chronic, one or more blisters over the perinæum will almost always have a happy effect.] Inflammation of the Seminal Vesicles in consequence of Urethral Gonorrhoea. The colliculus seminalis may be described as the startingpoint from which the inflammatory disease of the urethra and of the neck of the bladder attacks the organs that secrete and conduct the semen. It is even more difficult to describe fully the pathological condition of the inflammatory process in the seminal vesicle than that of the prostate. We can only draw certain inferences from appearances found in the cadaver as to the nature of the disease. The experienced physician will be able, on examination with the finger in the rectum, to detect, in pronounced cases, inflammation of the seminal vesicle. The latter is situated on the posterior surface of the bladder, directly behind the prostate, and, when inflamed, will assume the form of an oblong oval, painful and hot swelling, having a doughy feel. The subjective sensations in inflammation of the seminal vesicle differ but little from those in prostatitis. There is but one symptom that belongs exclusively to the disease under consideration, namely, the erections are well-nigh constant, and so painful as to constitute priapism. According to the observations of Lallemand, Gosselin, and Pitha, involuntary seminal emissions occur, attended by burning pains, the semen occasionally being red from an admixture of blood (red pollutions), or yellow from pus. In the intervals between the involuntary emissions, discharges from the urethra containing spermatozoa mixed with blood or pus also take place. A continued fever becomes superadded very early to this local phenomenon. In cases of intense inflammation the seminal vesicle may become transformed into a veritable pus-receptacle, which gradually empties itself into the urethra, or ruptures posteriorly into the rectum. As a result of suppuration, the seminal vesicle may disappear | entirely or become obliterated. If the disease assumes a chronic character, the seminal vesicle may undergo induration, calcification, and ossification. In tuberculous persons the exudation in and around the vesicle may undergo caseous degeneration. The result of grave disease of both seminal vesicles is sexual impotence. There are no special remedies that can be resorted to in the treatment of inflammation of these organs, and those that have been found efficacious in the treatment of prostatitis will, in general, also answer here. Functional Disease of the Seminal Vesicle and of the Testicle. Spermatorrhoea, Seminal Emissions, Pollutio Diurna, The opinion prevails, not only among laymen but also among medical men, that spermatorrhoea is of very frequent occurrence; but, according to our observation, it is quite the reverse. The disease occurs less frequently in consequence of the extension of gonorrhoea than from sexual excesses, onanism, etc. In most of the cases, the morbid condition which is looked upon as spermatorrhoea is really due to a constant discharge from the prostate (prostatorrhea). Through excessive indulgence and unnatural gratification of sexual intercourse the secretory and excretory seminal or gans are kept in a constant state of irritation, gradually producing exhaustion, atrophy and paralysis of the muscular apparatus appertaining to them. The beginning of the disease manifests itself by a rapid discharge of semen whenever the least excitement of the genital organs occurs, the erections, however, being short in duration and incomplete. Gradually the ejaculation of semen takes place even without any erotic thoughts or voluptuous sensations. While at first the emissions only occur at night, perhaps several times in one night (pollutiones nocturnæ), later on they take place even in the waking hours, with the penis perfectly relaxed, without any erotic thoughts—sometimes, indeed, attended by unpleasant feelings. The least psychical excitement, the most insignificant disturbance of the genital organs, indeed the ordinary act of micturition and defecation, are sufficient at times to produce an ejaculation of semen. Under these circumstances this fluid gradually loses its consistency, becomes watery, and resembles an albuminous secretion mixed with viscid mucus; the spermatozoa constantly diminish in numbers. Finally, it is not ejaculated, but oozes out from the urethra. This constant loss of seminal fluid produces a remarkable mental and physi cal exhaustion of the patient. In some cases, marked psychical disturbances, spinal diseases, and paralysis, may gradually supervene. The urine of these patients is generally turbid and cloudy, and has the odor of freshly-ground bone, due to its being mixed with semen. Notwithstanding the great loss of the seminal fluid, some of the patients are said to be capable of procreation; in most cases, however, prolonged spermatorrhoea produces impotence. The treatment of spermatorrhoea is not satisfactory. The efforts of the physician are limited to measures that will prevent all mental and psychical influences which directly or indirectly irritate the genital organs, and which will brace up the drooping spirits of the patient. For the purpose of preventing the seminal emissions the patient should keep cool, live upon a nutritious but unstimulating diet, moderately indulge in light wines, take cool baths and frictions, cold douches to the perinæum, and clysters of cold water, methodical use of the cold-water cure, or sea-baths. Hypochondriac patients should be urged to take exercise, try country air, so as to become invigorated in every possible way. We administer internally, against the frequent emissions: B Lupulini puri, 0·50 [grs. viij]; Sacchar. alba., 2·00 [grs. xxxii]. M. Ft. pil. No. X. S. Two pills to be taken during the day, and one directly before going to bed. Or we prescribe: Carb. ferri sacchar., 2:00 [grs. xxxij]; Camphora, 0.20 [grs iij]; Pulv. secale cor.; Sacchar. alba., ãã 5·00 [iv]. M. Div. in dos. æqualis No. XV. S. Three or four powders to be taken daily. If the erections are incomplete, or premature ejaculation of the semen takes place, iron and quinine will be found bene ficial, and may be prescribed in the following manner: Tr. ferri acet. æther., 2:00 [grs. xxxij]; Tr. cort, china vinos, 50.00 [3jss., Div]. M. S. One teaspoonful to be taken four times daily in sweetened water. We also use the following: M. times. B Extr. quassim, 20.00 [3 ss., Div]; Sulph. ferri puri, 2:00 [grs. xxxij]; Pulv. cort. cinnamom., 2:00 [grs. xxxij]. Ft. pil. No. CXX. S. Ten pills to be taken daily two or three In those cases in which the erections and ejaculations do not take place at all, yet the semen flows constantly, we use: B Acid. phosph. dil.; Sulph. quinine, ãã 2·00 [grs. xxxij]; Camphora, 0.50 [grs. viij]; Ext. cascarilla, q. s. ut fiant pil. pond., 0·15 [grs. ijss.]. S. Four or five pills to be taken three times daily. Bromide of potassium may also be prescribed in these cases. We generally order half of the following mixture, to be taken morning and evening: B Kali bromat., 5·00 [iv]; Aqua destil., 100-00 [3 iij, 3 ijss.]; Syr. cort. aurant., 12:00 [ 3 iij]. M. Locally, we advise the use of the following measures: Wax bougies (sonde à demeure) to be introduced and kept in the urethra, injections of tanno-glycerine into the urethra (0.50 [grs. viij] of tannic acid and 200·00 [3 vj, 3v, Dj] of glycerine), the injection of a weak solution of oil of camphor (1 to 2 grammes [grs. xxiij to xxxij] of camphor to 25 grammes [3 vj, Dij] of olive-oil) into the deeper parts of the urethra through a soft catheter, faradization of the genital organs, and the introduction of a cool steel sound. Little or no benefit is derived from cauterizing the deeper parts of the urethra with nitrate of silver, as recommended by Lallemand, while the danger attending this procedure is considerable. Diseases of the Bladder caused by Urethral Gonorrhea. The bladder, as a rule, only becomes affected, as a result of gonorrhoea, in those cases in which the disease has already involved the prostatic part of the urethra. At the beginning the disease generally attacks the neck of the bladder only; gradually, however, the fundus is also affected. The disease of the neck of the bladder has an acute character, while that of the fundus is chronic. Hence we distinguish an acute and a chronic catarrh of the bladder. Acute catarrh of the bladder manifests itself by evidences of intense hyperæmia and a moderate amount of secretion of mucus, the chronic form by a profuse discharge of catarrhal secretion. So long as the catarrhal disease is limited to the neck of the bladder, the patients complain of frequent desire to urinate and to defecate. If the patient endeavors to relieve himself, he only succeeds, under the most distressing pains, in passing a few drops of concentrated acid or neutral urine. After the last of the urine has been voided, one or more drops of blood as a rule follow. The urine is generally clear; on cooling, however, a sediment forms, which contains desquamated epithelium-cells, mucus, sometimes also blood and pus-corpuscles. The discharge from the urethral mucous membrane is then reduced to a minimum. A digital examination per rectum, in most cases, causes an unbearable pain in the region of the prostate, and the introduction of a catheter is usually impossible, because the neck of the bladder, in consequence of the spasmodic contraction, is impassable. Although febrile phenomena are present in all cases of disease of the neck of the bladder, nevertheless, not all of the patients are compelled to remain in bed; but if the tenesmus increases to a condition of ischuria, violent febrile symptoms, preceded by a severe chill, will ensue. If not relieved promptly, the ischuria may cause rupture of the bladder and uræmia. When properly managed, the acute phenomena will be relieved in from eight to twelve days. The inflammatory affection of the neck of the bladder, however, not infrequently extends to the excretory ducts of the prostate and vasa deferentia. A permanent hyperæmia of the colliculus seminalis remains, and as a result the patient, at each ejaculation, feels as if a hot needle were thrust through his perinæum. Acute cystitis may relapse from the slightest cause, in which case a permanent hypertrophy of the apex of the trigonum Lieutodii (la luette vesicale of Amussat) not infrequently develops, causing difficulties in voiding the urine and ejaculating the semen. |