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portions. 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 muscles 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 fulfillment 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.'
“Now, although the very nature and products of the changes that ensue in nervous organs during their exercise are less well known than 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 longcontinued 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 progessive 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 over-work; by similar process, 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 long-continued 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.
Of all the disorders of the sexual organs this is the one that a surgeon most frequently meets with.
Patients 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. The friction of the trousers, in
some instances, appears sufficient to produce emission; others affirm that ejaculation is attended with scarcely any spasm.'
In other instances, erection is hardly complete before emission follows, and then, as the erection immediately ceases, the intended intercourse fails. It is fortunate, considering the disappointment and distress which such a state of things causes, that it is very amenable to treatment.
Hardly any man ever attempted connection for the first time without emission taking place prematurely, sometimes from nervousness, but more frequently, perhaps, from natural impetuosity. This is, as I have said often the case with animals. In most instances the repetition of the act will soon correct this over-rapidity of ejaculation. Whatever the cause, the symptom, if it occurs, should not be neglected or treated lightly; above all, the patient should not be thoughtlessly recommended to repeat his attempts. I have seen some very lamentable cases of complete impotence result from such a course. In addition, however, to the more ordinary causes arising from ignorance, alarm, a bad conscience, or want of power over the will, I would particularly mention another which is not generally appreciated, namely, an excessive irritability of the organs.
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 mental or physical impression produced ejaculation. I desired my patient to uncover the glans; this he was unable to do; he feared either to touch the organ himself, or allow any part to be approached, so great was its sensibility. After several efforts I succeeded in uncovering the glans, and found it coated with hardened, wrinkled, and dry smegma, which was very tenacious. With great care this was washed off, and my patient fainted before I succeeded in removing the secretion. In subsequently passing an instrument, I could not discover any 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 tendency to premature ejaculation ceased.
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.
A tight foreskin is very often the cause of many a functional disorder, as the following instance will show :
A middle-aged clergyman called on me, stating that he was partially engaged, but feared he was unable, or rather unequal, to marry, and wished my opinion on the subject. External examination detected a very long foreskin, which I induced him, after some difficulty, to allow me to withdraw, as the parts, he stated, were too sensitive even to be touched. I effected my purpose after many attempts, but I was unable to return it without giving my patient more pain than I was disposed to do, in consequence of the glans penis being of that mushroom shape that I have spoken of at page 178. I therefore at once divided the little fibres which caused the paraphymosis, and at once the foreskin could be easily reduced. The satisfaction this gentleman the next day expressed was beyond measure for the benefit conferred; he at once felt that the cause of a miserable existence had been removed : he had been wretched for years,
he knew not why, till now. Fond of the society of women, he had shunned them, and he might have been married years ago had not his sexual sufferings been so great.
The treatment must depend upon the causes; but the first and most important step is to refrain from attempting connection when frequent efforts have already been made without success, until the patient has consulted a medical man. In the slighter forms of the affection, indeed, and in incipient cases, the patient may be told to repeat connection as soon as possible after failure, and as soon as erection returns. In the more severe cases, however, this will not be prudent. Indeed, erection will probably not again recur; the disappointment and depression is so great that a second attempt will not and cannot be made.
In such instances some irritability of the glans or urethra probably exists, and the surgeon's aid must be called in. It is surprising how easily these cases are cured if the irritability is first of all removed, as in the instance I have mentioned above. Merely accustoming the glans to the application of air, water, or lint, will often suffice. Sometimes the passage of a bougie along the urethra will be necessary, or cauterization may be required. (See page 291.)
The next affection which calls for notice is NON-EMISSION. An otherwise healthy patient will tell you that he is able to have connection, the erection is perfect, but no emission follows, and no pleasurable sensations are felt. I am indisposed to believe that a patient's sensations can always be depended upon when the organs have been much abused, for emission may sometimes take place without his knowledge. There are, however, numberless instances in which emission fails to occur.
Among the causes of this, the most frequent, perhaps, is stricture, often of old standing. In such a case the mechanical obstruction prevents the passage of the semen, and it is only when erection has passed away that the fluid oozes out. In very severe cases of stricture I believe the semen, if emitted from the testes, passes back into the bladder instead of forward along the urethra, and may be noticed in the urine in the form of a thick, viscous substance. But I would here warn the reader against mistaking for semen all deposits? observed in the urine. These are of the most miscellaneous and varying composition, such as mucus from the bladder, the lithates, or the phosphates, produced by a variety of causes which this is not the place to inquire into, and which only a medical man can diagnose. True
1 Patients often require to be warned against considering as semen the various deposits to be seen, the next morning at the bottom of the vessel into which they may have made water. If semen is present, it may be noticed falling to the lower stratum of the urine immediately after micturition. As a general rule it may be laid down that all deposits falling down when the urine is cold are not composed of semen. The knowledge of this fact will give great satisfaction to patients and prevent much misapprehension.