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would only be by causing the semen to pass back into the bladder; and make its exit when the patient micturated.
In the more obstinate cases mentioned under the head of Prognosis, page 230, the greatest watchfulness over the thoughts and actions during the day is absolutely essential. I find that there are patients (and very intelligent ones) who have had the greatest difficulty in surmounting the disposition the brain has to summon up and apparently revel in lascivious images. Such persons are not generally strong minded in anything; they express wishes, but have not the courage to employ the means which the medical man tells them they must use to carry out their purpose. And, most unfortunately for such persons, these frequent emissions react on the system, and render them more and more incapable of exerting proper self-control.
In the present improved way of treating such affections this is the only class of sufferers who do not readily recover, and I cannot but repeat that if a patient will not and cannot practice self-control, he must not expect that his medical adviser will continue to take any further interest in his case, for let me assure him (as I am obliged to do some of my most rebellious patients) that when the surgeon sees no efforts made towards self-cure, he loses trust, and is apt to prescribe haphazard.
Too many patients are under the impression that all their ailments may be removed by a dose of physic, and really disrelish the notion that it behooves them to do anything except take the draught. For such persons medical skill can do nothing, and they can expect to gain no relief. Cauterization may indeed remove morbid irritability from the urethra, and in cases where the emissions arise from this local cause, there is reason to hope that the reaction on the brain may cease. If the patient will co-operate with the surgeon, much good will result from it, but the operation alone is not sufficient. Constant supervision will be required; and if this is omitted, relapses are sure to follow.
In the more intractable cases of seminal emissions I should be disposed, at least with people of any strength of mind, to attempt the following plan, which Tissot recommended as far back as 1790. This author says, that since to break the habit is the first object, it is as well to go to the root of it at once, and accordingly recommends the following plan. I have met with one instance in which its manful adoption was attended with perfect success. “An Italian gentleman, of very high station and character, consulted me for quite a different affection; but in order to put me in possession of all the facts in reference to his state of health, he related his history. He had been inconvenienced five years before with frequent emissions, which totally unnerved him. He determined resolutely, that the very instant the image of a woman or any libidinous idea presented itself to his imagination, he would wake; and to insure his doing so, dwelt in his thoughts on his resolution for a long time before going to sleep. The remedy, applied by a vigorous will, had the most happy results. The idea, the remembrance of its being a danger, and the determination to wake, closely united the evening before, was never dissociated even in sleep, and he awoke in time; and this reiterated precaution repeated during some evenings absolutely cured the complaint.” 1
This plan is founded on such true physiological grounds, that I feel convinced it must succeed in a great variety of cases. To carry it out, however, requires great firmness and resolution, and it will succeed only with those who have habitually exercised self-control.2
” he says,
1" L'Onanism," p. 241.
2 A letter I received on this subject some time ago from a very distinguished provincial physician is interesting, and corroborates the above statement as to the possibility of schooling the will so as to awake in time to prevent emission. 66 I had no such success,
as to satisfy myself (in overcoming the tendency to emission during sleep), until I adopted the plan of being lightly clad in bed (on a mattress). When not in London studying, I never lay with more than a single sheet on the bed in summer, and a sheet and coverlet in winter, and one blanket extra during keen frosts. Even with this the abomination used to come on about once a month. Indulgence in wine or ale always made the erection more troublesome; but brandy invariably was followed by emission during sleep, without a dream. ..... From what a medical friend told me that he had accomplished, I have learned so to school my mind during sleep, that I awake in time to prevent a catastrophe. The
CURATIVE TREATMENT.—When a patient consults me, suffering from the severer form of the complaint, I almost invariably discover, on passing a bougie, an excessive degree of sensibility along the canal. This local cause reacts easily during sleep on the brain, which by reflex action brings on spasm, and hence the frequent emission, which is, as stated at page 234, more or less under the influence of the will. In
many instances the passage of an instrument once or twice a week will suffice to remove the morbid irritability particularly if the treatment be accompanied with some slight stringent injection. It is singular to note the success of this treatment in cases that have resisted all other means previously adopted, such as tonics, &c., and when the surgeon has omitted to accompany his tonics with any local examination.
When, however, this fails, and I admit it occasionally does, I generally have recourse to cauterization, and I find that few cases fail to yield to this treatment, which is attended with little or no pain when performed by a competent surgeon. Cauterization gives the permanent relief that nothing else often will, and I have never yet had cause to regret using it. Those who decry the above methods of treatment cannot, I venture to think, have employed them properly, for both theory and actual practice point them out, in my opinion, as the best means of checking the tendency. As soon as the excessive morbid sensibility of the canal of the urethra has disappeared, the will can assert its force, and then, if the after treatment recommended at page 77 be followed, I am convinced that the health will rally, and it is often surprising to see how the whole physical condition of the patient will improve. transition from the apparent reality of the dream to the consciousness that the scene is a dream which I must awake from, is very curious. The only occasions when I now suffer are after great fatigue, which involves a profound dreamless sleep. . . . . I do not know whether such things are common, but my father told me that he was very much troubled with wet dreams after he was sixty years of age, sexual desire and connection had ceased and did not return, yet the amount of the discharge was large and weakened him considerably.
Yours, very sincerely, W. Acton, Esq.
Successful as I have generally found this treatment, I must admit that even cauterization will not, in every instance, affect a cure. Every now and then I meet with exceptional cases where the irritation is not confined in the urethra ; but either from neglect or from some strong hereditary tendency the habit has already, before any medical aid has been sought, had too serious an influence on the brain or spinal chord to be thus overcome. Instances like these are the rare exceptions, and belong rather to the class of mental diseases, for the discussion of which this is not the place.
In the more severe cases of nocturnal emissions, by prescribing opiate enemata in the proportion of sixty or eighty drops of Liq. Opii sedativ. to an ounce and a half of fluid before going to bed, and following the plan recommended at page 236, a cure may generally be effected. In addition to the medical treatment, the patient should be advised to seek cheerful society, but at first to shun association with females. I need hardly add the obvious advice that he should, above all things, break off an acquaintance he may have formed with immodest women. His reading should consist of the light literature of the day, and strict injunctions should be given to abstain from the perusal of any book containing allusion to the subject of his complaint, or any work which would be likely to produce erotic ideas. I frequently have under my care persons who have brought themselves to the last stage of hypochondriacism by reading those pseudo-medical works so generally advertised in the daily papers.
SECT. IV.—DIURNAL POLLUTIONS OR EMISSIONS.
These terms properly include any emission of semen, voluntary or involuntary, during the waking hours. The emission is not necessarily preceded by erection, or attended with pleasure.
In the strictly continent man in good health, who follows the rules of healthy and chaste living, little or no secretion from the urethra will be noticed.
We must, therefore, consider as abnormal all moisture or discharges which the patient notices during the day, and the sufferer who has read in quack books of the exaggerated consequences of these affections, particularly if, as often occurs, he happen to be of a hypochondriacal disposition, will endure great anxiety as to the results. I propose making a few remarks upon these discharges.
I have already stated that, occurring during the day, they are abnormal, and betoken an impaired state of health ; but, at the same time, an occasional loss of even a teaspoonful of secretion will not alone bespeak disorder of the function. It is the repeated leakage, so to speak, that betokens a relaxed patulous condition of the sexual apparatus. I admit that great exaggeration has been indulged in upon the subject, but those are equally blameable who assert that the symptoms of debility, exhaustion, and impotence, cannot ever depend upon the loss of a little semen. In practice, we find this escape of semen once or twice a day, or every time a patient makes water,—goes to the water-closet,or suffers from sexual excitement,-is attended with a train of symptoms which have a very prejudicial effect on the constitution of a large number of susceptible adults.
It is very easy for any writer to ridicule the idea that the escape of a little fluid should be attended with such serious nervous depression. We must recollect that we are speaking of the loss of semen in an already exhausted individual. No one who has seen much practice can deny the statements of such patients, that one nocturnal emission will debilitate such sufferers for a week ; then why, I would ask, disbelieve that one diurnal emission does not produce a similar effect on the already exhausted sufferer? And often such patients will tell you that these losses occur several times a day.
I am ready to admit, however, that the hypochondriacal may exaggerate the influence of these losses, and that possibly what they suffer from may depend upon what they imagine they suffer. But whilst taking into consideration all these circumstances, facts are repeated too often not to satisfy me that a series of wellmarked symptoms, namely, those of exhaustive nervous power, attend and follow those diurnal losses. Indeed, they require very accurate diagnosis and appropriate treatment.