Chapter 24
Various devices are employed, sometimes with advantage, to prevent the patient from turning upon his back while asleep. The most simple is that recommended by Acton, and consists in tying a knot in the middle of a towel and then fastening the towel about the body in such a way that the knot will come upon the small of the back. The unpleasant sensations arising from pressure of the knot, if the sleeper turn upon his back, will often serve as a complete preventive. Others fasten a piece of wood upon the back for a similar purpose. Still others practice tying one hand to the bedpost. None of these remedies should be depended upon, but they may be tried in connection with other means of treatment.
6. Soft beds and pillows must be carefully avoided. Feather-beds should not be employed when possible to find a harder bed; the floor, with a single folded blanket beneath the sleeper, would be preferable. Soft pillows heat the head, as soft beds produce heat in other parts. A hair mattress, or a bed of corn husks, oat straw, or excelsior--covered with two or three blankets or a quilted cotton mattress--makes a very healthy and comfortable bed.
7. Too many covers should be avoided with equal care. The thinnest possible covering in summer, and the lightest consistent with comfort in winter, should be the rule. Sleeping too warm is a frequent exciting cause of nocturnal losses.
8. Thorough ventilation of the sleeping-room, both while occupied and during the day-time, must not be neglected. It should be located in a position to admit the sunshine during the morning hours. It is a good plan to keep in it a number of house plants, as they will help to purify the air, besides adding to its cheerfulness.
9. If wakeful at night, instead of lying in bed trying to go to sleep, get up at once, open the bed, air the sheets, remove the night clothing and walk about the room for a few minutes, rubbing the body briskly with the bare hand at the same time. A tepid sponge bath, followed by a vigorous rubbing kept up until really tired, will conduce to sleep in many cases. Sometimes a change of bed, or pulling the bed to pieces and arranging it again, is just the thing needed to bring sleep.
10. One of the most effectual panaceas for certain varieties of sleeplessness is going to bed at peace with all the world, and with a conscience void of offense toward God as well as man.
Dreams.--This is a subject of much interest to those suffering from nocturnal pollutions, for these occurrences are almost always connected with dreams of a lascivious nature.
In perfectly natural sleep, there are no dreams; consciousness is entirely suspended. In the ordinary stage of dreaming, there is a peculiar sort of consciousness, many of the faculties of the mind being more or less active while the power of volition is wholly dormant. Carpenter describes another stage of consciousness between that of ordinary dreaming and wakefulness, a condition "in which the dreamer has a consciousness that he is dreaming, being aware of the unreliability of the images which present themselves before his mind. He may even make a voluntary and successful effort to prolong them if agreeable, or to dissipate them if unpleasing; thus evincing a certain degree of that directing power, the entire want of which is characteristic of the true state of dreams."
Can Dreams Be Controlled?--Facts prove that they can be, and to a remarkable extent. A large share of emissions occur in the state described by Dr. Carpenter, in which a certain amount of control by the will is possible. This is the usual condition of the mind during morning naps; and if a person resolutely determines to combat unchaste thoughts whenever they come to him, whether asleep or awake, he will find it possible to control himself not only during this semi-conscious state, but even during more profound sleep.
The following case, related by an eminent London surgeon,[55] illustrates what may be done by strong resolution; the patient was an Italian gentleman of very great respectability.
[Footnote 55: Acton.]
"He had been inconvenienced five years before with frequent emissions, which totally unnerved him. He determined resolutely that the very instant the image of a woman or any libidinous idea presented itself to his imagination, _he would wake_; and to insure his doing so, dwelt in his thoughts on his resolution for a long time before going to sleep. The remedy, applied by a vigorous will, had the most happy results. The idea, the remembrance of its being a _danger_, and the determination to wake, closely united the evening before, were never dissociated even in sleep, and he awoke in time; and this reiterated precaution, repeated during some evenings, absolutely cured the complaint."
Several other cases of the same kind have been recorded. Doubtless the plan would be found successful in many cases when coupled with a proper regimen.
A still greater control is exerted over the thoughts during sleep by their character during hours of wakefulness. By controlling the mind during entire consciousness, it will also be controlled during unconsciousness or semi-consciousness.
Dr. Acton makes the following very appropriate remarks on this subject:--
"Patients will tell you that they _cannot_ control their dreams. This is not true. Those who have studied the connection between thoughts during waking hours and dreams during sleep know that they are closely connected. The _character_ is the same sleeping or waking. It is not surprising that, if a man has allowed his thoughts during the day to rest upon libidinous subjects, he should find his mind at night full of lascivious dreams--the one is a consequence of the other, and the nocturnal pollution is a natural consequence, particularly when diurnal indulgence has produced an irritability of the generative organs. A will which in our waking hours we have not exercised in repressing sexual desires, will not, when we fall asleep, preserve us from carrying the sleeping echo of our waking thought farther than we dared to do in the day-time."
Bathing.--A daily bath is indispensable to health under almost all circumstances; for patients of this class, it is especially necessary. A general bath should be taken every morning immediately upon rising. General _cold bathing_ is not good for any person, especially in the morning, though some may tolerate it remarkably well, being of exceptionally hardy constitutions; but the advice to try "cold bathing" often given to sufferers from seminal weakness, is very pernicious, for most of them have been reduced so low in vitality by their disease that they cannot endure such violent treatment.
Sun baths, electric baths, spray, plunge, and other forms of bath, are of greatest value to those suffering from the effects of indiscretions. These are described, with additional observations concerning temperature of baths, etc., etc., in works devoted to this subject.
Improvement of General Health.--Patients suffering from emissions and other forms of seminal weakness are almost always dyspeptic, and most of them present other constitutional affections which require careful and thorough treatment according to the particular indications of the case. The wise physician will not neglect these if he desires to cure his patient and make his recovery as complete as possible.
Prostitution as a Remedy.--Said a leading physician in New York to us when interrogated as to his special treatment of spermatorrhoea, "When a young man comes to me suffering from nocturnal emissions, I give him tonics and _send him to a woman_." That this is not an unusual method of treatment, even among regular physicians, is a fact as true as it is deplorable. There are hundreds of young men whose morals have been ruined by such advice. Having been educated to virtuous habits, at least so far as illicit intercourse is concerned, they resist all temptations in this direction, even though their inclinations are very strong; but when advised by a physician to commit fornication as a remedial measure, they yield their virtue, far too readily sometimes, and begin a life of sin from which they might have been prevented. There are good grounds for believing that many young men purposely seek advice from physicians whom they know are in the habit of prescribing this kind of remedy.
Few know how commonly this course is recommended, and not by quacks, but by members of the regular profession. A medical friend informed us that he knew a case in which a country physician advised a young man of continent habits to go to a neighboring large city and spend a year or so with prostitutes, which advice he followed. Of his subsequent history we know nothing; but it is most probable that, like most other young men who adopt this remedy, he soon contracted diseases which rendered his condition ten times worse than at first, without at all improving his former state. In pursuing this course, one form of emission is only substituted for another, at the best; but more than this, an involuntary result of disease is converted into a voluntary sin of the blackest character, a crime in which two participate, and which is not only an outrage upon nature, but against morality as well.
A final argument against this course is that it is not a remedy and does not effect a cure of the evil, as will be shown by the following medical testimonies:--
"The vexed question of connection is one which may be decided out of hand.... _It has no power of curing bad spermatorrhoea_; it may cause a diminution in the number of emissions, but this is only a delusion; the semen is still thrown off; the frame still continues to be exhausted; the genital organs and nervous system generally are still harassed by the incessant tax, and the patient is all the while laying the foundation of impotence."[56]
[Footnote 56: Milton.]
"In all solemn earnestness I protest against such false treatment. It is better for a youth to live a continent life." "There is a terrible significance in the wise man's words, 'None that go to her return again, neither take they hold of the paths of life.'"[57] This hazardous and immoral mode of treatment is the result of the common opinion that emissions are necessary and natural, which we have previously shown to be a falsity.
[Footnote 57: Acton.]
Marriage.--Another class of practitioners, with more apparent regard for morality, recommend matrimony as the sure panacea for all the ills of which the sufferers from self-abuse complain, with the possible exception of actual impotence. Against this course several objections may be urged; we offer the following:--
1. It is not a remedy, since, as in the case of illicit intercourse, "legalized prostitution" is only a substitution of one form of emissions for another, the ill effects of which do not differ appreciably.
2. If it were a remedy, it would not be a justifiable one, for its use would necessitate an abuse of the marriage relation, as elsewhere shown.
3. As another reason why the remedy would not be a _proper_, even if a _good_, one, it may well be asked, What right has a man to treat a wife as a vial of medicine? Well does Mr. Acton inquire, "What has the young girl, who is thus sacrificed to an egotistical calculation, done that she should be condemned to the existence that awaits her? Who has the right to regard her as a therapeutic agent, and to risk thus lightly her future prospects, her repose, and the happiness of the remainder of her life?"
In cases in which seminal emissions occur frequently, the most reliable writers upon this subject, Copland, Acton, Milton, and others, advise, with reference to marriage, "that the complaint should be removed before the married life is commenced." Independent of the considerations already presented, the individual affected in this manner and contemplating marriage should carefully consider the possible and probable effects upon offspring, the legitimate result of marriage; these have been already described, and need not be recapitulated.
Local Treatment.--While it is true that general treatment alone is occasionally successful in curing the diseases under consideration, and that local treatment alone is very rarely efficient, it is also true that in many cases skillful local treatment is required to supplement the general remedies employed. While there has been a tendency on the part of the profession generally to depend wholly upon general treatment, on the part of a less numerous body of specialists there has been an opposite tendency to depend wholly, or nearly so, upon local measures. Both extremes are evidently wrong.
The object of local treatment for the relief of emissions, especially, is to remove the local cause of irritation, which, as previously shown, is one of the most active exciting causes of seminal losses. To effect this, both internal and external applications are useful. We will now consider some of these agents.
_Cool Sitz Bath_.--The cool or cold sitz bath is one of the most efficacious of all remedies. It should be taken daily, and may often be repeated, with benefit, several times a day. Its effect is to relieve the local congestion, and thus allay the irritability of the affected parts. When but one bath is taken daily, it should be just before retiring at night. Full directions for this and other baths are given in works devoted to the subject of bathing.
_Ascending Douche_.--This is also a very useful means of allaying irritation, especially the reflex excitability which is often present in the muscles in the vicinity of the perineum and prostate gland, and when there is pain and fullness in these parts.
_Abdominal Bandage_.--This may be worn nights to very great advantage by most patients. It not only allays the irritability of the nerve centers which are closely connected with the genital apparatus, but serves to keep the bowels in a healthy condition. It should not be applied so continuously as to produce a very profuse eruption on the skin. If such a symptom should appear, discontinue the bandage for a time. When worn during the day-time, it should be changed once in three or four hours. It is generally best to wear it only nights.
_Wet Compress_.--This is an application to be made to the lower part of the spine for the purpose of allaying the excessive heat and irritation which often exist there. It may also be worn nights, as it in some degree prevents the danger arising from sleeping upon the back.
_Hot and Cold Applications to the Spine_.--These are powerful remedies under appropriate conditions. Hot applications relieve congestion of the genital organs and allay irritation. Cold applications are useful when a condition of debility and relaxation is present. Alternate applications of heat and cold are very valuable, when skillfully applied, as a means of allaying reflex excitability and promoting healthy action. These applications are especially useful in cases in which there is heat and pain in the lower portion of the back. Their effects are greatly enhanced by administering a foot or leg bath at the same time.
_Local Fomentations_.--When great local irritation exists, with considerable pain and spasmodic muscular action, the application of hot fomentations to the perineum will be found the most effectual means of giving relief. The hot douche and hot sitz bath are useful under the same circumstances.
In some cases, alternate hot and cold applications are more effectual in allaying local irritation than hot fomentations alone.
_Local Cold Bathing_.--The genital organs should be daily bathed in cold water just before retiring. Simply dashing water upon the parts for two or three minutes is insufficient; more prolonged bathing is necessary. A short application of cold occasions a strong and sudden reaction which increases local congestion; hence, the bath should be continued until the sedative effect is fully produced, which will require at least fifteen minutes. The water must be cold; about 60 degrees is the best temperature. Ice should be used to cool the water in warm weather. It should be applied thoroughly, being squeezed from a sponge upon the lower part of the abdomen and allowed to run down.
_Enemata_.--The use of the enema is an important means of aiding recovery, but it has been much abused, and must be employed with caution. When the bowels are very costive, relieve them before retiring by a copious injection of tepid water. The "fountain syringe" is the best instrument to employ.
Useful as is the syringe when needed, nothing could be much worse than becoming dependent upon it. The bowels must be made to act for themselves without such artificial assistance, by the use of proper food, especially graham flour and oatmeal, and the avoidance of hot drinks, milk, sugar, and other clogging and constipating articles; by wearing the abdominal bandage; by thorough kneading and percussion of the abdomen several times daily for five minutes at a time; by taking one or two glasses of cold water half an hour before breakfast every morning; and by plenty of muscular exercise daily. The enema should be used occasionally, however, rather than allow the bowels to continue costive, and to avoid severe straining at stool.
A small, cold enema taken just before retiring, and retained, will often do much to allay local irritation.
_Electricity_.--Probably no single agent will accomplish more than this remedy when skillfully applied. It needs to be carefully used, and cannot be trusted in the hands of those not acquainted with the physical properties of the remedy and scientific methods of applying it.
_Internal Applications_.--Complete and rapid success greatly depends upon skillful internal treatment, in a large number of cases. We are aware that there is considerable prejudice, in certain quarters, against internal treatment; but having had the opportunity of observing the effects of careful treatment applied in this way, and having put to the test of practical experience this method, we feel justified in recommending that which is approved on both theoretical and practical grounds; for it is rational to suppose that proper treatment applied directly to the seat of disease must be at least equally efficacious with methods less direct.
As heretofore explained, in the more severe cases the urethra is found in a very irritable condition. It is hyper-sensitive, especially in that portion just in front of the bladder, where the ejaculatory ducts open into it. We have also seen how this condition is one of the chief exciting causes of emissions. The remedies described for allaying this irritation are all excellent and indispensable; but there is another method of great value. This consists in the passage of a suitable instrument, a sound or bougie of proper size, two or three times a week. By the aid of this means, the abnormal irritation will often diminish with magical rapidity. The passage of the instrument of course needs to be done with great delicacy, so as to avoid increasing the irritation; hence it should not be attempted by a novice. Lack of skill in catheterism is doubtless the reason why some have seemed to produce injury rather than benefit by this method of treatment, they not recognizing the fact asserted by Prof. Gross in his treatise on surgery, that skillful catheterism is one of the most delicate operations in surgery.
_Use of Electricity_.--The use of electricity in connection with that of the sound adds greatly to its utility. By means of the metallic instrument, also, electricity may be applied directly to the point of greatest irritation; and its soothing effect is sometimes really wonderful, as the following case will show:--
The patient, a man of unusual physical development, was suffering from nocturnal emissions and diminished sexual power, the result of early indiscretions and marital excesses. One of his most unpleasant symptoms was severe pain in the portion of the urethra near the openings of the ejaculatory ducts. After he had been suffering more than usual for a few days, we applied the faradaic electric current in the manner indicated above, for about fifteen minutes. At the end of that time the pain was entirely removed, though considerable suffering had been caused by the passage of the instrument, so sensitive was the congested membrane. The pain did not return again for two or three weeks, though treatment was necessarily suspended on account of absence.
In another case, that of a young man, a student, at the beginning of treatment emissions occurred nightly, and sometimes as many as four in a single night, according to his statement, which we had no reason to doubt. Under the influence of these local applications, combined with other measures of treatment and a measurably correct regimen, the number of emissions was in a few weeks reduced to one in two or three weeks.
Numerous other cases nearly as remarkable might be detailed if it were necessary to do so. In quite a considerable number of cases in which we have employed this plan of treatment, the results have been uniformly excellent. A very slight increase of irritation sometimes occurs at first, but this quickly subsides.
The galvanic as well as the faradaic current is to be used under proper circumstances. The application of electricity to the nerve centers by means of central galvanization, and also general and local external faradization, are necessary methods to be employed in electrical treatment.
_Circumcision_.--In cases of phimosis, in which irritation is produced by retained secretions, division of the prepuce, or circumcision, is the proper remedy. These cases are not infrequent, but the exciting cause of much of the difficulty is often overlooked. The same remedy is often useful in cases of long prepuce.
When the glans penis is unusually tender and sensitive, this condition will usually be removed by the daily washing with soap and water necessary for cleanliness. If this does not suffice, or if there are slight excoriations caused by acrid secretions, apply, in addition, a weak solution of tannin in glycerine once a day.
_Impotence_.--Loss of sexual power arising from any form of sexual excess, should be treated on the same general plan laid down for the treatment of emissions and other weaknesses. Cold to the spine, and short, but frequent, local cold applications, are among the most useful remedies; but, probably, electricity, discreetly used, is by far the most valuable of all remedies. It should be applied both internally and externally.
The use of cantharides and other aphrodisiac remedies to stimulate the sexual organs is a most pernicious practice. The inevitable result is still greater weakness. They should never be used under any circumstances whatever. On the contrary, everything of a stimulating character must be carefully avoided, even in diet.
_Varicocele_.--Patients suffering from this difficulty should wear a proper suspensory bag, as the continued pressure of the distended veins upon the testes, if unsupported, will ultimately cause degenerative changes and atrophy. A surgical operation, consisting of the removal of a portion of the skin of the scrotum, is proper if the patient desires an operation; no other operation is advisable.
The wearing of a suspensory bag is also advisable for those whose testicles are unusually pendulous.