a person's spirits by insulting his understanding. The malady of the nerves is in general of too obstinate a nature to yield to a sarcasm or a sneer. It would scarcely be more preposterous to think of dissipating a dropsy of the chest than a distemper of the mind, by the force of ridicule or rebuke. The hypochondriac may feel, indeed, the edge of satire as keenly as he would that of a sword; but, although its point should penetrate his bosom, it would not be likely to let out from it any portion of that noxious matter by which it is so painfully oppressed. The external expression of his disorder may be checked by the coercive influence of shame or fear; but, in doing this, a similar kind of risk is incurred to what arises from the repelling of a cutaneous eruption, which, although it conceals the outward appearance, seldom fails still more firmly to establish the internal strength, to increase the danger, and to protract the continuance of the disease" (page 7). The immediate consequence of not attending sufficiently to these cases is, that the patients, who are often very sensitive, finding the profession unwilling to sympathize with them, at once resort to the quack fraternity, who humor their delusions at the same time that they fleece them, and have even been known to administer to their dupes depressing medicines so as to retain them still more surely in their power. The only other way in which this infamous trade can be checked is for the newspaper press to refuse to insert the quack advertisements. The more powerful organs have already done so to a certain extent, and with the best effect; and if this refusal were made general the system could be at once put a stop to. The Post Office authorities might assist also by refusing to circulate the pamphlets which these advertising firms now dispatch wholesale to the country, and by this means bring their plans for fleecing their dupes to the notice of every family in the kingdom. Lately this plan has been found to pay best. It is an abuse of the POST OFFICE which we should think need only be brought under the notice of the Postmaster General for an effectual remedy to be applied. The symptoms which patients who suffer from false spermator rhoea complain of are frequently of the most exaggerated description; they have been mentioned in the previous pages, and it is for the medical man to decide whether they are real or assumed. Frequently they partake of both characters; there is a certain proportion of true disease which has been aggravated by fear and ill treatment: and, I believe, as stated elsewhere (p. 69), that determination of the thoughts to a particular organ may superinduce, in a greater or less degree, its functional aberration. Admitting this, great sympathy must be shown to a class of sufferers whom I fear the profession often treat with too little regard to their susceptible feelings. In 1854 a medical student wrote to me from the country, saying that he had been twice cauterized; and he added, “supposing all further measures you may suggest for trial fail, what do you think of the operation of castration as a remedial means?" I wrote in answer, that the operator and operated upon should be both placed in a lunatic asylum, and that I declined prescribing without seeing the patient, experience having taught me the inutility of doing so. This man represents a large class who will undergo any amount of present physical suffering to get rid of the ailment under which they believe they labor; and the probability always is, that these exaggerated accounts of disorders will turn out to be cases such as we are now speaking of—namely, real complaints enormously magnified by a highly irritable temperament. If not judiciously treated, such sufferers will assuredly end their days in asylums. I every now and then see patients who avow that they owe their lives to me, since had it not been for the assistance and sympathy held out to them, they had determined to destroy themselves-so firmly convinced had they become that they were laboring under an incurable malady, the nature of which was apparent to all beholders. It is these victories of science that make up for the disappointments medical men sometimes meet with in this sad department of the profession. From what I occasionally witness, I am convinced that many of the suicides occurring among young men have been caused by the ineffectual treatment of supposed spermatorrhoea, and the fixed idea that no relief can possibly be obtained. If any additional reason can be urged why the profession should take these cases under its more immediate care it is this-the saving from utter destruction the future of a class of men, many of whom have, through the instrumentality of surgical means, been rescued from this unhappy state of mind, and to my certain knowledge have become useful members of society, and are now discharging most important duties in the higher ranks of their several professions. Treatment. The most difficult thing in the management of these cases is to bring the patients to exercise self-control. They have never been taught it early in life, and they have never practised it since they have arrived at adult age; yet without its exercise all our endeavors to obtain convalescence will fail. This self-denial must be mental as well as physical; the sufferers must be impressed with a full determination not to allow themselves to dwell on or think of their complaint. Such self-treatment is indispensable; these moral gymnastics are absolutely necessary, and they may be much assisted by regular bodily exercises and physical exertion, accompanied by a régime such as that described at page 297. Another of the difficulties which the medical man has to meet is that of being unable to persuade the misanthrope to seek cheerful society, and to give up his solitary habits and moping ways. The judicious treatment of a spoilt child must be the type for the surgeon to follow. He must display tact and knowledge of men, for what will succeed with the illiterate will fail with the imaginative and the intellectual, who must be reasoned with and convinced before much can be done with them. Above all things, a favorable prognosis should be given, where not inconsistent with conviction. The power which conscientious self-reliance, founded on a real knowledge of disease, gives a medical practitioner, especially in these cases of incipient mental disease, is remarkably great. The physician's convictions appear to be sympathetically communicated to his patients, and the moral influence thus established, once in full play, materially accelerates the cure. This power of imparting convictions and of controlling the will of the patient, so desired by the young surgeon, is more or less innate, but I believe can be developed by attention and extensive practice; it is frequently favored by the inferior mental acquirements of the patient, who feels comfort in reposing on one whose knowledge and truthfulness he has learnt to respect. Necessary, however, as the moral treatment I have above spoken of may be, it must often be aided by physical exertion, attention to diet, &c. In addition, local stimuli may be often necessary. When the hope can again be indulged that the dreaded impotence may, after all, be only a delusion, these and all other stimulants should be left off. It may be advisable to interdict all sedentary and intellectual employments for the time being, and to recommend the substitution of light literature, open-air exercise and change of scene; and I know of nothing that tends so much to the benefit of a patient as does a walking tour with a knapsack, particularly if he can secure the society of a pleasant companion. It is surprising what even a short trip of this kind will do, when a visit to Switzerland cannot be undertaken. It is by these means that I have been able to effect many a cure for patients whose cases had been considered hopeless. Before closing these remarks on false spermatorrhoea, I am glad to have the opportunity of inserting a letter from the late Sir B. Brodie, sent in reply to one from a patient of this class, who has asked me to print it for the benefit of sufferers. SIR, BROOME PARK, BETCHWORTH, SURRY, Your letter reached me this morning at my country house, where I am staying for my annual vacation. I am sorry that my absence from London has caused some delay in my answering it. The practice that you mention is certainly a very bad one, and, if carried to excess, is often productive of very ill consequences. At the same time it must be owned, that those who have been guilty of it are often led to think that they suffer from it more than they really do, by the obscene and wicked representations of quacks, whose object is to frighten young men and extort money from them. I have little doubt that you are one of the numerous class of persons who are unnecessarily alarmed. Most of the symptoms which you mention are nothing to the pur pose. Many persons besides yourself have pimples on the skin, which are of no consequence, and can have nothing to do with the bad habits to which you refer, though one testicle always hangs lower down than the other. (It would be very inconvenient if it were otherwise.) You cannot have been made impotent. If you were, you could not have nocturnal emissions; to which, by the way, all young men who are not having regular sexual intercourse are more or less liable. You cannot really be very weak, as you walk seven or eight miles daily, and could, if it were necessary (as you say), walk fourteen or sixteen miles. I can perceive, however, that you are very nervous, and I dare say that you have a weak digestion. I advise you first to take the mixture of which I enclose the prescription twice daily; to live on a plain and simple diet, avoiding malt liquors, raw fruit and vegetables; and drinking merely a small quantity of sherry or weak brandy and water. Probably a visit to the sea-side will do you good. It is important that you should keep your mind well occupied. You must not expect to be relieved from nocturnal emissions until you are married. I am, Sir, Your obedient servant, B. C. BRODIE. P. S. The medicine should be taken for three weeks; perhaps longer. |