known as falsetto. Not only non-development, but repeated loss of semen and abuse of the sexual organs has a perceptible effect in some cases upon the timbre of the voice.

It has not, however, until quite lately, been noticed how closely those affections of the throat, so commonly met with in young and continent men, and known generally under the term clergyman's throat, are connected with disorders or disturbances of the sexual organs.

That sexual intercourse has the singular effect of producing dryness of the throat has long been known. Masturbation often repeated, or profuse nocturnal emissions, have the same effect; and in process of time this symptom, which at first is only temporary, may become permanent. Of course the throat affection may arise from many other causes, but I have seen it so frequently associated with excesses which have debilitated the reproductive organs, that little doubt exists in my own mind that in the majority it is the consequence more or less direct of those excesses, and not merely a casually contemporaneous affection. That this must be so is proved, moreover, by finding the throatsymptom often cured by the treatment adopted to relieve the generative ailments, though they have resisted all other. When the fons et origo mali has been reached, the hoarseness disappears under appropriate treatment with great rapidity.

The following are notes taken down and sent to me by a young clergyman who was a sufferer from the complaint, and had derived no benefit from any treatment of the specific affection till the sexual symptoms had been overcome:

"When I began the practice of masturbation, at the age of 16, I was in the habit of exercising my voice regularly. The first part in which I felt the bad effects of that habit was in the organs of articulation. After the act, the

voice wanted tone, and there was a disagreeable feeling about the throat which made speaking a source of no pleasure to me as it had been. By-andby, it became painful to speak after the act. This arose from a feeling as if a morbid matter was being secreted in the throat, so acrid that it sent tears to the eyes when speaking, and would have taken away the breath if not swallowed. This, however, passed away in a day or two after the act. In the course of years, when involuntary emissions began to impair the constitution this system became permanent. The throat always feels very delicate, and there is often such irritability in it, along with this feeling of the secretion of

morbid matter, as to make it impossible to speak without swallowing at every second or third word. This is felt even in conversation, and there is a great disinclination to attempt to speak at all. In many instances, in which the throat has been supposed to give way from other causes, I have known this to be the real one. May it not be that the general irritation always produced by the habit referred to, shows itself also in this organ, and more fully in those who are required habitually to exercise it?"

Another case, of a different kind, may be interesting. A boy, fifteen years of age, was sent to me by a medical man in the country for an opinion as to his general state of health. He was small in stature, pale in face, with large ears, and prominent, thick lips. I noticed that he spoke thickly, and was very dull of comprehension. His health, I was told, had been failing for some time, and had not benefited under the ordinary treatment. The throat was painful, the tonsils swollen, the articulation thick,. and the words uttered with evident difficulty. The expression of his features irresistibly suggested vice and early sensuality.

On inquiry I found that this youth had been taken from school as he made no progress and had been petted at home. In reply to some searching questions, I learnt from the boy that he had masturbated himself at school three or four times a week for a long time; that the affection of the throat then became a prominent symptom, and that the condition of the throat was but one. of a series of symptoms, all of which I had no difficulty in referring at once to the excesses of which he had been guilty. I may add that, under proper treatment, this unpromising case recovered, and the youth is now able to pursue his studies with advantage, and in the holidays rides well across country.

Irritation of the Genital Organs and Scrotum.-A not less serious and distressing consequence of masturbation is the local irritation caused by it. A case which came under my notice in 1862, may serve as an example. Similar ones are by no means

uncommon.

Dr. wished me to see a case of his, a tutor in a family, who had been for eighteen months suffering severely, and whose symptoms had resisted all remedies. On examination, I found the testes large and somewhat pendulous. There were no external symptoms of mischief to be observed, yet the patient complained

of all sorts of uneasy sensations, weight, pain, and such severe irritation of all the genital organs, as to keep him awake during the greater part of the night, and to render his life a burden to him. I examined his urine, which was normal; I passed an instrument (bulbed bougie) and could detect no particular local irritation of the urethra. The patient, however, acknowledged that he thought his ailments might depend upon masturbation, which he had practised formerly, and even now he had not entirely abandoned, the desire being occasionally so strong as to amount almost to a sort of satyriasis. He had never had connection or even attempted it. He was a freshly-coloured man with somewhat sunken eyes. One of his most distressing symptoms was frequent and painful erection, and I advised cauterization as the best treatment under the circumstances.

THE PROGNOSIS OF SPERMATORRHEA.-We may usually give a very favourable opinion, in case of spermatorrhoea, as to the prospect of a cure if the surgeon be consulted in the early stages of the complaint. Unfortunately, ignorance on the part of the patient regarding the nature of the affection, general stimulants prescribed by some medical man, and the false delicacy of the sufferer often cause much delay and anxiety to the patient.

But, however confident we may be in giving a favorable prognosis relative to the disappearance of special and local symptoms in cases of spermatorrhoea, we must be somewhat cautious, when the nervous system has been once impaired, in promising perfect and speedy restoration of the natural sensations or feelings, or more than a very partial return to the buoyant state of health the patient previously enjoyed. We can guarantee, even in severe cases, a comfortable state of existence, but the patient must not expect his countenance will at once loose its haggard expression, or that his broken health will be immediately restored. His nervous system has received a shock from which it takes time to recover. Travel, amusing and intellectual employment, with cheerful society and the comforts of life which easy pecuniary circumstances give, do certainly sometimes effect greater cures than I at first had even dared to prognosticate.

DIAGNOSIS. The diagnosis of these affections is easy enough

when all the symptoms are present, and daily or nightly discharges of semen take place. It is not of such cases I am about to speak.

Most practical surgeons now acknowledge the complaint Spermatorrhoea to consist in the constitutional results of disorders of the reproductive system. Many a surgeon who a few years ago would have denied the relation of the two affections, now admits that diseases of the reproductive organs do produce constitutional affections. Their complication, however, with many nervous symptoms, causes functional diseases of the sexual organs to be confounded with the various affections of the brain, by which they are not uncommonly attended. It is impossible in this place to enter into a disquisition on the various shades of difference; my own belief is, that many cases of imbecility, insanity, and epileptic affections may be traced to previous abuses of the generative functions; still I am equally persuaded that affections of the brain and spinal cord can hardly run through their course without implicating the sexual apparatus, so intimately are the two related. Abuse of the sexual feeling has often been the cause which has first produced the head symptoms, and it unfortunately too often happens that the primary cause of the complaint is ignored, while the subsequent symptoms are treated as if the brain had been primarily affected. Modern psychologists are, however, more closely examining this subject, and many of the most enlightened physicians of our existing lunatic asylums recognize the dependence of insanity on derangements in the sexual functions, and direct their treatment accordingly. (See p. 116.)

If, then, the diagnosis between these affections of the sexual organs and the general diseases now admitted to depend upon the nervous system, may be difficult and ill understood, even in the present day, from a disinclination on the part of some persons to attribute the affection to the right cause, the same difficulty cannot impede the diagnosis of the purely local sexual lesions.

I have already pointed out (p. 274) the great error it would be to set down as seminal discharge all secretions that are to be

found in the urine at the time it is passed, or which may be discovered after allowing it to stand. In these cases of difficult diagnosis the microscope and chemistry generally enable us to decide on the nature of the secretion. Three rules, however, should never be forgotten, rules which are of equal value to the nervous patient and the medical man.

1st. Spermatozoa or traces of them are always to be found in a seminal discharge. To discover the presence of spermatozoa we should desire the patient, as I have already said, to micturate into a long and narrow tube capable of containing an ounce of fluid, and place it for a few minutes in a test-rack. The spermatozoa, in consequence of their greater specific gravity, will, if present, sink to the bottom of the fluid. If there is much saline matter, it may be dissolved by adding plenty of water and letting the mixture stand, when the spermatozoa will sink as before. Donné asserts that the fluid may even be boiled without destroying them. The same author states that he has discovered spermatozoa in urine several days after it has been passed (Loc. cit., p. 315).

2d. The presence of spermatozoa in urine does not conclusively prove the existence of spermatorrhoea, or even of constant seminal discharge. The effort of difficult micturition, or defecation, the fact of the patient having lately had connection, or even of having undergone sexual excitement, is enongh to account for the first subsequent emission of urine containing spermatozoa. A small quantity of semen may have been left in the urethra and pass away with the first stream. It is not then the occasional presence of spermatozoa in the urine, but the habitual escape of semen coupled with general symptoms of debility that constitutes the condition-Spermatorrhoea.

3d. Spermatorrhoea may really exist, though it may be impossible at first to discover spermatozoa in the urine.

Donné gives some interesting particulars of cases of suspected discharge of semen which he has watched for days together without finding any traces of spermatozoa. After several days, perhaps, the discharges all at once were found to contain large quantities of spermatozoa. In one case, during eighteen days the urine