Practical remarks on the treatment of spermatorrhoea and some forms of impotence / by John L. Milton.

  • Milton, J. L. (John Laws), 1820-1898.
Date:
1854
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Licence: Public Domain Mark

Credit: Practical remarks on the treatment of spermatorrhoea and some forms of impotence / by John L. Milton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    and having heard that strictures followed upon neglected disease of this kind, they cannot understand how one can occur with- out the other. When in cases of this class the stricture appears to arise from a fold of the mucous membrane growing up, I prefer the application of a film of caustic on a broad bougie, on the principle so ably ad- vocated by Sir Everard Home. Obs. 4.—In the autumn of 1852 I dis- sected, with great care, the genito-iwinary organs of a gentleman who had died of irri- tative fever, consequent on an operation performed by Mr. Gay for the relief of an impermeable stricture. He had become im- potent about the time he began to notice a material diminution of the stream in passing, urine. On e.vamination, the urethra was found extremely narrowed near the bulb. Close to this part were two passages, one lying hchind the other; they were on the lower side of the urethra, and were both larger than the contracted part of the tube; they were about four lines long, and were lined throughout with mucous membrane; the posterior lip of the second almost en- tirely overlapped and occluded the natural opening. No instrument could have been in- troduced into the bladder, and the exit of urine could only have taken place by the force of the stream pressing down the valve- like fold of the mucous membrane; that of the semen must, I think, have been very im- perfect, if not impossible, and I am induced to beheve that this case might have been advantageously treated by caustic, as I have suggested. I have cured in this way cases which appeared to me very similar, for no two are exactly alike, and at this present moment I have one under my care. I in- variably adopt it when there is a false passage difficult to steer clear of. Proffnosis of Spermatorrhwa.—Like many long-standing functional disorders, sperma- torrhoea may, in time, induce structural change either in the genito-urinary or in the vital organs, producing, on the one hand, impotence, on the other, paralysis, phythisis, or marasmus, &c. But, in the first place, it is very rarely that these serious changes ensue before the patient seeks for advice. Spermatorrhoea—i. e., imperfect secretion of semen from masturbation, accompanied by impotence from congenital imperfect erection —admits of very limited relief. Impotence consequent on disease of the spinal cord is necessarily incurable. All othtsr cases may, I think, be cured; but it must be borne in mind that in this, as in every long-standing disease, no sudden dure by sleight-of-hand, no miraculous restoration to health can be looked for. Steady perseverance in a rational eclectic ]>lan of treatment, will generally effect all that is necessary—the restoration of the balance. The dark fears which beset the minds of patients, and even of medical men labouring under this disease, are as fictitious as the formless shades which Fingal beheld issuing from the halls of Cruth-Loda. It will thus be seen that I differ widely from M. Lallemand, whom I cannot altoge- ther acquit of lending his great authority to the dissemination of exaggerated views as to the incurability and serious results of sper- matorrhoea. Not only has he attributed effects to it which it is not proved to have induced, but he has inferred spermatorrhoea where it appears to me never to have ex- isted. Thus, in a patient who died of stricture, complicated with cystitis and abscesses in every part of the prostate, M. Lallemand referred death, not to these causes, but to the “ profound alteration of the spermatic organs * this profound alteration consist- ing in an abscess of the left testicle; the corresponding ejaculatory duct and seminal vesicle being full of pus. Now, how could he believe that such slight disease as this of the testicle and seminM vesicle could pro- duce death, when he must, I suppose, have seen much more extensive disease, not merely of one, but of both testicles, without the health suffering materially ? How could he overlook the fact, that patients very often die of cystitis and stricture, and that the testicles may be removed without danger ? In another case he attributes the derange- ment of the patient’s health “ to the grow- ing influence of the seminal discharges on the whole animal economy,” although, in the next page, he informs us that long be- fore the cerebral symptoms, wliich he attri- butes to the seminal discharges, set in, there was most serious derangement of the diges- tive and nervous system, &c. Again, I will just ask the reader to look, among others, at M. Lallemand’s thirty- eighth case. I cannot find a single proof that spermatorrhoea was present, yet M. Lallemand comes to this conclusion, because the patient had lately become indifferent to connexion, and passed semen on going to stool. But the explanation seems easy enough. Disgust at the idea of passing semen, the ill-health which generally ac- companies this state, and the alarm and nervousness, often renders these patients temporarily impotent. In many of these cases M. Lallemand tells us that the patients were not aware of their having daily pollu- tions till he extracted the fact by cross- • Vol. i. p. 45.