

Impotency from Diabetes. — Intimately associated
with the other manifestations of general debility in

232

ON THE FUNCTIONAL DISEASES OF THE

diabetes, sexual impotency frequently co-exists. It is
not to the mere marasmus that this effect is to be
ascribed, for we know that in cases of constitutional
debdity, sexual impotency is not necessarily an
attendant phenomenon. In the instance under con-
sideration, this symptom is obviously due to the
derangement of the nervous system, of which the
arrested combustion of sugar is the paramoont patho-
logical aberration. With the diminished combustion*
there is in consequence an aiTested secretion by the
most of the secretory organs; the former is made
manifest in the diminished tempei^tm'e of the diabetic,
and the latter in the dryness of the skin, a notable dimi-
nution in the secretion of saliva and tears, constipation j
of the bowels; and Dupuytren and Thenard have
noted that old nclers of the thighs cease to suppurate,
and dry up. The diuresis is due to the presence in^
the blood, to an exiiggerated extent, of an insuffi-
ciently oxidised product of eremacausis, and itsi
stimulating effect in being so presented to the kidney, j
It is more than likely that the secretion of semen laj
diminished as the other secretions referred to, andJ
that it is to this, and not directly to the bodily]
enfeeblement, that the impotency of the diabetic is taj
be ascribed. M. Valleiux,t accordingly remarksj
under the article Glycosuria, ^* The generative func-1
tions are profoundly troubled. There are no erections;
there is no venereal desire ; sometimes even, according
to some authors, the testicles become atrophied anc
the scrotum flabby."

That the impotency is direct, and not consecutivej

♦ Vidi Author*a ** ObservatioiiB on Therapeutics and Difleafle.**
t Guide Aw M^iecin Praticien, 2d ©d. t. iii p. M9,

URINARY AND REPRODUCTIVE ORGANS.

233

upon the marasmus, has been shown, among other
cases, by the one communicated by Mialhe, and
Contour,* to the Academy of Medicine. In their
patient, the impotency had supervened antecedently
to the general enfeeblement and marasnms, and coin-
cided with the diminution of the other secretions.

Impotency from Affections of the Prostate,
Neck of the Bladder, and Vasa Deferentia.—
{Anticipating MisemissionJ) — In treating of spermor*
rhagia it was pointed out how frequently an inflamma-
tory condition of the prostate and adjacent portions
of the urethra were operative in maintaining pre-
ternatural seminal evacuation. In this place it
remains simply to remark, that not only does this
state give rise to spermorrhagia, but it may be the
direct cause of a distressing form of impotency, to
which the old writers applied the characteristic term
Anticipating Misenmsion. That I may not expose
myself to the charge of ignoring opinions contrary to
any I have already adduced, or may yet advance in
the sequel, and coming from any one whose opinions
carry respect and consideration, it is but right,
therefore, that I should assert that, in a vigorous
literary onslaught against a Mr Dawson of London,
Dr King Chambers contends that, ** over-emission,
when attempting connection, arises in sensitive persons
from allowing the mind to dwell too much upon it"
I may here remark, that I yield to no one in my
sympathy with the honourable motives by which Dr
Chandlers was so palpably and so justifiably actuated
throughout this controversy : but one is apt, in the

* Bulletin de rAcaddmie de M^tecine, 1B44.

234

ox THE FUNCTIONAL DISEASES OF THE

inipetiiosity of a righteous crusade against any form
iniquity, to be too exclusive, or too dogmatic in bis
assertions ; and while I believe with Dr Chambers, that
in a consideral^le proportion of those eases the condi-
tion is temporary, and due to transient emotional
causes, I am nevertheless persuaded that his assertion
is too absolute, for in many cases the malady is of s(|H
persistent a nature as to indicate genital hypenesthesia^
as its cause, and is alone curable by means so directed.
Unfortunately, in all books* in the English language
on the subject of genital functional derangements, the
most extravagant and unphilosophical prelections are
indulged in, and thus containing much that is pemi-^
cious and overdrawn, they cannot fail to have a cor^H
responding effect on all who come under the spell of
their perusab M

In referring to this condition, Tissot remarks, '* tha^^
symptom is very frequent among pei^sons enfeel>led (l»y
sexual excesses), and it contributes to produce impo-
tency; the least touch causing an erection, which is
immediately afterw^ards followed by a seminal dis-
charge/'

Dr Tanner refers to the following case of misemissu}^
anticipans. " A young man about twenty-five years i
age, has never had sexual intercourse, but he confesse
to havhig practised masturl>ation since he was thirteen*
or fourteen years of age. His penis is normal, both
testicles are of a proper size, they feel healthy, and they ,
are situated in the scrotum. ^|

• There is one honourable exception, which, in juatice to the author, 1 am
bound to mention. Making allowance for legitimate diffei-eoce^ of opinioD oti
minor jiointa, the little Ijook of Mr Courtenay on thw subject ib unobjection
able*

URINARY AND REPRODUCTIVE ORGANS. 235

'* He enters into a matrimonial engagement; but un-
fortunately a period of eighteen months or two years
must elapse before he can fulfil his contract. During
this interval he sees his future wife daily, and in spite
of his resolve not to encourage any feeling of excite-
ment, yet repeatedly he sufiers from seminal emissions.
At the time of marriage he is nervous, weak, and has
fits of mental depression, while his wedding trip is
rendered perfectly miserable on finding that immedi-
ately he attempts to have connection, an emission
takes place, and the erection ceases. Night after
night his efibrts prove unavailing; until at the end of
two or three weeks he becomes thoroughly ashamed
of himself, afraid of his wife's female relations, and
terribly depressed."

Is this the production of a luxuriant imagination?
Where this accusation begins, in the case of an
honourable man, argument ends. If this is a typical
case, as I believe of many that have come under my
own notice, and I am sure the experience of not a few
will furnish similar cases, is it a normal ? I trow not.

It is a condition which might justify divorce, and to
remedy which, it is as much the province of the
physician or surgeon as to extract a cataract or am-
putate a thigh.

The Treatment of this condition will be that of
chronic prostatic hypersesthesia as already referred to.

Impotency from Affections of the Nervous
System. — In general teims all afiections of the nervous
system are divisible into two primary classes, viz., 1st,
Such as are associated with a material lesion of a
nerve or the nerve centres; and 2d, Such as are not

236

ON THE HJNCTIONAL DISEASES OF THB

found co-existing with any apparent lesion. To the
latter the term 7ie?irosis more especially applies; and it
has been further subdivided according as the afiection
relates to the organic functions of the body^ or thosq^
termed intellectual and more pecidiarly central. ^

Relatively to sexual impotency, as already indicated,
aberrations of the nei'vous system, may operate (a)
through affeMions of the nervous rent res, and (b) through
diseases of the ?ierves of cornmuuication between th^
tierwus centres and the sexual sf/stem. ^|

The former category comprises almost all organic
affections of the brain and spinal cord, such as chi-onic
hydrocephalus, remoliissement, cancer, tubercle, &c.
How these states would thus operate by causing a
paralysis of the sexual nei'ves, a consideration of the
physiology of erection already referred to will make
abundantly obvious. As Foddre"^" remarks, ** Local
diseases of the vessels (of the penis), of the nerv^es, or of
the muscles of the organ, affect sometimes the cellules
of the cavernous bodies so that they do not fill suffi-
ciently with blood to produce erection, and thus
produce an atony approaching to paralysis. Chaptal
and Gesner have cured cases of atony of the penis, of
this nature, by repeated immersions in a decoction of
mustard seeds. Weikard has had the same succea^
with the internal administration of musk, in the caa™
of an octogenarian. Other physicians have employed
cold baths and iron^and have thus succeeded in subjects
rendered impotent by excessive sexual indulgences or
masturbation. Mahon has obtained cures by causing
the parts to be bathed in a mixture of the mineral water

♦ Tmiti fie Medicine legale et rr hygiene publique, t. i. p. 382.

URINAUY ANB REPRODUCTIVE ORGANS. 237

of Hofthian with water, and finally enveloping them in
cloths impregnated with the same mixture/'

Impotenrif from Diseased Coudifions of the Nerves
of Communmition. — ^These conditions comprise degen-
eration of the nerves, accidental, or pathological sec-
tion, compression, and influences operating through
reflex iiritation fi'om abnormal states of neighboming
organs.

Impotenq/ from Organic Neuroses occurs rather
as a symptom of certain conditions of mental aliena-
tion, and its etiological bearings are sufficiently ex-
plainable by the considerations advanced above, in
treating of psychical impressions as causes of impo-
tency.

Impotency from Tox.^mia. — Certain substances
introduced into the blood so change its constitution as
to occasion impotency ; and these may consist of either
animal poisons, or products of the vegetable kingdom.
To the foimer belongs the ^pphUiiir. poison. Accord-
ing to Kicord, as we have already seen, it may operate in
this manner by determining in the first place, chlorosis.
In other cases its action, in this wise, is not developed
until it has invaded the entire system, and then by
causing paralysis, due either to degeneration of the
nerve centres or to exostosis, &c.

Sometimes in syphilitic cases the semen appears to
lose its fecundathig property, while the sexual fmic-
tions retain their perfect energy.

Lead Poisoning is an occasional cause of impotency.
According to Orfila, lead is not poisonous when in
mass or in coarse pow^der; it is only when transfbrmcd
into an oxide in the digestive canal that it so operates*

238

ON THE FUNCTIONAL DISEASES OF THE

Its influence on the genital organs is characteristic.
According to Tanqnerel, it attacks the testicles, the
penis, the spernmtic cord, the uterus, the vagina, and
the breasts; and gives rise to gnawing pains in these
organs* Most frequently, this autliority* remarks, the
two testicles are affected with pains at the same time;
it is very rare that one alone is affected ; but frequently
one is more painful than the other. While the pain is
most severe the organs retract towards the groin. If
the left testicle is the seat of the greatest pain, it comes
to occupy a position nearer the inguinal canal than
that of the right, a condition the reverse of the
normal Compression ftTquently diminishes the pain;
thus patients relievo themselves by compressing
the testicles in their hands; suspension of the organs
is attended with a mitigation of the pain. Tume-
faction and redness of the painful organs is seldom
witnessed.

In seven cases Tauquerel found the pain seated
at the root of the penis; the entire portion of the
f>rgan was painful in twenty-four; in some cases
there is retract i(»)i of the penis t(» such an extent
that it is ahnost hidden in the skin of the scrotum,
especially when the latter is not contracted. Venereal
desires and seminal ejaculation were never observed
in the cases wliieh came nnrler Tanquerel's observa-
tion.

Impoteney and arthralgia have been known to
supeiTene on the drinking of beer from leaden vessels.
The treatment of impoteney so caused will he ob\iously
that of lead poisoning, viz., the administration of iodide
of potassium, and the use of galvanism.

♦ Traits de Toxicologie, 5e ed. t, i. p. 822.

urinary and reproductive organs. 239

Impotency from Antimonial and Arsenical
Poisoning.— Workmen exposed to the inhalation of
the fumes of antimony have been observed to become
in this manner impotent. Orfila, in referring to this
subject, quotes Lohmerer to the following effect.* This
authority, it is remarked, " has seen four individuals
who were frequently exposed to the fumes of antimony
in an establishment where tartrate of antimony was
prepared on a large scale. The chemical form of the
fumes thus inhaled was that of antimonic acid, and
the chloride of antimony. Lohmerer observed the
following symptoms: — Pains in the head, diflSculty
of respiration, pain in the back, mucous and sibilant
rales in the chest, difficult expectoration of tenacious
mucus, insomnia, abundant sweats, anorexia, diarrhoea,
dysuria, with a discharge of irritating muscus from the
bladder, atrophy of the penis, disgust of sexual relations^
aud complete impotency; pustules existed on different
parts of the body, particularly on the thighs and
scrotum; there was pain in the testicles, and atrophy
of them corresponding with the condition of the penis."
It is not to be doubted, Orfila adds, that the pro-
longed inhalation of these vapours suffices to cause
death; but he thinks that some of the effects thus
occasioned are due to the inhalation of arsenical vapours
as well, a metal in conjunction with which antimony so
largely exists in the condition in which it is used in
commerce. According to Lohmerer, antimonial poison-
ing, and consequently the impotency thus occasioned,
ought to be treated on the antiphlogistic method, with
milk, and finally by opium, tannin, and the internal
administration of quinine.

♦Traits de Toxicologie, t. i. pp. 660 et 651.

240

ON THE FUNCTIONAL DISEASES OF THE

Impotency from the Toxic Effects of Iodine anb
Bromine.-^ One of the most certain effects of the pro-
longed use of iodine, in large doses, is atrophy of the
the glandular system. Acting in this manner on the
testicles the abuse of iodine may be a direct cause of
impotency. Roubaud relates that he has seen it
thus induced. The patients were plitliisical, and
the impotency ensued in the course of treatment by
Chartroule's method, which consists in the mhalation
of iodine vapour. In one of the cases venereal disease
remained, but the penis was incapable of erection,
notwithstanding that tlie testicles retained their normal
development. In the remaining three there was
atrophy of the testicles and sexual frigidity. Iodide
of potassium, in large cases, exercises a similar influ-
ence. Bromide of potassium, I have known, in common
with many others, to cause temporary impotency.

With i-espect to the ti'eatmeut; of these causes, w^hen
the testicles are not atrophied, the mere suspension of
tlie influence of these agents is sufficient to cause
recovery. Good diet, country air, and direct genito-
urinary stimulants, are indicated in the more grave
cases.

The influence of camphor on the genital system has
been alieady referred to in the treatment of sper-
morrhagia. Its prolonged use may likewise occasion
temporary impotency.

EprroME OF the Treatment of Impotency. — The
treatment of impotency must vary as its cause is pre-
sumed to be psychical or physical. If the former,
attention must be judiciously directed rather to the
mental aberration, than to the local incapacity, though

UKINARY AND REPHODUCTrVE OKUANS. '241

this may be accompHslied by an ostensible treatment
of the latter. Shonld symptoms of constitutional pros-
tration predominate, then general stimulants and
nervine tonics are indicated, such as strychnine, phos-
phorus, &c. Cantharides must be careFuUy if at all
employed. Cold bathing and electricity (the constant
current) are of undoubted efficacy in the treatment of
irapotency. In general termSj good feeding, fresh air,
and moderation in all respects must be observed.

MALE PRECOCITY.

Even as history affords so many notable examples
of mental precocity, so does medical literature furnish
peculiar and unfortunate examples of genital precocity,
and these may be referred to in this place, as well
from their interest in a physiological point of view, as
for the purpose of reprobating the public exhibition of
such unfortunate children. The earliest notice of a
case of this kind with which I am familiar, is that
referred to by Pliny (Nat. Hist lib, viL c. 171). This
was the case of a boy at Salamis, foiu* feet in height,
who had reached puberty when only three years old,
Cratenis, brother of Autigonus, both generals in the
army of Alexander, and the former a man of consider-
able literary ftime, mentions having seen a 7nan who,
in seven yeai's was an infant, a father, and an old man,
and a corpse.

Saint Jerome relates that an infant of six years had
sexual connection with a nurse with w^honi he slept,
and impregnated her.'*' Planque reports the history
of two children who, at the age of four years, had their
genital organs so largely developed as to be capable of

* Biblii>tht*que cbakie Ue M^if'iue, t, i, art. Aygrots.

242

ON THE FUNCTIONAL DISEASES OF THE

accotiiplishiiig sexual congress. Fag^s de Gazelles*
states that, in tbe month of July 1753, there was born
at Cahors an infant who at the age of four seemed at
full puberty. The organs of generation had the volume
and exact form which they present at the age of thirty;
this boy manifested, at the same time, a decided
penchant for the opposite sex. M. Ruellet had observed
precocious puberty in a boy of three years and foiifl
months.

In 1748, Mr Dawkcs, a surgeon of St Ives, near
Huntingdon, published a small tract, entitled " Prodi-
gium Willinghamense ; or, an Account of a Surprising
Boy, who was buried at Willingham, near Cambridge,"
on whom he wrote the following epitaph :^ — ** Stop,
traveller, and wondering know, here buried lie the re-
mains of Thomas, son of Thomas and Margaret Hall ;
who not one year old, had the signs of manhood; not
three, was almost four feet high; endued with an un-
common strength, a just proportion of parts, and a
stupendous voice ; before six he died, as it were of an
advanced age. He was born in this village, October
31st, 1741, and in the same departed this life, Septembe
3rd, 1747.'' Otlicr cases of a similar nature may hi
found described in the ** Journal Des Savans for 1688/^
and the '' Philosophical Transactions for 1745.'*

TREATMENT.^The treatment of such unfortunate

cases as the above wiU resolve itself into moral as well
as medical The public exhibition of such children
cannot be too strongly reprehended, for, as Dr UooM
remarks, " The orgasm is fed by a repetition of examina-

"* Jcjurniil lie M^letine (Ancien).

t Bulletiti de rAcmldmie dc M^decine^ 1843.

URINARY AND REPRODUCTIVE ORGANS. 243

tions, and the polluting tide that exhausts and debases
the body, is at length accompanied, even though it
should not be so at first, with a polluting pleasure, that
in a still greater degree exhausts and debases the mind."
An occasional application of leeches to the afiected
part is recommended, cold bathing, aperients, and light
and unirritating garments. It is alleged that, by these
measures, a healthful repression is produced, and that
the unhappy infant is thus enabled " to grow up with
gradual vigour to the possession of a healthy manhood,
instead ^of sinking, as has been sometimes the case,
into a premature and rabid old age at the early period
of puberty."

Contents t— Simple ITrethritis { Pliallorrhoea) — Prostatitis — Leucor-
rhoea; its Comparison witli Gonorrhcea— Kuss^s Diiferentiation of
Specific and NoD-SpeciJic Vaginitis — Causes of Simple Ur^tkritis :
Maaturbation, Inordinate Sexual Indulgence, Vaginal Discharges,
&c. — Symptoms of Prostatitis — Acute Epididymitis a^ a Cause of
Urethral Discharge — Constitutional Causes of Simple Urethritis:
Teothiog, Worms, Skin Diseases, Long-continued Intellectual
Application, Excessive Physical Exercise, Hsemorrhoitls, &c.

That the urethra, like any other mucous surface of
the body, is capable, in any portion thereof, to take on
inflammatory action, attended with a purulent dis-
charge not specific or venereal, is a conclusion which
all must admit. It is one not only justifiable by the
most ample experience and observation, but hkewise
to be proclaimed, equally in the interests of science, as
in those of the closest social relationships. How fre-
quently are urethral discharges of a non-specific nature
observed in persons of xmimpeachable chastity, and
how fatal to peace of mind, and liow unjust to many
females, it would be to pronoimce such discharges
specific.

Under the term Anomalous Urethral Discharges we
include all such discharges as are not venereal, and
not seminal; consequently such as are caused by simple

URINARY AND REPRODUCTIVE ORGANS.

245

urethritis (i>hallorrhoea) ; discharges due to prostatitis
(prostatorrhoea) ; such as accompany orchitis, and such
as are induced by certain constitutional diatheses.

From what has been advanced aheady (Chap. IV.)
it will be manifest that it is impossible to pronounce
whether the secretion of Cowper's glands can be dis-
charged singly from the urethra, and that a preter-
natural discharge from the vesiculiti seminales, inde*
pendent of the fecundating portion of their contents,
is an absolute impossibility. It follows, accordingly,
that the diseased condition termed vesicular gleet,
has, properly speaking, no existence, save in luxuriant
fancy.

As in the female, in the present state of our know-
ledge, it is next to impossible to distinguish between
leucorrha3a and gonorrhoea, except by such surmises,
confessedly inexact, as general considerations afford ;
so in the male, it may be equally impossil>le to dis-
criminate between a case of simple urethritis and one
of gonorrhoea with any degree of well-founded assur-
ance. To such an extent, indeed, is this difficulty
recognised, that it is contended by certain modern
authorities, that gonorrhcea is capable of being com-
mimicated by females who are themselves perfectly
free from the disease. This, if admitted, would practi-
cally amount to the conclusion that there is no such
disease as specific gonorrhoea— an alternative to which
we cannot assent, even admitting, as we do, the
extreme difficulties of diagnosis. The relation of the
two affections is not more remarkable than that which
subsists between the suppuration of pyaemia and that
of a healthy surface; yet no one will contend that there
does not exist some specific distinction unrecognisable

246

ON THE FUNCTIONAF. DISEASES OF THE

chemical or microscopical test which we
Professor Kuss of Strasburg, in examining

ceM

V)y any
possess.

Lock cases, was in the habit of collecting the secretio^B
of the vagina and cervix uteri on a glass rod, deposit-
ing it upon small pieces of glass, and examining it
microscopically. If the liquid exhibited pus globuleaB
the patient was detained for gonorrhcea; if simply
vaginal cells, she was believed to be free from the
specific disease (France M^dicale, 1872). But th
distinction is, we fear, too absolute. The absence
pus cells might be presumptive, of a nou-gonorrhc
but then- presence, we submit, would not necessarily"
prove the existence of the specific disease.

The various causes of urethritis are to be regarde(l
as causes of phaUorrhoea. In the first category w^|
find the vaiions forms of UTitation, comprising mastur-
bation, inordinate sexual indulgence between perfectly
healthy persons, as Hippocrates so long ago remarked,
eatheterism, irritating injections, all vaginal and uterine
female discharges, and the sanious discharges accom-
panying malignant diseases of the uteinis. With
regard to the lochial discharge as a cause of phal-
lorrhcea, Cullerier remarks, that it is not while the
discharge is present, but two or thioe days before,
from twenty four to forty-eight hours after its cessatioi
that it is more apt to act as an irritant, for during this"
time preceding, or sulKsequcntly, there is an acrimony
of the vaginal mucus, which disapi>ears coincidently
with the menstrual flow. The pus of a chancre, ijH
the same manner, may act only as an irritant, its efFect^^
l)eing limited to a simple blenorrhagia.

Diday'^ alleges that in cases of simple urethritis sue!

♦ Ar.'h, Cicn. dc Mod., OrUdier, 1861,

the^

URINARY AND REPRODUCTIVE ORGANS.

247

causes are characterised by their obstinate persistence
under the usual treatment of gonorrhcea, and I am
disposed to think, from such cases as have come under
my own notice, that the statement is eonect. The fol-
lowing case may be cited in illustration. J. JJ., a
healthy young man^ then residing in the country, con-
sulted me on the 15th April 1871. On the 1st of
January, he had indulged freely in intoxicating di"ink,
and had connection with a female servant in the house
in which he resided. On the previous Friday he had
also connection. On Wednesday the 4th January, he
complained of a burning heat in making water. For
this symptom, no discharge having yet appeared, he
consulted a druggist on the following day. Internal
medicine alone had been prescribed. Patient believes
the medicine to have been copail>a. No discharge
taking place, the medicine was discontinued; but
within a week from its discontinuance a copious puru-
lent discharge from the urethra occurred. Patient, in
consequence of tlie supervention of this new symptom,
put himself agam under tlie treatment of his former
adviser. On this occasion the same internal medicine
was given, in conjunction, however, with an injection,
the latter of which patient believed to have been too
strong, as it made him worse. After contracting the
affection of the urethra, patient had frequent inter-
course with his paramour. He accused her of labour-
ing under venereal disease, which she stoutly denied.
He is confident that she suftered from no dischaige or
disease either then or afterwards. The female was
aware that he suffered from some disorder of the geni-
tals, but the fact that she enjoyed mi i7nmanity from the
affection confirmed her in the belief of his statement^

248

ON THE FUNCTIONAL DISEA«ES OF THE

that what he nuffered from was simply a " wqat
of the glands/' Tins discharge continued for
five months, despite the most painstaking treatment.

In the foregoing pages we have seen that the fluid
Avhich is sometimes discharged at stool, particularly
when the bowels are costive, is usually the secretioa
of the prostate. When the prostate has been excited
by excesses, this discharge becomes more abundant
and more continuons, and constitutes prostatorrhoea.
This secretion is distinguished from seminal fluid by
the absence of spermatozoa, by its being thinner in
consistence, more transparent, and more or less gummy
or tenacious in quahty. Evacuation takes place during
the least erection or excitement, and more especially
during deftecation^ the bowels being costive. This
discharge is not in itself very serious ; but, thanks to
Lallemand and his coi{freres, all urethral discharges *
are regarded with such dread, that the fear of sperma*
torrhoea, which may be thus induced, may amount t^fl
a positive disease. In the aggravated cases of pro-
statitis, the diagnosis is further aided by the sense
of weight in the hypogastrium, pain in the peri-
na^um, and difficulty of micturition, with more or
less rectal tenesmus. The pain has less tendency
to radiate towards the meatus urinarius than in cys-
titis, and it is besides pulsative. There is no vesic
tenesmus.

On examination by the rectum a tumour is foun<3
occupjang the pelvis to a greater or less extent; paii
ful on pressure if in the inflammatory stage, and
fluctuating if in the suppurative. On practising cathe*
terism an obstacle is presented in the prostatic region ;
tliis is overcome by the slightest pressure, a circum-

UKtNARY AND REPKODUCTIVE ORGANS.

249

stance which distinguishes prostatis from stricture ; and
different from what obtains in cystitis, the liladder being
entered, a great quantity of urine escapes therefrom.

The constitutional symptoms vary in Ulvc manner,
lu prostatitis they are more marked; the fever is high,
there is heat of skin, insomnia, and general anxiety.

The foUowing are typical cases of urethral discharge
from prostatitis.

A. R. consulted me, December ISth^ 1871. I had
formerly successfully treated patient for spermor-
rhagia. A short time prior to this period he called on
me with reference to a purulent discharge from the
urethi-a, which, iis he had married six months pre-
viously, and had led a life of perfect chastity, I had no
difficulty in pronouncing to be non-specific urethritis.
This affection yielded to ordinary means within a reason-
able time; but w^hile the purulent discharge had
disappeared, a considerable quantity of slimy matter
was voided immediately after mictmition and at stool,
and nocturnal emissions of semen were of frequent
occurrence. Of late patient has had no sexual desires;
he is troubled with restlessness, partly owing, no
doubt, to mental causes; and he is obliged to rise fre-
quently during the night to empty the bladder. Patient
was put under the treatment already described,
December Vlth. — The noctmnal emissions and the
slimy discharge have disappeared, but there is still
pain when seminal emission takes place, along with
deep-seated pain in the perinj^um, more or less con-
stant A short time afterwards these symptoms
entirely disappeared. *

* As we have alrendy fteen (vuh p^it^^e 181, «^ pcanim,)^ it cannot be absoUitely
iiiainUiined that seminal fluid uniy not ^(irnetiiiicH Ijii (lim:harb'ecl^ in conjimc-

250

ON THE FUNCTIONAL DISEASES OF THE

In the treatment of such cases as this I have seen
much benefit from the mternal administration of oil of
eucalyptus globulus and an ethereal extract of tar.
Mr Dun, chemist, Argyle Street, Glasgow, has put
tliis combination for nie in the convenient form of
capsule. These I have used with advantage.

G* G., aged 29, mamed, has suffered for years, to
use Ixis own language, *'fi*om seminal weakness."

tion ^ritli tlie aecretion of tbe proBtate, in tliis manner. Hence Tijssot remarita,
** Un n litre accitlcnt aiKjuel cette quatrifeme cause (mastiirT>atic>Ti) rend lea
niastiirbateiirs plus sujects, c'ei^t uue esp^*e de fkimlysie ties organes de la
j;^ii^ratioii» dV»£i naiiiiiieiit TirapuiBHance, par k d^faut d^^rectioiL, et lagonorrli^
siniple, parce que les jartiea relacln^es laissent tk!bapper la v<irital»le seraence, k
meaAure qu^elle arrive, et suiut^r continuelleiueiit riiumeiir que s^parent lea
prostiiU's ; et qu'euftn t^iute la meuil>Tane int^rieure de run^tre acquiert une
dispoaition catarrheusei c^ui la disposie k founiir \m ^couleuient de ra^ue nature
que €elle due {>erte8 lilancbes des fenunes; iliAposilion, paui' le dire en passant,
moifl rare qu'on ne pcjiBc," &c.

Boerliaave't? opinion on tliis pobit ia to the following effect: — "On lit» dans
quelt]uea livres de uiMecine, t|ue la semence s^'ej^l qnelquefois ^coul^ sans qu'on
Fait sentie. Mais cette muladie doit etre tr^^-rane ; et je ne saelie pas cjue la
ftemence ee 8oit 4couJ^e eana quelque chatouilJeineut, ou ee n*i*tait jxis de la
vraie aemenee H^paree dans les testicule.^, et aceuniul^e dana les vesicules
fteiiiiiiales, quoique j*aie %^u la liqueur dea prostrates B^icouler/' Tiasot holds a
ditfepent opinion, aud the one which, m we have already seen, the facte adduced
lead UH Ui support. He remaiks, *'i!ette auturite est Bans doute bien respect-
able, mai.% outre f[ne BoL-rhaave ne decide point poaitivenipnt, il a contre loi
tons left uiedecinii ; et, x>onr ue point mTtiT de aon ecole, Tun de ses plus illuatres
diseiples, GaubiufS adinet Ttvacuutiou de lenience sfms sensation. Mes
piiq>rea observations ne me bdsaent pii« dout^r de resi«tence de Tune et de
lautro nmbvdie. J'ai vu de-s bomiues qui, aprea una gouurrbdti viruleute,
api-tiS dea exces v^n^riens on des maeturbations, avient un t*eouleiiient con-
tinuel par le verge, mais qui ne les rendaient pas incapablea d'^rection et
d'ejaculalion ; ils se pluignaient meme qu*une seule Ejaculation le« affaibJis-
sait plus ([u'un etuulcnient de quelquea aemaineaj preuve (Jvidente que la

lifjUt'iir de ces deux evacuations n't-tait paa le nieiiie J 'en ai

vu d'autrtfi qui avaient, ctaimie les premiers^ un ^coulenient qui lea affaiblis-
salt beaucoup plus, qui lea rendait incapablea de tout prurit venerien, de
In Lite erection, et fnir }k mtoe de toute ^jaculaliun, quoi<|ue les t^sti-
cuIl'.<* ne parus8eiit jwiint bors d'etat de faire leurn fonctions, U ine pandt
diStuoutr^ que, dans ces {leniiers, la vraie semencc tcsticulaire ft*Ecoulait sana
sensation."

URINARY AND REPRODUCTIVE ORGANS.

251

I
I

Patient is not incapacitated for sexual congress, but
during the time there is a constant discharge from the
nrethra, f billowed afterwards l>y headache and general
pains thronghont the body. The act of copulation is
of normal dmution iis a rule; when otherwise it ia
abnormally protracted, and mmetimes ?io discharge
whaterer ensues. Patient is not troubled with nocturnal
emissions. Before marriage genital excitement was
accompanied, as it now^ is, with a copious secretion from
the urethra, and pain '* in the lower part of the stomach
and testicles, which almost doubled me up." This
state has lasted for eight years. Patient is at present
under treatment.

Acute Epididymitis is likewise occasionally attended
with a sympathetic discharge from the urethra, resemb-
ling a case of genuine blenoixhagia. It is not a little
remarkable, that in cases of acute gonorrhoea w^heii
orchitis supervenes, the discharge from the urethra is
generally suspended, and that the converse should
take place when orchitis is the primary affection, tlie
discharge in the latter case abating as the inflammatory
symptoms are moderated. I have more frequently
seen this discharge in cases of orchitis occurring within
a moderate time after the cure of gonorrhoea. It need
hardly be remarked, that the appropriate treatment
of this variety of nrethiid discharge is essentially that
of orcliitis itself

Excessive seminal emission is a frequent complica-
tion of the urctliial one thus arising. These take place
most frequently during the night. The semen is
usually normal, but sometimes it is tinged with bloody
and its ejaculation is attended with much pain.

252

UN THE FUNCTIONAL DISEASES OF THE

Constitutional Causes of Slmple UuETaKrrm, —
All constitutional states which cause undue acridity
of the urine may induce urethritis. Hence in a special
manner the lithic acid diathesis so operates. On the
14th August 1874, my attention was dii'ected to the
fact that a patient under treatment in one of the wards
of the Glasgow Royal Infirmary for obstinate aiticular
rheumatism andgranulai' conjunctivitis, had a purulent
discharge from the uretiira. Patient had been in the
hospital for six weeks, and it is hardly necessary to
say that neither during that time, nor within a con-
siderable time after date of admission, had he been
exposed to contagion.

Urethral discliarges are occasionally seen in both
sexes coincideiitly with teething. There exists at this
period an excitation of all the mucous surfaces, that
of the urethia being no exception. This fact lias an
important medico-legal bearing. Worms may some-
times in childi^cn be an indu^ect cause of uretliral dis-
charges, the iiritation wliich they set up causing the
patient to rub the genitals to such an extent that sup-
puration may bo induced.

Skin JJiseiises have been regarded from remote
antiquity as causes of blenorrhagia. Hippocrates (De
Natura Muhebri), regarded lepra and herpes in this
light. The fact is notorious, that skin diseases are occa-
sionally followed by urethral discharges, and acute
eczema is often seen to take the place of a discharge
of this nature.

The aiiimncular diathesis has in like manner been
regarded as a cause of blenorrhagia. Thus Cullerier
remarks — " Two years ago I was consulted by a col*
league for an emption of five or six boils, which I

URINARY AND REPRODUCTIVE ORCIIANS.

253

treated by bath and emollient applications, Tlie boils
disappeared gradually, and the patient believed him*
self cured, when he was seized with a blenorrhagia.
(He had never had such a discharge formerly.) He
came to me accusing his mistress, whom I carefully
examined, and found the sexual organs in perfect
health* The blcnon-hagia oliserved the usual course,
and was attended with acute pain. On the sixteenth
day of its duration, a new carbuncle appeared, with a
considerable fever, and the discharge, still considerable
and acute, disappeared the following day. During the
sixteen days that it persisted, I examined tlie female,
on three occasions, and discovered no disease. The
day after the disappearance of the discharge the patient
had connection with his mistress, and no bad conse-
quences resulted for either."

Civiale remai ks that he has seen urethral discharges
to supervene on long-continued intellectual application,
and of excessive physical exercise in persons not so
accustomed. Diseases of the rectum have a special
proneness to occasion urethral discharges, more espe-
cially in aged persons, Ht^morrhoids are frequently
noticed to act in this manner. As this happens in
the male, so in the female are uterine diseases seen
occasionally complicated with urethral discharges. It
is towards the primary lesion that treatment must
be directed.

The prolonged use of asparagus has been stated
to cause l)leiiorrhagia. The alleged influence seems
limited to its aggravating cases of existing disease.

Alcoholic drinks, especially in persons of feeble con-
stitution, are the occasional causes of blenorrhagia,
and they always aggravate it when otherwise existing.

254 ON THE FUNCTIONAL DISEASES OF THE

Beer, especially South Grerman beer, has been regardec
i as a common cause of urethral discharges.

Cantharides taken internally, or absorbed from t
blister, may so irritate the urinary canal as to cause
f superficial suppuration, and even gangrene. These

consequences are frequently noticed in cases when
cantharides is taken as an aphrodisiac. In contradis-
tinction to what obtains in ordinary blenorrhagia, thai
'/ arising from cantharides commences primarily in the

deeper portions of the urinary canal.

URINARY AND REPRODUCTIVE ORGANS.

255

CHAPTER VII.

IMPOTENCY AND STERILITY IN THE FEMALE.

Contents : — Conditions Essential to Fecundation in the Female— Im-
potency or Inaptitude for Copulation — Congenital, Aecidontal, and
Pathological Anomalies — Stricture of the Vagina — Congenital
Atresia of the Vagina — ^Pathological States of the External
Grenitak-^Infecnndity or Inaptitude for Impregnation — Absence
of the Ut«rua—Imperf oration of the Cervical Canal— Abnormal
States of the Uterine Keck and Os — Uterine Displacements Inde-
pendent of Coitus — ^Exaggerated Elevation, ProlapHus, Versions,
and Flexions — Uterine and Vapfinal Diachargca — Abnormalities of
Ovulation — -General Causes of Sterility^ — Bearings of Menstruation
on Fecundation — Venereal Excesses as a Causa of Sterility —
Frigidi ty^ Artific ial Impregnation.

Procreative capacity exists in the female from the
age of puberty, commencirig with the fimction of
lueostriiatioii, and terminating at the menopause, or
"change of life."

In order to fecnndation the following conditions
must exist; an ovimi must be formed in the ovary, it
must be transmitted to the uterus, and there must be
no impediment to its coming there in contact with
healthy male seminal fluid.

That the latter be capable of accomplishment, it is
requisite on the part of the female that the external
genitals he of normal conformation, permitting of
natural sexual intercourse, and there be no mal-

formation of the vagina, or dty. Consider-

able confusion has existed i tion of female

256

ON THE FUNCTIONAL DISEASES^ OF THE

sexual abenations. These conditions may be con-
veniently regarded from three positions — 1^/, impO'
tency ; 2d, infecundity ; and 2d, sterihty, fl

By the term impoteneif is to be nnderstnod, as in HH
male, an inaptitude for the performance of the sexual
act; by infecunditjf, an inaptitude for impregnation;
and by sterility , an inaptitude for germination, so t^
speak.

IMPOTENCY, OR INAPTITUDE FOR COPULATION.

The causes of female impotency resolve themselves
into congenital, areidental, and patliolor/ieal anomalies
of the vidva and vagina. ^d

The complete absence of the \ailva, a condition, hcflH
ever, very rare, and wlien it does exist usually accom-
panied with serious malformations of the interna]
organs, would constitute a complete and incurable
impotency.

Adhesions of the large and smaller labia sometimes
exist to such a degi'ee as either to offer an obstacle to
copidation, or altogether prevent its accomplishment,
to the extent that it partially or wholly occludes the
vaginal orifice. This condition is usually remediable
by gradual dilatation of the vagina, or forcible teari
ing, under chloroform, of the adventitious adhesi(^|
HjTpertrophy of the labia majora and minora, with prS
teniatural elongation of the cUtoris, while they do not
usually ofler a complete impedinient to the perform-
ance of the sexual act, offer more or less of an impe-
diment. The same obsen^ation applies to abscessed
of the pudenda, cysts, and diverse tumours, hemi^
protrusions of the bladder into the vagina, and
lapsus of the uterus.

UIIINAHY AND REPEODUCTIVE OKGANS.

257

Should the development of the labia and clitoris be
excessive, operation will not only be justifiable, but
will be successful in remo\dng the inconvenience there-
by occasioned. The other conditions referred to will
demand their own special and appropriate treatment.

Osseous tumours of the symphysis, particularly of a
sy|>hilitic nature^ may be found to such an extent,
[and occupying a situation in which they may occa-
sion an insurmountable obstacle to sexual congress.
Operations may or may not be justifiable according to
the indications presented. If the syphilitic cachexia be
surmised, general and local antisj^philitic treatment will
usually succeed in removing the diseased condition.

Complete absence of the vagina is a necessary cause
of impotency, and is an incural)le condition. Partial
absence of the vagina is not necessarily a cause of im-
potency, as the impediment may be only relative, and
capal>le of removal by surgical interference. It does
not follow that even the absence of the vagina, in its
inferior portion, necessarily presupposes absence of the
uteiTis and the upper portion of the vagina, and abro-
gation of the ovarian and uterine functions.

M. Amussat, in 1835, saw a case in which there w^as
absence of the vagina, but not only did a uterus exist,
but menstnial fluid escaped thereform. The patient
was a German, fifteen and a half years of age. Her
belly was enlarged by the accumulation of menstrual
fluid in the uterine cavity. The tumour ^vas liaixl, Arm,
and painful on pressiu-e. The vulva was perfectly
foiined, but on separating the labia majora and minora,
instead of a vagina continuous to the uterus, a raZ-tfo-
me was found, in the centre of which the meatus
urinariua existed. On intryducing the finger into the

258

UN THK PUNCTiONAL DIHEABB8 OF THE

Kt by a
Hefl

rectum the utcms was distinctly felt occupying the
entire cavity of the pelvis, Aniussat pcrformeti the
following operatioiL The patient being prepared by &
Inith and a cataplasm to the \^dva, tlie surgeon^
a largo sound, pressed in the direction of the \t
below the ureter, so as to cause a small hole. He :
peated this act with the little finger, having, preliminary
to this, introduced another finger into the rectum in
«>rder to serve as a guide; the pressiu-e was painful^
but alri^ady so tar uMcacions, that the impression of the:
little finger renuxined. With one finger in the rectiH
and the thumb in the vulva, he drew the peiimvuni
backwards in onler to affV>rd him more room, and int
duced a prepared sj^ongo into the liole he had fiir
in the vagina. Hiree days aftei-wards he i*opeated
intnHluctiun ainl impulsion of the finger; then hoi
troduced two fingers. After five other attempts
this nature, repeated at intervids of one or t%vo ilaj
he had formed an artificial passiige of aljout six ccql^
metres in length ; then, at the base of tliat piissage,fl
directed, uptm an indicator or director, a trocar whidi'
he plunged into the tumour. Tlien replacing the tro^d
by a bistoury, covered with lint t(» about a sixth of flV
extent, there l)eing yet twelve to fifteen millimetre*! to
traverse, vent wiiH given to 350 to 880 grammes of
black ehitted l)lood. By introducing a fine cannula into
the vagina, a cure was completed, lasting nnmy yeai&
Malgaigne^ in referring to this case remarks, ** I
had myself to perform a similar operation on a fci:
who had her Viigina obliterated in conse((uenca |
cliihl bearing, I conunenced l»y dividing the cicntrfif
w Iiich liad come almost to the level of the vulv

huH

eaH

• Munttcl *\c Mr'l*H iiiv l>|Vr**l<»inr, nth »"t |«|» 702. 7<>3, Vnrin Ih&I

URINARY AND REPRODUCTIVE ORGANS.

269

after the first bleeding, I tore the parts with a dij^ector
pushed forwards, and enlarged tlie ca\ity from right to
left until I had attained so far as the uterine neck.
^B It was necessary to have maintained dilatation of the
vagina during many years, with a gentian tent; but
ultimately success w as so far obtained that sexual con-
gress became practicable, though up to the present the
patient has not become enceinte^

" Stricture of the Vagina. — An altered condition of
the vaginal capacity according to its extent may offer
a complete or a relative obstacle to the sexual act.
This narrowTiess is sometimes limited to one point, but
more frequently it extends to the entire length of the
vagina, lo the slighter cases it gives way to the re-
peated peifoiTiiance of coitus. In the more obstinate
cases, gi-adnal dilatation by means of lamuiaria digi-
tata and sponge tents should lie practised. Certain
precautions should be adopted in the employment of

h these measures, which may be summarised as follows :
~lst. The tent employed should be well jn^epared;
2d, Before its introduction it should be ascertained
that there is neither any inHammatory condition of the
utenis nor of its annexed organs; 3d^ The operation
should not be performed at a period too near that of
menstrnation ; 4th, To enjoin the use of cleansing
injections during the retention of the tent» such as a
weak injection of permanganate of potash; 5th, Not
to leave the tent in the vagina for too long a period,
and to remove it promptly if it occasion much pain ;
6tli, To withdraw it very gently; 7th, To arrest
haemorrhage with a suitable styi>tic, such as p)crchluride
of iron solution, alum, &c. ; and Hth^ — ^A precaution,

260

ON THE FUNCTIONAL DISEASES OF THE

on which Marion Sims insists — the patient should
observe the recumbent position during the whole time
that the sponge tent remains in the vagina.

Congenital atresia of the vagina, while it may rendeF
coitus impossible, does not necessarily prevent fecun-
dation, A case of this description is rehited in the
Memoires de L'Acadimie des Sciences ds Paris. The
patient was a yoimg person whose vagina hanlly ad-
mitted a quill point. At each menstrual iieriod, she
experienced in her uterus intense pain, and the men-
stnial fluid wa.s discharged v^ith much difficulty. She
was married at the age of sixteen to a vigorous young
man, whose embraces she was unable to receive. Visited
and examined l>y physicians, she was declared by them
incapacitated for copulation. However, after eleven
years of impotency and sterility she became pregnant^
notwithstanding that the vagina had not acquired
greater dimensions; but towards the fifth month of
pregnancy the vagina commenced to dilate, and at the
end of the period of gestation it had acquired sucJi
dimensions as to permit the exit of a child. This caae
is the most unique on record.

Tanheu relates a somewhat similar cfise in his EtuJe
Aledicn-leffate »ur fes atUninl^ aur mumrs. It referred
to a young woman who became pregnant, though
M. Legrand found the usual signs of virginity at the
moment of accouchement

In such cases as these the seminal Huid has been
deposited at the entrance to the vagina, and has been
impelled towards the uterus by ciliary motion.

Longitudinal membrannns partitions sometimes exist
in the vjigina. They do not usually cause absolute
imp<»tericy, but they aie a source of pain to l)oth

URINARY AND REPRODUCTIVE ORGANS. 261

parties, so that in the absence of a double uterus, and
when the division occupies but a portion of the vagina,
the membrane should be removed. When the bifidity
is complete it should not be interfered with, in case of
uterine complications, and when the probability exists
that the course of normal labour would eflfectually
remove the obstacle.

When abnormal communications exist between the
vagina, the bladder, and the rectum, either in conse-
quence of congenital defects, or as the result of acci-
dent, coitus is still possible ; but impotency may arise
from feelings of disgust, as already referred to in a
foregoing chapter.

A case is, however, related by Louis* of a young
woman in whom no signs of external genital organs
were manifest. She menstruated, however, by the
anus, became enceinte, and an infant was bom through
this communication with the uterus !

Bloody tumours, abscesses, cysts, and vaginal polypi
render coitus sometimes difficult and painful.

Hernial tumours, cystocele, and rectocele, when they
have acquired large dimensions, may occasion impo-
tency.

Rupture of the perinseum may cause relaxation of
the vagina to such a degree that the seminal fluid will
not be retained in it. Cases of sterility from this cause
are of occasional occurrence.

Acute vaginitis is sometimes attended with an
amdimt of inflammatory hypersesthesia which renders
coitus impossible.

Spasm of the vagina (vaginismus) is a frequent cause
of impotency and infecundity, especially in nervous and

♦ Dictionnaire de M^icine pratique, t. iv. pp. 10, 26, ij. ed.

262

ON THE FUNCTIONAL DISEASES OF THE

excitable females during early life. In its contracted
coDilitioTi the vagina may be thus diminished to such
an extent as hardly to admit a quill The immediate
obstacle to coitus seems referable to two conditions—
tlie extreme hyperd^sthesia of the vagina and vulva,
and the spasmodic contraction of the sphincter which
is induced by the pain. The pain is not infrequently
of such severity as to cause syiicopep anrl sexual con-
gress comes thus to be regarded with dread and
loathing. Different from the lnq>enesthesia which ac-
companies inflammatory conditions, that of vagiuismus
is intermittent, and usually immediately associated with
physical or mental sexual excitation. In the treatment
of this condition narcotics will be found of the greatest
service. Belladonna^ valerianate of zinc, arsenic,
and other medicines of this class, should be given in-
ternally. Should sjroptoms of anaemia exist, the in-
ternal administration of bromide of iron is specially
indicated. The local treatment will resolve itself into
the gradual dilatation of the vagina by mechanical
means. Should this faU, the patient should be anjES-
thetised, and forcible dilatation practised. In cases of
this nature the sphincter has been incised by Huguier,
Dupuytren, and Michon, and more recently by Marion
Sims. This operation, however, should oidy be re-
garded in the light of a dernier ressort. The local ap-
plication, in the form of pessaries, of belladomia, opium,
camphor, veratria, &c,, should be enjoined. Sj^npa-
thetic irritation from the lower bowel should be guarded
against by the regidated administration of gentle
r lent 8.

Independently of the foregoing condition there sot
times exists a genuine neuralgia of the vagina, whic

irded

URINARY AND REPRODUCTIVE ORGANS. 263

may operate in a similar mamier relatively to sexual
congress. This affection is at times idiopathic, at
other times sympathetic of some uterine affection; and
Lisfranc* alleges that it is hereditary in certain cases.
According to Tanchout it recurs at the menstrual period,
and as a sympathetic nervosis of the menstrual state.

When due to uterine states, ulceration of the neck
of the uterus is the most frequent cause; next in point
of relative causation come simple inflammatory condi-
tions of the uterine neck, and uterine deviations.

Roubaud has insisted at considerable length on fn-
gidity, or the absence of sexual desires, as a cause of im-
potency. It cannot with strict propriety be so regarded.

Infecundity or Inaptitude for Impregnation. —
While the vulva and vagina may be perfectly normal,
it is further requisite, in order to impregnation, that
both the seminal fluid deposited in the vagina during
sexual congress, and the ovum have free communication
with the uterine cavity. Obstructions of the nature
here indicated will, it is obvious, refer to the Fallopian
tube and the uterus itself, and more especially to the
neck of that organ.

Congenital absence of the uterus is a circumstance
occasionally noticed, and must be regarded as most
obviously an incurable cause of infecundity. These
Qjases are confessedly of rare occurrence. An example
presented at the HOtel-Dieu, under the care of M.
Kostau.J The female was a prostitute. The external
organs of generation were of normal configuration, and

* Clinique Chimrgicale de ITiopital de la Pitid, t. ii. p. 163, et Gazette des
hopitaux, 1842.

t Gazette des hopitaux, 1842.

X France M<5dicaleet Pliannaceutiquo, t. ii. p. 149, 18.55.

266

ON THE FUNCTIONAL DISEASES OF THE

Congenital closure of tho neck of the utenis is a rare
affection. It may be limited to the utero-vaginal
apeitui'e or extend throughout the cervical canal. It
may constitute a cause of sterility, according to its
seat and the extent to which it offers an obstacle to tho
evolution of the normal function of the organ. fl

The canal is sometimes olistructed by the formation
of false memljraiies resulting from endometritis. This
meml>rane sometimes takes the form of a diaphragm
in the canal. To remedy this condition tho membrane
should be perforatcd^aii operation which ought to be
performed at the iutermenstruiil period — and dilatation
of the OS effected by sponge or laminaria digitata tents.
If necessary scarifications of the os may be beneficaUj
resorted to.

auy

led^

Wlien the obliteration extends to the uterine cavity
absolute sterility ensues, and the condition is irreinc
able by either medical or surgical treatment.

Impermeability of the os may further be occasioi
by the application of caustics, such as caustic potash,
acid nitrate of mercury, nitrate of silver, &c. The
occlusion in this instance is immediately due to the fi^r-
mation of a dense cicatrix, which, according as it may be
complete or incomplete, may be regarded as a cause of
sterility. The treatment will consist in division with
the bistoury, uterine catheterism, and gradual dilatation,

Stnelure of tlie cervical canal does not necessarilj^
prevent the passage of seminal fluid to the uterus ;fl
simply renders its penetration therein more difficult,
and the chances of impregnation thus correspondingly
less. It is usually occasioned by, and consequent upon
uterine inflammation, either general or limited to t he
cervix. Fecundation has taken place in such ca

URINARY AND REPRODUCTIVE ORGANS. 267

even when the cervical canal was so narrow as not to
admit an ordinary probe.

Fibrous strictures, and these associated with sub-
acute inflammation of the uterine mucous and sub-
mucous tissues, are frequently of such a nature as to
prevent fecundation. This is evidently due to the fact
that the uterine tissue is so matted with coa^lable
lymph (new formation of tissue), that it does not
expand coincidently with the development of the con-
tained ovum.

If the inflammation is confined to the surface of the
mucous membrane, the obstacle thus occasioned is but
temporary, subsiding under judicious treatment.

Fecimdation is often prevented by spasmodic con-
traction of the uterus — a circumstance which largely
accounts for the sterility of prostitutes, and of highly
nervous females, otherwise constitutionally and locally
healthy.

The OS uteri is sometimes the seat of calculous
impaction, which may prevent fecundation. This is
diagnosed by the sound, even as in the bladder. The
removal of such concretions is not usually a matter of
difficulty. Should difficulty, however, be experienced,
the mass may be forced into the uterus, and litho-
tripsy employed, as in the case of vesical calculi. The
debris should then be removed by the employment of
tepid injections.

When the diminished calibre of the canal is due to
simple inflammation, mechanical interference as by
soimds, dilatation, &c., is to be deprecated. The treat-
ment should here consist of emollient applications,
leeches if necessary, and the internal administration of
small doses of calomel and opium. When spasmodic

268

ON THE FUNCTIONAL DISEASES OF THE

contraction is diagnosed, the internal administration <^
bromide of potassium, bromide of camphor, belladoima,
and valerianate of zinc is specially indicated. Local
treatment by sedatives is Hkewise to be enjoined*

The position of the utems in the pelvic cavity — one
of the most prolific sonrces, by the way, of professional
charlatanism, and of groimdless feminine solicitude —
has uiK[uestional>ly an intimate bearing on the facility or
the reverse of impregnation, though I very much doubt
if many of the constitutional symptoms ascribed thereto
have any relation therewith save in the perverted brain
of the too fussy g)T3a3cologist. The nomial position of
the uterus is in the axis of the vagina; to the extent
that it deviates from this position so are the chances of
impregnation diminished, and vice versa, (/terinedu*
placements, in the fiist place, may be distinguished into
such a^ are temporary and such as are permanenL In
the former there exists a preternatural mobility of the
organ, and its conditiou may be varied by means of
the finger laterally, posteriorly, anterioriy, upwards and
downwards, and this may likewise take place during
coitus. The latter circumstance is capable of explain*
ing in an especial manner cases of relative sterility.

Uterine mobihty is frequently attended with nooro
or less deviation of the organ from its normal position,
and seems to be duo to a relaxed condition of its
ligamentous stnictures.

In the treatment of cases of this description general
and local tonics are to be employed. The internal
administration of strychnine, iron, and ergot of rye
should be counselled. Cralvanism should be employed;
and vaginal douches, shower baths, and open air bath
ing resorted to.

URINARY Amy REPRODUCTIVE ORGANS. 269

In addition to this form of uterine deviation, Roiibaud

describes what he terms vital displacements due to a

I hyper-excitability of the nervous system. The existence

' of this qnestionable variety of uterine displacements is

supported by Mercurialis, on the basis of a statement

by Lucretius. '* Est el aiiud quod peto,'' says he,

! **aiidiaiis sine risu, sdiicet forma et ratio conmtbitm;

quia si muf teres in concnbitu retractent eliines et fre-

' qmiiter agitent, mm mncipitmL Ilationeni adfert

\ Lucretius philosopohus (iv. De Natura) his duobus

^kTersibus.

Kkif enim mtlci recta regione vmgtts
VomeretUy of que locis avert it seminw ictum.

" Ilac rationed dicebat Lucretius^ doctas me ret rices /re-
' quenter r/mies agitare, nou ut deleetentur, sed ut mm
Jiantyramkey

Uterine Displacements independent of Coitus.*—
Uterine displacements admit of division either as they
aflfcct the entire portion of the organ or simply its more
movable portion, the body alone; the former are
flesignated versions, and the latter flexions; and they
comprise respectively abnormal elevation, preternatural
depression, ante- version, retro- version^ and latero-
version; ante-iiexion, retro-flexion, and latero-flexion.

Exaggerated Elevation as a cause of Sterility, — This
condition, though described by writers as an occasional
cause of sterility, is rarely, however, of such a natura
as to prevent fecundation. It has been noticed, not-
withstandhig,^ as a sequence of metro-peritonitis, which
by the fonnation of adventitious adhesions to the sur-

* M. BoiviB — RecheirheB f^ur !♦'« caufrcit lt?p plus fretiuentea de Fjivorlc-
Iment, 1S28.

270

ON THE FUNCTIONAL DISEASES OF THE

I
I

face of the uterus, had fixed the organ iii an abnormal ^
position. It will be obvious that tumours in the pelvis ■
Blight act upon the uterus in a similar manner. If
idiopathic displacement of this nature is sunnised to
exist, safe means might be adopted with a view to
its abasement, such as hot batlis, abdominal bandag-
ing, and exercise. Beyond these measures, surgical
or medical treatment of any description is to be
deprecated.

Proiapstis of the Uterus, according to its degree, may
certainly operate as a cause of female sterility. In its
fii\st degree it may be regarded as being rather favour-
able to fecundation ; when more considerable, the uterus
may so fill the vagina that coitus is rendered difficult;
and in the third degree it may be absolutely impos-
sible. The immediate cause of this condition seems to
be a relaxed state of the uterine ligaments, and it is
more frecpient in women who have borne large families.
Cases, however, occur, m which prolapsus of the uteinis
exists even in virgins and in women who have never
borne children. Munro records a case of uterine pro-
lapsus in an infant of three years of age.

While coitus is impossible in such conditions, it is
not absolutely impossible for impregnation to take
place. In these cases attempts should be made to
replace the uterus in the pelvis, and retain it in its
normal position with a sponge or annular pessary.

Versions of the Uterus, in either of the directions
above indicated, occasion infecundity only when they
exist in an exaggerated degree. This they may cause
both by the abnormal situation of the os, and by
presenting, often by the apposition of the walls uf
the cervical canal, a direct obstacle to the passage

■

UKINARY AND IlEPRODUCTlVE OROANcJ.

271

of the seminal fluid. The iiomial condition of the
uterus corresponds to the axis of the pelvis, and the
degi^ee of uterine version is estimated by the sine of
angle formed with this axis. According to Marion
Sims, if the uterus be retroverted to an extent of from
25° to 3{f , it is not inapt for fecundation ; but if it
readies an extent of 40"^, fecimdation is difficult, while
from 60' to 9(F it is absohitely impossilde. In retro*
version the uterine neck is foimd behind the arch of
the pubis. In this case the seminal fluid is deposited
in the posterior cui-de-sac of the vagina. In latero-
versions the uterine orifice approximates the ramus of
the pubis on the side corresponding to the displace-
ment, and the seminal fluid, in like manner, becomes
lodged in the lateral cul-de-sac. In cases of ante-
version, the cervix uteri has its axis directed towards
the concavity of the saciiim, a position diametrically
opposed to that in which the seminal fluid is projected,
and hence fecundation is less likely to take place in
this variety of uterine deviation than in any of the
others.

It is interesting to examine in what proportion the
several uterine displacements act as causes of sterility,
Marion Sims has arrived at the following conclusions^
on this point, after the examination of 505 cases of
sterility. He divides those cases into two classes^ — ^Ist,
Those who had never borne children; and 2d, such as
became sterile after one or more pregnancies. To the
first category belong 250 cases, in 171 of which number
uterme displacements existed, 103 being ante-versions
and Gs retro -versions. The second class comprises con-
sequently 255 cases, with 172 displacements, 01 being
ante- versions, and 111 retro -versions. It is thus appar-

272

ON THE FUNCTIONAL DISEASES OF THE

4
I
4

ent that uterine versions exercise an influence almost
parallel in each class ; that two*thinls of sterile females
are affect ed mth uterine displacements, so far as these
statistics show, without reference to the cause by which
they have been produced; and that the ante- versions and
retro-versions are in an inverse proportion in each class,
ante-versions predominating in the former, retro-ver-
sions in the latter, and almost in equal proportion.

WTicn uterme deviations attain an exaggerated
degree, the primary indication of treatment is to replace
the organ in its normal position, and retain it there by
mechanical means in expectation of the establishment
of the normal tone of its appendages. The methods of
treatment will vary accoidiug as the cause may be
simple, idiopathic, or complicated with organic disease
of the uterus itself or its associated organs. If the
displacements bo symptomatic, i.t\, complicated with
adjacent pathological states, mechanical interference
is, in the fiist place, to be reprobated, as it is both
ineflectual and dangerous under such circumstances.

The morbid states under consideration may consist
of utero-peritoneal adhesions, retractiun, and i^elaxa-
tion of the uterine ligaments, congestions, or tumom-s
either in the uterus itself, or in adjacent portions of
the pelvic cavity, and frequently by peri-uterine phleg-
masia3. These conditions will primarily demand the
treatment specially appropriate to themselves.

If, on the other hand, vaginal examination reveal
neither evident disease, pain on pressure, nor patho- fl
logical conditions of neighbom'ing organs, and if the ~
uterus is freely movable in tlie pelvis, and easily
reduced, then mechanical appliances ought to be
employed.

4
4

URINARY AND REPROnUCTIVE ORGANS.

273

Uterine pessaries are of diverse forms and composi-
tion. Having regard to the fact that pregnancy itself
occasionally cures the mal-position of the organ, it will
follow tliat such mechanical devices as retain the uterus
in its proper position, and do not interfere with the per-
formance of the sexual act, are to be preferred to such
as do not fulfil these indications. Aecoidingly such
pessaries as the saddle*pessary of Hodge, or the ring-
pessary of ileigs, answer best. It is requisite that the
pessary be suitable to the particular case; thus it must
retain the uterus in its normal position, and must
neither exercise an undue pressure on it, nor on the
walls of the vagina. This is not always determined on
the first trial of the instruments, but only after several
tentative experiments.

Marion Sims relates two cases of sterility cm-ed by a
pessary of cotton saturated in glycerine bemg placed
in the posterior ruf -de-sac of the vagina. In similar
cases^-cases of retroversion — a cylindrical piece of
sponge may be placed in the same position. The
diameter of the sponge ought to be about half that of
the vagina, and of a sufficient length to support at
least the half of the uterine neck. The vaginal mucus
causes swelling of the sponge, and the organ is thus
elevated above the surface of the vagina, on which it
formerly reposed.

Such means as these will be obviously ineflFectual in
remedying displacements duo to adhesions or contrac-
tion, &c,, of the uterine ligaments. In these cases
gentle attempts at reduction should be made by means
of the uterine sound. The soimd should be used as a
lever, and a toand-fro movement exercised in the
dii'ection opposite to that of the displacement. The

276

ON THE FUNCTIONAL DISEASES OF THE

minutes. The prone position is favourable to reduc-
tion, the patient being placed on her knees. Pressure
over the hypogastriuni has been counselled in order to
fix the neck. The operation vnW be facihtated by
emollient applications or pomades, and the inhalation
of chloroform.

Even after a considerable interval the taxis alone will
suffice to reduce the organ. M. Barrier lias reduced
an inverted uterus after five months, M. Courty after
six months, and Marion Sims after an interval of nine
and twelve months. It will be ob\ious that the extent
of displacement bears an intimate relation to the
facility with which reduction is accomplished.

Surgical interference mil be required in the chronic
and irreducible cases. The most simple operation
consists in making a few longitudinal incisions, in order
to divide the circular fibres. Should this not succeed
amputation of the organ may be considered requisite.
This, however, it must be admitted, is an operation of
great gravity, either owing directly to the large and
uncontrollable htemorrhage whicli often ensues, or to
secondary inflammation and its consequences. Removal
by the ecraseur is less dangerous than excision by the
knife, though the latter was successfully practised by
Velpeau. Ligature of the organ may accomplish the
same object, and with diminished risk, if care be talien
not to excite peritoneal inflammation. After the
operation the patient should be confined to bed untfl
the wound has completely healed. The healing process
may be accelerated by weak injections of chloride of
zinc with borax, permanganate, and potassium chlorate,
&c. When the inversion is irreducible, and the radical
cure may be contraindicated, all that can be done is

I
I

URINARY AND REPRODUCTIVE ORGANS. 277

to treat complications, and make the state of the
patient as tolerable as possible. Haemorrhage is to be
guarded against, and checked by topical astringents,
of which perchloride of iron, tannin, infusion of oak-
bark and logwood, answer well. Pain is to be allayed by
emollient applications containing belladonna and other
sedatives. Strong caustics may be judicially employed
with a view to determining atrophy of the organ. Much
exercise should be avoided, and the horizontal position
should as much as possible be observed.

UteHne polypi y if large, may occasion sterility; when
small, they do not necessarily so operate, but even then
they may be the immediate cause of uterine haemor-
rhages which prevent the growth of the foetus, and
determine its expulsion. When large they cause
sterility, by so obstructing the passages that the seminal
fluid is prevented access to the ovum. The extraction
of the polypus is the only means to remedy this form
of sterility.

Fibrous tumours are sometimes found embedded in
the walls of the uterus; when small, they do not prevent
fecundation, and women go through the full term of
gestation under these conditions. On the other hand,
when large, they may determine such haemorrhages, or
so occupy the uterine cavity, that the foetus is prema-
turely expelled. This cause of sterility must be deemed
incurable.

Congestion of the uteims^ when it is intense or habitual,
is a condition unfavourable to impregnation. It is a
frequent cause of abortion. This condition ought to
be treated by dry cupping, the application of leeches
to the OS uteri, and counter-irritation over the hypo-
gastrium.

278 ON THE FUNCTIOXAL Dl8EASEJi OF THE

Metritis* seeni8 to operate as a cause of sterility iit^
twofold manner, viz., either by the congestion of ijfl
endo-uterine mucous membrane, or by the inflammatoiy^
tiirgescence obstructing the canal of the Fallopian tulw
When the submucous tissue of the uterine ueck
affected^ an impediment \vill, in like manner^ be offei
to the passage of seminal fluid.

False membranes may form on the internal surfa^
of the uterus, and thus block up the uterine canal, and
that of the Fallopian tuljes similarly.

Morbid secretions from the uterine surface seem to
prevent fecundation in a twofold manner, either by
their quantity or quality. If the secretion be abundant
it may so occupy the canal that the passage of seminal
fluid will be prevented, or this may be occasioned still
further by the opposition presented by a copious flow
of the morbid secretion; or it may so dilute t|H
seminal fluid that it is rendered incapable of impr^J^
nating the o\^un. ^

Mucous secretions may be sometimes of such a co^^
sistency as to form a solid or semi-solid plug in the
cer\ical canal If the uterine secretions be too acid<
the chemical action on the spermatozoa whicli tliUfi
ensues is such that their death is caused. Accordi
to M. Donn<5, pus and muco-pus has no toxic influei]
on the spermatozoa.

What ai>plies to uterine leucorrhoea applies in IE
manner tu tliat which j>roceeds from the vagina. Evt
thing depends on the amount of acidity. Marion Si
has noticed a case in which the vaginal secretion
so acid that death of the spermatozoa resulted in five^

lilp

UKINARY AND KEPRODUCTIVE ORGANS.

Ii79

six miimtes after coitus. He likewise remarks^ that
with test paper he has been able to predict that the
secretions were of such a nature as probably to kill the
spermatozoa, and thus cause sterility.

Should these discharges be associated with indica-
tions of inflammatory action the preliminary treatment
will be regulated accordingly. Having subdued the
congestion and the tenderness, intro-uterine injections
should be resorted to; and these may consist of solu-
tions of nitrate of silver, chlorate of potash, chromic
acid, tincture of iodine, &c., or soluble bougies, or
uterine pessaries impregnated with tannin, or other
astringent according to the indications of the case, may
be inserted into the uterus, and allowed to remain
during night, and thus melt w ithin it.

When an acid reaction of the uterovaginal secre-
tions is very marked, weak alkaline lotions should be
injected into the vagina. I liave seen g^eat benefit
accrue in such cases from the use of a solution of
borax, with glycerine and infusion of oak-bark.
During my connection with the Glasgow Royal
Infinuary this was esteemed a favourite lotion, and
much beuetit from its use resulted.

Cotton pkigs, saturated w ith a convenient astringent
and detergent lotion, may be inserted into the vagina
with the prospect of amehoration,

Jdiopathic uterine hivmorrhages are a frequent cause
of sterility. The uterine plethora is to bo guarded
against by revulsive bleedings, as by leeches, about the
trunk and upper extremities. Dry cupping, sinapisms,
and cold baths may be used w^ith a like object in view,
and appropriate to the circumstance. Preparations of
opium and antispasmodics are useful when this con-

ON THE FUNCTIONAL DISEASES OF THE

dition is attended with an erethism of the nervous
system, and pains in the lurahar and uterine region*

My friend Professor Behier lias reported two ex-
amples of copions menorrhagia treated by large doses
of opium, although there was an absence of pain.

M. Costaz, with a view to its acting as a sedative to
the circidation, has en? ployed the hot bath during
from half an honr to an hour. He relates success.
This remedy seems more specially applicable to sthenic
nienorrhagifis, and those of nervous and highly excit-
able individuals.

Local applications of cold water or ice over the
hypogastrium, or introduced into the vagina, have fre-
quently a marked influence in cliecldng the Inunior'
rhage, The whole body may be immersed in cold water
with a like result. Astringents and styptics must be
employed with caution in these cases; they sometimes
cause secondary congestion and augmented haemor-
rhage. Absolute repose and the dorsal decubitus should
be strictly observed duiing treatment.

Fasdm hajmorrhaffe is of a difterent nature, and re-
quires relatively different treatment. Tliis is more fre-
quently observed in chlorotic females, in individuals who
have been debilitated by depressing social or hygienic
influences, or chronic organic diseases. In these cases
the uterus participates in the general enfeeblement.
Its walls have less tone, its blood-vessels are relaxed,
hence result stases and exudations of blood, leading to
menorrhagia. Two indications of treatment are here
obviously enough presented, viz., to invigorate the
general system ; and secondarily, to act directly on the
uterine circulation. To fulfil the first indication,
nourishing food should be taken; malt liquor, if not

I
I

URINARY AND REPRODUCTIVE ORGANS. 281

specially contraindicated, will have a good effect. Open
air exercise should be enjoined; and the preparations
of iron, quinine, strychnia, ergot of rye, offer a class of
medicaments for beneficial selection. The mineral
acids, with bitter infusions, may be more suitable for
certain cases. Local and general bathing is an admir-
able and effectual adjuvant to the general treatment.

The use of certain mineral waters has been counselled
in such cases, viz., the ferruginous waters of Spa, of
Forges, of Passy, &c.

To meet the second indication, to give tone to the
uterine fibres, the application of cold water over the
hypogastrium or into the vagina, perichloride of iron
injection, and of other astringent agents, should be
resorted to.

Ergot of rye — the watery extract being an excellent
preparation — may be given internally, or ergotine be
used in the form of subcutaneous injection. Extract
of nux-vomica may likewise be administered, and
galvanism be used beneficially. Obstruction, or stric-
ture of the Fallopian tubes, is an occasional cause of
sterility. To act in this manner, however, the affec-
tion must be double, i.e., it must coexist simultan-
eously on each side.

The development of the tubes may be aiTcsted, and
this takes place consentaneously with a like affection of
the ovaries. This is a perfectly irremediable condition.

Of all the morbid conditions of these tubes, their
obstruction and obliteration are the most frequently
disclosed on post-mortem examination.

Much obscurity surrounds the diagnosis of affections
of the Fallopian tubes, and medical or surgical inter-
ference is correspondingly impotent for benefit In

284 ON THE FUNCTIONAL DISEASES OF THE

of these causes of sterility, more especially when the
affection involves the entire extent of the structure of
the ovary. Some light may be thrown on the inves-
tigation by the palpation and percussion of the abdo-
minal walls, measurement, and rectal and vaginal
examinations. The presence or absence of menstrua-
tion will furnish valuable indications. Begular and
normal menstruation, with extensive disease of the
ovaries, is comparatively rare. On this point Roubaud
arrives at the following conclusions : —

1. Regular menstruation, that is to say, the secre-
tion, the development, and the expulsion of a Graafian
vesicle, may in some rare cases take place without
menstrual haemorrhage, and that absence to be the
result of an idiosyncrasy. In these cases where fecun-
dation is possible, menstruation is always disclosed
by some general or local phenomenon.

2. Menstruation, comprising secretion, development,
and expulsion of a Graafian vesicle, may take place,
without menstrual haemorrhage, in consequence of
some morbid condition of the uterus. In these cases
fecundation is possible, and menstruation is always
evinced by some general or local phenomenon.

3. Regular menstruation, comprising the normal
secretion, development, and expulsion of a Graafian
vesicle, interrupted or suppressed by a disease of the
ovaries, suspends or always delays the catamenial flow,
and that absence of the menstrual haemorrhage is never
replaced periodically by any abnormal phemonenon
whatever.

Vital Lesions of the Ovary as a Cause of
Sterility. — By these conditions are to be understood

URINARY AND REPRODUCTIVE ORGANS. 285

such as result from causes which pervert the normal
function of the ovary. M. N^grier (d'Angers) has
studied this yet obscure subject minutely, and the
conclusions arrived at by this authority are to the
following effect : —

" 1. The ovarian vesicules are capable of undergoing
changes which, far from obscuring a knowledge of the
functions of these organs (the ovaries), contribute to
demonstrate the reaUty of diverse phases of their
evolution.

" 2. The alterations of the vesicles are incomparably
more frequent than those of the parenchyma of the
ovary, and under the latter classification I speak of
the fibro-cellular and vascular tissue which constitutes
the principal mass of the organ.

" 3. The alterations of the ovarian vesicles are a
common cause of steriUty, and consist in an arrest
of development; this is complete or partial.

" 4. That arrest of vesicular evolution may determine
a true abortion of the vesicles at any degree of their
transformation.

"5. The consequences of incomplete or complete
abortion present great differences in respect of their
gravity.

" 6. Ordinarily, complete abortion of the ovules and
their vesicules does not cause accidents which compro-
mise life, and the debris of the organ disappears more
or less completely by resorption.

" 7. Complete abortion may be the occasion of an
inflammation, and consequent suppuration, leading to
grave consequences.

* Recherches anatomiques ei physiologiques sur les ovaries dans re82)fee
humaine,<p. 117, e^ seq.

286

ON THE FUKCTIONAL DISEASES OF TOE

narv ^

" 8. Partial abortion, tliat is to say, the arreist of
development of one of the constituent parts of an
ovarian vesicle, deteroiines an alteration more or less
profound in the functions of other parts of the orj
and an alteration in their reciprocal bearings.

'*9. Incomplete aboitiout which takes place when
the vesicles are only in the condition of a primary
vesicle, appears to be the cause of most of the eacysted
dropsies of the ovary.

" 10. The same partial abortions, when the %^esicle8
have become fatty pouches, appear to be the origin of
fibrous, cancerous, and other tumours of the o\^ar}'.

"11. Partial abortion of the vesicles, when they an
in the state of yellow vesicles, is the source of encysted
tumours of the ovary, containing matter of the apj>ear-
ance of butter.

" 12. Finally, it is to these cases of fecundation, with-
out separation of the ovum from its vesicle, that it is
necessary to attribute the foetal productions which are
found in the ovary, where they develop under the tuflu-
ence of vascular adhesions which they establish betwe<ni
themselves and the membranes which enclose them/*

Malposition of the ovarp may be a cause of sterility,
not, however, by interfering with normal ovulation, but
by so altering tlie relative |)08ition of the ovary to the
adjacent organs that the ovum is prevented entering
tlie Fallopian tul>e, and thus descending into the uterus.
Changes in the position of the ovary are described as
mnple or complicaUdi — simple, if the anatomical rela-
tions of the ovaiy only are altered ; complicated, when
it becomes engaged in a normal or accidental aj)erture.
In the first phice, strictly speaking, the malposition is
di^p/ne^ment, in the second heruia.

UltlNARY AND REPRODUCTIVE ORGANS.

287

Displamments of the ovary, according to their cause,
may be of a twofold nature; on the one hand, when the
determining cause of the altered rehxtionship is in the
organ itself, and on the other when it is the result of
adventitious adhesions involving the neighbouring
organs. In the first place, the mere increase in weight
may determine an abasement of the organ; and this
may be common to both organs. Sometimes, however,
but one is affected, the opposite remaining healthy.
The healthy one is, notwithstanding, dragged from its
normal position by the weight of the diseased one
operathig upon it.

The second variety of ovarian displacements is more
frequently met with, and this will be at once apparent
on consideration of the great mobility of the ovai'ies,
and the organs by which they are immediately sur-
rounded. Malpositions of the uterus may certainly
alter the position of the ovaries, but sterility could not
be ascribed to the latter, in the presence of the former
condition. The diagnosis of ovarian displacements, in
the absence of enlargement and augmented weight of
the organ, is difficult and obscui^e. Abdoniinal palpa-
tion, and vaginal and rectal examination, aflord but
equivocal evidence; and percussion cannot well define
organs so susceptible of being moved even by loops of
intestine. Menstrual hLiemon-hage is altered in its type
occasionally, but this apphes equally to abnormal con-
ditions of the uterus. A history of peritonitis, and
subsequent sterility in a female foraxerly prohfic, would
I have considerable significance in conjunction with
L other signs of ovarian disease or displacement. So far
B as treatment is to be conducted, it must be rather

ON THE FUNCTIONAL DISEASES OF THE

Hernia of the ovary was a condition to which little
attention liad been directed until the time- that Deneux
directed attention to it.* Soranus of Ephesus appears,
however, to have been the first to have made mention of
this condition. Haller, in 1755, recorded the thirteenth
case of hernia of the ovary mentioned in the annals of
medical science. Percival Pott relates a case of double
ovarian hernia.t The following is an outline of Pott*s
case : — A young woman of twenty-three years of age
entered St Bartholemew's Hospital, on account of two
tumours situated in the groin, and causing so much
pain that patient was unable to follow her ordinary
avocation. Patient was of a vigorous constitution, had
menstruated regularly, and was not incommoded save
when the tumom s were compressed in the act of stoop-
mg, &c. The tumours were without inflammation, soft,
irregular on surface; easily moved, and placed in the
tendinous orifices of tho costo-abdominal muscles.
Bleetlings, purgatives, and attempts at reduction made
by many surgeons, proved ineffectual, and operation
was determined on. The skin being divided disclosed
a thin membranous sac, in which was sitiuited a body
so like an ovary that mistake was impossible. In
front of the abdominal ring an incision was made, and
the organ was removed by a stroke of the knife. The
same procedure was observed on the opposite side,
and thus the two ovaries were removed. At\er that
period the patient enjoyed good health; the menses,
however, did not recur, obesity diminished, and the
muscular system partook of a masculine vigour.

InJIammatioM of the orary (ovaritis) sometimes sus-

♦ Rechercbea &iir lea honiies di? rovaiie, Parit*, 1843.
t Surgical Works, vol. 1. p. X\i'I,

URINARY AND REPRODUCTIVE ORGANS. 289

pends the function of ovulation; furthermore, the
intense suffering thus occasioned is of such a nature
that sexual congress is rendered either difficult, or
altogether impossible. Chronic ovaritis does not abso-
lutely prevent impregnation, but it causes an irregu-
larity of menstruation, which must necessarily influence
conception.

Congestion of the ovary when intense is capable of
acting temporarily so as to prevent iionnal ovulation.
Apoplexy of the ovary in like manner, produced by
physiological or pathological states, may operate simi-
larly. The extent to which it will thus operate will
depend on whether the ovary is totally or partially the
seat of disorder. If the affection is confined to the
parenchyma, ovulation may take place in the normal
manner; but if the depth of the organ be equally
invaded the hsemorrhagic infarction may lead to com-
plete atrophy of the organ.

Phlegmasise and inflammations of the organs sur-
rounding the ovary (haematocele), peri-uterine inflam-
mation, pelvi-peritonitis, etc., may occasion infecimdity
by determining sympathetic hypersemia of the ovary.
Permanent adhesions may thus result which will act
as incurable causes of sterility, as already indicated.
Affbctions of this nature must be treated solely on
general principles.

General Causes of Sterility in the Female, —
While in the vast majority of instances sterility is to
be attributed to conditions affecting the genital system,
cases sometimes occur in which the absence of manifest
local disorders implies the presumption of some con-
stitutional inaptitude for fecundation. The evidences,

ON TUE FimcrnONAL DISEASES OF THE

however, which are furnished in this manner are of the
most equivocal description. Thus frequently healthy-
Uioking women, with their ftinctioiis normal, are found
to remain sterile, whiledeHcatc females exhibit renuirk-
able aptitude for procreation. When there is a marked
predominance of one of the temperaments over the
others, fecundation seems less likely to occur. When
the sanguine temperament predoininate.s, it is apt to
deteiiuine uterine plethora and iKcmorrhage, eircum*
stances, as we have seen, unfavourable to impregnation.
In females in whom the lymphathic temperament pre- M
dominates, as evinced by midue obesity, sterility is not "
unfrequent. The same obtains with the nervous tern- '
perament, as females affected with violent emotions ■
are less apt to conceive than those of an equable I
temperanient. This has evidently some relationship
with spasmodic contraction of the uterus during
coitus,

Hereditariness seems to exercise some influence on
fcrtiHty ; and recent obseiTatious demonstrate that
consanguineous marriages are less fruitful than mixed
ones.

SteriUty is more frequent in cities than in nu'al
districts, and more frequent aniinig the rich than the
poor, two circumstances which admit of the same
explanation, viz., the excesses indidged in by the former,
and the various other social exigences which thus
underaiine health, more especially in crowded cities,
than in healthy rural districts.

Aptitude for fecundation does not manifest itself at
the same age in all persons. The majority of all
females conceive shortly after marriage; but others
equally healthy remain sterile after marriage, for

UKINAKY AND UEPUODUCTIVE ORGANS. 291

many yeai's, and then become mothers with a marked
legularity.

An explanation of these cases, evidently of long
sterility, is given by certain authorities, by the allega-
tion that conception does take place in the vast
majority, but that premature abortion is induced by
various circumstances, conspicuous among which is to
be foimd the syphilitic diathesis. When gestation pro-
ceeds to the extent of manifesting itself by the usual
phenomena, there can be no obscurity on tliis point ;
but if the expulsion of the ovum takes place during
the first days of fecundation, the matter will be less
clear. Parent-Duchfi,telet,* referring to sterility of pro-
stitutes, thus expresses himself: " I have spoken above
of the irregularity of menstruation in some prostitutes,
and of the interruption to this function which many
circumstances oflfer; can such not be attributed to a
veritable conception? That opinion, which has been
given in my presence by many distinguished physicians
and physiologists, acquires a great probability by the
observations made by M. Serres, when prostitutes were
observed in one of the divisions of La Piti^. I will
here. record the response made me by that academician.
'Abimdant evacuation is rare in these females; but
the young have their menstruation frequently retarded,
and comes on coincidently with the expulsion of what
they call a bondon. During two years, I paid no
regard to that expression; but having directed my
attention to embryology, I carefully examined these
productions, and had no difficulty in recognising the
human ovum; I have been able in a short period of
time to gather many such masses, which were all

* De la prostitution daiis la Ville de Paris, 2*' ed. p. 235 et 236

292 ON THE FUNCTIONAL DISEASES OF THE

expelled at a period indicating a conception of five or
six months.'"

In cases of anaemia and chlorosis^ in common with the
other functions of the body, those of the sexual organs
are perverted and impaired, and hence irregularity
of menstruation may operate as a cause of sterility.
The indications of treatment will vary according as
the anaemia and chlorosis may be the primary or
secondary affection.

Relationship of Menstruation with Sterility. —
When the absence of menstruation is the consequence
of an arrested development or atrophy of the genital
organs, the sterility will be absolute and incurable.
According to some authorities, the absence of men-
struation is not only compatible with a perfectly normal
appearance of the sexual organs, but also with fecun-
dation. The absence, however, of the menstrual
secretion is unfavourable to conception, and the re-
storation of the function is desiderated. In relation
to menstruation, certain periods seem more favourable
to conception than others. Thus Pouchet,* in his
theory of spontaneous ovulation, teaches that fecunda-
tion can take place only in the period comprised be-
tween the first and the twelfth day after menstrua-
tion. His general conclusions are summarised as
follows: — "The Graafian vesicle (for there is almost
always but one, which gives origin to the ovule),
developes itself during the menstrual period. Then,
either immediately after the cessation of the catamenial
flow, or two, three, or four days after it has ceased,

♦ Th^oric iK>gitive de Tovulatioii spontan^ et de la fecundation. Paris,
1847.

URINARY AND REPRODUCTIVE ORGANS. 298

that vesicle bursts and allows its contained ovum to
escape.

"The ovum is then seized by the fimbriated extremity
of the Fallopian tube, and slowly traverses the tube to-
wards the uterus. I think that a period of from two
to six days is requisite for the passage from the ovary
to the uterus.

" Arrived in the uterus, it is there retained from two
to six days by the decidua exuded on the mucous
surface of the organ, towards the decline of the irrita-
tion which follows the menstrual period.

"If the ovum is not then impregnated by the
seminal fluid of the male, it becomes detached with
the decidua, which usually happens from the tenth to
the twelfth day from the cessation of the menstrual
flow.

" Experience having proved, in other mammalia,
that the seminal fluid lodged in the interior of the
genital organs of the females retains its prolific power
during more than thirty hours, it is probably the same
in the human species. Thus cohabitation may be
succeeded by fecundation, though it happen two or
three days previously to the arrival of the ovum in the
uterus.

" But every sexual intercourse after the detachment
of the decidua, and during all the time intervening
between that process of detachment and the next
menstrual period, is absolutely unfruitful.

" But, as we know that the decidua detaches from
the tenth to the twelfth post-menstrual day, it conse-
quently follows that conception can take place only
during the period from the first to the twelfth day
after menstruation."

294 ON THE FUNCTIONAL DISEASES OF THE

Courty,* in a less decided manner, remarks — " We
are forced to conclude that in general, in the female,
conception takes place only during the first eight or
ten days following menstruation." The observations
of Wagner, Leuchart, and Raciborski, and many
others, have shown that the dogmas of Pouchet and
Courty are too absolute, inasmuch as impregnation has
been observed to take place at all the intermenstrual
periods; this, however, M. Coste endeavours to explain,
by asserting that ovulation may be incompletely per-
formed notwithstanding the perfect regularity of the
menses, and that thus the arrival of the ovum in the
uterus may be postponed. All the circumstances,
however, justify the conclusion, that the period at
which impregnation is most apt to take place is that
comprised between the first and the twelfth day after
the cessation of the menses.

Venereal Excesses as a Cause of Sterility.—
Excessive coitus may operate as a cause of sterility by
blunting the special sensibility of the organs, determin-
ing congestions, or by the production of an abnormal
excitation. These are the causes, no doubt, so largely
operative in determining apparent sterility in prosti-
tutes. The direct effect of excess of coitus on the geni-
tals has been described by Parent-Duchfi,telett in the
following terms: — "Prostitutes present frequently, in
the thickness of the labia majora^ tumours which com-
mence by a small nucleus and enlarge by tumefaction
at each menstrual period; these tumours are never
observed save on one side at the same time, and if left

* I)e roDuf et rle son ddveloppment dans rc8i)^ce hiuuaiue,
t Dc la iirostitution dans la Ville de Paris, t. I. p. 250.

p. 84.

URINARY AND REPRODUCTIVE ORGANS. 295

to themselves acquire a considerable volume. They
are indolent, and do not embarrass the female save in
a purely mechanical maimer. It is rare that these
tumours are fibrous; most frequently they are fall of a
very thick albuminous matter or a honey-like substance.
Sometimes they are developed at the base of the
nymphae; the latter are of the same nature as the
others, but more painful, and never attain to a great size.
The mode of life brings on inflammatory action, which
developes itself sometimes in these tumours, and cause
them to burst, but they soon refill, and thus determine
disagreeable fistulae. They cannot be cured save by
excision of the cyst, and setting up a new action.
All who have had occasion to 9pen these cysts, or to
excise these tumours, are agreed on the extreme fetidity
of the liquid which they contain. That foetor is
inherent to the contents, and cannot be ascribed to the
presence of air.

" Nothing is more frequent than the occurrence of
abscesses in the labia majora. They alway observe an
acute course, and terminate as in other females subject
to them. It is not the same with those which develop in
the perinaeum, a part which, according to some observers,
is very thin in prostitutes; they degenerate frequently
intofistulce very difficult to cure, and affict individuals
thus affected frequently during their lifetime; at other
times they contract and heal,»and do not offer an
impediment to sexual congress. At the period at
which I made my investigations in the prison, there
were five or six females with this infirmity; the phy-
sicians of that establishment estimated that there would
be in Paris thirty prostitutes following their avocation
with that disgosting infibrmiiy. WT I believe that

296

ON THE FUNCTIONAL DISEASES OP THE

^stul(B have been known to heal under such circum-
stances, calculated to cause and aggi^avate them 1

*' According to the observations made in infirmaiies
and prisons, these recto-vaginal fistula coincide almost
always with phthisis; they are frequently associated
likewise with engorgement of the labia majora. That
engorgement is not an ordinary infiltration of cedema ;
it is hard and resisting, and does not yield to pressure,
neither does it occasion pain*

" That infirmity acquires sometimes such dimensions
in these females that they are unable to pursue their
avocation, and that, become thus a chai'ge to them-
selves, they desire an asylum in which to terminate
their sad existence; they ordinaiily choose the prison
infirmary."

In a class of cases venereal excesses induce a peculiar
alteration in the mucous membrane of the vagina, which
is not without its influence in the causation of sterility.
It is well kno^vn that a mucous smface exposed to the
external air, or to the action of friction, undergoes a
change whereby the characteristics of the epidermis
are induced; excessive coitus seems to have, in certain
cases, a similar influence on the mucous membrane of
the vagina, which becomes thus dry and hard. This
condition is in all probability also hiduced, in a great
measure, by the frequent use of detergent and astrin-
gent lotions. It is attended by diminished special
sensibility of the sexual organs, a condition which, in
common with the dryness, vaginal examination with the
finger instantly reveals* In the treatment of tliis dis-
order, preliminary to the adoption of any special
method, the use of astringent injections should be at
once interdicted. Then emollient preparations may be

URINARY ANE REPRODUCTIVE ORGANS. 297

introduced into the vagina in the form of pessaries;
small doses of iodide of potassium may be administered
internally, and the mucous secretion may also be
stimulated by mild emollients. When the change in the
mucous membrane is complete little can be done to
remedy it.

Mental affections, according to Esquirol, are exceed-
ingly firequent among prostitutes; but this authority
has sufficiently established by statistics, based on his
experience at the Salpfitri^re, that erotic delirium is
exceedingly rare in this class of lunatics.

Influence of Frigidity on Fecundation. — By the
term frigidity is to be imderstood an absence of the
genital sense, independently of hypersesthesia and
other conditions which render the performance of the
sexual act on the part of the female either repulsive
or painful. Roubaud has dealt at considerable length
on the subject, in its bearings on the matter under
consideration. It is not to be disguised, however,
that genital sensibiUty is not essential to impregnation,
as sufficient testimony exists to the fact of fecundation
having taken place under the influences of repulsion or
direct violence. Notwithstanding this, the absence
of genital sensibiUty does seem to operate in some in-
stances, by interfering with, or perverting the spasmodic
movements of the uterus which occur consentaneously
with coitus, and which seem to favour the reception of
the seminal fluid.

Roubaud recognises five orders of frigidity as
follows : —

1st, Natural frigidity, due to vices of conformation.

2d, Idiopathic frigidity.

298

ON THE FUNCTIONAL DISEASES OF THE

3d, Symptomatic frigidity.

4tli, Consecutivo frigidity.

5th, Sympathetic or moml frigidity.

The evohitiuii of the genital sense is immediately
dependent on the anatomical and physiological integiity
of the parts concGrned, even as in the male. In the
female the bulbs of the vagina are the analogues of the
bidb of the urethra in the male; and the clitoris, as
with the penis in the opposite sex, is furnished with
two cavernous bodies communicating at their base with
the bulbs of the vagina through the interv^ention of a
plexus of veins. Under the influence of venereal exci-
tation, the bulbs become engorged with blood, which is
conveyed, by the intermediate network referred to, to
the cavernous bodies and glans of the chtoris, sensibi-
Hty being thus heightened. Under this influence the
constrictor muscle of the vagina, as with the bulbo-
cavernous in the male, contracts, and thus presses on
the bulbs of the vagina. It will be obvious then, that
if the special fmiction of any of these structures is
perverted, or if they happen to be altogether want-
ing, that the venereal erethism will be correspondingly
effected.

Roubaud has thus referred the causes of his first
order of frigidity to affections, or anomalies of the
cHtoris.

While arrested development of this organ may
diminish genital excitability, it does not follow that
the converse is absolutely true. Parent-Duchatelet,*
for instance, records the fallowing case: — "At the
period in which I made my observations there were in
Paris three prostitutes whose clitores presented a

♦ Op, cit. tup.

URINARY AND REPRODUCTIVE ORGANS. 299

notable enlargement. The clitoris of one of them was
exceptionally large, measuring in length eight cen-
timetres (three inches), and in thickness it equalled
the index finger. A well-formed glans covered with a
prepuce, under which sebaceous matter existed, was
apparent. The young woman was twenty-three years
of age, had never menstruated, and exhibited no trace
of breasts. It is probable that there was an absence of
the uterus, for vaginal examination revealed but a
small tubercular projection without manifest aperture,
and rectal examination gave similar negative evidence;
unfortunately, examination by the speculum was not
conducted. The subject of observation had been a
long time at the prison of Madelonnettes, and the
physicians of that establishment had long desired to
discover what influence the abnonnality exercised over
the genital passion; but the woman always asserted
that, in this regard, she was equally indifferent for
either sex, that she had abandoned herself to prostitu-
tion on account of privation. I watched this person
during six months, questioned many persons regarding
her, and the reply never varied. On leaving the
prison she replied in like manner to the medical
officers of the dispensary, who reported the case to me.
That indifference for the opposite sex, despite the
great development of the clitoris, may possibly be due,
in some degree, to the probable absence of the uterus
and its appendages."

In the second variety of frigidity, Roubaud recognises
as the cause, paralysis or diminished sensibility of the
organs. In the third, age, constitution, temperament ;
various nervoses, such as epilepsy, hysteria, catalepsy,
&c. In the fourth, the variety of sexual repugnance

300 ON THE FUNCTIONAL DISEASES.

manifested after child-bearing; as due to venereal
excesses, alcoholic excesses, narcotics, &c. In the
fifth, moral causes resulting from mal-assorted mar-
riages, disappointments, &c.

Artificial impregnation. — It remains but to glance
at the subject of artificial impregnation at first
attempted by Swanmierdam, and afterwards by Roesel
during the last century. Their experiments were not
attended with success. Towards the end of the same
century Spallanzani succeeded, however, in artificially
impregnating some of the lower animals.

Hunter records the first artificial fecundation of a
female in 1799, in " The Philosophical Transactions."
The subject seems to have lapsed into oblivion, from
which it ought perhaps not to have been rescued, until
Dehaut, in 1865, revived its consideration.

In 1866, Marion Sims,* dwelt at length on the
operation, and cited a case of success.

The " R^forme M^dicale " gives two accounts of suc-
cessfdl artificial impregnations, the one by Dr Lesneur,
and the other by Dr Gigon of Angouleme.

In 1868 Girault collected (I'Abeill? Mddicale) ten
cases of successful artificial impregnation in the human
female, the first as far back as 1838.

As a therapeutical means, a procedure so subversive
of female delicacy cannot fail to be always regarded
with feelings of just repugnance.

* Uterine Surgery. ^

INDEX.

Abdominal muscles, paralysis of, effects on micturition, 25.

Abercrombie, Dr, on dreams, 172.

Abscess of the labia majora, 256.

Abuse of the genitals, effects of, 134.

Abyssinian priest, Gregory, on circumcision, 175.

Accupuncture of the prostate, 173.

Acton, Mr, on seminal reabsorption, 182; on clergyman's iore throcU, as a

symptom of spermorrhagia, 118.
Adhesions of the labia migora, 256.
Alcohol, its influence on reflex excitability, 152; in production of urethral

discharges, 253.
Althaus, Dr, on galvanism in resical paralysis, 30, 31.
Amaurosis (*Aficav^, to darken), as an effect of masturbation, 97.
Amussat, his case of absence of the vagina, 257, 258.
Anaemia from sexual excesses, 108.
Antimonial poisoning, impotency from, 239.
Appetites, natural instinct, 177; Aristotle on, 177; Cicero on, 178; Ihigald

Stewart on, 178; Strauss on, 178.
Arsenical poisoning, impotency from, 239.
Aspermatozie, Hirtz on, 69.
Ataxy (a, priv., ruc9«ty to order), Dr Bradbury's case of, 99; its influence on

the genitals, 100; Hippocrates on, 79, 99; Celsus on, 99.
Atresia (ah'^^M*, immovable), congenital of the vagina, 260.
Atrophy of the testicles, alleged from disuse, 75.
Azoospermia from excessive coitus, 205 ; idiopathic, 209.

Bacon, Dr M^Eenzie, on castration as a cure for epilepsy, 1 26.

Barclay, Dr, on " spermatorrhoea,'' 97.

Barry, Dr, case of worms in the bladder, 43.

Bell, Sir Charles, on the sphincter vesicae, 11.

Belladonna in the treatment of enuresis, 152.

Bernard, his experiments on the sympathetic nerve, 8, 9.

INDEX.

Bljidder, nnatouncal struclure, 2, 3 ; ita mucoiit lueniLrane, 4 ;

but ion to tlie, 4, 5, 6 ; paralysis of, reteotion of aiiiie from, 10, K^ | tlMt-
ment, 25, 26, 27, 28^ 2t) ; Mr Hutchinsoti on, 26; Gntheterbm m^ Mi
cystitm in, 2^^ 27; depositor ^4ithtites and pboshiita in," 9Bl maami
function of^ on what dependjimt, 11) ; nmironnaltoiifl of thm^ at mamm^i
impot^nej, 2*24, 225, 226.

BlandiQ an congenital abnenoe of the testiclea, 197.

BlUtering in treatment of aelf-pollution, 173.

Boujfies, their employment in the trentnient of »pnimtU imcontiiience, m '

Bnvlburj-, Dr, un tjvatmt^nt of ripennorrhn^pu, 157.

BroniiJiL', toxic effects uf, im potency from, 24i).

Brown, Mr B^iker, hi^ connection with cliioridectoray, 127, 188L

Budge, hia experiments on dogs, 5, 6 ; h\& viewti of the tphincttr voicK, 10; '
on the coimection of the cerebellum and test*.**, 61.

Biu?dach on atrophy of the testes from oerebnil dropity, 112.

Cacoifenesia (*«*A*f, yiv*«(Ai), molecular, 33.

C^fctfein, its influence on reflex Gxcitabtlity, 152.

C'alculi, a cause of ennrenia, 51.

Camphor in treatment of enuresis, 153; a/s an anaphrodUkc, 1G8 ; br

l(jl> ; in 8tranj(ury, 42.
CimtharadiD, absorption of, as a cauae of ^tran^^iry, 42.
Ciintharidcd blister, application of, cau^inj; seminal emi^aioti, )4S.
Canthandes, internal administration of, canning tirethml dischar|^ 254.
Casper on zooaperms, 58, 59, 60 ; crypjtorchids, 196.
Caatnition, Sir As t ley Cowper^s case of, 56 ; Krahmer^i case of, 67 ; mAmaom

of, 81 ; caustic, employment in seminal incontinenoe, 163 ; oeplttlAlgiftv

due to exoef^tvc ooitas, 112.
Grfuixtheflia {nAi^is, comuion ; dtthmiSf feeling), 47, 48 ; rektian of Um^ la

hysteria, 49 ; to metrottumia, fiO«
Cert'bellum, iniluenoe on the genit&l organs, 82 ; Semw on tb«, 88.
(MiiimborH, Dr Kiu|{, on leminal emiasion, 136.
(liikrcot on byateria, 40.
Chloral hydrate, it^ inttuence on reflex eitcitabiUty, 151; la the I

seminal incontiuftjcc*. 168.
CldoroitiB as a muse of im potency, S2d ; caM of, 230.
Circumcijiion, antiquity of, 174.
(^*inxjcelo (»/e**»t * ri^K; *i^*»» » toraour), 107, 108.
Civiale on coitus, 181; on procr^tive ca|Nicity of ofTpaoithidi, 19tj

prostatic cauterisation, 167 ; on simple nrvthral diaohatgtt, 253.
r*liniat4>, in6uot)ce on n*productive faculty, 94,
Clitoridectoiuy (•>•/«, to nhut ; rif*im^ to cut 00), 127.
Clitofia, oxoMinvo deTclopmcnt of llic, S56L

INDEX. yu;5

Cloquet on or3'psorchid8, 195.

Cock, Mr, on ciypsorcliids, 194.

Coitus, Feuchtersleben on, 181.

Congestion of the genitals, influence on seminal secretion, 91, 101.

Ciinstitution, influence on repro<luctive faculty, 92.

Continence, physiological relations of, 179 ; Galen on, 183.

Copaiba in spennorrhstgia, 171.

Copland on sterility and allied diseases, 191.

Courtenay, Mr, on employment of lunar caustic in spermorrhagia, 104.

Cowper, Sir Astley, his case of castration, 66.

Cowper^s glands, functions of, 54, 68.

Cubebs in spermorrhagia, 171.

Cullerier on gonorrha'a (roi^ij, semen ; pia, to flow), 72, 73.

Curling on crypsorchids, 192.

Crypsorchids, 192.

Davy, Dr, on the functions of the vesiculas seminales, 60, 02, 63 ; amilysis of
his cases, 61.

Dawson, Mr, and Dr King Chambers, 234.

Defalcation, is semen normally discharged during, 55 ; nature of urethral dis-
charge during, 71, 72, 73.

Dementia, senile, Dr Brown on, 114.

Demarquay on vesical absorption, 159.

Deslandes on the influences of coitus, 130 ; sexual congress, 186.

Detrusor urinse muscle, 3.

Diabetes, impotency from, 231.

Diet, appropriate in treatment of enuresis, 161, 162.

Digitalis, its influence on reflex excitability, 152 ; as an anaphrodisiac (a, priv. ;
d^^ioU, Venus), 168.

Dogs, Budge's experiments on, 5, 6 ; Gosselin's experiments on, 67.

Douglas, Mr James, on prostatic cauterisation, 164 ; his c&sc of spennorrhagia,
165, 166, 167.

Dreams, Abercrombie on, 172 ; Tissot on, 172.

Dubois, his connection with clitoridectomy, 127.

Duct, Whartonian, Meryon*s observations on, 9.

Dumas on the vasa deferentia in frogs, 56.

Duplay on the effects of hydrocele on the spermatic function, 200.

Durham, Mr, on crypsorchids, 194.

DysspermatismuB Serosus, 205.

E
Egypt, circumcision in, 175 ; circumcision in Ethiopia, 175.
Ejacttlator seminis muscle, 12.
Emotion, mental, influence on secretion, 47 ; organic muscular fibre, 49.

304

INDEX.

Entonic impotency, 207.

Enuresis {'Ewv^i&t, to be incontinent of urine), 46 to 190 ; of a t

51, 52 ; periods of most frequent oocurrenoe, 51 ; Ktoloigj of* 51 ; DmmiH
on^ his psychical treatment of, 52 ; from debility due to sexual exotscft, Oi
different LHrti on of, from apennorrhagia, 53 ; nocturo&l, an&I<^ie« toMBiiaal
incontinence, 143.

EpidLdymitis from maaturbation, 106 ; treatment of, 2U3 ; m a caoae of imClicil J
discharge, 251,

Epiliptic misemiflston, 2l>8.

Epilepsy, w dne to maaturbation^ 115, 116,

Epispadi&a, 192 ; procreativo capacity o( 198.

Erection, physiology of^ 213.

Erethism, seminal, it» initial stage, 147.

Ergot of rye, in treatment of enuresis, 153 ; of spermoRliagia, 171.

Erotomania ("E^A/f, love; ptrnvUt madness), Ul*

E»qiiirol on the sexual appetite, 179; tlie inaaiiity of maaitirbalioii, tl(k.

Ethiopians, semen of the, according to Herodulus^ SSi

Excewive Rcminal emi^ion a pathological iitate« 96.

Excitement, induence of, on seminal secretion, 55.

Fabricius, bis case of raalfonnation of the penis, 199.

Fallopian tubes, obstruction of the, 263, 281 ; diagiioeit, 28 L

Faradisation in treatment of seniiiml inocmtinenoa, 176.

Feotmdation, inHtienoe of disease on, 2c)5.

Female impotency and ^t-prility, 255.

Feuchteraleben on period of puberty, 86.

Foder^, his case of malfonuatiun of the penis, 199.

Foil in on crypsorchids, 195.

Foote, Jesse, his criticism of Hunter. 131.

Frank of Vienna on continence, 1 79.

Frigdity as a cause of impotency, 263 ; influence of, on ftcundation, 297.

Frogs, peculiarity of Tasa deferentia in, 56.

Function, normal, how niamtained, 10,

^■Fnnctioiiaift" ilki term, 3a

Q
GtlfaBum in treatment of enureiis, 154 ; treatmesil cvf spemuOic UM

tinenoeiy 175.
Qall, Pr, on conttnenoe, 183^

O«iia«rat40D, the focoa o( 4d; relation to the org&iusm» 48.
Ctailal Moae, Rowhand on, 162 ; organs, wasting of» from aoddetit to

oefebeUtuiT 62^ 83.
Qoddart on proereation of crypaorchids, 193 ; on the trciattxient of epiiliidyiatlnv i

201; on the conatituiion of Mmen in epididymitis, 68*

INDEX.

305

Good» Msisoo, his varietiea of straw^ry, 41 ; on »exual abstinence as a curt" for

Bterility, 207, 208.
Cronorrh^Baj CuJlerier on, 72,
GoBs^lin, his experiments on dogs relative to seminal flniH, 67; on t\:absorptloii

of semen, 75; on sterility from epididymitis, 200, iJUL
Greek Church, its view of fornication, 177.
Gregary^ the Abyssinian priest, on cLrctimciiion, 175,
Goupil QQ mf&ut luasturbatioB, 126.

Habit, influence of, on reproductire faculty, 94.

^ Haemorrhoids, operation for, a cause of retention of nrinc (Aijitfli, blood ;
ftM^ to flow), 35.
Halkr on seminal reabsorption, 77 ; hisi caae of nLilfonnntion of the penis, 1!JU,
Hake, Dr, un seminal reabsorption, 78.
Hartsti'ker on spennatoroa, C4.

HaBsall, Dr, on the aymptoms of ** spennatorrhrrn/' lltl
Heart, affectiorta of the« aRcribed to spemiorrhagia, L 19.
Heidenhain on the sphincter vesica*, 12.
Herodotus on Uie semen of Ethiopians, 69.
Hicka, Br Braxton, on vesical absorption, 169.
Hippocrates on humid tabes, 79.
Hislop> Mr, his ease of urethritis, 104.

Hodgson, Dr Decimns, on the prostate gland (H^o ; 'ffru^/, to stand), 10.
Howahip, liii case of paralysis, 25 ; on disease of the vesicula? seminales, 137,
Hunter on the ve&icula; semiuales, 63 ; on the fluid diacbarge from the urethra

at stool, 69 ; crypsorchids, 102.
Hydrocele fTi«^, *iixu) of the vesicukB seminales, HO; symptoms, 140; effects

of, on the spermatic function, 206.
Hyoscyamus, ita therapeutic effects, 153.
Hyperteathesia, genital^ a cauae of seminal incontinence, 134.
Hypertrophy of the labia majora, 256.
Hypogastric plexus, distribution to pelvic viscera, 8 ; connection of, with

aortic and solar plexuses, 2L
Hypospadias, 192 ; procreative capacity of, 197.
Hysteria (T^ri^w, the womb), etiology and pathology of, 49.

Idiopathic aioospermiu^ 209.

Idiosyncnaies, their influence on the reproductive faculty, 91.

Impotency, definition of, 212; cntonic, 207, 208; idiopathic, from deftct ol
energy, 226; Montaigne on the cure of, 215, 216; objective causes of
215 ; physical causes of, 21 S ; paycbical causes of, 214 ; treatment of, 21 B;
symptomatic, 228,

306 INDEX.

Iinpoteucy in the female, 255, 256; from frigidity , 263.

Impregnation, artificial, 300.

Incontinence, physiological relations of, 179.

lufecundity, 263.

Insanity, relation to seminal incontinence, 109, 110; sexual, Maudsley on,

114 ; Esquirol on, 115 ; Dr Ritchie, 115 ; summary of the subject, 117.
Iodine, toxic effects of, impotency from, 240.
Iron, perchloride of, in treatment of uterine excrescences, 265.
Irritable bladder, 38; a functional disease, 38; treatment of, 40; causes of,

39 ; " nervousness," dyspepsia, etc., 39 ; symptoms of, 40.
Ischuria (/a^^i to check ; ot/poy), relation to section of the spinal cord, 19, 20.

Jarjavay on crypsorchids, 166.
J^r6nie, Saint, on male precocity, 241.

K.
Kirkes on seminal secretion, 54, 55. 50.
Rblliker on seminal reabsorption, 77.
Kraus on properties of seminal fluid, 68, 70.
Kupressow on the sphincter vesiwe, 12.
Kuss, Professor, on the differentation of gonorrhcea, 24(i.

Labia majora, hypertrophy of the, 256.

Lallemand on the connection of the cerebellum and genitals, 83 ; on prostatic
cauterisation, 164; on seminal reabsorption, 74, 75; on seminal secre-
tion, 189.

Lancetf Editorial, on sexual congress, 178, 179.

Larrey on the relation of the testicles to the cerebellum, 82, 83.

Lawrence, Mr, his case of worms in the bladder, 43.

Lead, preparations o^ in treatment of spermorrhagia, 169; poisoning, im-
potency from, 237, 238.

Leucorrha^a, its analogies to gonorrhrea, 245

Liegeois, on sterility from epididymitis, 201

liithic acid diathesis as a cause of irritable bjidder, 39.

Locomotor ataxy, Hippocrates on, 79 ; Bradbury on, 99.

Lucretius on enuresis and seminal incontinence, 89.

Lupulin on treatment of seminal incontinence, 170.

Mackenzie, Dr Bacon, his case of castration, 120.
Mnjcudie on the administration of phosphoruH, 170.

INDEX. 307

Miison Good) his yarieties of strangury, 31.

Marasmus as a cause of iinpotencj, 229.

Marsham on circumcision, 174 ; Macrones, circumcisiou among, 175.

Marshall on crjrpsorchids, 194.

Masturbation, its evil effects accounted for, 133, 162.

Material correlation, law of, 38.

Mauriac, M., on epididymitis, 108

Maudsley on the insanity of puberty, 112.

Memory, how influenced by excessive seminal emission, 97.

Menstruation, its relationship with sterility, 292, 293.

Mental states, seminal incontinence in relation to, 109.

Mercury, bichloride of as a vesical injection, 154.

Meryon, his experiments on the sympathetic, 9.

Metromania (^vr^*, relating to the womb, (auviu), 50 ; Louyer-Villenujiy on,

50 ; Helwich on, 50 ; due to pathological stjites, 50.
Micturition partly voluntary, partly involuntary, 2.
Misemission, epileptic, 208 ; anticipating, 233.
Monorchids, 192 ; procreative capacity of, 197.
Morality, its possible conflict with physiology, 176.
Morgagni on the fluid discharged from the urethra at stool, 73.
Morphia, its influence on reflex excitability, 152.
Mucous membrane of the bladder, its variety, 4.
Myosis, paralytic (Mt/6>, to contract), 24.

Nervous distribution to the bladder, 4 ; nervous system, impotency from attec-

tions of the, 235 ; excitability, influence of repeated stimuli on, 53.
Nymphomania (Nv^^yj ; f4,ot»ta\ 128; Richerand (Mi, 129.
Nux vomica in the treatment of enuresis, 153.

Old age, retention of urine from, 31 ; its pathology, 32.

Onanism, Tissot on, 172.

Orgasm (o^y««, to swell,) venereal, al^ent in certain caries of sperniorrhagia, 135.

Orchitis from gonorrhoea, 137.

Otaheite, circumcision in, 174.

Ovaiy, congestion of the, 289; displacement of the, 287; hernia of the, 288;

inflammation of, 288; vital lesions of the, 284, 285; malposition of

the, 286.
Ovid on accupuncture, 1 73.

Ovulation, abnormalities of, 282, 283 ; Roubaud*s conclusions regarding, 284.
Oxalic acid diathesis as a cause of irritable bladder, 39.

808 INDEX.

Palpitation of the heart, an indication of debility, 23.

Paraplegia, temperature of the body in oases of, 93 ; (n«^«xX«yici, benumbing

of parts — uff^A), verb), its influence on the pelric viscera, S3.
Partridge on crjpsorchids, 193.

Passions, their influence on the reproductire fiEunilty, 93.
Paresis, diminished, sterility from (Trd^twf, a letting go), 20&
Penis, sympathetic nerves of the, 8 ; abnormality of tiie, as a cause of impo-

iency, 220, 221 ; Petit on, 222.
Percival, his treatment of strangury, 42.
Perenial muscles {Ut^tntt^ to flow around), actions of the, 11, IS.
Peripheral irritation, a cause of epilepsy, 125.
Pessaries, their employment in uterine displacements, 27S.
Phallorrhoea {<^uXK6(^ a penis'; and ^«, to flow), 240.
Philips, Benjamin, on the fluid discharge from the urethra at stool, 72; on

sexual debility, 136.
Phimosis (<^//ciof, a muzzle), congenital, operation for, 173, 174.
Phosphorus in treatment of spermorrhagia, 170.
Phrenic focus, 48.

Phthisis, as due to masturbation, 118.
Pickford on seminal emission, 79, 98.
Planque on male precocity, 241.
Polygamy, Montesquieu on, 94 ; Chervin on, 94.
" Pollution," Roubaud on, 136.

Potash permanganate, as a vesical injection, 164 ; chlorate, as a vesical injec-
tion, 154
Potassium bromide, as an anaphrodisiac, 169, 170.
Powell, his case of hair in the bladder, 161.
Precocity, male, 241 ; treatment of, 242.
Prevost on the vasa deferentia in frogs, 56.
Prepuce, affections of the, reacting on spinal cord, 141 ; malformations of the,

as a cause of impotence, 223.
Priapism {U^Uwogt the penis), in cases of paraplegia, S3 ; pathology of, 24,

227 ; Roubaud on the treatment o^ 82 ; from injuries of the spinal cord,

112.
Procreative capacity, limits of, 65.
Prostate gland, chronic inflammation of the, 103 ; nerves of the, 8 ; impotency

from aflSsctions of the, 233.
Prostatorrhoea, 248 ; symptoms, 248 ; case of, 249.
Front on the prostatic secretion, 70;
Psychical (^vx^) iinpressions, influences of, on nutrition, 10; influences on

seminal secretion, 84, 142 ; influences on lactation, 90.

INDEX. 309

Puberty, characteristics of; 86; Feuchtenleben on, 86; Letourneau on, 86;
Cabanis on, 88 ; Mason GkHxl on, 87 ; Lucretkis on, 80 ; Insanity of,
Maudsley on the, 112, 113, 114.

Q.
Quack literature, influences of. 111.
Quacks, Dr Mapother on, 117.
Quinine, its influence on reflex excitability, 151.

Rayer on seminal emission during defaecation, 71.

Rectum, affections of the, their influence on the sexual oigans, 142.

Reflex paresis, diminished sterility from, 206 ; Schulz on, 206.

Reid, Dr John, on dreams, 172.

Remak, fibres of, their influence on blood-ressels, 10.

Retention of urine, synonyms of, 1 ; physiological, 15 ; from mental emotion,
17 ; from vesical paralysis, 19 ; from spinal paralysis, 24 ; when absolutely
complete, 25 ; from old age, its etiology and pathology, 31 ; its diagnosis,
32 ; its treatment, 33 ; from over distension of the bladder, 34 ; from
reflex irritation, 34 ; case of, 35 ; from shock, 36 ; diagnosis and treat-
ment, 37.

Rokitansky on catarrh of the yesiculse seminales, 138 ; on double penis, 199.

Rousseau on his passions, 105.

Russ and Susini on yesical absorption, 15a

Rye, ergot of, in spermorrhagia, 171.

Satyriasis (lary^g, a satyr), 227 ; physical production of, 83, 111 ; in loco-
motor ataxy, 100.

Sayre, Dr, his cases of reflex paralys 119, 120, 121, 122, 123, 124.

Schenck on the sexual appetite, 179.

Seasons, their influence on the reproductire faculty, 95.

Section of the spinal cord, its relation to ischuria, 19, 20.

Secretion of the prostate, Oowpei^s glands, and yesiculs seminales ; can they
occur independently one of another? 66.

Semen, its secretion by the testicles, constant or intermittant ? 54 ; reabsorp-
tion 0^ theoiy examined, 55, 74, 76, 77, 78, 80 ; its mode of excretion,
55 ; by what organs secreted, 54 ; composition of, 55 ; how influenced by
venereal excesses, 68 ; its emission in health, 85^ 98, 147.

Seminal emission a pathological state, 85.

Sensory nerves, their impressions transmitted by molecular action, 47.

Sexual congress, its influence on the genital functions, 173, 176, 177, 180;
excesses, and masturbation, correlation of symptoms, 129; "Editorial"
of Lancet on, 184, 185; criticism of, 187.

310 INDEX.

Sims, Marion, on uterine displacements, 271.

Smith, Dr, on phthisis, as due to masturbation, 118.

Solly, Mr, his case of spermorrhagia from spinal injury, 101.

Somatic impressions (Sa>^«, the body), their influence on nutrition, 10; on

nervous equilibrium, 46.
Sokoronin on the centre of vesical innervation, 6, 7.
Spasm of the bladder, 15 ; symptoms, 16 ; treatment, 16 ; urethra, 17 ; Civiale's

cases, 17, 18 ; etiology of, 18 ; ureter, 15.
Spermatic incontinence, its symptoms, 46.
Spermatozoids (fioir), 56 ; first described by Leuenwenhoeck, 64; Valentin,

Schwann, and Ponchit on, 64 ; influence of poisons on, 64.
Spermorrhagia (:xi^^«; ^nypvfAt, to break forth), 46 to IdO; its varieties and

causes, 133, 136 ; diagnosis of, 148 ; prognosis, 149.
Sphincter vesicae, 3 ; Kupressow on, 12 ; Heidenhain on, 12 ; Bell, Sir Charles,

on, 11.
Spallanzani on artificial impregnation, 198.
Splanchnic C^vy^ctyx^op^ a viscus), nerves, contradistinguised from the branches

of the sympathetic, 24.
Steel, tincture of, in enuresis, 153; in spermorrhagia, 171.
Sterility in the male, 191 ; definition of, 191.
Sterility from disease, 199; relative, 210; in the female, 255; general caiiNes

of; 289, 290, 291.
Sterility, relationship with menstruation, 292, 293.
Stimulation, law of emotional, 47.

Strangur}' (Ir^dy^^ a drop; ovQok) 38 ; diagnosis of, 41 ; varietief:, 41.
Stricture, sterility from, 202.
Strychnine in enuresis, 163; in spermorrhagia, 171.
Suppositories, sedative, in the treatment of spermorrhagia, 173.
Sympathetic ganglia, connection with motor and sensory nerves, 7 ; nerve,

Bernard's experiments on the, 8, 9 ; Meryon's experiments, 9 ; Valentin

on the, 21.

Tabes, humid, Hippocrates on, 79 ; Celsus on, 99 ; a cause of impotency, 229.

Tanner, Dr, his case of anticipating mbemission, 235.

Thompson, Sir Henry, on vesical absorption, 155.

Testicles, do they constantly secrete semen, 54 ; atrophy of the, from disus»\

75 ; chronic phlegmasia of the, from prolonged excitation, 102 ; syniptoms,

105 ; their relative position in health, 107.
Teevan, Mr, on " true spennatorrhoea,** 136.
Temperament, influence of, on the reproductive faculty, 192.
Tilt, Dr, on vesical absorption, 159.
Toxspniia, impot-ency from, 237.
Tricliiasis, G<jelicko on, 161 ; Scultetus on, 1(51 ; Hans Sloane on, 1(51.

INDEX. 311

Tripier on seminal incontinence, 147.

Trousseau on seminal emission, 98, 132 ; erethism ('E^f^/^«, to vex), 144; the

relation between enuresis, epilepsy, hTpochandriasis, and insanity, 146.
Trousseau, his rectal pessary in the treatment of spermorrhagia, 189.
Tubercular affections of the testicles, 203.

• Ureter, distribution of svmpathetic nerves to the, 2 ; spasm of the, 15.

Urethra, mucous membrane of the, 13; coarctation of the, from preternatural
excitation, 1(»3.

Urethral discharges, anomalous, 244.

Urethritis, simple, constitutional causes of, 252 ; from prolonged genital excit-
ation, 102 ; Civiale on, 103; simple, Diday on, 247.

Urinary canal, extent of the, 1.

Urine, expulsion of, a reflex act, 1 ; obstruction to flowof^ ph3r8iological, patho-
logical, and mechanical, 13, 14 ; incontinence of, relation to spinal nerves,

21, 162 ; profuse secretion of, in hysteria, 145 ; is semen removed with
the? 55, 73-

Uterus, congenital absence of the, 263 ; symptoms, 265 ; conicity of the neck
of the, 265 ; treatment, 265 ; congestion of the, 277 ; displacements of the,
268, 269 ; treatment, 272, 273 ; false membranes of the, 278 ; flexions of
the, 274 ; fibrous tumours of the, 277 ; morbid secretions of the, 278 ;
neck of the, hypertrophy of, 265 ; warty excrescences of the, 265 ; treat-
ment, 265; congenital closure, 266; pathological closure, 266; exagger-
ated elevation of the, 270 ; prolapsus of the, 270 ; versions of^e, 270 ;
influence on fecundation, 271; surgical extirpation of the, 264.

Uterine canal, stricture of the, 266, 267 ; calculous impaction of the, 267 ;
spasm of the, 268 ; hsemorrhage, idiopathic, 279 ; treatment^ 280 ; pas-
sive, 280 ; treatment, 281 ; polypi, 277.

Uterine ulcerations, Burdach on, 82.

Uvula vesicae, 4.

Vagina, abnormal communications of^ with other organs, 261 ; atresia of the,
260; inflammatory hypereesthesia of the, 261 ; membranous partitions in
the, 260 ; neuralgia of the, 262 ; spasm of the, 261 ; stricture of the, 259;
treatment of, 259 ; tumours of the, 261.

Valentin on the purpose of coitus, 198 ; on the physiology of the sympathetic,

22, 22.

Varicoceh* varusy knotted, and KfiT^m, a tumour) due to masturbation, 106 ;

diagnosis of, 107.
Vas deferen**, sympathetic nerves of the, 8.
Venereal excesses, a cause of sterility, 294, 295.
Vesical paralysis from shock, 30 ; injections, 154; vesical absorption, 160.

312 INDEX.

Vesical iDuervation, centre of, 6, 7, 13 ; vesicles of eToIutio&y 56,

Yesiculse seminales, sympathetic nerves of the, 8 ; are they merelj reservoin
of semen? 54, 55, 57; functions of the, 56; as secretoiy organs, 57; in-
flammation of the, 139; Hunter and Bransby Cooper on their functions,
57 ; Milton, Casper, and Duplay'on their functions, 58, 59.

Voice, alleged influence of seminal fluid on, 80.

Vdition, influence of, on micturition, 1.

Wemich on ergot of rye in vesical paralysis, 29 ; poisoning bj ergot, and con-
dition of the bladder in, 29.
Whartonian duct» Meryon's observations on the, 9.
Worms in the bladder, 43 ; cases of, 43, 44 ; symptoms and treatment, 45.

Zacchias, his case of malformation of the penis, 199.

Zinc, salts of^ their influence on reflex excitability, 151 ; chloride of, in the

treatment of uterine excrescences, 265.
Zoosperms diminished by coitus, 59, 66.

rRIlYTED BT KKILL AND COMPACT, EI>i:rBi:Rr.U.

APPENDIX.

Dr Black^s Letter to '' The Lancet," referred to in
Preface, and editorial comments thereon —

QUACK ADVERTISEMENTS.

TO THI IDITOR OF "THE LANCET."

Sir, — I have read with entire concurrence, as I am sure must
'have been very generally done, your remarks on the above subject
in your impression of June 18th. I am persuaded that the extent
to which functional diseases of the generative system worries
young men is not fully appreciated by the profession; and if
venereal diseases have been rescued from the quacks, I agree with
you in seeing no reason why the same could not be accomplished
in the case of spermatorrhoea, real or imaginary. You will correct
me if I am wrong in assuming, that of the number of young men
who address you regarding bodily disease, nine-tenths do so for
spermatorrhoea. Nor can surprise be felt, while such lukewarm-
ness exists among the profession with respect to this subject,
while the most unscrupulous of the provincial papers open their
columns to the filthy advertisements referred to by your corre-
spondent, that so many young men get entangled in the skilfully
wrought meshes of the charlatan. Either spermatorrhoea is or
is not a disease. If a disease, it cannot be beyond the pale of
legitunate practice any more than gonorrhoea or syphilis ; if not,
the delusion cannot be too soon exploded. While I believe that
the importance of the subject has been much exaggerated, there
is no doubt in my mind as to the iiunrious effects of an excessive
seminal drain and its atten us. Believing, then,

G APPENDIX.

labour is not adapted to modern requii'ements. Nor can we
admit that any class of disease ought to be turned away from
with affected disgust The greatest minds rise superior to such
pseudo-gentility. John Hunter and Parent Duchatelet did not
see anything derogatory in cultivating the department of medicine
to which we refer. And it would be well for us, and well for the
public, if they had more numerous imitators."

CRITICISMS

FIRST EDITION OF THIS WORK.

Fmm ;/**: Fhiladdphia Medical Tivtes.

Till a volume — ^the t^ximnsion, m tlie author tellj? im, of a proposed article
for ** The Britit^h Medicjil Joumiil '* — is evidently written hj a geiitleuiaii t»f
considerable pmclical exiierierice, deep thought^ and extensive reading. The
work begins with a djacj^iuBition upon the contlitioiis affecting the secretion
of urine with special reference to suppression, in which thcs-e all important
bases of exjict medical science, the patholog}^ and niorl>id anatomy of disease,
are by no means neglected. Following this part, abcmt seventy jiages are
devoted to a review of the varieties, caiiBes^and niiinagementof retention of the
urine after \ta secretion ; and the reraamder of the book is chiefiy occupietl
\%nth excellent investigations into the pathologj' and treatment of nocturnal
enurei*ifl, and spermatic incontinence, and tlie allied subjects of masculine
impotence and sterility, all of which the author moat judiciously maintains
liave been quite long enough abimdoned by the reifular profession to design-
ing charlatans, who not only take advantage of the natuml anxietieti which
assail BiiffeTerB from sexual disorders, but syEtematically aggravate the
upprehennions of their victims^ from baise pecuniary niotrvea Tlie style of
the author is clear^ easy, and agreeable. .... On the whole his work is a
valuable contribution to medic^tl ffciencc, and being j»enned in that di^-
position of unprejudicetl philosophical inquiry which shoyld always guide a
true physician, atlmind)ly emboilies the spirit of its opening q notation from
Profe«ssor Hivxley.

Frmn the Edinhtrgh Mtdiml JmnmL
There is so much clevemesft, bonhommie, and frankness, and apparent

Itoneflty of purpose, antl dinftaste for quackerj' It is an interesting,

original, and will probably prove a useful work. With Chap. IV. hcginfl
the real work of the author, <>n the pathology antl treatment of nocturnal
cntiresis and 8{»erniatic incontiMence. This ia foDowed by a well-i-easoned
and inaidy discusftion. ..... The practical observations on treatment are

sensible. The book is nicely got up, nnd the table nf contents and index are
iu] miral jly arranged.

CRITICISMS.

From the Michigan Univerniy Journal.

We like the tone of the book, though it iidvc»catea many prapoAtioBi
arcepte<l hy the profession. Even these, we think, will provoke
and Fit) banten the time when the ftinctioual dbeoBes ol the nude dull Im wb
c^tiefully Btudied and treated as those of the femalo.

From tht Birmingha'm Medical /?rnciP.
Dr Black de^^ien^es all prtiise for the niAnlineoB, heoHtneRS, boiMMty

purpo8e, and ecieLitilic zeal with which he has troated a imlgeel wllleli hm
become ilisogreeable from its associations, which bju been too tmicli Attimrf
by the proftHsioa, and which has unfortnxiately fallen aIummH aHogtHiar into
the hands of charktana . , , . . Dr Bhick's book coittAtsiB mack uwftU
information^ and wUl doubtless jtrore inlezoiting to many reaiiera.

Frorn^ the Doctor.

Thia la an important work, ahowing extensive reteazchf and «on%

much iwforraalion.

From the Medical Vrts$ and Cirmlar,

There are some points in reference to the functional diioideta of the ttpn^-
dnctive S3r«tem that are continually forcing tbemaelves upon medieal
but which few practitioners care to investigate. Some of tbc« bair« be«ti ftvaly
tliscussed in this and other medical journals, but unfortunately rock topioi
are apt to be neglected^ and hence full into the hands of thoi^e 1ea»t quAliffev)
til diacua^ them. Hence the continual increaaa of a elas» of IJU^mturv which
we cannot but condeiun, and which finds its way into the hands of ignoiant
young men, who thuj* l>ecome the victims of quackery. The^ topics rei|itit«
moat careful handling by highly i|nalified men, and yet the minority dislike
(a asaociate their names with thein, and even able writers on dtseaaei of tka
generative organs fretjuently omit the consideration of those diaordera thai
poooeit a real existence, and feed the charlatans. It is desirable, tberefoce,
that such writers should supply the omigAion, and thus prevent the subjecl
from remaining in unquAlified bands, and it b also well that medical journals
have of late yeara directed attention lo them. We have had by us, fur a lon^;
time, a volume by Dr Campbell Black, in which the topics we have allcidad
to are fully discusaed, and which it perhaps the host work of referenea
rsspecting tbem for medical merL r>r Camp 1^11 Blanks mune ia known lo
our readen in connection with medical reform, and bis powprful ^it*?] ami
fordble style were there at home, ami did good service.

Very interesting and valuable work on the i^nal and urinary orgna. —
FtJ^yUn y. fH%M E*q., M.IK Profeuor of Gmiithl/rimmf Dimm^ OoiU$i o/
l^jfnciam and Surifmntj Xnc York,

f KITICISMS,

By the same Acthor,

OBSERVATIONS ON THERAPEUTICS AND
DISEASE.

Br Blftck if one of thost thinkers who ought to be encoiirage<l. . . , , . We
limve aaid that we think much an attempt aa Dr Black's is one to l>e encouraged.
We think eo, because btikhjess of though t^ anil a dispoaition to handle the pro-
blems of diseaee and of health in a large spirit, are verj* necessary to that j^at
refonn in therapeutics which we all hope to see. There ia much ability in hi«
pamphlet, and it will be an immense gain to practical medicine if he sncceeds
in atirrini; up our scientific tlierapeutiBta to look at questions of medication in
a broad way, and iu relation to the great pbysiological states^ insteatl of merely
ticketing remediea with specific titles, and inducing the haplesa pnictltiuner to
discharge them at a supposed peccant oi^gan, as a boy might aim a pea from a
pop-gun, — Prat^iiioner.

Dr Black's essay displays an extensive knowledge of his subject, and
although many of liis views are necessarUj open to controversy, they are well
worth consideration. — BrUith and Ftirtfigfi Medic^'Chirurgkai ifmeir.

The book shows that its author possesses considemble speculative ability,
and that he entertains a he^dthy hatred of everything savouring of fanciful
refinement in diagnosis, as well as of all those who, in the pursuit of new
medicines and theories, ni«g1ect to exhaust the curative capacities of known
drugs. ..... It is fluggeative, and written with considerable vigour. — Edin,

Mtdknl JournaL

We have a thoughtful and carefully written pampMet from Dr Black on

*' Therapeutics and Disease.** There is a great deal of ban I reading in

t\ki& pamphlet^ and we shall not attempt to do justice to the author in tracing
his obaervations throughout His endeavour is to indicate certain couditions
of the system which give, aa it were, distinct opportunities for the attack of
certain diseases, and thus to show how renietlies which will cure these
diBeasea do so }yy restoring tlie system to itja properly balanced state. We are
compelled to place Dr Black's classification thus vaguely, for there is too much
in it to pretend to analyse it throughout — Cfumist aiid Dntggi§L

" Your * Observations on Therapeutics and Disease ' I have read with much
]>leasare.**— ^r, »*?, SaiHtry, FJIS., ^urgeo^n and Lefiurcr tm l^irgeiy^ St Btirtho-

4 CRITICISMS.

ON CERTAIN ASPECTS OF MEDICAL RE-

FORM, AND ON THE RELATIONS OF PRESCRIBER
AND DISPENSER.

Dr Black speaks boldly on these and other subjects, and we cordially i^dsh
him success in his efforts at medical reform. — Westminster Review,

Dr Campbell Black returns to a subject of which he has already discussed

some parts with considerable controversial vigour. Dr Campbell

Black is a vigorous accuser, and he does not spare sharp phrases ; but, on the
£eu» of it, he will probably cany with him the majority of the profession in
and out of Glasgow, in general principles. — Edit, British Med. Journal,

In the Press.

LECTURES ON BRIGHTS DISEASE.

(Delivered at the Royal Infirmary of Glasgow.)

London, New BwrlingUm Shmit
June, 1875.

SELECTION

FSOU

MESSES J. & A. CHDKCHILL'S

(§tmid dTiiiiilaguc

oovrsniita

ALL EECENT WOEKS PUBLISHED BY THEM

ART AND SCIENCE

MEDICINE

INDEX

Acton on the Reproductive Organs . 8

— on Prostitution . . .8
Adams (W.) on Clubfoot . . .6

— (B.) on Rheumatic Gout . 17
Allen on Aural Catarrh . . .5
Allingham on Diseases of Rectum . 6
Anatomical Remembrancer . . 11
Anderson QicC.) on Eczema . . 19

— (McC.) on Fbrasitic Affec-

tions . . . .19

— (A. P.) Photographs of Le-

prosy . . . .19
Amott on Cancer . . . .18
Aveling's English Midwives . . 13
Barclay's Medical Diagnosis . . 10
Barker's Puerperal Diseases . . 12
Barnes* Obstetric Operations . .12

— Diseases of Women . . 12
Basham on Renal Diseases . . 7

— on Diseases of the Kidneys . 7
Beale on Kidney Diseases . . .7

— on Disease Qerms . . .23
Bellamy's Guide to Surgical Anatomy 10
Bennet's Winter and Spring on the

Mediterranean . . .15

— Treatment of Pulmonary Con-

sumption . . . .15
Bennett on Cancerous and other Intra-
thoracic Growths . . .18
Birch on Constipated Bowels . . 16

— on Oxygen . . . .19
Black on the Urinary Organs . . 7
Bradley's Comparative Anatomy and

Physiology . . . .10
Brodhurst on Deformities . . G

Bryant's Practice of Surgery . . 4
Buchanan's Circulation of the Blood 8
Bucknill and Tuke's Psychological

Medicine 21

Buzzard on Syphilitic Nervous Affec-
tions 8

Carpenter's Human Physiology . . 9
Carter on the Structure of Calculi . 7

— on Mycetoma . . .18
Cauty on Diseases of the Skin . . 19
Chambers on the Indigestions . . 17
Chapman on Neuralgia . . .17
Chavasse's Advice to a Mother . . 12

— Counsel to a Mother . 12

— Advice to a Wife . . 12
Clark's Outlines of Surgery . . 4

— Surgical Diagnosis . . 5
Clarke's Autobiographical Recollec-
tions 22

Clay's Obstetric Surgery . . .12
Cobbold on Worms . . . .19
Coles' Dental Mechanics . . .23

Cooper's Surgical Dictionary . . 5
Cotton on Phthisis and the Stethoscope 14
Coulson on Syphilis . . . . 8

— on Stone in the Bladder . 8
Dalby on the Ear ... .6
Day on Children's Diseases . . 12
De Morgan on the Origin of Cancer 18
De Yalcourt on Cannes . . .15
Dobell's Lectures on Winter Cough . 14

— First Stage of Consumption 14
DomvUle's Manual for HospitalNurses 13
Druitf s Surgeon's Yade-Mecum . 4
Dunglison's Dictionary of Medical

Science 22

Elam on Cerebria . . . .20
Ellis's Manual of Diseases of Children 11
Fayrer's Observations in Lidia . . 4
Fergusson's Practical Surgery . . 4
Fenwick's Guide to Medicsd Diagnosis 10

— on the Stomach, &c. . . 16
Flower's Nerves of the Human Body 10
Foster's Clinical Medicine . . 11
Frey's Histology and Histo-Chem-

istry of Man . . . . 9
Gamgee on Fractures of the Limbs 5
Gant on the Science and Practice of

Surgery . . . . 4

— on the Irritable Bladder . . 7
Garrett on Irritative Dyspepsia . 15
Gaskoin on Psoriasis or Lepra . . 19
Glenn on the Laws affecting Medical

Men 19

Habershon on Diseases of the Liver . 16
Hamilton on Syphilitic Osteitis and

Periostitis ... .8

Hancock's Surgery of Foot and Ankle 6
Hailey on the Urine ... .6
Heath's Minor Surgery and Bandaging 5

— Diseases and Injuries of the

Jaws ... .5

— Practical Anatomy . . 10
Holden's Human Osteology . . 9

— Dissections. . . .9
Holt on Stricture of the Urethra . 7
Holthouse on Hernial and other

Tumours 6

Hood on Gout, Rheumatism, &c. . 17
Hooper's Physician's Vade-Mecum . 11
Horton's Diseases of Tropical Cli-
mates 16

Huth's Marriage of Near Kin . . 9
Jones (C. H.) andSieveking's Patho-
logical Anatomy . . .10
— (C. H.) on Functional Nervous

Disorders . .17

— (Wharton) Ophthalmic Medi-

cine and Surgery . . 22

INDEX

Jordan^B Treatment of Surgical In-
flammations . . .6

— Surgical Inquiries . . 6
Kcnnion's Springs of Harrogate . 15
Lee (H.) Practical Pathology . . 8
Leared on Imperfect Digestion . . 17
Liebreich's Atlas of Ophthalmoscopy 21
Lireing on Megrim, &c. . . .17
Mackenzie on Growths in the Larynx 15

— on Hoarseness . . .15

— Throat Hospital Pharma-

copoeia . . . .15
Macnamara on Diseases of the Eye . 21
Marsden on certain Forms of Cancer 18
Maunder's Operative Surgery . . 4
Mayne's Medical Vocabulary . . 22
Meryon's System of Nerves . . 17
Moore's Family Medicine for India . 16
Morris on Irritability . . .17

— on Germinal Matter . . 23
Paton on Action and Sounds of Heart 14
Parkes* Manual of Practical Hygiene 21

— Issue of a Spirit Ration . 17
Parkin's Epidemiology , . .23
Pavy on Food and Dietetics . . 16
Peacock on Valvular Disease of the

Heart . . . .14

— on Malformations of the

Heart . . . .14
Phillips' Materia Medica Hud Thera-
peutics • . . . .11
Pirrie's Principles and Practice of

Surgery 4

Power on Diseases of the Eye . . 23
Ramsbotham's Obstetric Medicine

and Surgery . . . .13
Reynolds' Uses of Electricity . . 21
Richardson's Practical Physic . . 11
Ross's Graft Theory of Disease . . 23
Roylo and Headland's Manual of

Materia Medica . . . .11
Sabben and Browne's Handbook of

Law and I<unacy . . .20
Salt's Medico- Electric Apparatus . 20
Sanderson's Physiological Handbook . 9
Sankey on Mental Diseases . . 20
Savage on the Female Pelvic Organs 5
Savory's Domestic Medicine . • 13
Schroeder's Manual of Midwifery . 13
Shapter's Diseases of the Heart . 14
Shaw's Medical Remembrancer . 10

Sheppard on Madness . . .20
Sibson's Medical Anatomy . . . 9
Sicveking's Medical Adviser in Life

Assurance 19

Smith (H.) on the Surgery of the

Rectum . ... 6

rA0s
Smith (£.) on Wasting Diseases of

Children . . . .11
Smith's Dental Anatomy . . .28
Spender on Ulcers of Lower Limbs . 19
Squire's Temperature Observations . 18
SteiAor's Diseases of Children . • 19
Stowe's Toxioological Chart . . 20
Swain on the Knee- Joint . . .6

— Surgical Emergencies . . 4
Swayne's Obstetric Aphorisms . . 18
Taylor's Principles of Medical Jnrii-

prudence . . . SO

— Manual of Medical Juris-

prudence . . . .20

— Poisons in relation to Medical

Jurisprudence . . .20
Thompson on Stricture of Urethra . 7

— on Practical Lithotomy

and Lithotrity . . 7

— on Diseases of the Urinary

Organs .7

— on Diseases of the Prostate 7
Thorowgood on Asthma . . .14

— on Materia Medica . 11
Tibbits* Medical Electricity . . 81
Tilf s Uterine Therapeutics . . 18

— Change of Life . . .18

— Health in India . . .16
Tomes' Dental Surgery . . .28
Tuke on the Influence of the Mind

upon the Body . .80

Van Buren on Diseases of the Genito-
urinary Organs . . .8
Veitch's Handbook for Nurses . . 18
Wahltuch's Materia Medica . . 11
Walker on Egypt as a Health B««

sort 15

Walton's Diseases of the Eye . . 22
Ward on Affections of the Liver . 16
Waring's Practical Therapeutics . 11

— Bazaar Medicines of India . 16
Waters on Diseases of the Chest . 14
Wells (Soelberg) on Diseases of the

Eye 22

— Long, Short, and Weak Sight . 22

— (Spencer) on Diseases of the

Ovaries . .18

Wife's Domain . . .14

Wilks' Pathological Anatomy . . 10
Wilson (E.) Anatomist's Vade-Meonm 9

— on Diseases of the Skin . 18

— Lectures on Ekzema . . 18

— Lectures on Dermatology . 18

— (Gt.) Handbook of Hygiene . 21
WinsloVs Obscure Diseases of the

Brain and Mind . . .20
Wolff on Zymotic Diseases . . 23

CATALOGUE OF EECENT WOEKS

THE PRACTICE OF SUEGERY:

a Manual Ly Thomas Bryant, F.E.O.S., Surgeon to Gny*B HoBpital. <

Crown 8vo, with 507 Engravings, 2l8. ""^

THE PRINCIPLES AND PRACTICE OF SURGERY

bj William Pimbie, F.R.S.E., Professor of Surgery in tbe Univemty
of Aberdeen. Thii-d Edition, 8va, with 490 Engravinge, 288. [IW»J

A SYSTEM OF PRACTICAL SURGERY

by Sir William Feegusson, Bart, F.B-C.S., F.R.S., Serjeant* |
Surgeon to the Queen. Fifth Edition, Svo, with 463 Engravings. 2l6* !

iiBm'

OPERATIVE SURGERY

by Q, F, Maunpeb, F.R.G*S., Surgeon to the London Hospital, for-^

merly Demonstrator of Anatomy at Guy'e Hospital. Second Edition

post 8vo, with 164 Engravings, 6a. ^^^^

THE SURGEONS VADE-MECUM

by EoBEET Beuitt- Tenth Edition, fcap.
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8vo» with numerous En-,
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THE SCIENCE AND PRACTICE OF SURGERY:

a complete System and Textbook by F, J. Gant, F.R.O.S,, Surgeon td
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OUTLINES OF SURGERY AND SURGICAL PATHOLOGY

including the Diagnosis and TreatmtJiit of Obscure and Urgent
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Regions, by F, Le GEoa Clark, F.R.S., Consultiiig Surgeon to St.
Thomas's Hospital. Second Edition, Revised and Expanded by the
Author, asaisted by W. W. Waostapfe, F.B.C.S., Assist-ant- Surgeon
to, and Joint -Lecturer on Anatomy at, St, Thomas's Hospital. 8vo,

lOs. 6d. a^m

CLINICAL AND PATHOLOGICAL OBSERVATIONS IN INDIA

by J. Fayeee, CS.L, M.D., F.R.C.P. Lond., F.R.S.E., Honorary
Physician to the Queen. 8vo, with Engravings, 208. * fisrs]

SURGICAL EMERGENCIES

together with the Emergencies attendant on Paiiurition and the
Treatment of Poisoning : a Manual for the use of General Practi*
tioners, by William P. Swain, F.R.C.S.. Sargeon to the Royal AJl>ert
Hospital, Devonport, Fcap. 8vo, with 82 Engravings, 69. aWil

PUBLISHED BY J. AND A. OHOECHILL

JIUfOE SUR0EEY ANB BAHDAGmQ

a Manual for t!io Use of House- Suigeons, Dresaera, and Junior
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versity College Hospital. Fourtk Edition^ fcap 8vo, wiih 74 Engrav*
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BY THE 8AMK ArTHOR,

iNJimiES AHB DISEASES OF THE JAWS:

Jacksoniaw Prize Ebsat. Second Edition, 8to, with 164 Engrav-
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DICTIONARY OF PRACTICAL SITEGERY

and Encyclopaidia of Siii'gical Science, hy Samuel Coopek. New
Edition, brought down to the present Time by Samuel A, Lakb,
Consulting Surgeon to St Mary's and to the Look Hospitals ; aaaisted
by various Eminent Surgeons. 2 vols. 8vo, 50s. [^^i ">d iB73j

THE FEMALE PELVIC OEaAHS

(the Surgery, Surgical Pathology, and Surgical Anatomy of), in ft
Series of Coloured Plates taken from Nature: with Commentaries,
Notes, and Cases, by Henry Savaoe, M.D. Lond-, F,R.O-S., Consulting
Physician to the Samaritan Free Haspital. Second Edition, 4to,
£1 lis. 6d. [18701

EBACTURIS OF THE LIMBS

(Treatment of) by J. Sampson Gamgee, Surgeon to the Qaeen'a
Hospital, Birmingham. 8vo, with Plates, 10a, 6d* D^l

DISEASES AWD XNITmiES OF THE EAR

by W* B. Balby, F,R,C,S,, M.B., Amral Surgeon imd Lecturer on
Aural Surgery at St, George's Hospital. Crown 8vo, with 21 Engrav-
ings, 6a. 6d. |i»7»J

ATTRAL CATARRH ;

or, the Commonest Forma of Diafiiess, and their Cui-e, by Petee
AxLEN, M.D,, F.B.C.S.Et, late Aural Surgeon to St. Mary's Hospitah
Second Edition, crown 8vo^ with Engravings, 8s. 6d. [^^74]

PRINCIPLES OF SURGICAL DIAGNOSIS

especially in Bektion to Shock and Visceral Lesions, Lectures
delivered at the Koyal College of Surgeons by F. Le Gbos Clabe,
F.R.C.S., Consulting Surgeon to St. Thomas's Hospital. 8vo,
10s. 6d. ti870i

CATALOGUE OF EEOENT W0BK8

CLtrBFOOT ;

its Causes, Pathology, and Treatment j being the Jacksonian
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pital. Second Edition, 8vo, with 106 Engravings and 6 Iiiihographk
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mJUEHS AKB BISEASES OF THE EKEEJOIHT

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DEFOEMITIES OF THE HUMAK BODY: i

a System of OrthopsBdic Surgery, by Beenard E. BBOBHTTBar?
F.R^O.S., Surgeon to the Royai Orthopaedic Hospital. 8vo, with
Engravings, 10a. Sd- ^^

OFEEATIVE SUltGEEY OF THE FOOT AlTD ANKLE

by Henry Hancock, F.R.C.S., Consulting Surgeon to Charing Cross
Hospital. 8vo, with Engravings, 159. OS^

THE TREATMENT OF SURGICAL INFLAMMATIONS

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BT TKB BAKE AUTHOB,

STTRGICAL INaTTIRIES

With numerous Lithogi-aphic Plates, 8vo, Ss.

HERNIAL AND OTHER TUMOURS

of the Groin and its Neighbourhood, with some Practical Remarks <
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THE SURGERY OF THE RECTUM:

Lettaomian Lectm^es by Heney Smith, F.R^C.S,, Surgeon to King^j
CoOege Hospital. Third Edition, feap 8vo, Zb, 6d* CH

FISTULA, HEMORRHOIDS, PAINFUL ULCER,

Stneture, Prolapsus, and other Diseases of the Rectum : their Diagn(
and Treatment, by Wm. Allinoham, RR.C.S., Surgeon to St. Mark*a
Hospital for Fistula, &c., late Surgeon to the Great Northern Hospil
Second Edition, 8vo, 7s. HJ

THE URINE AND ITS DERANGEMENTS

with the Application of Physiological Chemistry to tlie Diagnosis
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PUBLISHED BY J. AND A- CHUHCHILL

STEICTUEE OF THE UEETHEA

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BY THB SAME ACTTHOR,

PEACTICAL LITHOTOMY AWB LITHOTEITY;

or. An Inquiry into the best Modes of removing Stone from the
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AlifiO,

DISEASES OF THE XTBmAltY OEGAJTS

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C187J]

DISEASES OF THE FEOSTATE:

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STEICmmE OF THE UEETHRA

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KIDNEY DISEASES, ITBJjrAEY DEPOSITS

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THE lERITABLE BLADDER:

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EENAL, UEINAEY, AND EEFEODDCTIYE OEOANS

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8TO,I0«.6d. * ^*^^^

CATALOGUE OF EECENT WOEKS

THE REPEODUCTIVE OReAHS

in Cliiidhood, Youtb, Adult Age, and Advanced Life (Ftuictiona and
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BY TAB 6iJ£B ArTHOR,

PROSTITTmOBT :

Considered in its Moral, Social, and SanitaiT' Aspects. Second Bdiiion,
8to, 128. ti8«»3

PRACTICAL PATHOLOGY:

coutaining Lectures on Snppuratire Fever, Diaeasea of the Veinfi^|
Hffimorrlioidal Tumours, Diseases of the Rectum, Syphilis, Gonor*
rheal Ophthalmia, &^., by Heney Lke, F.E.,C.S,, Surgeon to StGeorg«'i
Huspital. Third Edition, in 2 vols, 8vo, 10s. each. tl»

GEHITO-irRraARY ORGAKS. INCLUDING SYPHILIS

A Practical Treatise on their Surgical Diseases, designed as a Manual
for Students and Practitioners, by W. H. Van Bxjbbn, M.D., Pro-
f esaor of the Principles of Surgery in Bellevue Hospital Medical Col-
lege, New York, and E. L. Keyes, M.D„ Professor of Dermatology in
BelleTQQ Hospital Medical College, New York, Royal 8yo. with 140
Engravings, 21a. Cie^fl'

SYPHILITIC ITERVOUS AFFECTIONS

(Clinical Aspects of) by Thomas Buzzaed, M.D., P.R.C,P. Loud,
Physician to the National Hospital for Paralysis and Epilepsy* P<
8vo, 5s.

SYPHILIS

A Treatise by Waltee J. Coulson, F.R.O.S., Snrgeon to the Lo<sl
Hospital. 8vo, lOs. [im\

BY THE SAMS ATJTHOS,

STOKE nr THE BLADDER:

Its Prevention, Early Symptoms, and Treatment by Lithotrity. 8to,
6s, UJ

SYPHILITIC OSTEITIS AND PERIOSTITIS

Lectures by John Hamilton, F.E.C.SJ., Surgeon to the lUchmoE
Hospital and to Swift's Hospital for Lunatics, Dublin, 8vo. with
Plates, 68. 6d. n«7f

THE CIRCULATION OF THE BLOOD

(Forces which eun^y on) by Andrew Bcchanak, M.D., Profe^as
of Physiology in the University of Glasgow, Second Edition, 8vo
with Engravings, 5s, q^4j

PUBLISHED BY J. AND A. CHUECHILL

PEIHCrPIES Ot HTJMAir PHYSIOLOGY

by \Y. B. Carpekteb, M.Dm F.R,S* Seventk Edition by Mr. Hsnby
PowEE, 8vo, with nearly 300 Illustrations, 28s. [lecft]

PHYSIOLOGICAI. LABOEATOEY

(Handbook for tbe) by B. Klein, M.D., formerly Privat-Docent in
Hiatology in tbe University of Vienna^ Aseistant Profeasor in tbe
FathologicaJ Laboratory of tbe Brown Institution, London ; J. BuB-
don-Sandeeson, M.D., F.B.S,, Professor of Practical Pbysiology in
University College, London; Michael Fostee, M.D., F.R.S,, Fellow
of, and Prajlector of Pbysiology in, Tiinity College, Cambridgo ; and
T. Laudee Beuntok, M.D., B.Sa, Lecturer on Materia Medica in the
Medical College of St. Bartholomew's Hospital j edited by J. Bubdon-
Saijdeeson. 8ro, with 123 Plates, 248. H^TS]

HISTOLOGY AKD HISTO-CHIHISTEY OF MAN

A Treatise on the Elements of Composition and Stmcture of the
Human Body, by Heinbich Fret, Profeasor of Medicine in Zurich.
Translated from the Fourth German Edition by Aethur E. J,
Baekee, Surgeon to the City of Dublin Hospital ; Demonstrator of
Anatomy, Royal College of Surgeons^ Ireland. And Revised by the
Author. 8vo, with ^8 Engravings, 2U. L187*J

THE MAEEIAGE OF KEAE KIN

Consider^^d with respect to the Laws of Nations, Results of Experience,
and tbe Teachings of Biology, by Alfeep H, Htjth. 8vo, 14b, [I875]

HUMAN OSTEOLOGY:

with Plates, showing the Attachments of tbe Muscles, by Luthee
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Edition, 8vo, 16s. i^^n

137 THE SAME irXHOB,

THE DISSECTION OF THE HUMAN BODY

(A Manual). Third Edition, 8vo» with Engravings, 168. Cl®^

MEDICAL ANATOMY

by Fkancis Sibson, M.D.. F.R.C.P., F.R«S., Consultiug Physiciim to
St. Mary's Hospital Imp. folio, with 21 coloured Plates, cloth, 42a. ;
half *morocco, 50a, [Coai|»letod m 1&S9]

THE ANATOMIST'S YADE-MECTTM:

a System of Human Anatumy by Ehasmus Wilson, F.R.O.S-, F.R.S.
Ninth Edition, by Dr. 6. Buchanan, Professor of Anatomy in
Anderson's University, Glasgow, Crown 8vo, with 371 Engi-avings,
lis, tib731

CATALOGUE OP EECENT WOBKS

THE STTJDEirT'S GUIDE TO MEUICAL DIAGNOSIS

by Samuel Fenwick, M,D., F.B.C.P., Aasistant Pliysician to Uie
London Hospital. Third Edition, fcap 8vo, with 87 EngraTinga^
68. 6d. EWa

A MAN¥AL OF UEDICAL BIAGMOSIS

by A. W. Babclay, M.1>„ F.R.C.P., Physician to, and Lecturer on
Medicine at, St* George's Hospital. Third Edition, fcap 8to, lOs, 6d.

[ISTO]

THE MEDICAL EEMEMIRAKCEE ;

or, Book of Emergencies, Fifth Edition by Jonathan HuTCHHisoir,
F.R.O.S,, Senior Surgeon to the London Hospital. 32mo, 2b. 6d [laeT]

geo^^

FRACflCAL ANATOMY:

a Manual of Dissections by Christophee Heath, F.R.C.S., Sur|
to University College Hospital. Third Edition, fcap 8vo, with 226
Engi*avings, 128. 6d* CWH

PATHOLOGICAL ANATOMY

Lectures by Samuel Wilks, M.D*, F.R.S., Physician to, and Lec-
tiu*cr on Medicine at, Guy*8 Hospital ; and Walter Moxok, M.D.,
F.R.C.P.j Physician to, and Lecturer on Materia Medica at, Gay's
Hospital. Second Edition ^ 8vo, with Plates, 18s. D'^*)

PATHOLOGICAL ANATOMY J

A Manual by C. Handfield Jones, M.B., P.R.S., Physician to SU
jyiary's Hospital, and Edward H. Sieyekino, M.D., F.R.C.P.,
Physician to St. Mary's Hospital. Edited by J. F. Payne, M.D.,
F.R.O.P., Assistant Physician and Demonstrator of Morbid Anatomy
at St. Thomas's Hospital. Second Edition, crown 8vo, with nearly
200 Engi^avings. 16s. QBTiJ

DIAGRAMS OF THE NERVES OF THE HTTMAN BODY ^

Exhibiting their Origin, Divisions, and Connexions, with their Distri-
bution, by William Henry Flower, F.R.S., Conservator of the
Museum of the Royal College of Surgeons. Second Edition, roy. 4to,
12a. '

COMPARATIVE ANATOMY AND PHYSIOLOGY

A Manual by S. Messenger Bradley, F.R^C.S., Senior ABdstani-
Surgeon to the Manchester Royal Infirmai^y. Third Edition, post
8vo, with 61 Engravings, 6s. Od. [WW

STITDENT'S GWIDE TO SITRGICAL ANATOMY:

a Text-book for the Pass Examination, by E. Bellamy, F.R.C.S.,
Senior Assistant-Surgeon and Lecturer on Anatomy at Charing

Cross Hospital. Fcap 8vo, with 50 Engravings, 6s. €d.

I1B73J

PUBLISHED BY J. AND A. CHUKOHILL 11

THE ANATOMICAL BEMEMBBAITCEB;

or, Complete Pocket Anatomist. Seventh Edition, 32mo, Ss. 6d. n873]

PBACTICAL THEBAPETJTICS

A Manual by E. J. Wabino, M.D., P.R.C.P. Lond. Third Edition,
fcap 8vo, 128. 6d. [I87i]

HOOFER'S FHTSICIAH'S VADE-MECUH;

or, Mannal of the Principles and Practice of Physic, Ninth Edition
by W. A. Guy, M.B., F.R.S., and John Haeley, M.D., F.R.O.P.
Fcap 8vo, with Engravings, 12s. 6d. C18741

CLINICAL MEDICINE

Lectures and Essays by Balthazab Foster, M.D., F.R.C.P. Lond.,
Professor of Medicine in Queen's College, Birmingham. 8to, 10s. 6d.

[1874]

DISCOURSES ON PRACTICAL FHTSIC

by B. W. Richardson, M.D., F.R.C.P., F.R.S. 8vo, 5s. P^Ti]

MATERIA MEDICA

A Manual by J. F. Royle, M.D., F.R.S., and F. W. Headland, M.D.,
F.R.C.P. Fifth Edition, fcap 8vo, with numerous Engravings, 12s. 6d.

[18«8]

A DICTIONARY OF MATERIA MEDICA

and Therapeutics by Adolpbe Wahlttjch, M.D. 8vo, 15s. [18681

MATERIA MEDICA AND THERAFEITTICS:

(Yegetable Kingdom), by Charles D. F. Phillips, M.D., F.R.C.S.E.

8V0, 158. [1874]

THE STUDENT'S GUIDE TO MATERIA MEDICA

by John C. Thorowoood, M.D. Lond., Physician to the City of
London Hospital for Diseases of the Chest. Fcap 8vo, with Engrav-
ings, 68. 6d. [1874]

THE DISEASES OF CHILDREN

A Practical Manual, with a Formulary, by Edward Ellis, M.D.,
Physician to the Victoria Hospital for Children. Second Edition,
crown 8vo, 7s. [1873]

THE WASTING DISEASES OF CHILDREN

by Eustace Smith, M.D. Lond., Physician to the King of tl^e Belgians,
Physician to the East London Hospital for Children. Second Edition,
post 8vo, 7s. 6d. ti870]

OATALOGUl OF BECEKT WOEKS

THE DISEASES OF CHILDREN

Essays by WiJULiAM Henby Day, M.D., Physician to the S&maritaii
Hospital for Diseases of Women and ChDdren. Fcap 8vo, 5s. C**'^

COMPENDmiE OF CHILDEEIT'S DISEASES

A Handbook for Practitioners and Students, by Johaitk Stei^ee,
M.D., Professor of tlie Diseases of Children in the Uni%*ersity of i
Prague. Translated from the Second German Edition by Lawsoh '
Tait, F^R.C.S., Surgeon to the Binningham Hospital for Women.
8vo, 128. 6d. nsTiJ J

ADVICE TO A MOTHER

on the Management of her Children by Pye H. Chavasse, F.RC.S,^
Eleventh Edition, fcap 8vo, Ss. Gd.

BY TBB SAlfB AUTHOB,

COUNSEL TO A MOTHER

on the Care and Bearing of her Children, being the Compaidoii
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AU30,

ADVICE TO A WIFE

on the Management of her own Health. With an Inti-oductory \
Chapter especially addressed to a Young Wife. Tenth Edition, fcap i
8vo, 2a. ed. CIS7J3 J

PXIEEPERAL DISEASES

Clinical I/ectiirea by FoRDYCB Baekeb, M,D.» Obstetric Pliymchm
to Btdlevue Hospital, New York. 8vo, 15s, Ci^^lj

OBSTETRIC OPERATIONS,

including the Treatment of Ha3raon*hage, and forming a Guide to the
Management of Difficult Labour; Lectures by Robert Babnes., M.D., I
F.K.C.P., Obstetric Physician to, and Lecturer on Midwifery at> St.
Thomas's Hospital. Seeond Edition, 8vo, with 113 Engravings, ISs,

Dm}

BY TQS BA1£B ATimOH,

MEDICAL AND SITRGICAL DISEASES OF WOMEN

(a Clinical Hiatory). Svo, with 169 Engravings, 23g, ClST*!

OBSTETRIC SURGERY

A Complete ITandbook, giving Short Rules of Practice in erery Emer*
gency, fi*om the Simplest to the most Form idable Operations connected
with the Science of Obstetricy, by Charles Clay, Ert.L.RC.P. Loud.*
L.R.C.S.E., late Senior Surgeon and Lecturer on Midwifery, St,
Mary's Hospital, Manchester. Fcap 8vo, v^ith J)l Engravings, 68. Gd,

[IS7«1

PUBLISHED BY J. AND A. CHUECHILL 13

OBSTETRIC MEDICINE AJSTD SUEOERT

(Principles and Practice of) by F. H. Bamsbotham, M.D., F.R.C.P.
Fifth Edition, 8vo, with 120 Plates, 22s. C18«7]

OBSTETRIC APHORISMS

for the Use of Students commencing Midwifery Practice by J. G.
SwAYNE, M.D., Physician-Acconchenr to the Bristol Gkneral Hos-
pital. Fifth Edition, fcap 8vo, with Engravings, 3s. 6d. nsTi]

SCHROEDER^S MANUAL OF MIDWIFERT,

including the Pathology of Pregnancy and the Puerperal State.
Translated by Chables H. Cabteb, B. A., M.D. 8vo, with Engrav-
ings, 128. 6d. [1873]

A HANDBOOK OF UTERINE THERAPEUTICS

and of Diseases of Women by E. J. Tilt, M.D., M.R.O.P. Third
Edition, post Svo, 10s. C18<»3

BY THE SiLHE AUTHOR,

THE CHANGE OF LIFE

in Health and Disease : a Practical Treatise on the Nervous and other
Affections incidental to Women at the Decline of Life. Third Edition,
8vo, 10s. 6d. [1870J

ENGLISH MIDWIVES:

their Histoiy and Prospects, by J. H. Avbling, M.D^ Physician to
the Chelsea Hospital for Women, Examiner of Midwives for the
Obstetrical Society of London. Crown Svo, 58. C18733

DISEASES OF THE OVARIES :

their Diagnosis and Treatment, by T. Spbnceb Wells, F.R.C.S.,
Surgeon to the Queen's Household and to the Samaritan Hospital.
Svo, with about 150 Engravings, 21s. C1872]

HANDBOOK FOR NURSES FOR THE SICK

by Miss Yeitch. Crown Svo, 2s. 6d. C187Q]

A MANUAL FOR HOSPITAL NURSES

and others engaged in Attending on the Sick by Edwabd J. DOM-
ville, L.R.C.P., M.R.C.S. Second Edition, crown Svo, 28. 6d. C1875]

A COMPENDIUM OF DOMESTIC MEDICINE

and Companion to the Medicine Chest; intended as a Source of Easy
Reference for Clergymen, and for Families residing at a Distance
from Professional Assistance, by John Sayost, M.S.A. Eighth
Edition, 12mo, 5s. C18713

CATAIOGUU OF EEC3ENT WOBKS

THE WIFE'S DOMAIK

The Young Couple— Tlie Motber — ^The Nurse— The NurBliBg, by Phi*
LOTHALOS. Second Edition, post 8vo, Ss. 6d. n^*I

WniTEE COUGH

(Catat*rh» BroncMtis, EmphyBema, Aatlima), Lectures by Hoe ACS
DoBEXL, M.D., Consulting Pliysician to tbe Royal Hospital for DiaeftMS
of the Chest. Third Edition , with Coloured Plates, Bvo, lOs, Gd, CWQ

BY THE SAltnE AVTHOR,

THE TKtJE FIEST STAGE OF CONSUMPTION

(Lectures). Crown 8vo, 3s. 6d. [1M71

DISEASES OF THE CHEST:

Contributiona to their Clinical History, Pathology, and Treatment, by
A. T, H. Watees, M.D., F.R.C.P., Physician to the Liverpool itoyml
Iiifirniar>% Second Edition, 8vo, with Plates, ISs. £1873]

PHTHISIS AND THE STETHOSCOPE;

or, the Physical Signs of Consumption, by R. P. COTTON, MJ>^
F.R,C-P., Senior Physician to tbe HospitaJ for Consumption, BTompton.
Fourth EOition, fcap 8vo, 3s. Cd, IXbmi

DISEASES OF THE HEART

and of the Lnege in Connexion therewith— Notes and ObBer\'^ationB
by Thoslas Shaptee, M.I>., F.R.C.P, Lond., Senior Physician to the
Devon and Exeter Hospital. 8vo» Ts. 6d. D^4}

VALVULAR DISEASE OF THE HEART

(some of its causes and effects). Crooniaii Lectures for 18G5. By
Thomas B. Peacoch, M.D., F.R.CR, Physician to St. Thomjis^s
Hospital, With EngraTings, 8vo, 5 a. [18S»1

BY THE SAME AUTHOE,

MALFORMATIONS OF THE HUMAN HEART

With Ooginal Caaea and Illustrations. Second Edition, 8vo, with
Plates, 10s. n8«73

THE ACTION AND SOUNDS OF THE HEART

Researchea by Geoege Paton, M.D., author of numerous papem
published in the British and American Medical Journals, Be-
issue, with Appendix, 8vo, 3a. 6d. 087*)

NOTES ON ASTHMA;

ita Forma and Treatment, by John C. Thobowgood, M.D. Lond*»
Physician to the Hospital for Diseases of the Chest, Victoria Park.
Second Edition, crown 8vo, 4s. 6d. £18791

PUBLISHED BY J. AIO> A, CBTJECHILL 15-

GEOWTHS m THE LAEYNX,

witE Bepoi-ia and an Analjaia of 100 coasectitiTe Oases treated since
tlie Invention of the Lai-jngoecope by Mob ell Mackenzie, M,B.
Loud., M.R,C*P., Physician to tlie HospitaJ for Biaeaees of the
TJiroat. 8vo» with Coloured Plates, 12b. 6d, d^Ti]

EY TUB SAMS AUTHOS,

HOAESEHESS, LOSS OF VOICE,

and Striduloufl Breathing in relation to Ncrro-Musenlar Affections
of the Laryni. Second Edition, 8vo, fully Illustrated, Ss. 6d, U^^l

AtSO,

THEOAT HOSPrrAL PHARMACOPEIA,

containing npwai-ds of 150 Formula?, Second Edition, fcap 8to,
2fl. 6d, t^s^^i

lEEITATIVE DYSPEPSIA

and its Important Connection with IrritatiTe Congestion of the
Windpipe and with the Origin and Progress of Consumption by
C. B. Gabbett, M.D. Crown 8ro. 28. 6d. 08«8i

MIlTEEAIi SPEIN0S OF HAEKOaATE

By Dr. Kennion. Ninth Edition, revised and enlarged by Aj>am
Be A LEY, M,A., M.D. Cantab., F.R.C.P, Load. Crown 8vo, Is. HSTSj

SKEf CH OF CAJTITES AND ITS CLIMATE

by Th. DeValcottet, M.B. Paris^ Physician at Cannes- Second

Edition, with Photographic Yiew and 6 Meteorological Cbarta,

Crown 8yo, Ss. 6d. ti»7»)

WINTEE AND SPEIKQ

on the Shores of the Mediterranean; or, the Genoese Rivieras, Italy,
Spain, Greece, the Archipelago, Constantinople, Corsica, Sardinia,
Sicily, Corfu, Malta, Tunis, Algeria, Smyrna, Asia Minor, with
Biarritz and Ai-cachon, as Winter Climates. By Heney Beknbt*
M.D. Fifth Edition, post 8vo, with numerous Plates, Maps, and
Engravings, 128. Gd. ^16743

BY TH5 SAMS AUTHOB,

TEEATMENT OF PtTLMONAEY COKSITMFTION

by Hygiene, Climate, and Medicine. Second Edition, 8vo, Ss. P^I

EQYPT AS A HEALTH EESOET;

with Medical and other Hints for Travellers in Syiia, by A. BuNBAB
Walkee,M.D, Fcap 8vo, 3s. 6d ti&731

CATALOGUE Of BECENT WOBKS

FAMILY MEDICDTE FOR IKDIA

A Manual, by William J. Mooke, M.I>.» Surgeon- Major H.M. Indian
Medical Service. Publialied uuder the Authority of the Goverument
of India. Post 8vo, with 57 Engravings, Be, Gd, ^^^^

BISIASES OF TEOPIGAL CLIMATES

and tlieir Treatment : with Hints for the Preservation of Health in the
Tropics, by James A. Horton, M.D., Surgeon-Ma^ or, Army Medical
Bepai-tment, Post Svo, 12s. 6d. n*f7*]

HEALTH IN INDIA FOE BEITISH WOMEN

and on the Prevention of Disoiise in Tropical Climates by Edwabd J.
Tilt, M.D., Consulting Phjsiciau-Accouclieur to the FarriiigdoiL
General Dispensary. Fourth Edition, crown Svo, Ss. [1^1

BAZAAR MEDICINES OF INDIA

and Common Medical Plants : Remarks on their Uses, with Pall Index
of Diseases, indicating their Treatment by these and other Agents pro-
curable throughout India, &€., by Edward J, Warikq. M,D., F.R.CP.
Lond,, Retii'ed Siu-geon H.M, Indian Army, Fcap Svo, 4s. ClsT*]

SOME AFFECTIONS OF THE LIVER

and Intestinal Canal ; with Remarks on Ague and its Sequelae, ScTarvy,
Pm-pura» &c., by STEPHEN H. Ward, M.D. Lond., FR.CP., Phyaiciwi
to the Seamen's Hospital, Greenwich. Svo, 7s. ilWUJ

DISEASES OF THE LIVER:

Lettsomian Lectures for 1872 by S.
Senior Physician to Guy*B Hospital,

O, Habershon, MJ)., F.R.C.F.,

Post Svo, 3a. 6d. imi}

THE STOMACH AND D¥ODENUM

Their Morbid Stales and their Relations to the Diseases of otber
Organs, by Samuel Fenwick, M.D., P.R.C.P., Assistant- Physician
to the London Hospital. Svo, with 10 Plates, 128. l^StSl

CONSTIPATED BOWELS:

the Yariona Causes and the Different Means of Cure, by S. B, Bi

M.D., M.R.CP, Third Edition, post Svo, Ss. U. aa

FOOD AND DIETETICS

Physiologically and Therapeutically Considered.
Svo, 158.

Second Edition,

PUBLISHED BY J. AND A* CHUEOHILL If

THE nTBIGESTIONS;

or, Diaeasea of tlio Digeative Organs Functionally Treated, by
T. K. CHAMBEits, M.D., F.R.C.P., Lecturer on Medicine at St. Mai7*s
Hospital, Second Edition, 8vo, lOe. 6d. O^T}

IMPEEPECT DIGESTION:

its CaiiBes and Treatment by Abthue Leased, M,D„ P.R,C.P.,
Senior Pbysician to the Great Kortliem Hospital. Fifth Edition,
fcap 8vo, 48. 6d. [1670]

THE ISSITE OF A SPIRIT RATION

dming the Asbanti Campaig^n of IST^ ; with two Appendices contain-
ing Experiments to show the Relative Effects of Rum, Meat Extract
and Coffee during Marching, and the Use of Oatmeal Drink drn-ing
Labour, by Edmund A. Parkes, M.D., F.R S., Professor of Hygiene
to the Army Medical School, Netley, Svo, 2s. 6d. nS7B]

HEGEIM, SICK-HEADACHE,

and some Allied Disorders : a Conti'ibution to the Pathology of Nei"ve-
Storms, by Edward Liveino, M.D. Cantab., Hon, FeOow of King's
College » London. Syo, with Coloured Plate, ISs. Cl^Til

lERITABIXITY:

Popular and Practical Sketches of Common Morbid States and Con-
ditiona bordering on Dieease; with Hints for Management, Allevia-
tion, and Cure, by James Moebis, M.D. Lond. Crown 8vo, 43. Gd.

n8«8]
FUNCTIONAX KERVOUS DISORDERS

Studies by C Handfield Jones, MB,, F,R.C.P,, F.R.S., Phyaician
to St. Mail's Hospital. Second Edition, 8vo, 18s. £1870]

NEURALGIA AND KINDRED DISEASES

of the Nervous System : their Nature, Causes, and Treatment, with a
series of Cases, by John Chapman, M.D.. M.E.C.R 8vo, 143. CWaj

THE SYMPATHETIC SYSTEM OF NERYES

and their Functions as a P by aio logical Basis for a Rational System of
Therapeutics by Euwaed Meeyon, M.D„ F.RCP., Physician to the
Hospital for Diseases of the NeiToiis System. 8vo, 3s. 6d. PiiTai

GOUT, RHEUMATISM

and the Allied Affections ; a Treatise by P. Hood, M.D, Crown 8vo,
IDs. ed. 0671]

RHEUMATIC GOUT,

or Chronic Ebeuniatic Artbritis of all the Joints ; a Treatise by
Robert Adams, M.D., M.R.LA,, Surgeon to H.M. the Queen in
Ireland, Regius Professor of Surgery in the TJniv^ersity of Dublin.
Second Edition, 8vo, with Atks of Plates, 2Is. ^972]

CATALOGUE OP EECENT WOBKS

TEMPEBATUBE OBSEEVATIONS

containing (I) T^jmperature Yarmtions in the Diseases of Cliildreiv
(2) Puei-poral Temperatures, (3) Infantile Tempfraturea in Health and
Disease, by Wm. S<iUiEE. M.RO.P. Lond. Bvo, 5s. CWiJ

MYCETOMA ;

or, the Fimgns Disease of India, by H. Vandyke Oabteb, MJ)., Sut-
geon^Major H.M. Indian Army. 4to, with 11 Coloured Plat^B» 438.

THE ORIGIN OF CANCEE

considered with Reference t« the Treatment of the Diseaae by CA][r*i
BELL PB HofiOAN, F.B..S., F.R.C*S„ Surgeon to the Middlesex Hoe- I
pital. Crown 8vo, Ss. 6d. 0^n§

CANCEE:

its varieties, their Histology and Diagnosis, by Henbt Abnott,
F.R.C.S., Assistant -Surgeon to, and Lecturer on Morbid Anatomy at,
St. Thomas's Hospital. 8to^ with 5 Plates and 22 Engrairings, 58. 6d«

awn

CANCEEOTTS AirB OTHEE INTEA-THOEACIC GEOWTHS:

their Natural History and Diagnosis, by J. Bisdon Bennett, M.D,»
F.B.C.P., Member of the General Medical CouncU. Poet Svo, mih
Plates, 88. Omn

cedfll

CEETAIN FOEMS OP CANCEE

with a New and successful Mode of Treating it, to which is prefixi
Practical and Systematic Description of all the varieties of this Disease^'
by Alex. Maesden, M.D.^ P.R.O.S.E., Consulting Surgeon to the
Royal Free Hospital and Senior Surgeon to the Cancer Hospital*
liondon and Brompton. Second Edition, with Coloured Plates and
Illustrative Cases, 8vo, Bs. 6d* Omzi

SISEAiES OF THE SKIN:

a System of Cutaneous Medicine by EttASMUS WlXSON, F,B.
F.R.S. Sixth Edition, 8vo, IBs., with Coloured Plates, 36s.

BY TBB SAME AITTHOa,

LECTTJEES ON EKZEMA

and Ekzemattjus Affections: with an Introduction on the Qeneral
Pathology of the Skin, and an Appendix of Essays and Cases. Bro,
10s. 6d.

ALSO,

LECTURES ON DERMATOLOGY

deliv<^red at tbc Royal College of Surgeons, 1870, 6s. j 1871-3, lOs.

PUBLISHED BY J. AND A. OHUEOHILL

ECZEMA

by McCall AnderboNi K.D,, Professor of Clinical Medicine in tbe
University of Glasgow, Tliird Edition, 8va, wit!i Engravings, Te. 6d.

D9741

BY THE 8AMB AUTHOR,

PABASITIC ATPECTIONS Of THE SKIN

Second Edition, 8vo, with Engravings, 7s. 6d% \X^^

FSOEIASIS OR LEPRA

bj Geoege Gaskoin, M.R.C,S., Surgeon to tlie Britieli Hospital for
Diseases of the Skin. 8vo, 58. ti»7Sl

DISEASES OF THE BKHl

in Twentj-four Letters on the Principles and Pi'actice of Outaneo^as
Medicine, by Hen BY Evans Cadty, Surgeon to the Livex-pool Dis-
pensary for Diseases of the Skin. 8vo, 12s. Bd. CiWii

ULCERS ANB CUTAKEOITS DISEASES

of the Lower Limba, a Manual of their Pathology and Treatment*
by J. K. Spender, M,I). Lond. 8vo, 4s, tiseri

FOTTRTEEir COLOITEED PHOTOGRAPHS OF LEPROSY

as met with in the Straits S«^ttkment8, with Explanatory Notes by
F. AnpersoNj M.D., Acting Colonial Sm-geon, Singapore, 4to,^

A.
31s. 6d.

[18737

WORMS:

a Series of Lectures delivered at the Middlesex Hospital on Practical
Hehninthology by T. Spencee Cobbold, M.D., F.E»S. Post 8vo^
5s. [iSTt]

OXYGEN:

its Action, Use, and Value in the Treatment of Tarions Diseases
otherwise Incui*able or veiy Intractable, by S. B. Biech, M.D.,
M.R,C.P. Second Edition, post 8vo. 3fi. 6d. 0^^

THE MEDICAL ADVISER IN LIFE ASSURANCE

by Edwabd Heney Sieve kino, M.D., F.R.C.P*, Physician to St.
Maiy's and the Lock Hospitals; Physician-Esttraordinary to the
Qween; Physician-in-Ordinary to the Prince of Wales, &c. Crown
8vo, ea. a874J

THE LAWS AFFECTING MEDICAL MEN

a Manual by Robert G. Glenn, LL.B., Barristei'-at-Law ; with a
Chapter on Medical Etiquette by Dr. A. Caepentee. 8vo, 14s,

[imj

:22 CATALOGUE OF EBOBNT WOBKS

AUTOBIOOEAPHICAL BECOLLECTIOVS

of the Medical Profession, being personal reminiscences of many
distinguished Medical Men daring the last forty years, by J. Fes-
KANDEZ Clabkb, M.B.C.S., f or many years on the Editorial Staff of
the 'Lancet; Post 8vo, 10s. 6d. CWfl

A DICnONABT OF MEDICAL SCIENCE

containing a concise explanation of the varions subjects and terms of
Anatomy, Physiology, Pathology, Hygiene, Therapeutics, Medical
Chemistry, Pharmacology, Pharmacy, Surgeiy, Obstetrics, Medical
Jurisprudence and Dentistry ; Notices of Climate and Mineral Waters;
formulsB for Officinal, Empirical, and Dietetic Preparations ; with the
Accentuation and Etymology of the terms and the French and other
Synonyms, by Boblby Dtjnolison, M.D., LL.D. New Edition,
by RicHAED J. DUNGLISON, M.D. Royal 8vo, 28s. Cis?*]

^ MEDICAL VOCABULAET;

being an Explanation of all Terms and Phrases used in the various
Departments of Medical Science and Practice, giving their derivation,
meaning, application, and pronunciation, by Robest G. Mayne, M.D.,
LL.D. FourthEdition, fcapSvo, 10s. d^TS]

OPHTHALMIC MEDICINE AND SUEOERT

a Manual by T. Wharton Jones, F.R.S., Professor of Ophthalmic
Medicine and Surgery in University College. Third Edition, fcap
8vo, with 9 Coloured Plates and 173 Engravings, 12s. 6d. Ci^sso

DISEASES OF THE ETE

A Treatise by J. Soelbeeg Wells, F.R.C.S., Ophthalmic Surgeon to
King's College Hospital and Surgeon to the Royal London Ophthalmic
Hospital. Third Edition, 8vo, with Coloured Plates and Engravings,

25s. C1873]

BY THE SAUE AUTHOB,

LONG, SHORT, AND WEAK SIGHT,

and their Treatment by the Scientific use of Spectacles. Fourth
Edition, 8vo, Gs. [1873]

DISEASES OF THE ETE

A Practical Treatise by Hatnes Walton, F.R.C.S., Surgeon to St.
Mary's Hospital and in charge of its .Ophthalmological Department
Third Edition, 8vo, with 3 Plates and nearly 300 Engravings, 258.

C1875]

^^V PUBLISHED BY J. AND A. CHUBCHILIi 23

DISEASES OF T^ EYE

111 list rations of^ with an Account of their Symptoma, Pathology,
and Treatment, by Henry Power, F.R.O.S,, M.B. Lond., Ophthalmic
Surgeon to St. Bartholomew's Hospital. Bvo, with 12 Coloured
Plates. 208. V^m]

A SYSf EM OF BEKTAL STJEGEEY

by John Tomes, RR.S-, and Charles S. Tomes, M,A„ Lecturer on
Dental Anatomy and Physiology, and Aesistant Dental Surgeon to
the Dental Hospital of London, Second Edition, fcap 8vo, with 268
EngravingB, 14s. [IWS]

A MAHUAL OF BEHTAL MECHAITICS

with an Account of the Materials ajid Applianc<^8 used in Mechanical
Dentistry, by Oakley Coles, L.D.S.* R.C.S., Surgeon- Dentist to
the Hospital for Diseases of the Throat. Crown 8vo. with 140
EngiuTing8» 7b. 6d. [iSTSj

HANDBOOK OF DENTAL ANATOMY

and Surgeiy for the use of Students and Practitionera by John
Smith, M,D., F.R.S. Edin,, Surgeon-Dentist to the Queen in Scotland.
Second Edition, fcap 8to. 48. 6d. CWl]

EPIDEMIOLOGY;

or, thi? Remote Cause of Epidemic Digeaaes in the Animal and in the
Yegctabk Creation, by John Paekin, M.D., F.RC.S. Part I,

8to, 5s. ami

OEEMINAL MATTHt AND THE CONTACT THEORY:

an Essay on the Morbid Poisons by James Morris, M.D. I<ond,
Second Edition, orown 8vo, 4a, 6d. \^^71

DISEASE GERMS;

and on the Treatment of the Feverish Stat^?, by Lionel S* Beale,
M.B., F.R.C.P., F.R.S.. Physician to King's College Hospital. Second
Edition, crown 8vo. with 28 Plates, 128. 6d. C187«]

THE GRAFT THEORY OF DISEASE

being an Application of Mr. Da.rwin*s Hypothesis of Pangenesis
to the Explanation of the Phenomena of the Zymotic Diseases, by
Jambs Ross, H.D. 8vo, 10s. owarj

ZYMOTIC DISEASES:

their Congelation and Causation by A. WotFV, F.R.C.S. Post
Sro, 58. Dsm

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