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If, then, we come to the conclusion that in the daytime emissions occur which give rise to a train of very distressing symptoms, the first question we have to discuss is as to what they consist of. I would lay it down as a rule that these discharges are not necessarily composed of semen. I am rather disposed to believe that in the majority of cases the exuding fluid is more frequently composed of those other secretions which mix with the semen previous to its ejaculation, such as the fluid coming from the vesiculæ seminales and the prostrate gland. I am, however, equally certain that in a large number of other cases semen does form a part of the emitted discharge, and when this is the fact must be considered in determining the line of treatment.
When any such secretion is observed to proceed from the meatus of the urethra, the immediately exciting cause is generally one of the following three-sexual excitement, defecation, or micturition.
DISCHARGES ARISING FROM SEXUAL EXCITEMENT.-In one sense all discharges of this kind take their rise from sexual excitement, for neither by common observation or the microscope can we detect fluid of any kind habitually coming from the urethra at any moment, unless the patient has been subject to more or less sexual excitement. And consequently in a state of health there can be no leakage (so to speak) of semen from the system. Under the influence, however, of sexual desire, a tenacious, transparent fluid frequently oozes from the meatus. Nervous patients pay great attention to this, and will tell their medical adviser a variety of circumstances that they have noticed attending it, and describe the qualities of the discharge with painful minuteness.
Instead of viewing this as an abnormal symptom, it would be very surprising if, under excitement, some such discharge did not occur. If it betokens anything, it is a sign that the patient is potent, as the non-emission of a small quantity of fluid under excitement usually betokens a want of power.
If, however, under very slight excitement—friction of the trousers, &c.—a large quantity of fluid comes away, say a teaspoonful, and if this, instead of being an occasional occurrence, is frequently repeated during the day, or if it occurs without having been preceded by any erection, then the semen, prostatic fluid, or secretion from the vesiculæ seminales (for, on microscopical examination, it may be found to be or contain either or all of these), may be said to flow away in an abnormal manner.
There are cases in which the slightest sexual allusion or thought-or the least exercise that tends to increase the susceptibility of the genital organs—such as riding on horseback, sitting in a carriage or a railway train, will occasion an escape. In such a state of things medical assistance should always be sought, more especially if the general health suffers, or the patient acquires that careworn haggard look which a skilled eye detects at once as dependent upon sexual derangement. Proper surgical care will easily arrest the discharge if taken in time. But amenable as the special symptom is to cure, it must not be forgotten that, if the general health has been seriously impaired, the renovation of the constitution may be a far slower and more difficult matter.
DISCHARGES DURING DEFECATION.-If the bowels are not habitually confined, they will usually be relieved without any secretion being forced from the urethra ; but in many persons a hard stool will cause a small quantity of liquid to pass from the meatus each time the bowels are evacuated, or at least whenever any straining takes place. This must not be considered as an abnormal symptom; it depends upon the hardened fæces mechanically pressing on the prostate or vesiculæ seminales, and driving forward their contents, which thus exude from the meatus. As soon as the bowels cease to be confined this oozing ought at once to cease. When, however, each act of defecation is attended with the discharge of a considerable quantity of fluid from the urethra the case is one requiring medical interference. As in the last case, excess is a local sign of an unnatural state of the canal of the urethra.
The best remedy for this is to relieve the habitual.constipation. Mild remedies will often suffice. A little fruit or a draught of cold water (half a pint to a pint) taken immediately on rising in the morning, or brown bread instead of white with meals, will frequently give great relief. Another very good plan is to commence breakfast with a saucerful of oatmeal porridge."
DISCHARGE DURING MICTURITION.—In a perfectly healthy individual, who has not been subject to sexual excitement, the urine ought to be passed clear to the end, the last drops being as transparent as the first. If, however, sexual excitement has been indulged in, the first as well as the last drops of urine may be somewhat thick, and, if collected and examined under the microscope, traces of spermatozoa may be discovered in them. Such an occasional slight discharge is not what should be stigmatized as a diurnal pollution. In cases, however, where the least amount of straining to make water, or indeed very slight effort, invariably causes a certain quantity of thick fluid to exude after the last drops of urine have been expelled, and when the microscope shows that this fluid contains spermatozoa, and the general health is noticed to suffer from its abundant expenditure, the medical man should at once be applied to.
I am daily convinced that a very considerable proportion of that class of persons who are constantly ailing rather than ill, whose health is impaired, whose spirits are low, and who derive no benefit from tonics, change of air or doctors, are often suffering loss of semen, brought about by marital or other sexual excesses, or in one or more of the ways just specified. I have more than once alluded to the fact that loss of semen (in whatever way caused) induces a peculiar train of symptoms that are very marked and common to all such cases. The usual treatment for affections of the stomach or the liver, or the heart or the lungs, is futile, as long as the system is being thus exhausted. Physicians frequently do not suspect that this seminal drain on the system is the cause of the patient's suffering; or if they do, hesitate even to allude to such a source.
1 As many cooks do not understand how to make the Scotch dish, I append the following directions from Tegetmeier :"Strew oatmeal with one hand into a vessel of boiling water (to which salt has been previously added), so gradually that it does not become lumpy, stirring the mixture the whole time with the other. After the requisite quantity has been stirred in-namely, about two large handfuls of coarse oatmeal to a quart of boiling water-the whole should be allowed to stand by the side of the fire, so as to simmer gently for twenty-five or thirty minutes. During this time it thickens considerably. As thus prepared it is usually eaten with the addition of milk. There are only a few places in London where a fresh supply can be depended on ; that which has been three months in a baker's drawer is to be avoided. Bartrop's in Holborn, and Simpson's, in Skinner Street, Euston Road, I know both to sell good fresh meal at a reasonable price per stone, and doubtless many others do the same."
I cannot help thinking that the professional ignorance evinced of what is at least a possible cause of such symptoms is one of the causes of the success of the quacks who fatten on the fears of hypochondriacal or conscious-smitten patients. If the true cause of these ailments is forgotten or put out of sight, most pernicious falsehoods are tolerably sure to grow and flourish in this as in other cases.
DIAGNOSIS.—Grave errors have been committed in diagnosing these secretions. A discharge consisting only of mucus from the bladder, or composed of phosphatic deposits, which in nervous subjects pass away like so much cream or milk, and in surprising abundance, is often taken for true seminal fluid, to the great alarm and serious detriment of the patient. These phosphatic deposits, which occur at certain times of the day, generally after breakfast, and most abundantly in damp weather, have been often mistaken for semen. Cases are often sent to me from the country, even by medical men, and I am told the sufferers labor under diurnal emissions, but, on examination, I find that it is only the phosphates, and not semen, which cause the peculiar appearance in their urine. However, it is no wonder that these white secretions should alarm the patient; the hypochondriac fully believes that it is semen that is passing away; and curiously enough, the general depression which attends the profuse discharge of these deposits bears a close resemblance to that following loss of semen. Simple microscopic and chemical tests will, however, speedily clear up the difficulty.
Donné, who has made the microscopic examination of semen his especial study, says—“At the moment that semen is ejaculated, the zoosperms move about so rapidly that the eye can with difficulty follow each separate animalcule. They move in all di
rections in the fluid, just as so many eels would do, by means of their tails, overcoming obstacles in the current, avoiding obstructions, and in fact possessing and exhibitirg the power of locomotion to the fullest extent. Little by little, however, their movements diminish in rapidity and energy. This depends on two causes—1st, by the actual diminution of the vitality of the spermatozoa themselves ; and 2d, by the condensation of the liquid in which they exist, and which evaporates. Their progression becomes more difficult, soon they only oscillate, and it seems as if they were held in consequence of their tails becoming fixed in the viscous fluid. They cease to move, and, in fact, die. I have, however, seen the movements of these zoosperms last for hours, even days, provided care be taken to protect the fluid in which they are, from evaporation and from cold.”—Cours de Microscopie.
Such appearances as the above are quite sufficient to distinguish semen from all other fluids under the microscope. But I need scarcely say that this way of distinguishing semen avails little when it is passed in the urine. As soon as the spermatozoa become mixed with that fluid, they die and are not to be looked for in the fluid, but are only to be discovered at the bottom of the vessel. Their discovery under these circumstances is not so easy as Donné's account would lead us to suppose.
To the naked eye I know of no means by which one secretion coming from the urethra can be distinguished from another. Even when diffused in the urine, semen presents no particular appearances; and we cannot distinguish it from the mucus that is often suspended in the urine in the form of a cloud, entangling sometimes epithelial scales, and at other times semen.
PROGNOSIS.—“Diurnal pollutions,” Lallemand says, (other things being equal) much more difficult to cure than nocturnal emissions; and seminal emissions which attend the simple passage of the urine are more serious and more obstinate than those which take place during the effort of straining in defecation. In a word, experience proves that the severity of spermatorrhoea is proportioned to the ease with which it takes place, and common sense would predict such a result.” (Vol. i, p. 627.)