n^ NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland Gift of The National Center for Homeopathy GROSVENOR LIBRARY FOUNDED BY THE JOINT MUNIFICENCE OF SETH GROSVENOR AND THE CITY Of*'BUFFALO <^H.___——•^J/feA^. M^mm^n^M^&W^^^Si PRESENTED BY Mrs. Peter Erb ^ •v.. A. Ibanrimq Panes Library O* M- 19 <*, ^ ^ •p 2&" ^OaioeO ^ ffi A PRACTICAL TREATISE ON THE SEXUAL DISORDERS OF MEN. BUKK G. CARLETON, M. D., Genito-Urinary Surgeon and Specialist to the Metropolitan Hospital and Polyclinic of the Metropolitan Hospital; Consulting Genito-Urinary Surgeon to the Hahnemann Hospital, etc., New York. NEW YORK: BOERICKE, RUNYON & ERNESTY. COPYRIGHT BY BOERICKE, RUNYON & ERNESTY. 273587 CWL.. PREFACE. The physical and mental manifestations of the sexual dis- orders of men have long been an unfailing source of profit to unscrupulous practitioners and charlatans, who, with their literature and advice, have often caused untold misery and almost irreparable damage. This class of ailments being so frequent and intractable the author believes that a more complete understanding of them with their manifold complications and reflexes will lead to a better appreciation of their gravity. With this view in mind, this little volume is presented to the medical profession. In no variety of illness is careful prescribing so essential as in disorders of the generative organs. In order to more fully cover this important feature in the treatment the last thirty-four pages of this manual are devoted to the sympto- matology and adaptability of the drugs found useful in sexual infirmities. The symptomatic and clinical hints of the rem- edies briefly mentioned in each chapter for special conditions will be found under Chapter XXI. The cause of the failure of the well-chosen remedy to give satisfactory results is often due to the neglect in considering the congenital and pathological conditions present, which re- quire hygienic or surgical treatment before the selected remedy will remove the morbific phenomena. The author is indebted to Doctor R. du Jardin for valued assistance in revising proof. Bukk G. CARI.ETON. 7S Westsoth St., New York, October is, 1898. CONTENTS. Introduction, CHAPTER I. Physiological Consideration.—The Seminal Fluid. — Spermato- genisis.—Vesicular Fluid.—Prostatic Secretions.—Peri-Urethral Fluid.—Erection of the Penis, Ejaculation, etc.,....... 13 CHAPTER II. Prevention of Sexual Disorders,................ 21 CHAPTER III. Acute Seminal Vesiculitis and Ampullitis. — Etiology. — Pa- thology. — Clinical History. — Diagnosis. — Prognosis. — Treat- ment............................ 24 CHAPTER IV. Chronic Seminal Vesiculitis and Ampullitis. — Etiology. — Pa- thology. — Clinical History. — Diagnosis. — Prognosis. -— Treat- ment, ............................ 30 CHAPTER V. Tubercular Seminal Vesiculitis and Ampullitis.—Etiology.—Clinical History.—Diagnosis.—Prognosis.—Treatment,......... 44 CHAPTER VI. Vesicular and Ampullar Anomalies, Cysts, Growths, etc.—Mal- formations.— Injuries.—Treatment. Cystic Disease. — Treat- ment. Concretions.—Treatment. Malignant Growths.— Treat- ment, .................. ......... 47 CHAPTER VII. Prostatic Congestion.—Etiology.—Clinical History.—Prognosis.— Treatment, .".................. • • . . 49 CHAPTER VIII. Acute Prostatitis.—Etiology—Pathological Anatomy.—Clinical His- tory.—Diagnosis.—Prognosis.—Treatment,.......... 51 6 CONTENTS. CHAPTER IX. PAGE. Chronic Catarrhal Prostatitis.—Etiology.—Pathological Anatomy. —Clinical History.—Diagnosis.—Prognosis.—Treatment, ... 55 CHAPTER X. Chronic Catarrhal Inflammation of the Verumontanum and the Prostatic Urethra.—Etiology.—Pathological Anatomy.—Clinical History.—Prognosis.—Treatment.............. 62 CHAPTER XI. Hypertrophy of the Prostate.—Etiology—Pathological Anatomy.— Clinical History—Diagnosis.—Prognosis.—Treatment,..... 66 CHAPTER XII. Tubercular Prostatitis.—Etiology.—Pathological Anatomy.—Clini- cal History.—Diagnosis.—Prognosis.—Treatment, . . . . ' 81 CHAPTER XIII. Malignant Growths, Cysts, Calculi, etc., of the Prostate. Malig- nant Growths.—Etiology.—Clinical History.—Diagnosis.—Prog- nosis.—Treatment. Cysts.— Etiology.— Treatment. Calculi — Etiology.—Clinical History.— Treatment. Polypus.— Prostatic Injuries,......................... 83 CHAPTER XIV. Priapism.—Treatment,..................... 86 CHAPTER XV. Psychical Impotence.—Treatment,............... 88 CHAPTER XVI. Symptomatic Impotence.—Treatment,............. 92 CHAPTER XVII. Organic Impotence....................94 CHAPTER XVIII Derangements of the Sexual Functions of Men.—Etiology.—Clini- cal History, Sexual Erethism, Impotence, Pollutions, Urethral Discharges, i. e., Urethrorrhcea Ex-libidine, Urethral Blenorrha- gia, Prostatorrhcea, Spermatorrhoea, Urethral Tuberculosis, etc., Micturition.—Reflexes.—Prognosis.—Treatment,....... 99 CONTENTS. 7 CHAPTER XIX. PAGE. Psychopathia, Sexualis.— Masturbation.—Treatment.—Sexual Ex- cesses. — Heterosexuality.— Sadism.— Moschism.— Homosexual- ity.—Psychical Hermaphroditism.—Urnings. —Effemination and Viraginity.—Androgyny and Gynandry,........... 117 CHAPTER XX. Sterility.—Oligospermatism.— Oligozoospermatism.—Azoosperma- tism.—Aspermatism.—Misemission...............123 CHAPTER XXI. Therapeutics,.........................126 INTRODUCTION. A careful examination and analytical study of a large num- ber of patients suffering from the various diseases of the prostate, prostatic urethra, seminal vesicles, ampullations of Henel, the testes and spermatic cords, with the numerous associated reflex symptoms, which disappear as recovery pro- gresses, cannot but strengthen the opinion that the great majority of the so-called functional diseases of the sexual organs of man and their accompanying neuroses will be found to be reflexes from a local disease of these parts. If these lesions are recognized and properly treated, many, if not all, of the disorders of sexual function can be relieved and a normal, moral and sexual life re-established. The nervous reflexes and manifestations associated with sexual disorders have been considered in the past to be diseases per se, or arising de ?wvo, it being almost the unani- mous opinion that the cause in general was a diseased con- dition of the brain, aggravated possibly by environment, or communications received through the special senses of sight, hearing, smell and touch. The true causes were, however, generally allowed to pass without attention or treatment, and untold thousands of individuals with bright minds were permitted to degenerate or become total wrecks. It must not, however, be inferred that the author is of the opinion that all mental and moral depravities or physical and financial failures are due to lesions within the sexual sphere, but he is distinctly of the opinion that a large percentage of these conditions arise primarily from morbid impulses which originate from irritation or local disease of these parts. Comparative recent and exhaustive researches have given new light to the anatomy, physiology and diseases of the semi- nal vesicles and the ampullations of the vas deferens. Here- 10 INTRODUCTION. tofore, the seminal vesicles were considered to be receptacles or storehouses for the surplus spermatozoa produced between the ejaculatory acts. While it was known that the mucous membrane lining them secreted # fluid, this was thought to be ouly a lubricant. They were commonly believed to be unim- portant, and thus their true functions and clinical importance as presented in disease were overlooked for want of careful physiological consideration. While agreeing mainly with Fuller in the new anatomy and physiology of the seminal vesicles and the clinical symptoms presented when they are diseased, the author does not think he has given the ampullations, the prostate and prostatic urethra proper credit in the various complex sexual acts, and in their relation to the functional derangements of the male sexual organs and the varied reflex neuroses. The principal causes of derangement of function of the male sexual apparatus are excessive or perverted sexual acts, habitual sensual indulgence and unchaste thoughts, anterior and posterior urethral inflammations of simple or bacterial origin, with their results, and excessive or ill-advised instru- mentation or treatment; tubercular involvement of the prostate or seminal vesicles, which is usually of a haemato- genic origin, though it may be the result of extension from associated organs, and other growths of benign or malignant nature; disease or injury to the central brain mass or the nervous system; general disease, with consequent local effects and malformations. In all animals where there is a continued abnormal irrita- tion of the sexual organs from local congestion or disease, the habit of onanism will probably be found to exist. When the abundant sympathetic nerve supply of the prostate, semi- nal vesicles and ampullations, and the intimate association of the three with the rectum, anus, penis, urethra, bladder, testes, etc., together with the blood supply, and its return circulation, are considered, it is self-evident that all abnormal conditions, irritations, or disease of these parts will cause active or passive hyperaemia of the generative organs. If this hyperaemia is long continued, it causes structural changes in the epithelium aud sub-epithelial tissues of the verumon- INTRODUCTION. II. tanum and the adjacent floor of the prostatic urethra, con- gestion, thickening and hyperaemia' of the seminal vesicles and ampullations, with subsequent irritation of the sympa- thetic nerves and their chain of little brains, not only in the hollow of the sacrum, but elsewhere, which, by reflex action upon the cerebral cortex, produce sensual thoughts and acts. When this complex net-work of nerves is unbalanced by disease, is it any wonder that man, the greatest example of God's handiwork, is transformed into a degenerate? Can a man be expected to develop into a perfect being if his sympa- thetic nerves are constantly irritated ? The physician must go deeper than the surface or superficial history in the treat- ment of these diseases and strike at the cause. This can only be done as he grows more thorough, scientific and practical, and in treating these cases gives more care to the histories, and more study to the reflexes presented. Until this is done the profession will be, to a large degree, accountable for the human wrecks produced by these conditions, not only those who find their way, as paretics, to the insane asylums, but the great host of unsuccessful men without aim or thought in life and deficient in moral courage, as well as those in the less marked cases, classed as eccentric. Frequently disease of the seminal vesicles, the ampulla- tions, the verumontanum or the prostatic urethra, presenting as symptoms nervousness, indecision, mental and physical irritability, want of firmness and self-confidence, lack of confidence in the judgment of others, suspiciousness, with moral, physical and financial failure, are treated as neuras- thenias or general mental and physical decadence, the local sexual disease being neglected or treated only for the indi- vidual symptoms of impotence, priapism, satyriasis, diurnal and nocturnal pollutions, spermatorrhoea, etc., without actual knowledge of the cause of the reflexes which appear in various parts of the body. In the author's opinion, when the conditions which cause unnatural hyperaemia of the several organs can be eradicated, diseases of the prostate, the ampullations and the seminal ves- icles will be of infrequent occurrence, and consequently impo- tence, spermatorrhoea, etc., will be proportionately rare; 12 INTRODUCTION. there will then be no need for lectures to young men on the dangers of masturbation and other unnatural sexual acts, for if men are physically normal, association will not succeed in debasing them. The sexual impulse as rightly sent through the nerve centers by the special senses to the cerebral cortex and the medulla oblongata, and reflected to the genito-spinal or gan- glion of Budge, opposite the fourth lumbar vertebra, and the nervi-eregenetes of Eckhard, included in the first three sacral nerves, and those of Eckhard and Goltz, midway between the brain and genital organs, with their general distribution, would be as nature intended it to be, and perverts would cease to exist. The reason why treatment of this class of ills has failed in the past has been due to the fact that the cause was not recognized. SEXUAL DISORDERS OF MEN. CHAPTER I. PHYSIOLOGICAL CONSIDERATION. The quantity of semen discharged at each complete ejacu- lation varies from a few drops to eight or nine drachms, the latter occurring in the celebrated case reported by Ultzmann. In young men the quantity is usually about two drachms, in the middle-aged from a drachm to a drachm and a half, and in old men a drachm or less. Its quality depends some- what upon the age of the individual, together with his various congenital or acquired defects. The spermatic fluid is of heterogeneous character, opaline or whitish in color, viscid and stringy in consistency, alkaline in reaction, and possesses a peculiar strong odor resembling sawed bone. It is the prod- uct of the combined secretion of the testes, the vas deferens and its ampullations, the seminal vesicles, the prostate, Cow- per's and the peri-urethral glands. Mieocher says, "The spermatic fluid is composed of 82 to 90 per cent, water and the remainder of serum albumin, alkali albuminate, hemi- albuminose, nuclein, lecithin, guanin, hypoxanthin, protomin, fat, cholesterin, inorganic salts, phosphoric and muriatic acids in combination with inorganic salts and organic bases. Microscopically the spermatic fluid presents spermatozoa, seminal bodies, fine seminal granules, epithelial cells from the genital tract, and phosphate crystals, usually of lime or mag- nesia." The spermatozoa in the semen of young and middle-aged men are large and active, but, as age advances, they become 14 SEXUAL DISORDERS OF MEN. relatively less abundant and lively, frequently disappearing entirely by the sixtieth year, though undoubtedly many men continue to be virile even to the ninetieth year or more. All things being equal, the spermatozoa are proportionately less numerous in the spermatic fluid of those who indulge in sexual intercourse at frequent intervals. The number of sperma- tozoa discharged at each ejaculation varies. Lode estimates the number to be about two hundred and twenty-five million, while Guelloit places the average at about four hundred and twelve million five hundred thousand. The spermatic fluid is sometimes red, dark red, brown or brownish yellow in color, caused by the admixture of blood. When it has a yellowish color it is usually from the preseuce of pus. The consistency of the spermatic fluid depends on the relative proportion of its seminal and prostatic component parts, the fluidity depending upon the quantity of prostatic fluid present. Dr. Lecco (Therapeutische Monatshefte, October, 1897) gives the following sensitive microscopic test for spermatic fluid: A drop of semen diluted with sterile water is intro- duced between a microscopic slide and a cover glass, and a drop of a saturated solution of iodine in iodide of potassium allowed to flow under the latter, when a number of remark- ably beautiful crystals, characteristic of spermatic fluid, will form; they are rhomboidal, often occurring in the form of crosses, and present a brownish color. This reaction was, at the same time, independently discovered by Florence. Lecco claims that even after the lapse of several years spots of spermatic fluid are easily recognized by dissolving them with a little water and testing as above. Spermatogenesis.—The testes, by a process called sper- matogenesis, produce the leaping point of life known as the spermatozoa. Taylor describes this process as follows: '' Upon the endothelial basement membrane of the convoluted seminiferous tubules the nucleated parietal cells are seated, the outermost layer of which is composed of sustentacular cells, which are not concerned in producing spermatic elements. Inside and on the foregoing layer are the sper- matogenetic cells, of which the outer ones are the longer or mother cells, and the inner ones the smaller or daughter cells. PHYSIOLOGICAL CONSIDERATION. 15 From the nuclei of the latter cells the spermatoblasts are developed, and from these structures the spermatozoa are directly formed. They are closely packed together, side by side, in a finely granular semi-gelatinous substance. They gradually become elongated and bean-shaped, and finally are elaborated into fully developed spermatozoa." The spermatozoa formed in the convoluted portion of the seminiferous tubules escape by the straight tubes, enter the vasa efferentia of the epididymis, and going through the various and tortuous canal enter the vas deferens, where by their own vibration, assisted by the action of the ciliated columnar epithelium, the rythmical action of the circular muscular fibres in the walls of the vas deferens and the pump- like action of the ampullations of Henel, they pass onward toward their destination. A spermatozoa is composed of a head and tail, and resembles in general contour a tadpole, the upper and lower surfaces of the head being flat and of oval outline, its sides wedge or spear-shaped. The size of the head varies with the general health and the age of the subject. If the spermatozoa be the product of one advanced in years, or of one suffering from depressed vitality, from disease, etc., the head will be found thin and small, but if the product of a young and vigor- ous man the head may be of remarkable size. Ultzmann says, '' They may be hydrocephalic and sometimes double- headed, these anomalies being found among those of normal appearance.'' In this fact may possibly be found the solu- tion of twin pregnancy. The length of the tail varies; all other things being relatively equal, those produced by young men are the longest, the length diminishing as age advances or disease impairs the system. Occasionally they have two \Vtails. If the spermatozoa are dead when discharged, the tails will be curled up; if alive, they will be outstretched or slightly K curved at the end. In the semen of young and middle-aged men there is a varying number of seminal bodies or cells, which are about four times the size of a white blood corpuscle, presenting a granular appearance, and under a high power give evidence of a fibrous structure. Frequently they contain one or many i6 SEXUAL DISORDERS OF MEN. nuclei. In men past fifty, the semen contains seminal gran- ules, which have a yellowish cast and fatty appearance. These granules and cells are the bi-product produced in the breaking up of the protoplasm of the daughter cells during the formation of the spermatozoa. Vesicular and Ampullar Fluid.—This is secreted by the tubular glands situated in the mucous membrane lining the seminal vesicles and the ampullatious, and serves not only to separate the spermatozoa and give them proper individuality, but also, between the periods of ejaculation, to protect, pre- serve and nourish them. In this connection the careful and extensive investigations of Huntington must be taken into consideration. He is of the opinion that the spermatozoa never reach the seminal vesicles and are never stored or nour- ished in these receptacles, except possibly in disease, and that those who have found spermatozoa in the seminal vesicles, when conducting investigations along this line have been deceived by some accidental condition or want of techni- que. If Huntington's investigations are correct, the func- tion of the seminal vesicles is the secretion of a special mucus, which is poured forth in abundance during sexual congress, and by its volume and force carries any and all spermatozoa, which have been expelled from the ampul- lations of Henel into the corresponding ejaculatory duct, with it in its onward course; however, as all investigators agree that the* gross and histological structure of the walls of the seminal vesicles and the ampullations of Henel and the glandular secretions of both are identical, together with the close anatomical association of these parts, from a clinical point of view disputed points become unimportant. The vesicular and ampullar fluid is gelatinous, viscid, without special odor, of a grey or greyish blue cast, of high specific gravity, and is alkaline in reaction. Microscopically it is composed of large globular masses of mucus, of oval or irreg- ular form, granular phosphates, leucocytes and epithelial cells, with a varying number of spermatozoa, and sometimes small masses of a yellow color, composed of mucus, phos- phates and occasionally a few calcareous concretions. Prostatic Fluid.—The prostate has the power to secrete PHYSIOLOGICAL CONSIDERATION. 17 its special fluid in abundance, but possesses no receptacle for the storage of its surplus product. In health, the amount of secretion is very small, except during the period of functional activity, when it is poured out in large quantities. It is a thin, mucous alkaline fluid, with the fragrant odor peculiar to the seminal fluid. Microscopically, prostatic fluid contains cylindrical cells and granular phosphates, which in disease may be very abundant. Peri-Urethral Fluid.—Littre's follicles, the crypts of Morgagni and Cowper's glands produce their contribution to the spermatic fluid, their secretion being discharged into the urethra, anterior to the triangular ligament. This fluid is particularly concerned in keeping the mucous surfaces of the urethra alkaline and neutralizing the effect of the acid urine. It also lubricates the urethra during sexual congress, facili- tating the onward passage of the ejaculated seminal fluid. The secretion furnished by Cowper's glands, at the proper period in the act of copulation, mixes with the thick seminal fluid from the deeper tissues and increases its fluidity. During sexual excitement, the secretion of the glands anterior to the triangular ligament is frequently so abundant that the peri-urethral fluid appears as a drop or even a discharge at the meatus. In long-continued sexual excitement without gratification, the secretion from these glands may be quite profuse, constituting a urethrorrhoea ex libidine. This fluid is alkaline in reaction, clear, viscid, and looks like the albu- minous portion of a fresh egg. Erection, Ejaculation, Etc.—In the act of copulation, the physiological part taken by the male is as follows : The erection of the penis being consummated, either by an impulse generated in the cerebral cortex and conveyed to the sexual organs through the nerve trunks or by tactile influences, or a combination of both, intromission accomplished and the act commenced, the friction of the glans penis upon the vaginal walls produces certain motor and reflex impulses, which in turn cause increased functional activity of the testes, while at the same time the cremaster muscle draws them upwards and retains them at the abdominal ring. During this period testicular fluid is poured out of the coni vasculosi into the i8 SEXUAL DISORDERS OF MEN. vas deferens where the strong circular muscular coat of this canal by a rythmical action conveys it to the ampullations of Henel. The prostatic gland becomes active, and secretes an abundance of fluid, which is poured into the prostatic urethra. This fluid is prevented from flowing back into the bladder by the sphincter vesicae, or forward into the urethra by the cut- off muscle of the membraneous urethra and the rigid penis, which is overdistended with blood. As the act progresses the prostatic fluid, with the overflow from the seminal vesicles and ampullations, accumulates in this closed canal, and in so doing presses upon the hyperaemic erectile tissue composing the verumontanum. The fluid con- tinues to accumulate in the prostatic urethra, until, like a time-lock, the point of irritative tolerance, or pressure upon the montanum masculinum is reached, causing a contraction of the muscular fibres of the prostate which produces an ejacu- lation. The muscular fibres of the prostate pass backwards and upwards and become continous with those forming the muscular coat of the seminal vesicles; the outer or connective tissue layer of the two organs pass over and join intimately with each other; therefore, a contraction of the prostate draws upon the main cavity of the seminal vesicles, and assists in their complete collapse with discharge of the retained sperma- tozoa and the protecting vesicular fluid into the prostatic urethra, where it mixes with that of the prostate and is pro- pelled onward. During this period, the urethral follicles, located along the anterior urethra, secrete a small amount of clear, viscid, alkaline fluid, which lubricates the canal. When the ejaculated spermatic fluid reaches the bulbous por- tion of the urethra the perineal muscles, by their contraction, propel it onwards and, at the same time, press out the fluid in Cowper's glands and mix it with that from the deeper parts. When there is an obstruction in the anterior portion of the urethra, the seminal fluid may be discharged backwards into the bladder, causing a mis-emission and sterility. When, in the consummation of an emission, the seminal vesicles contract, the central cavity only is emptied, the reason being that the little chambers or sacs situated upon PHYSIOLOGICAL CONSIDERATION. 19 the sides of the vesicles are connected by short canals which enter the central cavity at an acute angle directed from above downward and forward and are completely closed to exit or entrance during the contraction of the vesicular walls. The opening of the ampulla of Henel, or clubbed end of the vas deferens, is also closed and its exit barred by the same act and for the same reasons. The contraction is followed by relaxa- tion of the vesicular walls. When relaxed, the cavity pro- duces a suction and the fluid in the distended sacculations in the vesicular walls finding less resistance soon empties itself into the main cavity, together with the fluid in the distended ampulla, the muscular coats of which now contract and press its contents into the seminal vesicles. Hence, in the second copulation, a profuse seminal discharge, containing all of the component elements and about equal to the first, is ejaculated. If a third act is at once indulged in, the discharge will be largely if not entirely composed of prostatic fluid, and the generative apparatus will be correspondingly congested and impaired. The lower expanded end of the vas deferens, called the ampulla of Henel, does not communicate directly with the ejaculatory duct, but opens into the seminal vesicle, and, while its mucous membrane secretes a fluid that lubricates and to a certain extent preserves the spermatozoa, the principal object of the ampulla'is to act as a pump to assist the spermatozoa in their transit from the testicle to the seminal vesicles. When it becomes filled its muscular walls contract and force its contents into the seminal vesicles, and forming a vacuum as its muscular walls relax, it facilitates the onward progress of the spermatozoa by its suction-like action, the com- munication between the clubbed end of the vas deferens and the seminal vesicles being arranged in such a manner that, while fluids can be forced into the seminal vesicles, the acute angle of the opening prevents a return flow. Accord- ing to the physiology and anatomy taught by Huntington and Taylor the ampullae open into the ejaculatory ducts. Taylor says : '' With the advent of the erotic impression and consequent erection there is increased functional testicular activity, semen being discharged from the coni vasculosi of 20 SEXUAL DISORDERS OF MEN. the epididymis into the vasa deferens. By strong and rythmi- cal muscular action it is thence carried upwards to the am- pullations of Henel, causing their over-distension, and the point of tolerance being reached at the verumontanum, the ampullations contract simultaneously with the seminal vesi- cles and expel their contents into the ejaculatory duct where the abundant fluid is sweeping onward." CHAPTER II. PREVENTION OF SEXUAL DISORDERS. This must commence at birth and continue during life, by giving proper attention, not only to the care of the morals, with protection from improper association, but also to careful, scientific and hygienic treatment of the genital organs. Too much attention cannot be paid to the removal of con- genital defects, however slight, for if Nature's laws are vio- lated her penalties will always be exacted. It is the duty of every physician attending the birth of male children to carefully examine the genito-urinary organs, to strip back the prepuce, thoroughly expose the glans, the corona and sulcus behind it, and break up adhesions; if smegma is found behind the glans, or if at a future time evidence of its presence appears, it should be removed and measures taken to keep the parts clean. At the same time unnecessary handling must be avoided. When the prepuce is abnormally long, or becomes so after stripping it back, or the preputial opening is narrow, the child should be properly circumcised. The meatus urinarius must receive attention, and if there is evidence of over-coarctation of the mucous membrane at this point, suffi- cient to obstruct the urinary stream, it must be properly in- cised, not indiscriminately,but with care and judgment, to pre- vent early irritation of the parts, which leads to self-handling, orgasms, nervous derangements and, especially, early prostatic hypersemia. Later in life if abnormal sexual impulses exist or appear, the urethra should be carefully examined for con- genital or acquired stricture and other defects or disease. Congenital strictures are usually located at the meatus or in the pendulous portion of the urethra. In many cases of dis- orders of sexual function, even when of slight degree, relief can only be obtained after a corrective internal urethrotomy. 22 SEXUAL DISORDERS OF MEN. A normal condition cannot be established until abnormal conditions have been removed. These conditions are the essential factors in the causation of masturbation and many of the sexual disorders. When bad habits have been practiced, and, owing to proper advice or from fear of the results, have been discontinued, unless, at the same time, the irritating cause is removed, the mind will continue to dwell upon lasciv- ious desires and keep up the same chronic congestion of the sexual organs, which, at a later period of life, will produce imperfect sexual power, etc. The promiscuous association of sexes is to be avoided. The intense strain, testicular, pro- static and vesicular of the unsatisfied desire, etc., which results from the close association frequently allowed among the young and unmarried, or practiced by the so-called sexual triflers, is often the cause of future sexual derangements, ill- health and unhappiness. This occurs while the person, in blissful ignorance, believes that no harm has been done as no commandments have been broken. The too frequent advice given to the young or older unmarried men that for their health they should practice prostitution is to be condemned; they might as well be advised to practice self-pollution or in- dulge constantly in sensual thoughts. The excessive co- habitation indulged in by many married and unmarried men is a very fruitful source of future weakness. Whenever the sexual act is repeated more than twice within a few hours, the strain upon the empty seminal vesicles and the prostate produces congestion if nothing more; and, if frequently re- peated, may result in serious local disease. It may be added, that the perverted sexual habits of married men, who for some reason do not desire the greatest of God's gifts—the family— are still more harmful. Conjugal onanism, the use of a cun- drum, or the practice advocated by the founder of the Oneida Community, all have practically the same effect. A chaste mind and body are perfectly consistent with health. If abnormal irritations cause lust, remove the condition, but do not pander to it. If there is a urethritis, do not dismiss the patient until the urine is free from epithelial and other shreds. When stricture, congenital or acquired, is present, give it the proper treatment, and if there is stone in the PREVENTION OF SEXUAL DISORDERS. 23 bladder remove it. If the saddle on the wheel they ride be improperly constructed or adjusted, and it cannot be changed, have them discontinue riding. If the urine is over-acid, alka- line or irritating, give it the proper attention, etc. CHAPTER III. ACUTE SEMINAL VESICULITIS AND AMPULLITIS. Etiology.—The most common predisposing cause is acute urethritis, which may be either of the bacterial, toxic, trau- matic, chemical or specific variety. It is most frequently produced by the-extension backwards of an acute or, pos- sibly, a chronic gonorrhoeal urethritis. In acute urethritis the continued ingestion of fluids containing alcohol, the in- dulgence in excessive muscular exercise, bicycling, long rail- road, carriage or horseback rides, standing, walking, and, especially, the various forms of sexual acts—coitus, masturba- tion, or sexual excitement of any kind—may precipitate the advent of this disease. In those predisposed, instrumentation or local treatment of the prostatic urethra may occasion it, even when conducted with the utmost care and for justifiable reasons. Rectal examination or massage of the seminal vesi- cles when diseased is not free from danger, and surgi- cal operations or traumatism in their vicinity may also create it. The acute tubercular variety may be caused by haematogenic infection, or by extension from neighboring organs, etc. Pathology.—One or both vesicles may be simultaneously involved. This disease is dependent upon germ invasion, either by extension from neighboring parts or from systemic involvement. The most extensive pathological changes are found in those cases originating from an acute or latent gonor- rhoea, the tubercular being less severe and usually moderate in intensity. The walls of the seminal vesicles present the usual evidences of inflammation, though, in many cases, the exudation extends into the surrounding peri-vesicular tissue. It may even involve the neighboring peritoneum, producing ACUTE SEMINAL VESICULITIS AND AMPULLITIS. 25 a localized pelvic or general peritonitis. The sac is often dis- tended and filled with purulent matter, which may possibly contain gonococci or tubercular bacilli. The mucous mem- brane lining the vesicle presents a simple congested appear- ance, or, if the purulent matter in the sac is considerable in amount, it may be inflamed and ulcerated. The sac may rup- ture and discharge into the bladder, the rectum, or both, pro- ducing a vesico-rectal fistula, or into the peritoneum, causing a general or localized purulent peritonitis. When the prostate is involved, it is extremely difficult sometimes to decide whether the original lesion commenced in the seminal vesicles, ampullae or the prostate, or whether they were infected simultaneously. In abscesses in the male pelvis, with pyaemia and death, it may be impossible to differentiate those originating in these organs from those arising in the peri-vesicular tissues. Clinical History.—There are all grades of severity, from one so transitory and unimportant that it passes unnoticed to one in which the symptoms are distressing and serious. The disease may develop gradually, but often, after some of its well- known exciting causes, the advent is abrupt. In the gon- orrhoeal variety it is generally associated with an epididymitis, an epididymo-orchitis, a deferentitis or an acute prostatitis. Pain referred to the sacrum or supra-pubic region of the affected side is common; it may be burning, lancinating or excruciating in character and extend upward and backward to the kidney, down the spermatic cord to the testicle, or down the thighs into the perineum and rectum. During the paroxysm, the testicles are frequently drawn up by contraction of the cremaster muscles. The corresponding supra-pubic region is tender to manipulation, and palpation may cause severe pain; sometimes when the inflammation is intense and the exudation extensive, the inflamed mass can be distin- guished by deep palpation over this region. The inflamed vesicle or ampulla can usually be distinguished by a rectal examination, the diseased tissues being frequently extremely sensitive to the touch. The amount of tumefaction varies with the degree of inflammation. If the disease is confined to one side, the seminal vesicle or ampulla may feel like a small sausage extending up and beyond the reach of the 3 26 SEXUAL DISORDERS OF MEN. finger; only about one-half or two-thirds of the seminal vesicle, however, can be digitally reached and examined through the rectum. When the peri-vesicular tissue is in- volved the cysto-rectal space will be thickened, tumefied and very sensitive. The swollen mass may feel doughy, or even give some degree of fluctuation. If pressure is applied by the tip of the finger some of the fluid contents will be discharged into the urethra; it may be quite profuse, a drachm and some- times even more appearing at the meatus. When the pres- sure is removed the tumor will not fully round out. The prostate is usually swollen and sensitive, especially over the median line along the situation of the inflamed ejaculatory duct. The pain and uneasiness in the seminal vesicle or ampulla is increased by over-distension of the rectum, by fecal matter or gas, and their removal is followed by relief. In many cases the inflamed vesicle or ampulla and sur- rounding tissues press upon the rectum producing a continu- ous desire to evacuate the bowels. If this desire for stool is encouraged, the straining, etc., will greatly augment the sufferings of the patient. In the early stage, persistent erections with noctural emis- sions are frequent, the ejaculated fluid being usually mixed with pus; occasionally, with a little blood. As the inflam- matory condition becomes more pronounced, the carnal de- sire become less distressing, but emissions are usually accom- panied by pain, which often continues for hours. Mictu- rition is increased in frequency, and is accompanied by pain referred to the neck of the bladder or the fossa navicularis. It may extend along the whole length of the urethra. The urine is occasionally retained, or discharged in a small stream with great difficulty, owing to a prostatic or. muscular spasm, or an associated acute prostatitis. The urine at first is clear and free from shreds, pus, etc. When, however, the acute seminal vesiculitis or ampullitis develops as a sequela of an acute urethritis, the urethral discharge, as iu epididymitis, generally ceases; but, as the pain, fever, etc., disappear and the organ becomes able to discharge itself, the urine again be- comes cloudy and the urethral discharge returns. The degree of fever, with its thirst, general erethism, restlessness, head- ACUTE SEMINAL VESICULITIS AND AMPULLITIS. 27 ache, vomiting, etc., varies with the intensity of the local disease. In one of the author's cases the temperature for two days remained at 1050 Fahr. This, however, is uncommon, the temperature usually ranging from ioo° to 1030 Fahr. The fever, pain, etc., ordinarily subside by the fourteenth day. In the acute tubercular variety the range of tempera- ture is lower and the pathological lesion is generally bilateral. Diagnosis.—In the more severe cases the patient, when in bed, assumes a characteristic position, reclining on the back with the thigh of the corresponding side drawn up to relieve the pressure of the abdominal muscles. The disease must be differentiated from acute posterior urethritis, acute prosta- titis, urethro-cystitis, cystitis, pyelitis, renal colic, acute appendicitis, acute proctitis, etc. Acute seminal vesiculitis may be associated with these conditions, as well as epididy- mitis and deferentitis. As an associated lesion, it is fre- quently overlooked, but if a rectal examination is made, the condition of the seminal vesicles and ampullatious will give physical evidence of their association in the diseased con- dition. Prognosis.—When seen early, even in the most severe form, a favorable prognosis can be given, if the patient will go to bed and avoid over-exertion. The disease, with its fever and pain, from over-distension of the vesicles, may advance for two weeks before resolution commences; the fever and pain will then cease and the seminal vesicles will discharge their surplus fluid, and any antecedent urethral discharge will be re-established. Treatment—Rest in bed is of the utmost importance, and if neglected the course of the disease will be proportionately more painful and protracted. During the first two weeks of the severe cases it is especially important that the patient should remain in bed, keeping on the back with the head low, and, in some cases, it is even well to have the extremities slightly elevated. In all cases, whether the testicles are involved in the dis- eased condition or not, the scrotum must be properly sus- pended to relieve tension on the vas deferens. This may be accomplished by a broad piece of surgeon's adhesive plaster 28 SEXUAL DISORDERS OF MEN. six inches wide and of sufficient length to reach from thigh to thigh and fit in quite closely against the perineum, its upper surface being covered with rubber tissue, thus forming a table of support for the scrotum, or, still better, by Fuller's method, described in the "Journal of Cutaneous and Genito-Urinary Diseases," February, 1895. This is accomplished by means of a band of muslin adjusted with safety pins as follows: " A broad waist-band is first firmly applied, then a broad sling is passed under the perineum and scrotum, to hold it up in the supra-pubic position, allowing the penis to lie naturally on the hypogastric region. To prevent the scrotum slipping back, strips of muslin are attached to the middle of the sling posteriorly and carried backwards and pinned or tied to the waistband, and, to guard against the testicles slipping over the rim of the loop, a strip of muslin is pinned across the front," or the testicle may be supported by a pillow or suitable roll of cotton pressed up well against the perineum between the thighs. The ideal support for the testes, which has been successfully used for many months in the genito-urinary ward at the Metropolitan Hospital, is a semi-natural suspensory and is applied as follows : The testes are pressed up into and against the external abdominal ring, the scrotal tissues well extended and the testes retained in this position by a few turns around the scrotum of an elastic adhesive bandage, one and a half inches wide and eight inches long, this reliev- ing all possible tension on the vas deferens, and at the same time allowing the lower part of the scrotum to be exposed for observation in case the circulation is interfered with. Poultices of flax seed and tobacco, 16 to 1, or a number of layers of cotton-wool, moistened with a hot boric acid solu- tion, or one of calendula or hamamelis, a tablespoonful of the tincture to the pint of hot water, applied over the correspond ing side of the hypogastic and iliac regions covered with flannel and oil silk, and changed as often as required, give great comfort and relief. This variety of local treatment must, however, be discontinued as soon as the pain stops or the discharge appears, with other signs of the subsiding of the inflammation. Sometimes cold applications act well. The bowels must be moved daily, a mild aperient being at ACUTE SEMINAL VESICULITIS AND AMPULLITIS. 29 times required, but a violent one must never be administered. Rectal enemas of hot water, containing a teaspoonful of glyc- erine to the pint, or glycerine suppositories may act satis- factorily. When administering an enema, a long, soft, rectal tube should be used to carry the enema well up into the sigmoid flexure. The intense pain and loss of sleep may necessitate the use of morphia and atropine suppositories and possibly hypodermics of morphia. The food must be light, milk being the classical diet, to which may be added the usual light nourishment allowed in other inflammatory conditions. Pure waters of all kinds, in moderation, will be of benefit. In some of the more severe cases it is advisable to incise or resect the diseased mass and drain the purulent sac through the perineum, or to aspirate and inject the cavity with a 10 per cent, emulsion of iodoform. The remedies most frequently indicated during the acute period are Aconite nap., Aloes soc, Arnica mont., Bella- donna, Bryonia alb., Cubeba, Ferrum phos., Gelsemium, Kali brom., Pulsatilla nig., Veratrum vir., etc., and, during the convalescent period, Hekla lava, Hepar sulph. c, Lith- ium, Mercurius, Phytolacca dec, Selenium, Sulphur, etc. CHAPTER IV. CHRONIC SEMINAL VESICULITIS AND AMPULLITIS. Etiology.—Perverted sexual habits are undoubtedly the most frequent causes of this disease, masturbation taking the first rank, especially when practiced to excess by the grow- ing boy. It is often occasioned by the unnatural sexual acts indulged in by libertines to produce great and prolonged gratification, or to stimulate an orgasm when erections are imperfect or impossible, as well as by excessive intercourse, or cohabitation, when the wife considers it a nuisance, to be allowed only at stated intervals, without a semblance of reci- procity and sometimes with the coldness of a stone. The practice of conjugal onanism, and, to prevent conception or to conciliate the wife, the use of a condrum has a potent in- fluence in the production of this disease. It is prevalent in the unmarried, who, from fear of contagion, the consequences, lack of opportunity or for moral reasons, while living a life of continence, encourage a state of constant irritation and con- gestion in their sexual organs. The same conditions are often operative in recent widowerhood, and in those particularly who play the part of triflers, taking great liberties with mem- bers of the female sex, but never consummating the act. In fact anything, be it action or thought, which causes in- tense strain or hyperaemia of the sexual organs, if protracted and repeated at frequent intervals, may be considered a cause of this disease. Improperly treated acute seminal vesiculitis frequently terminates in the chronic variety. Often it is caused by the extension backwards of an old urethritis which does not reveal itself until years after the original invasion, hav- ing lain dormant in the prostatic urethra or elsewhere, then, after some deep urethral or bladder douche, instrumentation, 3o CHRONIC SEMINAL VESICULITIS AND AMPULLITIS. 31 excessive sexual act, etc., it becomes aroused, and, by con- tinuity of tissue, travels up the ejaculatory duct to the semi- nal vesicles or ampullations. Congenital or acquired strict- ure of the urethra may cause chronic congestion or posterior urethritis, which by extension may also involve the seminal vesicles and ampullations. The reflex irritation excited by a long or contracted foreskin, haemorrhoids, fissures, strict- ures of the rectum, etc., occasionally cause seminal vesiculitis and ampullitis. Local conditions are not the only cause of this disease, for anything which lowers the general tone of the system may, by weakening the contractile power of these organs, interfere with their complete collapse and allow them to become over-distended and diseased. When the cen- tral nerve or the trunks connected with these parts are in any way injured or diseased, a seminal vesiculitis or ampullitis may result. Pathology.—The walls of the seminal vesicles and ampullae may be greatly thickened and infiltrated, the inflammatory deposit occurring principally in the sub-mucous cellular tissue, and, to some extent, between the fibres of the muscular coats. In well-marked cases there is considerable infiltration and swelling of the peri-vascular tissue in the vesico-rectal space. The muscular layer may become hypertrophied. In these conditions the cavity is usually contracted, though not infre- quently it is dilated. In cases in which the vesicular walls are greatly thinned the cavity is proportionately dilated. In either case the inflammatory changes in the walls greatly interfere with the normal elasticity and function of the organs. The inflammatory changes in the mucous membrane are simi- lar to those occurring in inflammations of similar mucous sur- faces, and the amount of purulent matter present depends upon the severity of the inflammation. The blood vessels are thinned and tortuous, and upon slight provocation rupture, imparting a red or bloody color to the seminal fluid. When blood from any reason has remained in the cavity of the vesicles for some time, the contained fluid may become quite black. If pus predominates the fluid will be of a yellow or yellowish green color, or it may assume a blue shade, due to the presence of indigo. The condition of the mucous mem- 32 SEXUAL DISORDERS OF MEN. brane also influences the character of the vesicular fluid. When the seminal vesicles and ampullae are congested, the vesicular fluid becomes thick, gelatinous and more diffi- cult to expel through the ejaculatory ducts. When the fluid remains alkaline it will contain more or less symplexions, i. e., small highly refractive amylaceous particles, somewhat resembling starch granules. These are never present in the semen of boys or in fresh, healthy specimens, nor when the pathological process is well advanced. Symplexions are fre- quently found in the grey, sticky mucous discharge from the urethra, so common in this disease; they are also found mixed with shreds and other material in the urine, and cause the thickening of the vesicular fluid and over-distension of the seminal sacs in the lighter grades of inflammation. Symp- lexions are frequently observed in the small globular masses and in the stringy shreds one-fourth to one inch in length, about the size of the ejaculatory ducts, and slightly protected by a mucous coating, which are voided in the urine by the patient. The vesicular fluid may contain bacilli coli corn- muni, etc., but the alkaline condition of this fluid inhibits the growth and causes the death of the gonococci, which may have been the exciting cause. Gonococci are, however, fre- quently present in the urine, being brought down from co- existing disease in the prostatic urethra. Occasionally the inflammatory exudation breaks down and small abscess cavities form, which may remain isolated, be ab- sorbed or by burrowing and amalgamating form large abscesses and open into the neighboring organs causing fistulae, etc. Clinical History.—-The disease may commence insidu- ously or it may be the sequela of an acute inflammation. When an acute vesiculitis or ampullitis has existed for eight weeks it may be considered chronic, though the clinical aspect of the case will vary greatly with the severity and duration of the disease. The inflammatory symptoms, which are promi- nent in acute seminal vesiculitis and ampullitis, are rarely present in the chronic conditions, fever being uncommon unless excited by bacterial infection from accidental or surgi- cal traumatism. Pain of moderate intensity is not uncom- CHRONIC SEMINAL VESICULITIS AND AMPULLITIS. 33 mon; it may be located in the supra-pubic region of the affected side, in the bladder, at the root of the penis in, the glans, the scrotum, perineum, or sacrum. It is aggravated by sexual congress, or excitement without gratification. Sometimes it is agonizing and may continue for hours or days. This is called spermatic colic. In one of the author's cases, the pain after coitus was so intense that the patient was obliged to walk the floor for relief, with a pale face covered with cold sweat, and, on a few occasions, the agony was so great that it caused fainting. The perineal region is often so sensitive to touch that soft seats must be avoided and hard ones selected so the tuberischii will take the weight of the body, or a ring air cushion may be necessary for comfort. Micturition is usually increased in frequency, especially during the day; often it is painful and burning in character. This pain may extend along the whole length of the canal; it may be referred to the fossa navicularis or "the neck of the bladder; sometimes it is most severe at the end of the act. It is generally increased after excessive coitus or sexual ex- citement. In aggravated cases the urethral pain may even cause urinary incontinence, and may, by reflex spasm, produce retention. The urine is frequently phosphatic in character and often contains quantities of oxalate of lime, derived from the associated chronic prostatitis, which may irritate and congest the urethra. The urine voided may from the ad- mixture of seminal fluid be albuminous; when present it is most marked in the morning. Otherwise, the urine may be healthy and free from all evidences of Bright's disease. In disease of the seminal vesicles, the bacilli coli com- muni sometimes appear in the urine, having entered the vesicle, either through lymphatic connection, or directly through the tissues, discharging themselves through the ejaculatory duct into the prostatic urethra, directly into the bladder through its walls, or by means of an undis- covered sinus. In seminal vesiculitis or ampullitis, if the urine is examined when voided, it will contain numerous long, viscid strings composed of symplexions, seminal fluid, spermatazoa, epithelia, etc., or rounded masses of the same microscopic nature. In a certain proportion of these cases 34 SEXUAL DISORDERS X)F MEN. the meatus urinarius is bathed with a sticky discharge, at times causing agglutination, or it may be quite profuse, and especially noticeable after a constipated or diarrhoeic stool. Microscopically, this fluid is composed of symplexions, dead and living spermatazoa, leucocytes, etc. Before careful minute examinations were made, many attributed this dis- charge to an old gonorrhoea, the improper use of sounds, a urethral douche, etc. A careful investigation often re- veals a clinical history of vesiculitis and ampullitis which have existed for a long period previous to the gonorrhoea or instrumentation. In the majority of cases of chronic seminal vesiculitis or ampullitis, when a urethral discharge forms a part of the history, the patients are virgin to gon- orrhoea, but a gonorrhoeal infection may rekindle and aggra- vate an old vesiculitis or ampullitis. This urethral discharge is occasioned not only by the vesiculitis and ampullitis pro- ducing overdistention of the cavities by the products of catar- rhal inflammation and consequent incontinence, but also by the patulous and relaxed condition of the ejaculatory ducts, the result of associated inflammatory changes in their walls. These pathological conditions explain the reason of the discharge as it appears continuously, increased at stool, when urinating or during muscular efforts. This urethral dis- charge is also increased by sexual excitement, by the presence of a sensuous women, or of certain women; sometimes by a woman's photograph. In the early period of this disease there is often great and prolonged sexual excitement, with carnal desire and continued priapism, gratification giving no relief; coitus may be very un- satisfactory. In others, the lascivious desire is so great and annoying that the inclination to self-abuse cannot be with- stood, while in the less severe forms, the desire and erections amount merely to a little increased erethism. Chronic seminal vesiculitis and ampullitis develop slowly, consequently the early manifestations in those who are married are often overlooked until a rapidly diminishing power of erection with loss of sexual desire is noticed and that coitus affords little or no gratification; emissions are incomplete and occur too early, complete impotence finally CHRONIC SEMINAL VESICULITIS AND AMPULLITIS. 35 resulting. Pathological nocturnal emissions are frequent, i. t more frequent, but as the genital organs regain their healthy tone, they cease or become normal. Patients should be informed of this probable condition or they will, in their morbid state, think they are growing worse. Under no circumstances should fornication be allowed or ad- vised, as it is injurious, will do no good, and may make the treatment unsuccessful. In the author's opinion, in the ma- jority of cases, the physician might as well advise masturba- tion. The indicated remedy must be carefully selected to cover not only the local but the general symptoms. In this part of the treatment we have a great advantage over Old School phy- sicians. Fuller and Lydstone who have given this subject very careful consideration, affirm, that after the cure of a local disease, symptoms frequently remain for months or years. These same symptoms are frequently quickly removed by the indicated remedy. Cod liver oil acts very kindly. Hemaboloids, by building up the system and increasing the number of red blood cor- puscles, are beneficial. Hypophosphites are very useful. In many cases of hyperaemia or catarrh of the posterior urethra, as well as in all cases complicated by cystitis, the bladder douche, as advised in chronic seminal vesiculitis, is to be recommended. Deep urethral douches, applied either by the hydrostatic method of Valentine, or with the Janet anti- septic vesical syringe, or a fountain syringe to which is at- tached a soft rubber catheter of proper size and length are useful. A few ounces to a pint of the hot selected solution, as recommended in bladder lavage, every one to four days as in- H4 SEXUAL DISORDERS OF MEN. dicated, may be used to advantage. Sometimes instillations act best when applied through a soft rubber catheter cut 8 ** inches in length, so that the eye of the catheter when fully intro- duced will be located in the centre of the prostatic urethra; when, with a Taylor's minim syringe, from ten to sixty minims of the appropriate solution can be introduced and ap- plied without injury or special pain, the compressor urethrae muscle preventing the solution from passing forward into the urethra and facilitating the backward flow of the surplus into the bladder. The Keyes-Ultzman syringe should be used for the strong instillations, and the bladder should be partly full at the time of instillation to properly dilute the solution before its exit through the urethra. If the neck of the bladder or prostatic urethra requires local treatment with the weaker solution, the bladder should be emptied before the ap- plication. The stronger solutions which give excellent results are Nitrate of Silver, i to 10 per cent., Cuprum Sulphate, 10 per cent., or Tinct. of Iodine, Carbolic Acid and Boro-glycer- ide equal parts. When using the stronger solutions, commence with a solution one-tenth the strength of the one to be finally used, and, at the first seance, apply only ten minims, gradu- ally increasing a tenth at each sitting, and repeat every fourth day until the strength desired is reached or satisfactory results have been produced. The weaker solutions should always be placed in the pos- terior urethra, and allowed to flow back into the bladder and voided per urethra, thus giving a double application. In the anterior urethra, strong applications should be made through the electric urethroscope; the weaker urethral irrigations of Nitrate of Silver, i to 2,000 to 8,000, Permanganate of Potash, 1 to 1,000 to 10,000, Permanganate of Zinc, 1 to 3,000 to 10,000, Bichloride of Mercury 1 to 10,000, Sulpho-carbolate of Zinc 1 to 1,000 to 3,000, Carbolic Acid 1 to 100 to 500, can be used with the hand syringe or by the hydrostatic method of Valentine and Janet. The efficacy of all urethral irrigations is greatly increased by heat, and they should therefore be used as warm as is agreeable to the patient. When Nitrate of Silver solution causes too much reaction, the pain can be relieved by a supplementary douche of Sodium DERANGEMENTS OF THE SEXUAL FUNCTIONS OF MEN. II5 Chloride. If urethral instillations cause too great reaction they must be discontinued, reduced in strength, or be preceded by a solution of cocaine. All instrumentation must be performed under strict asepsis. Instruments must be annointed to facilitate their introduction with lubri-chondrin, boro-glyceride, 33 percent., sterilized white vaseline or albolene. When the hyperaesthesia in the posterior urethra, with or without impotence, continues, the urethral psychophore, with cold water at 40 to 500 F., applied for five or ten minutes, every one to three days, is very bene- ficial, especially when the urethral discharge is free from pus. In anaesthetic impotence, with loss of tone of the parts, hot water, at 105 to 110° F., acts very kindly. A psychophore of sufficient size to fill the urethra should be selected, and so placed that its three distal inches come in exact relation with the local lesion, the remaining portion of the instrument not transmitting heat or cold. The warm or cold full-sized conical steel sound introduced every fifth day, by its massage effect, relieves hyperaemia of the urethra, and its pressure from within acts kindly upon all the lobules of the prostate which are in a state of catarrhal inflammation. If proper care, however, is not observed in in- troducing the sound, particularly early in the treatment, or it is allowed to remain in the urethral canal too long (five to ten minutes as advised by some authorities), many unpleasant results may occur. Strictured conditions of the urethra may necessitate mea- totomy, internal or external urethrotomy, gradual dilatation or a possible division by Fort's linear electrolysis. A diseased condition of the prostatic urethra may require the prostatic dilator to mechanically open and empty the fol- licles of the prostate, as the prostatic urethra cannot be com- pletely distended with a steel sound which the remaining portion of the canal admits. When this is necessary the author's prostatic dilator will be satisfactory, but if it is de- sired to dilate the bulbous urethra simultaneously, the Koll- mann's antero-posterior dilator will be required. The pros- tatic urethra can frequently be dilated to a 36 to 42 F. to great advantage. Prostatic dilatation should always be preceded by n6 SEXUAL DISORDERS OF MEN. urethral irrigation, and be followed by a proper bladder douche or urethral instillation. It should not be repeated more frequently than once in ten days. Hot or cold rectal injections of a full quart of a weak Sodium Chloride solution about TV per cent., thrown against the prostate and seminal vesicles once daily may be of benefit, but in chronic cases the rectal psychophore or Kemp's prostatic cooler, will be found more convenient and will give equally satisfactory results. In acute cases, hot water should be used. The rectal bag of hot or cold water as indi- cated, applied from ten to twenty minutes every second day, is often very beneficial. Rectal suppositories containing a grain of icthyol introduced at bedtime, often cause rapid absorption of inflammatory ma- terial in the prostate and peri-prostatic tissues. Massage of the prostate is of the utmost importance. It can be given advantageously once a week. Electricity often gives satis- factory results. Faradism can be used to advantage with the brush applied to the genitalia, or with King's rectal electrode. It invigorates the muscles of the genital organs and perineum. When using the galvanic current, the positive pole must be applied to the lumbar or sacral region and the negative to the parts by means of the electrode or a conical steel sound. In the hyperaemic urethra the ordinary steel sound is the best elec- trode. A current of one or two milliamperes may be given, but should not be continued for more than one or two minutes. As the general urethral condition is relieved, and the hyperaes- thesia becomes localized or confined to the prostatic urethra, or the openings of the ejaculatory ducts, the Newman sound will be required. With this, three milliamperes can be given. Gal- vanism by means of King's rectal electrode, as advised in chronic seminal vesiculitis, is frequently required. In some cases, local treatment irritates and aggravates the condition; here the indicated remedy and general hygiene must be de- pended upon. The various methods of local treatment can be used separately or together. Every case, however, must be carefully studied and individualized and surgical relief given when required. Careless or routine medication almost invari- ably results in failure. CHAPTER XIX. PSYCHOPATHIA SEXUALIS. The various forms of sexual perversion may be described under the following headings: Masturbation, Priapism, Satyriasis, Sexual Excesses and Impotence, together with Sexual Paraesthesia, this form being divided into Hetero- sexual and Homosexual perversions. Masturbation.—The etiology has already been discussed in the introductory and in the chapter on functional sexual diseases. In the opinion of the author, the mental and physi- cal conditions caused by this habit have been greatly exag- gerated. He believes that a great injustice has been done boys collectively by the claim that it is universal and is practiced to excess by a majority of them. From a careful history of a large number of patients he is thoroughly con- vinced that the habit is only practised to excess by those who have some local focus of irritation, as phimosis, adhe- sions of the preputial sac, retained smegma, thread worms, hemorrhoids, stone in the bladder, etc Sometimes it is induced and established by nurses, who handle the parts to quiet the child. It is occasionally a result of the accidental discovery of a pleasureable sensation, as when climbing a tree or sliding down a banister. Onanism is un- doubtedly caused in many cases by nervous defects, as noticed sometimes in epileptics, hydrocephalic infants, and those suffering with cerebral and spinal diseases. The views of Sir James Paget seem to us to be wholly cor- rect. He said that: '' You may teach positively that mastur- bation does neither more nor less harm than sexual intercourse practised with the same frequency with the same conditions of general health, age and circumstances—that is, at any time n8 SEXUAL DISORDERS OF MEN. before or at the beginning of puberty—masturbation is very likely to produce exhaustion, effeminancy, oversensitiveuess, and nervousness, just as equally frequent copulation at the same age would probably produce them. Or, practised every day, or many times in one day, at any age, either masturbation or copulation is likely to produce similar mischiefs or greater. And the mischiefs are especially likely or nearly sure to hap- pen, and to be greatest, if the excesses are practised by those who, by inheritance or circumstances, are liable to any nervous disease, to 'spinal irritation,' epilepsy, insanity or any other neurosis. But the mischiefs are due to the quantity, not to the method, of the excesses; and the quantity is to be esti- mated in relation to age and the power of the nervous sys- tem." He has seen as numerous and as great evils conse- quent on excessive sexual intercourse as on excessive mastur- bation; but he has not seen or heard anything to make him '' believe that occasional masturbation has any other effects on one who practises it than has occasional sexual intercourse, or anything justifying the dread with which sexual hypochon- driacs regard the having occasionally practised it." Dr. H. Fournier, one of the most eminent physicians of Paris, says : '' There is not a vice more fatal to the conserva- tion of man than masturbation. This unfortunate habit is sometimes acquired by very little boys and girls. Foolish or vicious nurses may bring it on by handling young children most indelicately. This is one of the many reasons why none but virtuous servants and nurses should be employed by wise parents and physicians. In later years, children often learn this degrading and most injurious vice from their depraved companions, some of whom seem even to regard the practice of it as a manly accomplishment. When habitually indulged in, it produces on the health and the strength of the constitu- tion effects the most deplorable. Even the intellect is liable to become thereby enfeebled, a want of virility is exhibited both in the body and in the mind of its victims; then follows a loss of ambition and self-control." "When this morbid passion gets control of a person," writes an experienced practitioner in medicine, "it is as though an unclean spirit had entered, subdued the will, weakened the PSYCHOPATHIA SEXUALIS. 119 moral forces, enfeebled the intellectual faculties, lessened the power to resist temptation, and overcome every obstacle op- posed to its gratification. Even while the intellect is still clear, and the sense of wrong keen, the individual is a slave to this morbid impulse." This habit if prac- ticed to excess, produces hyperaemia of the bulbous and prostatic urethra, which in time becomes a true catarrhal inflammation, involving,during its course, the verumontanum, the sinus pocularis, the prostate and the seminal vesicles, and manifests itself by the many and varied symptoms already described as peculiar to these local conditions. There is with this condition general relaxation and numbness or hypersensi- tiveness of the scrotum, the testes may become soft and flabby, the skin of the penis dark and thickened, the prostate swollen and sensitive, and, if pressure is applied, prostatic fluid is easily pressed into the urethra. The seminal vesicles are frequently hyperaemic, inflamed and distended. In the more severe cases micturition becomes frequent, and incontinence or dribbling of the urine is not uncommon. The voiding of the urine is frequently accompanied by a severe burning sen- sation as though hot lead was passing down the canal, the act terminating with a flow of blood and constrictive pain in the prostate. The nervous lesions and neurasthenic manifesta- tions are legion, as already enumerated under chronic semi- nal vesiculitis and disorders of function of the generative organs of man. When long-continued, masturbation undermines the consti- tution. It is especially harmful when practiced to excess by the growing boy, whose sexual organs and nerve centres are immature and undeveloped. Fortunately in the majority of cases the bad effect of the habit is discovered by the patient and discontinued or proper steps are taken to make him understand the effect of the habit and realize its demoralizing results if continued. Infantile masturbators are usually characterized by their irritable, peevish condition, flabby tissues and lowered powers of digestion and assimilation. Treatment.—The young masturbator must be told of the perniciousness of the habit and its serious consequences if continued. This advice should be given in a kindly 120 SEXUAL DISORDERS OF MEN. way, persuasion and sympathy doing more than fear and punishment. In all cases the parts must be carefully and scientifically examined and judicious attention given to any point of irritation likely by reflex condition to cause abnormal hyperaemia of the genitalia. In young children the knowledge of its danger should be imparted by the mother; at a later period, by the physician. Pure morals promote health and strength, give vitality to form, grace of action, keenness of intellect, continued energy, and lasting success, with years of life, while excessive and abnormal sexual acts and habits undermine the system, sap the constitution, exhaust the mental and physical system, and lead to early death or decrepit old age. Boys who have practiced or who are suspected of practicing masturbation should not be kept too closely at their studies, but should be encouraged to engage in out-door sports and exercise. They should be carefully watched and advised, and when the habit is discovered should not be allowed to associate too intimately with other children or to occupy the same beds with them. Sexual Excesses.—The sexual vigor varies greatly in different individuals. Immoderate indulgence for one may be moderation for another. The results of sexual excesses usually appear between the fortieth" and fiftieth years. If the cause of diminished sexual vitality can be found and re- moved, though there is frequently associated general disease or intemperate acts, much can be accomplished. Sexual ex- cesses, if continued only for a short time or indulged in occasionally, usually right themselves, as is frequently ob- served in the young or old recently married man. Excesses are always to be condemned, and whenever they have pro- duced sexual weakness, if any part of the sexual tract is diseased, it must receive proper attention, its return to a normal condition frequently resulting in revitalization of the patient. At the same time it is well to impress the idea that the control of the sexual appetite adds strength of mind, bodily health, power and soundness of judgment, with length of life. If the inordinate appetite is gratified the commencing PSYCHOPATHIA SEXUALIS. 121 vesiculitis, ampullitis and prostatitis will become chronic, with the train of well-known symptomatic manifestations. Heterosexuality is a variety of sexual perversion char- acterized by a desire for association during coitus of acts of cruelty and violence, presenting itself either as an active or passive algolagnia. Sadism, or Active Algolagnia, is that variety of sexual perversion where the acts of violence are directed against the co-partner. It is more common among males than females. It is a frequent cause of uncontrollable and unnatural crimes, as probably exemplified in the Whitechapel murders and, in a less degree, in those abnormal impulses in which ejacula- tion only occurs while its victims are biting, scratching, or in some other manner inflicting pain upon their companions. Moschism, or Passive Algolagnia, is the opposite to sadism, the sexual pervert only experiencing carnal pleasure when he subjects himself to violence and cruelty, varying from the slightest to the most repulsive. Homosexuality is characterized by sexual desires and in- stincts opposite to those which the sex would naturally indi- cate. It has the following varieties: Psychical Hermaphroditism, is characterized by a de- gree of inversion of sexual instinct with pronounced desire for sexual relations with members of the same sex with an occasional desire towards the opposite sex; Urnings, characterized by sexual desires and inclinations for persons of the same sex exclusively, with disgust for coitus with the opposite sex. The victims are usually emotional and passionate, and present sentimental attachments for those of their own sex which would be considered normal only between individuals of opposite sexes. These are usually unable to have normal successful intercourse. In this class mutual masturbation is common, and pederasty affords the greatest sexual gratification. Effemination and Viraginity is characterized not only by inversion of the sexual instincts, but all feelings and inclinations in habit, sentiment and character are reversed. Coitus with the opposite sex is impossible. The man has the feelings of and acts like a woman. 9 122 SEXUAL DISORDERS OF MEN. Androgyny and Gynandry is a most extreme type of homosexuality. Not only are the feelings and sexual desires reversed, but the form, features and voice closely approach those of the opposite sex, and the genital organs frequently present anatomical signs of degeneration. CHAPTER XX. STERILITY. As a twentieth to a fifth of all childless marriages are due to some sexual weakness of the husband, this condition should receive careful consideration. The inability to propagate one's kind is not necessarily accompanied by impotence. It may be due to absence of or a diseased condition of the spermato- zoa, to congential or acquired obstruction or obliteration of some portion of the genital tract. In some of the uncivilized parts of the world male sterility is compulsory. Carl Lumholt, in his "Four Years in Australia Among Cannibals," says the " Mika-Operation " is required by law. " In a few tribes the children are oper- ated on, only about five per cent, being spared. In other tribes it is the husband who, after becoming the father of one or two children, must submit to the requirements of the law, the reason for the operation being that they do not like to hear the children cry in the camp, or be burdened with too many children." The artificial hypospadias is pro- duced as follows : '' The cut, which is made with a flint knife, is about an inch long, and extends almost to the scrotum. The surface of the wound is first burnt with hot stones, whereupon the wound is kept apart by little sticks, and in this manner an opening is formed though which the sperma is emitted." He further adds : "The natives of these tribes are fat and in good physical condition." For convenience of description sterility is classified as Oli- gospermatism, Oligozoospermatism, Azoospermism, Assper- matism and Misemission. Oligospermatism is that variety in which there is a defici- ency in the quantity or quality of the seminal fluid. It may be due to the various anomalies of the genitalia or removal of the parts, but more frequently it is the result of disease. Excessive venery may, for the time being, impair the quantity I24 SEXUAL DISORDERS OF MEN. and quality of the seminal fluid ejaculated. In wastiug dis- eases, in the feeble and those advanced in years, the quantity of spermatic fluid ejected is usually reduced. When the pros- tate fails to give its quota of secretion to mix with the deeper fluid a thick spermatic fluid results. Chronic inflamma- tion of the seminal vesicles and ampullations of Henel may so modify their secretions as to produce thickening of the vesicu- lar fluid, and the spermatozoa, though properly liberated, be- come agglutinated, or the seminal fluid may, on the other hand, become so watery in character and so diluted that the spermatozoa are washed out of the vagina. This latter con- dition is sometimes the result of gonorrhoeal vesiculitis. The spermatozoa contained in the seminal fluid may be of low vitality or lifeless, the admixture of pus from the deeper por- tions of the genital track being a frequent cause of this con- dition, its presence giving a yellow or green color to the sper- matic fluid. Oligozoospermatism is the variety in which the ejected spermatic fluid contains comparatively few spermatozoa, the result of imperfect development of the testes, as in ectropia testes, or of advanced years, when there is a tendency to fibrous and malignant degeneration, temporary or permanent disablement of the testicles by epididymo-orchitis of any form —simple, tubercular, traumatic, gonorrhoeal or syphilitic— producing obstruction in the conducting tubes by inflamma- tory changes. Syphilis often brings on this condition with- out producing local lesions demonstrable by a local or general examination of the parts, though, usually, there is a history of a specific orchitis or epididymitis, in which case it involves by preference the head of the epididymis, while in gonorrhoeal involvement the tail is usually attacked. Press- ure exerted by hydrocele or haematocele may temporarily cause the process of spermatogenesis to cease, the function returning on the removal or cure of the cause. Varicocele is supposed to produce atrophy of the testicles, and may therefore cause oligozoospermatism. Nerve involvement and the inges- tion of certain drugs, such as potassium iodide, the bromides, etc., have caused it. Azoospermism is the condition where the seminal fluid STERILITY. 125 does not contain spermatozoa, or, if present, they are diseased and unproductive. It may be due to double occluding epidi- dymitis, simple, syphilitic or tubercular orchitis, obstruction at any point of the conducting tubes of both sides, atrophy or absence of the testes, etc. Sterility may be due to want of life and vitality in the spermatozoa ejected. It is often the result of neurasthenia, masturbation or unnatural and ungratified sexual desires. Healthy spermatozoa should retain their life and vibratory motion for at least twelve hours after emission. Aspermatism is a condition where copulation is not com- pleted with the ejaculation of seminal fluid, the act in all other respects being normal. In these cases the sexual de- sire may be normal or absent. A nervous form of this con- dition exists, where the patient is unable to complete the act except with certain parties, caused by an imperfect co-ordina- tion of the muscles of ejaculation. In some cases there are oc- casional nocturnal emissions but a complete failure of ejacula- tion when intercourse is attempted, owing to the above cause, or to a sensory paralysis. It may be due to obstruction by a foreign body in the seminal ducts. The pressure excited upon the urethra by tubercular, malignant and other growths, loss of tone of the muscles concerned in the act of ejaculation, or anaesthesia of the prostatic urethra or glans penis may cause this condition. In some cases it occurs without local patho- logical cause, from want of lumbar reflex in the ejaculatory centers. In others there will be, under apparently the same conditions, ejaculation at one time and failure at another. Misemission, also called false aspermatism, or male emis- sion, is the condition where, although seminal fluid is ejacu- lated during the act, it is not deposited in the vagina, either passing back into the bladder to be voided with the urine or to be discharged as a dribbling fluid after relaxation of the penis and deeper parts. It may be due to hypospadias, epispadias, strictures, or fistulas of the urethra. The prognosis and treat- ment vary with the cause, which must be carefully searched for and treated as the individual, local or general lesion may dictate. CHAPTER XXI. THERAPEUTICS. Acidum Fluoricum.—Sexual desire increased, with erec- tions at night during sleep; erections in the morning without desire; occasional sticking pain extending through the left testicle along the spermatic cord to the abdominal ring; fre- quent desire to urinate; burning in the urethra during and after micturition in the morning; whitish or copious purple sediment in the urine. Forgetfulness of dates and common employments; exceedingly anxious; sensation of weakness, like numbness in the head. A marked characteristic is appa- rent necessity for rapid and energetic motion. Acidum Muriaticum.—Erections feeble; weak feeling in the genitals; awakens with a sensation as though emission would occur; erections feeble; seminal discharge watery, frothy, odorless, followed by persistent erection, with ten- sive pains in the penis; boring tension in right testicle, ex- tending to the middle of the penis; constant desire to urinate, with scanty flow; must wait some time before the urine can be voided; frequent ineffectual urging at night to urinate; involuntary micturition at night; cutting pains far back in the urethra, when urinating and when at stool; cut- ting and biting in the meatus after urinating. Tottering gait from weakness; vertigo and unsteadiness. Headache on ris- ing up in bed, or moving the eyes; restlessness. Acidum Nitricum.—Erections diminished, unsatisfactory or absent; excited only by fondling, occasionally satisfactory; thrill imperfect; discharge of prostatic fluid during excite- ment; frequent emissions; tearing, twisting and burning pains in the left testicle and spermatic cord; bruised, sore feeling in the testicles; after stool and micturition discharge of prostatic fluid; discharge of mucus when not urinating; THERAPEUTICS. 127 smarting in the urethra when urinating, with burning, cutting and sore pains; penis sore to the touch; urine has the odor of horse urine; clear on passing, but on standing becomes cloudy and thready; sad and despondent; irritable, vexed at trifles. Especially suited for lean persons, with dark com- plexion, black hair and eyes. Acidum Oxalicum.— Erections in the forenoon and when lying down, followed by dulness in the occiput, or by pains in the testes and spermatic cord; during micturition burning in the urethra, with voluptuous sensations; increased frequen- cy of urination; burning through the urethra, as if a drop of acrid urine had passed; urine loaded with oxalate of lime; numbness and weakness of the limbs; circulation poor. Acidum Phosphoricum.—Frequent and debilitating emis- sions, with very little sexual excitement; erections, without sexual desire, in the morning and when standing; sudden relaxation of the erection during intercourse; intercourse or emissions are followed by great exhaustion; excessive loss of seminal fluid, voluntary, involuntary, nocturnal or diurnal, when straining at stool, while urinating; penis and scrotum relaxed; testicles hang low down; general crawl- ing sensation over the scrotum; erection difficult or im- possible; when coitus is attempted ejaculation occurs too early in the act; micturition frequent, profuse; urine milky, having a white jelly-like sediment; frequent micturition, burning in the neck of the bladder; cutting in the prostatic urethra during micturition and followed by cramp-like pains in the small of the back; burning in the prostatic region; vertigo, as if about to fall; when reclining, sensation as if the feet would go higher than the head; crushing pain in the ver- tex, accompanied by cold, clammy perspiration late in the afternoon and evening; stupefaction or sensation as if intoxi- cated; low-spirited, indifferent, sad, disinclined to talk; eyes glassy and lustreless. Aching in the small of the back. Whole system generally relaxed without marked local pain; burning sensations in lumbar region; back and legs weak; totters when walking. It is particularly indicated in those who grow too fast or who are greatly debilitated; in cases of 128 SEXUAL DISORDERS OF MEN. excessive masturbation; for the debilitating effects of seminal emissions, being more suited for the acute than the remote symptoms. Onanism, when the patient is disturbed by the thought of the culpability of his indulgence; pain on the top of the head following the loss of animal fluids; indifference to the affairs of life; quiet apathy; weak feeling in the small of the back and heavy limbs; nervous palpitation in mastur- bators; face pale, eyes sunken, blue rings around them. Acidum Picricum.—Priapism; violent erections; penis dis- tended almost to bursting; agonizing desire for an embrace. (It is reported that many of the provers were compelled to leave lectures and return to their homes for a few days.) Seminal emissions, followed by hot feeling in the dorsal and lumbar regions, worse from motion; desire, with almost constant priapism night and day; lewd dreams and emissions; emis- sions every second night; erections continue for some time after the emission; violent erections at eleven A. M.,with bruised pain in the left testis, extending up the cord to the external ring; urine yellow, dark, with strong odor, copious and pale; urine hot when voided, causing burning pain in the urethra; urine contains urates in abundance and indican. Tired, aching feeling in the lumbar region on awakening, with heaviness in the feet and lower extremities, accom- panied by a heavy, tired feeling in the occiput, forehead, or both. The least mental exertion causes prostration and brain fag; vertigo on walking, stooping or going up stairs; numb- ness, crawling and pricking in the limbs; rapid development of boils over all parts of the body. Aconite.—Stitching pains in the glans when urinating; frequent erections; drawing pains in the testes; tenesmus at the'neck of the bladder; burning in the prostatic region when not urinating; drawing and pressing pain in the sides of the abdomen on pressure; prostatic region sensitive to deep pres- sure; fever, thirst, restlessness; testes swollen and hard, ac- companied with bruised pains. Agaricus muse.—No pleasurable sensation in the embrace in spite of strong excitement; aversion to sexual intercourse; ejaculation insufficient or very late; frequent nocturnal emis- sions; great desire for intercourse with relaxation of the THERAPEUTICS. 129 penis; emissions painful, with burning pain in the urethra; dragging in the testes in the evening; spasmodic pain in the left testicle and cord; penis cold and shrunken; discharge of viscid mucus from the urethra, or a sensation as though a drop of cold urine had passed; disagreeable sensations in the the glans penis; tickling as of a small foreign body in the fossa navicularis; burning when urinating, or a sensation as though they have not finished; micturition intermittent or only possible after several attempts, followed by dribbling; frequent urging to urinate; urine copious, accompanied with stitches in the meatus urinarius; urine scanty. It is often beneficial when coitus is followed with great weakness of the whole body; choreic symptoms caused by masturbation; bad effects from sexual excesses; complaints after sexual de- bauch, with loss of appetite; pains in thighs; nervous symp- toms, twitching and jumping of the muscles. Agnus Castus.—Impotence; organs relaxed and cold, nothing excites an erection; sexual desire diminished or almost lost; emission of mucus from the urethra during sexual excitement; involuntary emissions during the night, even after coitus; seminal fluid watery or yellow; testicles cold; emissions at night after an embrace; seminal fluid dis- charged in a stream without ejaculation; spermatic fluid scanty and almost odorless; discharge of prostatic fluid when straining at stool and during micturition; disagreeable sensa- tion in the back part of the urethra during urination; de- ficiency of sexual instincts; low-spirited; melancholy; fear of approaching death; loss of memory; heaviness and pressure in the head as if it would fall forward; pain in the vertex and great debility; sleeplessness though very tired when retiring; sleeps but little during the night. This remedy has acted very kindly in impotence the result of a neglected gonorrhoea; useful in those advanced in years, who in their youth have carried sexual indulgence to extremes, and who, while phy- sically impotent, are mentally excitable as in early life thus leading to many perverted acts and orgies. Ambra gris.—Violent erections on awakening without carnal desire and the parts externally numb; after the erec- tion subsides, tingling in the fore part of the urethra, burning 13° SEXUAL DISORDERS OF MEN. internally in the region of the seminal vesicles; intercourse delightful and voluptuous; pinching constrictive pain in the region of the mons veneris and bladder, sometimes on one side only; it may extend down the dorsum of the penis, oc- curring when the bladder is full and after emptying it; drag- ging pains in the spermatic cord, extending into the testes; smarting, burning, stitch-like pains in the testes; coldness and swelling of the scrotum; penis shriveled and retracted; coldness and numbness of the prepuce and glans; stitches in the fore part of the penis; smarting and burning in the fore part of the urethra; ejaculations too early and too weak; neu- ralgic pains in the cord and testes; bloody emissions; urging to urinate, often the urine cannot be retained; feeling in the urethra as though a few drops were being expelled; burning in the orifice of the urethra; pain in the bladder and rectum; urine turbid and dark brown; great sensitiveness to external impressions, the slightest influence causing excitement and difficulty in breathing, usually attended with vertigo; forget- fulness; does everything in a hurry, yet time passes slowly; sleeplessness. Often indicated in thin, spare, nervous men. All pains in the genitals are increased by motion. Anacardium.—Cutting pains along the penis; desire for an embrace from voluptuous itching in the scrotum; emis- sions at night without amorous dreams; discharge of prostatic fluid after micturition and stool; constant desire to urinate; frequent, clear, watery urine, especially before breakfast; urine turbid when voided, depositing a turbid sediment. Nervous prostration resulting from excessive emissions; lack of confidence; weakness of memory with impaired intellectual powers; psychical impotence; lack of confidence in their own powers; fear marriage on account of their supposed sexual weakness; tendency to curse and swear. Aloe soc.—Frequent urging to urinate at night; difficult micturition; flow interrupted; burning on urinating; urine dark, with slimy sediment, bloody; fine granular cloudiness, with whitish sediment; pollutions during the mid-day nap; heaviness and pressure in the lower part of the abdomen, with a feeling of a plug in the pelvis; disinclination to mental THERAPEUTICS. 131 labor; speedy fatigue on mental application. It has been of benefit in acute prostatitis and in prostatic hypertrophy. Alumina.—Emissions at night, with voluptuous dreams, also during the afternoon nap; jelly-like emissions during coitus; violent erections during the night and in the after- noon; constrictive pains in the right spermatic cord accom panied with the painful drawing up of the right testicle; pressure and drawing-like pain in the prostatic region; tenes- mus at the neck of the bladder and in the rectum after uri- nating; urine white and turbid, as if chalk had been stirred into it; urine turbid at night; painful feelings about the soles of the feet; staggers when walking in the dark; burning pains in the spine. This remedy has been found especially useful in old people suffering with involuntary emissions, par- ticularly when straining at stool. Argentum nit. —Coitus painful, with stitches in the urethra and absence of pleasure ; spasmodic contraction of the cremaster muscle, drawing the testes high into the scrotum ; erections fail when intercourse is attempted ; gen- erative organs shriveled, with loss of desire ; cutting pain from the prostate to the rectum when voiding the last drops of urine; sensation as though fluid was running down the urethra, or a burning drop after urinating ; micturition dif- ficult ; burning pain and discharge of a white pedicle with shreds of epithelium from the mucous membrane ; inability to void the urine in a projecting stream ; at night, urine copious, pale and frequent; at noon, cloudy from mucus ; inorganic salts increased. This remedy has been found use- ful in hypertrophy of the prostate and the anaesthetic stage of impotenc accompanied with general emaciation, poor circu- lation; blue skin, general loss of strength and trembling of the limbs, particularly of the lower extremities. Arnica.—Erections after walking, without amorous thoughts or desires; carnal desire with continued erections; stitches through the glans penis in the afternoon; itching of the glans; emissions during a caress; several at night with voluptuous dreams; stitches in the anterior part of the urethra after uri- nating, also between the acts; ineffectual urging to urinate; desire to urinate, with burning and biting after urinating; fre- 132 SEXUAL DISORDERS OF MEN. quent micturition; urine scanty and white, pale and copious; urine retained with aching and pressing in the bladder; has to stand a long time before the urine is voided; inability to retain the urine long at night; urine flows slowly; earthy phos- phates increased; sediment contains crystals of phosphoric acid, ammonia-magnesia phosphates and urates; urine acid in reaction, high specific gravity; sulphur-colored, turbid, frothy, neutral in reaction, depositing a sediment. Dr. S. W. Mills reports a case of chronic prostatitis, with a feeling of soreness in the testes, pain extending to inguinal region and back accompannied with a discharge at the end of the penis in the morning and on walking, cured by Arnica. The remedy is also indicated in traumatic priapism. Aurum met.—Nightly erections, with or without pollu- tions, not followed by weakness; strong erections, with relax- ation on attempting intercourse; penis relaxed, with discharge of prostatic fluid; seminal emissions do not apparently cause weakness; tearing stitches in the glans penis when obliged to urinate; urine more copious than the amount of water imbibed turbid like buttermilk, with mueh mucous sediment; low-spiri- ted; lifeless; memory bad; settled melancholia with suicidal mania; appetite for plain food poor; tongue coated at the back. Baryta carb.—Diminished sexual power and desire; falls asleep during coitus; sudden erection in the evening, with shivering of the body and great desire; emissions are fol- lowed by a dryness of the whole body; enlarged prostate; want of confidence in others; vertigo; trembling when stand- ing, with fear of falling; feeling of heaviness in the body; general emaciation; sensitiveness to cold; all symptoms ag- gravated when thinking of them. Useful in the aged, where there is great weakness of mind and body; premature im- potenc Belladonna.—Nocturnal emissions with relaxed penis and without lascivious dreams; drawing pains in the spermatic cord during micturition; discharge of prostatic fluid from relaxed penis; micturition difficult; urine voided only in a small stream; frequent urging to urinate; pain in the region of the bladder; twisting as of urine in the bladder; when walking stitch-like pains from the bulb to the meatus; burn- THERAPEUTICS. 133 ing in the urethra, with ineffectual urging to urinate; invol- untary micturition when asleep; irritation at the neck of the bladder, with strangury and bloody urine; urine deep red, bloody, turbid with reddish sediment. Sexual irrita- tion in boys manifested by constant erection and seizing of the member with the hands. Berberis vulg.—Erections weak; ejaculation occurs too early; thrill not satisfactory; neuralgic pains in the testicle and cord, increased by motion; urine pale yellow, with slight gelatinous sediment, which does not deposit, or a tur- bid, flocculent, clay-like, copious, mucous sediment mixed with white or whitish gray, and later a reddish mealy sedi- ment; urine clear, saturated, yellowish thick, flocculent, or like muddy water, depositing a copious mealy sediment, with white, greyish white or a dirty red granular sediment It is specially useful in sexual disorders, accompanied by neuralgic pains, apparently located in the testes, which are sore and sensitive. Borax.—Rapid emissions with dreams of coitus which awaken; emissions very soon after intromission, with con- tinued irritation of the genitals; meatus agglutinated; urging to urinate, with pain at the meatus after urinating, as if it were sore; burning tension in the urethra after urinating; urine has a pungent odor. Brachyglottis.—Pain in the bladder during micturition, with soreness in the urethra and a feeling as though the urine could not be retained; pain in the bladder and urethra after evacuation, with stinging in the penis; pressure at the neck of the bladder, with soreness and urging to urinate; stinging pains in the urethra; throbbing of the penis, with a desire to urinate, and pressure in the bladder; urine abundant and pale; full of mucus, pus corpuscles and epithelium, oxa- lates, phosphates and triple phosphates; loss of flesh, weak- ness, heaviness, irritable mood, confusion in the head; vertigo with flushed face. Gnawing pain in the region of the kidney; weakness after walking, weariness in the back, weakness of the limbs in the morning. Bromium.— Emissions at night; during coitus early discharge of clear mucus from the urethra; stitches in the 134 SEXUAL DISORDERS OF MEN. meatus and along the side of the penis; burning after uri- nating, with pulsation behind the testes; sensation of fulness in the prostate gland when walking; stitches in the left sper- matic cord and pressure in the right; swelling of the left testicle; urine turbid with whitish sediment, containing large flakes of white mucus. Cactus grand.—Congestion of the genito-urinary organs; priapism towards evening, just before retiring, with great de- sire; copious emissions about 12 p.m., after strong desire; frequent urging to urinate at night; ineffectual urging; urine voided in drops, with much burning; irritation of the urethra, as though he would constantly urinate; redness of the orifice of the meatus; heat in the urethra. Caladium.—Glans penis flabby and relaxed, the result of masturbation; want of tone in the organs; when the fore- skin is retracted there is not sufficient reaction or contracti- bility of the parts to replace themselves, or, after coitus, the prepuce remains behind the glans and becomes swollen and painful; relaxation of the penis during sexual excitement and desire; erection suddenly ceases during coitus, without cog- nizance as to whether there was an ejaculation of semen; no orgasm; parts flabby; imperfect erection, with permature or- gasm; nocturnal emissions, with or without lascivious dreams, or with dreams in no way associated with sexual subjects; complete impotence without erections; genital organs cold to the touch; urine pale, turbid, with a pedicle and gelatinous precipitate, smells strong; low-spirited, gloomy, forgetful; attacks of faintness after writing or mental exertion; disin- clination to move or act; lewd thoughts without erection. Calcarea acet.—Frequent emissions at night with or with- out voluptuous dreams; tickling and itching at the end of the glans and prepuce; left testicle spasmodically drawn up to the abdomen; painful to the touch; frequent urging to urinate; urine turbid, becoming like gruel on standing; anxiety as if he had committed a crime, or feared reproach, with constant inclination to work; anxiety about the present and future; sadness, almost to weeping; fretfulness, disinclination to talk; indifference to the most important subjects. Calcarea carb.—Sexual power diminished or imper- THERAPEUTICS. 135 feet; emissions premature; great prostration after coition, followed by weakness and trembling, especially in the knees, with headache, vertigo and night sweats; impotence, with in- creased sexual desire; during coitus; burning and stinging while the semen is ejaculated;frequentnocturnal emissions; pain in the spermatic cord, as if contracting; crushing pain in the testes; sexual desire increased in the evening and when walk- ing, caused by lascivious fancies; erections only induced by handling followed by ejaculation on intromission, then weak- ness and excitability, anger and general giving way; flow of prostatic fluid after urinating and after stool; urging to urinate, aggravated on walking; sensation as though the act was not finished; pains in the urinary passage after wetting the feet, and through the bladder at night, with cutting on uri- nating; scrotum relaxed and hangs down; much mucus voided with the urine; urine turbid, with whitish, flaky sediment; fatty pedicle having a fatty smell on the surface; white, mealy sediment in the evening; urine copious and sour smelling; weakness of mind and body; apprehension and anxiety about health; fear they will lose their reason, or others will notice their confusion of mind; despair; mental application diffi- cult; nervous relaxation, ill-humor, faintness, great de- bility and emaciation, with prominence of the abdomen and good appetite; dark circles around the eyes; palpitation of the heart; perspiration of the hands and feet; cold- ness of and dead feeling in the feet, especially at night. Frequently indicated for those who have led a rapid and un- chaste life, and, having settled down to a moral and healthful state, suffer from excessive sexual desire and physical deficiency; more passion than physical power to carry out the act. Indicated in all conditions caused by sexual excesses. Calcarea phosph.—Erections without desire when riding iu a carriage; painful erections in the evening, with burn- ing in the urethra and tension in the penis; cutting pains in the neck of the bladder and in the urethra before urinat- ing; shooting pains in the root of the penis and bladder; cut- ting, drawing pains in the glans when sitting; urine copious with flocculent deposit, smells like strong tea; general tremb- 136 SEXUAL DISORDERS OF MEN. ling and weakness; mental or physical weakness and indiffer- ence. Camphor.—Painful priapism, relieved by urinating; when standing, pressure and pain in the left side and root of the penis and groin; desire increased with delusions in respect to the object of embrace; nightly emissions; urine voided in a thin, small stream; dribbling; frequent and painful micturi- tion ; strangury ; biting pains in the posterior part of the urethra when urinating, followed by pressure in the region of the bladder; burning and sticking pains in the urethra when walking; urine scanty, burning. Cannabis Ind.—Penis relaxed and shrunken; sticking and burning sensation in the glans; satyriasis; painful erections after coitus; thrill prolonged, with more than a dozen ejacula- tions; the thrill may consist of intense burning with no ejacula- tions; during coitus scarcely any emission or ejaculation, but afterwards acute pains in the loins; erections when riding, walking or sitting, not caused by amorous thoughts; excessive discharge of prostatic fluid at night and during hard stool; stitches and burning in the urethra before, during and after micturition; sensation as though a gonorrhoeal discharge was present; uneasiness in the urethra and penis with burning and frequent desire to urinate; oozing of white, glairy mucus from the meatus; urging after micturition, with much strain- ing; constant ineffectual desire to urinate; dribbling of the urine after the straining has ceased; has to wait some time before the urine flows; has to force out the last drops with his hands; frequent micturition; the stream suddenly stops and then flows on again; urine colorless, copious; disinclination to physical efforts; weakness from short walks; desire to lie down in the day time. Cannabis sat.—Penis swollen without special erection; frequent erections, with stitches in the urethra; on standing, dragging in the testes; coldness of the genital organs with warmth of the rest of the body. Impotence from sexual abuse. Cantharis. — Priapism; satyriasis; spermatorrhoea re- sulting from gonorrhoea; great increase of sexual appetite, which is sometimes uncontrollable; erections violent and sometimes painful; erections continuous without sensation/ THERAPEUTICS. 137 urethral irritation, with priapism and constant desire to urinate; seminal fluid bloody. Painful erections, severe at night, with contraction and sore pain the whole length of the urethra; uneasy and uncomfortable sensation in the glans penis, producing a desire to pull at the organ; cutting pains in the urethra before, during and after micturition, and burn- ing pains through the whole urethra; discharge of a pasty, colorless liquid from the urethra; urine scalds and is passed drop by drop; frequent micturition; constant urging to urinate; great urging and tenesmus, always preceded by pains in the penis; pain at the base of the urethra extending to the meatus; burning pain in the seminal vesicles during and after coitus; discharge of blood from the rigid penis and the anus; pain before micturition; drawing in the back and thighs; urine bloody, contains bloody filaments, coagulated masses of blood and mucus, high specific gravity, turbid when voided; urine has a white sediment which adheres to the glass; some- times an iridescent film; urine turbid, loaded with sediment. Insanity of masturbators; amorous frenzy; unchaste actions; shamelessness; eyes fiery, sparkling and protruding; over- sensitiveness of all parts of the body. Capsicum.—Violent erections occurring during the day and relieved only by the application of cold water; violent erections in the morning; trembling of the whole body during sexual excitement; loss of sexual power; coldness of the genitals, accompanied by cold chills down the back; loss of sensibility, with atrophy of the testes; coldness of the scrotum in the morning; frequent desire to urinate, difficult and in drops; burning pains in the urethra after urinating; itching and stinging pains on the glans; urine copious with white sediment. Vertigo; pressive headache, darting pains through the head, worse when at rest; peevish and sleepless. Carboneum sulph.—Erections with nightly emissions; violent erections, with burning in the urethra; loss of sexual power; erections rare; ejaculations short and incomplete; constant fatiguing erections, speedily changing to impotence; indefinite coitus without ejaculation; scrotum shrunken and painful; testes small with diminished sensativeness to pressure; tickling in the fore part of the urethra as though a discharge 10 138 SEXUAL DISORDERS OF MEN. would appear; sexual organs relaxed; burning, sticking pains in the spermatic cord running deep into the abdomen, aggra- vated in the evening and at bedtime; cramping pains at the neck of the bladder during micturition, extending to the urethra, with similar pains in the anus and rectum; urging to urinate, with burning in the urethra and neck of the bladder; inability to retain the urine even an hour; urination painful and slow; bloody urine; turbid and pale; burning, smarting and cutting in the urethra during micturition; urine high in color, containing an abundance of carbonates and phosphates. Carbo veg.—During coitus ejaculations too early, followed by a roaring in the head; emissions without sensation; ex- cessive emissions which strain the nerves and cause burning in the fore part of the urethra; cutting and burning in the urethra on urinating; discharge from the urethra when straining at stool; loss of ejaculatory thrill; excessive emis- sions; burning in the fore part of the urethra; burning and cutting in the urethra when voiding' the urine. Causticum.—Discharge of prostatic fluid after stool; fre- quent emissions in old men; emissions every night and during the afternoon nap; impotence with ejaculation of semen during coitus; discharge of blood; burning in the urethra after urinating and after emissions; urging to urinate after walking; intermittent micturition in the evening; delay of the last drops of the urine; enuresis, with violent erections without desire; urine copious, then scanty, slightly acid, be- coming turbid on standing; vertigo on looking upward or fixedly at anything. China off.—Morbid excitability, with lascivious fancies; emissions caused by slight abdominal irritation; premature ejaculations, followed by great weakness; frequent nocturnal emissions after self-abuse; scrotum relaxed; itching and crawling in the scrotum at bedtime; tearing pains in the left testicle; sticking pains in the urethra when urinating; urethra sensitive when sitting or rising, with stiffness in the penis; burning and biting in the fore part of the urethra; urine whitish, turbid, depositing white sediment; mental indifference; pain in the small of the back when lying upon it; weakness of the knees; trembling of the hands. It is use- THERAPEUTICS. 139 ful for the weakness immediately following a sexual debauch, or when several emissions have occurred during the previous night, with nervous irritability and desire to be alone. Chlorinum.—Impotence of recent appearance, with aver- sion to sexual intercourse; fear of impending danger; fears loss of reason; forgets names and places: disinclination to arise in the morning, accompanied by ill-humor; loss of flesh; aged appearance. Clematis erect.—Burning pains in the penis on emission during coitus; long-continued erections, with aversion to coitus; erections frequent and strong; right spermatic cord sensitive, with drawing up of the right testicle; frequent, in- tense pain in the prostate; frequent urging to urinate during the day, with burning at the orifice of the urethra; micturi- tion slow, urine voided in a thin stream, as if the urethra was contracted; mucous discharge sticking in the meatus and fossa navicularis; when not urinating, irritation in the fore part of the urethra; urine milky, with floating flakes of mucus; low-spirited, fear of approaching misfortunes; aver- sion to talk; fear of being alone; memory impaired; giddiness in the head. Cobaltum.—Lewd dreams are frequent, with seminal emissions which awaken, and are accompanied by headache; voluntary and involuntary emissions are followed by back- ache, referred to the lumbar region, aggravated when sitting; emissions without erections; frequent micturition with floccu- lent deposit in the urine, burning in the urethra during mictu- rition; frequent desire to urinate after drinking coffee; urine has a greasy pedicle. Conium mac.—Impotence; imperfect erections; excessive seminal emissions resulting from sexual excesses or celibacy; seminal weakness, with erethism and premature emissions; flaccidity of the parts, with weakness in the back; emissions without erection; discharge of prostatic or other fluid from the urethra during stool and with every emotion; sexual organs very irritable; desire increased; emissions while caressing; frequent urging to urinate, with burning pains at the neck of the bladder and along the urethra; frequent mic- turition at night; discharge of mucus from the urethra after 140 SEXUAL DISORDERS OF MEN. urinating; cutting pains in the meatus in the morning; urine turbid, frothy, bloody; copious urine, voided by fits and starts; hypochondriacal; morose; avoids society; sad, anxious and low-spirited; vertigo, worse on turning in bed; difficulty in walking; numb feeling in the brain; dread of being alone, yet dreads society; melancholia of celibacy; sudden loss of strength, as if paralyzed; desire for sun's warmth; inability to sustain any mental effort; vertigo on lying down. Especially indicated in complaints from denial of carnal desires. Cubeba.—Prostatic gland enlarged; impotence; weakness of the sexual organs; cutting and constricting pains on urinating; the last few drops of urine voided with pain; after micturition bladder still feels as if a portion was retained; urine frothy and copious. Cuprum acet.—Impotence; penis easily becomes erected, but on intromission immediately becomes flaccid, sometimes followed by an escape of semen; during erection, tension in the perineum, often accompanied by rheumatic pains in the back and legs. Digitalis.—Violent erections; involuntary seminal emis- sions without dreams, followed by great prostration, sadness and utter despair; frequent sensation at night as though emis- sion would occur without pollution, and in the morning agglu- tinous moisture of the meatus; sexual power and quantity of seminal fluid diminished; bruised pain in the right testicle. Gloomy; peevish; great anxiety and apprehension about the future; dullness in the head, with a limited power of applica- tion; attacks of debility and faintness, especially after break- fast and dinner; great nervous weakness. Dioscorea.—Sexual organs relaxed and cold, with great weakness of the parts; seminal emissions frequent, sometimes two or three times nightly, accompanied by erotic dreams, followed by weakness, especially about the knees, and possibly pain and spasm of the spermatic cord; strong-smelling sweat on scrotum and pubes. Equisetum.—Violent erections; pain in the bladder not relieved by micturition; pain and tenderness in the region of the bladder with soreness of the testes and spermatic cord; pricking pain in the urethra during and after micturition; THERAPEUTICS. [41 constant urging to urinate, only a small quantity voided; sharp pains in the right testicle before urinating; the urine becomes cloudy on standing from excess of mucus. Eryngium aquat. — Excessive erotic priapism; nightly erections without emissions; sexual desire suppressed, then excited with lewd dreams and pollutions; discharge of prostatic fluid from slight causes; urine contains semen; decrease of vital powers; lassitude; dragging pains in the lumbar region; general depression; urine scanty; sensation as though some of the urine remained in the urethra with continued burning, smarting and urging to urinate; urine voided in drops, with stinging and burning in the urethra and fossa navicularis during micturition; thoughts confused; difficult of concentration of mind; loss of energy; spirits de- pressed; nervous, constantly running about; faintness on rising suddenly, stepping down or turning the head quickly. Euphorbium.—Erections at night, without emissions or lacivious dreams; emissions without cause when sitting; voluptuous itching of the prepuce, with discharge of prostatic fluid; pinching and burning pains in the left side of the scrotum, whole body seems relaxed and tired; discharge of prostatic fluid from relaxed penis; frequent desire to urinate with scanty discharge; urine voided in drops, with sticking pains in the penis; strangury; itching in the fore part of the urethra when not urinating; whitish sediment in the urine; cutting and sticking in the glans when standing; apprehen- sive, starting as from an electric shock at night when awake. Ferrum.—Constant urging to urinate, accompanied with pains in the region of the kidneys, liver and chest; tickling in the urethra, extending to the neck of the bladder; tickling in the urethra, when beginning to urinate, gradually extend- ing along the whole length of the canal; soreness of the urethra on urinating; tickling of the glans, with warmth and irresistable desire to urinate; urine light-colored with a whitish sediment. Gelsemium.— Sexual organs relaxed, cold, and often accompanied by cold perspiration on the scrotum; frequent nocturnal pollutions without lascivious dreams; diurnal emissions; spermatorrhoea; emissions followed by languor; 142 SEXUAL DISORDERS OF MEN. impotence, with weakness and irritability of the seminal vesicles from masturbation; agreeable sensation in the urethra when micturating; sensation when urinating as though the urine had not been entirely voided; stream intermittent; frequent micturition of a clear limpid urine, which relieves dullness in the head; urine at times clear and limpid or milky and turbid; vertigo, accompanied by pain in the occipital region; irritability and languor. Acute prostatitis, folio vving suppression of the urethral discharge. Ginseng.— Erections frequent, occurring at night with- out polutions; frequently when sitting quietly engaged in en- grossing business; sexual excitement; urine scanty; clear urine voided in a thin stream, when pressure is applied is voided in a broad stream; urine yellowish or lemon-colored; frequent urging to urinate, with burning and itching in the urethra, sometimes smarting in character, with tickling pains in the fossa navicularis. Gnaphalium. —Erections and desire for an embrace; oc- casional stinging pains in the glans penis; frequent pain in the region of the prostate; bladder feels full and tense, even when just emptied; urine copious, pale and inodorous. Graphites.—Violent erections, with uncontrollable sexual desire and excitement; during coitus cramps in the calves of the legs; no ejaculation follows the sexual act in spite of every exertion; impotence; absence of sensation during coitus, and no discharge of semen; gluey, sticky discharge from the urethra; voluptuous irritability: sticking and jerking pains in the testes; sexual debility; seminal emissions; biting in the urethra during micturition; urine voided in a thin stream as if the urethra was contracted; tickling in the urethra when urinating; at the meatus, after urinating; burning in the urethra between the acts of micturition; rawness and pressure at the root of the penis, with desire to urinate; urine clear when voided, but after a few hours it covered with an iri- descent film; urine become turbid and deposits a white sedi- ment; melancholy; inclined to grief; fear of approaching danger; forgetfulness; on awakening semi-lateral headache; fear of insanity; sexual thoughts fill the mind to the exclu- sion of all others, with voluptuous irritability of the sexual THERAPEUTICS. 143 organs; emaciation, with feeling of great debility; unhealthy condition of the skin. Hamamelis. — Nocturnal emissions, without lascivious dreams and without cognizance of their occurrence; emissions without erections; neuralgic pains in the testes, extending to the stomach and abdomen, causing nausea and vomiting; fre- quent pain in the spermatic cord, extending into the testes; drawing pains in the testes; copious and frequent urination; profuse, light-colored urine, having a greasy deposit, which may rise to the top when shaken and have the appearance of pus. Hepar sulph. c.—Discharge of prostatic fluid during stool; sticking pains in the prepuce and frenum; during caress, painful erections, accompanied with soreness and pinching pains in the penis, extending into the bladder; emissions with- out amorous desires or fancies; testicles relaxed; micturition impeded, must wait some time before the flow commences; can never completely finish the act, some urine always remaining behind in the bladder; the urine drops vertically from the end of the penis; urine pale and clear, becoming thick and turbid on standing, with a whitish sediment; urine dark and scanty or copious and pale, frequently presenting an oily film on standing; urine acrid and burning. Hydrocotyle.— Impotence; no desire for sexual inter- course; drawing in the spermatic cords; scrotum relaxed; feeling of weight and heaviness in the prostatic gland; fre- quent desire to urinate; irritation of the neck of the bladder; urine turbid without sediment; weariness, dulness and heavi- ness of the body; gloominess, indifference and inclination for solitude. Hyoscyamus.—Constant erections after meals; excite- ment and erections, without lascivious fancies; licentious mania; improper exposure of person, etc.; hallucinations, etc. Ignatia.—Irresistible desire for an embrace, with relaxed penis; profuse nocturnal emissions; impotence, with weak- ness in the hips; urging and pressure about the penis, with violent erections, ending with emissions; erections during stool; paroxysms of pain at the root of the penis, relieved on walking, aggravated when standing or leaning against 144 SEXUAL DISORDERS OF MEN. the sacrum; biting and itching pains in the glans penis; pain in the neck of the bladder, aggravated when urinating, re- lieved by walking and eating; stitches and scraping pains in the middle of the urethra, worse in the evening and when sitting; burning and biting in the urethra, aggravated when urinating; during stool, discharge of much prostatic fluid; micturition increased in frequency; urine lemon-colored, with whitish sediment; urine turbid. This remedy is fre- quently indicated by its general symptoms in diseases of the genital organs caused by continence, grief, etc. Lascivious fancies, with sexual excitement, followed by weakness of the genitals and external heat of the body. Psychical impotence. lodium.—Priapism; violent and continued erections, with- out lascivious thoughts; frequent tickling and itching of the glans; sexual desire increased; seminal fluid increased; noc- turnal emissions followed by weakness; testicles increased in size, followed by diminution in size and consistency, with im- potence; increased frequency of micturition; polyuria; cutting and itching in the meatus urinarius; urine dark, turbid, milky, greenish yellow. It has been found of benefit in tubercular prostatitis. Jatropha.—After excessive intercourse, aching in the testi- cles, with drawing pains extending along the inner side of the right thigh to the knee; spasm at the neck of the bladder, with desire to urinate; constant, frequent and difficult mic- turition; tickling in the fossa navicularis, with frequent mic- turition; stitches in the urethra; oozing of clear mucus from the urethra, when walking or sitting. Kali brom.—Sexual excitement during light sleep, with erections and emissions, which awaken him, and of which he is conscious; nocturnal emissions; erections persistent and normal; impotence, with wasting of the organs; nocturnal pollutions, followed by great nervous irritability; pains, swelling and tenderness in the left spermatic cord and testicle; burning at the neck of the bladder, with sensation of a ball being forced from behind, then discharge of a half an ounce of liquid, like the white of an egg; frequent desire to uri- nate, with burning and smarting pains along the urethra; the act of micturition closing with a spasmodic constriction of THERAPEUTICS. H5 the urethra, and sharp pains extending back into the bladder, as though it was being distended with a large instrument, fol- lowed with a whitish-yellow discharge; urine copious, clear and yellowish; urine loaded with phosphates. This remedy is especially efficacious in sexual diseases the result of ex- cesses where there is loss of memory, melancholia, impaired coordination, numbness and weakness in the limbs; nervous conditions from continence; weakness in the lower extremi- ties, with great nervous excitability, after imperfect inter- course and masturbation; nervous conditions from continence; mental depression, with weakness in the lower extremities after sexual abuse or imperfect intercourse and great nervous excitability, Kali bich.—Constrictive pain at the root of the penis on awakening in the morning; pain in the penis; stick- ing pains in the prostatic region, preventing walking; dis- charge of prostatic fluid during stool: frequent micturition, with burning along the urethra after the act; burning in the bulbous urethra and fossa navicularis when urinating and afterwards; urine turbid and thick, milky, with whitish sedi- ment; urine high-colored, with pearl-white sediment and white film. Kali carb.—Emissions followed by weakness; erections, with voluptuous dreams; coition, without emission; violent erections during sleep; painful and spasmodic contraction of the spermatic cord; soreness and bruised pain in the scrotum; itching of the scrotum, preventing sleep; drawing, tearing, burning sensations, with tension and itching of the glans or meatus, becoming tearing and itching; tearing at the neck of the bladder when not urinating, with cutting pain during the act; burning and cutting pain in the urethra dur- ing and after urinating; urging desire to urinate but obliged to wait some time for the flow to commence; discharge of prostatic fluid after micturition; urine dark yellow and cloudy; turbid, with much sediment on standing. Kali iod. — Erections tardy; coition painful, prolonged, with no emission; atrophy of the testes; frequent micturi- tion; increased micturition at night; bladder irritable; urine 146 SEXUAL DISORDERS OF MEN. pale and watery; increase of the ammonia-magnesia-phos- phates. Sterility from specific disease. Lachesis.—Excessive desire, with constant erections at night; during the day amorous thoughts, and at night lascivi- ous and quarrelsome dreams; awakening in the morning, with pain and bruised feeling in the loins with relaxed penis; erec- tions feeble; inability to accomplish the act; emissions during the mid-day nap, followed by weakness and headache; pollu- tions at night, followed by unconsciousness and weakness; seminal fluid has a penetrating odor; urinary symptoms are aggravated by alcohol in all forms; discharge of a milky fluid from the urethra; discomfort in the region of the bladder; slimy sediment in the urine; milky, gleety discharge after mic- turition; cutting, sticking pains in the fore part of the ure- thra; pressure and burning in the urethra during urination; jealousy; incessant talk; nervous palpitation; can bear noth- ing tight around the throat or abdomen. This remedy is especially useful in the early stages of sexual derangements. Ledum. — Excessive and constant erections; nocturnal pollutions, without dreams; seminal fluid bloody and watery; constant desire to urinate; burning in the urethra after urinating; stitches in the meatus. Lithium.—Pains in the right side of and at the root of the penis; throbbing stitch-like pains in the penis when sitting; twitching stitch-like pains in the seminal vesicles, super- pubic region and in the spermatic cord; tenesmus before and after micturition, urine copious, clear and frothy; urination followed by sensitiveness and pain in the middle of the urethra; fugitive pains in the region of the bladder, especially on the right side, before urinating; afterwards extending to the left spermatic cord. Lycopodium.—Erections imperfect or absent; parts cold, small, relaxed and shriveled; licentious thoughts cause no erection, though they may be persistent and the inclination may be ever present; voluptuous dreams and fancies, with excessive emissions, followed by great exhaustion; dread of sexual intercourse after too much indulgence; complete impotence; erections absent or imperfect; falls asleep during co;tion, without emissions; drawing and sticking pain in THERAPEUTICS. 147 the seminal ducts; sticking, griping, pinching pains in the testes; scrotum relaxed; sticking, cutting, jerking, drawing pains in the penis; pain in the perineum when sitting; pain in the region of the bladder and scrotum; discharge of prostatic fluid; thin and yellowish discharge from the urethra, with burning after micturition; constant desire to urinate, with tickling in the urethra; micturition ceases suddenly with the discharge of a few drops of slimy fluid, with pain in the urethra and groin; frequent micturition at night, with interrupted urination and subsequent dribbling of the urine; urine burning, of ammoniacal odor; urine turbid, as if mixed with brick dust; urine copious, with red, sandy deposit; low- spirited, melancholy, despondent, desires to be alone, dreads the company of men; general prostration and emaciation, faintness at certain hours of the day; gastric disorders. The old man's balm; mental torpor; confusion of thoughts and words. Magnesia carb.—Sexual desire diminished, and, while erections appear slowly, intercourse terminates naturally; discharge of prostatic fluid; during emission of flatus; fre- quent micturition with smarting in the urethra, during and after the act; stitching pains in the fore part of the urethra; urine has a whitish sediment. Magnesia mur.—Violent erections; if the desire is not satisfied it is followed by pain in the testes, spermatic cords and small of the back, with soreness and tenderness of the testes: frequent emissions; morning erections, with burn- ing pains in the penis; urine voided in drops, some always seeming to remain behind; micturition only possible by exer- tion of the abdominal muscles, and it may even be necessary to press upon the abdomen with the hands to facilitate the act; frequent micturition day and night, accompanied with burn- ing in the urethra and frequent erections; involuntary mic- turition when walking, yet on attempting to urinate no urine is passed; urine almost opaque, as if mixed with yeast; deposit copious. Manganum.—Drawing pains and weakness in the sper- matic cords and testes; itching pains within the scrotum, re- lieved by manipulating the parts; itching of the corona glandis; 148 SEXUAL DISORDERS OF MEN. burning, dragging pains from the seminal vesicles to the glans; cutting pains in the region of the bladder in the even- ing when sitting, aggravated when standing and walking; cutting and sticking pains in various portions of the urethra, when not urinating; increased frequency of micturition. Mercurius corr.—Violent erections, with great desire; coitus slow, emission delayed; sticking pain in the right testicle; sticking pain in the fore part of the urethra in the evening after urinating, when walking, accompanied with pain in the anus and left testicle; burning during micturition; itching in the orifice of the urethra, with burning, biting and sticking pain through the urethra during urination; micturi- tion frequent, painful, difficult, ineffectual. Mercurius sol. H.—Impotence; emissions at night; fre- quently bloody in character; cutting, biting and burning in the urethra when beginning to urinate, increased toward the end of the act; frequent urging to urinate, after a nocturnal emis- sion; urine looks as if mixed with meal; urine clear at first, but afterwards as if mixed with chalk, followed by pain and burn- ing in the urethra and when touching the penis. Acute sup- purative prostatitis. Mezereum.—Frequent erections during the day, becom- ing violent in the evening, with yawning and sleepiness; testi- cles painful to pressure; drawing and stitching pains in the spermatic cords; after emission or sexual excitement, crawling over the whole body, as from lasciviousness; swelling and heat of the penis; stitches in the meatus; tearing and jerking pains in the penis and right side of the abdomen; after urination, discharge of a few drops of blood; between the acts of urination, discharge of a watery mucus and tena- cious transparent fluid; sticking, crawling pain in the urethra, with emission of fluid; cutting pain in the fore part of the urethra after micturition; drawing, cutting pains at the neck of the bladder when walking; frequent micturition; dark, wine-colored urine, becoming turbid on standing; bloody and hot, with reddish sediment. Moschus.—Increased sexual desire; involuntary emis- sions; painful emissions without erections; great pain in the penis, followed by relaxation; coitus followed by nausea and THERAPEUTICS. 149 vomiting; during erection, burning in the urethra; urine clear and copious, or scanty and thick as yeast. Mygale.—Violent erections of the penis; penis curved, ex- quisitely painful. Naja.—Great sexual desire, with psychical impotence; awakes at night, with vivid imaginations and involuntary emissions, followed by prostratiou and great distress; sting- ing, burning pains along the right side of the penis; uneasi- ness and pressure in the region of the bladder; urine straw- colored, loaded with mucus. Natrum carb.—Erections in the morning, without sexual excitement; frequent erections during the day, often violent and painful; nocturnal pollutions, followed next day by fret- fulness and discontent; lascivious dreams, without erections; intercourse incomplete; erections imperfect, ejaculation too early; heaviness, pain and pressure in the testes and spermatic cords; priapism towards morning; emission, without desire, followed by tensive cutting pains in the penis; excessive irrita- bility of the genital organs; coitus always followed by physical weakness; glans penis swollen; pain back of the glans, with erections after coitus; emissions retarded during an embrace; nocturnal emissions, even immediately after coitus; discharge of prostatic fluid during stool or voided with the urine; tearing and smarting in the urethra during micturition; pain in the ure- thra and testicles; burning in the urethra during and after micturition; frequent desire to urinate, urine may be scanty or copious; desire to urinate continues after finishing the act; when voiding the last few drops of urine cutting in the bladder and discharge of a few drops of mucus; frequent micturition at night; urine sour-smelling, offensive, becomes turbid soon after passing. Natrum mur.—Emissions even after coitus; great weak- ness after seminal emissions; erections not strong; ejac- ulations weak; pollutions followed by backache, night sweat, weakness in the limbs and melancholia; nightly pollutions, with or without erethism or lascivious dreams, followed by weakness of the back; trembling of the knees, as if they would give way; sudden voluptuous irritation when sitting, relieved by walking; sexual erethism, followed by depression I5Q SEXUAL DISORDERS OF MEN. and weakness; emission delayed or abenst during coition; ejac- ulation too early; emissions with the morning stool; pain in the testicles; stitching, pinching pains transversely in the neck of the bladder when walking; after urinating, discharge of a thin, yellow, purulent liquid, soiling the linen; may cause burning and itching in the urethra; discharge of pros- tatic fluid, with lascivious thoughts, without excitement and without erection; constant moisture of the meatus, with draw- ing pains in the spermatic cord; sticking pains in the fossa navicularis during and after micturition and after coitus; burning and cutting in the urethra towards the close of mic- turition, followed by thin moisture; agglutination of the meatus in the morning; urging to stool, with constriction in the rectum; dribbling after micturition, with pressure in the rectum so he could not sit down; urging to urinate, with fre- quent micturition; urine turbid, with strong odor, milky iu the morning, depositing a white sediment; urine clear, greenish, reaction feebly acid, frothy on shaking. Natrum phos.—Pollutions nightly, with or without ere- thism or lascivious dreams, but followed by weakness in the back; trembling in the knees, as if they would give way. Nuphar lut.—Impotence; entire loss of sexual desire and erections; diminution of carnal thoughts and inclination; voluptuous ideas and imaginations do not cause erection; noc- turnal pollutions; discharge of seminal and prostatic fluid during stool and with the urine. Nux vom.—Involuntary emissions; erections easily ex- cited; during an embrace the penis often becomes relaxed; nocturnal pollutions; pollutions without erections, followed by relaxation of the lower part of the body, coldness of the feet; emissions occur mostly toward morning, followed by headache and difficulty in walking; constrictive and stitch- like pains in the right testicle and spermatic cord; pain in the neck of the bladder before micturition, with burning and tearing during the act and pressure afterwards; discharge of tenacious mucus during micturition; constriction in the fore part of the urethra, extending backwards; itching and burning in the urethra when urinating; frequent, painful, ineffectual urging to urinate; incontinence of urine; urine THERAPEUTICS. 151 turbid, watery, pale, followed by a discharge of thick, whitish matter; nervous depression; irritability; over-sensitiveness to external impressions; inclined to fault-finding; habitual mali- ciousness; debility of the nervous system; sensation of heavi- ness of the body, alternating with lightness; aversion to motion in the open air; attacks of faintness; gastric and bilious disturbances; congestion of the abdominal organs. Especially useful in derangements resulting from self abuse or excesses at an early age. Opium. — Erections during sleep, but impotent when awake; involuntary emissions at night, even when awake; procreative power lessened; tenesmus on beginning to urinate; is obliged to wait on account of spasm of the sphincter vesicae; stream interrupted; micturition possible only after long exer- tion; urine turbid, scanty, brown, with iridescent film; trembling of the whole body, with external coldness and jerk- ing of the limbs; stupid, indifferent. Osmium.— Priapism; rigid erections after midnight and on awaking in the morning; continuing after rising without spe- cial sexual desire; during coition, long-lasting emission of semen; sexual acts suppressed; conjugal act accomplished by volition, the usual thrill and ejaculation being absent; pain in the testicles, preventing sleep, and in the spermatic cord, ex- tending into the testicles; stinging, throbbing, pinching pains on the left side of the glans and in the tip of the penis. Paris quad.—Sexual erethism, with rigid erections; desire increased, with voluptuousness during coition; nocturnal pol- lutions; burning, drawing and sticking in the fore part of the urethra between and during micturitions; frequent desire and urging to urinate; has to wait a few minutes before the act can be accomplished; tenesmus after urinating; urine turbid and on standing becomes covered with a fatty film. Petroleum. — Frequent erections without amorous thoughts; violent desire, with itching of the genitals on awakening in the morning; emissions followed by anxious heat; discharge of mucus with the urine; jerking in the urethra, as in ejaculation of semen; cutting in the neck of the bladder, at the beginning and end of micturition, and during the act so severe that the urine may stop; frequent desire to '52 SEXUAL DISORDERS OF MEN. urinate, only a little being voided; burning at the neck of the bladder, involuntary micturition; urine bloody, turbid, offensive, depositing a reddish film, which adheres to the ves- sel; excited, irritable; inclination to anger and to scold; sad- ness, despondency; great deblity and trembling; fainting, with ebullitions; heat, pressing on the heart, palpitation; sleep, with distressing dreams, as though some one was lying alongside of him Phosphorus. — Uncontrollable sexual desire; frequent emissions, with great feebleness, loss of strength and flesh; abnormal sexual app tite and excitability, with burning, tingling and formication along the spine; erotomania; great sexual excitement; revealing the person without shame and seek to gratify debased appetites without regard to time or place; sexual niania; constant torment for an embrace, fol- lowed by impotence; discharge of seminal fluid during stool; nightly emissions, with great prostration; discharge of fluid from the urethra during stool, after micturition, from friction of the clothes or when talking to a woman; genital organs re- laxed, with moisture at the meatus as of prostatic fluid; discharge of prostatic fluid when walking; moisture at the meatus, yellow and causing a yellow stain; cutting and sticking pain in the anus and perineum when at stojl and urinating; pain in the penis, with cramp-like pain in the upper part of the scrotum, aggravated when urinating; burning, sticking pains in the fore part of the urethra during micturi- tion, often extending forward from the scrotum when not urinating; discomfort and biting in the fore part of the penis; dribbling and burning after urinating; urination difficult and burning; urine covered with an iridescent, fatty film; whey- like sediment, whitish, like white sand; urine offensive, hav- ing the odor of violets; urine milky white; contains an abun- dance of triple phosphates, epithelium, etc Great excitability; becomes easily vexed and angered; never wants to be left alone in a room; mental application difficult, cannot think; easily fatigued; vertigo on arising in the morning or on rising from a seat; dull pain in the head; trembling on beginning to walk; tired feeling; difficulty in walking; heaviness of the back and limbs; locomotor ataxia from sexual excesses. THERAPEUTICS. 153 This remedy will be indicated not only in satyriasis, but is required in impotence and other sexual disorders which have resulted from over-excitability or abuse of the genital organs. Impotence from chastity is frequently cured by this remedy. It is also indicated in those who have lived a rapid life and are trying to restrain their passions and are unable to do so from local erethism, etc. Phytolacca.—Frequent gurgling sensation in the prostate, grinding and sharp pains, sometimes paroxysmal, shooting up the spermatic cords, followed by soreness; urine copious, clear and watery, chalk-like sediment. Platinum.—Sensitiveness and pressure in the mons veneris, with internal shaking and external coldness, followed by op- pression, anxiety and exhaustion; sexual desire inordinately increased, with violent erections, especially at night; exces- sive sensitiveness and titilation in and upon the genital organs, with an almost uncontrollable desire for an embrace; satyria- sis; sexual desire and strength abnormal; micturition fre- quent, but slow; urine red, with white clouds, becoming turbid on standing; spasms and convulsions from abuse of the sexual organs previous to puberty; the mental symptoms are charac- terized by haughtiness, egotism and a feeling of self-superior- ity; looks upon everyone as being inferior; objects appear smaller than normal; home associations appear strange; great excitability of the nervous system; sees horrid objects, de- mons, ghosts, etc.; hysterical conditions, crying and laugh- ing at inopportune times and places. In boys this drug is frequently required where they have masturbated to excess before puberty, resulting in hollow eyes, yellow skin, melan- cholia and sheepishness; tendency to spasms and epilepti- form seizures; consciousness not often lost, the limbs are drawn up and separated. Grauvogl says this remedy will cure mental imbecility resulting from masturbation. Plumbum.—Impotenc; penis flaccid; frequent erections, with spasmodic contraction of the testes, and emissions during the colic; violent emissions on the slightest provocation, scanty during coition; shooting pains through the testicles, almost causing faintness; paroxysmal jerking pains in sper- matic cord, extending into the left testicle; induration of the 11 154 SEXUAL DISORDERS OF MEN. prostate; pain, itching and burning in the neck of the blad- der and perineum; micturition difficult, by drops a little at a time. Pulsatilla.—Itching in the region of the seminal vesicles, causing inclination for an emission without erection, and without amorous thoughts; nocturnal pollutions, followed by lassitude and heaviness in the limbs; sticking, cutting pains, with pressure at the neck of the bladder, without the desire to urinate; burning in the neck of the bladder, as if it would compel micturition; backache, extending into the hips. Acute prostatitis. Rana bufo.—Imbecility and loss of decency. Useful in convulsions from masturbation and in those who seek solitude, to practice the vice. Fits during coition; constant pulling at the penis. Sabadilla. — Painful erections in the morning without desire; insensible to excitement; nauseated by amourous caresses; penis relaxed, accompanied by lascivious dreams and emissions; afterwards painful erections and extreme lassi- tude; desire lost; pollutions, followed by loss of power in the extremities; genitalia relaxed; mind filled with voluptuous thoughts, which cannot be expelled; intermittent, bruised pain in the left testicle; slow, undulating motion in the testi- cles, with tingling from thigh to thigh; drawing, beating, sticking, intermittent pains in the tip of the penis; constant desire to urinate, with burning in the urethra; scalding when urinating; urine muddy, mixed with blood. Sabal ser.—Weakened sexual power; impotence; loss of ejaculatory thrill; discharge of yellowish, watery prostatic fluid; prostate enlarged, with dull, throbbing, aching pain at the neck of the bladder; sharp pains in the testes and sper- matic cords, with depression of spirits; urinary retention; dribbling of urine; lack of mental vigor. Muscular jerk- ing of the body on first lying down, which awakens him from sleep. Sarsaparilla.—Desire for coitus, with restless sleep and emissions; pollutions bloody, with lascivious dreams; the least carnal excitement causes emissions without sexual feeling; pollutions followed by backache, prostration, vertigo, etc.; tearing pain from the glans to the root of the penis; burning THERAPEUTICS. 155 pain in the urethra during micturition; urine copious, con- taining elongated flakes; urine turbid when voided; on stand ing, clay-colored sediment and iridescent pedicle; strangury, with discharge of mucus and a white, turbid matter; when urinating the stream frequently stops, with burning and straining; swelling and soreness of the spermatic cord, espe- cially after sexual excitement. Secale corn.—Erections vigorous and numerous, even after coition; dragging in the spermatic cord; testes draw up to the groin; micturition frequent and copious; burning and cutting in the urethra, during micturition. Selenium.—Impotence, with lascivious thoughts; carnal desires, mental not physical; erections slow and incomplete; emissions premature; seminal discharge thin and without odor; seminal discharges when walking; discharge of a sticky watery substance before and during stool; dribbling of pros- tatic fluid, with disagreeable sensation; dribbling of prostatic fluid, after urinating walking and sitting; always obliged to urinate after stool; sensation as if a biting drop was forcing its way out of the urethra; urine dark and scanty, with the odor of violets; jerking pains in the testicles; general relaxa- tion of the system, all conditions worse after sleep and from mental or physical exertion; easily fatigued; irritability; headache, sleeplessness and mental confusion; paralytic weak- ness of the spine; wants to sleep from sheer exhaustion, yet is always worse after sleep. Pollutions are followed by irrita- bility, mental confusion, paralytic weakness, etc. Sepia.—Coition and nocturnal emissions, followed by erec- tions; erections painful when sitting, after the bath; erections strong, but emissions premature; intercourse followed by vertigo, weakness of thought, relaxation of the body, low- spiritedness and nervousness; imperfect emissions, with las- civious dreams; intercourse unsatisfactory; seminal fluid watery; heat, pinching, cutting, tearing, rheumatic pains in the testicles and along the thighs; discharge of a milky fluid from the urethra after micturition and with a difficult stool; burning in the fore part of the urethra after micturition; tear- ing and smarting near the meatus; burning in the fore part of the urethra; pressure in the bladder, must wait a long 156 SEXUAL DISORDERS OF MEN. time before the urine comes; burning in prostatic urethra without desire to urinate; urine copious; general relaxation, fatigue and exhaustion; staggering gait and forgetfulness from sexual excesses; coitus is followed by restlessness and anxiety; chronic headaches. Silicea.—Sexual desire increased; violent erections during the day, at night without desire; discharge of prostatic fluid when straining at stool; dragging pain in the prostate, ex- tending forward; testicles retracted; pain in the testicles and spermatic cord; worse at night; urging to urinate at night, with erections, burning and smarting in the urethra; cutting and burning in the urethra when urinating; stick- ing in the fore part of the urethra; exhaustion; patient dreads exertion of mind or body, but when the work is com- menced they do fairly well; numbness in the toes, fingers and back, with constipation. Solidago virgo aurea.—Doctor Gallavardin records the fact that the first dilution of this remedy in seven cases, ranging from 42 to 74 years of age, in which catheterization was necessary for weeks, months and years, were thoroughly cured, the indications being scanty urine, with dark brown sediment, pains in the kidneys, etc. Stannum.—Erections at night and emissions with lasci- vious dreams, especially when sleeping on the back; voluptu- ous excitement of the whole body, even to a pollution; erections at night without emissions, and without lascivious thoughts; drawing, tearing pains in the testicles; discharge of prostatic fluid after hard stool; burning in the urethra, and sprained pain in the upper part, during and after micturition; biting and crawling in the orifice of the urethra and along the canal when not urinating; jerking pains in the penis, almost as if ejaculating semen; pain in the neck of the blad- der and along the urethra, after urinating; seems as if more urine would pass, and some drops follow, when the pressure is worse; frequent micturition at night, in a thin stream; dribbling sensation, as if the bladder were not empty, with erections; burning at the neck of the bladder and frequen, desire to urinate; fullness in the bladder; urine scanty and offensive; frequent desire to urinate; great anxiety and rest- THERAPEUTICS. 157 lessness; irritable, sadness, disinclination to talk; vertigo, seems as if all objects were too far off; pains as if paralyzed in the extremities; emaciation, weakness and trembling, felt more when slowly exercising or walking. Staphisagria.—Prostatic irritation and posterior urethritis, the result of unnatural or perverted thoughts or habits. This drug is frequently indicated for the results of per- verted sexual habits and the dwelling of the mind upon these subjects, more than the result of any excessive sexual habits or vice. These conditions are frequently accompa- nied in the male by prostatic irritation or posterior urethritis. Useful in masturbation and other sexual perverts who be- come over-sensitive and easily angered; in these cases this remedy is frequently of untold value, as well as for those nervous derangements of highly nervous patients, when continence is enforced from reading and pondering on im- pure literature; nervous system worn out; weakened and undermined condition of brain and spinal cord, caused by perverted sexual habits, or the result of a mental state which has allowed the mind to dwell too much on sensual thoughts; gloomy; apathetic condition; shy, peevish; prefers solitude, and avoids the company of the opposite sex; the face appears shrunken; eyes listless, deep-set and hollow, surrounded by dark rings; nose pointed; great emaciation. This remedy is characterized by constant suspicion; chip on the shoulder waiting for some one to knock it off. Sulphur.—Genital organs relaxed; testicles and scrotum hang down; penis cold; erections infrequent; involuntary dis- charge of spermatic fluid, with burning in the urethra; if coitus is attempted the ejaculation occurs too early, almost at the first contact of the parts, and before intromission; noc- turnal pollutions frequent; discharge of prostatic fluid after micturition; seminal fluid thin, watery and almost inodorous; tingling in the testicles; sticking pains in the neck of the bladder passing through the anus, with soreness on pressure; dragging and pressure in the prostatic region, after micturi- tion, with sensation as though the urine was retained by con- traction of the sphincter, with the same sensation in the anus; urging to urinate at night, with cutting pains over the sym- 158 SEXUAL DISORDERS OF MEN. physis pubis; frequent urging to urinate, with voluptuous pressure reaching as far as the anus; discharge of prostatic fluid from the urethra in long threads, after micturition and stool; sticking in the fore part of the urethra in the morn- ing; painful ineffectual desire to urinate; retention of urine; hypochondriacal; faintness; low-spiritedness; peevishness; irritability; difficult thought and speech; heat on top of head; cold feet; backache; weakness in the lower extremities; un- able to digest milk or farinaceous food; chronic prostatitis; profoundly melancholy; forgetful; constant pain upon the top of the head. Useful for the bad results following sexual ex- cesses. Sumbul.—Desire absent, from physical weakness; erec- tions few and without pleasurable sensations. Thuja.—Prostatitis following gonorrhoea; impotence after gonorrhoea; painful erections at night; nocturnal pollutions; watery discharge from the urethra. Tribulus ter. (Indian name, Ikshugandha.) — It has proved useful for sexual disorders caused by sexual excesses, by irritation or chronic inflammation of the prostatic gland, seminal vesicles, etc., or masturbation, and both diurnal and nocturnal emissions. Also for impotence caused by mastur- bation and accompanying spermatorrhoea, especially when the vice has not been committed to such an extent as to have ruined the nervous system, and for partial impotence or seminal debility caused by excess or impotence produced by diseased state of the testes, with resulting thin and watry se- cretions. In impotence accompanied by such urinary trouble as painful micturition, inability of the bladder to keep the urine for a long time, etc. It is more suitable in partial im- potence and seminal debility than a thoroughly confirmed case of impotence where sexual pleasure and erection are entirely lost. It is used in painful micturition, calculous affections, urinary disorders and spermatic derangements. Of great benefit for old persons getting weak sexually day by day. Dose, 10 to 20 drops of the ti three or four times a day. Ustilago.—Erections frequent during the day; irresistible desire to masturbate: pain in the testicles, sometimes neural- gic in character, sometimes causing a faint feeling, genitalia THERAPEUTICS. 159 relaxed, with a cold sweat upon them; eratic fancies, fol- lowed by prostration, dull pain in the back, and irritability. Veratrum vir.—Frequently indicated, according to its general symptomatology, in acute prostatitis and acute seminal vesiculitis. Zincum.—Emissions at night without lascivious dreams; ejaculation premature; spermatorrhoea; neuralgic pains in the spermatic cord, with headache and depression of spirits; discharge of prostatic fluid; after painful micturition, flow of blood; urine discharged in a thin stream, with dribbling; cut- ting, drawing, tearing pains in the fore part of the urethra; urine yellow, depositing white flakes; the last urine voided has a turbid appearance; these patients cannot keep quiet, must be in motion all the time; hypochondriacal. Useful in spermatorrhoea following long-lasting self-abuse, with face pale, sunken, and blue rings around the eyes. INDEX. \ CIDUM fiuoricum, 126 ■^ muriaticum, 126 nitricum, 126 oxalicum, 127 phosphoricum, 127 picricum, 128 Aconite, 128 Agaricus muse, 128 Agnus cast, 129 Ambra gris., 129 Anacardium, 130 Aloe soc, 130 Algolagnia, active, 121 passive, 121 Alumina, 131 Ampullar fluid, 16 Ampullations of Henel, 16, 18, 19, concretions in, 48 treatment of, 48 cystic disease of, 47 treatment of, 48 injuries of, 47 malformations of, 47 malignant growths of, 48 treatment of, 48 Ampullitis, acute, 24 etiology of, 24 pathology of, 24 clinical history of, 25 diagnosis of, 27 prognosis of, 27 treatment of, 27 chronic, 30 etiology of, 30 pathology of, 31 clinical history of, 32 diagnosis of, 37 prognosis of, 39 treatment of, 39 tubercular, 44 etiology of, 44 clinical history of, 44 diagnosis of, 44 prognosis of, 45 treatment of, 45 Androgyay, 122 Argentum nit., 131 Arnica mont., 131 Aspermatism, true, 125 false, 125 Aurum met., 132 Azoospermatism, 124 DIFID penis, 95 u Baryta carb., 132 Belladonna, 132 Berberis vulg., 133 Bloody emissions, 31 Borax, 133 Bottini's galvano-caustic incision for prostatic hypertrophy, 75 Freudenberg's modification of, 75 Bottcher's crystals, 105 Brachyglottis, 133 Bromium, 133 nACTUS grand., 134 ^ Caladium, 134 Calcarea acet., 134 carb., 134 phosph., 135 Calculi, preputial, 95 prostatic, 84 clinical history of, 84 treatment of, 84 l62 INDEX. Camphor, 136 Cannabis Ind., 136 sat., 136 Cancer of the male generative or- gans, 95 Cantharis, 136 Capsicum, 137 Carboneum sulph,, 137 Carbo veg., 138 Carcinoma of the prostate, 83 etiology of, 83 clinical history of, 83 diagnosis of, 83 prognosis of, 84 treatment of, 84 Castration for prostatic hypertrophy, 78 Catarrhal inflammation of the veru- montanum aud the prostatic ure- thra, chronic, 62 etiology of, 62 pathological anatomy of, 62 clinical history of, 62 prognosis of, 63 treatment of, 63 prostatitis, chronic, 55 etiology of, 55 pathological anatomy of, 55 clinical history of, 56 diagnosis of, 58 prognosis of, 59 treatment of, 59 Causticum, 138 Catheters, care of, 74 China off., 138 Chlorinum, 139 Clematis erect., 139 Cobaltum, 139 Concretions in the seminal vesicles and ampullae, 48 treatment of, 48 Congestion of the prostate, 49 etiology of, 49 clinical history of, 49 prognosis of, 49 treatment of, 49 Conjugal onanism, 30 Conium mac, 139 Copulation, 17 Cubeba, 140 Cuprum acet., 140 Cystic diseases of the ampullae and seminal vesicles, 47 treatment of, 48 Cysts of the prostate, 84 TDERANGEMENTS of the sexual •^ functions of man, 99 etiology of, 99 clinical history of, 99 prognosis of, 109 treatment of, 110 Digitalis, 140 Dioscorea, 140 Double penis, 95 Duration of priapism, 86 pFFEMINATION, 121 ^ Ejaculation, 17 Emasculation for prostatic hyper- trophy, 78 Emissions, pathological, 102 treatment of, 102 physiological, 102 Equisetum, 140 Erection of the penis, 17 Erethism, sexual, 99 Eryngium aquat., 141 Excesses, sexual, 120 pERRUM, 141 *- Fibroid sclerosis of the penis, 96 etiology of, 96 clinical history of, 96 treatment of, 97 Fracture of the penis, 97 treatment of, 98 p ANGRENE of the penis a cause ^ of organic impotence, 95 Gelsemium, 141 INDEX. 163 Ginseng, 142 Glands, Cowper's, 17 Glans penis, vegetations on, 95 treatment of, 95 Gnaphalium, 142 Graphites, 142 Gynandry, 122 TTAMAMELIS, 143 Hepar sulph. calc, 143 Hermaphroditism, psychical, 121 Heterosexuality, 121 Homosexuality, 121 Horny growths of the penis, 95 treatment of, 95 Hydrocotyle, 143 Hyoscyamus, 143 Hypertrophy of the prostate, 66 etiology of, 66 pathological anatomy of, 67 clinical history of, 69 diagnosis of, 71 treatment of, 71 TGNATIA, 143 A Impotence, 100 treatment of, 100 organic, 94 from abnormal size of the penis, 94 absence of the penis, 94 bifid penis, 95 cancer of penis, 95 chancroidal ulceration, 94 congenital defects of the penis, 94 curvature of the penis, 98 double penis, 95 elephantiasis of the penis and scrotum, 94 fibroid sclerosis of the corpora cavernosa, 96 of the corporus spongiosum, 96 fracture of the penis, 97 gangrene of the penis, 95 horny growths of the penis, 95 infantile penis, 94 monstrosity of the penis, 94, 95 ossification of the penis, 97 phagedena of the penis, 95 preputial calculi, 95 rudimentary penis, 94 syphilis of the penis, 97 traumatism of the penis, 94 vegetations on the penis, 95 psychical, 88 prognosis of, 88 treatment of, 89 symptomatic, 92 treatment of, 93 Injuries of the ampullae and seminal vesicles, 47 of the prostate, 85 Introduction, 9 lodium, 144 J ATROPIA, 141 T/ALI brom., 144 *•*■ bich , 145 carb., 145 iod., 145 Kemp's prostatic cooler, 60 T ACHESIS, 146 *** Ledum, 146 Leucaemia and priapism, 86 Ligation of internal illiac artery for hypertrophy of the prostate, 80 of the vas deferens for hypertrophy of the prostate, 79 Lithium, Littres follicles, 17 Lycopodium, 146 if AGNESIA CARB., 147 "*■ mur., 147 Male sterility, 123 Malformation of the ampullations of Henel, 47 of the seminal vesicles, 47 164 INDEX. Malignant growths of the ampullae and seminal vesicles, 48 treatment of, 48 of the prostate, 83 etiology of, 83 clinical history of, 83 diagnosis of, 83 prognosis of, 84 treatment of, 84 Manganum, 147 Masturbation, 117 treatment of, 119 Mercurius corr., 148 sol. H., 148 Mezereum, 148 Misemission, 125 Moschism, 121 Moschus, 148 Mygale, 149 jaAJA, 149 ■^ Natrum carb., 149 mur., 149 phos., 150 Nocturnal emissions, 102 pathological, 102 physiological, 102 Nuphar lut., 150 Nux vom., 150 OLIGOSPERMATISM, 123 " Oligozoospermatism, 124 Onanism, 117 treatment of, 119 conjugal, 30 Opium, 151 Orcheotomy for prostatic hyper- trophy, 78 Organic impotence, 94 from abnormal size of the penis, 94 absence of the penis, 94 bifid penis, 95 cancer of the penis, 95 chancroidal ulceration, 94 curvature of the penis, 98 double penis, 95 elephantiasis of penis and scro- tum, 94 fibroid sclerosis of the penis, 96 fracture of the penis, 97 horny growths of the penis, 95 infantile penis, 94 monstrosity of the penis, 94, 95 ossification of the penis, 97 overhanging abdomen, 94 preputial calculi, 95 rudimentary penis, 94 syphilitic nodes in the penis, 97 traumatism of the penis,,94 vegetations on the penis, 95 Osmium, 151 Ossification of the penis, 97 treatment of, 97 DARIS quad., 151 1 Penis, abnornal size of, 94 absence of, 94 bifid, 95 cancer of, 95 treatment of, 95 congenital defects of, 94 curvature of, 98 double, 94 elephantiasis of, 94 fibroid sclerosis of, 96 etiology of, 96 clinical history of, 96 treatment of, 97 fracture of, 97 treatment of, 98 horny growths of, 95 treatment of, 95 infantile, 94 monstrosity of, 94, 95 ossification of, 97 treatment of, 97 syphilitic gummatic deposits of, 97 treatment, 97 torsion of, 98 vegetations on, 95 treatment of, 95 webbed, 95 INDEX. 165 Peri-urethral fluid, 17 Petroleum, 151 Phosphorus, 152 Phosphoric acid, 127 Physiological consideration of the male generative apparatus, 13 Phytolacca, 153 Platinum, 153 Plumbum, 153 Pollutions, 102 Priapism, 86 and cerebro-spinal disease, 86 clinical history of, 86 duration of, 86 etiology of, 86 leucaemia, and other general causes, 86 modes of onset, 86 prognosis, 86 traumatism, cause of, 86 treatment of, 86 Preputial calculi, 95 Prevention of sexual disorders of men, 21 Polypus of the prostatic urethra, 85 Piostate, hypertrophy of, 66 etiology of, 66 pathological anatomy of, 67 clinical history of, 69 diagnosis of, 71 treatment of, 71 malignant growths of, 83 etiology of, 83 clinical history of, 83 diagnosis of, 83 prognosis of, 84 treatment of, 84 Prostatectomy, 77 Alexander's operation, 77 Nichol's operation, 77 Prostatic calculi, 84 clinical history of, 84 treatment of, 84 congestion, 49 etiology of, 49 clinical history of, 49 prognosis of, 49 treatment of, 49 cysts, 84 injuries, 85 urethritis, 62 etiology of, 62 pathological anatomy of, 62 clinical history of, 62 prognosis of, 63 treatment of, 63 Prostatitis, acute, 51 etiology of, 51 pathological anatomy of, 51 clinical history of, 51 diagnosis of, 52 prognosis of, 52 treatment of, 53 chronic catarrhal, 55 etiology of, 55 pathological anatomy of, 55 clinical history of, 56 diagnosis of, 58 prognosis of, 59 treatment of, 59 tubercular, 81 etiology of, 8 r pathological anatomy of, 81 clinical history of, 81 diagnosis of, 81 prognosis of, 82 treatment of, 82 Prostatorrhoea, 105 etiology of, 105 microscopic character of, 105 treatment of, 106, no Psychophore, rectal, Carleton, 41 Psycopathia sexualis, 117 Psychical impotence, 88 treatment of, 89 REFLEXES in sexual disorders, 108 treatment of, 109 Remedies for sexual disorders of men, 126 Acidum fluoricum, 126 muriaticum, 126 i66 INDEX. nitricum, 126 oxalicum, 127 phosphoricum, 127 picricum, 128 Aconite, 128 Agaricus muse, 128 Agnus cast., 129 Ambra gris., 129 Anacardium, 130 Aloe soc, 130 Alumina, 131 Argentum nit., 131 Arnica mont., 131 Aurum met., 132 Baryta carb ,132 Belladonna, 132 Berberis vulg., 133 Brachyglottis, 133 Bromium, 133 Borax, 133 Cactus grand., 134 Caladium, T34 Calcarea acet., 134 carb., 134 phosph., 135 Camphor, 136 Cannabis Ind., 136 sat., 136 Cantharis, 136 Capsicum, 137 Carboneum sulph., 137 Carbo veg., 138 Causticum, 138 China off., 138 Chlorinum, 139 Clematis erecta, 139 Cobaltum, 139 Conium mac, 139 Cubeba, 140 Cuprum acet., 140 Digitalis, 140 Dioscorea, 140 Equisetum, 140 Eryngium aquat., 141 Euphorbium, 141 Ferrum, 141 Gelsemium, 141 Ginseng, 142 Gnaphalium, 142 Graphites, 142 Hamamelis, 143 Hepar sulph., calc, 143 Hyoscyamus, 143 Hydrocotyle, 143 Ignatia, 143 lodium, 144 Jatropia, 144 Kali brom., 144 bich,, 145 carb., 145 iod., 145 Lachesis, 146 Ledum, 146 Lithium, 146 Lycopodium, 146 Magnesium carb., 147 mur., 147 Manganum, 147 Mercurius sol. H., 148 corr., 148 Mezereum, 148 Moschus, 148 Mygale, 149 Naja, 149 Natrum carb., 149 mur., 149 phosph., 150 Nuphar lut., 150 Nux vom., 150 Opium, 151 Osmium, 151 Paris quad., 151 Petroleum, 151 Phosphorus, 152 Phytolacca, 153 Platinum, 153 Plumbum, 153 Pulsatilla, 154 Rano bufo, 154 Sabadilla, 154 Sabal serr., 154 Sarsaparilla, 154 Secale corn., 155 Selenium, 155 INDEX. [67 Sepia, 155 Silicea, 156 Solidago virga aur., 156 Stannum, 156 Staphisagria, 157 Sulphur, 157 Sumbul, 158 Thuja occ, 158 Tribulus ter., 158 Ustilago, 158 Veratrum vir., 159 Zincum, 159 OABADILLA, 154 ^ Sabal serr., 154 Sadism, 121 Sarcoma of the prostate, 83 etiology of, 83 clinical history of, 83 diagnosis of, 83 prognosis of, 84 treatment of, 84 Sarsaparilla, 154 Sclerosis, fibroid, of the'penis, 96 Scrotum, elephantiasis of, 94 hematocele of, 96 hydrocele of, 96 new support for, 28 Secale corn., 155 Selenium, 155 Semen, 13 character of, 13 composition of, 13 in old age, 13 in youth, 13 microscopic character of, 13 Seminal bodies, 15 granules, 16 vesicles, 16, 18, 19, 20 concretions in, 48 treatment of, 48 cystic disease of, 47 treatment of, 48 injuries of, 47 malformation of, 47 malignant growths of, 48 treatment of, 48 vesiculitis, acute, 24 etiology of, 24 pathology of, 24 clinical history of, 25 diagnosis of, 27 prognosis of, 27 treatment of, 27 chronic, 30 etiology of, 30 pathology of, 31 clinical history of, 32 diagnosis of, 37 prognosis of, 39 treatment of, 39 tubercular, 44 etiology of, 44 clinical history of, 44 diagnosis of, 44 prognosis of, 45 treatment of, 45 Sepia, 155 Sexual disorders of men, prevention of, 21 erethism, 99 treatment of, 99 excesses, 120 treatment of, 120 functions, derangements of, 99 etiology of, 99 clinical history of, 99 prognosis of, 109 treatment of, no Silicea, 156 Spermatic fluid, 13 color of, j 4 microscopic test for, 14 Spermatoblasts, 15 Spermatogenesis, 14 process of, 14 Spermatorrhoea (see chronic seminal vesiculitis), 106 etiology of, 106 treatment of, 39, 107, no Spermatozoa, 13 form of, 15 Guilliot on, 14 migration of, 15 168 INDEX. of seminal vesiculitis and ampul- litis, acute, 27 of seminal vesiculitis and ampul- litis, chron:c, 39 of sexual excesses, 120 of stricture of the urethra, 115 of syphilis of the genital organs, 97 of vegetations, 95 Tribulus ter., 158 Tubercular prostatitis, 81 etiology of, 81 pathological anatomy of, 81 clinical history of, 81 diagnosis of, 81 prognosis of, 82 treatment of, 82 seminal vesiculitis and ampullitis, 44 etiology of, 44 clinical history, 44 diagnosis of, 44 prognosis of, 45 treatment of, 45 urethritis, 107 treatment of, 107, no TTRETHRAL blenorrhcea, 104 *^ etiology of, 104 microscopic character of, 104 treatment of, 105, no discharges, 102 tuberculosis, 107 treatment of, 107, no Urethrorrhcea ex-libidine, 17, 103 etiology of, 103 microscopic character, discharges of, 103 treatment of, 103, no Urine in sexual disorders, 107 treatment of, 108, no Urnings, 121 Ustilago, 158 number of, 14 Lode on, 14 size of, 15 structure of, 15 Stannum, 156 Staphisagria, 157 Sterility, 123 cause of, 123 forms of, 123 relative frequency of, 123 Sulphur, 157 Sumbul, 158 Symptomatic impotence, 92 treatment of, 93 therapy for sexual disorders of men, 126 'pESTES, absence of, 123 *■ ectropia of, 23 function of, 14, 17, 66 undescended, 92 syphilitic, 124 tubercular, 92, 124 Thuja occ, 15^ Testicular fluid, 17 Treatment of ampullitis and seminal vesiculitis, acute, 27 of ampullitis and seminal vesicu- litis, chronic, 39 of cancer of the penis, 95 of chronic catarrhal prostatitis, 59 of chronic inflammation of the verumontanum and prostatic urethra, 63 of congestion of the prostate, 49 of elephantiasis of the penis and scrotum, 94 of fibroid sclerosis of the penis, 96 of fracture of the penis, 97 of horny growths of the penis, 95 of hypertrophy of the prostate, 71 of masturbation, 119 of ossification of the penis, 97 of posterior urethritis, 63 of priapism, 87 of psychical impotence, 89 yASECTOMY for prostatic hyper- ^ trophy, 79 Vas deferens, ligation of for pros- tatic hypertrophy, 79 Vegetations on the glans penis, 95 Veratrum vir., 159 Verumontanum, chronic catarrhal inflammation of, 62 etiology of, 62 pathological anatomy of, 62 clinical history of, 62 prognosis of, 63 treatment of, 63 Vesicular fluid, 16 Vesiculitis, acute, 24 etiology of, 24 pathology of, 24 clinical history of, 25 diagnosis of, 27 prognosis of, 27 treatment of, 27 chronic, 30 etiology of, 30 pathology of, 31 clinical history of, 32 DEX. diagnosis of, 37 prognosis of, 39 treatment of, 39 tubercular, 44 etiology of, 44 pathology of, 44 clinical history of, 44 diagnosis of, 44 prognosis of, 45 treatment of, 45 Viraginity, 121 TT7ATERY semen, 124 " Warty growths on penis Webbed penis, 95 Withdrawal, 30 yiNCUM, 159 CATALOGUE OF MEDICAL ROOKS--- PUBLISHED BY BOERICKE, RUNYON & ERNESTY, 497 FIFTH AVENUE, NEW YORK. Any book in this Catalogue will be sent mail or express at advertised price, or they can be had at any Homoeopathic Pharmacy in this country or in England. REMITTANCES SHOULD BE MADE BY CHECK, BANK DRAFT, P. O. MONEY ORDER, OR REGISTERED LETTER. MEDICAL BOOKS PUBLISHED BY A Manual of Genito-Urinary and Venereal Diseases. By Bukk G. Carleton, M. D. Genito-Urinary Surgeon and Specialist to the Metro- politan Hospital, Blackwells Island, Department of Public Charities of New York City and the Metropolitan Hospital Polyclinic, etc., etc. 315 pages. Cloth, $3.00 net; by mail, $3.20. Half morocco, $4.00 net; by mail, $4.20. From The North American Journal of Homoeopathy. " It covers the field very com- pletely and gives the latest and most reliable facts concerning Genito-Urinary Diseases. In few of our works upon the ' Specialties' are there to be found so many pages devoted to the homoeopathic indications of the various drugs most frequently of use. We predict for the book a wide sale, as it will prove of great value to the general practitioner." . From The Haluiemanniaii Monthly. "A work giving the best medical and surgica thought and teaching on the subject in the most concise and comprehensive manner possible, coupled with thoroughly practical information in regard to the homoeopathic treatment of this class of cases. The book is a model of excellence of the book- maker's art; the paper and binding cannot be improved upon, and the typographical work is second to none." From The American Homoeopathist. " It deserves to be well read and as carefully studied. It lacks in naught. Any one chapter would be worth the price of the book itself. The indications for the diseases treated are excellent, and its materia medica is beyond criticism for its thoroughness and faithfulness of prescription according to the masters of the profession. Altogether the work is a desirable one for every prac- titioner and ought to find its way into the college room," etc. From Kent B. Waite, M. D., Prof. Genito-Urinary Diseases and Operative Surgery, Cleveland University of Medicine and Surgery. " A careful examination shows it to be the work I have long sought. It will be adopted as the text book in that department in the University." From Medical Century. " The new book is a concise treatise on the subject and is up to date. It is the only book in the homoeopathic school of which this can be said. The authors have done credit to themselves and homoeopathy by writing the work. The publishers have done their work well, typographically it is remarkably free from error and the binding is neat," etc. From Medical Record. "This very compact well written book gives a very clear picture of the clinical phenomena noticed in connection with the different features. The sur- gical procedures and manipulations are up to date, and all the essential surgical appliances and methods are given in sufficient detail," etc. From The Chironian. "The treatment, outside of the medicinal, is a recapitulation of the author's very successful experience. The chapter devoted to the treatment of gonor- rhoea is especially to be commended. Acute cystitis is treated briefly, but to the point; BOERICKE, RUNYON & ERNESTY. and the treatment of chronic cystitis is excellent. The article on stone covers the subject admirably. Purely functional diseases which in the ordinary text-book are simply mentioned, are here taken up individually and in a manner which cannot be mis- understood. The article on Syphilis is exceptionally good; eighty-three pages are devoted to aetiology, symptoms, cutaneous lesions, treatment," etc. From The Homeopathic Eye, Ear and Throat Journal. " This work covers a field hitherto unfilled in homoeopathic literature. Its thirty-nine chapters are an able expo- sition of the subject from all standpoints, while the special therapy of the various diseases is very complete and valuable. Dr. Carleton, who has had an extended experience in this special line, has presented a timely book. It also marks the appear- ance of the well-knows firm of Boericke, Runyon and Ernesty as publishers of homoeopathic works. They are to be congratulated upon the excellent appearance of their first venture, which is typographically all that could be desired, and an admirable exposition of the printer's art." From Will. B. Van Lennep, A. M., M. D., Prof, of Surgery, Hahnemann Medical College of Philadelphia, Pa. " Concise, comprehensive and up to date." From W. A. Dewey, M. D., late Prof of Materia Medica, Hahnemann Hospital College of San Francisco, Cal. " I am much pleased with the work; it is the latest and best on the subject in the Homoeopathic School; a special feature is the excellent arrange- ment of the Homoeopathic Remedies, and the careful indications therefor." From Nathaniel Robinson, M. D., Pres. Kings County, N. ¥., Homeopathic Medical Society. "Avery flattering triumph both for author and publishers; it should be in the library of every Homoeopathic physician and surgeon. It is clear, precise, and remarkably well up to date, both medically and surgically. There is nothing in Homoeopathic literature that can compare with it." From E. Guernsey, M. D., Pres. Medical Boards of the Metropolitan Hospital and Hahne- mann Hospital of N. Y. " A model of condensed thought and practical information." Diseases of the Eye. By N. L. MacBride, M. D., O. et A. Chir. Dean of the College of the New York Ophthalmic Hospital; Professor of Ophthalmology in the College of the New York Ophthalmic Hospital, etc., etc. Illustrated. 310 pages. Cloth, $3.00 net; by mail $3.20. Half morocco, $4.00 net; by mail $4.22. From The Medical Century. "There are chapters devoted to the ophthalmic diseases, the diagnosis and correction of anomalies of refraction, operations on the eye and other important topics not heretofore published in any work on this subject by a homoeopathic author. Throughout the text of the book the indications for the use of the homoeopathic remedies are tersely given and in most instances the potency is also mentioned. The author has in this handy volume about all that is necessary for the busy doctor to know of eye diseases in order to treat them with satisfaction and success." From The Homoeopathic Eye, Ear and Throat Journal. "This work is a model of brevity from the preface to the end, and bears the impress of the author s personality throughout. Within a reasonable compass is given a concise description of the diseases Of the eye, optics, errors of refraction, etc The remedies mentioned in the treatment MEDICAL BOOKS PUBLISHED BY are those most frequently used by the author, and the potency he has found most efficacious is expressed. In giving the pathology the latest German authorities have been followed. The chapter on the "Use of the Ophthalmoscope" is excellently adapted to teach students and general practitioners the art of using this excellent aid in diagnosis." From The Medical Era. "An examination of the book makes clear the fact that the author has succeeded most admirably in his design. It is eminently a practical work for the general practitioner, and gives instructions by which he may deal with all cases that arise in his practice that must not of necessity go to a specialist. The descriptions of disease are clear, and the instructions for treatment are plain and practical. For the general practitioner it is the best book on the eye and its diseases that we have seen. We wish to congratulate the publishers of Dr. MacBride's work on the very handsome book that they have made; it is on a fine quality of paper, type is large and clear, and the binding handsome and substantial. We earnestly commend the work to the student and the practitioner." From The North American Journal of Homoeopathy. "The aim of the author has been to set forth in as concise and useful a manner as possible the results of his long experience. While the illustrations are not numerous those that are used, both of the eye itself and of the instruments employed, convey much useful information to the general practitioner. In mentioning the remedies found to be curative the potency is often given, which is something contrary to the usual custom. Many important subjects are treated, among them being "The Art of Using the Ophthalmoscope," "The Diag- nosis and Correction of Anomalies of Refraction," "Operations," etc." From Dr. C. M. Thomas, Prof. Ophthalmology Hahnemann Medical College, Philadelphia, Pa. "Dr. MacBride's book is much appreciated and you will find it among those recommended to the students in the college announcement." A Compend of the Principles of Homeeopathy as Taught by Hahnemann, and Terified by a Century of Clinical Application. By William Boericke, M. D. Professor of Materia Medica in Hahne- mann College of San Francisco, Cal., etc., etc. 160 pages. $1.50 net; mailed, postpaid, on receipt of price. From North American Journal of Homoeopathy. "This book covers concisely the whole field of Homoeopathy, with many references to its literature for its further systematic study both as a science and as a practical art.—It is just what it was intended to be — an intelligent elucidation of the salient points so often metaphorically treated by Hahnemann." From The Chironian. "To those who wish to understand, and especially to those who are desirous of defending the principles of our school, the book is well worth perusal." From The American Homoeopathist. "The book is divided in thirteen chapters and an appendix. Taking them seriatim the titles are the following: The Therapeutic Field; Principles of Pharmacology; The Homoeopathic Materia Medica; Drug Proving; Interpretation of Drug Pathogenesis; Drug Relationship; The Application of Homoeo- pathy; The Simillimum; The Second Prescription ; Hahnemann's Nosology ; Posology; The Preparation of Homoeopathic Medicines; Hahnemann's Philosophy; Appendix. BOERICKE, RUNYON & ERNESTY. A 'Compend of the Principles of Homoeopathy' should be in the hands of every honest homoeopath; it is not a large book, it is not a costly book: but it is a book that talks out in meeting and is filled with homoeopathic data collected from the original papyrus and put into readable shape. All hail to the Compend." Therapeutics of the Eye. By Dr. Charles C Boyle, M. D., O. et A. Chir. Surgeon to the New York Ophthalmic Hospital; Professor of Ophthalmic and Aural Therapeutics in the College of the New York Ophthalmic Hospital, etc., etc. 404 pages. Cloth, $3.50 net; by mail $3.72. Half morocco, $4.50 net; by mail $4.72. —A reference work, divided for convenience for consultation into three parts: Part I. Remedies alphabetically arranged with the therapeutics relating to eye symptoms. Part II. Affections of the eye, under which are given the different remedies with their applied therapeutics. Part III. A repertorial index, alphabetically arranged. From Dr. Timothy F. Allen, A. M., JL. L. D., Prof. Mat. Med. and Therapeutics N. Y. Homceo. Med. College. "'The Therapeutics of the Eye,' by Boyle, is a step in the right direction; namely, an examination of our Materia Medica and its convenient presentation for use in diseases of the eye by a competent specialist,—when every organ shall have been studied by specialists after this fashion, their work tested and the results given to us, homoeopathic therapeutics will be more readily and successfully applied." From Dr. Martin Deschere, Prof. Pediatry N. Y. Homceo. Med. College. "Dr. Boyle's work on Therapeutics of the Eyes will be of invaluable service, not only to the specialist, but to every homoeopathic practitioner. It abounds in reliable indications." From Dr. F. H. Boynton, Prof, of Ophthalmology, N. Y. Med. College; N. Y. Ophthalmic Hospital College, etc. "Prof. Boyle's 'Therapeutics of the Eye' is an admirable com- pilation of verified symptoms, the major portions of which have proved curative in the experience of the author and his associates, the surgeons of the N. Y. Ophthalmic Hospital. The arrangement under anatomical heads and repertorial index will be useful to the careful homoeopathic prescriber in finding the indicated remedy. The section on ' pains in the eyes and head' will be of great value not only to the ophthal- mologist, but as well to the general practitioner. I gladly welcome the book and shall recommend it to my students." Diseases of the Kidneys and Ureters with their Homoeopathic Treatment. By Bukk G. Carleton, M. D. Genito-Urinary Surgeon and Specialist to the Metropolitan Hospital, Blackwells Island, Department of Public Charities of New York City and the Metropolitan Polyclinic, etc., etc. Illustrated. 253 pages. Cloth, $2.75 net; by mail $2.91.—A com- panion volume to " Carleton's Genito-Urinary and Venereal Diseases," thus completing the subject of the Uropoietic Diseases. MEDICAL BOOKS PUBLISHED BY From The American Homoeopathist. "Dr. Carleton gives the profession a valuable book and upon an exceedingly interesting subject. — He handles his subject in a masterful manner; brings his authorities in witness; and presents the matter in such attractive form that it appeals to the general practitioner as a good book to have near at hand. In forty chapters he traverses the whole subject and in every aspect of it, giving many very good photomicrographic plates; while especially good are the homoeo- pathic remedy indications." From The Hahnemannian Monthly. "It is a book presenting established facts which have been proven and developed by the author's own personal experience, which has been extensive. The treatment of each disease, medical and surgical, is fully considered, brief drug indications being given under each condition described. The closing chapter is devoted to a complete resume of the symptomatic and clinicaHndications of the drugs used in these diseases, and it will prove to be of great assistance to all practitioners of medicine. The general make-up of the work is a good specimen of the bookmaker's art, the illustrations being exceptionally good." From The Medical Times. "As we turned over one page after another of this book we were fascinated with the clear, terse style of the author, his wonderful faculty of con- densation, and the evidence of logical thought and extensive reading everywhere shown. We know of no work on the subjects discussed which contains so much valuable in- formation in so short a space. We congratulate the author upon the excellence of his work, and the young publishing house upon the success of their new venture. Hints and Suggestions as Aids in the Care and Preservation of the Teeth, and the Relation of the Dental Organs to our Health. By Charles G. Pease, M. D., D. D. S. Professor of Oral Surgery in the Metropolitan Post Graduate School of Medicine of New York City, and Late Lecturer on Materia Medica, Therapeutics and Pathology in the New York Dental School, etc., etc. 98 pages. Cloth, $1.00 net; mailed, postpaid, on receipt of price. — Dr. Pease has given us a book of great value to every one, not alone to the medical profession. The Treatment of Disease with the Twelve Tissue Remedies, Reing a Treatise on Riochemistry. By William Boericke, M. D. 189 pages. $0.75 net; by mail $0.81. — This little book is a con- densation of our larger works upon the subject, and gives all the sharp, characteristic symptoms of each of the 12 remedies, and is just the work for beginning the use of the Tissue Remedies in treatment of disease. Nervous Diseases, and Homeeopathic Treatment. By Joseph T. O'Connor, M. D.? Ph. D, Professor ot Nervous Diseases in BOERICKE, RUNYON & ERNESTY. the New York Homoeopathic Medical College and Hospital; Professor of Mental and Nervous Diseases in the New York Medical College and Hospital. Neurologist to the Laura Franklin Hospital for Children; Consulting Neurol- ogist to the New York Ophthalmic Hospital; Neurologist to the Metropolitan Hospital, BlackwelPs Island, New York. Member American Institute. Il- lustrated. 416 pages. Cloth, $3.75 net; by mail $399. Half morocco, $4.75 net; by mail $5.00. This work is based upon the author's lectures at the Colleges in which he is Professor of his specialty, and he has treated the subject comprehensively, yet without omission of necessary detail. The work is divided into sections, each considering some large division of the Nervous System and introduced by description of the finer anatomy assisted by illustrations. The dominant note of the book is Homoeopathy as given by Hahnemann's Organon. IN PRESS. Diseases of Children and their Homoeopathic Treatment. By Martin Deschere, M. D. Professor of Psediatry, New York Homoeo- pathic Medical College and Hospital, etc., etc. Practical Obstetrics. A Handbook of Treatment for Students and General Practitioners. By L. L. Danforth, M. D. Professor of Obstetrics in the New York Homoeopathic Medical College and Hos- pital (Maternity department, Flower Hospital), Hahnemann Hospital, Maternity department. A treatise intended to furnish the practitioners of midwifery with a definite and comprehen- sive description of the details of conduct which are necessary to the management and homoeopathic treatment of every case of gestation, labor, and the puerperal state. Diseases of Nose, Throat and Ear. By Samuel H. Vehslage, M. D. Asst. Surgeon, N. Y. Ophthalmic Hospital, etc.; and George De Wayne Hallett, M. D. O. et A. Chir. Lecturer, N. Y. Ophthalmic Hospital College; Asst. Surgeon, N. Y. Ophthalmic Hospital, etc., etc. MKDICAL BOOKS. IN PRESS (Continued). Diseases of the Skin, Diagnosis, and their Treatment. By Henry M. Dearborn, M. D. Professor of Dermatology, New York Homoeopathic Medical College and Hospital; Clinical Professor of Der- matology, New York Medical College for Women; Dermatologist to the Flower Hospital; Dermatologist to the Laura Franklin Hospital for Children; Visiting Physician to the Metropolitan Hospital; Consulting Physician to the Hospital of the N. Y. Medical College and Hospital for Women, and the Memorial Hospital for Women, etc., etc. External Medication. By E. Guernsey Rankin, A. M., M. D. Visiting Physician to Metropolitan Hospital, Blackwell's Island; Hahne- mann Hospital of New York, etc., etc. Disorders of Function of the Male Sexual Organs. By Bukk G. Carleton, M. D. Genito-Urinary Surgeon and Specialist to the Metro- politan Hospital, Blackwell's Island; Consulting Genito-Urinary Surgeon to the Hahnemann Hospital, New York, etc., etc. VEST POCKET SERIES.-Coughs: Diarrhoea: Constipation: Intermittent Fever. By A. R. McMichael, A. M., M. D. Professor of Clinical Medicine and Physical Diagnosis, Metropolitan Post Graduate School of Medicine; Professor Materia Medica and Therapeutics of N. Y. Medical College and Hospital for Women, etc., etc. PUBLISHERS: BOERICKE, RUNYON & ERNESTY. 497 FIFTH AVE., N. Y. I 'ST1' 7iF .-■vtr^y-T-'",V5 r~'^ Penalty for Injuries to Property State of New York, Laws. 1927. Ch. 542 A person who wilfully or maliciously cuts, tears, de- faces, disfigures, soils, obliterates, breaks or destroys, a book, map, chart, picture, engraving, statue, coin, model, apparatus, specimen, or other work of literature or ob- ject of art, or curiosity, deposited in a public library, gallery, museum, collection, fair or exhibitions, or in a library,gallery, college or university, or to any incorpor- _W_ ated institution devoted to educational, scientific liter- ary, artistic, historical or charitable purposes, is punish- able by imprisonment of not more than one year, or by a fine of not more than one hundred dollars, or by both such fine and imprisonment. IIMUilltUfWH niiiKiit.iiiiiiiiifimBiHMwiniiniiiiiii .iidiiiiiiM iiiijiiiiiiiifnwssnmiiiiiitii; .JrtUiliiiiM 11 il;iilil!llimi88flBm»illlif!i: iJiiirivrrtriiiiiiiiiiiWiirtiattftHUUijiiiifii \tmiit%tuxm _____wms.t i nil i n in*..... 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