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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    S) far as we can, to set right any derangement in the other functions; and tWs can only be done by carrying out a fixed plan of treat- ment, from which the surgeon should never deviate when he has once, formed his diag- nosis. WTiere this is at fault, it can only be from want of observation at the outset, or from discrepancy in the patient’s statements. The treatment of the disease, however, seems to be regulated by no fixed principles. Many of the prescriptions shown to me by patients contained cantharides, or quinine and steel combined—remedies calculated to make the disease worse; others could have had no effect on this or any other disease. Quinine without steel, is a most valuable remedy in this affection, and in many of the slighter cases, or where there is not much irritation, it may be begun with at once; but in others it can never be borne, and in most cases some preparatory treatment is requisite. I have over and over again been unable to cure patients until I bad persuaded them to abandon their eclectic ideas and to give up some tonic medicine containing steel or quinine, to which they were fondly attached. But is the use of caustic called for ? Un- doubtedly not, I think, in most cases. A strictured, or granular uneven state of the posterior part of the urethra, from gonor- rhoea, may require caustic or dilatation ; the irritation of the urethra caused by the sper- matorrhoea may call for the aid of the bougie, or an injection of nitrate of silver ; but this in no way justifies a resort to caustic for the cure of the spermatorrhoea. It has been urged that there is often an ulcerated, inflamed, or injected state of the mouths of the seminal ducts and the neigh- bouring part of the urethra, and that so long as this is kept up, irritation will be conveyed to the seminal vesicles, and, as a result, sper- matorrhoea will be maintained; and this as- sertion has been repeated again and again, as if it could gain strength by repetition. But what in the first instance caused this irritable ulcerated state ? Was it the first link in the chain of disease ? Clearly not; the urethra is quite healthy at the begin- ning of spermatorrhoea; it is only when it has reached a very advanced kage that the extreme tenderness of this canal, and the redness of the orifice, are met with, and not always then; I have seen it in its worst form without any- apparent change, and unaccompanied by tenderness. The highly sensitive state of the urethra, which makes these patients shrink instinc- tively from the approach of an instrument, appears to be caused by, and not to be the cause of, the spermatorrhoea; and Dr. Tyler Smith has given us a satisfactory reason why the frequent presence of a crude fluid in a canal, which nature only intended to tra- verse it occasionally and in a consistent state, produces inflammation. It is self-evident, then, that it is either an effect or a complication of the spermator- rhoea, and to treat the disease here by begin- ning with its effects, would be exactly the same as if a surgeon, in a case of irritable bladder in the female, were to limit his treat- ment to cauterizing the excoriations caused by the constant flow of urine over the vulva; or if a physician were to cauterise the rectum when diarrhoea produces heat and smarting there. But the advocates of cauterization point to its success; one fact they say is worth a hundred theories: thousands of cases have been cured by it, &c. To which, however, they might add, that thousands of cases have not been cured by it, wliich might have been cured by other means; that where it succeeds, it is from its counterirritant action, and that this action may be much more surely obtained by the use of gentler and safer counterirritants. Those who uphold this view thought to find a convincing argument in the results which follow cauterization,* but one gentle- man who was appealed to, proved rather too much, for, finding his patients suffer severely from cauterization, he gave them injections of nitrate of silver to use, which also cured them ; and “ a well known and experienced Scottish surgeon observed that, when caute- rization of the urethra failed, he had applied the cautery to the external orifice of the urethra with more decided advantage.” I presume the truth is, that the source of suffering is the irritation set up in the testi- cles, and that any active and wholesome counterirritant, applied sufficiently near, will allay or even cure it, upon which the redness and tenderness of the urethra will soon subside. However, the caustic is often of great service in these cases, for such patients will bungle with every remedy put into their hands, as though they derived gratification from thus giving evidence of the miserable state to which they are re- duced. With the application of the caustic they have nothing to do; it is sufficiently powerful to keep their fingers quiet for a little time, and in cases complicated with gleet arising from the “ granular urethra,” it seems almost indispensable. Then, again, they say, what is to be made of those cases of spermatorrhoea caused by gonorrhoea ? Does not the disease ensue in • nritisli and Foreign Medical Review, April, 18-tS.