PAPERS for the Original Department should be in hand one month in advance, and contributed to THE MEDICAL FORTNIGHTLY exclusively. A liberal number of extra coples will be furnished authors, and reprints may be obtained at reasonable rates, if request accompanies the manuscript. Engravings from photographs furnished free. Contributions. and books for review, should be sent to the Editors, 318-320 Century Buliding, St. Louis. COLLABORATORS. ALBERT ABRAMS, M. D., San Francisco. ARTHUR R. EDWARDS, M. D., Chicago, Ill. Mr. REGINALD HARRISON, London, Eng RICHARD T. HEWLETT, M. D., London, Eng HOBART A. HARE, M. D., Philadelphia, J. E. JENNINGS, M. D., St. Louis, Mo. H. M. WHELPLEY, M. D., St. Louis. Diagnostic Points of Difference Between Spermatorrhea and Seminal Pollutions. BY F. R. STURGIS, M. D. NEW YORK CITY. Read before the Mississippi Valley Medical Association at Kansas City, Oct. 15, 1902. occurred to me that a paper calling attention to the diagnostic points of difference between spermatorrhea and seminal pollutions, would be of interest; first, because this is a class of diseases which has been comparatively little, worked over, indeed, has been rather slighted by the medical profession; and, second, because I have noticed in reading over the literature of the subject, which appears in medical journals, that there seems to be a confusion in the minds of medical men as to the nature of these two diseases. With the majority of doctors the two diseases seem to be convertible terms and practically the same. This, in my opinion, is decidedly wrong, and in consequence of this confusion the treatment of this class of diseases is uncertain and happygo-lucky, being rather empirical than based upon sound, scientific knowledge. In this paper I shall not attempt to present a natural history of these two diseases, except in so far as it may be necessary to elucidate the points which I wish to make, and these points I shall lay down as follows: rhea. First.-Spermatorrhea is a disease sui generis. Second. Spermatorrhea has nothing in common with pollutions. Fifth.-Pollutions are liable to lead to impotence. For the purposes of this paper I shall not, of course, under pollutions, include the nocturnal variety, or, what is vulgarly termed, “wet dreams," but shall confine myself to a consideration of the diurnal forms of this type of the disease, where the losses are constant, and where the results are much more serious than they are in the nocturnal variety. 1. Spermatorrhea is a disease sui generis and has nothing in common with pollutions. In this class of sexual diseases the symptoms are so distinct that when its natural history is studied it will be noted that the seminal loss which occurs is not constant. It occurs occasionally and under certain conditions, and those conditions are chiefly of the class which requires some strong muscular or expulsive effort to produce the loss, thus, severe coughing, sneezing, straining-as at stool, or during the expulsive efforts in urination--as well as the effort made in lifting heavy objects, where the abdominal muscles are tense while respiration is suspended, are the usual conditions under which the seminal loss occurs, and it is associated, but not constantly so, with a sense of smarting and burning in the deep urethra. The patient is then aware that fluid is running along the course of his urethra, and this sensation is associated with a distinct feeling of depression, so marked that, as patients have expressed it to me, they feel as though they had been "let down." This depression is not only mental, but also physical, and may last anywhere from fifteen minutes to two or three hours before the patient entirely recovers his normal tone. At the end of this time the patient has entirely recovered from his attack, and feels practically as well as ever, having no sensation of mental depression or physical fatigue, nor any of the symptoms which would be grouped under the generic name of neurasthenia. This is one of the commonest of the causes which produce spermatorrhea; but it may also be caused at times by constipation, which induces the seminal loss, not as has been supposed because the hardened feces press upon the ejaculatory ducts or upon the vesiculae seminales, but because the fixation of the abdominal muscles, as well as the muscular effort necessary to expel the contents of the bowels, strip the seminal vesicles, much as a sponge is squeezed of the water which it may contain. But, oddly enough, the opposite condition may obtain and seminal losses may ensue with an attack of diarrhea, especially of that type known as "nervous diarrhea," but only where an irritation of the deeper portion of the canal is present. Now let us turn to pollutions and see what occurs in this type of disease. Here the seminal loss occurs without any effort whatever. It is purely a passive condition, increased, of course, if violent expulsive efforts are made; but in the more advanced type of the disease this is frequently absent, and the loss is a steady, continuous one, the seminal fluid leaking and dribbling from the patient without any effort upon his part; the sensation of the urethral smarting or burning may or may not be present; if it is present it is continuous and not occasional, and the patient's entire urethra feels sore and tender; there is a continuous irritation throughout the canal. At stool, during seminal pollutions, there is no special increase in the loss; indeed, it is sometimes absent, but at the end of the act of defecation a gush of fluid may ensue, varying from several drops to a teaspoonful, unattended with any pleasurable sensation and hardly recognizable by the patient, so far as subjective symptoms are concerned; indeed, this may only be noticed by the patient at the end of his stool, when he finds that his underclothing is wet from the secretion which has escaped from his urethra. Now let us mark the difference which occurs in the two diseases during micturition. In spermatorrhea the seminal loss occurs toward the end of urination, when the last expulsive efforts are made to eject the few drops of urine that remain in the canal. In seminal pollutions, on the other hand, the expulsive power is found almost completely lost, and the patient is totally unable to expel the last few drops of urine, which leak away either accompanied with or followed by a seminal loss. Indeed, the difference between the tonic and atonic symptoms in these two diseases is particularly well marked. As regards the subjective symptoms in these two classes of disease, the patient afflicted with spermatorrhea is not neurasthenic nor hypochondriac. He is, as a rule, cheerful, physically capable and mentally sound. It is true he is somewhat upset by the thought that he is losing his semen, but it does not depress him to the same degree as it does the unfortunate victim of seminal pollutions. He is interested in the daily affairs of life; he attends to his business matters with promptness and efficiency, and he is, taking it all the way round, still a man. The unfortunate pollutionist* is the opposite. He is depressed mentally and physically; he is unable to make out any prolonged or sustained effort, whether the same be corporeal or mental; he is easily fatigued; he is constantly worrying about himself, regarding himself somewhat in the light of the Peri expelled from Paradise. For him, truly, there seems to be no hope, certainly not in this world, and as for the future, he is either exceedingly doubtful or indiffer In other words, he is a wreck, certainly not a man, for he is deprived of all that makes a man; he has no will power and no force. In this regard the distinction between these two classes of patients is well marked. In one other point there is an exceedingly great difference between these two diseases. 2. Spermatorrhea does not usually lead to Impotence while Pollutions are liable to. In regard to sexual potency and the capacity for coitus, the spermatorrheic is capable of coitus. In the lighter forms of the disease his copulative powers are practically unimpaired; possibly the ejaculation may take place a little more rapidly than normally, and this is due to the inflammatory condition of his urethra and to a lack of tonicity. I ask pardon for this word, as also for "spermatorrheic." in the opening of the ejaculatory ducts. But taking everything into consideration he is without doubt a man with virile sexual powers and enjoying the pleasure which coitus brings in probably as great a degree as formerly. In the more advanced types of the disease the patient's erections may, perhaps, not be so good. He may find that the gaudium coitus is not as keen as it was before; he is not as eager for the fray, and he may notice, perhaps, that his ejaculation is a trifle too rapid and the duration and amount of pleasure curtailed by the rapidity of the act; still he is capable of efficient coitus, and many a man suffering from this class of disease is a happy father. So far as the partner of his joys is interested, she probably notes very little, if any, difference between the past and the present, for few women, so far as this act is concerned, are very observant. It becomes with them a duty to be performed, and it is seldom that there is much pleasure attached to it, and, of course, the shorter the copulative act in the male, the less the pleasure of the female, and the more perfunctory the act becomes on her part. Now let us see what happens with the pollutionist. He, unlucky wretch, cannot get an erection, or if he does, it is such a feeble, trifling affair as to hardly be dignified by the name of erection, and what makes his disease peculiarly aggravating is that while he has a flabby turgescence of the penis, in lieu of the normal erection, he has also more or less of the libido sexualis; libido sine potestate; he wants coitus and he cannot get it, for his membrum virile is of no use except for urinary purposes; and to cap the climax, the more the desire the greater the seminal loss. Thus the unfortunate is between the Devil and the deep sea; he cannot perform his duties as a man or as a husband, yet he continually wishes to and he feels that the more he wishes it the less capable he is of performing the duty. With this condition, very naturally, an intense melancholy ensues. The patient oftentimes can hardly behave himself decently. He is irritable, has no appetite, he cannot sleep, in fact, he is a wreck; a curse to himself, a trial to his wife and a bore to his neighbors who find it difficult oftentimes to put up with his vagaries. Now let us watch the result as these two diseases progress. The spermatorrheic usually recovers; especially so if the form of his disease be that of defecation and not of urination. The urinary type of the disease is usually more obstinate and takes longer to recover from. The patient's condition does not end in impotence, or very rarely so, although, of course, it is quite possible that this disease may be associated with seminal pollutions, but then he is suffering from another disease, and not from his original one, when he goes through the various stages and presents the various symptoms which the pollutionist exhibits. Under these conditions he may become more or less impotent, but I am perfectly satisfied, from a fairly extensive acquaintance with and observation of this type of patient, that this does not, as a rule, occur; with the pollutionist it unfortunately does; he becomes not only sexually but physically and mentally impotent. All around him is gloom, and he can see nothing before him but impotence writ large, and the verdict is: Thou art no longer man, but eunuch. Is it a wonder, then, that he sometimes ends the tragedy or comedy of life, as you may choose to call it, by his own hand? These are the main points of diagnostic differences which exist between the two diseases, and I believe you will agree with me that they are pretty clearly marked. There are one or two points, perhaps not directly connected with the subject, but still germane to it, upon which, before closing, I should like to make a few comments, and one is that a man may suffer from spermatorrhea without being aware of it, but he never suffers from seminal pollutions without knowing it. Many a strong, healthy man, especially if continent, will pass spermatozoa in his urine, and since I have begun to study these forms of disease more carefully I have been peculiarly struck with this fact. Occasionally patients may tell me that they had periods where the head aches a little, and they have a feeling of depression for no earthly reason, or as they style it, the "blues;" they do not feel quite up to the mark, a condition for which they offer no explanation, and they are not quite as ready with their work, or as bright in their wits when this occurs as usual, and in getting them to send me a specimen of urine, when such a condition of affairs obtains, I have been surprised, more so in my earlier days than now, to find spermatozoa in the urine. Now the opposite obtains with the pollutionist. He is aware not only that he is not up to the mark, but that he is decidedly below par, and he stays there. He deos not recover as the other man does, and he notices, moreover, that his virile powers are not good, that his erections are flabby, and that the slightest friction of his genitals against his clothing, or the slightest sexual thought will prodcue a flabby erection with some leaking of what he believes is semen, and nine times out of ten it is a seminal loss. He The other point to which I wish to call your attention, is that the spermatorrheic is subject to nocturnal emissions, as healthy men are, and if the disease be slight his emissions are like those of other men. wakes up immediately after or during the emission, and on finding out what the matter is he gives it no other thought than a feeling of regret that it should be another instance of "Love's labor lost." But the pollutionist does not have nocturnal emissions, in the correct sense of the term. True, he finds the evidences of a seminal loss upon his night clothing, in the shape of the stiffened linen, and other tell-tale marks, but it has not awakened him, or, if perchance he does wake, he finds he is having or has had his emission without any erection whatever, unless possibly there may be a very flabby and feeble attempt at one; and in the morning he rises without any erection to greet him. With him the penis is as quiet and dead as is the traditional Caesar; whereas, the spermatorrheic rises with all the evidence of virility upon him, and rejoices to think that he is yet a man. I know that with the number of papers before you time will not allow a further discussion of this subject which is especially interesting to us all, and many points I have not touched upon, but I trust in the discussion which follows I may be able to supply many of the points which I have omitted and which, perhaps, would more properly come out in the discussion than they would in the text of the paper. 16 West 32d street. |