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still suffers from nocturnal emissions because he dreams he has had them.
A case now under treatment will illustrate this. A rather dreamy-looking individual came to me, after having been under the care of most of the leading physicians and surgeons in London, complaining that he suffered severely from nocturnal emissions. He was cauterized and recovered his health; he admitted he had never felt better, and, but for the emissions, would consider himself quite well. I could find nothing the matter with him; he had gained flesh, he had regained his former bright look, but he maintained that he had bad emissions sixteen times in the last month. All that I can say was that his looks did not correspond with his statements. To convince me, he brought some of the fluid emitted, but I failed in detecting in this any of the characteristics of semen. I do not believe this patient wished to deceive me, but I feel convinced he dreamed that emissions occurred, and probably what he brought me was prostatic fluid.
Such cases deserve great commiseration, for they frequently arise from hypochondriasis, that strange pyschological phenomenon which has often puzzled me as well as other surgeons. Where it is present it often retards convalescence, as the invalid cannot bring himself to believe that he is recovering his health and vigor as long as he thinks himself subject to nightly wet dreams.
There is a popular belief existing that it is dangerous to attempt to check emissions. This is as true and as false at the same time as many popular notions are. It is undoubtedly dangerous mechanically to prevent ejaculation, as for instance by pressure in the perinæum, or by the pressure of a cord tied around the penis, for in these cases the semen is merely forced back into the bladder, but not prevented passing from the vesiculæ seminales.
It is dangerous for a man to excite himself, or to allow his sexual feelings to be excited frequently, and by his will habitually to attempt to check emission; but it is not dangerous, nor is it attended with any ill consequences, so to train the will that
emissions shall not occur, or if in spite of our will they do commence involuntarily, to shorten the duration of the emission, which in a manner all can more or less do.
Patients will tell you that they cannot control their dreams. This is not true. Those who have studied the connection between thoughts during waking hours and dreams during sleep know that they are closely connected. The character is the same sleeping or waking. It is not surprising that, if a man has allowed his thoughts during the day to rest upon libidinous subjects, he should find his mind at night full of lascivious dreamsthe one is a consequence of the other, and the nocturnal pollution is a natural consequence, particularly when diurnal indulgence has produced an irritability of the generative organs. A will which in our waking hours we have not exercised in repressing sexual desires will not, when we fall asleep, preserve us from carrying the sleeping echo of our waking thought farther than we dared to do in the daytime.
Tissot, who wrote more than seventy years ago, says: “Occupied with ideas relating to the pleasures of love, given up to lascivious dreams, the objects which the brain paints for itself produce on the organs of generation the same movements which would have been produced during our waking moments, and hence the ejaculatory act is physically produced instead of being so only in imagination.”—“L'Onanisme," p. 222.
The PROGNOSIS of an ordinary case is very favorable, provided the patient will honestly aid the surgeon in effecting a cure. Even when nocturnal emissions are alarmingly frequent, occurring night after night, and sometimes more than once in a night, and perfectly prostrating the patient, still these discharges are quite under control of local treatment. But at a later stage, when the emission has become a confirmed habit, a cure is not so certain.
The disposition in the system to repeat an act and establish a habit is very curious. We notice it in children who wet their beds. Another instance is that of going to stool at a particular hour. Once establish the time of the bowels acting, and they act with regularity. The same rule is more or less true of emissions; if they occur one night they are likely to occur the next, and the next. The secret of success is to break the habit. The sooner this can be effected the better, and it should be done before the habit becomes imprinted on the system.
It is a fact so generally known that the reader need scarcely be more than reminded of it, that one nocturnal emission in a reduced constitution often weakens the subject of it much more than does connection repeated several times the same night by a healthy person. It is, moreover, a well-ascertained fact, that erotic dreams attended with pleasure leave less weakness than when emissions occur without the knowledge of the dreamer. Explain this as we may, the fact is undoubted; but it is no more to be wondered at than that persons will undergo great exertions and perform extraordinary feats when inspired by hope, and confident of success. We may say such results depend upon nervous influence others call it courage. It is said that persons so situated have a good tone of the system; that reaction takes place readily. Doubtless the brain or spinal cord has a great influence on the results we are describing, as well as in supporting the loss of semen which some constitutions have the power of renewing much more readily than others.
PREVENTIVE TREATMENT.—In strong robust young men the surgeon need not take much notice of emissions coming on once a week, but recommend the patient to avoid suppers, to abstain from tea, coffee, and tobacco, and to lie on hair or spring mattresses, instead of feather beds, and with only a moderate quantity of clothing.
I recommend my patients to drink no fluid after dinner, supposing that meal to be taken at 6 or 7 o'clock. This and regular evacuation of the bladder at bedtime, will singularly assist the treatment. A very little fluid will be sufficient to relieve any great thirst that may occur in the evening, but the rule should be, avoid drinking after 8 o'clock.
The sufferer should be told that emission usually takes place in heavy sleepers, and the best way of preventing this intense drowsiness in the morning is not to load the stomach over night with all sorts of indigestible and miscellaneous food. Care should he taken in regard to quantity and quality, and I should rather say to such persons, make your principal meal in the middle of the day, and let your evening meal be light. I do not advise a man to go hungry to bed, but I am convinced if a patient will judiciously attend to his diet, and in this respect exercise selfcontrol, he may, without much assistance from his medical adviser, ward off emissions. If, however, he will persist in gorging himself with what to him is an indigestible meal, he must not expect that any means a surgeon has at his disposal will avail.
Let me further remark, that if a man is disposed to emissions he should not fall into a second sleep, but should rise early, in which there is no difficulty if he goes to bed at a reasonable hour. No doubt can exist that emissions most frequently take place in this second sleep; and although a man awakes thoroughly refreshed from his first sleep, he may arise after having taken a second doze thoroughly prostrated. An early call, or an alarm clock, may cure many a patient better than all the preparations in the pharmacopoeia. At first these early hours may disagree with him, but they soon become as natural as late ones were, and the patient feels a disinclination to lie in bed, equal to his old disinclination to get up early. Of course large numbers of patients will tell you that they feel so fatigued in the morning that they cannot get up. If more sleep is required—should be the answer—let it be taken in the daytime. It is very probable that in some way or other the very feeling of fatigue complained of depends upon spasmodic action or nervous excitement induced by this second sleep.
It would be a curious and important question for physiologists to investigate why the second sleep refreshes us so slightly when compared with the first ? On awaking the first thing in the morning, most persons, and especially convalescents, feel refreshed by their night's rest; but if they go to sleep again, and rise say at ten, they remain languid all day. Perhaps it may depend in a great measure upon the first sleep being sounder and quieter, and not being disturbed by the dreams to which those who indulge in the second are liable.
I have often thought of recommending some of my confirmed
cases to take a voyage on board ship, and keep the watches with the sailor, which allow of taking only four hours' sleep at a time, in the belief that this interruption of rest would break through the almost inveterate habit; but it is difficult in these, the worst forms, to induce the patient to take any trouble to cure himself; he wishes to rely on medicine, and will not give himself the trouble to act independently.
Another very valuable suggestion is to desire the patient to practice the habit of waking early in the morning, turning out of bed, and emptying the bladder. It is in the early morning, when the bladder is full, that emissions and erections take place. In such cases, if a patient rises at 5 or 6, and goes to bed early, he may altogether avoid emissions.
I believe this precaution of keeping the bladder empty at night to be more important than almost anything else in the simpler cases, and that it will be usually successful. I have known an enema of half-a-pint of cold water, used at bedtime, to work well where other means have not produced satisfactory results. It has been said that sleeping between the blankets will prevent emissions, but I cannot say that I have any experience as to this remedy. Tying a towel round the waist, so as to bring a hard knot opposite the spine, will, by preventing the patient from lying on his back, often prevent emissions at night. It is doubtless quite true that the close observer of his own symptoms finds himself generally lying on his back when the emission takes place, but it is equally certain that emissions may occur when the patient lies on his side, as in the following case. One of my most intelligent patients notices that, on suddenly waking on the occurrence of an emission, he finds himself lying on his left side, his legs and knees firmly drawn up against the abdomen, and the erect penis prevented from gaining its natural position by the thighs. Trousseau, in the “Gazette des Höpitaux,” Mai 15, 1856, recommends an instrument to pass up the rectum to press on the vesiculæ, and mechanically prevent the emissions. I have tried the plan on one or two patients, but was obliged to leave it off, as I found that it produced considerable irritation; and even if such clumsy contrivances answered, it