Document 23846

THE
NEUROSES
THE
OF
SYSTEM
GENITO-URINARY
IN
THE
MALE,
WITH
OF
ULTZMANN,
R.
DR.
PKOFESSOK
IMPOTENCE.
AND
STERILITY
IJISEASES
GENITO-UKINAKY
I.N
TRANSLATED
W.
GARDNER
SUKGEON
IN
THE
AKY
GE.NnOUKIN
Philadelphia
F.
A.
DAVIS,
.
THE
U.NIVERSITY
OF
VIENNA.
BY
ALLEN,
DEPARTMENT,
and
London:
PUBLI8HEK
1S89.
M.D.,
BOSTON
DISPENSARY.
Entered
Office
according
of
the
to
I-ibrari.in
Act
of
of
Congress,
Congress
in
at
the
year
Washington,
in
1889,
D.
C.
the
TRANSLATOR'S
of
is
permission,
the
und
generandi
is
that
hoped
of
as
Prof.
of
of
Inasmuch
subjects
as
there
by
The
omissions
first
part.
will
this
than
the
is
two
some
and
tofore
herethe
to
country
successful
rity
autho-
an
throw
are
parts
light
on
and
been
fractory
re-
indicated
by
kindred
repetition
to
abridging
of
treat
necessary
has
slightly
1889.
It
has
difficult
very
Ueber
coeundi."
the
in
extent
some
second
references
G.
March,
"
eminent
so
Ueber
cases.
This
original.
avoided
of
Ultzmann
class
this
teachings
treatment
management
the
in
"
and
Potentia
accorded
author's
mannlichen
"
circulation
pathological
methods
the
und
wider
a
been
sound
des
Geschlechtsapparates
Potentia
the
monographs,
two
(Neurosen)
Neuropathien
Harn-
with
published
translation,
This
die
NOTE.
part.
to
W.
A.
the
THE
NEUROSES
OF
SYSTEM
THE
IN
URINARY
GENITO-
THE
MALE.
THE
NEUROSES
OF
THE
SYSTEM
T^HE
ual
diseases
the
find
of
of
of
usually
united
origin,
so
of
in
the
the
it
of
of
of
this
Now
the
of
we
nervous
same
individual,
same
setiological
treat
the
of
the
genital
roses
neu-
organs
it
is
be
to
so-called
and
of
class
in
now
may
in
sought
of
neck
disease
the
general
local
bladder
ances
disturb-
nutrition.
disturbances
general
in
sometimes
of
of
consequence
spinal affections,
abnormal
and
to
still
connection.
(prostatic urethra),
The
the
best
seems
urinary
greatly.
of
and
one
aetiology
changes
the
in
those
as
alone,
forms
quent
fre-
nervous
well
as
sex-
more
the
occur
several
systems
by
that
same
The
vary
both
tlie
system,
may
and
urinary
among
urinary
organs,
disease
MALE.
Although
infrequently
not
THE
male
disease.
the
sexual
the
belong
system
forms
of
of
neuroses
^
IN
URINARY
GENITO-
reflex
they
or
nutrition
chronic
consist
in
appear
brain
that
excitability, sometimes
and
congenital,
with
anaemia
and
usually,
a
feeble
however,
and
exalted,
inherited
associated
constitution.
Per-
8
of the G-enito-UrinarySystem
Neuroses
constitution
perfectlynormal
may
reflex excitability,
nevertlieless acquire an exalted
which
disposes to neurosis of the genitourinary
their organism
system, if they weaken
physical, but
especially by
by overstrained
Not
exciting mental, activity long kept up.
find nervous
vesical
infrequently,indeed, we
tenesmus
(cystospasmus) in persons who have
in individuals
to do, or
exacting night work
hold
mental
who, in addition to severe
activity,
iers,
an
unusually responsibleposition,as with cashsons
of
a
secretaries,and
such
Even
persons.
so
engender the most varied
Still farther,
in the urinary system.
neuroses
the
shocks
to
general nervous
system, great
turbances
dispain, and grief,give rise to nervous
fright,
well of the urinary as of the sexual
as
also the
of life
cares
immediate
The
functions.
system
nervous
be
even
from
fear of threatened
involuntarilyin
vesical
individuals
in
punishment
with
long-continuedexcitement
before
candidates
in
a
outcome.
property, sucli
as
for
and
of
state
a
instance,
when
who
have
speculationof
unexpected
ful
doubt-
in
or
mercantile
Great
as,
in
see
itself in
examinations,
severe
the result is uncertain,
engaged
;
we
show
themselves
urine
pass
Likewise
polyuria
keep
who
tral
cen-
urinary apparatus
children, when
they
their clothes.
tenesmus
of the
the
on
observed
may
influence
sometimes
persons
occurs
in
loss
of
unfort-
9
in the Male.
stock
unate
operations,
person,
phenomena
nervous
Thus
apparatus.
of
also
may
the
or
the
in
the
cause
a
and
in
seen
loved
be-
varied
most
urinary
often
I have
of
death
sexual
the
case
business-men
frequent
micturition, polyuria, sometimes
even
slight
sions,
glycosuria,and, further,sexual impotence, emisand spermatorrhoea suddenly appear.
A much
larger contingent in these nervous
tions
by those manifestacases, however, is furnished
of disease which
their origin in local
have
sequently
conchanges in the urinary system, and which
seriously damaged
In
be looked
to
are
this
the
connection,
reflex
as
upon
roses.
neu-
harmful
most
influence
on
the
urethra
exercised
by
the
A gonorgonorrhoealprocess.
rhoea,
normal
a
begins at the
course,
which
runs
orifice of the
of the
an
and
urethra, and
sphincter vesicjB
abnormal
ends
beyond the isthmus
first place, the prostate
;
catarrh
it becomes
once
becomes
symptoms
now
in the
gonorrhoea
is involved
;
in venery
system.
occurs,
the
and
after
in
pathy
sym-
prostatic
various
vous
ner-
in the
ary,
urin-
Likewise
even
masturbation.
through long-continued and
ized
local-
prostatic
after
verumontanum
and
by
if
and
chronic, then
sexual
catarrh, around
this case,
beginning
If,however,
gradually arise,now
hypersemia
excesses
the
urethrse, then,
catarrhal
is
prostate
in, if the
extends
the
at
externus.
sets
course
the
on
too
gross
In
often
Neuroses
10
of the
Ge
o-Urinari/Si/stem
)i it
repeated sexual excitement, the congestion of
and especiallyof the caput
the prostaticurethra
is so long kept up that it has finally
gallinaginis
localized
become
a
pocularis,and
sinus
established
has
of
urethra
This
a
which
from
if
suffer
inflammatory
similar
prostate
that
men,
female
The
the
in
men
in
tensely
in-
women,
many
associated
with
to
strange
seem
chronic
of the
us
congestive or
prostate present
the
especiallyas
is, in
masculinus
utriculus
finds its
analogue
and
the
yet
know
for the
the
in
of semen,
Eckhard
nerves
the
are
and
which
to
the
be
urinary
Goltz
that
preside over
souglitin tlie
spinal cord.
tlie action
nervous
and
little understood
is still very
for instance,
region of
of
functions
from
the
between
connection
apparatus
centres
of
uterus.
sexual
we
from
which
organ
exact
system
not
phenomena,
with
eral
gen-
affections,suffer
hysterical
processes
nervous
a
only
appear
Since
catarrh, it will
who
men
prostatic
find
Ave
of the uterus
abnormalities
cervical
the
consequence,
usually
and
nervous
of
sometimes
hystericalwomen.
ill with
and
hypereemic
a high degree
excitability,
and
phenomena
of
has, as
reflex
nervousness,
prostaticducts, of
the ejaculatory
ducts
condition
sometimes
exalted
the
itself.
chronicallyinflamed
and
affection,
chronic
a
as
condition
catarrhal
the
there
of the
Also
vasa
tlie
;
the
tion,
erec-
bar
lum-
tion
secre-
deferentia
in the Male.
and
of
the
influence
The
vesiculse
of the
prostate
seminales,
under
are
the
spinal cord.
and
the
in
nerves,
rich
very
11
uterus
both
are
and
they
tures
struc-
vated
inner-
are
nerve-plexus. The
by one and the same
hypogastricplexus of the sympathetic,which is
reinforced
by filaments from the sacral ganglia
and
from
the
pudendal plexus of the sacral
innervates
nerves,
of
means
in
the
men
to
plexus
find
circular
scattered
extend
cortical
which
sensitive
elsewhere
and
plexus
connection
spinal
rich
nerves,
the
plexus
with
their
the
in
and
of
also
pudendal
hold
in
in organs
its
very
the
gastric
hypo-
is in intimate
presents
nerves,
so,
cortical
corpuscles,
plexus
latter
nerves;
the
lion
gang-
Since
the
and
contains
sympathetic
in
the
numerous
nerves.
sacral
in
urethra, and
Pacinian
and
this
side, stand
lumbar
of the
only present
of the
with
the
fibres
prostate
layer ganglia
are
in
fibres
their
The
cells.
according
sphincter urethrse
along
between
of
means
nerve-trunks
striped muscular
layer,which
tate,
pros-
ber
greater numaccording to Klein, we
especiallynumerous
the
uter-
and
uterus,
found
are
cervix, and
the
plexus
vesicles
the
by
women
bladder, by
In
nerves
prostate between
on
the
vesicalis.
Kilian, the
in
plexus, the
seminal
with
together
in
uterus
its accessory
inus, and
the
the
which
closest
when
of
a
the
ordinate
sub-
again,
relation
in
organs
Xeu
12
rich
very
in
the
prostate,
Genito-UrinarySystem
such
nerves,
peripheral
kept
are
nerves
of the
roses
in
the
as
of
terminations
constant
a
and
uterus
the
of excitement
state
inflammatory processes, it appears
of this
clear that by transmission
very
in the area
irritation to other nerves
supplied
belonging to the
by ramifications of the nerves
of the most
varied
plexi mentioned, neuroses
in
the
character
genito-urinary
appear
may
In like manner
tract.
worms
Oxyuris vermiby
chronic
"
cularis,
"
and
eczema,
catarrhal
of
ulcers
the
of the
neuroses
produce by transmission
urinary and sexual apparatus as well as general
reflex excitability.
records
in this
The
pathological-anatomical
anus
connection
are
several
scanty.
very
autopsy
organic changes
as
with
in the
extends
the
the
sults
re-
to
prostatica
ejaculatoryducts
changes
fices
ejaculatoryducts, widening of their oriof their lumen, sometimes
and
dihitation
total
on
found
pars
seminales, sometimes
strictures,inflammation
or,
lected
col-
tion,
suppurative,inflammathe
the vesiculse
and
has
sometimes
ulceration, in
urethrae, which
has
reports, and
follows:
of chronic, in part
Kaula
the
or
of the neck
partialhypertrophy of
other
hand, atropliyof
of the bladder,
the
prostate,
the
prostate
(Curschmann).
The
UiiiNE
in
those
in
neuroses
of
the
general,and especially
genito-urinary system,
in
13
in the Male.
offers sometimes
that
an
aids
in
this
case
such
of
knowledge
exact
conditions
characteristic
them
materially
ticed
diagnosis. First of all it is to be noaffected with
that patientswho
roses
neuare
time
not
infrequentlysuffer at the same
with polyuria. They urinate often, yet have no
pain or inconvenience
except that they have to
The
urine of polyuria
urine.
produce so much
is of a pale straw
color, and clear,with a low
specific
gravity (urina spastica,nervosa, diluta).
Yet sometimes
there is a great quantity of urine
without
the specificgravity of the urine
being
diminished
in a corresponding proportion. In
there
of
excretion
I have
is at the
excitable
in
boy, who
specific gravity
increased
clear
7 litres of colorless
water,
as
1.005.
was
This
and
13-year-oldanemic
a
as
an
insipidus.
dailypassed
urine, almost
the
diabetes
solids,a
observed
time
same
of which
24-hour
The
81 grammes.
to
quantity of solids amounted
The patient was
at any
always thirsty,and was
time
ready
Sugar
a
pass
not
was
It has
to
been
puncture
and, indeed,
or
500
c.c.
of
the
in
a
since
floor
small
Claude
of the
Bernard
fourth
same
circumscribed
tween
spot be-
origin of the vagi and that
produces polyuria, and
nerves,
that
glycosuria. It
certain changes in the
time
has
also
central
that
ventricle,
the
acoustic
urine.
present.
known
in
400
been
nervous
of the
at
the
found
sys-
14
Neurones
tern
are
accompanied by polyuria
puncture fails to
If the
and
to
from
and
Lecorche
system.
diabetes
of
affection
an
there
mellitus
the
others
is
uncommon
ing
suffer-
are
central
nervous
found
have
increased
an
uria.
glycos-
there
glycosuria,
cause
usually pol3airia. It is not
find polyuria in patients who
is still
also
Si/stem
of the G-enlto-Urinary
that in
excretion
of
nitrogenous urinary constituents,that is to
sipidus;
inaccompanying azoturia or diabetes
say, an
and I have had repeatedopportunitiesto
convince
myself that the lightforms of diabetes
be cured
can
mellitus, which
by an exclusive
and
meat
urea
diet,excrete
considerablymore
healthy
from
who
in
after
acid
uric
a
In
azoturia.
in 24
5 per
cent,
short
time
of
so-called
the
yet
the
24-hour
was
100
grammes,
sugar,
the
an
diabetic
about
patient
ing
contain-
disappeared
sugar
exclusive
of
amount
or
a
still suffer
4 litres of urine
hours
under
of
case
other
than
cure
words, they
other
in
men;
passed
the
diet
meat
solids in the
one-third
more
;
urine
than
normal.
cannot
always be
Polyuria in neurotic cases
explainedin the same
way, still it is generally
associated
with irritability.
By experiments on
Bernard,
animals
find,according to Claude
we
that
after each
appear
Much
puncture
the
abdominal
viscera
highly congested.
more
seldom
we
find
in
nervous
trou-
in the Male.
bles
of the
diminution
a
is,oliguria and
both
small
very
such
from
draw
lasted
from
a
in
paratively
com-
In these
with
the bladder
quantity only of
to two
one
days.
in
case
eight days.
urine
I have
not
yet
;
catheter
the
Benedikt
anuria
reports
which
hystericalwoman,
a
the
cases
seen
lasted
anuria
nervous
men.
Sugar
2
quantitiesand
the
in
cent,
per
infrequentlyfound
is not
in small
found
2 per
in several
after violent
weeks.
the
I have
presence
urine
in
Leudet
also
chronic
has
found
a
blow
on
of
(curare, morphine),
in the
urine.
which
is
A
same
in
importance
spinal
the
sugar
in
and
urine
certain
is found
the
diseases.
diseases.
head, after
in
the
Also,
drugs
temporarily
light symptomatic glycosuria,
usually transient, is
in diseases
of sugar
cerebral
the
days
infrequentlyobserved
and
sugar
Further,
lasted
amounts
brain
transient
disturbance
mental
which
not
of small
greatest variety
after
cent,
glycosuriaensued
mild
general
of sugar.
glycosuriawith
cases
have
to
patients.
and
impotence
of
amount
of neurotic
urine
patient affected with
reflex irritability
I once
temporarily
the
to
even
A
a
Anuria
anuria.
even
hystericalwomen.
in
times
1 could
in
of urine, that
amount
of
disease
healthy persons without
observed
but twice, and
kidneys I have never
the
a
15
of the
is
by
nervous
no
means
a
common
system,
rence
occur-
and
the
to be attributed
of the
y^euroses
16
it
to
had
who
man
about
diabetes
to
as
ten
Genito-Urinary System
3 per
and
three
set
in.
I
consulted
was
longer found
death
to his recent
up
able
been
find
to
at
yearly.
had
come
on,
suddenly
urine
time, and
this
have
nor
sugar,
any
of
retention
ago
uriae
diabetic
Karlsbad
bladder
the
his
in
old
an
other
no
visited
he
years
had
He
Gradually paralysisof
and
of sugar
cent,
j^ears ago.
symptoms,
I knew
mellitus.
I since
no
then,
(of interstitial nephritis),
any
in his
sugar
In
urine.
sociated
glycosuriaappears to have been aswith the development of paralysisof the
That
bladder.
glycosuriaof a mild form is also
is
in diseases of the liver and portal vein
found
this
a
the
case
need
fact,which
well-known
be
not
considered
here.
Very often, in
of neurosis, the
cases
freshly
even
passed urine has a neutral and sometimes
reaction, although the patient
a faintlyalkaline
alkalies nor
mineral
have ingestedneither
may
could explain
water, nor anything, indeed, which
the
of
reaction
of
only
does
a
the
to
seem
of
Carbonate
other
Such
urine.
pale wine-yellow
when
it
the
is
reaction
contrary, there
urine
and
is
ally
usu-
clear ; and
decidedly
alkaline
slightlycloudy turbidity.
ammonia, the ordinary alkali of
have
a
urines, is
alkaline
color
a
is
carbonate
of soda.
succeeded
in
a
making
not
fixed
On
the
alkali,generally
Cazeneuve
the
present.
urine
and
of
I^ivon
dogs
the
have
alkaline
of the Genito-UrinarySystem
Neuroses
18
presentedby the earthy
of bone.
constituents
Phosphoric acid forms
with lime and
magnesia three classes of salts,
accordingto its basicity. First,acid salts,when
ent
one
equivalentof acid unites with one equivalof base ; these salts are readilysoluble,and
cal
which
compound
present
salts,when
are
in
is
all acid
basic
Second,
urines.
equivalent of acid unites
equivalents of base ; these salts are
three
and
one
exist in alkaline
urine
in
with
soluble,
in-
form
the
Lastly, neutral
amorphous sediment.
one
equivalent of acid unites with
salts,when
of
an
base ; these
equivalentsof
two
less soluble
in
found
solution
neutral
than
the
urine.
in neutral
If
salts
acid
these
are
what
some-
salts,and
salts
are
are
in
urine, the simple warming
them.
If,
precipitate
however, they are in the sediment, they appear
to the basic earthy phosin contrast
phates.
crystalline
Since, on heating the urine, albumen
in
a
test-tube is enough to
of the white
the character
precipitated,
be shown
must
by the addition of a
precipitate
drop of acetic acid ; the earthy phosphates are
is also
immediately dissolved,while a precipitateof
remains
albumen
unchanged on the addition
solved
disbecomes
If the precipitate
of acetic acid.
active development of gas, it
with
an
of carbonic and phosphatic
consists of a mixture
out
earths ; if it dissolves withphates
production of gas, it consists of phos-
salts (jf the alkaline
the
alone.
Sometimes
there
masturbation
linen, show
blue
indigo
find
the
This
urine.
is also
known
cesses
ex-
in
indican
in
occurrence
common
of the
diseases
a
excitement
It
hystericalwomen.
in
that
a
with
After
color.
after sexual
their
on
bordered
are
the
even
dried
when
large quantitiesof
and
nervous
a
violet
or
as
general,we
practise
large quantity
in the urine, and
which
spots
in
who
persons
persons,
in venery,
in
In
found
of these
emissions
of indican
increase
an
is sometimes
there
of indican
marked
is
in neurosis.
the urine
19
the Male,
in
m
central
is well
nervous
meningitis,
system, especiallyin cerebro-spinal
large quantitiesof indican are found in the
urine
is usually present
(Oppolzer). Indican
in solution, yet not
in the urine
infrequently
very
and
scales
found
is also
indigo
flakes
the nitric acid
a
blue
bluish
or
nitric acid
is
of
Jaife's test is
an
and
be
about
ten
added
mixed
one
a
in
two
the
of
narrow
brown
the
orless
col-
bluish
separation
the
Jaffe
test.
ner
following man-
of urine
and
strong hydrochloricacid
together, and
or
beautiful
by
a
If this
centimetres
of
by
ring of
urine.
In
presence
between
obtained
cubic
equal quantity
are
the
performed
the
the
border
distinctlyseen,
indigo may
:
the
on
bluish-black
is shown
restingon
zone
coloringmatter
zone
for albumen
of indican
large amount
and
urinary sediment.
the
in
test
blue
in
drops
to
the
of
a
mixture
cold
are
saturated
N^euroses of the
20
solution
of
Genito-Urlnary
System
hypochlorite of
immediately becomes
mixture
to
cubic
and
made
colors
flow
the
ing
accordof chloroform
centimetres
to
indigo
If now,
violet.
or
Senator, a few
added,
The
separated,and
bluish-black
are
lime.
through
the
by repeatedshaking of the test-tube,the
chloroform
takes up the indigo,and is colored a
mixture
beautiful
blue.
It is well
in the urine
known
that
indican
eases
large quantitiesin disof the abdomen
(in peritonitis,
constipation,
in a
incarceration, etc.). I have
seen,
fatal case
of peritonitisin the clinic of Prof.
colored
violet
Lobel, a urine
by the large
of indigo,not
red wine
amount
unlike
in appearance
and with a deep-bluesediment.
appears
Albumen
is
also
in
yet relativelyseldom
cases,
amount.
This
mild
is
produced by injury
ventricle, and
albuminuria
of the
of
only
only
is
in
these
in
small
ordinarily
after great
found
example, after
be
Albuminuria, indeed, may
excitement, just as it
epilepticfit.
and
albuminuria
merely transient,and
an
found
sometimes
Coe
occurs,
to
even
pregnancy
the
for
floor
of
maintains
the
fourth
that
the
is also
rosis
only a neulast opinion is to
this
kidneys. Still,
be accepted with
if
great caution, since, even
this explanation be the
in ceitain
right one
cases,
yet it certainly does not hold in the
of pi-egnancy.
of albuminuria
majority of cases
The
is
urinary sediment,too, in the neuroses
sometimes
indeed
found, and
The
ly in large quantities.
in
the
with
bell
the
are
Fig.
various
much
of
infreq[uent-
not
of lime
oxalate
colorless
mixed
seen
1."
sizes.
Oxalate
of
I have
with
lime.
seen
greater quantitiesof
urinary sediment
of renal
less
form
lime
of
pears
ap-
usually
crystals,
and
its combination
quadrate octohedron
the prism, but not infrequentlythe divingor
hour-glassforms and spheroidsof oxalate
of lime
the
Oxalate
characteristic.
very
often
is very
21
the Male.
m
calculi.
I
importance, in
to
the
pointed uric
oxalate
acid.
of
cases
the
of
octohedra
300 diameters.
and
oftener
much
of lime
oxalate
of neurosis
in
than
attribute, therefore, much
the
formation
of lime
For
years
than
of renal
to
the
together
in
culi,
cal-
sharpcases
Neuroses
22
I have
of neurosis
of oxalate
renal
of the Genito-UrinarySi/steyn
of lime
the
seen
without
calculus
heaviest
sediment
of
symptoms
appearing at
the
ning
begintime
same
(Fig. 1).
Another
which
not
appears
urinary sediment,
uncommon
only
as
a
of
result
a
neutral
or
faintlyalkaline reaction of the urine, consists of
amorphous or finel}^
granular carbonate of lime
Fig.
2.
"
Finely
granular
phosphate
mixed
carbonate
of lime,
of
lime
and
cryBtallino
300 diameters.
with
amorphousphosphateof lime. The
is dissolved
white, finelypulverized sediment
the addition
of a drop of acetic acid,with
on
the
of
formation,
many,
Sometimes
sometimes
bubbles
of
consistingof
also, mixed
with
few, sometimes
carbonic
tlie
acid.
amorphous
sediment, small, colorless,
wedge-shaped crystals
23
in the Male.
these
bevelled
appear
of
crystallineplio^iohate
of
consist
which
of
found, tlie bases
are
;
lime.
times
single,and somecrystalsappear sometimes
so
grouped together that several crystals
their
lie side by side with
apices converging
whole
rosettes
or
to a single point. Moreover,
The
sheaves
are
the
of
periphery,while
middle
point of the
sediment,
rare
A
(Fig. 2).
of the
the bases
which
the
form
at
seen,
tals
crys-
apices unite
the
rosette
sheaf
or
found
sometimes
phosphate of lime, is
crystalline
crystalline
phosphate of magnesia. This appears
mixed
the
with
the
usually
tablets,of
rounded
long quadrilateral
the
opposite corners
appear
of
forms
these
crystalline
which
off.
All
of
are
also
ingestion of
fixed
earthy phosphates
after the
form
in the
found
the
in
alkalies
or
urine
of mineral
containing such.
in the
Spermatozoaare likewise not uncommon
of men.
They are found in
urinary sediment
in spermatorrhoea,
in the urine
large numbers
waters
yet singlespermatozoa
in
other
also
appear
of
neuroses
the
in
the
urinary system
(Fig. 3).
Finally,as already mentioned, indigo in
blue
in
or
the
present
appears
occurrence.
bluish-black
urinary
scales
blue.
large amount
that
This, however,
In
one
case
flakes
is
of tabes
small
is found
indigo
Sometimes
sediment.
in such
and
ment
sedi-
the
a
and
is
sediment
very
rare
paralysis
24
Kfuroses
of the
of
the bladder
Genito-Urinary System
I liave
had
opportunity for
the
long time of observing the blue sediment
precipitated
indigo ; this glaucuriasuddenly
a
The
temporary
glycosuria with
without
sugar,
diabetic
8
"
two
simultaneous
symptoms.
urate
especially
Fig,
patient suffered
same
of
ammonia,
Amorphous
carbonate
of magnesia
and
of
cent,
per
time
same
lime, crystalline
spermatozoa.
300
of
other
urates,
present
are
appeared.
dis-
also with
polyuria or
If at the
of
in
the
phosphate
diameters.
urinary sediment,
and
appear
violet
The
they decompose the indigo,
colored
sometimes
blue, sometimes
in their otherwise
Neuroses
Organs
of
may
recognizedgroups,
be
characteristic
the
Urinary
divided
into
forms.
and
ual
Sex-
three
well-
accordingas tlieyaffect
"
of the G-enito-Urinary
System
Neuroses
26
The
hypersesthesia is ordinarily
cutaneous
confined
to
of the
the
the
of
the
penis itself
Yet
veneris.
mons
complain
of
skin
sometimes
varied
most
and
that
patients
in
sensations
the
abdominal
region,in the nates and the
derness
a
thighs; now
burning,stinging,or great tenof the skin, again a feelingof numbness
and weakness.
In some
patients there is
time
increased
at the same
an
general reflex
and these cases
often present sympirritability,
toms
which
would
only be looked for,in such a
degree,in hystericalwomen.
As to setiology,
the patientsgenerallyascribe
their trouble
to a gonorrhoea which, indeed, has
been
of long standing, and
one
commonly
tion
accompanied by swelled testicle or inflammawhole
of
the
prostate 2^er
The
urine
or
which
it
have
bladder.
On
shows
either
contains
just been
the
described.
At
common
to find in the
amount,
shreds
the
same
are
and
[Tripperfilden],
from
large-headed nails, which
the
prostatic urethra.
short
ones,
in the various
hypersesthesiaor
frequent
in-
not
urine, in greater
thick
that
Thus
precipitated
time, also,it is
those
known
constituents
earthy phosphates
by heating.
and
of those
one
tion,
condi-
abnormal
no
the
is felt.
nothing abnormal
rectum
of
examination
or
less
especially
sometimes
bling
resem-
usually
come
It
is
also
well
diseases
of
the
tate,
pros-
neuralgia of
the
urethra
27
in the 3Iale.
Thus
occurs.
I have
of
degree
affected
a
of the bladder.
neck
the
with
the
est
highand
penis,
glans,in patients who
neoplasm in the region
the
with
least,the
at
of
sensitiveness
especiallyof
prostate and
found,
On
were
of the
tion
examina-
tiveness
sensigreatly increased
in the prostatic
with
met
sound
a
is sometimes
urethra.
Hypersesthesia and
neuralgia of the
accompaniments of spasm
common
are
bladder, and
will be
All
these
of
consequence
and
catarrhal
prostatitis.The
expulsion
and
with
of
the
least
shreds
micturition, and
from
secretion
make
militaire),
is in the
therefore
tatica urethrcTe
to
baths
and
camomile
and
local
the
tea, at
[95"Fahr.],twice
a
region of
three
which
action, and
is
Improvement
the
of
times
tion
por-
the external
place
a
Next
temperature
or
(goutte
pars
prostate itself
full baths, enemata
even
diseased
the
when
treatment.
ning
beginof
urethra
micturition.
forthwith
ensues
ous
numer-
the very
sphincter; consequently in
ordinarilyclosed by muscular
only o^Tenedduring
of
absence
that
with
connection
the
it certain
of the urethra
is
the
in
generally reflex
gonorrhoea,are
in
readilyoccur
short
nection,
con-
occurring
neuroses,
thick
the
neuroses.
of sensation,
neuroses
of
of later in that
treated
the motor
among
bladder
to
warm
of 28"
pros-
jected
sub-
are
sitz
warm
water
or
Reaumur
daily,will
prove
System
of the G-enito-Urinary
Neuroses
28
with
efficient in connection
most
This
prostaticurethra.
carried out
that, by
of the
so
astringentsand
the
usually employ
in
prostaticurethra
a
of
calibre
has
is
silver
duced
intro-
are
for
16.
The
of
this
metallic
is
pose.
purhas
a
end
vesical
catheter,
perforatedlike
is furnished
end
catheter
long, and
cm.
and
of
treatment
made
of the
ordinary curve
smoothly rounded,
outer
local
short, metallic
No.
Charriere
The
the
is 16
catheter
the
sieve.
of instruments,
of
had
I have
(Fig.4), which
The
be
prostaticurethra.
into the
I
latter should
means
nitrate
even
local treatment
with
a
round
a
rubber
tubing (Fig. 4).
to such
catheter
is introduced
The
a
depth that
its point is just within the membranous
portion
of the urethra
(consequently anterior to the
prostate). The disk prevents the catheter from
time
deeply, and at the same
slippingin more
plate
and
to
serves
on
the
a
piece
close
disk
the
external
into
having
the
of
been
to
the
100
tubing on
with
of
contents
gentle
pressure
urethra
into
vesical end.
the
the
end
ordinary
an
of
grammes
the
-The
introduced
manner
urethra,
the latter is steadied
the whole
the
in this
membranous
syringe, containing
attached
mark
always, in introducingthe
shows
catheter, the direction
catheter
A
meatus.
of
ter,
cathe-
the
hand,
and
syringe is slowly
and
with
driven
the left
fluid, is
through
bladder.
the
If the
prostatic
of
end
is
the catheter
the fluid
injectedthrough the prostatic
is
since the catheter
difficulty,
be
can
without
urethra
portion,all
membranous
the
m
29
the Male.
min
already partly within the
external
sphincter,which
offers
therefore
If
the
the
only
however,
bulbous
the
fluid
the
portion,then
not
can-
the
through
be driven
prostaticportion even
strong
either
will
der
un-
pressure
flow
catheter,
the
distend
of
point
catheter,
reaches
ance.
resist-
no
beside
out
will
or
it
;
fully
pain-
urethra.
the
These
injectionsthrough
the
prostatic
should
be
cent,
per
carbolic
then
I
1-2
[sulphate
of
]
and,
as
patients
bear
to
of
acid,
to
1-4
a
solution
a
;
the
injection
(a
grammes
100
change
least,
For
day.
syringe full) of
1-2
once
second
first and
use
at
or,
other
every
I
given
day,
every
urethra
per
cent,
zinc
tion
solu-
soon
the
as
the
Fig.
4.
"
Ultzmann's
Syringe-catheter.
injection well,
I
increase
of the G-enito-Urinari/S"/stem
30
Neuroses
the
strength gTadually to
cent,
the
also
and
per
2
solutions,
used
and
before
I have
more
I have
zinc solution.
bladder
used
tannin
3, 4, and
5
per
the
patientsempty
after each
injection.
of 1-2, 1,
solutions
cent.,
but
have
found
zinc
and
alum
together, much
or
efficient.
before
a
Similar
for the
same
instruments
purpose,
the
have
as
zinc
been
by Guyon
recentlyby Gross.
The
patientsbegin to feel better after a few
and
later they urgently crave
the
injections,
each time.
excellent is the
Especially
injection
effect of the injectionsin those
nervous
men
like hysterical
behave
Thus
not
who
women.
with
met
are
who, after a
infrequently men
and
when
gonorrhoea,
especially
long-continued
with
swelled
testicle
or
catarrh
plicated
com-
of the
moody and melancholy, have
before was
desire for daily work, which
a
no
necessity for them, complain of a feelingof
in the legs,and various
in
sensations
weakness
the genitals,and
the hypogastricregion and
time with frequentand
suffer at the same
ful
painmicturition, emissions, impotence,and other
The
gin
such symptoms.
patientsimmediatelybethe local treatment
carried
to improve under
After
few injectionsthe
described.
out
a
as
lost energy
ble
returns, the patientsfeel their troudisappear,and become
again graduallyin
tions.
funcevery respect capable of performingtlieir
bladder, become
31
in the Male,
The
(h)
confined,
are
testicle
to
now
sexual
of the
neuroses
sensory
spermatic cord, now
and
of the
sensitiveness
a
to
a
atus
appar-
dragging
stinging sensation in the testicle Qieuralgia
that comes
on
periodically. Sometimes
testis},
in both
there is a painful sensation
groins or a
during and after
stinging pain in the urethra
and
the
ejaculation
sound
the
with
of
is found
urethra
the
the
throughout,but especiallyin
the
where
that
the
pain
may
examination
On
semen.
attain
prostaticportion,
such
a
degree
aloud, and
patientscreams
sensitive
gnashes
his
teeth.
diminished
A
also of the skin
and
uncommon,
degree
extreme
is
sensibilityof
of the penis and
designatedas nervous.
By impotentiacoeundi
of
scrotum,
is sometimes
in that form
consummating
urethra,
the
with
met
of
impotence
is meant
the
the normal
act
as
is not
in
an
which
lity
impossibiof coition.
explanation of this condition is to be sought
either in an
organic change, a malformation, a
defect of the penis, or, the penis being healthy
and normally formed, in the inabilityto have a
The
lastingand
we
with
have
a
nervous
in chronic
also
do
to
drugs
as
powerful
in
may
with
or
cause
diseases
diabetes
erection.
In
the first
case
organic,in the second
tain
psychical impotence. Ceran
temporary
of the
brain
mellitus,
impotence, and
and spinal cord,
even
permanent
32
Neuroses
impotence
only
of the Genito-UrinarySystem
occur
may
under
is here
frequently,and
known
as
of
suffered
have
or
who
and
addicted
be
may
is understood
sexual
have
the
for
the wife
impotence
convince
myself
to have
with
of
potence
im-
in
the
hold
relative
married
case
subjects,when
to
up
awake
from
each
impotence
the
with
of
her
the
that
in
nervous
they
are
lascivious
sleep
at
husband
sexual
persons.
all.
when
It also
in coitus
one
account
on
I
case,
able
was
in
was
intercourse
Moreover,
a
to
dition
con-
at any
it is
monly
com-
impotence that the
selves
alone, and give them-
thoughts,or when
they
night,have powerful and
lastingerections, while the same
it comes
to actual intercourse,can
at
In
divorce
husband,
who
people
other.
for
sued
normal
other
the
that
form
it may
time
for instance, it succeeds
prostitutes,
This
of things occurs
well.
state
aversion
an
in which
time
torrhoea,
sperma-
long
a
This
By
cases.
infrequently among
not
for
in
persons,
very
of
been
or
inabilityto consummate
certain
individuals,while
with
is
fer
suf-
either
emissions
have
all
who
the
act
other
from
relative,or
degree in
same
those
masturbation.
to
most
occurs
as
and, indeed, in
men,
young
impotence
alreadymentioned,
or
psychicalimpotence.
impotence usually occurs
nervous
form
This
which
discussion
which,
of
form
that
;
not
there
persons,
get
no
when
tion
erec-
infrequentlyhappens,
is
an
erection
at
first.
Neuroses
34
This
the G
of
of
form
impotence
by considering the
According to
erections
manner
Under
"
large
is still a second
factor
is the
that
blood
the
spaces
inter-
of blood.
the
There
of great importance, and
prevention of
of the
out
ernous
cav-
ready for
made
amount
eri-
nervi
of the
and
relaxed,
a
following
of the
fibres
muscular
thereby enlarged and
reception of
Kohlrausch,
the
in
influence
become
tissue
be
and
about
System
explained
tion.
origin of erec-
and
KoUiker
the
gentes the organic
best
can
nature
brought
are
:
nit o-Urinary
e
This
cavernosa.
corpora
of the
back-flow
the
ming
dam-
probably accomplished
apparatus. Along
by the following muscular
lies the musculus
the i:)ars subpupica urethrse
which
don
bulbo
cavernosus
begins behind in a tenof the back-flow
which
from
the
intei and
origin.
like the
of
which
with
muscle
this
tendons
in
merge
is continuous
the
of
is
a
a
pen,
fork.
thin
the dorsum
on
the
(Linhart). When
contracts, the penis in
nosi
of
a
musculi
constricted, and
region
the
and
The
their
on
ject
pro-
ends
aponeurosis
of the penis
ischio-caver-
this muscular
the
per-
arranged
are
plumes of
prongs
take
externus
fibres
muscular
either side like the
transversi
musculi
also the
sphincter ani
The
above
is
apparatus
of the
return
physis
sym-
of blood
time
also (probably
prevented; at the same
iscliiothrough the influence of the musculi
cavernosij the [)enis is raised, ix.^ erected.
in the Male.
When
this
action
against
and
that
on
the
the
the
of too
or
penis by
erection
short
cular
mus-
is incomplete,
symphysis
account
feeble, incomplete,
is well
of
constriction
35
is too
duration, it
that
known
voluptuaries,in order to
action, place about
"strengthen this muscular
ber
the root of the penis a constrictingring of rubother
or
influence
the
According
in
of
as
the
diseases
of
erections
as
central
known
position,the
found
with
an
that
during
empty
of
pressure
returning blood-vessels
We
powerful erections.
irritation,as
of the
in
seminal
constant, indeed
the
very
a
is
have
with
bladder.
night, in
a
full
last
It is also
the
full bladder
sufficient
know,
of
erections.
easily,and
more
occur
men
excitation
causes
that
as
certain
as
system
nervous
also
brain
find in
we
well
as
excited
be
of the
Peripheral
result.
a
erections
longer than
well
the
system.
can
irritation
thoughts
essentially
nervous
erections
genital apparatus
it is commonly
bladder
the
is
cord, and, indeed,
libidinous
Thus
of
electrical
also that
the
erection
Eckhard,
to
dogs by
well
of
mechanism
This
under
material.
dorsal
on
to
the
excite
matory
too, that inflam-
prostatitisand
vesicles,serves
tion
inflammato
produce
painful, priapism.
And,
it is well known
that peripheralirritation
finally,
applied to the glans penis,the skin of the penis,
and
the
testicles, causes
erection.
Neuroses
36
Goltz
of
discovered
has
of erection
Genito-UrinaruSystem
the
that, for the
through peripheral nerve-irritation
dogs, it is brought about
powerfully when the lumbar
promptly and
portion is divided
in
the
from
excitation
rest
of the
more
cord.
the influence
He
from
concludes
of the
cerebral
inhibitory
the erection is thereby eliminated.
nerves
over
fore
thereNervous
or
psychical impotence may
of
the increased
be dependent on
action
the inhibitorynerves
ant,
brought about by unpleasof the brain.
excitement
strongly agitating,
Through the action of these inhibitorynerves
fibres of the corpora
the organic muscular
ernosa
cavthis that
and
will contract
the
of
entrance
with
in
well
whom,
itself in
due
be
bands
to the
in
be
wrinkled
The
on
the
certainlybe
as
power
shows
cavernous
in
not
a
state
shrivelled and
manner,
of these
corpora
to
infrequently
which
might
cular
organic musination
Exam-
cavernosa.
penis of
small, retracted,and with
the
such
sons
per-
the
skin
the dorsum.
testicles
even
action
the
not
they are
penis is
worm-like
a
usually
to
when
excitement, the
of sexual
moves
into
Indeed, patients are
tissue.
met
blood
the
obstacle
an
oppose
are
usually normal, indeed
times
some-
strongly developed, and it would
to draw
a mistake
clusions
any general conto
increased
from
the size and
since
often, as
or
diminished
consistence
is well
sexual
of the
ticles,
tes-
known, patients in
in the Male.
the
whom
function
lost
wholly
cleferentia
of the testicles in coition
potent.
of
the
very
insensible
to
there
is also
of
skin
entire
than
sensitive
found
also
to
common
muscular
the
skin
flow
condition
find
that
which
of blood
this is the
throws
declaration
is
the
of
acts
from
the
out
patients
that
electrical
the
be introduced
over
of the
the bulb
perinseum,
muscular
such
conditions
current
that
hand
the
holding
the
urethra
powerful
apparatus
normal
as
can
be
apparatus
during
powerfully as
semen
sluggishly,
second
on
tion.
stimula-
urethra, the
into the rectum,
electrode
rectal
trode
elec-
and
nary
ordi-
electrode
an
pole placed
the
raphe
about
brought
feels
a
of the
of
contractions
of the
by the use
perinseum bulges out,
the
ernosa,
cav-
corpora
of the
semen
is
by preventing
muscular
same
It
before-mentioned
no
sponge
halves
two
out
as
longer thrown
formerly,but that it only flows out
is explained. If in healthy men
a
coitus
degree
reversed.
the
only feebly to
reacts
Since
the
on
the
arrangement,
return
which
the
different
very
genital apparatus. According to
right half is physiologicallymore
quently
infrethe left,yet I have
not
the
Benedikt,
stimulation, and
electrical
a
found
frequently
is
penis
commonly
of
irritability
of the
is
of both
vasa
through obliteration
after gonorrhoeal epididymitis,may
yet be very
The
37
this
under
induced
and
strong
the
im-
Neuroses
38
pulse.
of the
Now
in
found
muscular
that
these
quently
infre-
not
contractions
with
even
have
the
of the
of
use
strong
and
produced only incomj^letely,
scarcelyperceptible.
The
potence
imprognosis in psychical or nervous
are
usually favorable.
is
otherwise
are
erections
time
;
strong
since
desire
the treatment
psychical.
since
for
an
of the
The
the
and
tals
genitionally
func-
also, usually,powerful
although always
just at that time
occur,
and
Since
normally formed
capable ;
a
I
impotence
apparatus,
currents,
are
Genito-UrinarySystem
erection
the
when
wrong
there
is
it is
patient must
influence
at
of the
wanting, so
be, above all,
excited
bral
cere-
of erection
inhibitorynerves
be overcome,
the patient will
then
must
have
do
to
again be potent. Ordinarily we
with
abnormally excitable, so-called nervous
patients,who enter upon coitus with powerful
erection, but
extraordinary excitement, yet
before
the beginning of the act the penis has
becomes
already drooped, and its introduction
an
impossibility. Such a failure so discourages
the patientsthat, if it is repeated,they abstain
from any further trial from
a
feelingof shame,
and
as
impotent. In such
regard themselves
the comforting advice
of the physician
cases
with the assurance
of complete cure
has a very
quietingeffect on tlie abnormally excited mind,
and
such
not
infrequently the pliysiciansees
activityover
the
39
in the Male.
with
and
their eyes
of
with
despairing patients depart
often
sincere
the most
in
tears
expressions
gratitude.
If
physician has, in this manner,
of his patient,the
latter
confidence
then
the
the
won
is much
also
composed, and the further
more
practicable. Should
more
treatment
is made
evidences
of
quieting
advantage.
cold
water
Local
treatment,
effectual.
This
be
instrumental.
that
the
through
rectum
erections
the
are
The
erections
object
clear to the
that
he
powerful
is
treatment
patient that
a
offers
therefore
erections.
dikt, Schulz,
is
well
most
or
known
and
the
was
by
to
make
it
impotent, and
lasting and
patient has once
the relief of his
difficulties.
the
to
secure
others
be
have
to
further
This
urethra, very
he is not
of this,then
to
sounds
infrequently occur.
When
no
when
or
must
condition
himself
impotence
the
electrical
the
in
not
erections.
convinced
point
of
is in
It
remain
to
powerful
always
either
of enemata,
administering
allowed
is
applicationof irritants in the
the prostaticportion of the urethra
be produced.
Thus, after
can
in
or
be
however,
mechanical,
day), or
prescribedwith
a
grammes
cure
may
apparent
potassium might
of
notwithstanding, bromide
be given in large doses (3
a
be
excitement
strong
patient
attained
means
by
of the
The
expected
un-
Benecon-
40
of the
Neuroses
Crenito-Urinary
System
currents
good result. Weak
were
pole is
usually employed. The
copper
the lumbar
vertebrae, and with the
placed over
zinc pole the
perineum, spermatic cords, and
of
Duration
successively stroked.
penis are
with
current
slant
2
daily sitting,
6 to 10
dikt
or
weeks.
employs
unites
Avith
3 minutes
a
the
;
duration
In obstinate
urethral
Bene-
cases
electrode
pole,and
zinc
of treatment,
which
introduces
he
into
This
ever,
proceeding, howprostaticurethra.
current, is only
by the use of the constant
of the pars prostatica
a galvanic cauterization
alkalies of the tissues
of the caustic
by means
(caustic soda?), since, according to electrical
laws, the alkalies are set free at the zinc pole.
ing
Although these methods are capable of producexcellent
results,yet I employ the faradic
current, following the experience of Duchenne,
with this modification, that one
pole,a metallic
staff about 6 cm.
long, is placed in the rectum.
the other electrode
this pole in the rectum
With
the bulb of the ureis appliedsuccessivelyover
thra,
the ascending rami
and rightand left over
of
contractions
of the pubes. In this manner
the
the
bulbo-cavernosus
musculus
culi ischio-cavernosi
of
that
erection
muscular
of
of tlie
anaesthesia
semen.
apparatus
the
of the
favors
which
promotes
If there
the skin
of
mus-
produced, consequently
penis,and
the
of
are
and
the
is at the
tion
ejaculatime
same
penis and
the
its
sur-
42
jVeiiroses of the
G-enito-UrinarySyBtem
by masturbation, it is very probable that
a pathological
change of the caput gallinaginis
of impotence must
This form
is involved.
condered
reflex neurosis
as
a
sequentl}^be looked
upon
emanating from the prostate,and is to be treated
also those
obstinate
are
accordingly. There
prove
which, according to Benedikt, only imcases
applicationof
after the
If the
of
the
procedure.
treatment
and
More
leaving-inof wax
powerful is the
metallic
exert
the
a
same
of
phor
while
Should
to
nitrate
methods
of silver
will be
very
be
of
of
the
heavy
urethra, and
of
(psychro-
advantageously,
cold
a
gallinaginis
be tried.
more
is added.
avail, then
no
caput
might
treated
bougies.
and
cold, sound
pressure
means
cauterization
the
est
mild-
caput gallinaginis.In
works
metallic
all these
mild
with
Winternitz)
here
stretch
also, the
way,
the
the
introduction
of thick
action
the
on
pressure
the
ment
treat-
least
flexible rubber
or
which
sounds
is at
be
sought
local
this end
To
to
appears
is
the
prostatic urethra
rational
trode.
catheter-elec-
neurosis
then
caput gallinaginis,
in the
most
of the
cause
the
All
these
in detail under
pollutionsand spermatorrhoea.
The
of the so-called aphrodisiacs,
as
use
cantharides,phosphorus, and other remedies, I consider
harmful.
Just
as
injurious I regard all
are
rings which
placed
apparatus and rubber
about
of the penis for the purpose
the root
of
the head
of
producing more
Tonics, such
43
and
lastingerections.
powerful
2.
(")
and
Motor
The
cold
a
ment.
after-treat-
as
of the
Neuroses
form
the
of
find these
which
is the
In the
paralysis.
In
forms
defined
urinary
these
distinctlydefined.
which
the
which
and
sometimes
brings
more
drain
they
urine
trousers
after
of
of
spasm
the
patients
they
have
have
urethra,
much,
very
completely
allowed
replaced it
the
tied
emp-
penis
in their
to
trousers,
times
suddenly, on taking a few steps, somefew drops, and
again a larger quantity
the
flow from
the penis,and sometimes
are
wet
phenomenon,
through
to
have
retention
remained
of
down
the
this
small
behind
urine
in
in
the
to
I believe, may
by supposing
urine
to
feel
a
This
that
off,and
dition
peculiar con-
the
to
bladder, have
the
a
very
physician,namely, the
profuse drihhling of nrine after
The
patients complain to the
micturition.
physician
worries
them
less
or
is
fibres
not
are
attributed
muscular
organic
organ.
there
be
might
bladder,
in the
phenomena
Yet
the
in
again in
urinary system
the
muscular
most
urethra
best
water
useful, and
air,are
sometimes
genital system appear
of spasmodic contractions, and
form
The
iron,
recommended
be
especially to
of
and
quinine
as
sea-bathing,mountain
cure,
we
in the Male.
the
best
knee.
be
quantity
the
plained
ex-
of
urethra.
urethra
is
of the G-enito-UrinarySystem
Neuroses
44
by
the
contraction
fibres
by
which
favored
made
its walls
of the
lasts,the urine
of
closed.
As
a
with
gut
as
soon
thin
is
Now,
of
which
the
then
soft
with
tube
out
than
a
one
end
is
organic
of the
contents
a
as
as
fibres
of these
relaxation
out, just
filled with
long
as
a
flow
more
no
and
in
it were,
glass tube
a
trickles
urethra
tube
can
cular
organic musnarrowed, and
organic muscular
fibres ensues,
muscular
canal
stands,as
It
rigid walls.
the
resistant.
more
this contraction
fluid out
the
of
fluid
of
out
a
walls, as, for instance,
with
water
end
one
tightly
fore,
dribblingof urine, thereshould
be attributed
to
traction
a
spasmodic confibres of the
of the organic muscular
urethra
throughout its whole length.
Much
more
important and noteworthy is
of the external
sphincter of the bladder,
spasm
itself
vesicce. It shows
the sjyasmiis sphincteris
ing
in this way, that the patients complain of hava
frequent impulse to urinate ; but when
call comes
the
only satisfyit with
they can
and
wait
to
they have
difliculty.Sometimes
closed.
so-called
This
strain
five
or
comes,
and
then
the
slightspurts, and
the
end
of
drops, and
first
at
finallyin
the
micturition
thinner
then
does
urine
force,but
its normal
before
minutes
ten
until
after
the
the
any
not
urine
flow
with
by drops, then
full stream.
a
stream
urine
flows
penis
has
in
At
comes
again beonly by
been
re-
45
in the Male.
placed in
still flows
trousers, there
the
small
a
plain
They also comquantity of urine.
ate,
to urinthat they are often entirelyunable
although they have the desire,and that they
have to depart from
the closet without
having
mildest
effected their purpose.
The
degree of
additional
of the
spasm
with
sphincteris
certain
individuals,of
of
presence
cannot
to
in which
made
of
The
urethra
the
with
sound
but
Spasm
the
in
fact,
sensitive
could
only
then
be
sphincter of
the
of many
prostate
to
or
a
were
sense,
there
besides
a
nervous
only
the
made
under
made
or
be
in
been
there
of
either
In
ease.
has
Since
passage
to
thesia;
anaes-
with
bladder
classified
the
defecating.
examination
stricture.
strictures
also
a
that
mistakes.
when
was,
time
while
be
formerly thought
was
of the
each
was
so
obstacle
an
lead
injectionof a large dose
ate
patient also could only urin-
it could
of the
occasion
there
was
to
as
distinctlyremember
sittingposition,and
a
harmless
the
The
morphine.
of the
so
violent
so
micturition
possibleby
in
I
happens
one
of
the
they
contraction
always
it is
of urine.
retention
case
is not
Sometimes
nature.
Sometimes
if any
urinal
a
in
urinate
to
spasmodic
sphincter,however,
a
able
person.
in
This
near.
being
not
pass water
be
to
mon
phenomenon, commostly very nervous
persons,
second
a
the
is,
urine,
disease
early times,
the
broadest
ure,
inflammatorystrictNow
spasmodic stricture.
46
Neuroses
this
of
spasmodic stricture is ahvays a spasm
external
The
sphincter of the Wadder.
of this spasmodic stricture
is generall)'
a
the
cause
diseased
of the
of
condition
the urethra
Genlto-UrinarySystem
of the
or
the
prostatic portion
prostate itself.
sphincter,which
and
membranous
have
We
find
ani
in
indeed
within
of
in
of the
at the
catarrhal
of
spasm
no
of irritation
its limits.
the
ulceration
sphincter
fissure,
or
of the
inflammation
simple
urethra,
wonder
that
we
tum
rec-
have
tions
sphinctervesicae with similar affecneck of the bladder, especially
when
of the
reflex spasm
about
brought
Such
analogue
an
cases
themselves
it is therefore
spasm
the
localized
even
;
be
portions of
sources
as
nel-shaped
fun-
represents the prostatic
spasmodicallywhen
contracts
The
of
sphincter of
irritation
by
localized
irritation
the bladder
in the
in
the
may
rectum.
prostaticurethra
rhalis
tion.
gonorrhoeaor of masturbaOf gonorrhoea, when
a
prostatitiscatargonorrhoica is present and we find its
traces
in
be the
may
the
urine.
examination
urethra
result
of
thick-headed
the
Of
masturbation,
with
is very
shreds
the
sound,
sensitive,and
when
that
bleeds
contained
we
in
find,on
the
prostatic
out
easilywith-
being evidence of any inflammation
that
or
gonorrhoea; since we may then assume
the
in the
prostatic urethra, probably about
hypersesthesia,hypersemia,
caput gallinaginis,
condition
with superficial
catarrhal
eroa
even
there
in the Male.
of
sion
the
47
become
has
membrane,
mucous
localized.
The
examination
attended
with
with
the sound
demands
and
great difficulty,
practisedhand.
It is best
to
cylindricalm.etallic
a
is sometimes
in the
use
sound
a
nation
exami-
of the greatest
well-rounded
and
with
a
possiblethickness
soft instruments
the object is not
point. With
ous
bent in the membranattained,for they become
portion.
metallic
Thin
small
instruments, especially
catheters, never
the
serve
absolutelydangerous, because
are
they
may
false passages.
sound,
by
lessness
care-
some
easilycause
injury and
Having selected a suitable
passed,
is
between
possible
with
it
the
held
thumb
aud
purpose
make
allic
met-
lightly as
forefinger,
as
and
down
to the
steady,gradual movement
it is held, and
the
triangularligament. Here
blunt
is pushed gentl}^and
point of the sound
After
firmly against the isthmus.
waiting a
few
a
the
moments
of the
contraction
graduallyfelt to relax, and
easilypassed into the bladder.
be done
roughly, and
is
at the
isthmus, be thrust
because
is
we
cannot
only stimulated
and
pass
reach
the
through.
to
sound
the
can
be
If the catheterization
the
about
sound, arrived
here
and
there,
the bladder, the
renewed
instrument
One
sphincter
sphincter
traction,
spasmodic con-
cannot
be made
easilyexplained
this difficult catheterization
is the
result
to
of
diagnosis of
4S
N'eiu'oses of the
Gcnifo-Urinari/
Si/stejn
stricture made
urethral
by
unskilful
physicians
of the sphincter.
there is only a spasm
when
osities,
We
also find in literature cases
reportedas curiin which
surgeons, assuming stricture to
omy,
urethrotbe present,proceeded to do external
and then to their great astonishment
were
struments
able, during anesthesia, to pass very large ininto the bladder.
The
must, above
treatment
all,be directed
to
sphincterpenetrablefor catheterThis is best accomplished
formed
instruments.
by the dailypassing of large metallic sounds,
utes
allowingthem to remain in from 5 to 15 minand over.
This practice
alone is ordinarily
making
the
establish
sufficient to
certain obstinate
erosions
or
cases,
normal
In
micturition.
when
however, especially
of the bladder
fissures at the neck
urethra
the prostatic
suspected,
with nitrate of silver by m"ans
must
be
are
ized
cauter-
of the
porte-
spasm
of the
remede.
Much
frequentis the
more
bladder,cystospasmus,which
vesical
tenesmus,
considered
as
a
and
spasm
true
accompanied by
must
properlybe
is
which
of the
detrusors
of the
bladder.
The
eases
in disvesicce occurs
spasmiiH detrusorum
of the central nerwell as irritability
vous
as
malies
system,and also as a reflex neurosis in anoof the urethra, especially
the prostatic
portion. Frequent micturition
y"
is common
with
Xt'uroses
50
of the Crenito-Urinary
System
under
etc.),yet
these
circumstances
spasmus
sphincteris vesica, as already mentioned,
much
more
frequentlyfound.
detrusorum
Accordingly, by spasmus
understand
frequent, although
a
painless,impulse
urinate
is,when
that
In
the
for the
occurs,
we
generally
impulse to
part, only by day,
most
mental
physicalor
activitybegins.
usually not the least need
long as the patients quietly
night there
felt to urinate,
This
urinate.
to
is
is
so
sleep; when, however, they pass a sleepless
is all the stronger.
night the vesical tenesmus
desire comes
sometimes
The
hourly,again every
10
that
minutes, and
15
or
when
the
closet the
urine
their will.
is sometimes
patients do
flows
This
into
of
state
just the oppositeto
so
hasten
not
violent
to
their clothes
the
against
things is consequently
described
that
in the
case
of
sphincterisvesicae.
of a pale yelThe
urine is usually clear and
low
It has a low
color.
specificgravity and a
spasmus
taneous
faintlyacid reaction. There is simulpolyuria (urina spastica,nervosa). Not
neutral
or
without
bladder,
water
there
being
and
without
any
and
therefore
such
abnormal
cause
in
since
cases,
urine
the
alkaline
sign of catarrh
alkali, or
any
containing such, liaving been
In
evident
is turbid
urine
infrequently the
mineral
taken
alkaline
an
is secreted
kidneys,
of the
we
ternally
inand
without
must
as-
sume
perversion
a
of
If
the
neutral
and
which
of
of
with
litmus
cretion,
se-
result
neys.
kid-
the
paper
drop
a
neutral
in
acid
earthly phosphates.
of
these
neutral
with
connection
urine
of acetic
the
tral
neu-
essentiallysupports
of
neurosis
the
urinary
and
general, and here especially
frequency of micturition, cj^stoin
system
nervous
We
spasmus.
in
discussed
under
If the
as
of
those
short
sediment
which
in
of
"
detrusorum
from
tion
soluready
al-
Urine
has
we
thick-headed
come
other
an-
has
gonorrhoea,
and
or
which
the head
spasmus
result
a
one
constituent
urinary sediment,
in Neuroses."
occurred
sometimes
urinary
the
been
find
also
abnormal
the
of
the
diagnosis of
usually
the
as
neurosis
demonstration
reaction
or
of
consists
earthlyphosphates
sexual
urinary
urine
shows
addition
The
in
this
urine
the
on
of
normal
faintly acid reaction, we
find, on
solves
turbidity which
completely dis-
or
heating, that
the
the
coexisting secretory
a
a
of
consider
and
51
the Male,
m
find
shreds
the
tatic
pros-
urethra.
On
and
examination
bladder
are
with
found
the
very
sound
sensitive,the
portion being recognizedas
spot.
with
of the
The
the
urine,
on
negative result
sound
or
and
urethra
the
the
the appearance
boiling,together
the most
of the
normal
tive
sensi-
tion
examinacondition
of neutral
with
tatic
pros-
the
phates
phos-
neutral
of
reaction
Genito-Urhiary System
of the
Neuroses
52
the
If short, thick
diagnosisof cystospasmus.
the
shreds
are
also
visible
urine, then
the
in
opinion gains probabilitythat
with
a
as
cystospasmus
a
have
we
has
which
the
from
neurosis
reflex
establish
freshly passed urine,
the
do
to
about
come
prostatica
pars
urethrae.
The
has,
treatment
If
to fulfil.
which
central
have
tions
condi-
varied
with
spasmus
cysto-
a
irritation of the
on
this
system
do
to
dependent
is
nervous
first of
must
we
in this case,
influence
harmful
Such
wholly removed.
all be
himself for a time
patient must withdraw
overstrainingmental occupation; likewise
sexual
excesses
micturition,
in
and
baths
the
pain
as
effect.
In
a
permanent
a
pleasurejourney does
a
stay
of cold-Avater
at
Romerbad,
in
cure,
the
sea
ences
influ-
harmful
and
when
cult
of his diffi-
cause
other
from
fear,have
such
cases
excellent
duced
protimes
some-
service,
country,
bathing, or
Gastein, Teplitz,etc.
a
mild
warm
If all
tion
impracticable,agreeablerecreaand diversion must
be provided for as much
of
possible. Of internal remedies, bromide
these
as
when
or
such
general,
sometimes
course
been
have
a
things are
daily)
large doses (3 or 4 grammes
nary
best, or quinine,iron, and arsenic in ordiother narcotic will
doses.
Morphine or some
potassium
works
in
temporarily relieve the severe
and is best given in the form
vesical
of
a
tenesmus,
suppository.
53
in the Male.
If,on
the other
which
spasm
hand,
of
undertaken.
effectual,or
the
short
cysto-
a
tion,
masturba-
to
oi;gonorrhoea,then
the
prostaticamust
be
pars
such
sounds
passing
cases
is
with
astringentby means
catheter
(as described
treatment
urethral
29), in
page
the
In
do with
to
attributed
excesses,
local treatment
of
be
may
venereal
have
we
with
connection
on
clystersand
warm
baths.
warm
the
Among
motor
of
neuroses
system, and
especiallyof the
accompanied by diminished
are
of the
the
be
to
are
mentioned
sphincterand
bladder.
with
associated
and
paresis
with
of
the
of
retention
By paresis of
urinary
bladder, which
of
power
paresis and
also of the
of
Paresis
the
the
traction,
con-
ysis
paral-
detrusors
sphincter is
quently
fre-
of urine,
incontinence
detrusors
of
uncommonly
not
urine.
the bladder
be
is to
understood
the
inabilityto completely empty the bladder.
Paresis
is usually meant
of the detrusors
by
this expression. A
of urine
tardy evacuation
sometimes
occurs
Thus
I have
which
24
the
One
young
man,
desire
to
only
more
in
several
urine
hours.
in
was
morning
habit
than
men.
cases
in
evacuated
apparently
the
normal
observed
times
patient
urinate, and
from
otherwise
in
only twice in
particular,a strong
never
said
and
from
had
that
he
evening,
a
pressing
a
urinated
and
desire
then
to
re-
Neuroses
54
of the
lieve
himself.
very
well
for
Once
when
he
had
not
Genito-Urinarii System
He
could,
24
said,hold
hours, urinating only
to
came
he declared
me
for 20
passed urine
after
forthwith, and
urinate
lie
so
hours.
out
once.
that
I had
he
him
straining and
some
urine.
delay he passed about a litre of normal
bladder
the
The
to be felt over
was
distinctly
ficult
s^'mphysis. The patient complained only of difand
in general. I
infrequent urination
prescribedmineral waters containing soda salts,
of the
massage
bladder, cold
region after
least
5
whether
every
the
times
he
in
had
4 hours
patient was
that
he
could
a
bath, and
warm
24
hours.
desire
and
in
4
the lumbar
micturition
or
without
time
5
at
patient must,
In
his urine.
short
a
The
on
not, go to the
or
pass
urinate
and
douches
so
times
closet
this way
far restored
daily,in
a
straining.
Paresis of the detrusors
is either dependent
fibres (hypertroph
organic change of the muscular
upon
fattyand amyloid degeneration)or
The
inaneurosis.
it is a question of motor
is best
Inlityto completely empty the bladder
der
verified by liavingthe patient empty his bladmuch
as
as
possible and then immediately
A
bladder, to be normal,
passing a catheter.
must
empt}''itself completely, so that not a
drop of urine can be obtained with a catheter.
If the
spontaneous emptying of the bladder,
it will l^e possil)lc
however, is insiiflicient,
always
normal
manner
65
in the Male.
with
evacuate
to
quantity of
The
urine.
will be
evacuated
catheter
the
The
more
drawn
with
the
be
there
residual
catheter, the
on
Such
obstruction.
mechanical
weaker
I say
in which
cases
are
is insufficient
of urine
there
urine
of the bladder.
detrusors
usuallyare the
usually,because
thus
insufficiency
of the
of the bladder.
is to
of urine
a'mount
measure
a
the
of
account
hypertrophy
is also found
bladder
there
is
of
the passage
a
as
urine,
are
tatitis,
prossuch
the
ever,
complication. If,how-
have
we
some
of
coat
obstruction
mechanical
such
no
muscular
of the
cuation
eva-
obstructions
generallystrictures of the urethra, chronic
and hypertrophy of the prostate. In
cases,
less
greater or
a
as
rule
a
to
to
paresisor paralysisof the detrusors.
The
patients usually complain that
do
with
urinate
wait
a
until the
it does
lying down
the
and
press
urine
to
and
bow-like
a
trickles
cannot
flows
of urine
satisfaction
after
at
they
The
the
turition,
mic-
urinating.
comes
falls
urethra,
While
ing
all,and standlean
never
If the
forward
incomplete
more
is, the oftener
urinate, yet there is
but
the roof.
from
if
it
stream,
urinate
best
the abdomen.
on
when
even
perpendicularlyfrom
they
the evacuation
desire
in
rain-water
justas
of
act
indeed
comes,
flow
force
without
is
urine
not
each
painless,they have
long time, pressing and straining,
which
to
Before
badly.
very
they
comes
a
the
feeling of
paresisJ3ass
Xeuroses
d6
of the G-enito-Urinary
System
graduallyinto paralysis,incontineuce
first during the night,and after some
becomes
feeling of
urinate
fulness
time
patients
ually
gradhave
a
the
in
hypogastrium, they
often, and each time only a small
urine
is passed by resorting to abdominal
very
of
quantity
The
constant.
at
occurs
pressure
;
yet
by drops.
the
They
still flows
urine
have
again
never
stantly
con-
the
feelingof satisfaction after urination.
Paralysisof the bladder is generally found
chronic
and
cerebral
spinal diseases. Yet
also
occurs
in
when
of
the
for the
various
they are
central
most
as
cesses
pro-
but
system,
advanced
In
evacuation
it is then
of
urine
age
occurs
rule, although well-pronounced paresis
a
is not
always apparent. In youth and
vigorous middle life a paretic condition of
bladder, especially of the detrusors, occurs
such
a
individuals
long time,
of venereal
cases
or
have
such
retained
as
the vesical
or
their urine
suffer from
sphincter as
prostaticenlargement
paresisof the detrusors
established, has been
the
in
for
a
result
That,
and
permanent obstructions
urine, hypertrophy in the
in
spastic
of masturbation.
other
later
becomes
in
excesses
of
of
and
as
or
of
contractions
in
it
complicated with affections
nervous
the
febrile
acute
part temporary.
of
insufiBciency
almost
the
in
of stricture,
to
the
cuation
eva-
beginning
of the
bladder
already
tioned.
men-
JVeiiroses of the
dS
On
of the
examination
diagnosisis
Si/stem
Cre}uto-Un')iari/
sometimes
If the detrusors
patientthe
much
easier
alone
are
differential
still to establish.
paretic,and
the
the
sphincter still works efticiently,
found
tumor
distended, as a fluctuating
bladder
symphysis, or else a flaccid bag filled
is felt,which, being compressed with
with
desire
a
causes
the
over
the
It is also
urinate.
to
is
fluid
hand,
possible,
spiteof the patient'sdeclaration that he has
by percussion several
just urinated, to demonstrate
in
of dulness
the symover
finger-breadths
physis. In paresisof the sphincterthe spherical
of the
form
distended
the
The
symphysis.
degree weakened
offer resistance
in
the
;
is
it is not
felt
never
is
sphincter
that
to
bladder
bladder
in
to
the
flows
urine
such
it is
found
seldom
very
impossibleto
distention
urine.
of
If
we
show
away
indeed,
over
bladder
the
pass
;
a
tarily.
involun-
paresisof
with
accumulated
catheter
resistance, we
almost
the
cases
symphysis any
into
usually meet, in paresis of
powerful resistance at the neck
in
some
urine
the
we
whereas
in
to
of urine
Consequently large quantitiesof
are
a
condition
a
large accumulation
a
over
the
the
bladder,
detrusors, a
of the
bladder,
sphincter,
meeting
fall with
the
no
instrument,
If the
speaking,into the bladder.
figuratiyely
urine be drawn
ally
off,a larger quantity will usuthan in
in paresisof the detrusors
be found
paresisof the sphincter. Yet not infrequently
59
the Male.
in
complicatedwith paresis
of the sphincter,so that these typical phenomena
no
are
longer capable of demonstration.
When
the urine flows through the catheter, the
position,we
patient being in the horizontal
notice at the beginning of the flow a relativelypowerful stream; soon, however, it diminishes,
flows down
and the urine
perpendicularlyand
paresisof
in
weak
a
the
the
impulse
bellyis
is
a
end
the
from
stream
Only by
on
detrusors
the
of the
of
coughing or by pressure
powerful and bow-formed
more
immediately
caused, which, however,
stream
catheter.
comes
be-
powerless again. Finally the
stops flowing entirely,yet if we
press
and
weak
urine
the flat of the hand
with
bladder,
have
or
patient get up and gradually
upright position, then the
from
still flows
urine
of the
the
the
assume
fundus
the
on
the
bladder
in
greater
or
less amount.
The
is either
urine
normal,
it shows
or
a
tral
neu-
faintlyalkaline reaction, with a precipitate
of neutral earthy phosphates. Sometimes
or
has
the uriue
without
catarrh
of
whitish
sometimes
there
sediment
birth
being
the bladder.
phosphates. In
the amorphous
lime, the
from
been
The
consist
the
turbid
even
accompanying
turbidityand the
merely
sediment
are
the
phosphate
line,
alka-
an
granular
crystalline phosphate
or
and
of
of
found
earthy
either
carbonate
of
of
lime, and
magnesia
crys-
60
of the G-enito-Urinari/S//stem
Xeuroses
tallizing
long, rectangular plates.
in
also found
I have
amount
cent., in paresisof the bladder, without
of 2 per
there
the
to
sugar,
sionally
Occa-
being
in addition
of diabetes.
any
The
of the
general symptoms
after
moreover,
sugar,
and
being present months
years long, has
disappearedcompletely from the
sequently
suburine
without
done
for the
anything having been
glycosuria. If,however, the stagnationof urine
bladder
the
in
for
continues
a
long time,
a
purulent catarrh of the bladder or a purulent
about, and in the
cystopyelitis
graduallycomes
urine
well
as
characteristic
and
of
and
renal
The
not
must
has
or
occurs
been
other
very
purulent catarrh
the
easily when
previouslyexamined
catheter-formed
favorable, and
thenceforth
This
be
tion,
solu-
corpuscles,crystals
phosphate, bladder
in most
with
a
instrument.
prognosis in paralysisof
very
in
pus
This
epithelium.
bladder
bladder
sound
sediment
the
such
affections,
of ammonia
carbonate
in the
found
are
of these
ammonio-magnesic
the
of
sediment
evidences
and
albumen
as
in the
as
the
cases
constantly
bladder
the
drawn
is
urine
with
explained to the
else they will unnecessarilyblame
the
patients,
physician for having, by catherization,reduced
them
to such a condition that they are no longer
able to pass their water
spontaneously,as was
still possible,
they say, before the use of the
the
catheter.
must
be
61
in the Male.
catheter.
The
which
be drawn
can
catheter,the
the
greater
from
the
bladder
unfavorable
more
of
amount
urine
with
the
is also, usually,
the
of the
prognosis,as regards the contractility
bladder.
tion,
During the subsequent catheteriza-
also, inflammatory processes
set
life of the
expressions which
with
in connection
used
bladder, such
the
and
they
are
often
are
the
may
motor
of
neuroses
gury,
urinee,stran-
here
not
made
use
of,
only general diagnostic terms,
morbid
in entirelydifferent
used
the
Nevertheless
conditions.
formerly
were
incontinentia
as
ischuria, I have
and
since
which
urinary tract,
patient.
older
The
quently
infre-
capable of immediately threatening the
be
even
in the
up
not
are
etymology
of these
employed,
expressions,which are still sometimes
be
should
By incontinentia
brieflyreviewed.
urince (from in privative and contineo, to hold
together,hold fast)is
to
hold
may
back
urine.
the
in the
occur
most
strain) is understood
the
urine
great pain.
a
comes
Finally, we
(from
Ux*^,
urine)
retention
to
hold,
of
difficult micturition.
the
this
That
inability
condition
varying afl^ections of the
clear.
By strangury (from
urinary apparatus, is
the urine, and
TO
ovpov,
when
understood
I
srpayyw,
press,
urge,
strainingat micturition,
only by drops and with
understand
hold
urine
back,
or
by
ischuria
and
sometimes
ovpov
very
I^eu
62
The
be very
of the
roses
Genito-UrinarySystem
treatment
of
paresis of
the
varied.
In
lightcases
where,
mostly from
infrequent micturition
a
persons,
daily
with
of
massage
has
the
regular micturition
mild diuretics,such
with
soda
a
salts,will
visit to
rubbing of
douching of
the
the
bad
habit, a
become
bladder,
at
as
be
country
bladder
short
in
strong
slow
and
established,
in
connection
intervals
mineral
waters
sufficient.
or
may
and
taining
con-
tics,
Gymnas-
mountains,
cold
whole
body, cold sitz-baths,
the perinaeum, over
the
bladder
and the lumbar
region ; further,showering the
back
with cold water
immediately after coming
out of a hot bath, all work
very advantageously
of the bladder.
in stimulatingthe contractility
Of internal remedies, quinine,ergot,and strychnia
are
given with good effect. Of quinine
and ergot 0.5 gramme
dailymay be given, and
strychnia either internally(strych.sulph. 0.02,
sacch.
albi
3.00, div.
in dos.
no.
vi ; 1
or
2 powders
endermically(strych.nitr. 0.10,
sacch.
albi 5.00, div. in dos. no.
x), the mons
veneris
moved
being shaved, the epidermis being reof a
blister,and every day
by means
a
corium; or
powder dusted on the denuded
hypodermically (strych. nitr. 0.05, aq. dest.
half to a whole
Pravaz
10.00 ; one
syringeful
and
offers the most
convenient
daily),which
of employing strychnia. It is
the best means
best to injectit into the skin of the abdomen
over
daily);
or
the Male.
m
the bladder.
As
muscular
as
soon
63
twitching or
of exalted
muscular
general symptoms
are
apparent, this remedy must
Electricitymay be used ; one pole,as
electrode, being passed into
and
the
other
introduced
vertebrae, or
constant
well
as
I
employed.
means
only
for
beginning
often
bladder
that
it is
and
bladder.
the
later
a
of the
detrusors
introduction
and
the
of
lumbar
treatment,
of
at the
Just
other
when
electrode
only
prostaticaurethrge.
made
to
brane,
mem-
of
of
In
lent
puru-
using
paresis
the
electrode
in
into
The
contract
passed into the
sphinctervesicae
by
over
paresis of
predominates, the
be
the
treatment,
pole being placed
this
to
reason
time
same
in
of the
is to be recommended
vertebrae, while
is
has
stimulation
catheter-formed
a
sphincter,or
be
trode
elec-
months.
course
not
there
l:he bladder, the
also
of electricity
harmfully,for the
for the mucous
too
irritating
sets
a
purulent catarrh
up
in
be
may
use
this method
pyelitisor nephritis,
often shows
electricity
good results.
the
The
acts very
however, if there is
of the
lumbar
catheterization
of treatment,
Later
der,
blad-
catheter-formed
period
weeks
the
rectum.
the
regular
practisedfor
been
the
of
continued
dis-
ter-formed
cathe-
a
current
recommend
until
not
the
into
be
the
over
the induced
as
can
by
indeed,
pole placed
ability
excit-
faradization
the
same
pars
can
per
more
method
first
of
urethra, which
the
into
pole
need
the
without
rectum^
System
G-enito-Urinary
of the
Neuroses
6-A
passing
be
will
a
discussed
with
enuresis.
This
fully in connection
for very sensitive
is especiallyindicated
patients.
best
The
is
however,
treatment,
always
thoroughly carried out, regular course
and
as
be
bladder, whenever
the
beginning of
in the
vulcanized
rubber,
should
most
now
must
it to
favorable
a
Since
kind
this
the
terization
cathe-
as little
gentle,and cause
in paresisand paralysisof
possible,
should
irritation
with
catheterization.
result without
of catheterization,
of
case
treated
be
scarcely ever
can
advanced
an
a
be
as
and especially
practicable,
treatment, only catheters of
the
so-called
Nelaton
ters,
cathe-
as, manufactured
used, such
from
(Jaques' patent), are
der
imported from England. A paretic bladcannot
completely empty itself,and we
therefore,by regular catheterization,force
draw
off its
while
we
graduallycontract
excellent
material
contents.
The
use
bladder
a
of
the
in
paresis of
the
ficulty.
usually attended with no further difThe
learns the management
patientvery soon
of it himself, and
in cases
running
course
gradually diminish
to
in
is
favorable
even
catheter
discontinue
cases
it will
become
possible to
the catheterization,indeed
it
running
altogether. Not
an
unfavorable
ever,
so, howcourse.
Neuroses
(oQ
of the
G-enito-Urinary
System
With
third
the
good health.
day,
however, tliey begin to complain of depression
iu
passed
lassitude, the
and
temperature rises,and
severe
chill,which
unable
to
leave
his bed.
bladder
a
of urine
is which
catheter,so
renders
the
must
be
much
the
more
or
sixth
day
the
first
comes
the
That
is,and
turbid, the
fifth
the
on
first catheterization
the
after
becomes
urine
patient wholly
the
ficient
insuf-
more
greater
the
drawn
off with
quantity
is the
severe
reaction, is easily understood.
are
recorded
cases
of the
bladder
was
undertaken
and
where
urine
had
in literature
the
with
where
the
sequent
sub-
There
in
paresis
evacuating catheterization
the patient standing erect,
patient,after a large quantity of
drawn
been
off, at the end of the
the
It is therefore
suddenly fell dead.
in the
advised always to pass the catheter
horizontal
in
position. Not rare also are cases
which, with the first catheterization,a perfectly
normal
urine is evacuated, the patient looking,
healthy and strong, and in which,
moreover,
of 8 to 10 days, the
interval
after an
same
In
patient perishes with urtcmic
symptoms.
these
to the purulent cystopyelitisan
cases,
acute, usually suppurative, nephritisis added.
catheterization
There
are
also
cases
in
whicli
after
the
third
day of catheterization, the urine begins to grow
atous,
bloody. The bleeding is usually parenchymnot
coagula are
present, yet it can
microscopically,by the
hsemorrhagic renal epithelium and
demonstrated
be
of
so-called
color
whole
the
has
urine
casts, that
blood
but
now
red,
a
has
purulent catarrh
developed, the color
brownish
strongly alkaline,
We
with
pyelitiswith
Sometimes
or
it is
of
growth
Not
only
bacteria
massed
when
plug
have
to
with
the
reaction
in
shreds
which
microscope,
four
and
vigorous motion,
are
brought to
consist
is
sediment
the
that
rapidly progressing.
of
but
view
motionless
limbed
whole
by
the
bacteria
compressed
in
the tubules, and
off with
they have
the kidneys, they tightly
teria
such
when
plugs of bacbut
masses;
the urine,
if
they appear under
cylindricalcasts,
microscope as beautiful
which
consist
entirely of motionless
(Nephritisparasiticaof Klebs). The
the
nephritissuppurativa
these
of
together. These collections of bacteria,
in large,irregfrom
the bladder, appear
ular,
pass
in
the
compositi
strong of dedo, then, in a word,
the
is
bacteria
seen
of
odor
observed, when
membranous
been
the
single,small, two
are
clumps and
microscope
and
examined
thoroughly
the
green,
black
or
cystohsemorrhagic cystitis
without
suppurative nephritis.
ichorous
an
or
a
also
becomes
urine
brown
a
now
of
The
bleeds.
tract
dence
evi-
der,
blad-
the
alone
not
urinary
later, after
;
bladder
a
67
the Male.
in
in
cases,
unfavorable.
is
almost
bacteria
prognosis
always,
in
Neuroses
08
There
of the
yet
are
other
suppurativa
kidney, and in the
health
Genito-UrlnarijSystem
in which
cases,
has
involved
not
of
course
however, is graduallyassociated
nephritis,to
ritis
neph-
the
few
a
established;
is
the
whole
weeks
this
parative
com-
process,
with
stitial
inter-
an
patient with
kill the
all the
certaintyafter an interval of 2 or 3 years.
Very often we see parenchymatous processes
tion.
in the urinary organs
in after catheterizaset
The
patientsare usually confined to the
The
is relatively
urine
bed, and are feverish.
more
and
with
only slightlyclouded
muco-pus,
only correspondinglylittle albumen.
and
second
ofthere
lasts
chill that
a
comes
a
third,and
large
a
is
improvement.
only a short time,
again to give
repeated evacuations
and
until
months,
ensues,
remains
or
Yet
for
way
this
of pus.
urine,
improvement
after
improvement
This
may
play
of improvement
last weeks
and
improvement
patientperishes.
constant
a
the cliills begin
finallypermanent
urine
by
tion
evacua-
the
with
soon
to
exacerbation
until the
in the
last,after the
at
denly
Sud-
followed
soon
of pus
amount
anew,
is
tains
con-
evidence
Still there
of
cysto-
which, although late, passes gradually
pyelitis,
into a nephritis.
The
of these
cause
unpleasant complications
after catheterization
is
of paresisof the bladder
of presto be sought in the negative conditions
sure
In paresis
within
the urinary apparatus.
in
can
paralysis of tlie bladder, this organ
be
completely emptied spontaneously ;
and
never
there
remains
of urine,
this residuum
in the
also distended
suffer
from
the
of
the
bladder
and
their
urine
on
and
flow
in order
This
to
ously passed
urine.
If
urine, which
a
negative
say
tubules
such
a
and
of
there
such
finds
cases
for years
hyperaemia
in
ex
or
the
had
pressure
evacuated
immediately
fluctuation
ters.
ure-
greater
a
back
once
of
still spoatane-
perhaps
at
sure,
pres-
bladder
in
and
must
pressure
in the
now
the
back
evidence
albumen
catheterization, then
might
Since
secretory pressure
strong lateral
urinary tract, be all
a
kidnej^s
of the renal
the
in
in
urine
the
on
the
in the
of
less amount
such
of
hindrance.
overcome
increased
its confirmation
the
acts
freelyout
accumulated
accumulated
Still further, the
stagnation,the kidneys
increased
secreting power and
with
the urine
pressure
of the
account
exerted
a
as
are
them,
in
lateral
urine.
ureters
function
cannot
work
of
large quantity
a
of
latter
standing
urine
accumulated
accumulation
the
on
account
on
these
;
great degree
a
exerts
year,
bladder, is the flow of urine
the
by
residuum
pressure
Likewise,
embarrassed
the ureters
and
lateral
certain
a
greater
a
This
of urine.
of the bladder.
walls
bladder
the
usually increasingyear by
its volume
from
in
ahvays
residuum
smaller
or
by
69
Male.
the
the
vacuo,
in
by
ensues
pressure,
that
I
in-
y^euroses
TO
of the
Crenito-UrinarySystem
flammatory processes
the
necessary
In
the
favorable
catarrh
as
rule, follow
a
as
of this disturbance.
consequence
more
purulent
must,
of the
or
only mucous
bladder, of the pelvisof
cases
the
kidney and ureters, will take placefrom this
shall then have only
hyperemia ex vacuo
; we
a
severe
cystitisor cystopyelitis.In the more
added
to the
are
purulent cystopyelitis
cases,
of the prostate,
parenchymatous inflammations
of the
bladder, and
the rest of the
usually with
abscess
severe
cases
the whole
urinary
formation.
parenchymatous
urinary tract is added
a
ratus,
appa-
In other
haemorrhage
of
already
and
by decomposition of
present cystopyelitis,
the urine
ered.
suppuration in the bladder is engendthe kidneys also
cases
Finally,in severe
of
will react, presenting usually the symptoms
nephritissuppurativa.
after
Since, then, these unpleasant symptoms
catheterization
it is
occurrence,
with
the
are
not
to
to
the
be counted
enjoined to
manage
as
of
such
rare
cases
greatest precaution. If the paresisof
bladder
be somewhat
advanced, it is important
the
patientgo immediately to bed.
I never
completely empty the bladder at once,
of the patient.
that is,at the first examination
to
have
If the bladder
I
to
never
500
go to
at
the
contain
the first
c.c.
bed, and
I send
then
large amount
sittingdraw more
the
a
patient home,
empty
the bladder
of
urine,
than
400
have
him
gradually
71
in the Male.
less than
first catheterization
and
I do
allow
not
of
and
1-2
a
have
for
some
advanced
mild
system
After
by
in
left in
only
few
of
1-2
per
left
still sometimes
ary
part of the urin-
the
is
completely emptied
washed
solution
of carbolic
of
this
The
solution
carbolic
after
each
acid
power
of the
carbolized
;
left
solution
is
is
completely empty,
and
the
that
;
to
the
bladder.
solution
that
the
acid
catheterization
advantage
has
out
then
are
graduallydiminished
centimetres, corresponding to
the
and
himself
undressed
has
bladder
injection of
not
standing
notwith-
cent,
contractile
bladder
and
and
quantity
cubic
original
latter by
the
;
the
the
catheter
c.c.
the
the
of
soft
a
bladder.
the
on
bladder
the
100
about
Only
processes
within
of pressure
patient
bed
a
bed.
occur.
means
with
acid
gradually restore
to
symptoms
the
to
gone
100
carbolic
to
go
regular catheterization
the patient is in bed,
violent
very
of
inflammatory
organs,
of
urine,
patients promise to keep their beds
time
(2 or 3 weeks) is it possible,in
paresisof the bladder with relatively
relations
means
of
c.c.
his bladder
solution
immediately
reactive
urinary
cent,
per
him
the
when
400
injectinto
I
but
empty bladder,
c.c.
at the
contain
meaning to,
completely without
the patient to depart with
an
it
I empty
the bladder
If
completely.
but
a
turning
re-
The
into
bladder
the
is
its walls
of the Genito-Urinary
System
Neuroses
72
times
against each other, which someto the pacauses
tient.
very painful sensations
carbolic acid also has the advantage
The
fluids of effectuall}^
other
over
checking the
growth of bacteria,which, with the prevailing
negative pressure in the urinarytract, may penetrate
need
rub
not
from
unresisted
Pressure
hand
of the
without
the
on
the
over
the
palm
consider
necessary,
un-
soft catheter, the
the
completely emptied by siphon action
facility
correspondingto the lowering of
bladder
the
with
symphysis I
with
because,
with
bladder
neys.
kid-
the
to
even
is
a
end
outer
of
the
catheter.
In
beginning inflammatory action
this
moreover,
oftener
promotes
the
the
with
pressure
in
of
occurrence
the
case
of
bladder,
the
hand
much
atous
parenchym-
processes.
When
that
the
paresisof
milder
a
patient is
form
still able
to
is
pass
present, so
his
urine
spontaneously after catheterization,a complete
emptying and washing out of the bladder by
of the catheter
a
once
means
day is suflicient.
ate
When, however, the patient can no longer urinspontaneously after catheterization,then at
times
vesical
least three
daily,and if severe
s'hould be present, still oftener,must
tenesmus
the bladder
solution
of
be
emptied
carbolic
galvanism and
a
washed
out
witli
a
acid.
In the after-treatment
as
and
course
the
of
drugs as well
bathing at a moder-
use
of
of the O-enlto-Urinary
System
Neuroses
74
of
the
will
the
urine
will
at
of
The
one.
the
abilityto
hold
usually established
is
second
that
year,
at
is,after
first dentition.
Now,
yet
little
back
the end
about
the
the
children
who
hold
back
able
to
diseased
neither
the
child
Enuresis
which
is
enuresis
to
appears
usually the
nor
organs
Yet
is weakened
be much
in
have
abnormal
may
deed
usually,in-
by
run
not
disease
down.
sleep (at night),
and
case,
who
enuresis
later years,
either
occurs
period are
urine, and
enuresis.
suddenly in
the organism
when
and
the
urinary
urine, suffer from
first appear
after this
is then
called
bed-wetting;or it occurs
only by day and then only after vigorous bodily
and muscular
movement
action, such as running
up stairs,laughing, gymnastics, coughing,etc.,
nocturna,
and is called
or
enuresis
involuntaryurination
as
by night,and the
the
occurrence
itself
takes
place by day
condition
With
coutinua.
In still other
diurna.
is then
regard
enuresis
is
to
the
as
called
manner
cases
well
resis
enu-
of
continual, repeating
day; or it is periodical,
occurring irregularly.
the various enfeebled
Respecting the aetiology,
regularly every
anaemia, scrofula, rachitis,etc.,
conditions, as
were
yet
formerly
these
do
very
cheeked
considered
not
well
children
explain
of
all
first
cases.
importance,
Not
developed, sturdy,and
are
found
wlio
suffer
quently
infrerosyfrom
in the Male.
enuresis, while
small
proportion
other
In
a
as
children
without
bed.
so
from
awaking, yet they do
often complain to
Parents
bed
still the
all.
the
during
and
night
is found
Indeed,
tion.
condi-
dressed
un-
another
to
the
wet
the
compel
be
can
not
child
the
very
sleep is suggested
Most
healthy
bed
one
of
a
this
wrongly.
soundly ^thatthey
that, although they wake
times
with
but
moved
and
only
sound
too
cases,
cause,
sleep
affected
are
number
great
children
scrofulous
and
rachitic
the
among
75
physician
two
three
or
it to urinate,
through in spite of
infrequentlyis the bed found
not
wet
directlyafter going to sleep,although the
child had
passed his urine immediately before.
Trousseau, Bretonneau, and Desault have sought
wet
for
the
of
cause
weakness, but
the bladder
Desault
rather
and
the
in
that
detrusors
suffice
to
are
might
of
the
sudden
of the
account
most
organs,
and
a
normal
spasmodic
children
contraction
Trousseau
say
and
to
do
sciousness,
con-
This
explanation
for the
satisfactorily
condition
occurring in sleep is,to
tions
contrac-
bladder, which
bed-wettingwhich sometimes
occurs
to cystitis,
and lithiasis.
pyelitis,
urine
of
bladder.
of enuresis.
cause
general
relations
violent
bring sleeping
the
in
abnormal
neck
assumes
of the
not
bed-wetting,not
the
as
With
of
the
of the
sequel
a
normal
urinary
detrusors
least,very
Bretonneau
lematical
prob-
consider
Xeu
7t)
enuresis
with
identical
as
is the
view
the
only
of
neck
they regard the
as
external
correct
other
the bladder
of
fundus
sphincter,
Guersant
one.
or
of the vesical
bladder
general. They would
is, after all, only able to
amount
of urine, and
in
membrane
has
Lebert
brought
about
there
is
a
thinks
in
such
the
degree
is
urine
heed,
without
through. My
idea
have
to
do
That
of enuresis.
that
with
detrusors
and
sphincteris
during sleep
of
narcosis
of the
the
necessity of
The
felt
the
bed
is then
with
a
that
as
I
neurosis
the
of
wet
resis
enu-
of Trousseau
also
assume
in this form
innervation
sphincter,and
there
of
is
a
the
that the
Since
imperfectlyinnervated.
from
the expirationof
is normal
until the completion of dentition,
very
this condition
the first year
that
is
nocturna
is to say, I believe
disproportion between
flows
mass
of enuresis, at least
inasmuch
Bretonneau,
we
so
tity
quan-
to
sufficiently
is satisfied immediately
not
coincides
nocturna,
of
children.
consciousness, and
arouse
that
small
a
certain
a
the
that
hold
enuresis
wa}^:
mucous
say
whole
the
that
this
certain
sphincter in
passing
that, when
exceeded,
been
away.
that
der
blad-
velopment
(imperfect decongenitalweakness
of the sphincter,yet this opinion
Still
only to certain cases.
most, applicable
authors
a
hypercesthesiaof the
suppose
is,at
and
the
a
assumes
and
bladder.
of the
neck
of the
neurosis
a
Inasmuch
their
of the G-enito-Urinari/
Si/stem
roses
in the Male.
in
so
all those
does
not
the
time, enuresis
in
of
continuance
in whicli
cases
cease
77
infantile
this
bed-wetting
represents the
condition.
That
consists
results
only in an imperfectinnervation
sphincterof the bladder, is shown
by the
which are attained by electrical treatment.
There
are
enuresis
of the
namely, which
cases,
after the first faradization
remain
can
alreadycured
of the
sphincter and
henceforth.
Such
a
so
sult
therapeutic revation,
only be explained by imperfect inner-
and
the
are
by imperfect development
never
of
sphincter.
Sex
exerts
influence
no
authors, indeed,
than
that
assert
affected
girlsare
on
with
Some
enuresis.
many
boys
more
enuresis, yet this is
girlsparticularly,when
only apparent. With
advanced
in years, the parthey are somewhat
ents
this condition,
take great pains to conceal
as
they know
especially
at puberty.
ceases
As
are
regards age,
affected
tenth
yet
years
old.
That
enuresis
as
a
that
most
between
often
I have
well
girlsas
it is found
enuresis
with
years,
that the enuresis
of
continua, may
children
the third and
had
boys, 14, 15,
kind
usually
under
and
ment
treateven
17
bed-wetting, especially
often
be
brought
(especiallyphosphatic stone),
and further
tory
and
by inflammacystitis,
pyelitis,
affections of the vagina, vestibule,and urethra
about
by
in
lithiasis
such
girls,
as
are
sometimes
caused
hy
78
ye
of the Genito-UrinarySystem
OSes
ur
raasturbation,has
already mentioned.
been
absolutelynecessary that, in every
urine as well as the genitalsof a child
with enuresis be subjected to a close
is
Having
of the
satisfied ourselves
urine,
proceed
we
of the
examination
filled
of
urine,
Then
etc.
affected
tion.
examina-
condition
inspectionand
whether
ascertain
to
the
there
the
urinarius
meatus
found
are
If these
cut
are
found
off with
An
the
polypous
of
treatment
For
local.
cold
the
water
and
country
enuresis
Trousseau
before
girls.
with
if the
the
urine
is
in
as
be
general
quinine and
are
indicated,
may
children
well
cure
cold
of
an
general.
excellent
26"
R"^au-
sitz baths
mountains, river and
have
sometimes
and
crescences
ex-
ence
incontin-
examination
feeble
[90" Fahr.],as
mild
in
the
scissors
especiallypreparationsof iron
at a temperature
baths
aromatic
mur
entrance
meatus
necessary
is
normal.
to be
The
small
about
usually ceases.
is not
always
sound
and
Sometimes
vagina.
it
is retention
observed, and, in girls,
especiallythe
to
the
carefullyexamined
is
not, whether
or
the
case,
hypogastric region and
bladder
genitals. The
by palpation in order
is well
the
to
the
to
as
It
A
or
visit
sea
effect.
going
to
ing,
bathdonna
Bella-
by
highly recommended
the evening
In
Hretonneau.
atropiaare
and
a
to bed
0.0 1 extract
of belladonna
79
the Male,
m
(1-120 gr.) atropia is given. With
cliildren these preparations
smaller and weaker
dier
demand
great precaution; with largerand sturbe gradually
children
the dailydose may
increased until some
enlargement of the pupils
or
0.0005
apparent. At any
preparations must
well
Ergot, as
given good
sometimes
incontinence
found
is
these
months.
vomica, have
nux
results.
If
local.
is the
however,
of
in these
of treatment
best method
The
for
continued
be
tincture
as
with
rate, treatment
is
in
the
a
cause
weakness
cases,
of
the
of
the
it seems
logicalthat an attempt must
sphincter,
weakened
muscle.
be made
to strengthen the
This is best accomplished by electricity.The
earlier
Also
formed
of
adults, is
are
urethral
the
in
the
the
restless,and
the
sults.
re-
catheter-
incontinence
practicablewith
not
too
with
used
marked
no
gave
method
the
electrode, as
Children
of
metliod
cutaneous
children.
introduction
boys,
injury. The
electrode, especiallyin
scarcelybe performed without
quently
infrealso not
applicationof this electrode
conditions
sets up urethritis and
cystitis,
which, in enuresis, can
only have a very
can
harmful
influence.
Since, then, direct
urethral
electrode
with
the
with
children, I have
relying
on
stimulation
the rectum.
is
brought
surgical experience, the
of
the
sphincter vesicae
ment
treat-
cable
impractiinto
use,
indirect
through
It is
a
G-e nit o-
of the
Neurones
80
^Yell-kllo^vll fact
in the
Cases
with
met
that
in which
rectum
by complete
difficult
of
operations performed
part of the
lower
infrequentlyfollowed
urine.
Urinary System
the
also
are
voided
be
during
defecation.
of
sphincter ani and the sphincter vesicae
stimuli
the applicationof various
on
the
externus
the
in
is the
rectum
of
method
This
only
can
of
retention
micturition
urine
not
are
in
of
point
which
treatment,
departure of
also
anatomical
the
action
simultaneous
finds
this
its
of
relations
planation
ex-
this
region.
hsemorrhoidal
The
both
median
nerves,
arising from
the
pudic
and
ferior,
in-
of
branch
sacro-coccygealplexus,supply together the
with
the sphincter
lower
part of the bladder
and
vesictje,also the sphincter ani externus
in women,
the vagina. It
internus, and finally,
the
is therefore
applied in
of the
neck
clear
the
that
rectum,
bladder,
an
electrical
is
transmitted
sets
stimulus
the
to
contractions, and
up
thereby strengthensthe sphincter vesicie.
for this purpose
I use
an
ordinary sledgebattery [Schlitten-Apparat] of Dubois-Reyelement.
is armed
with one
One
mond, which
pole of
large as
wooden
and
an
the
a
induced
lead
handle
current
pencil and
(Fig. 5j,
is
7
a
cm.
which
The
passed into the rectum.
ordinary sponge-holder,and
metallic
pin
long, with
is well
other
in
as
a
oiled
pole is
boys is
JVeuroses
82
and
0/ the
without
defecation
Pollution
the
of
semen
or
at
muscular
occurs
as
apparatus
of
coat
of micturition.
described
sexual
the
copiously
more
end
the
be
might
of the
neurosis
sensation.
especiallypleasurable
Tliis evacuation
after
G-cnitn-Vrinary
System
motor
a
with
spasm
of
vesicle,and
seminal
spermatorrhoeaas a similar neurosis with paresis
ducts.
of the ejaculatory
The
ideas
of pollution and
spermatorrhoea
there are
as
are
commonly confused, especially
of spermatorrhoeawhich
mixed
forms, ^.e., cases
There
sometimes
have pollutionsalso.
also,
are
however, perfectlypure
forms, and therefore
the division into pollutions and spermatorrhoea
of
There
be retained.
must
are, namely, cases
lose semen
by day, after
pollutionwhich never
urination
defecation
or
;
likewise
there
are
pure
of
have pollutions,
spermatorrhoeawhich never
instead
of them
but
in
dailylose semen
quantitiesand often continuously.
cases
small
Other
describe
authors
and
pollutions,
and
which
This
colorless.
for,where
a
after
from
case
viscid
classification
dischargeof
hand, in the
chronic
is not
looks
so-called
defecation
nal
diur-
designate as spermatorrhoea
discharge which
every
and
nocturnal
and
is
poUutiones
and
of
urination
a
viscid
the urethra, the
whitish
or
inappropriate,
diurnse
is also
semen
rhoea,
gonor-
are
ent,
pres-
usually found
;
and
on
the
turbid
diagnosisof
other
charge
dissper-
in the Male.
matorrhoea
be
cannot
made
without
That
examination.
secretory neurosis of the
rhoea,which also furnishes
is to
has, however,
semen,
as
will be
admits
Curschmann
there
say,
a
is
with
nothing in common
fullydiscussed
more
scopical
micro-
a
prostate, prostatorviscid,turbid fluid,
a
which
83
and
nocturnal
later
diurnal
on.
lutions
pol-
spermatorrhoea,and at the same
considers
spermatorrhoea the superlative
and
time
of
degree
When
pollution.
they
may
they
occur
looked
be
Curschmann
once
upon
oftener
much
will
allow
not
in 10
14
days,
as
physiological; if
they are pathological.
pollutionsoccur
a
to
division
based
on
the
frequency of the pollutions,but holds that
when
pollutions,even
they occur
frequently,
still be regarded as
charge
a
physiological dismay
of
the
on
the
followingday
of
sense
relief.
other
He
and
Since
in
semen
important r61e, its
brieflyspoken of.
Normal
which
of
the
semen,
consists
seminal
which
as
of mental
of the
a
when
from
ache
head-
vigor.
affections
anomalies
is well
has
patients feel
the
suffer
these
feels
pathological on
pollutions,even
languid, and
impairment
the
strong, or
considers
rarelyoccurring, after
and
and
well
hand, all those
exhausted
affected
if the individual
semen
plays
should
known,
secretions
vesicles, of the
is
of the
here
a
an
be
mixture
testicles,
prostate, and
J^^euroses
84
the
of
Genito-UrinarySyatem
glands of the urinary system.
time
amount
is somedischarged at one
times
smaller, according to
greater, sometimes
of the producer ; ordinarily
continence
it is
other
The
the
accessory
10
between
Normal
boiled
15 grammes.
and
has
semen
starch
whitish
a
paste,
color,resembling
peculiar,characteristic,
a
Its consistence
heavy odor, and an alkaline reaction.
immediately after ejaculationis hone}^and
like
become
gelatine,to
of 5
course
The
10
or
and
hours,
of the
cellular
normal
semen
some
and
a
of
constituents
the
in
semen,
few
cells and
of
the
sometimes
to
as
the
some
detritus.
From
layer containing spermatozoa
possible to arrive at a
generative
power
of the
in
question.
If a drop of fresh semen
is examined
the microscope,a picture full of movement
semen
be
test-
s^^ermatozoa. The upper layer
ing
translucent,the microscope show-
it is
conclusion
poured into a
settle,is found, after
of
thickness
the
to
been
separated into two layers. In
the two layers are of equal bulk.
layer is w^hite,opaque, and consists
lower
only
the
have
semen
is turbid
fluid in
more
minutes.
allowed
to
normal
stiffens like
however,
again yet
having
semen,
tube
The
; it soon,
ropy
seen.
with
a
As
if
stick,so
an
the
confusedlysquirm
ant-hill had
been
spermatozoa
in
about.
Besides
under
will
stirred
up
livelymotion
these
are
to
85
in the Male.
be
only
seen
cells,and
epithelialcells, spermatic
some
little fine
a
granular
matter.
consist of
semen
spermatozoa of normal
oval
flattened, pear-shaped,shovel-like
or
Tlie
an
head
and
divided
into
middle
piece
the
times
should
be
show
and
6.
"
day
300
normal
are
found,
time,
at first
colorless
crystals (Fig. 6).
on
The
ten
spermatozoa
diameters.
and
after
been
has
semen
considerable
hours
is
least
at
The
Crystals.
tail.
a
be
the head.
at least 12
greater numbers,
boidal
and
which
present in large numbers,
a
a
piece
tail should
Spermatic
movement
When
third
middle
length of
Fig.
stand
a
end
thread-like
long
a
the
still
tion.
evacua-
allowed
to
second
or
only single,later
in
transparent, rhomWhen
incompletely
of the Genito-
Neuroses
S6
Urinary System
these crystalsappear
crystallized,
rounded
the
at
ends.
albuminoid
them
A.
tapering
Bottclier
other
bodies,
considers
authors
nio-magnesicphosphate. I have also
that they
these
crystals,and found
phosphoric acid and magnesia ; ammonia
ammo-
examined
of
consist
I could
find.
not
As
at
and
regards the
time, it is,as has
one
very
variable.
The
repeated the
finallyonly
the
the
lives,on
of
amounts
which
a
The
other
time
few
remarked,
hand,
the
the
two
amount
greater
discharged
are
is
drops will be
continently a
more
semen
there
Nevertheless
been
frequently coitus
will each
painfullyproduced.
discharged
semen
before
more
smaller
until
become,
man
of
amount
at
are
coitus.
conditions
extreme
easily distinguishable,
ivdmely,polyspermia
are
and
aspermia.
of a largeamount
Polyspermia^the ejaculation
of semen
at one
coitus, is relativelyseldom
I have
observed.
examined
such a
only once
A
case.
very
about
man
tospasmus, and
to
he lost such
drawers
wet
and
a
with
that
felt themselves
and
he
so
were
that
must
wet.
with
polyuria,cys-
plained
neuralgic pains, comnocturnal
pollutions
of
large amount
the bed
through;
declared
various
that
me
old, robust, yet
years
suffered
who
nervous,
40
each
time
after coitus
have
that
semen
his
thoroughly
the
women
urinated, for they
I had
the
patient col-
87
in the Male.
coitus, and
discharged at one
about
found, indeed, an extraordinary amount,
Yet the patient told me
35 grammes.
that he
lect
the
had
semen
been
not
able
The
semen.
showed
semen
After
spermatozoa.
constituents
with
the white
lower
elements,
were
Somewhat
either
Its
obstacle
the
of the
that
no
In
semen
one
lular
cel-
It
semen.
a
mechanical
ation
(obliter-
semen
brought
is
condition.
temporary
in
or
fact
the
is produced,
light by
to
in a
aspermia occur
after prostatitis suppurativa, he
to produce semen
during coitus,
man
be
a
me
in
rare
very
coitus
semen.
he
of sexual
nor
I
as
was
man,
case
24
was
observed
I have
old, which
years
This
occurrence.
whether
to
as
perfectlypossiblebefore
another
robust
a
marriage,since
the act
seen
been
In
prostatitis.
aspermia
of
be
have
I
case
being able
although this had
in
a
it cannot
not
must
the
stimulus.
married
the
or
of
ejaculatoryducts), or in
is produced, or, if semen
that
sexual
absence
sought either
discharge of the
to the
comparison
aspermia
is
frequent
is to be
cause
in
semen,
the
that
increased.
permanent
a
showed
living
layer comprising
more
aspermatismus,
and
normal
it
settling,
of the
fluid
of the
the whole
collect
to
he
might
perfectlyable
at first distrustful
sulted
con-
contract
to
a
of the
a
perform
had
intercourse, yet he
pollution produced
man
never
discharge
patient's
of the Genito-UrinarySystem
Neuroses
88
st("rv, but
able, after long observation, to
was
The
young
disease.
His
formed
;
produce
from
him
the
but
the
months
semen
;
my
and
the
24th
his
to
had
man
nor
year,
oft-repeatedsexual
of
I believe
semen,
with
do
he
Whether
the
reflex
that, in this
such
in
centre
to
be
express
an
opinion.
Cases
of
other
unable
was
to
me
that
recently again
Since
the
case,
have
we
to
aspermatismus.
of
non-excitability
ejaculationis,according to
considered,
Schulz,
and
In
the
cases
of
result.
genital
mal,
entirelynorhad a pollution up
never
had
been
able, in spite
excitement, to ejaculate
absolute, permanent
an
excite
to
informed
advice.
professional
apparatus of this patient was
sought
I tried
later I received
he
and
with
met
coitus
patient
Several
no
sound
repeated
letter,in which
a
normally
were
without
ual
sex-
any
prostaticurethra.
in order
testicles,
both
semen.
still had
he
with
times
many
had
never
genitalorgans
excitement,
sexual
had
of semen,
the formation
of liis assertions.
correctness
man
in the
of
faradization
spite of
the
examination
obstruction
no
of
myself
convince
I do
not
venture
aspermatismus,
temporary
on
to
the
Usually,in such
patients,gonorrhoea with prostatitishas gone
These
also generally suffer at
before.
persons
other
the
hand, frequently occur.
same
time
neuroses,
with
now
several, and
of
the
often
urinaryand
veiy
now
ferent,
dif-
of
90
Neuroses
of the Genito-Urinary System
of the testicles,
are
blood
and
shortened
pus,
the
in
seen,
motionless
spirallytwisted
shovel-shapedheads alone.
infrequentlyappears,
not
examination, among
the
form
blue,
or
as
When
the
Since
flakes
bluish-black
scales.
spermatozoa
in this
to
the
semen
there
scopic
micro-
on
spermatozoa,
of
a
in
is called
azoospermia.
is
fructifyingelement
is
impotentia generandi. It is
from
distinguishthis condition
tentia
impoare
that
in
cornflower
coeundi, for patients affected with
often
the
entirely absent
are
condition
the
semen,
wanting,
well
the
beautiful
of
with
spermatozoa
tails,or even
or
Indigo
ing
contain-
semen
and
their
spermia
azoo-
perform the act of coitus
vigorously,and usuallyhave no idea
able
to
is abnormal.
semen
after
Azoospermia usuallyoccurs
epididymitis
when
the latter was
teral.
bilagonorrhoica,especially
Yet this is not absolutelynecessary,
since
inflammation
of the spermatic cords
alone
an
Azoospermia
bring about this condition.
may
of the vasa
takes
deferplace by obliteration
entia; the
testicles
to
stopped,and
in the
only
mixed
If
semen
passage
of
the
vesiculse
the
secretion
seminales
the
spermatozoa
ejaculatedsemen.
the
secretion
witli that
of
this kind
of
of the
can
is
no
The
the
from
thereby
longer appear
semen
sents
repre-
vesiculso
urethral
be examined
the
nales,
semi-
glands.
in
a
fresh
in
in
state, it will
in
noticed
normal
the
in
only
normal
be
in
seen
served.
ob-
microscopically,
corpuscles will
great
;
transparent
more
to
be
semen
slightdifference
If allowed
charged
dis-
Avill also
be
times
some-
seen,
degenerated epithelium,and
fat.
are
It
If it be examined
colloid
there
a
been
it has
is much
semen
lymph
molecular
that
amount.
color will
watery.
sometimes
91
coagulates like
it
The
and
noticed
be
that
the Male.
settle
hours,
some
well formed
and
numbers
again,
those
large, transparent crystalsof phosphoric
acid
and
From
magnesia
this
of
that
the
of
account
the
vasa
the
spermatic crystals.
of azoospermia after obliteration
clear
deferentia,it appears
"
ejaculatedsemen
the
seminal
of
consists
vesicles,and
the
that
tion
secre-
the
cles
testi-
furnish
only the fructifyingconstituent, the
Since the spermatic crystalsalso
spermatozoa.
in azoospermia, it can
be affirmed with
occur
certainty that they are peculiar to the secretion
of the seminal
The
quick
affords
contain
many
appear
third
in
a
day,
tardy
or
semen.
and
very
because
of
appearance
inference
an
of the
power
vesicles.
as
That
to
the
these
tals
crys-
fructifying
is to say, if
livingspermatozoa,
not
late, sometimes
a
semen
the
until
tals
crysthe
is impossible
crystallization
fluid full of movement,
such
as
a
normal
If,
containing many
livingspermatozoa.
contain
motionless
however, the semen
spermasemen
Neuroses
92
tozoa
none
or
in the
appear
Gcnito-Urinary
System
of the
all,then
at
of
course
therefore,and
the
commonest
half
the
the
greater
lier,
ear-
do
is their
is the
worse
semen
pollutions and
of
sexual
and
excesses,
Sexual
masturbation.
The
hour.
an
causes
spermatorrhoea are
spermatic ciystals
formed
perfectly
more
and
crystalsappear,
number, just so much
containing them.
these
The
the
cially
espe-
imply
excesses
ciated
protractederections,and each erection is assowith
swelling of the caput gallinaginis.
Through this too frequent and long-continued
swelling in the prostatic urethra, a catarrhal
localized in the caput gallincondition becomes
aginis,
and a marked
hypersemia and hypersesin the whole
thesia
prostatica urethr?e,
pars
sometimes
whence, originatingreflexly,come
and sometimes
spermatorrhoea. That
pollutions
in the caput gallinaginis
is at
a catarrhal process
times
involved,
urine
of
are
pus
such
we
that,in
the
pollutions,there
with
of
epithelium,and spermatozoa.
corpuscles,
with
the sound,
patientsbe examined
If
membrane
and
the fact
consist
shreds
sometimes
patientsutter
red
from
patientsaffected
prostaticurethra
the
see
is found
loud
of
which
floating
cries
this
endoscope,it is
sensitive
so
of
found
be
to be
of
color,swollen, partlydenuded
bleedingeasily.
If the
pain.
region
that
examined
a
tlie
the
ous
muc-
with
dark, cherryof
epithelium,
93
in the Male,
Inflammations
of the prostate also have
pollutionsand
as
a
after
of
the
prostate,
sediment,
or
processes
of
the
as
the
rhoea,
gonor-
seminal
their appearance
icles,
vesnever
as
and hypertrophy
prostatitis
chronic
almost
can
of
inflammation
In
chronic
Especiallyin
pollutionsmake
before.
spermatorrhoea
sometimes
consequence.
times
some-
the
on
contrary, spermatozoa
in the
urinary
constantly be seen
a proof that, through inflammatory
gland enlargement, the sphincters
ejaculatory ducts
rendered
been
have
insufficient.
In
affections
sometimes
known
to
its
also
obstinate
The
at
and
the
alone
in
severe
time
same
diagnosis of
confirmed
the presence
In
with
osis,
phim-
well
as
hardly
are
nervous
cularly
parti-
persons
committed
seminal
sexual
discharge
microscopically. Of
of
spermatozoa plays here
important r61e,yet only when the semen
individual
of
would
yet they
semen,
of
cause
masturbation.
or
always be
too
spermatorrhoea
tightprepuce,
not
produce dischargesof
excesses
A
Nervousness
impotence.
have
sometimes
occur.
system,
nervous
infrequentlythe
I have repeatedly,in cases
removal, cured pollutions as
phimosis,is
pollutions.
who
central
pollutionsand
are
by
of the
in
question actuallycontains
azoospermia,
which
pollutionsor
with
may
must
course
the most
of the
tozoa.
spermabe
ciated
asso-
spermatorrhoea,
JVeiu'Oses of the
94:
the
of spermatozoa
absence
evidence.
fluid,on
a
In
slide,must
hours
some
Genito-Urinary
System
examined
sucli
is,of
cases
droj3 of
a
be covered
ficient
insuf-
course,
the
and
after
for the characteristic
matic
sper-
over,
crystals.
If
be
found
constantlj^or very
frequentlyin the urinarysediment; if the patient
discharge after urination or after defecation a
spermatozoa
of
large amount
possible to
semen
; or,
out
squeeze
of
if it
finally,
the penis a
be often
whitish
drop containing spermatozoa, then the patient
suffers with
spermatorrhoea. If, however, the
be negative,and only
result of this examination
take place at
a
copious discharge of semen
night,then the patient suffers with pollutions.
Mixed
forms
indeed,
are,
of
not
rare,
yet either
those
of spermatorrhoea
preponderate,so that this
almost
always be easily made.
may
If pollutionsoccur
very often,the
associated
are
general symptoms
especially
symptoms of irritation of
distinction
the
symptoms
nervous
pollution or
system, while, in
with
faintness and
appear
and
true
varied
with
them,
the
general
form
of spermatorrhoea,
of
impotence,
depression,
melancholy are most prominent. Patients
frequent pollutionsusually suffer from
symptoms
and
the
most
render
exertion.
dizziness in the head, which
on
the
toms
symp-
morning after the pollution,
tal
patient incapable of every menthere
Sometimes
is a dragging
the
95
in the Male.
bit
occipitalregion. The patients exhireflex irritability,
so
greatly exaggerated
they start at every unexpected noise, at
pain in
a
that
the
roll
in
the
unsteadily,and
highest degree
noticeable
that
often
Very
made
bare
be
the testicles
;
while
The
and
these
patients.
sexual
excitement
the
country
milk
sea
mental
or
or
cold
infrequentlyfound
is not
to
is
of the
external
electrical
tion
stimula-
skin
hype rsesthe
tic.
discharges is both
At the same
time
a
strictly
life must
be prescribed for
It
likewise
at least
ten-
of seminal
general and local.
regulated habit of
or
patients
observing carefully the
the
urethra
the
treatment
avoided;
If the
occur.
less sensitive
genitalsare
nervous
noticed.
spermatorrhoeait
that
words.
certain
and
far
so
continual, slight,subsultus
a
will
In
strip,on
to
body
dinum
fails at
the voice
the heart
is
of excitement,
in breathing
difficulty
palpitationof
are
changes color, the eyeballs
of speech,
a disturbance
face
the
moment
every
is
and
clear
that, before
masturbation
is it necessary
must
for
the
all,
be
tients,
pa-
sical
phytemporarily,to avoid severe
labor.
An
invigorating trip to
mountains,
water
cure,
in
as
connection
well
as
with
river
a
or
diet
The
especiallyindicated.
consist of easily digestible
dishes, and
be
entirely non-stimulating. Spices,
bathing, are
should
should
spirituousliquors,strong
coffee and
tea
should
of the G-enito-Urinary
System
Neuroses
96
the
and
day,
not
to eat
much
too
evening, before
in the
often
during
at a time.
cially
Espegoing to bed, only
It is also better
be avoided.
extremely frugal meal, with little drink,
the
should be partaken of,in order that neither
an
and
stomach
intestines
bladder
the
nor
may
be
overloaded.
sleep should not
risingis particularlyto
The
bed
should
have
and
for
heating
long,and
early
recommended.
be
Tlie
hard, well-filled
rather
pillow should
The
and,
a
last too
be
tress.
mat-
hair,
horse-
filled with
body, thick, heavy,
covering
the
coverlets
should
used.
be
never
lie on the back ; and
patients should never
when
in the morning they should
they awake
sal
immediately empty the bladder, for,in the dorThe
position,the distended
return
blood-vessels,and
viscera
on
the
increase
the
press
thereby
hyperaemia of the prostaticurethra.
hypersemia intensifies also the
sesthesia of tliis part, and
The
creased
in-
hyper-
tively
requires then relaslight irritation (for instance, a
very
heavy coverlet, a touch of the hand, etc.),to
set
reflex
up
contractions
that is to say,
Quinine
weakness
and
and
and
iron
anaemia
from
it
of the
seminal
icles,
ves-
pollutions.
as
tonics
are
indicated
predominate.
From
when
phor
cam-
no
lupulin I have seen
great
and
results,and just as little from belladonna
On the other hand, bromide
of potasvalerian.
Xt'uroses
98
System
of the Cienito-Urinary
large a
sound
be made
to
pass
Nos.
to
26
20
should
always
the
orificium
of the
be
chosen
urethrse
Charriere
as
can
usually
;
scale
are
ployed.
em-
sounds
These
act
the
on
through pressure
pars
prostaticaas well as by thenweight. If there is at the same
marked
time
h^^per^sthesiaof
the urethra, we
begin with
may
for
this
passing bougies, and
Pitha
gives preference
purpose
all
the
to
wax
bougie over
others.
much
In very
and
the
cold
the
closed, double
rubber
The
end
inflow
is
the
vessel
Fio.
The
Cold
7.
on
on
the
of
cold
of
leads
cold
to
water
is
an
By
the
tube
the
elevated
an
the floor.
outflow
from
tube
with
which
attached.
are
placed in
the
water;
empty
suction
current
started, and
Sound
(Psychroplior).
into
tubes
of the
outflow
metallic,
a
outflow
filled
vessel
(called
Winternitz)
catheter, to
and
long
better,
sound
psychrophor by
(Fig. 7). This is
inflow
way,
much
sometimes
works
same
the
lower
flows
through
vessel
and
the double
sound
the
sound
keeps
in the Male.
uniformly
The
urethra.
stood
72"
Fahr.]),
graduallypass
often
that
borne, while
has
[68" to
fresh
to
observed
tatic
pros-
that
to
well
is not
water
the
of the water
temperature
and
I have
water.
pressure
on
air
the
in
cold
the
begin with water
(16" to 18" Reaumur
It is usual
varies.
metallic
the
with
connection
in
acts
Here
cold.
99
spring
cold
very
water
the
at
A
well.
ordinary temperature works
very
sitting lasts, at first,5 minutes, increasing to
Should
30 minutes.
bladder
for
a
arise,the
few
days.
Astringents also work
liquidform as well as in
of the
suppositories,
Dittel's
be
as
very
in
beneficially,
of small
the form
size of
a
a
ral
ureth-
troduced
barleycorn,in-
of
prostaticaby means
porte-remede. For using astringentsin
the
into
the
suspended
be
must
treatment
of the
of catarrh
symptoms
pars
liquid form, my short catheter-syringemay
manner
employed to advantage, in the same
described
on
powerful and
page 28. If a more
is to be
lastingeffect
produced
on
the
mucous
suppositories and Dittel's
porte-remedeare used (Fig. 8).
In the figure,A
represents a catheter,with
urethral
membrane,
open
end
is closed
The
and
a
by
an
obturator
which
just
C, and
rounds
short
fits in
in
the
off the
of silver.
B, also made
obturator
ends
made
curve,
an
of silver.
olive-shaped bulb,
opening
end.
This
At
of the
the
catheter
distal end
is
100
a
Xeiiroses
knob,
be fixed
I use,
of the Genito-Urinari/
of
which
b}^means
immovably in
for the
System
bayonet-lock may
a
the catheter.
small
purpose,
tannin
of
or
suppositoriesof
and
cacao-butter,
of
nitrate
and
cacao-butter
0.1
gramme,
silver
(tannin
nitrate
or
of silver 0.01
in
gramme,
each
suppository).
The
patient lying on
his back,the porte-remede
is
of
passed, under control
left
the
forefinger,
is in the
which
is then
the obturator
and
the
pushed
it is
given
the
in
urethra.
If
cauterize
the
same
we
By
a
prostatic
wish
using
strengthof
double
nitrate
(i.e.,0.02
the
of
is done
way,
After
^''^'TSie''^''''''
deposit
to
caput gallin-
of
deposited in
in.
amount
aginis,it
been
drawn
withsitory
suppo-
possible to
remedy
has
;
of this instrument
means
a
rectum
in
a
the
pository
supthe
of silver
gramme).
the
suppository
pars prostatica,the
in the Male.
101
patient lies quiet a quarter of
the suppository has
this time
done
its work.
severe
vesical
It is then
hour.
an
During
melted
and
has
for the
best
patient to
of cauterizing,
the
If,for the purpose
go to bed.
stronger nitrate of silver suppositorieshave been
minutes
used, the patient feels, some
later, a
the
neck
and
tenesmus
the bladder.
of
sometimes, however,
bleeding from
slight,sometimes
and
sensitive
crave
the
the
pain
and
few
until
urethra
profuse.
hours
the
The
be
The
is very
patients
bed.
If
After
desire
diminish, and
urinate
"
sometimes
profuse, cold
the joerinseum.
to
"
day
urethra
painful.
position in
at
later
next
ensues,
micturition
horizontal
haemorrhage
be applied to
A
not
the
stinging pain
a
must
compresses
2
the
3
or
days
the
patient finds himself well, with the exception of
a
slighturethral discharge which vanishes in a
I have observed
retention
of urine,
day or two.
profusehcemorrhage, and other unpleasant symptoms
after cauterization.
be
cauterization
can
remain
I therefore
only undertaken
quietly in bed
advise
that
when
the
for from
2
tient
pa5
to
days. In very sensitive patients I use at first
only half the dose, that is,half a suppository,and
if this is well
borne,
the
full dose
A
singlecauterization is not
be repeated at least 2 or
must
than
once,
however,
cauterizingwith
or, at
nitrate
is then
given.
usuallyenough ; it
3 times.
most,
twice
of silver should
Oftener
a
week,
not
be
Neuroses
102
done.
Good
Lalle
by
of the
of
I
possibleby
With
the
through
described
in
take
erections
rectum
tioned,
men-
ment
instru-
thra
prostaticure-
This
fitted with
perforated,for
of hard
a
the
rubber,
on
together the
the
and
lished
estab-
again aroused,
of
semen
and
turnal
noc-
that
Assuming
relaxed
condition
has
a
a
the
trived
con-
cure
of
the
size
plug,
of
hen's
^gg^
olive-
end
graduallytapering
cross-piece. The plug
free
escape
of
and
is
in
T-bandage. This
flattened plug, which
presses
page
far
Trousseau
is
a
ducts
on
ceases,
a
pigeon'sQgg to that of
sh:jpedon one end, the other
rectum,
tried, as
so
prostatse for
a
of
is
instead.
compressor
and
is
defecation
and
emissions.
seminal
be
place,the frequentloss
spermatorrhoeaconsists in
of the ejaculatoryducts,
his
zation
all, faradi-
at
enuresis
desire
pollutionsoccur
of
this
may
with
sexual
after urination
press
the
improvement
the
that
means
of
not
or
connection
Sometimes
made
porte-
already
as
means
seldom
pollutions occur
is
the
of nitrate of silver.
given amount
spermatorrhoea predominating, when
a
of
cauterization
prefer
place accurately in
to
of
Dittel, because,
it is
80.
the results
are
lid's method,
ma
remede
as
Genito-UrinarySystem
the
dilated
kept
flatus,is
place by
what
someolive-shaped,
is pushed into the
prostate,
and
thereby bring
spcrniatorrlia;a.The
and
should
relaxed
about
latory
ejacua
instrument
cum
i."
in the Male.
usually very
it works, as
When
badly
a
borne
rule, very
varicocele, stone, and
these
all
The
of
of
(a)
Since
and
will
gen-
be
of the
there
renal
of
there
being
of the
anomalies
has
of
"
bladder.
alkaline
an
at
the
Sometimes
earthyphosphatesprecipitatedby
the
urine
the
indican
is found
sugar
and
turbid
urine
uria, Teissier), sometimes
been
Urine."
the
and
tion
func-
polyuria (urina
(anuria hysterica),
secretion
7ieutral urine, without
catarrh
the head
anuria
the
the
urine, which
sometimes
spastica), sometimes
sometimes
of
urinary system
recognizethese
the
few
a
brieflymentioned.
detail under
in
found
of
description
neuroses,
anomalies
We
the
in
sensory
now
to
examination
a
secretory neuroses
secretory neuroses
confined
considered
of the
considered
of secretion.
see
the
often
so
most
motor
only
The
are
time
of
must,
of
Neuroses
are
already been
them
We
influences
the
in
processes
complicated
the motor
and
scribed
neuroses
just desensory
that they are
tion
of secondary consideraand are only rarelyobserved
as independent
certain
by
morbid
Secketoky
conditions.
have
by phimosis,
up
hy operation.
ito-urinarysystem
with
kept
harmful
be removed
course,
3.
by the patient,and
unsatisfactorily.
pollutions are
rectum,
103
or
same
we
ing
heat-
(jphosphat-
large amount
times
Kletzinski),some(^glaucuria,
albumen
temporarily appear.
a
of
104
of the
jVeuroses
The
(b)
system
secretory
polyspermia and
it remains
described, and
secretory
With
glands.
erection
as
sexual
of
of
excitement,
penis has
ejaculationof semen
the
accessory
tract, and
consists
gland
mass
Since
Littre.
to
the
the
of this clear fluid must
object of
The
the
lubricate
discharge of
urethra
the
viscid fluid is secreted
continuallyand
first to
describe
ascribes
as
the
in
of the
the
the
glands
largest
the
that
clear
tion.
prostaticsecre-
be
to
seems
thereby facilitate
and
which
semen,
without
is called
be
of
is
this secretion
greater consistency than
condition
This
secretion
of the
prostate
connection, it is
this
in
like
drop,
meatus.
prostate,of Cowper's glands,and
of
taken
has
of
drop represents the secretion
tal
glands of the urinary and geni-
clear, viscid
the
from
as
occurred,
the
oozes
egg^
urethral
the
long before the
place, a clear, transparent, viscid
white
sexual
ready
aspermia^ alsider
only to con-
of
neuroses
every
the
of
neuroses
include
the
soon
G-enito-Urinary
System
is
If
urine.
a
fluid
this
of
clear,
greater amount, indeed
sexual excitement, this
the
Gross
was
prostatorrlioea.
this condition
correctly. He
cause
Prostatorrhoea
subacute^nd
may
be
chronic
transient
tatitis.
prosor
manent.
per-
slightdegree it is often found
the yellowishdrop ally
when
after gonorrhoea,
graduand finally
whitish
and flocculent
becomes
To
a
colorless,watery, and
slightlyviscid.
The
pa-
fluid contain
the
the
on
Genito-UrinarySystem
of the
Neuroses
106
spermatozoa,
no
it may
be
either
azoospermia or it is secretion from
prostate.The drop is allowed to dry slowly
the microscope slide,or, if a largerquantity
semen
of
be
obtained
can
for examination, it is allowed
and
hours
to settle several
If the beautiful
the
sediment
is
amined.
ex-
spermaticcrystalsare
of the semof the contents
inal
(characteristic
of a patient
the fluid is the semen
vesicles),
affected with azoospermia ; if,however, in the
tals
slowly dried drop only the characteristic crys-
found
of
salt
common
question is
concentric
from
the
amyloid
are
seen,
prostate.
bodies
secretion
the
may
Sometimes
be
in
also
discovered,
certaintythe prostatic
Usually, however, in
origin of the secretion.
the clear,viscid fluid are found
only a few cylindrical
cells and mucous
corpuscles.
epithelial
which
demonstrate
On
examination
with
with
the sound
the urethra
is
tatic
generallyfound extremely sensitive in the proswith the finger
per
portion. Examination
shows
Sometimes,
rectum
nothing abnormal.
dent,
eviof a prostatitis
are
however, the remains
such as hard places,pit-like
depressions,
asymmetry
of
the
lobes,
etc.
The
urine
is
on
heating,the phosusually,
phatic turbidity.
is favorable ;
The prognosisin prostatorrhoea
the
genito-urinaryneuroses,
yet, as in most
of the treatment
ery
to complete recovduration
cannot
certainlybe stated.
clear and
shows
The
that
of
treatment
of
seminal
It
Most
to
40)
be
use
of
short
The
of
however,
desired
effect,
page
100)
means
results
in
solution,
have
by
is
these
cauterization
indicated.
Dittel's
rectum
results.
the
is
the
of
means
page
not
of
local
followed
(see
methods
times
some-
per
however,
best
of
here
good
very
as
same
minutely
that
prostate
given
the
been
has
catheter-syringe
urethral
by
the
has
astringents
Should,
urethra
and
recommended,
treatment.
is
remarked
be
may
faradization
page
107
prostatorrhoea
emissions,
described.
(see
Male.
the
in
the
porte-remdde
have
the
29).
the
prostatic
(see
IMPOTENCE.
STERILITY
AND
AND
STERILITY
is of
men
few
the
ago
were
able
procreative
operation,
for
baths,
the
has
semen
sometimes
the
most
desired
begun
lead
and
does
It
where
is
a
of
power
signifies
coitus,
cases
that
generandi
procreative
coeundi
in
and
the
well-known
the
is
the
has
always
not
Potentia
of
sterility
the
ability
often
fact
to
found
is
semen
in
coeundi
perform
upon
the
the
potentia
the
unimpaired
so-called
to
generandi.
while
absolutely
that
come
solely
semen,
male
gradually
potentia
depends
taining
at-
processes
truth
potentia
imply
and
examined
have
male
the
to
the
since
morbid
the
on
without
closely
more
since
established
become
male
be
understood,
better
be
to
to
thrown
treatment
Only
result.
sess
pos-
sometimes
however,
part,
to
unfruitful
usually
local
to
men
also
of
subjected,
a
coitus
must
case
was
was
microscopically,
which
In
that
of
act
parties
blam^e
She
wife.
the
the
both
Only
held
was
power.
the
all
marriage
date.
recent
perform
of
in
potentia generandi
opinion
to
satisfaction
the
the
most
the
years
who
of
knowledge
OUR
IMPOTENCE.
act
in
sterile.
impotent
112
and
Sterilitif
who
men,
still sometimes
if
coitus
attempt
thej only
of
able
are
flaccid
with
penis,are
impregnate the female,
normal
a
possess
paternity
There
to
Impotence.
not
are
tions
Accusa-
semen.
this
in
rare
also in literature
tion.
connec-
of
cases
nation
impreg-
of
virgins with a wholly intact,narrow
the ejaculation in order
hymen, where
to
avoid
had
taken
impregnation
place at the
vulva or its neighborhood. Professor
G. Braun,
time ago, published some
some
very interesting
"
"
of this class.
cases
known
fact
that
It is,moreover,
here
and
also
there
obstetric
in
clinics
met
girls in labor are
with, in
The
hymen is found entirelyintact.
the
of
procreation depends,
the
upon
quality
proof of this
sterile
of
for the
the
most
man's
marriages are
well-
a
whom
power
part, only
As
semen.
often
brought
to notice, where
the husband
is remarkably potent
and fulfils his conjugal duties perfectlyin
particular; yet the marriage remains
every
sterile
because
the
of
semen
the
husband
is
unfruitful.
In
the
generandi
followingpages
will first be
the
subject of ijotentia
discussed, and, later, that
of
potentiacoeundl ; finally,a few therapeutic
hints will be given.
^ince 2)ote7itia
generandi^ as already mentioned,
depends, for the most part, on the good or bad
condition
of the
the
male
semen,
semen
first of all should
in health
and
be
sidered
con-
disease.
(Oid Impotence.
Steriliti/
114
spermatozoa
ous
these
granules
forms.
These
still found.
are
also
are
have
massed
Sometimes
in
cylindrical
resemblance
some
to
the
dark
in the
occur
granular renal casts which
urine in chronic
Bright'sdisease. The spermatic
cells are the breeding-places
of the spermatozoa;
and, according to Kolliker, out of each
of a cell a spermatozoon develops.
nucleus
d.
Fig.
Semen,
Normal
9."
cells; c, epitbelium
300
granules.
Normal
after 48
(from
spermatozoa;
the
6, Spermatic
prostate ?); d, seminal
diameters.
sheltered
semen,
hours
Living
a,
still shows
lightand cold,
living spermatozoa
from
microscope. In spermatozoa which
have
died gradually after ejaculationthe tail
is outstretched, or, at most, slightlycurved,
under
whereas
the
in
those
that
are
discharged motion-
bent.
spiral or
rolled
tail is either
dead, the
less,i.e.^
115
Impotence,
and
Sterility
which
Spermatozoa
in
up
a
been
have
nal
by injurious secretions (urine, acid vagithis
secretions, etc.) very commonly show
killed
condition.
The
of the
motion
in fresh
spermatozoa
semen
extremely lively. By whiplike wriggling of
winds
and
is urged forward
the tail the head
is
its way,
without
through
the
field.
other
striking against
narrowest
migration of
This
in
passages
the
cells,
the
scopic
micro-
spermatozoa,
ers
observsuggestive of voluntary motion, caused
in early times to regard the spermatozoa as
indicated
by
organized living creatures, as
animalcules
the term,
seminal
[Samenthier"
''
chen].
Water
in
albumen,
sugar,
these
motionless
their
of
alkaline
favorable
while
acid
arrests
metallic
the
and
acid
potash
on
and
the
other
their movements,
salts and
so
that
Animal
acids.
a
salts,
the
harmful
they
gain
re-
secretions
strength are
spermatozoa,
secretions, such
soda
of
however, revive
moderate
vitalityof
etc., have
mucus,
;
and
reaction
thin
Caustic
activity.
the
tails to curl
solutions
spermatozoa,
former
to
the
causes
etc.,may,
urea,
of
movements
Concentrated
loop.
a
the
often
and
spermatozoa
up
checks
soon
as
urine,
influence.
invigoratethe spermatozoa
hand, cold completely
as
also do
solutions
of
and
SteriUti/
116
manifold.
The
distinctions
Aspermia
understood
unable
absolute
The
is
condition
a
to
and
It is either
it
during their
whole
as
either in
nocturnal
Such
years
a
His
the
sexual
men
lives,been
patient,
is either
temporary.
or
of
aspermia
acquired. In
who
have
able
to
sexual
never,
discharge
excitement,
pollutions.
have
case
had
this is
excitement, is
form
Qoitus,under
I observed
been
never
that
wife declared
wet
which
congenitalor
with
semen
in
he
had
able
to
old, who, although
10 years,
By
Aspermia
concerns
by
the following
semen.
permanent
the first case
or
in
are
"
relative, permanent
absolute
semen,
of
other
or
:
ejaculatesemen.
or
rare.
variable,and
very
absence
"
semen
furnished
semen
ma}^ be drawn
in coitus
whether
of
amount
is
ejaculation
1.
of male
changes
pathological
The
one
Impotence.
she had
after
pretty good, although not
testicles were
small, otherwise
40
man,
been
married
produce semen.
found
never
coitus.
was
a
His
remarkable.
the
self
herpower
The
gans
genital orpatient said
The
perfectlynormal.
that during coitus he experiened the sensation
felt a kind
of satisfaction,
of ejaculation,and
In order
seen
although he had never
any semen.
the semen
whether
not
to prove
or
regurgitated
into the bladder
during coitus, the urine passed
were
after the act
but
was
with
examined
for seminal
negative result.
ents,
constitu-
single man, 24 years
(see page 87).
publishedelsewhere
form of permanent
aspermatismus no
Another
this
of
that
case,
old, I have
For
a
usuallybe shown ; the condition seems
merely congenital. The genitalsin the
case
appeared perfectlynormal, the penis
can
cause
be
to
second
capable of erection, the
yet
could
semen
no
the testicles
case
often
are
be
drawn
system
could
In such
cases
in
In
we
come
of the
erection.
from
be assumed
or
which
Ejaculationis
the
lation.
ejacu-
constituent
drops
two
the
of
smaller
company
generally acing,
wholly want-
of
the accounts
that
other
Schulz,
of
centre
from
and
urethra
nervous
with
assume,
one
the
demonstrated.
be
no
can
quality of
central
reflex
aspermia
which
glands
and
the
than
mucus
first
conclusions
and
case
is secreted
viscid
the
perfectsemen.
no
the
only
can
absolute
semen
of
either
of
non-excitability
of
furnish
quantity
affection
No
semen.
In
smaller, yet small testicles
which
the
to
as
small, and
not
produced.
be
were
with
met
testicles
the size of the testicles
From
a
117
Imj^otence.
Sterilityand
patients it must
of
spasmodic contractions
the
lation
perinealmuscles which complete the ejacuare
entirelyabsent.
More
than congenitaland permanent
common
of semen
absence
the acquired forms.
are
The
loia
acquired
are
forms
usually brought
of
permanent
about
by
asper-
affections
118
and
Sterility
of
the
Impoteiice.
Not
infrequently purulent
lobar
or
prostatitis
suppuration of the whole^
prostate has preceded. In the acquired form
of permanent
aspermia,both ejaculatoryducts
become
occluded
and
have
the
must
dular
glanprostate.
of the prostate itself have
tissue
the
part destroyed. The
most
duct
sometimes
only
the
in
A
from
man
once
consulted
had
formerly
manner
one
a
of
;
but
Roumania,
me
cohabited
some
and since
40
He
entirelynormal
previouslyhe had had
an
of urine
and
perinseum,after
the
old,
years
of this kind.
retention
that time
dischargesemen
conclusion
in
years
illness,with
severe
about
for trouble
suppuration in
to
of
noticeable.
is not
a
occlusion
for
nution
perceptibledimibut usuallyit
semen,
causes
amount
been
he had
in coitus.
He
never
rhoea,
gonor-
been
said that
fuse
pro-
able
at the
experienced a sort of
satisfaction,
althoughno ejaculationtook place.
On
examination
of the genitaltract I found
the urethra
slightlycontracted in the bulbous
tracted
a
portion. The
deep, reperinseum showed
where, apparently,after an operscar,
ation,
of pus had been
a great deal
discharged.
In place of the prostate there was
felt,per rectum^
flattened nodule, scarcelythe size
small
a
of
a
of
pigeon'sQgg,
of the
rectum
contraction.
he
coitus
was
and
the
involved
whole
in
anterior
the
wall
cicatricial
and
Sterility
In
a
of
view
doubt
about
and
there
had
aspermia
here
119
is
scarcely
been
brought
ejaculatory ducts
of the
by obliteration
suppuration of the prostate.
moderate
Although the
easily dilated, no
toward
the
of
He
of
aspermia.
Formerly he
of coitus
in
able
was
could
semen
forcible
be
made
me
but
to
At
of
patient complained
account
on
childless.
the
within
had
the
also
and
act
year
with
entirely
time
same
frequent
a
even
appear
Pollutions
this time.
within
Vienna,
in
accomplish
to
manner,
straining.
ceased
here
married, but
was
normal
a
semen.
consulted
old, likewise
31 years
be
made
was
progress
merchant
a
case,
could
stricture
further
secretion
second
A
no
condition
this
that
Impotence.
the
scalding
micturition.
The
patient
of feeble
was
build, had
hoarse
a
voice,and had
with
of the
showed
already suffered years
lungs. Physical examination
the
at
ness
yearly visited
urine
passed
only
the
contained
of
resort
and
showed
the
bladder.
of
ease
as
far
be introduced
and
difficulty
immovable
as
pain.
tumor,
the
the
into
Per
as
The
lungs.
health
pus
catarrh
with
of the
apices
catarrh
patient
Roznau.
the
dul-
The
istics
characterThe
sound
prostate, but
could
bladder
great
rectum
large as
a
wdth
hard,
lar,
nodu-
the
fist,was
that
tubercu-
found.
In this
case
it must
be
assumed
120
SteriUti/and
Impotence.
of the
losis
had
here grown
to
prostate,which
infiltration,
unusually developed, indurated
an
had
rendered
and
the
ejaculatoryducts
prostate incapacitated.
Beside
the
these forms
mia,
with
the
sexual
there
is
comparatively
a
apparatus.
a
temporary
normal
This
impervious
asper-
condition
form
of
of
aspermia
months,
in
or
suddenly,lasts a few weeks
and then vanishes
as
suddenly as it came.
thus affected are
Persons
generally of a very
Either
nervous
they have been
temperament.
from birth or have
become
nervous
so
through
in venery, masturbation, or frequentattacks
excesses
of gonorrhoea.In the first case
it is usually
a certain
anxiety,a dread of failure of the act
the patient someof intercourse,which
makes
times
impotent, sometimes
; in the
aspermous
last case, however, the gonorrhoealprocess
pears
ap-
sets
to have
of the
These
yet
been,
in
fact,the immediate
disturbances
nervous
cause
in the sexual
sj^stem.
in coitus,
usually aspermous
infrequentlysuffer with pollutions.
patientsare
not
Sometimes
such
after inflammation
at the
neck
Here
a
of
of the
reflex
occur
cases
the
after
prostatitis,
testicles,and
catarrh
bladder, followinggonorrhoea.
neurosis, proceeding from
prostate, is generally concerned, which
the
monly
com-
yieldsto appropriatelocal treatment.
be
Relative
admitted, is
aspermia, it must
to do with
Here
have
cases
we
especiallyrare.
122
and
Sterility
since
it cannot
Impotence.
ture,
strictlirouglithe narrow
and the patient appears
seen,
pass
be
it cannot
aspermoiis.
Since, during erection, the caput gallinaginis
swells
and
the
urethra
toward
the
is made
stricture
is
bladder
thereby
riorly
postethe
since, moreover,
;
much
so
closed
the
by
narrower
the
pains of the patient,during
ejaculation,
easilyexplained. The semen, which
erection,so
is
the
are
compressed in
the
the
stricture, can
part
of the
neither
escape
behind
urethra
forward
nor
lancinatingpain in the
erection
perinaeum during ejaculation. The
subsides
and
with
it the swelling
now
graduall}^
of the stricture and
that of the caput gallinagini
then
semen
usually flows back
; the
the
the
it mingles with
into
bladder, where
urine, although a small quantity may pass the
hence
backward,
and
stricture
Such
normal
appear
cases
condition
removal
or
the
of
In absolute
the
and
are
orifice of the
the
at
of
restored
course
by dilatation of the
existingobstruction.
patientis
In relative
and
in
so
far
the
stricture
permanent aspermia, it
evident, impotentia generandi
the
to
thra.
ure-
is involved
is selfand
sterile.
aspermia
male
present,as
the
is
sterility
semen
likewise
charged
fails to be dis-
In this
genitaltract.
artificial impregnation with fresh semen
an
case
maybe brought about,
dischargedas a polluti(jn
into
the
female
Sterilitycmd
succeeds
which
well
very
semen
the
procreative
the
as
long
be
no
of
urethral
as
of the
power
talk of
aspermia
patient depends
the
although,
semen,
remains
semen
in which
cases
temporary
quality of
the
solely upon
in those
In
is normal.
the
123
Imj)otence.
absent, there
impregnation. Sterilityin
is, of
contractions
can
cases
ceteris
course,
paribus^cured by their removal.
2. Polyspermia.
This condition
is relatively
than
rarer
a
siderable
conaspermia. By it is understood
"
increase
at
double
be
be found
three
allowed
that
of
amount
charged
dis-
semen
single ejaculation,which
even
or
semen
a
the
in
times
settle in
to
only the
If the
normal.
test-tube,it
a
fluid is increased
them
elements, among
the
the
be
may
;
the cell-
show,
spermatozoa,
comparison with the normal
increase.
Microscopically the
normal; living spermatozoa are
in
will
no
ejaculation,
semen
appears
in
seen
large
numbers.
A
me
40
single man,
on
3.
this account
(see page
Oligospermia. By
"
of very
small
evacuated
amount
varies
from
found
very
at
this
86).
is meant
of
amounts
a
in
advanced
the
gonorrhoea.
charge
disThe
semen.
condition
diminution
as
in
and
usually
the
is
wise
like-
age;
of the testicles
prostate, such
The
the
singleejaculationusually
This
commonly
consulted
once
2 to 5 grammes.
after inflammation
of
old,
years
eases
dis-
follow
amount
of
124
Sterilityand
after these
semen
of
another
or
one
inflammations
readilyaccounted
is
tract
the
of the
in obliteration
contains
of
which
secretions
lectively
col-
Thus,
ejaculatedsemen.
deferentia
vasa
the
semen
seminales
as
well
of the
that
as
diminished.
In
essentially
ciated
cases, therefore,oligospermiais often assowith azoospermia.
already mentioned, the color of normal
be very
prostate may
is
semen
whitish,
dried
The
the
longer the secretion of the testicles,
the secretion
spermatitisor prostatitis
the Yesicul?e
As
by
genital
deficiency
no
after
such
in the
for
of the
constitute
and
Impotence.
linen
in
stain
like
of
boiled
starch.
stiffens
which
semen,
characteristic
a
of
that
the
has, while
manner,
row,
light,grayish-white color and a narIn disease,espebrownish-yellowborder.
cially
of the genital system, the semen
may
fresh,
a
shades.
various
assume
These
yellow color.
the admixture
become
come
from
linen
brown
blood
The
:
"
brownish-
generally due
are
in these
to
cases
part, in the prostatic portion
urethra, where, in the neighborhood
most
a
caput gallinaginis,
has
semen.
shades
of blood.
arises, for the
of the
found
are
of recZ,
reddish-brotvn^and
1. Semens
of the
Thus
localized.
the
In the
The
seminal
first
case
chronic
blood
vesicles
the
may,
along
dried
urethritis
however,
with
stains
on
the
the
On the rustycolored.
irregularly
stains there
are
usually small blood-
appear
Impotence.
Sterilityand
specks,while in the second
evenly colored, which
mixing
happen
of the
blood
in the
seminal
yellow
semen
the
case
indicates
with
the
125
stains
intimate
an
might
as
semen,
vesicles.
The
pear
ap-
brownish-
contains, usually,blood
and
pus
in
varying proportions.
The
of bloody pollutions is generally
cause
gonorrhoea of the posterior urethra, the pars
Not
infrequentlyin the
fourth week
of acute
gonorrhoea priapism with
bloody pollutionssets in. These often last only
time and then disappearentirely,
a short
yet they
prostatica
urethrse.
sometimes
continue
with
and
undiminished.,
them
by
local
In
treatment.
not
no
general, in
in
excesses
prostate and
seminal
The
bloody pollutions
in
these
stains
on
change
the
linen
from
red
and
Yelloiv
and
The
are
semen
and
ual
sex-
diseases
of
as
in
sometimes
cur
oc-
come
infrequentlybethe
observed
color
to
reddish-brown
of the
gradually
to
ish-yellow
brown-
yellow.
The
semen.
usually due
a
are
the
organs.
which
acute
on
later and
various
gonorrhoea not
purulent. In such cases
have
cases
vesicles,as well
degeneration of
cancerous
is
many
a
may
2.
is put
until
occur
years
check
sequel of chronic gonorrhoea.
also be bloody after masturbation
then
the
if
power,
bloody pollutionsdo
persistmany
may
to
pus.
yellowish or
color
In
this
greenish
of
these
stains
the
stains
case
color.
The
pus
Imjyotence.
and
6'teriliti/
126
for the
comes,
part, from
most
the
urethra
and
during
mingles only imperfectlywith the semen
stains have
not, therefore,
ejaculation. These
yellow color, but
even
an
dried
stain in smaller
seminal
irregularlydistributed.
of
inflammation
in
the pus
The
the
or
pus
seminal
directlyfrom these organs and
evenly yellow colored.
appear
the first kind is very commonly
inflammation
the
at
the neck
of the
largerpatclies,
however,
may,
vesicles,come
then
only found
are
well
the
Yellow
stains
of
semen
found
in chronic
bladder, whereas
evenly colored pollutionsappear
and
the
on
appears
marked
rarely
more
in chronic
sper-
matitis.
As
for
also for
bloody pollutions,so
purulent
the commonest
factor
^etiological
yellow semen
is gonorrhoea,and, as already mentioned, tlie
become
bloody pollutionsnot infrequently
transformed
into the purulent.
3.
these
Wine-colored
violet
or
ually
grad-
Tlie color of
semen.
pollutionsis,especiallyin
the
dry state,
It arises from indigo. The
very characteristic.
shows
only a grayishfreshlydischarged semen
violet tint,yet with the microscope it is possible
of blue crysto demonstrate
a large amount
talline
indigo. The wine-red color of this semen,
which
is
due
to
tlie red
indigo,often gives
with bloody semen,
test
for
blood
modification
occasion
A
shows
to
its
once
the
the
confusion
microscopical or
at
of
cal
chemi-
coloring
of
agent
stain
the
bloody
the linen
on
is very
even
of
specimen
contained
pus
indigo there
in
very
stains, discharged
linen, there
on
the
semen,
of
is
strong indigo and
the
In
semen.
ing
contain-
semen
individuals, especiallyafter
excesses
or
of
jaundiced
that
show
persons
yellow beer color.
Freshly evacuated,
normal
the
tions
pollu-
brownish-
a
contains
semen
The
livingspermatozoa in large numbers.
of the majority of the spermatozoa is
few
a
moving
healthy semen
field,with
ocular
3, about
According
ereal
ven-
masturbation.
also be liere remarked
active, only
of
color
nervous
It may
a
usually living spermatozoa
in
Such
pollutions occur
are
numbers.
normal
I
dried
in this
case.
yet there must
infer this,because
of seminal
result
which, with
seen,
grass-green
is the
which
the
rare.
pollutions and
as
seldom
though
collection
my
even,
never
coloring of
the
is very
I have
semen
be such,
Besides,
semen.
semen,
Blue
in
the
127
Impotence.
Sterilityand
100
to the
more
should
a
slowly.
show
Hartnack
in
tion
mo-
very
A
the
mal,
nor-
scopic
micro-
objective 7
and
livingspermatozoa.
relative numbers
of the
matozoa
sper-
distinct
pathological conditions
are
recognized,namely, oligozodspermiaand azoa
ospermia. By oligozoospermia is understood
two
marked
diminution
while
in
the
azoospermia
number
means
of
their
tozoa,
sperma-
total
ab-
Impotence.
Sterilityand
128
Oligozoospermiaoften
sence.
yet
age,
often
that
it is found
also
secreted
are
The
(Fig. 10).
10.
"
Semen
h, dead
corpuscles;
in
in
even
are,
for
the
commonest
of
c, seminal
g, pus
granules.
spermatozoa
perfectlyfresh
a
part dead
most
cases
Olip^ozoospcnnia.
spermalozoa;
frequently
youth. Very
more
the few
that
and
state, motionless
FiG.
still
congenital condition
a
as
it is found
vanced
ad-
in
occurs
n.
of
Living
corpuscle;
oligozoo-
tozoa;
sperma-
d, blood
300 diameters.
of the
spermia are the gonorrhoealinflammations
flammatio
epididymes and spermatic cords. By these insometimes
is brought about
comand sometimes
l)lete
only partialobliteration of
the
vasa
deferentia.
from
becomes
the
The
testicles
passage
to
of
the
llie seminal
matozoa
spercles
vesi-
thereby very imperfectand scanty.
130
ter
Sterilityand
Impotence,
do
auonialies, however,
Much
azoospermia.
form.
more
Here,
a
as
always
not
involve
is the
common
rule,there
have
quired
ac-
been
of the testicles and
gonorrhoealinflammations
cords, with subsequent complete obliteration of
In certain cases
the latter.
azoospermia comes
about
of
gradually,at first with the occurrence
until the
bloody,and then of purulent pollutions,
semen
finallybecomes
watery and the spermatozoa
The bloody and the purulent
to appear.
cease
semens
generallystill contain spermatozoa, but
and are
in number
they are usually diminished
often motionless, and at last,after repeated observation
disappear. Very
they all at once
about
frequently,however, azoospermia comes
without
previous bloody and purulent pollutions.
The
flammatio
intensityand frequency of the inof
for the
who
men
have
had
tlie
yet have
other hand,
normal
rule
no
There
azoospermia.
bilateral
and
8 times
On
of
occurrence
furnish
testicles
the
are
epididymitis6
and
fruitful
or
semen.
slightpain in the spermatic
cords and
a
mild, unilateral epididymitis
bring about azoospermia; the most intense
may
inflammations
of the testicles and
epididymis
often
the
leave
very
semen
unharmed,
slightinflammatory
very
processes
testicles and
The
spermatic cords result
size and
density also of
induration
of
the
while
epididymisdo
in
times
some-
in
the
mia.
azoosper-
the
not
ing
remain-
always
Sterilityand
opinion
Impotence.
azoospermia, altliougii
bilateral,
great importance, and, when
warrant
an
it is of
to
as
renders
of the
imperativean examination
Although in azoospermia the semen
consists
of the
only
ulse seminales, the
testicles is
always
in
general.
always
are
in the amount
The
in these
of
The
exhibits
of
the
and
of
that
these
consists
properties
ducts
and
often
also
crystals.
masses
and
forms
a
times
a
not
There
the act
day.
to
of
settle in
under
the
sometimes
concentric
the
a
seminal
very
spermatic
not
semen
frequentl
in-
microscope colloid
most
of oval
varied
arrangement.
also, fatty molecular
cretion
se-
This
granules, and
consist
the
the
is formed.
well-formed
shows
to
test-tube,only
epithelium from
numerous
proves
azoospermous
a
sediment
exhibit
coagulating
which
When
azoospermous
sometimes
semen
strong
very
belong
not
Fresh
which
in
do
urethra, of seminal
of
is not
perform
semen,
testicles.
mostly
have
several
normal
little whitish
very
there
peculiaritiesof
is allowed
semen
of
secretion
azoospermia, freshlydischarged,
as
the
ous
muc-
of the
able to
are
even
same
smell
of
who
men
daily and
semen
other
materipJlyimpaired.
cases
desire,and who
coitus
vesic-
potentia coeundi, also, is
azoospermous
sexual
the
wholly wanting, yet
diminution
a
the
the
urethra, and
semen.
discharged
from
secretions
prostate, and
of the
glands
the
131
detritus
kernels,
spheroid
ally,
Occasionwith
small.
132
Sterilityand
Impotence.
strongly refractinggranules
forms
In fresh
vesicles.
derived
probably
are
are
from
they
semen
These
seen.
seminal
the
often form
clumps
shape of
yellowish bodies of the size and
grainsof sago.
The so-called sijeymiatic
almost
are
crystals
found
in azoospermia. The
thinner
of
and
appear
is,the
semen
azoospermous
the
larger they
semen
they
first appear
hours,
even
a
if
day or
drop is
these
sooner
In
are.
after the
They
two.
allowed
be
the
crystals
normal
lapse of
may
stantly
con-
many
strated
demon-
dry in the air on
the microscope are
then
a
glass slide. Under
found
stone-shaped
colorless, whetimperfectlycrystallized,
forms, usually lying upon
one
another
or
arranged in rosettes.
chemical
The
composition of the spermatic
Bottcrystalsis not yet clearly understood.
cher
considers
Schreiner
Other
of
a
them
authors
or
The
that
that
these
the vesicula3
lie
an
identifythem
Charcot,
wherever
mucous
the secretion
authors
crystals of
occur
from
of
substance,
organic base.
consider these crystalsphosphate
even
ammonio-phosphate of magnesia.
later
so-called
they
albuminoid
an
phosphoricsalt
a
magnesia
the
to
there
and
with
assume
cretion
profuse setains
glands. Fiirbringermaincrystalsare present neither in
from
the
testicles
seminales, but
also
holds
is
in that
nor
only
that
a
the
in
from
cretion,
prostaticsepeculiarodor
Sterilityand
of
semen
do
not
arises from
belong
the
are
found
the
greatest number,
in
Since,
in the
not
least
the
rhomboid
rhomboid
incomplete
boat
or
of
is the
these
the
stant
con-
tion
asser-
crystals
of
secretion
colorless, and
of
system
found
are
a
these
long
be-
crystals.Under
rhomboid
When
rosette.
a
or
so
to
prisms. Sometimes
to
prisms combine
rhomboid
is
part,
almost
are
semen,
spermatic crystals are
microscope
cross,
latter
seminales.
the vesiculse
to the
concretions
spermatic crystalsare
the
in
of pros-
secretion
disregarded,that
be
to
in
of azoospermia.
prostatic
the
and
forms, and
semen
in the
azoospermous
belong also, at
The
in the
while
only rarely found,
secretion, for they
beautiful
most
concentric
common,
are
crystals. They surely
orchitic
moreover,
the
tatorrhoea
these
the
to
133
Impotence.
tablets
two
or
form
the
crystals take
whetstone, of which
and
more
oblique
crystallization
an
the
form
the
g^f a
tapering
in
bent
an
oj)posite direction
angles are
(Fig. 6, page 85).
The
spermatic crystalsare not a product of
as
was
decomposition of the semen,
formerly
in azoospermous
supposed, for they are found
after ejaculation, and
few
hours
in
a
semen
normal
semen
immediately
glassslide.
That
only
late,often
third
appear
the
after
crystalsin
not
day, is explained by
until
the
drying
normal
the
abundance
on
the
semen
second
of
or
liv-
Sterilityand
134
in such
ing spermatozoa
of movement,
such
In
semen.
a
healthy semen,
as
take
cannot
Impotence.
place. Only
fluid full
ation
crystallizthe
wlien
matozoa
sper-
comes
begraduallydied and the semen
Therefore,
quiet,can the crystalsform.
after the
in normal
semen
they are first found
lapse of 24 hours ; in azoospermia, on the other
have
hand,
in
hour
an
usually a permanent affection.
flammati
temporarily only a short time after inis
Azoospermia
It
occurs
of the
always
of the
one
In
with
move
when
harmful
unfruitful
is
riage.
mar-
the
fresh,healthy semen
other
of
causes
catarrhal
oligozoosper-
and
sterility,
male
involves
commonest
with
in
ospermia
frequentlypractised.Azo-
great activity.
mixed
or
testicles,and
coitus is too
when
mia
two.
or
If the
spermatozoa move
however,
semen,
secretion,with
substance,
the
acid
be
urine,
spermatozoa
sluggishlyor not at all,even
ately
is immedithe freshlyejaculatedsemen
flammati
placed under the microscope. During ineither
very
testicles,of the prostate,and
of the
especially of
spermatozoa
often
are
vesicles, motionless
seminal
the
of tlie seminal
found.
vesicles
spermatozoa, indeed sometimes
found, on examination, to be
In
the
majority of
all of them,
secretion, althougliit has
reaction,
seems
exert
a
jjarniful
an
tarrh
ca-
the
are
The
motionless.
catarrhal
to
chronic
alkaline
influence
on
Sterilityand
the
is climiiiished
the number
that
which
Semen
contains
unfruitful.
is
tozoa
at the
the
have
they
been
time.
same
motionless
only
Whether
spermatozoa, when
speryna-
motionless
discharged
gain
genital tract in coitus,ever reI can
mobility is not known.
only
the female
into
their
that in several
say
usually observed, also,
is
It
spermatozoa.
185
Impotence.
found
1 have
forced
the
the
Professor
because
of such
wives
about
of the
condition
abnormal
has
men,
still
contains
this
all the
more
examining the
nothing abnormal
on
found
living ones,
some
analogous condition to
contains
only a few,
that
favorable
that
generally have bent
already remarked.
abnormal
;
and
be
and
the
semen
living,spermatozoa
not
absolutely sterile,
under
only occur
dead
are
or
forms
p"a.thological
mentioned
3, those with
only rarely and
when
the
:
tails,as
of spermatozoa
1, spermatozoa
; 2, spermatozoa
two
tails. These
alone, mingling with
spermatozoa.
discharged
spirallytwisted
large hydrocephalic heads
2 heads
in which
an
conditions.
Spermatozoa
may
furnishes
but
(oligozoospermia); it is
although impregnation can
formed
am
genitals. Semen, however, which,
majority of the spermatozoa motionless,
a
Of
sterilityin
semen,
C. Braun,
I
the
with
most
of
cause
marriage
motionless.
spermatozoa
seek
to
of unfruitful
cases
with
with
occur
normally
Impotence.
and
Sterility
136
of semen,
constituents
pathological
with the microscope,besides blood and
observed
corpuscles and epithelium, is sometimes
pus
beautiful blue crystalline
indigo in largeamount.
the
Among
This
is found
and
glands of
which
of
semen
free
the
then
in
semen
of the
movements
possible;
is
this
sory
acces-
charged
partly dis-
it,appears
In the first place
purposes.
the
of the
partly before
and
semen
dilute
to
made
are
prostate and
urethra, which
various
serve
serves
the
the
with
to
scales,
individuals.
secretion of the
The
it
the
infrequentlyin
not
nervous
very
flakes and
blue
in corn-flower
occurs
general,by
spermatozoa
secretion
also
has
probably the function of preparing the urethra
urethra
The
is,
for the receptionof the semen.
in its whole
is well known,
length to the
as
which
canal
a
belongs as
caput gallinaginis,
A
well to the sexual as to the urinary system.
let
outan
as
usually serves
canal, however, which
urine, cannot, without
acid
for the
modification, also
serve
an
as
outlet
further
for
the
epithelialcovering of the
dilated
urethra, especiallyin its physiologically
portions, for instance, the bulbus urethra, is
alkaline
The
semen.
"
"
moistened
I.e.,
tlie acids
on
to
neutralize
the urine
the
with
of
the
the
the
remains
urine
of urine, and
and
the
urea,
these,
act
juriousl
in-
spermatozoa. In order, then,
acid by
urethral
walls, made
adlieiingto them,
and
to
prepare
them
138
SteriUty and
however,
nales
from
come
evenly mixed
within
with
^^^^
the
vesiciilae semithe
semen,
cauteri-
accomplish much.
Fortunatel}^,however, this is
^H^
tial
'^l^^^^
rare
The
occurrence.
diagnosisbetween
from
pus
B
the
will not
zation
/^i,
Impotence.
the
and
from
nales
may
by
a
of
the
be
differenblood
prostatic
the
a
and
urethra
vesiculte
semi-
generallyestablished
microscopical comparison
the
sediment
urinary
with
the
If, namely,
semen.
neither
contain
urinary sediment
blood nor
ever,
if,howpus corpuscles,
they
it
semen,
they
found
are
from
come
assumed
be
may
the
the
in
that
vesicula3
seminales.
Oligozoospermia is
activity of
of
stenosis
condition
testicle
the
the
which
of
or
deferentia, a
vasa
is
result
functional
diminished
of
either
the
brought
about
especially by epididymitis and
funiculitis spermatica. There
can
be no thought of operative interiiianu's
Dropper.
lury
fcrcuce
uieujiai
y/, Capii-^ij^^
^j^
caUietcr;
remains
Hynngo.
but
of the
accouut
.
their
to
arouse
,,
,
luiiicn
,
deferen-
vasa
^^
,,
Pravaz
the
with
.
nothing
fiueness
ii
of
r
tnereiore
the testicles tliemselves
SteriUtifand
If the tissue
organs.
form
to
in a condition
this
the
of
At
current.
the
spermatozoa
increased
in such
Not
favorable
so
Here
have
we
atrophy
is the
do,
of the
of the
faradization
If
tried.
only
of
the
singlerare
there
favorable
be
expected
no
more
in
inflammation
for, even
to be
If
impervi-
of the
but
not
be
no
a
spermia,
azoo-
be
may
eration
oblit-
an
present,
ensue.
may
plete
com-
therapeutic
testicles
up,
be
imperviousness
cause
the
in
ever,
If, howment
treat-
avail.
then,
azoospermia
year,
of the
azoospermia be
more
all
deferentia
result
than
the
plugging
a
with
plete
com-
complete obliteration,this
will be of
A
be
azoospermia.
If there
testicles
recovery
be
vis
permanently
in
testicles,or
of
vasa
cases
as
rule, either with
powerless.
deferentia
vasa
a
result
deferentia.
vasa
will be
measures
as
of the
atrophy
be
same
deferentia,
vasa
even
may
acts
on
semen.
to
of the
ousness
the
formation
semen
tergo^ dilatingthe contracted
and
large
in
spermatozoa
induced
the
still
is
testicles
the
these
infrequently happens
not
increased
the
time
a
of
use
of
faradization
direct
accomplished by
numbers,
this is best
and
secretory activity,
increased
to
139
Impotence.
as
a
when
rule, is only
it has
to
existed
counting from a preceding
testicle.
If, however, the
of
ing
longer duration, there is nothhoped for from therapeuticmeans,
if the
vasa
deferentia
could
be
made
140
and
Sterility
pervious,there
would
of the
atrophy
of
of its loss
Impotence.
takeu
have
pkce ah-eady
during this long period
testicle
function.
If the
epididymes
or
ened
i.e.,thickspermatic cords feel infiltrated,
and
of inunction
hard, resorptionby means
the
and
bathing should
be
attempted.
the
ability
inBy impotentiacoeundi is understood
to accomplish the
of sexual
course
interact
v^ith erect penis. This inability
is sometimes
due
be
the
to
about
broughi
that
sometimes
make
case
of
it
possibleto
of the
penis and
the
should
semen
about
place
In the
act.
at
the
to
latter
the
better
ing
understand-
lyieclianism
mechanism
Kolliker
of
of
of ejaculation
and
Kohlrausch
"
by
the
the
spaces
reception of
of
erections
^
Under
:
followingmanner
the nervi erigentesthe organic
fibres of
presence
erection
of
first be elucidated.
muscular
for the
the
in the
influence
which
For
impotence
According to
The
coitus, and
ejaculationis usually the cause
plishment
penis becoming flaccid before the accom-
of male
the
can
long enough
last
not
finish the
of coitus.
come
takes
erection
it does
of
time
at all
premature
the
the
erection
no
the
at
an
time, but
proper
fact that
this
*
See
are
a
cavernous
widened
tissue
and
also
prepared
large quantity of
largequantity of
pugj;
'.'A.
relax,
blood.
blood
in
and
Sterility
the
explain
of the
erection
which
penis
blood
the
cannot
this end
as
it flows
would
never
mass,
addition, be provided
in
must,
a
is
alone
could
flow
perfect
in, a
There
occur.
contrivance
a
into the
poured
141
not, however,
erection, for if the blood
the
again,in
out
does
cavernosa
corpora
Impotence.
by
nosa
caver-
corpora
immediately flow out again, and
omical
accomplished by the following anat-
arrangement.
At
the
of the
elements
the
opened
the
at
nervi
Joh.
according to
nae
and
"
the
through
short
with
arterial
cavernous
Miiller,the
the
muscular
erigentes. Thereby
in the
fillingthem
cavernosa
corpora
the
relax
time
same
branches, anastomosing
"
erection
cavernosa
corpora
of the
influence
are
of
beginning
spaces
helici-
arterise
blood.
blood
From
partly
returns
through veins which empty into the vena
lis penis, and partlythrough those which
from
the
means
of gaps
under
side
the
in the
of the
are
cavernosa
of
of the
interior
with
cavernosa,
the
blood
outflowing veins, and
the corpora
relaxation
cavernosa
of the
of the nervi
the
into
the
on
corpora
the
reflux
cavernosa,
chief
the corpora
pressure
is checked.
corpora
the
forms
poured
necessarilyexerts
by
blood, the filling
cortical reticulum, which
receptaclefor
emerge
reticulum
penis. If,then,
distended
dorsa-
cavernosa
corpora
cortical
the
the
on
of blood
If
from
now
z.e.,
the
be incomplete, a
erigentes,
the
tion
ac-
suf-
1-1:2
Impotence.
Sterilityand
ficient
quantity of
tissue
to
veins, and
blood
exert
the
cannot
the
on
pressure
be
penis cannot
the
enter
tile
erec-
outgoing
brought
to
state
a
of erection.
The
mechanism
of erection, then, is under
of the
influence
erections
electrical
stimulation
cord.
In.
According to
excited in dogs by
system.
nervous
Eckhard,
the
be
can
of the
brain
as
well
as
of
observe
we
analogous manner
fluence
that in men
erections take place through the inof lustful thoughts in the brain, as well
of spinaldisease. Peripheral
in certain forms
as
irritation also, applied to
the genitals,causes
the
erection.
full
a
pressure
the
of
night, in
the
last
dorsal
the
the
on
than
known
that
seminales, such
as
position,the
veins
Also
erections.
erections
longer
It is also
viscera
powerful
the vesiculse
bladder,
easilyand
more
empty bladder.
an
during
excite
with
Thus,
usually occur
with
an
suflices to
distention
occurs
of
in strict
gives rise to frequent erections.
of the rectum,
diseases
Constipation,lithiasis,
continence,
above
with
of the
all,diseases
frequent erections.
diseases
of
the
prostate,are
associated
tory
Especially inflamma-
prostate
are
not
quently
infre-
prolongederection of the
of painful priapism. Finally,
penis,and even
it is well known
that peripheralstimulation, as
skin
to the glans and
applied in masturbation
erection.
of the penis and to the testicles,
causes
the occasion
of
Sterilityand
doubt
is,accordingly,no
There
reflex
that
peripheral
well
genitals,as
able
of the prostate, are
conditions
about
the
applied to
irritation
143
Impotence.
table
irri-
as
to
bring
erections.
Regarding
the
of erections
excitation
nerve-irritation, Goltz
pheral
by peri-
found
has
that
more
promptly and
brought about
they are
powerfully when, according to experiments on
region.
dogs, the cord is divided in the lumbar
from
concludes
He
a
brain, and
The
experiment
cord
occur
cord
brain
made
have
promptly
of
erections
of the
will be
To
existence
psychical form
of
the
occurs
division
the
from
and
of
thereby
inhibitory
well
the
currence
oc-
impotence,
as
mechanism
of
only
also
brieflyconsidered.
conditions
the corpora
ginisswells
subject, the
also be
normal
are
bar
lum-
peripheral
on
severed
very
must
ejaculation
of
erection.
supposition.
with
explains
complete
semen
of
to
fullyexplained later.
more
Under
check,
inhibitorynerves
been
The
powerless.
nerves
the
also
this
from
to
severed
the
for
argues
more
lumbar
of the
ducts
with
dogs
stimulation, because
nerve
proceed
occurrence
hibitory
in-
also
are
designed
are
on
plainly
Erections
the
which
extent, the
certain
there
of erection^ which
nerves
the
that
this
;
thereby
with
the
erect
cavernosa
the mouths
directed
ejaculation of
penis. With
tion
erecthe
caput gallina-
of the
forwards
ejaculatory
toward
the
Impotence.
Sterilityand
144
portion,and
membranous
behind.
is closed
bladder
the
at
ordinarilyserves
urethra, which
for the
dischargeof urine, is
of
sexual
the
clear from
appears
void
to
easy
the
in
the
with
discharge semen.
perinaeum during
the
toward
backwards
to the
use
penis erect,
impossible
very
pain, felt
ejaculationof semen
the
tightstricture,shows
of
canal
a
is erect, but
Also
the
as
caput gallinaginis
penis
to
cases
the
the fact that it is
when
urine
process
devoted
the
by
the
only
That,
system.
is closed
bladder
the
this
By
time
same
in
that the passage
bladder
is closed
the
to
semen.
Before
glands
the
of
of
occurrence
urethra
the
ejaculation
begin
the
secrete, and
to
infrequently appears, with
strong erection, as a viscid, clear drop at the
The
orifice of the urethra.
tion
object of this secretralize
is probably,as already mentioned, to neuthe
secretion
not
the urethral
by
of
means
them
a
walls, bathed
ropy,
for
the
alkaline
fluid,and
reception
coitus, the
in acid
of
the
urine,
to
pare
pre-
semen.
of
ejaculation
tuous
approaches,a spasmodic sensation with volupis experienced in the
excitement
periWhen,
in
moment
begins
discharge of semen
At
the same
through the ejaculatory ducts.
Then
time the prostate dischargesits secretion.
the semen,
graduallypouring from the narrow
ejaculatoryducts, is impelled forwards, since it
nteum,
and
the
Stenlityand
14G
Impotence.
followingforms of impotence are to be
is
distinguished:1, organic impotence, which
usually absolute j 2, psychicalimpotence,with
its variety,relative impotence; 3, impotencedue
with
abnormal
to iveahiess
nervous
irritability,
in premature
which
culminates
ejaculation;4,
form
of impotence.
the paralytic
1. Organic Impotence. In this case, on
count
acof organic malformation
and
mutilation,
The
"
of disease
account
on
or
of
ity
vicin-
be perpenis, coitus cannot
formed.
this class belong extensive
spadias
hypoepispadias,deficiencyor abnormal
and
of
smallness
the
and
penis,elephantiasis
penis,deviations
erection
on
immediate
normal
a
To
of the
in the
due
to
in
cavernosa
and
of
curves
partialdestruction
consequence
tumors
the
penis
of the
of wounds
cavernitis,finally
swellings in the
pora
cor-
and
surrounding
largehernise and scrotal tumors,
etc. Also generalcorpulence,with a very prominent,
overhanging belly, may, in many
cases,
render
the organic
coitus
impossible. With
form
of impotence there may
be very strongly
developed sexual desire. Ejaculationmay take
parts, such
place
in
a
as
normal
manner,
but
tlie insertion
of
of the organic changes
penis, on account
mentioned, has become
impossible. Organic
impotence is, for the most
part, absolute, and
only rarely accessible to therapeuticmeasures.
the
An
interestingcase
in this connection, which
Impotence.
Sterilityand
another
published in
I have
147
be
place, may
here
brieflymentioned.
J., 41
Adolf
bookstore,
Adolfine, because
name
affected
with
scrotum,
were
He
originallybaptized
was
the
with
birth
at
his voice
to
and
men's
his
assumed
he
sex
the
masculine
genitals,
and
cleft
feminine.
sprout and
medical
established.
From
of
and
name
But
year.
character, the
careful
a
girl,
Adolf,
amination
ex-
this
wore
examination, the following condition
found
;
with
had
the
scrotum
half
the
a
of
split into
somewhat
was
testicle
completely wanting.
in
The
the
lower
penis, very
right half
thighs
cleft
were
scrotum
female
parts.
than
the
;
lower
The
of
angle
left
small,
the
the
angle
of the
right
left, and
The
none.
subpubica
was
ated
situ-
was
cleft scrotum.
so
that
when
appeared
rose-red skin,
The
upper
The
there
delicate
vestibule.
small
firmlyadherent
was
spread apart,
with
The
the
meatus
of the scrotum,
closelyjoined to
in the
two
thicker
small
vulva.
a
oi the pars pendula and
urethra
was
thighs spread apart, the genitals
appearance
was
contained
the
to
a
clothes.
On
the
begun
subjected to
patient was
time
had
the
assume
his 20th
in
a
his
considered
until
later his beard
when
as
hypospadias
extreme
girls'clothes
wore
here
old, employed
years
glans penis
wall
of
the
cleft scrotum.
to
the
the
like
was
urethra
Sterilityand
148
Impotence.
patient had strong sexual
strange to sa}^, married, yet, of
desire
The
and
was,
was
course,
able
un-
satisfied
He
perform the act of coitus.
his desire by friction of his genitalsagainstthose
of his wife, whereupon ejaculation
followed.
On
erection half of the scrotum
bulged out with the
enlargement of the penis.
This
make
to
him, by
patient desired me
I
operation,a penis capable of intromission.
attempted the operation,and, indeed, succeeded
in producing a small, freely movable
penis,
which
could
be partiallyinserted,to the great
joy of the patient.
form
of impo2. Psychical Impotence. This
tence
It is
is usuall}^of a temporary nature.
in
individuals.
nervous
commonly observed
for marriage in advanced
They are either candidates
to
"
or
age,
who
persons
have
masturbated
early youth, or those who have
had
prostatitis,
gonorrhoea complicated with
of the
catarrh of the bladder, and inflammation
a
great
deal
testicles.
of
In
the first
confidence
that
act
his
in
makes
find
men
of
in
the
it is
case
to
perform
In
manner.
excitement
their
the
have
a
promise
of
a
great
state
a
dread
of not
conjugalduties
consequence
action
of
account
marriage contracted, in
able
These
patient impotent.
tliemselves, on
excitement, and
to
power
usually a lack
accomplish the
of the
in
of this
vous
ner-
being
a
able
suit-
nervous
nerves
inliibitory
Sterilituand
from
the
fails at
brain
the
and
dread
may
sometimes
of such
be
their
themselves
in the
table
and
the
When
they
have
of
to
by spasmodic
fibres
of the
trabeculce
is
the
inhibitorynerves
the
fear and
the
same
folds
nosa.
caver-
only
be
those
ganic
or-
in
This
cavernosa.
corpora
plained
ex-
embedded
are
of the
of erection
action
stimulated
of
by
In
of catheterism.
dread
feels
penis
of
the
that
corpora
manifestation
a
of
transverse
contraction
a
come
be-
less than
can
which
in
move
cavernosa
the
appearances
ally
gradu-
seen
the
shows
skin
have
stretched
diameter
touch
contraction
muscular
is
penis
corpora
the
erection
examination
smaller, and
To
of
the
pendulous portion is
These
contraction
the
erection
of
harder, the
the
cartilaginous,
the
influence
and
The
glans.
to
The
sounds.
manner.
smaller
the
the
on
clothes
the
on
worm-like
and
occurrence
studied
shrink, grow
to
due
the
on
patients with
unfastened
of
aggravated
critical moment.
fear
penis
is
149
Impotence,
exactly
fluences
purely psychical inway, then, other
of the inhibitory
the action
stimulate
and
nerves,
the
such
patient is, at
moments,
impotent.
In
be
to
are
not
there
of masturbation
case
taken
unnatural
their sexual
consideration.
into
accustomed
to
means
is another
coitus, who
normal
for
appetites,may
Men
the
not
tor
facwho
ploy
em-
gratificationof
succeed
in the
150
Impotence.
Sterilityand
performance of their conjugal duties, but still
be fullycompetent to cohabit
in the usual
may
with
manner
prostitutes. A failure in the
marriage bed so discouragesthese patientsthat,
after repeated attempts, they become
incapable
of gettingan
tions
erection, although powerful erecIt
is
also
times.
remarkable
a
that
circumstance
formerly in
tent
temporarilyimpohigh degree potent, become
after a gonorrhcea,especiallywhen
cated
compliwith
catarrh of the bladder, prostatitis,
sometimes
a
other
at
occur
may
such
patients,who
inflammation
or
the
of the
the
testicles.
In these
apparently exerted
gonorrhoea has
influence
were
the
on
nervous
a
cases
lyzing
para-
apparatus of
prostate.
prostate contains in its superficiallayers
ers,
lining the urethra, as well as in its cortical layThe
extensive
ganglia,and
other
nervous
to
this
plexi,interspersedwith
arrangement belongs,among
functions, that
of
tions.
reflexlyexcitingerec-
eter
ordinary pressure of a metallic cathsound
is not
or
infrequentlyfollowed by
zation
cauteristrong erection of the penis. Likewise
the application of astringentsto the
or
It is also
prostaticurethra produces erection.
The
well known
that
tumors
of the
prostate,calculi,
inflammations
of the prostate,are
especially
very often accompanied by painful erections
priapism,much
against the will of the patients.
and
"
doubt
is,then, scarcely a
There
151
Impotence.
Sterilityand
that
from
prostate reflex erections can be produced.
reflexes,however, are transmitted
by the
branches, and
when
altered
way,
in
any
these
these
rule, to
all
part, and
take
kind
of these
defloured
away
of
marriage, the
graduallyand
the
in
is
a
In
varied
most
gradual
moval
re-
come
patientsagain beone
and
not
been
where,
cases
later,however, the
;
the
after the
only
I know
3^eaTs after
become
give rise, as
impotence.
of
latter will the
potent.
two
however,
processes,
psychicalinfluences
cases
nerve
by inflammation, as
following gonorrhoea
transient, temporary
a
The
e.g.^
impotence
prostatitis,
explained.
All
have
latter
the
wife
had
impotence passed
bore
women
one
child
after another.
affected
Patients
psychical impotence
genital apparatus. In
certain
however, azoospermia is found.
cases,
These
patients, when
they lie alone in bed,
in distinction
have
powerful erections
very
usually
have
with
a
normal
"
from
soon
paralyticform of impotence,
yet as
as
they attempt coitus, which
they generally
approach with doubt, anxiety, or fear,there
the
is either
The
"
no
erection
or
a
very
imperfect
prognosis of psychical impotence
is
one.
usually
favorable.
Relative
which
the
psychicalimpotence is that
patient is unable to perform
form
in
the
act
and
Sterility
152
of coitus
with
Impotence.
certain
women
In
such
onl}^ It is very
the impotence is manifested
unpleasant when
toward
the patient'sown
quently
wife, as is not infrethe
case.
generally plays
least
wife.
from
aversion
an
In
on
which
interests, this form
found.
and
time
do
can
it
when
individuals
such
nerves,
and
to
men
a
who
men
large number
not
quently
infre-
can
at
the
sexual
of
any
who
men
it is
play
who
as
endowed
are
so-called
no
a
woman
Impotencedue
thing for
rare
such
tive
sensiary
liter-
tual
intellec-
r61e in sexual
lamentable
to
with
book-worms,
partly indeed, from
3.
the
material
is not
perform
the
at
willinglyyields
large contingent is furnished
by
A
men,
are
woman
is still
only
herself.
those
any
from
impotence
There
with
act, yet there
of
sion
aver-
contracted,
are
but
affection,
mutual
or
mutual
a
important part, or
side,especiallyof
an
one
marriages
love
cases
natural
tveahiess
tercourse
in-
ness.
awkward-
with
abnormal
This
form
of impotence is always
irritability.
distinguishedby premature ejaculation. The
affected
coitus with
enters
man
so
penis
upon
"
erect.
Just, however,
the act,
even
into
tlie
as
he
is about
l)efore the penis
can
vagina, ejaculationand
to
begin
be introduced
immediate
flac-
cidityof tlie organ take place. This form of
impotence with j)remature ejaculationis very
common
with
persons
who
enter
upon
coitus
154
Sterilityand
Lnpotence,
wilts even
queutl}'the 2;)enis
Ejaculationalso is abnormal,
not
at all
within
since
the
vagina.
it either
does
else verj- late.
During ejaculation
the semen
comes
no
longer in jets,but
graduallydrops,as it were, from
very slowly
the urethral orifice. This form of impotence is
observed
not
of
infrequentlyas a symptom
chronic
general diseases,as in diabetes mellitus,
in the morphine habit,in cerebral and spinaldiseases,
occur
or
"
and
of the
cachexiae
with
On
erection
affection
The
is
volved.
in-
are
sociated
infrequentlyas-
skin
of the
found
ered
with-
penis and
without
the
into
pain
skin
sound
the
of
the
genitalsis
to the electric current
passes
with
thigh and
than
even
urethra
bladder.
found
the
of the
sensitiveness
diminished:
of the
cord
genitalsare
The
The
the
Lesions
only slightlysensitive, indeed
anaesthetic.
much
the
in
is not
the
flaccid.
testicles
kinds.
spermatorrhoea.
examination
and
and
of
centres
of various
Not
in
much
more
that
of the
is
ease
quently
infre-
ity
the vicinsensitive
penis and
scrotum.
immediate
The
is not
the
cases
is
who
The
in whom
of
cause
this
form
of
tence
impo-
largeproportionof
furnished by masturbators, and profligates
desist from their practices.
cannot
always
prognosis is
the
power
lost, improvement
clear.
A
doubtful.
of
and
In young
erection
even
is not
recovery
persons
wholly
may
be
patients,however, restoration
is scarcelyto be expected.
power
of impotence varies according
The
treatment
attained
of
155
Impotence.
Sterilityand
or
older
different
to the
In
; in
organic impotence,
relief
obtained
be
can
about
in
the
penis, the
former
as
condition
be
removed
hyper tropliiedintegument
the
in
least
the endeavor
of
be
must
made
to
infiltration.
the
treatment
antisypliilitic
will
mercury
traumatic
have
cavernitis,or
of the
cavernosa
corpora
here
a
favorable
in
the
as
latter,at
in the
corpora
of the erect
causing distortion
cavernosa,
the
well
as
in
infiltration
With
part.
be formed.
can
elephantiasisof
and
must
be
may
small, freelymovable
a
intromission
of tumors
case
only by surgicalmeans.
far
so
penis capable of
In
rule, improvement
a
of the
improvement
brought
as
epispadias,by plasticoperations,
and
hypospadias
In
affection.
of the
forms
penis,
orption
bring about resvolved,
If syphilisis in-
and
iodine
with
In
influence.
advanced
destroyed reticular
a
age,
storation
re-
of
structure
is inconceivable.
Yet
even
for the promotion
iodine, local applications
of
absorption,compression by
of
and
sticking-plaster,
lukewarm
means
of
strips
douching
may
large irreducible herniae as well
as
great swellings of the testicles, especially
by operation.
hydrocele,may be remedied
be
tried.
The
The
psychical form of impotence
disappears spontaneously,
not
when
quently
infrethe
156
and
Sterility
disturbances,
mental
depends, vanish.
become
impotent
them
have
when
they
have
a
been
which
on
Thus
the
men
when
suddenly
may
those
snatched
impotence
however,
their circumstances
to
by death,
away
their
unexpectedly lost
In these cases
pain,grief,and
paralyzinginfluence on the
When,
dear
most
have
erection.
time
Impotence.
of
centres
of
course
and
improve
erty.
prop-
misfortune
the
in
or
come
be-
they
In such
quieted,the impotence vanishes.
the
cases
friendlyadvice of a physician,who
the confidence
of his patient,has a
possesses
favorable
very
Most
influence.
this form
commonly, however,
is found
in
nervous
previously been
addicted
have
gonorrhoea.
had
and
in vivid
and
severe
those
excess,
such
"
read
have
and
Quinine, iron, cold
and
groundwork
more
of
which
them
up
the
penis is by
functional
always
they are
occur
no
means
ber.
largest num-
form
travel
extinct.
at
wished
the
for.
wrong
Local
There
that
time
and
treatment
is
the
the
Much
ment.
treat-
of
erectile power
disturbance, in
worst
bathing,country
water
the
paint
in the
tlie
cases
or
uals
individ-
general treatment.
eflicacious,however, is the local
In these
a
have
of masturbation
air and
especiallymountain
who
Nervous
books
show
make
persons
tence
impo-
masturbation,
to
colors the consequences
sexual
light
who
men
young
of
the
merely
erections
never
must
when
then
for
have
object,in
an
thinks
in his
trust
patient becomes
Since,
local
the
point of
the
forms
recommended
:
allowed
With
keep
towel
and
or
the
heavy,
metallic
and
the
sound
distal end
the
in
sounds
of
Nos.
horizontal
tion,
posi-
the
into
bladder
of
means
a
pressure
alone
prostate,
thereby
manner
it is well
the
increase
acts
the
on
infrequently happens
even
5 16 10 minutes.
depressed by
so
bladder,
Here
urethra, sometimes
similar
consists
prostaticurethra.
the
a
be
Charri^re
for from
in the
as
so
excited
In
there
to remain
are
cases
pulation.
manito
metallic
being passed
pressure
it not
in
prostate
are
This
usually from
patient in the
the
on
the
for instrumental
of
otherwise
tension
attack
sounds.
curve,
the sounds
and
the
prostate, so
impotence
with
daily passage
20 to 30, with
that
"
1. Treatment
moderate
the
following methods
The
to
of
the
explained in detail,
from
excited
treatment
much
and
potent.
already been
be
may
tient
pa-
place. The
unexpected
an
so
power
soon
very
has
as
erections
the
in such
the
self-confidence
sexual
own
when
take
cannot
strengthens the
manner
by
to
applications,
time
a
erection
an
local
at
erection
an
of
occurrence
a
and
creations
about
bring
artificial manner,
an
of instruments
means
157
Impotence.
and
Sterilitif
while
the
after
in the
course
acts
"
that
sound
a
few
of
a
the
erections
is still in
days, in
few
tain
cer-
minutes.
158
and
Sterility
2.
Cold
The
bladder
with
the
tube
patient in
action.
with
flow
beginsto
through
vesical
the
other
of the water
used
at
the
togetheron
act
a
51"
to
this
only cold
In
well.
of
Avater
warm
over
be
may
heat
heat
sound
is
3. The
three
by
one
on
of
mechanical
sel.
ves-
the temperature
be
that
is,
[52"
14"
to
be
used.
works
water
16"
to
RdNot
remarkably
has
no
effect,
[100" Fahr.] and
circulate
through the
to
observed
in
certain
cases
quickly and
of
cold.
Irritation by means
the prostate through the cold
the best means
of excitingerections.
treatment
means
cold
allowed
excites
exerted
empty
verj^ sensitive
of from
Reaumur
powerfully than
thence
9" to 10" Reaumur
30"
It may
sound.
and
Fahr.] may
where
cases
half of
one
water-main,
heat sometimes
but
by siphon
from
and
patientsare
68"
[63" to
the
water
temperature
aumur
that
If
Fahr.].
water
circulating
through the sound
prostate. Usuallythe water is
of from
temperature
end,
pressure
from
it is taken
as
through
of the
the
sound
half into the
metallic
tion,
posi-
the free end
the cold
the
the
horizontal
syringe,and
flows
water
to
Here
hand
a
the
from
through
The
sound
back
the
or
air is exhausted
outflow
the
P$i/chrophor
(see page
having been passed into the
sound
The
98).
Sound
Impotence.
erections
of
the
more
^:""rs
prostaticaure-
Just as heat
astrinrjents.
irritants,astringentsalso act on
of
and
the
and
Sterility
Impotence.
159
Even
prostate by exciting erections.
simple
irrigationof the posterior urethra with weak
of zinc, alum, and
solutions
erections
causes
used
best
are
in the
which
suppositories,
urethra
by
100).
page
other
form
of small
of Dittel's
means
Tannin
works
urethral
in the
prostatic
porte-remede (see
well
first,0.05
containing, at
frequent
in-
not
ever,
astringents,how-
;
placed
are
agents
in
suppositories
latter
gramme,
0.1
gramme.
should
Patients
half
the
retain
suppositoryabout
urinating. On urinating,
hour, before
an
penis usuallyswells
and, later,erections
more
may
be
day,
powerful and
A
5
per
the
erections
solution
cent,
of
in
a
the
similar
due
to
douching
in
ejaculation,
the
of the
urethral
In the
cold
have
nitrate
urethral
become
sound
dropper
work
paralyticform
effect
are
of
the
of
silver,
dropper (see
way.
is
with
connection
and
abnormal
associated
mild
caput gallinaginisby
of local treatment
favorable
of
weakness
which
irritability,
premature
frequentlyand
urethral
suppositories
day, or at least every
enduring.
impotence
nervous
painfulsensation,
a
more
every
until
applied by means
page 138) acts
In
occur
introduced
other
with
These
powerfully.
the
with
with
cold
tions
cauterizaof the
means
especiallywell.
of
not
impotence
the results
encouraging, yet
treatment
v/ith
the
sounds,
160
Sterility and
of
sound
cold
the
and
sometimes
may
important
Also
coitus.
long
all
other
with
connection
excellent
In
where,
the
from
attempts
excitement
water
at
must
in
treatment
here
accomplish
should
of
perinseum.
the
of
very
other
In
slight degree
then, should
described
contraction
is observed
local
above
of
to
carried
be
until
the
take
a
also
the
raphe
men,
perinseum
in
out
the
the
and
traction
con-
paralytic
to
occurs
tion,
Faradiza-
all.
in
is
the
manner
powerful
bulbo-cavernosus
musculus
faradization
the
through
distinct
place.
into
healthy
at
not
metallic
a
on
phenomenon
or
For
pushed
while
this
musculus
of
increased, the
muscles,
impotence
form
normal,
powerfully
out
the
be
the
pole placed
is
current
of
the
pole, in
one
bulging
be
to
is
semen
sluggishly
recommended.
and
the
dribbles
is
rectum
the
ejaculation,the
of
electrode,
form
time
jets, but
in
rectal
felt
is
patients complete
urethra, faradization
purpose
when
It
these
Cold
on
bulbo-cavernosus
this
observed.
electricity may
discharged
from
suppositories,
results.
cases
not
be
sexual
strictly forbidden.
be
a
for
a
tannin
here
advise
for
abstinence
the
even
to
Impotence.
In
many
avails
cases,
nothing.
ever,
how-
`