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PART II.

DISORDERS AFFECTING EMISSION.

We have now to consider the disorders that may complicate or interfere with the ejaculatory part of the sexual act. It has been generally supposed that the loss of semen was the cause of sexual debility in the male, arising from excesses. That such is not the case is proved by the depression coming on in young children before they can be said to secrete semen; and is likewise noticed in women who do not secrete any such fluid, but merely mucus,' and yet may experience the nervous orgasm or spasm which acts as harmfully on them, when much indulged in, as on males. The immediate cause of this nervous depression has, within the last few years, excited a good deal of attention; and I think, with many modern writers, that there is a good deal of evidence now existing which shows that shocks constantly received and frequently repeated on the great ganglionic centres may produce irritation in them, thus causing many of the obscure forms of disease to which we have hitherto failed in discovering a key. If there is any cause which is likely more than another to produce undue excitement of the ganglionic system, it is the too frequent and repeated ejaculatory acts involving this nervous orgasm.

It has been clearly proved by Brachet that if the solar plexus and semi-lunar ganglion in an animal be irritated, it will, as soon as the parts become inflamed, express feelings of suffering. When the communication is cut off between these ganglia and the spinal cord, all symptoms of pain or irritation of the ganglia cease.

Hence we should infer, I think, that undue excitement of the generative functions may set up irritation of these ganglia, and that this undue excitement will be communicated to the spinal cord, producing depression of spirits, pain at the pit of the stomach, and general prostration. I may, moreover, remark, that if this is the modus operandi of such lesions, it is not altogether so surprising if in many cases where we notice the effects of excesses in young men, nature has been unable to recover from too rapidly repeated shocks; the irritation set up has morbidly excited the channels of nervous influence, they have re

1 No woman, any more than any other female animal secretes or loses semen during connexion, or anything analogous to it; nothing, that is, which contains animated "beings. What passes, if examined under the microscope, consists of mucus or the debris of epithelium. Nevertheless, as an effect of long-continued, and often-repeated sexual shocks, women may,-feeble as their sexual tendencies are compared with men's, become subject to epileptiform attacks, and various nervous affections.

ceived some permanent influence that they never wholly recover from. In Dr. Tilt's late work on 'The Change of Life in Women," he gives much evidence in corroboration of this. Dr. Tilt, I think very properly, agrees with Müller in considering the ganglia the source of the energies of the sympathetic nerves, and the fountain from which the ganglionic system draws the constant, gradual, galvanoid action which is kept up in the capillaries throughout the frame. Many of my readers will agree that this view of the subject is the one most in accordance with our knowledge of physiological phenomena of the nervous system: it of course does not admit of positive proof, but it has experiment on its side, and is in strict accordance with our observations on the living. If it be true, we should the more insist upon the necessity of great moderation in exciting the nervous system at any time by sexual shocks, and the baneful effects of any such excitement, before it has arrived at maturity. Mr. Paget has kindly favoured me with his opinion on the probable morbid state of the nervous system induced by excesses:

"I believe that the morbid state of the nervous system-more particularly of the spinal cord—which is produced by excessive sexual intercourse, is analogous to that which is sometimes observed in muscles after excessive exercise. The history of some of the cases of 'progressive muscular atrophy' makes it evident that, in some persons, the excessive employment of single muscles, or groups of muscles, may lead to their complete atrophy; and that this atrophy may be manifested sometimes by simple wasting of the muscular tissue, sometimes by fatty degeneration, sometimes by these forms of atrophy combined in various proportions. And it seems not improbable that these states are to be ascribed to the impairments of texture, which are naturally produced in the exercise of muscles, being in these instances unrepaired. It is certain, that in the natural exercise of a muscle, its composition and texture are, in however small a measure, changed; many of the results of the change have been traced by chemical analysis; fatigue is the sensation we have of the changed state of the muscle or its nerves; and the state is one of impairment, for the muscle has lost power. In health, and the natural course of events, the repair of the thus impaired muscle is accomplished during the repose which follows exercise. But, if due repose be not allowed, the impairments may accumulate, and the muscles may become gradually weaker, so as to need greater stimulus for the fulfilment of their ordinary work; and at length, in some instances, they may even lose the power of repairing themselves during repose. In these instances they are the subjects of the 'progressive muscular atrophy.'

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Now, although the very nature and products of the changes that, ensue in nervous organs during their exercise are less well known than

A Practical Treatise on the Nervous and other Affections incidental to Women at the Decline of Life.' Second edition. Churchill, London.

are those that ensue in muscles, yet the occurrence of such changes is certain; some of them are traced by analysis; they are similarly felt by fatigue; similarly repaired in repose. And it seems a fair analogy which suggests that the loss of nervous power, and especially the paraplegia, that may follow long-continued sexual excess, are due to changes parallel with those that are witnessed in the progressive muscular atrophy after excessive muscular exercises-the softening and wasting of the paraplegic cord being a process of fatty and wasting degeneration essentially similar to that traced in muscles.

"In the progressive muscular atrophy, the wasting or other degeneration of the muscles generally proceeds, in course of time, to muscles more and more distant from those first affected after overwork; by similar progress, the degeneration of the spinal cord may extend far from the part first affected in consequence of its over-exercise in the sexual acts.

"It is taken for granted here that the act of copulation and emission is associated with what may be regarded as violent exercise of the spinal cord; and this cannot reasonably be doubted. But I have also no doubt that cases of paraplegia may be sometimes seen in which the excessive exercise of the cord has been in its participation in violent and longcontinued voluntary muscular actions, especially in excessive walking, running, and other such acts.

"In what is said above, I have had in view only the cases of gradual loss of nervous power due to excessive sexual acts. Where the loss is rapid, it may be due to inflammation (associated as that process is with rapid degeneration) of the nervous organs. But here, also, the parallel with muscles will hold; for an excessively exercised muscle not unfrequently becomes inflamed, and its inflammation may very quickly lead to its wasting or other degeneration, and its corresponding loss of power.

"I cannot guess why excessive sexual acts should be followed, in some persons, by loss of nervous power, while in other persons they seem harmless; but the same differences are seen, and are equally inexplicable, in the case of the muscles. In some persons the same exercise which in others leads to muscular atrophy is followed by the attainment of greater power, and by the growth of the exercised muscles.

"I do not know what lesions ensue in the nerve-fibres when the cord degenerates in the instances referred to above; but the analogy of the muscular atrophy, in which the nerves degenerate with their muscles (though probably only secondarily), makes it probable that the spinal nerves partake of the degeneracy with the cord."

SECT. I.-PREMATURE EJACULATION.

This is one of the commonest of the disorders, if they may be so called, which interfere with this portion of the generative act. It may arise from a variety of causes, which it should be the object of the surgeon to remove. The novelty of the act, want of power of the will, previous excesses, fear, disgust, apprehension, may all have this effect. The treatment in simple cases consists in desiring the patient to have no fear, but allow a certain time to elapse, and attempt connexion again; but where the symptom arises from weakness induced by excesses, a cure is not so easily effected.

The affection, however, is frequently a result of excessive irritability of the glans penis or prepuce.

A gentleman was sent to me from a midland county suffering from debility of the most marked kind. He was subject to frequent emissions, and the least cause produced ejaculation. I desired my patient to uncover the glans; this he was unable to do; he feared even to touch the organs, or allow them to be touched, so great was their sensibility. After several efforts, I succeeded in uncovering the glans, and found it coated with hardened, wrinkled, and dry smegma, which was very tenacious. Little by little this was washed off, and my patient fainted once or twice before I succeeded in removing it. There was not, however, unusual morbid irritability of the urethra in this case. Nothing but the sensibility of the glans and prepuce had caused the morbid symptoms, and as soon as these were relieved, the previous rapid ejaculation ceased. Patients not unfrequently complain that semen is emitted so readily, that if they even converse with women, or if they ride on horseback, or walk fast, semen will come away; that the friction of the trousers will be sufficient to produce emission, and that ejaculation is attended with scarcely any spasm.1

These are cases that more properly may be considered as diurnal pollutions, and on this subject I would refer my readers, to page 144.

In other men we find that the act fails, in consequence of sexual intercourse not being attended with any emission, and we shall therefore devote a few lines to the consideration of—

1 This rapidity of emission has been likewise noticed, under similar circumstances, in animals. Breeders know so well, that the first leap which an entire horse takes after being put by for some time, will be attended with too rapid ejaculation, that at the end of a few days the mare is again put to the horse.

SECT. II.-NON-EMISSION.

In these cases, instead of emission occurring too rapidly, it does not take place at all. The desire is strong. Erection follows, but no emission. In such cases we may naturally expect stricture, and a bougie will often satisfy us that there is a mechanical obstruction to the passage. Under these circumstances, the remedy consists in removing the stricture.

The most serious and puzzling instances of non-emission are those where there is no apparent mechanical cause to account for it.

I met with a most singular case of this kind some time ago. The patient was an American. Erection was perfect, but no emission followed, except that when erection ceased, there was occasionally a slight oozing from the urethra. Yet, strange to say, the patient had emissions at night once or twice a week. The testicles were small. A short time he had been operated on for varicocele without any good effect. He had been also cauterised. There was slight stricture, as shown by the bulbed instrument, but a conical bougie easily passed. There was apparently nothing but a want of consentaneous action between emission and erection, both being perfect at different times. The patient, I may add, was cured ultimately, after careful treatment.

Another class of cases are met with which are less amenable to treatment, viz., where non-emission depends upon complete obstruction of the vasa deferentia. The dissection of these appendices or canals for conducting the semen from the testes to the vesiculæ seminales, shows that after inflammation or injury they may be completely blocked up, and yet the secretion of the testes go on. Now it stands to reason that if the semen cannot force its way through these obstructions it cannot be emitted, and, in such cases as these, sexual intercourse will be unattended with any kind of emission, or, if fluid is ejaculated, it will not contain spermatozoa and be fertile, but must consist only of prostatic fluid, or the secretions from the vesiculæ seminales. These are cases that have not yet attracted much attention from the profession, but of their existence there can be no doubt. The cause may be suspected when we find the testicles enlarged, painful, and tense, and yet no emissions following sexual intercourse. In time the testes will probably diminish in size until we have hopeless impotence, arising from atrophy of these organs as well as obstruction of the vasa deferentia. Such cases, I fear, must be considered beyond the reach of our art.

Among the derangements or disorders of the act of emission, must be classed that very frequent one, which has been so often referred to in preceding pages, viz.: