{"1": {"fulltext": "", "height": "4332", "width": "2676", "jp2-path": "practicaltreat00tayl_0001.jp2"}, "2": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0002.jp2"}, "3": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0003.jp2"}, "4": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0004.jp2"}, "5": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0005.jp2"}, "6": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0006.jp2"}, "7": {"fulltext": "PRACTICAL TREATISE\\nSEXUAL DISORDERS\\nMALE AND FEMALE.\\nBY\\nROBERT W. TAYLOR, A.M., M.D.,\\nCLINICAL PROFESSOR OF VENEREAL DISEASES AT THE COLLEGE OF PHYSICIANS AND SURGEONS\\n(COLUMBIA UNIVERSITY), NEW YORK SURGEON TO BELLEVUE HOSPITAL, AND CON-\\nSULTING SURGEON TO THE CITY (CHARITY) HOSPITAL, NEW YORK.\\nSECOND EDITION, THOROUGHLY REVISED.\\nWITH 91 ILLUSTRATIONS AND 13 PLATES IN COLOR AND MONOCHROME.\\nLEA BROTHERS CO.,\\nNEW YORK AND PHILADELPHIA.\\n1900.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0007.jp2"}, "8": {"fulltext": "TWO COPICS RICE1VSD,\\nLibrary of Congee*\\nOffice., tk\\nMAY 24 1900\\nHegl.ter of Copyrlg\u00c2\u00bb u\\n9*\\nSECOND COPY.\\n2 9\\n6*713\\nEntered according to the Act of Congress, in the year 1900, by\\nLEA BKOTHEKS CO.,\\nIn the Office of the Librarian of Congress, at Washington. All rights reserved.\\nDORNAN, PRINTER.", "height": "4153", "width": "2420", "jp2-path": "practicaltreat00tayl_0008.jp2"}, "9": {"fulltext": "TO\\nGEOKGB L. PEABODY, A.M., M.D.,\\nPROFESSOR OF MATERIA MEDICA AND THERAPEUTICS AT THE COLLEGE\\nOF PHYSICIANS AND SURGEONS (COLUMBIA\\nUNIVERSITY), NEW YORK,\\nTHIS WORK\\nIS CORDIALLY DEDICATED\\nTHE AUTHOK.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0009.jp2"}, "10": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0010.jp2"}, "11": {"fulltext": "PREFACE TO SECOND EDITION,\\nThe very gratifying reception accorded to the first edition of\\nthis work has prompted me to make every effort to render the\\nsecond edition still more acceptable to the profession. To this\\nend I have carefully gone over the whole text, and have revised,\\namplified, added to, and in places modified it.\\nThe subject of sexual disorders in women has been more\\nthoroughly treated, and entirely new chapters have been written\\non vaginismus, masturbation in women, and kraurosis vulvae.\\nThe chapters on the anatomy and physiology of the sexual\\napparatus and on psychical impotence and masturbation in male\\nsubjects have been rewritten and very much enlarged.\\nIn addition, many new sections and interpolations have\\nbeen added, notably those on enlargement of the dorsal veins\\nof the penis as a cause of impotence, on syphilitic oedema of\\nthe penis, tuberculosis of the prostate, and tuberculosis of the\\nseminal vesicles.\\nMuch attention has been paid to the matter of therapeutics in\\nthe direction of clearness of statement and of practicality. Many\\nnew illustrations in color and monochrome will be found in\\nthis edition, the majority of which are original.\\nIt is therefore hoped that this work will continue to merit\\nthe favor of practitioners as a guide to the study and treatment\\nof this important class of diseases.\\nRobert W. Taylor.\\n40 West Twenty-first Street, New York.\\nMay, 1900.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0011.jp2"}, "12": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0012.jp2"}, "13": {"fulltext": "CONTENTS\\nCHAPTEE I.\\nPAGE\\nINTRODUCTION 17\\nCHAPTER IT.\\nANATOMY AND PHYSIOLOGY OF THE SEXUAL APPARATUS \u00e2\u0080\u0094THE PENIS,\\nTHE URETHRA, THE BLADDER, THE PROSTATE, THE SEMINAL VESICLES\\nAND ACCESSORY PARTS.\\nThe corpora cavernosa Nerves of the penis The integument of\\nthe penis The prepuce The meatus The compressor urethra?\\nmuscle The bulbous urethra\u00e2\u0080\u0094 The penile urethra Mucous\\nsecretion and the follicles and glands of the urethra The pros-\\ntate gland and the prostatic urethra The seminal vesicles The\\nampullations of the vasa deferentia and the ejaculatory ducts\\nThe intrinsic and extrinsic muscles of the sexual apparatus The\\ntestes and the vasa deferentia 20-55\\nCHAPTER III.\\nTHE PHYSIOLOGY OF THE MALE SEXUAL FUNCTION.\\nThe mechanism of erection The mechanism of ejaculation 56-60\\nCHAPTER IV.\\nNATURE AND COMPOSITION OF THE SEMINAL FLUID.\\nThe semen The secretion of the seminal vesicles The secretion of\\nthe prostate gland\u00e2\u0080\u0094 The secretion of Littre s follicles, of the\\ncrypts of Morgagni, and of Cowper s glands 61-75", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0013.jp2"}, "14": {"fulltext": "viii CONTENTS.\\nCHAPTER V.\\nPAGE\\nIMPOTENCE IN THE MALE 76\\nCHAPTER VI.\\nPSYCHICAL IMPOTENCE 78\\nCHAPTER VII.\\nSYMPTOMATIC IMPOTENCE.\\nPeripheral irritation Chronic bulbous urethritis and stricture\\nChronic bulbous and posterior urethritis\u00e2\u0080\u0094 Chronic bulbous and\\nposterior urethritis with prostatitis Chronic posterior urethritis\\nChronic prostatitis Inflammation of the seminal vesicles 88-97\\nCHAPTER VIII.\\nATONIC IMPOTENCE 98\\nCHAPTER IX.\\nORGANIC IMPOTENCE 105\\nCHAPTER X.\\nORGANIC IMPOTENCE FROM CONGENITAL DEFECTS AND MALFORMATIONS\\nOF THE PENIS AND VARICOSITY OF ITS DORSAL VEINS.\\nAbsence of the penis Hypospadias and epispadias, and torsion of the\\npenis Abnormalities in the size of the penis Double penis\\nEnlargement of the dorsal veins of the penis 106-118\\nCHAPTER Xr.\\nORGANIC IMPOTENCE FROM DESTRUCTION OF THE INTEGUMENT OF THE\\nPENIS, AND FROM BENIGN AND MALIGNANT NEW-GROWTHS AND\\nPREPUTIAL CALCULI.\\nDestructive lesions of the integument of the penis Chancroidal\\nulceration Phagedena in syphilis Gangrene of the penis\\nTraumatism\u00e2\u0080\u0094 Vegetations of the penis Horny growths of the\\npenis Elephantiasis of the penis Cancer of the penis Indu-\\nrating oedema of the penis Preputial calculi 119-136", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0014.jp2"}, "15": {"fulltext": "CONTENTS. ix\\nCHAPTER XII.\\nPAGE\\nORGANIC IMPOTENCE DUE TO DEGENERATIVE, HYPERPLASTIC AND TRAU-\\nMATIC CHANGES IN THE CORPORA CAVERNOSA.\\nOssification of the penis Fibroid sclerosis of the corpora cavernosa\\nSyphilitic nodes in the corpora cavernosa and corpus spongiosum\\nCurvature of the penis Fracture of the penis 137-152\\nCHAPTER XIII.\\nSTERILITY IN THE MALE 153\\nCHAPTER XIV.\\nAZOOSPERMATISM.\\nEctopia testis Changes in the epididymis, testis, and vas deferens,\\ndue to gonorrhoea\u00e2\u0080\u0094 Gonorrheal epididymitis Gonorrheal orchi-\\ntis\u00e2\u0080\u0094 Gonorrheal funiculitis, or deferentitis Changes in the\\nepididymis, testis, and vas deferens, due to syphilis Syphilitic\\nepididymitis Syphilitic orchitis Syphilitic funiculitis, or defer-\\nentitis Hereditary syphilis of the testis Chronic orchitis and\\nepididymitis Orchitis and epididymo-orchitis, due to general\\ninfective processes Mump orchitis Tonsillar orchitis Variola\\norchitis Scarlatina orchitis Malarial orchitis Grip orchitis\\nOrchitis due to muscular effort Strangulation of the testis and\\nepididymis from torsion of the cord\u00e2\u0080\u0094 Hydrocele Hematocele\\nTuberculosis of the testis Tuberculosis of the prostate Tuber-\\nculosis of the seminal vesicles Atrophy of the testis 155-185\\nCHAPTER XV.\\nAZOOSPERMATISM DUE TO ABNORMAL CONDITIONS OP THE SEMEN.\\nThe effects of repeated and excessive coitus Influence of the prostatic\\nsecretion Pus-admixture Blood-admixture Bloody ej acula-\\ntions The influence of general morbid conditions Watery semen\\nand colloid semen Diminished quantity of semen 186-196\\nCHAPTER XVI.\\nASPERMATISM.\\nLesions of the seminal vesicles and deferential ampullations Lesions\\nof the ejaculatory ducts Stricture of the urethra and urethral\\ncalculi Anomalous cases of aspermatism Mutilating meatotomy\\nand damage to the urethra Partial aspermatism Debility and\\nlack of nerve force 197-207", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0015.jp2"}, "16": {"fulltext": "x CONTENTS.\\nCHAPTER XVII.\\nPAGE\\nCHRONIC INFLAMMATION OF THE BULBOUS AND PROSTATIC URETHRA,\\nSTENOSIS AND STRICTURES.\\nChronic inflammation of the bulbous urethra Chronic posterior\\nurethritis Treatment of stenosis and strictures of the bulbous\\nurethra 208-228\\nCHAPTER XVIII.\\nCHRONIC AFFECTIONS OF THE PROSTATE.\\nGonorrheal congestion of the prostate Chronic inflammation of the\\nverumontanum and prostatic urethra Chronic catarrhal inflam-\\nmation of the prostate \u00e2\u0080\u0094Catarrhal prostatitis in young subjects\\nCatarrhal prostatitis in older subjects\u00e2\u0080\u0094 Prostatorrhcea\u00e2\u0080\u0094 Hyper-\\ntrophy of the prostate 229-263\\nCHAPTER XIX.\\nINFLAMMATION OF THE SEMINAL VESICLES.\\nChronic seminal vesiculitis More advanced form of seminal vesic-\\nulitis 264-277\\nCHAPTER XX.\\nVARICOCELE 278\\nCHAPTER XXI.\\nMASTURBATION IN MALE SUBJECTS. 286\\nCHAPTER XXII.\\nSEXUAL EXCESSES AND SEXUAL ERETHISM.\\nSexual erethism 297-302\\nCHAPTER XXIII.\\nSPERMATORRHEA.\\nImaginary spermatorrhoea 303-308\\nCHAPTER XXIV.\\nSEXUAL WORRY AND HYPOCHONDRIASIS AND SEXUAL NEURASTHENIA.\\nSexual worry Sexual hypochondriasis Sexual neurasthenia 309-322", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0016.jp2"}, "17": {"fulltext": "CONTENTS. xi\\nCHAPTER XXV.\\nPAGE\\nCOITUS RESERVATUS VEL 1NTERRUPTUS WITHDRAWAL, OB, CONJU-\\nGAL ONANISM 323\\nCHAPTER XXVI.\\nPRIAPISM.\\nPriapism after spinal injury Priapism in cerebral and descending\\nspinal disease Priapism due to sexual and alcoholic excess\\nPriapism of leuksemic origin 333-342\\nCHAPTER XXVII.\\nSEXUAL PERVERSION 343\\nCHAPTER XXVIII.\\nSTERILITY IN THE FEMALE 346\\nCHAPTER XXIX.\\nVAGINISMUS 351\\nCHAPTER XXX.\\nMASTURBATION IN THE FEMALE 357\\nCHAPTER XXXI.\\nNEW GROWTHS AND HYPERTROPHIES OF THE VULVA WHICH MAY\\nLEAD TO STERILITY 366\\nCHAPTER XXXII.\\nVEGETATIONS OF THE VULVA.\\nVulvar hypertrophy consequent upon vegetations Hyperplastic\\ngrowths of the vulva Urethral caruncles 369-377\\nCHAPTER XXXIII.\\nLARGE HYPERTROPHIES OF THE VULVA 378-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0017.jp2"}, "18": {"fulltext": "xii CONTENTS.\\nCHAPTER XXXIV.\\nPAGE\\nINFILTRATION AND DISTORTION OF THE VULVA FROM CHRONIC\\nCHANCROIDS 388\\nCHAPTER XXXV.\\nHYPERTROPHIES OF THE VULVA DUE TO SYPHILIS.\\nCondylomata Vulvar deformities in the early and late stages of\\nsyphilis due to indurating oedema Chronic chancroids in old\\nsyphilitics Distortion of the vulva in old syphilitics Distortion\\nof the vulva with destructive ulceration 394-405\\nCHAPTER XXXVI.\\nTUBERCULOUS ULCERS OF THE VULVA 406\\nCHAPTER XXXVII.\\nA PECULIAR NEW GROWTH OF THE VULVA 408\\nCHAPTER XXXVIII.\\nKRAUROSIS VULVAE 422", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0018.jp2"}, "19": {"fulltext": "SEXUAL DISORDERS\\nOF THE\\nMALE AND THE FEMALE\\nCHAPTER I.\\nINTRODUCTION.\\nIt certainly can be stated, without fear of contradiction, that\\nuntil recently the subject of sexual disorders had been treated in\\nbooks and essays in a loose and impracticable manner. This condi-\\ntion was due to the facts that the study of these affections was not\\nthoroughly entered into and that the necessary groundwork of\\npathological anatomy had been entirely neglected. It thus came\\nto pass that works on these subjects were unsatisfactory, unscien-\\ntific, and largely based on unsound and visionary theories, and that\\nclearly stated scientific facts were not advanced. Unwarranted\\nand theoretical assumptions were indulged in and no real progress\\nwas attained. In looking over the various treatises one is struck\\nwith the entire absence of definite and rational statement and\\nargument and the utter want of proper therapeutic deductions\\nand indications. Heretofore the whole basis of medical knowl-\\nedge of sexual disorders might be summed up in the recital of\\nvarious ill-defined symptoms, such as sexual debility and irrita-\\nbility, seminal losses, spermatorrhoea, pollutions, and functional\\ndisturbances and sensory and motor neuroses of .the genital system\\nin the male. It can be readily understood that no author can\\napproach toward doing justice to the study of sexual disorders\\nwho allows himself to be fettered and trammelled by the study\\nand elaboration of this unscientific conglomeration of symptoms.\\n2", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0019.jp2"}, "20": {"fulltext": "18 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThe trend of thought and study of sexual and genito-urinary\\ndiseases among some authors within the last few years has been\\nin the direction of acquirng knowledge of the intimate structure\\nand functions of the various portions of the urinary and sexual\\napparatus and of the nature and course of the various morbid\\nprocesses which attack this highly important system, and it is\\ngratifying to be able to state that much useful information has\\nbeen gained. This spirit has dominated the writer in the prepa-\\nration of the present volume and while by classic custom it has\\nbecome an author s duty to treat of the various forms of sexual\\ndebility prominently as symptoms, the underlying anatomical and\\nphysiological conditions have never been lost sight of, and the\\nlight of pathology has been thrown on the picture as fully as our\\npresent experience will warrant.\\nThe endeavor has been made to fully describe the anatomy and\\nphysiology of the whole sexual apparatus in a scientific and philo-\\nsophical manner, and in so doing the results of extended personal\\ninvestigations have been incorporated. The importance of urethral\\ninflammations as an underlying cause of sexual impairment has\\nbeen duly emphasized. Much care has been bestowed on the\\ndescription of chronic affections of the prostate (an organ, when\\ndamaged, so often the cause of sexual debility), and in this chapter\\nthere is much that is new which has been developed by the inves-\\ntigations of the author. The conditions of the seminal vesicles\\nand their relation, when diseased, to sexual disorders have been\\nfully elaborated, and much information based on personal inves-\\ntigation is here given. In fact, the basis of the study of genito-\\nurinary diseases will be found in this book. But so vast and\\nintricate is the field of sexual disorders that more is required of\\na man who wishes to thoroughly understand the subject than has\\nthus far been mentioned.\\nIn the first place, well-grounded knowledge of physiology and\\nof general medicine and a general understanding of the anatomy,\\nphysiology, and pathology of the nervous system are absolutely\\nnecessary. And, in addition, the surgeon needs a clear under-\\nstanding of the nature and course of syphilis, of the pathology", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0020.jp2"}, "21": {"fulltext": "INTRODUCTION. 19\\nof gonorrhoeal infection, and of all acute and chronic infective\\nprocesses. And, still further to this long list of requirements, the\\nknowledge of the use of the microscope in the examination of the\\nurine and of the various secretions of the body is absolutely essen-\\ntial. When studied on these broad lines diseases which in former\\nyears were vaguely if at all understood, and even shunned by\\nmedical men, can now be discussed on scientific and practical\\ngrounds, and whereas heretofore treatment was largely haphazard\\nand empirical, and, as a rule, without benefit to the patient, to-day\\nit can be entered upon on a scientific and satisfactory basis.\\nThe subject of sterility in women is considered in a general\\nmanner with the idea of conveying to the mind of the reader the\\nconditions which tend to render a woman unfertile. The various\\nforms of sexual disorders in women are also quite fully considered.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0021.jp2"}, "22": {"fulltext": "CHAPTER II.\\nANATOMY AND PHYSIOLOGY OF THE SEXUAL APPARATUS\\n\u00e2\u0080\u0094THE PENIS, THE URETHRA, THE BLADDER, THE PROS-\\nTATE, THE SEMINAL VESICLES AND ACCESSORY PARTS.\\nThe penis is a pendulous organ consisting of root, body, and\\nglans, and through it three-fourths of the urethra runs. It is\\nthe organ of copulation and of urination, and is composed of two\\nparallel cylindrical bodies called the corpora cavernosa, which,\\nlying side by side, have a groove on their under surface in which\\nis situated the corpus spongiosum. These cylindrical bodies, with\\nconnective tissues, vessels, nerves, and lymphatics, together with\\nthe tegumentary investment sheath, form the penis. (See Plate\\nI., Fig. 1.)\\nTHE CORPORA CAVERNOSA.\\nEach corpus caver nosum has a dense, quite, thick, but very\\nelastic fibrous investment, from which thin processes or trabecule\\npass inwardly and form cavities, which are filled with erectile\\ntissue. The inner surface of each cavernous body is thick and\\ncomplete in the proximal part of the penis consequently, there\\nis at that part a distinct septum formed by the fusion of these\\ntwo inner surfaces. More anteriorly or distally there are only a\\nnumber of vertical bands of fibrous tissue arranged like the teeth\\nof a comb, and hence called the septum pectiniforme. It is im-\\nportant to bear in mind the structure and relations of the cavernous\\nbodies, as well as of the spongy body, in operations on the penile\\nurethra. The corpus spongiosum also consists of a firm, fibrous\\nsheath, from which trabecular processes pass inward and form\\nmeshes which contain erectile tissue. In the outer coat of the\\ncorpus spongiosum is a thin layer of circular muscular fibres con-\\ntinuous with those of the bladder. A second layer of longitudinal", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0022.jp2"}, "23": {"fulltext": "PLATE I\\nFIG 1.\\nTransverse Section of the Penis.\\nShowing Corpora Cavernosa, Corpus Spongiosum and Urethra, with\\nMusculature of the Parts.\\nFIG. 2.\\nCAVERNOUS\\nBRANCH\\nINTERNAL PU DIC^;,\\nArteries of the Penis. (Testut.)", "height": "3980", "width": "2675", "jp2-path": "practicaltreat00tayl_0023.jp2"}, "24": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0024.jp2"}, "25": {"fulltext": "ANATOMY. 21\\nmuscular fibres is situated between the inner surface of the corpus\\nspongiosum and the mucous membrane of the urethra.\\nThe corpora cavernosa constitute the chief bulk of the penis,\\nand each one begins in a tapering portion, the erus penis, which is\\nattached along a groove in the rami of the ischium and os pubis.\\nThey are further attached to the symphysis pubis by a strong,\\nelastic suspensory ligament, the base of which is fused in their\\nfibrous tissue, and the apex is inserted into the symphysis. Con-\\nverging together at once at the root of the penis, these cylindrical\\nbodies run parallel side by side, and each ends in a bluntly rounded\\nextremity which fits in a depression in the base of the glans\\npenis.\\nThe Corpus Spongiosum. The corpus spongiosum surrounds\\nthe urethra from the triangular ligament to the meatus urinarius.\\nIt begins in the centre of the perineum in an expanded form\\ncalled the bulb, which rests directly on the anterior surface of the\\ntriangular ligament. It then runs under the corpora cavernosa\\nin the groove left for it, like a ramrod under a double-barrelled\\ngun, and ends in an expanded extremity the glans penis, the\\napex of which corresponds to the meatus.\\nThe glans penis is, therefore, the expanded distal portion of the\\ncorpus spongiosum, while the bulb is its proximal expanded por-\\ntion. The glans is an obtusely conical, acorn-shaped body, some-\\nwhat flattened on its upper surface, and ending in a rounded,\\nexpanded portion called the corona, which rounds off abruptly\\nand projects like a collar beyond the body of the penis proper,\\nand behind it is seen, when the prepuce is retracted, a nearly cir-\\ncular groove called the coronal sulcus, the balano-preputial fur-\\nrow, and the cervix. A little below the centre of the apex is\\nthe vertical slit-like opening of the urethra, called the meatus.\\nThe under surface of the glans is flat and triangular in shape,\\nthe apex of which usually ends in the inferior commissure of the\\nmeatus, and into it the frsenum of the prepuce is inserted.\\nThe arteries of the penis are derived from the external pudic\\nand from the superficial perineal and the dorsal artery of the penis,\\nwhich are branches of the external pudic. (See Plate I., Fig. 2.)", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0025.jp2"}, "26": {"fulltext": "22 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThe veins of the penis converge from the prepuce and the three\\ncavernous bodies and begin as a common canal at its dorsum, called\\nthe superficial dorsal vein. (See Plate II.)\\nNerves of the Penis.\\nThere are different classes of nerves in the penis concerned in\\nerection and ejaculation. Those of the first order are the sensory\\nnerves, which are most abundant in the glans penis but they are\\nalso present in the integument of the organ, and transmit irrita-\\ntions, stimulation, and impressions backward to the sexual centre.\\nIn the second order, anatomically speaking, but more important,\\nperhaps, in a physiological sense, are the excitor nerves.\\nThese nerves, called the nervi erigentes, or excitor nerves, are\\nderived from the first and second and sometimes from the third\\nsacral nerves. It is thought that these nerves originate in the\\nsexual centre, which is supposed to be seated in the lumbosacral\\nportion of the spinal column. Experiments on animals have\\nshown that stimulation of these nerves causes erection of the\\npenis, which is, therefore, essentially due to the vasodilator action\\nupon the arterioles.\\nThe facts are well established that in the human subject mental\\nimpressions are transmitted down the spinal cord, probably in its\\nlateral columns, to the sexual centre, which undergoes excitation,\\nwhich is thereupon further transmitted through the nervi erigentes\\nto the penis and accessory parts of the sexual apparatus. Periph-\\neral excitation of the sensory nerves in the glans penis and penis\\nitself is conducted back by them to the spinal sexual centre, which,\\nin turn, by reflex action through the nervi erigentes, acts upon the\\nsexual sphere and induces erection.\\nCertain facts derived from experimental physiology, and sup-\\nported by clinical observation, go to show that it is probable that\\nbesides the excitor nerves there are inhibitory nerves of erection\\nwhich originate in the brain and pass down the lateral columns of\\nthe cord to the sexual centre. As will be shown in subsequent\\nsections, erection may be materially modified or extinguished by", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0026.jp2"}, "27": {"fulltext": "PLATE II.\\nIAL DORSAL VEIN\\nEXTERNAL PUDIC VEIN\\nURATOR VEIN\\nVeins of the Penis. (Testut.)", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0027.jp2"}, "28": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0028.jp2"}, "29": {"fulltext": "ANATOMY. 23\\nmental impressions, and it is very probable that this restraining\\neffect is due to these inhibitory nerves.\\nIn the glans penis the nerve-supply is peculiarly exuberant,\\nand many of the nerves end in Pacinian bodies, while others\\nhave at their ends peculiar bulb-like expansions. This rich\\nnerve-supply also exists in and about the frsenum, and it is to it\\nthat the excessive sensitiveness of these parts is due.\\nThe foregoing facts certainly warrant the opinion that the sen-\\nsorium commune of the external male genitals is seated in the\\nglans penis, which includes in its territory the regions of the\\nfrsenum and of the fossa navicularis.\\nIt is claimed by some that at the bulb of the urethra the nerve-\\nsupply resembles that of the glans. Certain it is, that in this\\nregion the blood-supply is particularly copious. The integument\\nof the penis, the scrotum, and urethra are also abundantly sup-\\nplied by nerves.\\nAs might be expected from the structure and function of the\\ncorpora cavernosa and corpus spongiosum, these parts are freely\\nsupplied by fibres of the sympathetic nerves which are derived\\nfrom the pelvic or inferior hypogastric plexus. It is claimed by\\nsome investigators that the entire sympathetic nerve-supply goes\\nto these erectile bodies.\\nIn the consideration of the nerve-supply to the penis particular\\nattention should be paid to the verumontanum. In this structure,\\ncomposed of mucous membrane, erectile tissue, and muscular tissue\\nrichly supplied by bloodvessels, the nerve-supply is particularly\\nabundant hence, this part is usually exquisitely sensitive, is the\\nseat of the pleasurable sensations in coitus, and in disease becomes\\na factor of much importance and gravity.\\nIt will be thus seen that while there is an external sensorium\\ncommune of the sexual apparatus, seated at the distal part of the\\npenis, there is also an internal sensorium, seated in the middle of\\nthe prostatic urethra.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0029.jp2"}, "30": {"fulltext": "24 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThe Integument of the Penis.\\nThe integument of the penis forms an investing sheath which\\nretains its tubular form in the normal condition up to a little\\nbeyond the extremity of the glans penis. Then it is reflected or\\nfolds on itself backward, in the form of a mucous membrane, and\\nis inserted by gradual merging into the whole length of the cor-\\nonal sulcus. It is then reflected forward over the glans, to which\\nit is firmly adherent, and ends at or a little within the orifice of\\nthe meatus, with the mucous membrane of which it is continuous.\\nThus it is that for a short distance (one-quarter to one inch or\\nmore) the mucous membrane of the urethra consists of squamous\\nor pavement epithelium.\\nThat portion of the under surface of the prepuce which is in\\nthe median line becomes transformed into a fibrous band, which is\\ncalled the frsenum preputii, and which, as we have seen, is in-\\nserted just under the lower part of the meatus urinarius. The\\nprepuce, therefore, consists of two layers the outer one integu-\\nmentary and continuous with the skin of the penis, and the inner\\nor reflected one formed of mucous membrane, which is covered\\nwith stratified pavement epithelium, which extends, as already\\nstated, into the meatus for a varying distance.\\nThe integument of the penis is very thin and extensible, and\\nvery readily movable over the cavernous and spongy bodies by\\nmeans of a very delicate, loose, and abundant connective tissue\\ndestitute of fat-cells.\\nThe integument of the penis is plentifully supplied with seba-\\nceous and hair-follicles, which frequently become the seat of in-\\nflammatory processes and of new growths (milia and wens).\\nThe Prepuce.\\nIn the normal condition the prepuce, or foreskin, forms a tube\\nof quite uniform calibre, which is loose and roomy and readily\\nadmits of its retraction and replacement over the glans penis.\\nUsually it ends at or just beyond the meatus. In some cases,\\nhowever, it is redundant and extends more or less beyond the end", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0030.jp2"}, "31": {"fulltext": "ANATOMY. 25\\nof the penis. Then, again, it may be short, so as only to cover\\na portion of the glans, and in quite exceptional cases in the adult\\nthere is no prepuce at all. In this event it has happened that as\\nthe penis developed the integumentary layer did not correspond-\\ningly increase.\\nSometimes the preputial orifice is very small, so that it will\\nwith difficulty allow the glans to emerge through it. Then,\\nagain, this contraction may be so great that only a pin-sized\\naperture is seen, in which event retraction is impossible, and\\nvery little of the glans or meatus can be seen. In some cases\\nthe calibre of the prepuce is decidedly too small for its easy\\nretraction, and it then may exert injurious pressure upon the\\nglans. In other cases the frsenum is too short (and it is then\\nusually a rather thick cord), and by the contraction which it\\nexerts upon the prepuce some deformity results.\\nThe penis is cylindrical when flaccid, triangular in shape when\\nturgid, and therefore has three sides, with corresponding rounded\\nmargins. The dorsal flat surface is broader than the lateral sur-\\nfaces are.\\nThe Glandular Structure of the Prepuce. It is widely stated\\nthat the mucous layer of the prepuce normally contains minute\\nsebaceous glands called by old writers glandulce Tysonii odoriferce.\\nThis, however, is erroneous. Whenever present, Tyson s glands\\nare situated externally on the penis, and are distributed along the\\ncorona glandis in the sulcus and on the reflection of the prepuce\\nand near the frsenum. In young children these glands are fairly\\nnumerous, but in adults they are much more difficult to find, as\\nthey seem to become atrophied to a large extent. Tyson s glands\\nare identical in every respect in structure to the sebaceous glands\\nof the skin or scalp. They consist of two or more bag-like acini\\nlying just beneath the epidermis, which open into a common duct,\\nand the whole cellular lining of the duct and the gland is con-\\ntinuous with the epithelium of the skin. (See Fig. 1.)\\nRecent observations show that the preputial mucous membrane,\\nas a rule, contains no glandular structures whatever, but that there\\nare minute inversions or invaginations of the mucous membrane", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0031.jp2"}, "32": {"fulltext": "26 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nin the form of diverticula, aud longer and narrower ones found\\nnear the frrenum, which are called cysternse frsenuli. The so-\\ncalled glands are therefore simply reduplicatures or invaginations\\nof the membrane in the form of minute shallow or deep crypts.\\nCertain clinical and pathological observations, however, seem\\nto show that occasionally one or more Tyson s glands persist in\\nlater life.\\nFig. 1.\\nShowing a section (much magnified) through one of Tyson s glands in the\\nprepuce of a young child. Drawn from nature.\\nPreputial smegma, that whitish coating of cheesy odor, is there-\\nfore simply effete epithelium, perhaps formed in the crypts or on\\nthe mucous membrane itself.\\nThe Meatus.\\nThe meatus is normally a constricted part of the urethra. In\\nstructure it varies more or less in different individuals. In some\\nits vertical lips are thin and coapt with each other like the leaves\\nof a book, forming a not prominent vertical slit. In other cases\\nthe lips are more or less rounded and the meatus has a rather\\nexpanded, pouting appearance. Then, again, owing to the fact", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0032.jp2"}, "33": {"fulltext": "ANATOMY. 27\\nthat the mucous membrane is rather redundant and loose, its lips\\nsometimes have an uneven, somewhat mammillated appearance.\\nIn some very rare cases the mucous membrane forms a cylinder\\nof a line, or even a third of an inch, in length beyond the apex\\nof the glans, constituting a membranous extension of the urethra.\\nIn somewhat rare cases a thin septum is seen to extend horizon-\\ntally across from one lip to the other, seemingly dividing the\\nmeatus into two parts. Separation of the lips, however, shows\\nthat this septum simply forms a blind pocket which may be shallow\\nor rather deep. In this condition the narrowing of the meatus is\\nat its superior portion, and therefore the surgical indication here\\nis to relieve the trouble by cutting toward the roof of the urethra,\\nwhile in almost all other cases the rule is to cut toward its floor.\\nIn somewhat exceptional cases the meatus is very small, even\\nof pin-head size. In this case it will generally be found, by pass-\\ning the tip of a probe inward and downward, that the abnormal\\nsmallness of the calibre is due to the fusion of the mucous mem-\\nbrane at the lower commissure.\\nThe Male Urethra. The male urethra is a slit-like canal,\\nregarded by some as a closed valve, which extends from the\\nbladder to the meatus urinarius. It is the vent-pipe for the\\nurine and gives issue to the seminal fluid. It therefore has two\\nfunctions, which must be kept in mind in order that its diseases\\nmay be clearly understood. It is in direct relation with the kid-\\nneys, the ureters, and the bladder, and may be the means of trans-\\nmitting disease to these organs of the urinary system, or it, in turn,\\nmay become diseased by the extension of pathological processes\\nfrom these organs and structures. Then, again, pathological pro-\\ncesses attacking the urethra may extend to all or to certain portions\\nof the genital system namely, the testicles, the vasa deferentia,\\nthe seminal vesicles, and the prostate and its crypts and follicles.\\nIn its turn the urethra may be involved by the extension of dis-\\nease from either of these structures and appendages, with which\\nit is in direct anatomical relation. If the function of the urethra\\nwere simply that of transmitting the urine, a length of about two\\ninches would be sufficient, as it is in the female, but, being also a", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0033.jp2"}, "34": {"fulltext": "28 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\npart of the genital apparatus, its length is necessarily much in-\\ncreased for purposes of intromission and fecundation of the female.\\nThis increase in length, as we have seen, is due to the existence\\nof the cavernous and spongy bodies.\\nThe urethra is composed of three layers a mucous layer, a\\nsubmucous connective tissue layer, and a muscular layer. Its\\nwalls are always in contact, except during the passage of urine\\nand semen, a period of three or four minutes during the day.\\nThe average length of the urethra is from seven to eight and a\\nhalf inches, but it may be shorter or longer. It is increased in\\nlength during erection and in hypertrophy of the prostate.\\nWhen the urethra is split longitudinally in its whole extent on\\nits upper surface, its course, with its varying expansions, comes\\ninto view. (See Fig. 2.) At the meatus urinarius we find a nor-\\nmal narrowing of the canal, which then expands into a spindle-\\nshaped portion, which is called the fossa navicularis hence this\\nis called the navicular portion of the urethra. As this part\\nemerges into the spongy or penile portion a slight constriction\\noccurs. The canal then expands, and we find it of somewhat\\nuniform calibre in its course through the corpus spongiosum for\\na distance of four or five inches. It then expands again, in con-\\nformity with the bulbous expansion of the corpus spongiosum,\\nand a spindle-shaped canal is formed, which is from an inch to\\nan inch and a half in length, and which is called the sinus of the\\nbulb or the bulbous portion of the urethra. Again becoming con-\\ntracted at the anterior layer of the triangular ligament, it has a\\nuniform calibre for a distance of about three-quarters of an inch,\\nwhen, at the posterior layer of this ligament, it emerges to expand\\nagain into the prostatic urethra. In its course through the trian-\\ngular ligament it is simply a membranous canal seated about an\\ninch beneath the summit of the pubic arch and surrounded by the\\ncompressor urethrse muscle. The prostatic urethra is the direct\\ncontinuation of the membranous urethra. It also has a spindle\\nshape, and is about an inch and a quarter in length. (See Fig.\\n2.) Thus, anatomically, there is a navicular, a spongy, a bulbous,\\na membranous, and a prostatic portion of the urethra, making five", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0034.jp2"}, "35": {"fulltext": "ANATOMY.\\n29\\ndivisions in all. The term\\npenile, or pendulous,\\nurethra is also applied to\\nthat portion which extends\\nfrom the glans to the peno-\\nscrotal angle.\\nClinically, in a general\\nway, we speak of the ante-\\nrior and posterior urethra,\\nthe former extending to the\\nanterior layer of the trian-\\ngular ligament, and the lat-\\nter including the portion\\nbeyond.\\nThe mucous membrane of\\nthe urethra, is smooth and\\nshining and of a yellowish-\\npink color, which is deeper\\nat the first inch and at the\\nbulbous portion. For a\\nshort distance one-fourth\\nto one inch within the me-\\natus the membrane is cov-\\nered with flat pavement epi-\\nthelium beyond that part\\nit is of the columnar variety\\nas far as the vesical orifice.\\nCourse of the Urethra.\\nThe direction of the pros-\\ntatic urethra, which is in a\\nfixed position, is downward\\nj t .i i Showing the normal urethra opened longi-\\nand torward until it reaches s A^\\ntudmally on its upper surface. Drawn from\\nthe posterior layer of the na ture.\\ntriangular ligament, when it\\nbecomes the membranous urethra, which pursues nearly the same\\ndirection, with a slightly upward tendency.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0035.jp2"}, "36": {"fulltext": "30 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThe membranous urethra is from three-quarters to an inch in\\nlength and of a calibre of 27 F., and, owing to the fact that this\\nsegment of the canal forms a part of the subpubic curve of the\\nurethra, its superior wall is somewhat shorter than the inferior\\nwall. It is peculiar in the fact that it is composed wholly of\\nmucous membrane, with a submucous connective tissue coat and\\nsome unstriped muscular fibres. It is the least vascular part of\\nthe urethral canal, and has very few mucous glands and crypts.\\nBy reason of its anatomical structure it is not so severely affected\\nby the gonorrheal process as the other portions are consequently,\\nit is rarely, if ever, the seat of true stricture except from exten-\\nsion of the process from the bulbous urethra.\\nThe membranous urethra is situated and held in a fixed position\\nbetween the two layers of the triangular ligament a knowledge\\nwhich is essential.\\nThe Triangular Ligament. The triangular ligament, which is\\na portion of deep perineal fascia, consists of two layers an ante-\\nrior and a posterior layer between which is the compressor ure-\\nthras muscle. The anterior layer is a dense, fibrous membrane\\nstretching from the posterior lip of the os pubis and ischium.\\nThis anterior layer is about an inch and a half in length, and, in\\naccord with the direction of the pubic bone, its base is directed\\nbackward. About an inch below the symphysis pubis is the\\nurethral orifice, the external termination of the membranous\\nurethra. The triangular ligament extends upward toward the\\nsymphysis to a distance just above the hole for the urethra,\\nand above that is the dense, fibrous tissue called Henle s\\ndeep transverse ligament of the pelvis, which is pierced by\\nthe openings for the vessels and nerves. The triangular liga-\\nment and Henle s ligament, therefore, close this part of the\\npelvic outlet.\\nThe posterior layer of the triangular ligament is derived from\\nthe obturator fascia, and from it a prolongation passes backward\\nand forms the outer capsule of the prostate. Its upper portion,\\ncalled Henle s ligament, is pierced by the opening for the plexus\\nvenoms pubicus impar, which consists of veins returning from the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0036.jp2"}, "37": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0037.jp2"}, "38": {"fulltext": "PLATE III.\\nShowing the Compressor Urethrse or Cut-off Muscle.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0038.jp2"}, "39": {"fulltext": "ANATOMY. 31\\npenis and of the dorsal arteries. The triangular ligament proper\\nis pierced by the membranous urethra.\\nThe Compressor Urethrae Muscle.\\nWhen the anterior layer of the triangular ligament is dissected\\noff the compressor urethrae muscle is exposed in the form of a\\nfirm, flat muscular band, rather more than an inch wide, stretched\\nbetween the pubic rami, but not wholly covering the pelvic outlet\\nat its apex. (See Plate III.) This muscle, also called the con-\\nstrictor urethrae, the cut-off muscle, is composed of transverse\\nfibres of the striped variety, some of which pass directly over and\\nsome under the urethra, while others pass around and encircle it.\\nThis muscle is very powerful, and, being under the control of the\\nwill, it can at any time suddenly stop the flow of urine. Though\\nthe external prostatic sphincter consists of rings of unstriped\\nmuscular fibres at the apex of the prostate, the greater part of the\\ntrue sphincteric action is performed by the compressor muscle.\\nIn the course of acute and chronic gonorrhoea, and during irrita-\\ntive processes in the prostate, seminal vesicles, and bladder, this\\nmuscle may undergo spasm and produce what is wrongly termed\\nspasmodic stricture. Under the influence of rough manipula-\\ntion by instruments in the urethra, of cold, and of very strong and\\nirritating urethral injections, spasm may also be produced. Then,\\nagain, as a result of operations about the rectum, abdomen, lower\\nlimbs, etc., this muscle may be thrown into spasm, and retention of\\nurine may result. Some authors claim that this muscle is always\\nin a state of rigid contraction, or tonus, so that the lumen of the\\nurethra is of the fineness of a hair, and that this contraction tends\\nto prevent the extension of the gonorrheal process from the ante-\\nrior into the posterior urethra, and also acts as a dam, preventing\\nthe secretions in the prostatic and membranous urethra escaping\\ninto the anterior urethra. This is far too sweeping a statement.\\nWhen the bladder is more or less full the compressor or constrictor\\nurethrae closes up the membranous urethra and prevents the escape\\nof urine but when the bladder is not full, even in cases of sub-\\nacute inflammation in any part of the urethra, bulbous or prostatic,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0039.jp2"}, "40": {"fulltext": "32 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nthere is not in the majority of cases any unusual tonus or spasm\\nof this muscle. This fact can be readily demonstrated, as I have\\ndone hundreds of times, by the gentle passage into the bladder of\\na soft catheter or bougie of a calibre of 12 or 14 French. This\\ninstrument, causing no irritation or nervous shock, glides easily\\nfirst into the membranous urethra, then along the prostatic urethra\\ninto the bladder. The excessive tonus claimed to be peculiar to\\nthis muscle in general occurs when rigid instruments, particularly\\nof large size and when not skilfully passed, are used, or when in-\\njections have been forcibly made. Then the nerves of the urethra\\nare disturbed and prompt reflex spasm of the muscle occurs. In\\nthe majority of persons the compressor muscle and the external\\nprostatic sphincter keep the urethral canal mildly compressed\\nthat is, its tonicity is such that the lumen of the canal is obliter-\\nated by the coaptation of the folds of membrane, but there is no\\nspasm. Consequently, it occurs, as a rule, that the secretions of\\nthe prostatic urethra are kept from escaping into the anterior\\nurethra. Though this may be stated as the law, it has exceptions\\nin some cases of acute posterior urethritis, in some of prostator-\\nrhoea, and in some of suppuration of the seminal vesicles.\\nOn each side of the membranous urethra, quite near to it and\\nseated in the substance of the compressor muscle, are Cowper s\\nglands. (See Fig. 3.)\\nThe Bulbous Urethra.\\nLying just upon the anterior layer of the triangular ligament\\nis the bulb of the corpus spongiosum, containing the bulbous ex-\\npansion of the urethra. Here the membranous urethra ends, and\\nthe part is called the bulbo-membranous junction. The urethra\\nenters the bulbous expansion nearer its upper than its lower half\\nconsequently the pouch-like dilatation of the urethra is greater\\non its lower surface. It is this condition which sometimes causes\\ntrouble in the passage of sounds and catheters, to obviate which\\nit is necessary to keep the point of the instrument toward the roof\\nof the urethra, and to put the penis on stretch in order to efface\\nthe pouchy pocket as much as possible.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0040.jp2"}, "41": {"fulltext": "ANATOMY.\\n33\\nThe bulbous portion of the urethra or the sinus of the bulb is\\nunusually vascular, and its tissues are soft and succulent. Con-\\nsequently, the gonorrheal process is often very acute and severe\\nat this part, and the disease shows a tendency here to remain in a\\nchronic condition. As a result, we find the larger number of true\\nstrictures in this region.\\nThe direction of the bulbous urethra is forward and upward,\\nand its calibre is from 33 to 36 French. The downward and for-\\nward direction of the prostatic urethra and the slightly upward\\nFig. 3.\\nShowing the normal contractions and expansions of the urethra from the\\nmeatus to the bladder, with a Cowper s gland opening by its duct into the bulbous\\nurethra. (Schematic from nature.\\ndirection of the membranous urethra, with the decidedly upward\\ndirection of the bulbous urethra, form what is called the subpubic\\ncurve.\\nThe Penile Urethra.\\nContinuous outwardly with the bulbous portion of the urethra\\nis the spongy penile or pendulous urethra. It, like the bulbous\\nportion, is contained in the corpus spongiosum. It is from six\\nto six and a half inches (sometimes more) in length, and is sur-\\nrounded by erectile tissue. The mucous membrane crypts and\\nfollicles of this portion of the urethra will be described a little\\n3", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0041.jp2"}, "42": {"fulltext": "34 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nfurther on. The calibre of the penile or pendulous urethra is\\nusually from 27 to 30 French, but it is often found to be greater\\nthan this measurement. The penile urethra is susceptible of con-\\nsiderable clilatability, but it must be remembered that the word\\ncalibre represents normal distention, such as is found by the\\nmoderately easy passage of instruments or by the stream of urine,\\nwhile dilatability means a calibre produced by unusual or ex-\\ncessive distention of the canal by instruments.\\nThe distal portion of the urethra seated in the glans penis is\\ncalled the fossa navicularis or the navicular portion of the urethra.\\nIt is of spindle shape, and at its middle portion its calibre is 30\\nto 33 F. At its point of junction with the penile urethra the\\ncalibre is from about 28 to 30 F. The calibre of the meatus,\\nthe terminal point of the urethra externally, is from 21 to 28 F.\\nexceptionally, however, it is greater. A schematic representation\\nof the urethra with its normal contractions and expansions is given\\nin Fig. 3.\\nThe degree of mobility of different portions of the urethra is\\nchiefly influenced by the attachments of the neighboring fasciae.\\nThe anterior part of the penis is free, and capable, in a flaccid\\ncondition, of assuming almost any position in its posterior third,\\nhowever, this organ is connected with the symphysis by means of\\nthe suspensory ligament, with the ischiatic and pubic rami by the\\ncrura of the corpora cavernosa, and with the anterior layer of the\\ntriangular ligament by means of the bulb the spongy urethra\\nmay, therefore, be said to be fixed in proportion as it approaches\\nthe membranous region. The membranous region is the least\\nmovable of all, owing to its firm connection with the pelvis by\\nmeans of the two layers of the triangular ligament. The pros-\\ntatic urethra is susceptible of some slight change of position, de-\\npendent upon the action of the anterior fibres of the levator ani,\\nthe amount of urine in the bladder, and the passage of sounds or\\ncatheters.\\nIn a flaccid condition of the penis the urethra has two curves\\nthe first confined to the anterior, the second to the deepest\\nportion of the canal. The former is simply due to the dependent", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0042.jp2"}, "43": {"fulltext": "ANATOMY. 35\\nposition of the anterior part of the organ, and is effaced in a state\\nof erection or when the penis is elevated to an angle of about 60\u00c2\u00b0\\nwith the body. The latter is called the subpubic curve, from its\\nposition beneath the symphysis. Unless some degree of force be\\nused to straighten the canal this curve is permanent, and a knowl-\\nedge of its direction is essential in determining the proper form\\nof instruments and the manner of their introduction.\\nThe subpubic curve commences an inch and a half anterior to\\nthe bulb in the penile urethra, attains its lowest point when the\\nbody is in the upright position nearly opposite the anterior layer\\nof the triangular ligament, and finally ascends through the mem-\\nbranous and prostatic regions.\\nMUCOUS SECRETION AND THE FOLLICLES AND\\nGLANDS OF THE URETHRA.\\nIn healthy individuals in moments of sexual excitement a\\nfew or many drops of a clear and mucous secretion escape from\\nthe meatus. In some forms of sexual ill-health the secretion may\\nbecome much more abundant than normal, and both in health\\nand in ill-health it is sometimes the cause of much mental anxiety.\\nIt is necessary, therefore, to understand clearly the nature and\\norigin of this mucous secretion.\\nInto the anterior urethra, which includes that part of the canal\\nin front of the triangular ligament, three orders of muciparous,\\nglands open by means of ducts. These are the follicles of Littre,\\nthe lacunae or crypts of Morgagni, and Cowper s glands. All\\nthese glands are of the compound racemose type, consisting of\\nacini which open into a common duct. (See Fig. 4.) The fol-\\nlicles of Littre are structurally the same as the crypts of Mor-\\ngagni, but are smaller in dimensions. The lacuna magna in the\\nfossa navicularis is a good illustration of a typical Morgagni s.\\ncrypt. As shown in Fig. 5, it is a valve-like structure, at the\\nbottom of which the duct of the gland opens. There may be\\nseveral of these crypts along the roof of the urethra, but they are\\nusually not found deeper than three inches. In Fig. 5 two of\\nthese valve-like pockets may be seen.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0043.jp2"}, "44": {"fulltext": "36 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nLittre s follicles are quite numerous, and are seated mostly on\\nthe floor of the urethra and sometimes, though in less numbers,\\non its roof. The ducts of these follicles open obliquely forward\\ntoward the meatus, and by the naked eye or by the aid of a mag-\\nnifying glass may be seen as very minute depressions in the mucous\\nmembrane. In Fig. 6 these follicles are indicated by the many\\nminute bristles which have been passed into their ducts.\\nFig. 4.\\nOne of the mucous glands or follicles of Littre opening into the lumen ot the\\nurethra x y, lateral branches of main duct with their more superficially situated\\nacini z z, continuation of main duct with deeply seated acini s s, trabecule of\\nthe cavernous tissue; ww, tunica albuginea. (Drawn from nature, much magni-\\nfied.)\\nCowper s glands are two compound racemose bodies, seated just\\nbehind the anterior layer of the triangular ligament in the sub-\\nstance of the compressor urethrse muscle. (See Fig. 11.) Their\\nducts are about three-quarters of an inch in T length, and they pass\\nobliquely forward through the anterior layer of the triangular", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0044.jp2"}, "45": {"fulltext": "Fig. 5.\\nANATOMY. 37\\nFig. 6.\\nShowing the lacuna magna and a deeper\\nvalve-like pocket and the orifices of numer-\\nous mucous glands. (Drawn from nature.\\nI\\nligament and open separately into\\nthe bnlbons urethra on each side\\nof the median line. (See Fig. 8.)\\nAll these glands and follicles\\nsecrete a clear, viscid mucus of\\nalkaline reaction which resembles\\nglycerin in appearance. It is prob-\\nable the secretion of Littre s folli-\\ncles and Morgagni s crypts is most\\ndeveloped for the lubrication of the\\nurethral mucous membrane, but this\\nfluid is also quite abundantly pro-\\nduced during the sexual act. By\\nsome it is thought that the acidity\\nof the urine left in the canal after\\nmicturition is neutralized by these\\nsecretions. The secretion of Cow-\\nper^s glands is quite copious and\\nsimilar in character to that just\\nShowing roof of the urethra,\\nwith bristles passed into Littre s\\nfollicles. Drawn from nature.", "height": "4097", "width": "2420", "jp2-path": "practicaltreat00tayl_0045.jp2"}, "46": {"fulltext": "38 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ndescribed. It forms part of the seminal discharge in coitus,\\nand is frequently found in cases of sexual excitement without\\norgasm. This secretion plays an important part in certain sexual\\ndisturbances to be considered later.\\nTHE PROSTATE GLAND AND THE PROSTATIC\\nURETHRA.\\nThe prostate gland is an accessory sexual organ of much im-\\nportance, which also is employed in urination. In order to obtain\\na clear idea of this sexual gland it is necessary to study its struc-\\nture microscopically in young subjects, both children and animals,\\nand then to trace its development at later periods of life. Such\\nstudies develop the following facts\\nThe prostate is essentially a glandular organ, and the chief func-\\ntion of its other component tissues, namely, the fibrous connective\\ntissue framework and the unstriped muscular fibres, are 1, to form\\na nidus for the lodgement of the glands, and, 2, to assist in their\\nnormal action. The glands are of the compound tubular type, and\\nend in short ducts which open into the prostatic urethra. The\\nducts are merely fibrous tubes lined with columnar epithelium.\\nThe secreting portions of the glands are the tubules and the gland\\nalveoli, which consist of longer or shorter, wavy, convoluted,\\nbranched tubes which terminate in saccular blind extremities.\\nTo some glands there are short lateral club-shaped branchlets.\\nThe secreting portions of these glands are lined by long, slender\\ncells which are surrounded by a delicate connective tissue base-\\nment membrane in which bloodvessels, lymphatics, and nerves\\nare seated. Outside the gland proper there are bundles of un-\\nstriped muscular fibres, some of which are circularly arranged,\\nwhile others cross each other in various directions. By the con-\\ntraction of these muscular rings the secretion of these glands is\\nthrown into the urethra.\\nIn the young normal prostate the glands are grouped in toler-\\nably well-defined lobules. This is well shown in Fig. 7, in which\\ncan be well made out eleven distinct lobular groups of prostatic", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0046.jp2"}, "47": {"fulltext": "ANATOMY. 39\\nglands. In these lobules the tubular glands are inexplicably\\nmixed up with each other very much as a bunch of earth-worms\\nare, but all their ducts point toward the urethra. In the figure\\nthe irregular spaces in white are the glands cut through, but there\\nare very many long tubules shown, which in the section happen to\\nhave been cut in the continuity of the glands.\\nThere is no muscular investment of the ducts of the glands,\\nand it is probably owing to this condition that these outlets some-\\nFig. 7.\\nJk\\n-0\\n.\u00e2\u0096\u00a0\u00e2\u0096\u00a04?%^*\u00c2\u00a3\\nc ^r\\nShowing section (much magnified) of normal prostate of a subject aged nine-\\nteen years, made through middle of verumontanum 1, urethra 2, verumonta-\\nnum 3, sinus pocularis; 4, ejaculatory ducts; 5, prostatic glands. (Drawn from\\nthe Edinger projection apparatus.\\ntimes become plugged up with amyloid bodies, concretions, and\\ncalculi, which in all probability would be expelled by circular\\nmuscular fibres if they were present.\\nThere is no reservoir in the prostate gland for storing up or\\nretaining its secretion. The latter in the sexual act is very copi-\\nously elaborated, and is quickly thrown into the prostatic urethra\\nby means of the muscular mechanism which is so admirably\\nadapted to that purpose.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0047.jp2"}, "48": {"fulltext": "40 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThe prostatic urethra is normally about an inch and a quarter\\nor an inch and a half in length, and extends from the apex to the\\nbase of the prostate. It has a calibre of 30 F. at the apex, 45\\nin its middle portion, and 33 at its vesical end. It tunnels the\\nprostate gland one-third nearer its upper than its lower surface,\\nand its direction is downward and forward until it reaches the\\nmembranous urethra. 1\\nWhen laid open on its upper surface the prostatic urethra is\\nfound to be of fusiform shape and to present certain anatomical\\npeculiarities. (See Fig. 8.) On its floor is a narrow, longitu-\\ndinal, wedge-shaped ridge called the verumontanum, the caput\\ngallinaginis or crista galli. This structure, which is from one-\\nhalf to three-quarters of an inch in length, and one or two lines\\nin height, is composed of erectile tissue and muscular fibres and\\nmany tubular glands, all of which are covered with a dense mucous\\nmembrane. At each side and at the base of the verumontanum\\nis a depression which is called the prostatic sinus, and it is upon\\nthe surface of these sinuses, right and left, that in a tolerably\\nregular linear arrangement many prostatic ducts open, usually\\nabout twelve, and in some instances as many as twenty or\\nthirty.\\nThe Sinus Pocularis. On the summit of the verumontanum,\\nsometimes at its forepart and sometimes about its middle, a slit-\\nlike depression may be seen, which leads to a cul-de-sac or flask-\\nshaped pouch about one-quarter to three-quarters of an inch in\\nlength and of a calibre of about three millimetres, which is\\ndirected upward and backward in the axis of the prostatic gland.\\nThis cul-de-sac, which is called the uterus masculinus, or sinus\\npocularis, is really a separate structure and distinct from, but sur-\\nrounded by, the prostate. It consists of a secreting surface of\\ncolumnar epithelial cells surrounded by connective tissue and\\n1 The usual anatomical descriptions of the prostatic urethra are based on the\\nposition of the canal as found in the cadaver when it is laid flat on its back. In\\nstrict accuracy, the prostatic urethra in the living male, as he stands up, has an\\nanterior and a posterior wall which are nearly in accord with the vertical axis of\\nthe body.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0048.jp2"}, "49": {"fulltext": "ANATOMY.\\n41\\nbloodvessels and circular layers of unstriped muscular fibres. It\\nmay or may not Have blind diverticula.\\nThe function of the sinus pocularis is not known. It is thought\\nFig. 8.\\nShowing bladder and urethra opened on the upper surface 1, the trigone and\\nopenings of ureters 2, prostate and prostatic urethra 3, bulb of the urethra,\\n\u00e2\u0096\u00a0with openings of Cowper s glands 4, verumontanum, with orifice of sinus pocu-\\nlaris 5, openings of ejaculatoiy ducts 6, linear series of openings of prostatic\\nducts 7, groups of openings of prostatic ducts behind veruniontanum. Drawn\\nfrom nature.\\nby some that by reason of its position between the ejaculatoiy\\nducts, its round shape, and its well-developed musculature, in\\ncoitus it so contracts that it draws upon the openings of the ejacu-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0049.jp2"}, "50": {"fulltext": "42 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nlatory ducts, and thus renders them so patulous that the semen\\nreadily passes through.\\nProstatic Tubules. Upward and beyond the verumontanum\\nthere is a small mass of gland tissue enveloped in a connective\\ntissue stroma and covered with mucous membrane which is pierced\\nby the orifices of many gland-ducts. This tissue-mass is seated\\nbetween the two lateral lobes, and it ends at the orifice of the\\nbladder. In some subjects the development of this glandular\\narea is very sparse, in others more luxuriant, while in a more\\nlimited class of subjects it is very exuberant. This mass of gland-\\nular tissue plays an important part in many young and middle-aged\\nsubjects in being the seat of a low grade of chronic inflammatory\\nprocess, and in later life it may undergo such marked hyperplasia\\nthat a third lobe of the prostate is formed, which, becoming in-\\nvested by a capsule derived from and continuous with that of the\\nrest of the gland, offers more or less impediment to the passage of\\nthe urine.\\nIt will thus be seen that some of the ducts of the prostate\\ngland open on each side of the verumontanum in a linear manner,\\nand that there is also a group of them clustered in the tissue be-\\nyond this structure as far as the vesical orifice. (See Fig. 8.)\\nIn the mucous membrane lying laterally beyond the region just\\nmentioned we frequently find scattered here and there orifices of\\ngland-ducts, but never in large number.\\nOn each side of the orifice of the sinus pocularis, or uterus\\nmasculinus, in the vertical walls of the verumontanum, are the\\nslit-like openings of the ejaculatory ducts. In some cases one or\\nboth of these ducts open into the cavity of the sinus pocularis.\\nIn the anterior wall of the prostatic urethra, near its middle\\nportion, are numerous venous channels, almost amounting to a\\nplexus, which are superficially seated in a dense submucous tissue\\nand covered only with mucous membrane. It is the injury of\\nthis plexus by careless sounding which sometimes gives rise to\\nsevere hemorrhage.\\nThere are three layers of unstriped muscular fibres in the pros-\\ntatic urethra (1) An internal circular layer immediately beneath", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0050.jp2"}, "51": {"fulltext": "ANATOMY. 43\\nthe raucous membrane (2) a middle longitudinal layer, which\\nforms an imperfect sheet of muscle and (3) an outer, annular\\ncoat, which is continuous with the circular muscular fibres of the\\nbladder. There are, in addition to the foregoing, the external\\nand internal sphincters of unstriped muscular fibres of Henle,\\nand in the capsule of the gland beneath the striped muscle is an\\nindependent thin layer of non-striped muscle, from which fasciculi\\npass inward and invest the ultimate groups of tubules. (See\\nFig. 7.)\\nThe arterial supply of the prostate is very considerable, and is\\nderived from branches of the internal pudic, vesical, and hemor-\\nrhoidal arteries. The veins are correspondingly large, and they\\nend in a plexus which is situated at the side and base of the gland.\\nThere is also an abundant distribution of medullated and non-\\nmedullated nerves to these parts, which are derived from the\\npelvic plexus.\\nIn and about the verumontaniun there is an abundant supply\\nof nerves of peculiar sensibility, and here it is thought that the\\nseat of pleasure in the sexual act is centred. This part may be\\ncalled the internal sensorium sexuale.\\nThe prostatic urethra in health ends abruptly at the vesical\\norifice, which is well shown in Fig. 8. When the gland under-\\ngoes enlargement, particularly when its third lobe is hyper-\\ntrophied, and also in the lateral lobe, it begins to pass beyond\\nthis vesical orifice, and may eventually extend into the bladder\\ncavity.\\nTHE SEMINAL VESICLES.\\nThe seminal vesicles are two elongated and lobulated mem-\\nbranous pouches situated at the base of the bladder just beyond\\nthe prostate and in front of the rectum. The seminal vesicles\\nhave been erroneously and variously described as convoluted\\ntubes, as little sacculated bladders, and as racemose glands. They\\nare really blind-ending tubes with diverticula of various sizes.\\nThis can be seen from a study of Figs. 9 and 10. In Fig. 9\\nthe vesicle (1) is portrayed, divested of its loose connective", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0051.jp2"}, "52": {"fulltext": "44 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ntissue, and its three tubes are quite distinct to view. The ampl-\\niation of the vas deferens is also shown. In Fig. 10 the tubes\\nFio. 10.\\nShowing the relation of the various parts of the seminal vesicles to each other\\nand the ampullations 1, seminal vesicle; 2, inner tube; 3, second tube; 4,\\nouter or third tube, or handle of the jack-knife. (Drawn from nature.\\nare shown dissected apart. The inner or first tube (2) is seen\\nto have a decided distal enlargement. The middle or second", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0052.jp2"}, "53": {"fulltext": "ANATOMY.\\n45\\ntube (3) is seen to join the outer or third tube (4) at right angles.\\nThese two tubes (the third and fourth) bear the same relation to\\neach other that the blade of a jack-knife bears to its handle. The\\nouter enlarged tube, of dog s-ear shape, is called the handle of the\\nFig. 11.\\nUnder view of bladder and sexual apparatus and of urethra and prostate: 1,\\nureter 2, ampullation of vas deferens 3, seminal vesicle 4, prostate 5,\\nCowper s glands 6, bulb of urethra 7, membranous urethra 8, crus penis.\\nDrawn from nature.\\njack-knife, and the middle tube is its blade. When placed in\\nnatural coaptation the knife-blade fits snugly in the concavity ex-\\nisting in the handle, and these lie side by side, all welded together\\nby dense connective tissue with the first or inner tube.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0053.jp2"}, "54": {"fulltext": "46 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nEach seminal vesicle measures two and a half inches in length,\\nabout half an inch (sometimes an inch) in breadth, and a quarter\\nto a third or half an inch in thickness. (See Fig. 11.)\\nThe anterior or pointed extremities of the seminal vesicles are\\nsituated, when the bladder is empty, within a finger s breadth of\\neach other on each side of the median line just above the base of\\nthe prostate. In this interval the ampullated end of each vas\\ndeferens joins the anterior pointed extremity or outlet duct of the\\nseminal vesicle at a very acute angle, and, merging together, they\\nform the ejaculatory duct. Thus there are two of these ducts\\none on the right of the median line and one on the left lying\\nFig. 12.\\nTransverse section of the base of the bladder just behind the prostate, showing\\nthe relation of the seminal vesicles and the ampullations, which are embedded in\\na dense connective tissue stroma 1 and 2, chambers of seminal vesicles 3, am-\\npullations of the vasa deferentia.\\nvery near to one another. These ejaculatory ducts enter the pros-\\ntate at its base, tunnel its structure side by side (see Figs. 14 and\\n15), pass downward and upward, and enter the prostatic urethra\\neither on the sides of the sinus pocularis or into its cavity.\\nAlthough the seminal vesicles and the ampullated extremities\\nof the vasa deferentia lie very close to one another when the\\nbladder is empty, when that viscus is normally distended these\\nstructures are separated from each other so that they form the\\nletter V on the outside of the vesical wall. (See Fig. 11.) On\\nthe inside of the bladder at its base a Y-shaped space, corre-\\nsponding to the external one just described, exists, which is called\\nthe trigone. (See Fig. 8.) It will be seen that in this figure,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0054.jp2"}, "55": {"fulltext": "ANATOMY.\\n47\\nwhich is accurately drawn, the orifices of the ureters are unsyin-\\nnietrically placed.\\nThe seminal vesicles have the usual muscular, connective tissue,\\nand mucous membrane coats. Each portion of the vesicles has a\\ncalibre varying from 10 to 18 of the French scale (and in some\\nyoung and vigorous subjects 30 French), while its outlet duct has\\na calibre of about 4 to 6 French, and sometimes less. (See Fig.\\n12.)\\nThe epithelium lining the vesicles is of the columnar and\\ncuboidal varieties. The mucous membrane, which is studded\\nwith the orifices of numerous tubular glands, is thrown into folds\\nby which its extent is greatly increased. Thus the muscular\\nFig. 13.\\nShowing the internal structure of the seminal vesicle and of the ampullation of\\nthe vas deferens, and the union of the two ducts which form the ejaculatory ducts\\n1, interior of the seminal vesicle 2, interior of ampulla 3, junction of the ducts\\nforming the ejaculatory duct. (The section is taken in transverse diameter of the\\nprostate and in the long axis of the seminal vesicles and vas deferens. Drawn\\nfrom the Edinger projection apparatus.\\nlayers form trabecular, which produce many depressions and\\ndiverticula. (See Fig. 13.) In structure the seminal vesicles\\nhave thicker and denser walls than the ampullated parts of the\\nvasa deferentia. They also have an abundant musculature, by\\nthe contraction of which the secretion is promptly expelled.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0055.jp2"}, "56": {"fulltext": "48 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThe seminal vesicles are firmly welded to the prostate by means\\nof dense, fibrous connective tissue, which, besides completely in-\\nvesting the sacs, so adjusts the anatomical relation of the parts\\nthat the normal position of the ejaculatory ducts is always pre-\\nserved, and there is never danger of their being accidentally bent,\\ntwisted, or compressed. This condition of affairs is most impor-\\ntant in coitus, since by it any hinderance to ejaculation is prevented.\\nThis perivascular connective tissue is also interesting in clinical\\npractice, since in some cases inflammatory action extends beyond\\nthe vesicles themselves and involves it more or less extensively.\\nThe arterial and venous distribution of the seminal vesicles is\\nvery rich, and is derived from the middle and the inferior vesical\\nand middle hemorrhoidal trunks.\\nThe nerve-supply is abundant, and is furnished by the pelvic\\nplexus.\\nThe chief function of the seminal vesicles, besides acting as a\\nstorehouse for the spermatozoa, is the elaboration of a peculiar\\nmucus in large quantity, which, in coitus, by its volume and force,\\ncarries along with it without impediment the seminal fluid, which\\nexists in much more sparing quantity- in the ampullations of the\\nvasa deferentia.\\nIn this connection it is well to call to mind the position and\\nfunction of the seminal vesicles and of the ampullae, their imme-\\ndiate surroundings, and the conditions to which they are subjected\\nin health, since such an understanding renders clear many patho-\\nlogical conditions which are now obscure.\\nIn health these seminal reservoirs, when the man is in the erect\\nposition, are seated nearly in a vertical position that is, they are\\nbags with their bodies high up and with their outlet ducts low\\ndown, looking downward and slightly forward. From their posi-\\ntion one might think that their mucous contents might readily\\nescape in obedience to the laws of gravitation. But we find that\\nthe secretion is retained in health in its reservoirs by wonderful\\nprovisions of nature. The healthy seminal secretion of these\\nparts is very viscid, consequently it is not prone to leak out of\\nthe outlet ducts. In ill-health it is more fluid, and then it tends", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0056.jp2"}, "57": {"fulltext": "ANATOMY. 49\\nto escape. Then we must consider the interior structure of these\\nreceptacles. They are not simply cavities like an egg-shell, but\\nare composed of intricately arranged chambers with decidedly\\ndeep trabecule and diverticula, all of which tend to keep the\\nsecretion pent up until discharged by the functional activity of\\nthe parts. Then at the orifices of the outlet duct such is the\\ncompactness of the structure of the circular muscular fibres that\\nthey possess a certain tonus which prevents the escape of the\\ncontained secretion. It is probable, also, that in a measure the\\nnormal action of the musculature of the ejaculatory ducts so\\ncompresses these tubes that escape of secretion through them is\\nprevented. The reduplicatures of the mucous membrane also\\nhelps to stop up these tubes. Therefore, we see that the condi-\\ntions inherent in the secretions themselves and of the parts which\\nhold them ready for discharge all tend to keep them well stored\\nup until they are thrown out in ejaculation. In disease all this is\\nchanged, and tonus is replaced by lack of normal contractile power,\\nand a general nabbiness and inertness of the parts are present.\\nThen, with secretions less viscid than normal, and with loss of\\ntonus and functional activity in the reservoirs and their outlet\\nducts, it is readily seen why these secretions escape.\\nWe must further fully consider the various influences to which\\nthe seminal vesicles and ampulla? are constantly subjected. Welded\\nas they are to the base of the bladder, they undergo more or less\\nexpansion and contraction, according as that viscus is full or\\nempty. In the act of urination, when the size of the bladder\\ndiminishes until it becomes a mere ball, there must be some\\npressure exerted upon these seminal appendages but in health,\\nas a general rule, no expression of their contents is produced.\\nThen, again, we must remember that the bladder and all struc-\\ntures connected with it are necessarily more or less acted upon\\nby intra-abdominal pressure (the weight of the intestines and\\ntheir distention after eating, the distention of the rectum by gas\\nor by feces, and abdominal fat), which in health does not, with\\nvery few exceptions, produce any change either in the vesicles or\\nthe ampulla?. Further than this, in the expulsive and contractile\\n4", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0057.jp2"}, "58": {"fulltext": "50 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nefforts of the rectum, which lies immediately behind them, in defe-\\ncation, particularly if the fecal mass is large and firm, consider-\\nable pressure must be exerted upon these intimately connected\\nparts, particularly when there is strong contraction of the levator\\nani muscle. Even with all these surrounding and neighboring\\nforces acting upon the vesicles and ampulla?, they, as a rule,\\nremain unaffected, and their secretion is not in any way abnor-\\nmally disturbed. When these facts are fully understood much\\nadvance is made toward a clear and scientific comprehension of\\nthe nature and extent of seminal losses.\\nThe Ampullations of the Vasa Deferentia and the Ejaculatory\\nDucts.\\nThe ampul lated ends of the vasa deferentia are really expan-\\nsions developed in these true spermatic canals at their point of\\njuncture with the inner or first tube of the seminal vesicles at the\\nniche in the base of the prostate. They have the same histo-\\nlogical structure and the same glandular supply as the seminal\\nvesicles, except that their fibrous and muscular tissues are rather\\nless copious but they are, nevertheless, firm and strong. The\\ncalibre of the ampullations of the vasa deferentia varies between\\n6 and 10 French, but in vigorous young men it may be much\\nlarger. The internal structure of these dilated extremities of the\\nspermatic canals is trabeculated like that of the vesicles, by which\\narrangement a greater amount of secreting surface is produced.\\n(See Fig. 13.) There are present numerous tubular muciparous\\nglands throughout their extent. These ampullae become narrowed\\njust at the base of the prostate, and they then form a tube into\\nwhich a bristle or a knitting-needle will pass without the use of\\nmuch force. Around the orifices of these ducts the muscular\\ntissue is somewhat increased in quantity, so that a not very well\\ndeveloped sphincter is formed. This duct is then joined by a\\nduct of similar calibre, which is the prostatic end of the inner or\\nfirst seminal vesicle tube. (See Fig. 13.) In this manner are\\nformed the ejaculatory ducts, which are about three-quarters of", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0058.jp2"}, "59": {"fulltext": "ANATOMY.\\n51\\nan inch in length and have a calibre of about two millimetres.\\nThey run, as has already been stated, through the prostate down-\\nward and upward and open on each side of the verumontanum.\\n(See Figs. 14 and 15.) The mucous membrane of the ejaculatory\\nducts contains tubular glands, is somewhat trabeculated, and from\\nit numerous diverticula and duplicatures are developed.\\nFig. 14.\\nShowing the position of the ejaculatory ducts in the upper part of the prostate\\nand behind the urethra 1, vesical orifice of the urethra 2, ejaculatory ducts.\\nDrawn from nature.\\nMicroscopical study of the structure of the ejaculatory ducts\\nshows that their fibrous coat is not very thick, heavy, or con-\\ndensed, and that their muscular coat is correspondingly sparse\\nand weak. A careful examination of these structures will con-\\nFig. 15.\\nShowing the position of the ejaculatory ducts in the middle of the prostate\\nunder the verumontanum just before they turn upward and end in the prostatic\\nurethra. Drawn from nature.\\nvince the observer, I think, that their role in ejaculation is either\\npassive or their function is to contract moderately after the ejacu-\\nlate has passed through them. There are no such firmness and\\ndensity of structure of the ejaculatory ducts as there are in\\nthe vesicles and ampullae, whose expulsive power is very great,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0059.jp2"}, "60": {"fulltext": "52 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nowing to the preponderating amount of unstriped muscular tissue.\\nIn the rhythmical process of ejaculation the secretion passes from\\nabove through the ejaculatory ducts, which then remain patulous,\\nand it enters the prostatic urethra, and just as this occurs the\\nprostate contracts quickly, firmly, and synchronously. The ejacu-\\nlatory ducts then contract as strongly as their feeble structure will\\nallow them. Thus the ejaculate is thrown forward.\\nThe chief function of the ejaculatory ducts, however, seems to\\nbe secondary to that of the orifices of the seminal vesicle and\\nampullae. The sphincteric action of these orifices is quite power-\\nful, owing to the goodly quantity of circular muscular fibres.\\nNow, added to this we have the secondary sphincteric action of\\nthe ejaculatory ducts, which closely compresses the lumen of these\\ncanals. It must be remembered that there is no fibrous and firm\\ntube to occlude, but there are so many trabeculations and redu-\\nplications in the mucous membrane of these ducts that by their\\ncoaptation alone the lumen is occluded, and by this condition,\\naided by moderate muscular contraction, they may be said to\\nbecome normally plugged up, and thus offer a bar to the escape\\nof secretions from above. In disease these parts become flabby\\nand their muscular tonus is more or less lost.\\nThe Intrinsic and Extrinsic Muscles of the Sexual Apparatus.\\nIn the performance of the sexual function a number of corre-\\nlated groups of muscles and muscular structures are concerned in\\nthe process of ejaculation, which are called intrinsic and extrinsic\\nmuscles.\\nThe intrinsic muscles, which are of the unstriped, involuntary\\nvariety, consist, first, of the musculature of the prostate and pros-\\ntatic urethra, which are described on page 42 second, of the\\nmuscular fibres seated in the walls of the seminal vesicles, of the\\nampullations, and of the ejaculatory ducts, and those of the cir-\\ncular and longitudinal muscular fibres connected with the corpus\\nspongiosum.\\nThe extrinsic muscles are of the striped or voluntary variety,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0060.jp2"}, "61": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0061.jp2"}, "62": {"fulltext": "PLATE IV.\\nntrinsic and Extrinsic Muscles of the Sexual Apparatus.\\n1. Corpus Spongiosum. 2. Bulbo-eavernous Muscle. 3. Isehio-eavernoii!\\nMuscle. 4. Transversus Perinei Muscle. 5. External Sphincter Ani\\nMuscle. 6. Levator Ani Muscle.", "height": "3963", "width": "2578", "jp2-path": "practicaltreat00tayl_0062.jp2"}, "63": {"fulltext": "ANATOMY. 53\\nand they consist of some of the muscles of the male perineum,\\nand of the anal region, and of some which belong to the penis\\nproper. These are all well shown in Plate IV.\\nIt is unnecessary to fully and technically describe these various\\nmuscles, since all the facts can be readily ascertained by consult-\\ning any text-book on anatomy. These muscles are as follows\\nthe bulbo-cavernous or accelerator urninse muscle, which surrounds\\nthe bulb and extends over the corpus spongiosum and on to the\\nside of the corpora cavernosa for a length of fully two inches and\\nperhaps more. These muscles compress the corpus spongiosum\\nand bulb. Secondly, the ischio cavernous muscles, also called\\nerector es penis, which are attached to the ramus of the ischium,\\nand are inserted on each side into the crus penis, and by their\\naction compress the parts and maintain erection. Thirdly, the\\ntransversus perinei, the external sphincter ani, and the levator\\nani, which give strength and firmness of support, and by their\\ncombined powerful contractions aid ejaculation of the semen.\\n(See sections on the Mechanism of Ejaculation in the next\\nchapter.)\\nTHE TESTES AND THE VASA DEFERENTIA.\\nIt is unnecessary in this work to give an elaborate and tech-\\nnical description of the minute structure of the testes, but certain\\ngeneral facts concerning these glands should be emphasized. In\\nthe glandular portion of these organs we find the conical-shaped\\nlobules whose apices end in the mediastinum testis. These lobules\\nare formed of convoluted seminiferous tubules, in which are devel-\\noped the seminal cells and the spermatoblasts. (See Fig. 16.)\\nEach lobule is enclosed in fibrous tissue, which forms the frame-\\nwork of the gland, its outer coat being the dense tunica albuginea,\\nand its inner portion, less dense, being the mediastinum testis,\\nthrough which the seminiferous tubes pass, turn upward at right\\nangles, and perforate the upper inner portion of the tunica albu-\\nginea. Here they become much enlarged and convoluted, and\\nform the globus major or head of the epididymis. All these", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0063.jp2"}, "64": {"fulltext": "54 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nminute seminal tubules then merge into one tube, which becomes\\nmuch convoluted on itself and forms the body of the epididymis,\\nwhich is the narrowed portion just below the globus major. Thi\\nconvoluted tube then forms a large mass, which is called the globus\\nminor or tail of the epididymis. From the globus minor the tube\\nascends, growing less and less convoluted, and then forms the\\nnearly straight tube the vas deferens which, with the vessels,\\nlymphatics, and nerves, and its connective tissue sheath, consti-\\nFig. 16.\\nTunica Vaginalis.\\ni\\\\mica Albuginea.\\nIts Septa.\\nShowing intimate structure of the testis. From Gray s Anatomy.\\ntutes the spermatic cord, which begins at the tail of the epididymis\\nand ends at the internal abdominal ring. (See Plate V.)\\nIt is well to remember that in health the spermatic veins coming\\nfrom the back of the testes become convoluted and form the pam-\\npiniform plexus. In disease this tortuosity of the veins is more or\\nless increased, and we have the condition known as varicocele.\\nAt the internal abdominal ring the vas deferens turns and\\ndescends into the pelvis, crosses the external iliac artery, curves\\naround the bladder on the outer side of the epigastric artery and", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0064.jp2"}, "65": {"fulltext": "PLATE V.\\nVAS DEFERENS\\nJUNCTION OF\\nPARIETAL\\nAND VISCERAL\\nLAYERS OF\\nTUNICA VAGI-\\nNALIS\\nLOBUS MAJOR\\nUPPER END\\nOF TESTIS\\nHYDATID\\nLOWER END\\nOF TESTIS\\nPARIETAL LAYER OF\\nTUNICA VAGINALIS\\nRight Testicle, its External Surface. (Testut.)", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0065.jp2"}, "66": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0066.jp2"}, "67": {"fulltext": "ANATOMY. 55\\ninner side of the ureter, backward and downward to its base,\\nwhere it becomes ampullated, as we have already seen.\\nA survey of the structure of the testes shows that pathological\\nchanges which destroy the tubules and the lobules may give rise\\nto sterility. In such an event, however, it would be necessary\\nthat all the glandular tissues of the organ should be destroyed.\\nBut it will be seen that the more vulnerable points are the medi-\\nastinum testis, and the head, body, and tail of the epididymis.\\nIn these parts such infiltration and compression may take place\\nthat the efferent ducts are obliterated, and thus no spermatic cells\\nor spermatozoa can escape from the testes.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0067.jp2"}, "68": {"fulltext": "CHAPTER III.\\nTHE PHYSIOLOGY OF THE MALE SEXUAL FUNCTION.\\nHaving acquired a clear knowledge of the anatomy and struc-\\nture of the sexual apparatus, it is now necessary to study in detail\\nthe physiology of the sexual function. To this end it is necessary\\nto describe in a lucid and concise manner the mechanism of erec-\\ntion, the mechanism of ejaculation, and the nature and composition\\nof the seminal fluid.\\nTHE MECHANISM OF ERECTION.\\nIn order to understand the mechanism of erection, or that state\\nof rigidity of the penis necessary for intromission and copulation,\\nthe facts connected with the anatomy and physiology of the gen-\\nital apparatus already brought out should be recalled to mind.\\nConcisely stated, this condition of erection may be induced by\\npsychical or tactile influences, or by the combination of both.\\nSexual impulses, as we have seen, originate in a sexual centre\\nwhich is seated in the lower lumbar part of the spinal cord. This\\ncentre is stimulated into functional activity by impressions or sen-\\nsations which originate in the brain, and are transmitted through\\nthe pedunculi cerebri and the pons down the spinal cord to it, and\\nalso by excitation and frictional influences which are applied to\\nsome part of the penis i. e., glans, frsenum, fossa navicularis,\\nor integument. In the first place, the mental excitation throws\\nthe genital centre into a condition of erethism, which immediately\\nacts upon the penis and its accessory sexual organs by means of\\nthe nervi erigentes, and causes its rigid condition. In the second\\ncase the peripheral nerve irritation is transmitted backward to\\nthe sexual centre by means of the sensory nerves, which throws", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0068.jp2"}, "69": {"fulltext": "PHYSIOLOGY OF THE 31 ALE SEXUAL FUNCTION. 57\\nthe centre into a condition of excitation, which is reflected or\\ncarried outward to the penis by the nervi erigentes, and erection\\nfollows.\\nIt is thought by some authors that besides the sexual centre\\nwhich governs erection there is also a centre for ejaculation.\\nThis view is mainly based on the not very uncommon occurrence\\nof erection without ejaculation. In many cases in which coitus\\nis thus interrupted some inhibitive influence is undoubtedly trans-\\nmitted from the brain, and in these cases at least there seems to\\nbe no necessity for supposing that there is an ejaculatory centre\\nthe function of which is disturbed.\\nThus we see that the requirements for erection are first, a\\nhealthy and stable condition of the genital centre secondly, a\\nperfect competence on the part of the nerves which originate\\nin the brain and of the erigentes and sensory nerves to transmit\\nthe influences of excitation which are communicated to them.\\nStimulation of the sexual centres with resulting erection may\\nalso occur through influences brought to bear upon the prostatic\\nurethra. Thus friction of this point by instruments and appli-\\nances passed down the urethral canal, either by the surgeon or by\\nthe individual himself for erotic purposes, excites the genital centre,\\nwhich reacts through the nervi erigentes upon the penis. Calculi\\nin the prostatic urethra and distention of the canal by urine also\\nproduce a similar effect.\\nThen, again, injury or disease of the lower part of the spinal\\ncord may cause erections by means of the irritation transmitted\\nfrom the sexual centre to the penis.\\nThe physiological actions involved in erection of the penis are\\nvery instructive and interesting. Under the influence of stimu-\\nlation of the nervi erigentes, derived, as we have seen, from the\\nsexual centre in the lumbar part of the spinal cord, a vasodilator\\naction takes place in all the erectile tissues of the penis. Coin-\\ncidently with the nervous excitation and vasodilator action, relax-\\nation of the muscular bundles and fibres of the trabecule of the\\ncavernous and spongy bodies occurs, and thus the full distention\\nof the blood sinuses and cavities is rendered possible. In propor-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0069.jp2"}, "70": {"fulltext": "58 SEXUAL DISORDERS OF THE MALE AND FEMALE\\n(ion, therefore, as the afflux of blood from the arterial capillaries is\\nabundant and the muscular relaxation is complete, so is the erec-\\ntion moderate or very firm.\\nAlthough little is said on the subject by authors, it is possible\\nthat the sympathetic nerves of the erectile tissues play an impor-\\ntant part in the production of erections. The function of these\\nsympathetic nerves is in immediate reciprocal relation with that\\nof the cerebro-spinal nerves. The former induce relaxation of\\ntissues and vascular dilatation, while the latter, the excitor\\nnerves, are concerned in the prompt and full supply of blood to\\nthe trabecular. If, however, the condition of the blood-supply\\nwere not safeguarded, and if an impediment were not provided\\nagainst immediate escape and return of that fluid to the body by\\nthe veins, erections would in all cases be abortive or of very short\\nduration. But perfect stability is insured and maintained by cer-\\ntain anatomical conditions. With the filling of the trabecular there\\nnaturally occurs an engorgement of the venous sinuses, which, in\\nits turn, so compresses the large longitudinal veins of the penis\\nthat decided stasis occurs, and thus the volume of distention of\\nthe penis is materially increased and maintained until orgasm or\\nejaculation has occurred.\\nFurther than this, the engorgement of the penis is also mate-\\nrially enhanced by the direct action of various extrinsic muscles,\\nnamely, the bulbo-cavernous muscle, which compresses the erectile\\ntissue of the bulb as well as the dorsal vein of the penis, and of\\nthe erector penis and the transversus perinei, which compress the\\ncrus penis and retard the return -supply of blood. The levator\\nani also acts as a powerful extrinsic compressor of the parts. (See\\npage 52, and Plate IV.)\\nThe mechanism of erection, therefore, depends on a peculiar\\nnervous stimulation which results in a well-defined temporary\\nblood-engorgement of the penis.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0070.jp2"}, "71": {"fulltext": "PHYSIOLOGY OF THE MALE SEXUAL FUNCTION. 59\\nTHE MECHANISM OF EJACULATION.\\nThe combined physiological processes which take place in the\\nproduction of erection are preparatory to the completion of the\\nsexual act, which culminates, in coitus, with emission or ejacula-\\ntion. The emission of semen is produced by a series of complex but\\ncorrelated agencies involving the whole sexual sphere. Whether\\nthere is a special sexual centre for ejaculation, as has been stated\\nbefore, is doubtful. With the development of the erotic impres-\\nsion and the erection of the penis the testicles are, in all prob-\\nability, thrown into a condition of increased functional activity.\\nThe first visible evidence of the participation of these glands in\\ncopulation or sexual erethism is the strong action of the cremaster\\nmuscles, which draw them quite tightly up to the internal abdom-\\ninal rings. Synchronously semen escapes from the coni vasculosi\\nof the epididymes and reaches the vasa deferentia. Arrived in\\nthese tubes, the strong circular muscular fibres contract power-\\nfully and rhythmically, and the fluid is forced up to the ampul-\\nlations of these tubes, which then become very much distended.\\nAt this moment the seminal vesicles become functionally active,\\nand they contract and expel part of their contents synchronously\\nwith a similar action of the ampullations of the vasa deferentia.\\nThe seminal fluid in relatively small quantity is thus mingled\\nwith the copious ejaculate of the seminal vesicles, and the mix-\\nture thus produced is thrown through the ejaculatory ducts, the\\nmucous membranes of which take on functional activity and add\\ntheir quota of mucous fluid, by strong muscular action, into the\\nprostatic urethra. While this part of the function has been going\\non the follicles of the prostate and the sinus pocularis have been\\nactive in the elaboration and expulsion of their secretions into the\\nprostatic urethra. At this moment the caput gallinaginis becomes\\nswollen and erect, and it so adjusts itself that in the normal state\\nthe seminal fluid must go forward through the now patulous ori-\\nfices of the ejaculatory ducts, and cannot pass backward. At this\\ntime the compressor urethral muscle is so relaxed that it offers no\\nimpediment to the escape of the semen, which is thrown out of", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0071.jp2"}, "72": {"fulltext": "60 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nthe prostatic urethra by means of the complex but powerful mus-\\nculature of this gland. At this crisis it is believed that the pecu-\\nliar sensation of the sexual orgasm is experienced. The combined\\nsecretion of the ampullations, of the vasa deferentia, of the semi-\\nnal veiscles, of the prostate, of the sinus pocularis, and of the\\nejaculatory ducts then flows into and distends the bulbous urethra,\\nbeing there mixed with the secretion of Cowper s glands. Then\\nthe circular muscular fibres of this portion of the urethra contract\\nforcibly, and at the same time the accelerator urinse muscles con-\\ntract upon the bulbous urethra, and thus the ejaculate is quite\\nforcibly thrown along the urethra and out of the meatus. In its\\npassage through the penile urethra the ejaculation. of the seminal\\nfluid is further accelerated by the rhythmical contraction of the\\ncircular muscular fibres of the corpus spongiosum. The secretion\\nof Littre s follicles and Morgagni s crypts lubricates the urethral\\ncanal and adds somewhat to the volume of the ejaculate. In the\\nact of ejaculation it can be seen that unstriped muscular fibres,\\nthe intrinsic muscular tissue of the sexual apparatus, play a very\\nimportant part but the completion of the act is largely aided by\\nthe powerful contraction of the extrinsic muscles, the levator ani,\\nthe external sphincter of Henle, the ischio caver nosus muscle, and\\nthe transversus perinei. As stated by Foster, 1 A contraction\\nbegins in the external sphincter ani, extends to the levator ani,\\nand then passes to the other muscles, progressing in a wave-like\\nmanner from behind forward, and is repeated in a more or less\\ndistinctly rhythmic manner until all the semen is ejected from the\\nurethra.\\n1 A Text-book of Physiology. Part iv. p. 373. London, 1891.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0072.jp2"}, "73": {"fulltext": "CHAPTER IV.\\nNATUEE AND COMPOSITION OF THE SEMINAL FLUID.\\nThe proper performance of the sexual function in the human\\nrace, the natural outcome of which is the propagation of the spe-\\ncies, requires not only the integrity of the composite mechanism\\nof the sexual apparatus, but also the elaboration of healthy semi-\\nnal fluid in normal quantity. A clear knowledge of the nature\\nand composition of this secretion in health is absolutely necessary\\nto the understanding of the changes which take place in it as a\\nresult of disease.\\nTHE SEMEN.\\nThe semen is a composite liquid of a whitish, opaline color,\\nsomewhat resembling starch paste, alkaline in reaction, and viscid\\nand ropy in consistence. It emits a peculiar odor, like that of\\nsawed bone. It is the combined secretion of the testicles, of the\\nseminal vesicles, of the prostate gland, of Cowper s glands, and of\\nthe muciparous glands of the urethra. According to Miescher, 1\\nwhose conclusions have been accepted by the best authorities, the\\ncomposition of semen is as follows Water, 82 to 90 per cent., the\\nremainder composed of serum albumin, alkali albuminate, henii-\\nalbuminose, nuclein, lecithin, guanin, hypoxanthin, protomin, fat,\\ncholesterin, inorganic salts, and phosphoric acid, muriatic acid in\\ncombination with inorganic salts, and organic bases.\\nWhen semen is examined under the microscope we find sperma-\\ntozoa, seminal bodies, and very fine seminal granules, with per-\\nhaps a few epithelial cells and crystals of phosphates, chiefly of\\nmagnesia and lime.\\n1 Verhandl. der Naturfor. Gesellsch. zu Basel, 1874, Band vi., Heft 21, p. 138.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0073.jp2"}, "74": {"fulltext": "62 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nSpermatogenesis. It is important here to call to mind the\\nessential facts concerning spermatogenesis. Upon the endothe-\\nlioid basement membrane of the convoluted seminiferous tubules\\nthe nucleated parietal cells are seated, the outermost layer of which\\nis composed of sustentacular cells, which are not concerned in pro-\\nducing spermatic elements. Inside and on the foregoing layer are\\nthe spermatogenetic cells, of which the outer ones are the longer,\\nor mother-cells, and the inner ones the smaller or daughter-cells.\\nFrom the nuclei of the latter cells spermatoblasts are developed,\\nand from these structures the spermatozoa are directly formed.\\n(See Fig. 17.)\\nFig. 17.\\nShowing transverse section of human seminiferous tubule 1, membrana pro-\\npria 2, zone of parietal cells 3, mother-cells undergoing division 4, partially\\ndeveloped spermatozoa 5, enveloping connective tissue. (After Peaesol.\\nThe spermatoblasts are closely packed together, side by side, in a\\nfinely granular semigelatinous substance. They gradually become\\nelongated and bean-shaped, and finally are elaborated into fully\\ndeveloped spermatozoa. Pearsol and others state that each\\nspermatozoon is developed from the nucleus of a spermatoblast.\\nThe secreting portion of the testes is confined to the convoluted\\nseminiferous tubules. From this part of the organ the sperma-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0074.jp2"}, "75": {"fulltext": "NATURE AND COMPOSITION OF THE SEMINAL FLUID. 63\\ntozoa enter the straight tubes or canals, pass into the vasa eff er-\\nentia, and from there through all the manifold convolutions of the\\nepididymis until they reach the vas deferens, which they traverse\\nuntil they arrive at the deferential ampullations and seminal vesi-\\ncles, where they remain until ejaculation occurs. The migration\\nof spermatozoa, probably, is effected by their own vibratile move-\\nments, but there are certain delicate vital and mechanical aids\\nwhich speed them on their journey. From the beginning of the\\nFig. 18.\\nShowing section of a tubule of the human epididymis: 1, membrana propria;\\n2, columnar cells crowned with, 3, long cilia; 4, layer of non-striped muscular\\nfibres 5, intertubular connective tissue 6, masses of spermatozoa in the lumen\\nof the tube. After Peaesol.\\nstraight tubules up to the ampullated expansions the seminal\\ncanals are lined with ciliated columnar epithelium and surrounded\\nby circular layers of unstriped muscular fibres, so that, in addition\\nto their own motility, these bodies receive propulsion from the\\nmotion of the cilia, and also by the rhythmical contraction of the\\nmuscular rings. (See Fig. 18.) It will thus be seen that the\\nprocess of spermatogenesis is a most delicate and elaborate one,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0075.jp2"}, "76": {"fulltext": "64 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nand that the mechanism of transportation of these vitalized bodies\\nis wonderfully Intricate and effective.\\nThe spermatozoa are highly vitalized elements composed of a\\nhead and a cilinm or tail, and in their shape resemble tadpoles.\\nThe head viewed on its broad surface is oval in shape, but when\\nexamined on its side it appears somewhat triangular or wedge-\\nshaped. The length of a spermatozoon is 50 to 60 ft, of which\\nthe head is 3 to 5 /i, while the rest consists of the thin, tapering\\ntail. The seminal bodies or cells are of considerable size, have a\\nwell-defined outline and granular appearance, and contain nuclei.\\nThe smaller cells are about four times the size of pus -corpuscles,\\nand contain a large nucleus and much granular protoplasm. The\\nlarge cells are oval or irregular in shape, and they may contain\\nseveral nuclei. Under high powers seminal cells show a fibrous\\nstructure. In my examinations I have most encountered the\\nseminal cells in the semen of young men and in those of early\\nmiddle age. It is not, I think, common to observe them in the\\nsemen of men past fifty years of age. In such subjects we usually\\nfind spermatozoa and seminal granules.\\nThe seminal granules are extremely minute and fine, sometimes\\npresenting a yellowish color, again having a greasy appearance.\\nThey have a much less refractive capacity than amorphous phos-\\nphates and carbonates, are very much smaller, and are scattered\\nevenly over the microscopic picture.\\nWhen healthy semen is allowed to stand in a test-tube the\\ntissue-elements slowly settle to the bottom, and in about twelve\\nhours we find that it presents two layers of equal bulk, an upper\\none, which is of the consistence of semen, and may be slightly\\nturbid or perfectly clear, and a lower one, which is opaque, and\\nlooks like starch or tragacanth paste. The lower layer is com-\\nposed almost wholly of spermatozoa.\\nAccording to Mehu, 1 healthy semen should on evaporation\\nyield 10 per cent, of its weight in organic and inorganic matters.\\n1 Kemarques eur les Variations de la Composition du Sperme dans quelques cas\\npathologiques. Annales des Mai. des Org. Gen.-urin., Tomei. pp. 303 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0076.jp2"}, "77": {"fulltext": "NATURE AND COMPOSITION OF THE SEMINAL FLUID. 65\\nWith the change in the composition of the fluid due to disease,\\nlocal or general, this quantity is proportionately lowered. In\\nazoospermatous semen the solid constituents are diminished about\\none-half in quantity.\\nThe microscopic picture of fresh, healthy semen presents a\\nbewildering appearance. It looks, as Ultzmann says, as if an\\nant-hill had been stirred up with a stick. The spermatozoa\\nsquirm about in the most lively manner, and there being so many\\nof them, and all of them going in zigzags, the eye may become\\nFig. 19.\\nShowing spermatozoa and seminal cells.\\nconfused by the sight. Their propulsive power is sometimes well\\nshown when they easily push crystals of inorganic salts several\\ntimes their size, and scattered over the field, out of their way.\\nAs a rule, it may be stated that in spermatozoa which have died\\nafter ejaculation the tail is well outstretched or slightly bent at the\\nend, whereas when they have been discharged dead the tail is\\nusually curled up or much twisted. In Fig. 19 spermatozoa are\\nshown as they appear under the microscope in life. The speci-\\nmen from which this figure was made was secured from a sper-\\n5", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0077.jp2"}, "78": {"fulltext": "6Q SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nma tic cyst in a vigorous young man. The heat applied to the\\nobject-glass in the drying process necessary to staining suddenly\\nkilled the zoosperms when they were wriggling in a very lively\\nmanner over the field. These spermatozoa, which are very large\\nand have very long tails, are good examples of these bodies in\\nstrong, healthy men.\\nIn weak, anaemic persons and in old men spermatozoa may be\\nsmaller than normal, having strikingly small and thin heads and\\nshort tails, and showing much less vigor of motion. On the other\\nhand, in some young and robust men they may be of exceptional\\nsize and very vigorous in their movements. In water, spermatozoa\\nsoon become motionless, but in alkaline or salt solutions, as well\\nas in those containing sugar, albumin, and urea, they seem very\\nvigorous. Cold, acids, and solutions of metallic salts quite quickly\\nkill these bodies. In the vagina the conditions seem favorable\\nfor the life of spermatozoa, and it is stated that they have been\\nfound in the cervical canal seven days after coitus.\\nUp to puberty the seminal fluid contains seminal granules but\\nno spermatozoa, and from that period until the age of fifty years,\\nand even beyond in well-preserved subjects, these bodies are healthy\\nand abundant. Toward sixty decrease in size, number, and vital\\nenergy is usually noted in spermatozoa.\\nThough authentic cases have been reported in which sperma-\\ntozoa were found in the semen of men of seventy and eighty years,\\nand even beyond these advanced ages, and although men over\\nninety years old have been known to procreate children, such\\noccurrences cannot be taken to constitute a rule, and they must\\nbe looked upon as very exceptional. A fair average, I think, of\\nthe limit of many men s virility in general is between sixty and\\nseventy or even seventy-five years, though there are very many\\nmen whose sexual powers and desires cease much earlier. It\\nmust be remembered that although spermatozoa may be found in\\nthe semen of aged men, it does not follow that they possess the\\nvital energy necessary to the fructification of the female ovule.\\nThe number of spermatozoa, as well as their structure and\\nvirility, varies according to the constitution of the producer. In", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0078.jp2"}, "79": {"fulltext": "NATURE AND COMPOSITION OF THE SEMINAL FLUID. 67\\nvigorous, robust meu they are found in abundance in a healthy\\ncondition.\\nLode/ by computation, estimates that at each normal ejacula-\\ntion a man discharges two hundred and twenty-five million sper-\\nmatozoa. Guelliot, 2 however, thinks that this estimate is too\\nsmall, and claims that in his researches the figures reached were\\nfour hundred and twelve million five hundred thousand sperma-\\ntozoa.\\nIn less robust persons these bodies are less abundant and have\\nless vital energy, while in weak and debilitated individuals they\\nare usually small in quantity and feeble in vitality. In some\\npersons they are after ejaculation rapidly replaced by a new crop,\\nwhile in others their generation is slow and meagre. During\\nacute illness of various kinds the function of the testicle is not\\nperformed, and in chronic diseases the development of spermatozoa\\nis slow, intermittent, and slightly productive.\\nExtended post-mortem studies made under my direction clearly\\nshow that the more nearly normal the sexual organs and function\\nare at the time of death the greater is the number of spermatozoa\\nin the seminal vesicles and the ampullae of the vas deferens.\\nIn one case of miliary tuberculosis, in a patient aged fifty-five\\nyears, the seminal vesicles were found contracted, their cavities\\nclosed and entirely devoid of spermatozoa. In a case of tuber-\\ncular peritonitis and in one of chronic uraemia no spermatozoa\\nwere found in either ampulla or vesicle. All of these cases had\\nbeen in very low general condition for from two to four weeks\\nbefore death.\\nIn two cases of pneumonia there were distinctly more sperma-\\ntozoa in the ampullae than in the seminal vesicles.\\nIn five cases the spermatozoa in the ampullae and vesicles were\\nvery numerous and nearly equal in number. These cases include\\nfracture of the skull, age twenty-two years cerebral hemorrhage,\\n1 Ueber spermaproduction beim Menschen und Hunde. Wien. klin. Wochen-\\nschrift, 1891, Band iv. p. 907.\\n2 La Numeration des Spermatozoi des. Annales des Mai. des Org. Gen.-urin.,\\n1892, Tome x. pp. 77 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0079.jp2"}, "80": {"fulltext": "70 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nFig. 20.) The greater part of the field is covered with large,\\nmedium-sized, and small globular masses of mucus, which, when\\nonce recognized, will afterward be readily detected. These globu-\\nlar masses are well shown in Fig. 20. It can be seen that they\\nhave no structure, and they may be mistaken for globules of oil\\nor air-bubbles. They are less refractive of light than air or oil,\\nand sometimes they have a whitish tint, like that of moon-stones.\\nThey may be of oval or of irregular shapes. They are surrounded\\nby small quantities of granular phosphates, and spermatozoa may\\nFig. 20.\\nJ\\nNormal secretion of the seminal vesicles.\\nbe seen intermingled with them. It is important to have a clear\\nidea of the composition of this secretion in health, in order to\\ncompare it with the appearances found in disease.\\nThe secretion of the seminal vesicles is relatively quite copious,\\nand by its viscidity, large quantity, and the force of its propul-\\nsion in coitus it carries the spermatozoa along in the rushing\\ncurrent toward the prostatic urethra. Besides this function, this\\nsecretion serves as a very efficient diluting agent in the seminal\\nejaculate.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0080.jp2"}, "81": {"fulltext": "NATURE AND COMPOSITION OF THE SEMINAL FLUID. 71\\nEven in health, but usually as a result of a chronic inflamma-\\ntory process, we may find calcareous concretions and certain little\\nyellowish masses, presumably of organic or inorganic origin, com-\\nposed probably of phosphates and mucus, which are called sym-\\npexia. Blood-corpuscles also may be noted as an accidental ad-\\nmixture. In some instances, under the microscope, epithelial cells\\nof the columnar variety may be found. No ciliated epithelial\\ncells are found in any part of the seminal vesicles.\\nThe Secretion of the Prostate Gland.\\nThe secretion of the prostate gland in a state of health is a thin\\nliquid of alkaline reaction and milky color, and from it the odor\\nof the semen is derived. It serves to dilute and render less viscid\\nthe secretion of the ampullations and seminal vesicles, and to exert\\na nutritional influence on the spermatozoa. When taken by aspi-\\nration and with care that there be no foreign admixture, from a\\nperfectly healthy prostate of a recently dead individual, the liquid\\nhas the appearance just described, and under the microscope it is\\nfound to contain cylindrical cells and some granular phosphates.\\nThe amount of mucus in the secretion is not great. In Fig. 21\\nthe microscopic picture of the prostatic fluid taken immediately\\nafter the sudden death of a young man whose gland was in a state\\nof perfect health is well shown. Many examinations have con-\\nvinced me that this is a typical microscopic picture of the normal\\nprostatic secretion. In health the granular phosphates are seen\\nto be not very copious in the secretion under the microscope, but\\nin disease these granules become very copious. (See Fig. 21, also\\nsections on Affections of the Prostate.)\\nThe prostate has no apparatus for storing its secretion, there-\\nfore the latter is elaborated in periods of functional activity and\\nof sexual excitement. There is usually a very moderate amount\\nof secretion in the tubules in the quiescent state, and this can be\\nobtained in small quantities after death, provided great care is\\ntaken in the removal of the sexual organs from the pelvic cavity.\\nIt is claimed by a number of writers that the prostatic secre-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0081.jp2"}, "82": {"fulltext": "72 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ntion contains an organic base, which, when acted upon by a chem-\\nical solution, becomes converted into what are known as Bottcher s\\nBperma-crystals.\\nBottcher s Sperma- crystals. These crystals are interesting\\ncuriosities rather than valuable diagnostic indices. They are\\nobtained by mixing about equal parts of azoospermatous semen\\nand a 1 per cent, watery solution of phosphate of ammonium.\\nIn this combination these crystals quite quickly form in great\\nnumbers. When normal semen is mixed with the phosphate of\\nFig. 21.\\nShowing normal prostatic secretion of a young man.\\nammonium solution these crystals form quite slowly and may be\\nsomewhat smaller in size. It is not uncommon to look in vain\\nfor them in this combination, since they are not invariably formed.\\nSperma-crystals are colorless, very transparent, and of quite\\nlarge size. The dominating forms of these crystals (see Fig. 22)\\nare in the shape of daggers or of cuttle-fish. In the first there is\\na median elevation, or ridge, which slopes gradually to the sides\\nof the crystals in the second the surface is moderately convex.\\nIn many crystals the dagger s point is broken off, and in others", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0082.jp2"}, "83": {"fulltext": "NATURE AND COMPOSITION OF THE SEMINAL FLUID. 73\\nit does not exist, as each end of the crystal is cut off at an oblique\\nangle. These crystals are sometimes so long that their whole\\nlength cannot be viewed in one microscopic field. In some crys-\\ntals a very fine longitudinal striation can, be made out. When\\nfractured these long crystals sometimes have jagged ends, like a\\nbroken piece of wood. There is a marked tendency of the crys-\\ntals to group together, to lie side by side and upon and across one\\nanother, and they sometimes appear to pierce and fuse with each\\nother, and without break or fissure to form a cross. It is not\\nuncommon to find a rosette-like arrangement of crystals which\\nFig. 22.\\nBottcher s sperma-ciystals.\\nis very pretty. Then, again, we may find rhomboidal forms, and\\neven thick, square crystals. Although sperma-crystals suggest to\\nthe eye the appearance of ammonio-magnesian phosphate, a little\\nexamination will soon show that they are rather less translucent\\nand brilliant and more uniformly dagger-shaped.\\nThe interest in these crystals centres in the fact that they are\\nsupposed to be the result of a combination of an organic base\\nwith an ammonio-phosphate salt. The organic base is thought\\nby Bottcher, Schreiner, and Poehl to be derived from the semi-\\nnal fluid, and is called by the latter spermin. Furbringer claims\\nthat this organic base exists only in the prostatic fluid therefore,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0083.jp2"}, "84": {"fulltext": "74 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nwhen these crystals are formed after the addition of the ammonio-\\nphosphate solution to a secretion derived from the sexual tract\\nthat secretion must have come from the prostate. On the other\\nhand, the more recent observations of Lubarsch 1 have convinced\\nhim that Furbringer is wrong, aud that these crystals have as\\ntheir organic base the epithelial cells of the testicles.\\nSeeing that we now have reliable descriptions and facts as to\\nthe microscopic appearance of the secretion of the seminal vesicles,\\nof the ampullae, and of the prostate, it is no longer necessary to en-\\ndeavor to fortify the diagnosis by the development and discovery of\\nBottcher s crystals, the opportunity of which very often fails, while\\nthe experiment in many instances comes to naught. It may be of\\ninterest here to state the fact that the crystals depicted in Fig. 22\\nwere found in the azoospermatous semen of a man, aged thirty-\\nfour, treated in the usual way by me, which secretion, when unmixed\\nAvith the chemical, contained very many seminal cells, all of which\\ndisappeared with the development of Bottcher s crystals. This,\\nthough a single, well-studied observation, is in striking support of\\nLubarsch s contention.\\nThe secretion of the ejaculatory ducts and of the sinus pocu-\\nlaris is in all probability simple mucus, and is not very copiously\\nproduced.\\nThe Secretion of Littre s Follicles, of the Crypts of Morgagni,\\nand of Cowper s Glands.\\nIn periods of sexual excitement Littre s follicles, Morgagni s\\ncrypts, and Cowper s glands give forth a quite abundant secretion\\nof clear, viscid, thready, alkaline mucus, which looks like the\\nwhite of an egg (unboiled) or glycerin. This secretion differs\\nmarkedly from the secretion furnished by the deeper parts of the\\nsexual apparatus. It is thrown into the urethra anterior to the\\ntriangular ligament, and is very frequently found without any\\nadmixture of secretion from the deeper parts. This secretion\\nseems to be concerned in the dilution of the semen. Its chief\\n1 Deut. med. Wochenschrift, 1896, No. 47.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0084.jp2"}, "85": {"fulltext": "NATURE AND COMPOSITION OF THE SEMINAL FLUID. 75.\\nfunction, however, is to neutralize the anterior urethra, which is\\nusually rendered acid by the passage of urine. It also acts as\\nan efficient lubricant in preparing the urethra for the transmission\\nof the seminal discharges. A portion at least of the secretion of\\nthe glands under consideration appears during erection and before\\nejaculation in the shape of one or two clear drops, which are seen\\nat the orifice of the meatus.\\nUnder the microscope we find in this secretion strings of mucin,\\nflat or cylindrical epithelial cells, and perhaps a few coffin-shaped\\ncrystals of phosphate of magnesia or lime. This secretion, which\\nis known when abundant under the name urethorrhoea ex libidine,\\nis usually of no significance whatever. It is found, as a rule, in\\ncases of sexual excitement, especially when it is great and pro-\\nlonged. It may also be observed in cases of excessive sexual\\nindulgence and of masturbation in young men, and is seen in\\ncases in which men, for various reasons, injuriously and frequently\\npress the glans penis between the thumb and forefinger.\\nThis secretion first appears as a thin cloud in the urine, -and\\nthen slowly settles to the bottom of the glass, from which it may\\nbe secured for microscopic examination by means of the pipette\\nas a small, clear, gelatinous mass.\\nIf the man has had a recent seminal emission or has indulged\\nin coitus within a few hours, some spermatozoa may have been left\\nin the urethra and have become entangled in this secretion. This\\naccidental occurrence may perhaps not be recognized by the micro-\\nscope, and erroneous ideas as to the nature of the secretion are\\nliable then to be formed. This fact should be remembered in\\nclinical practice.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0085.jp2"}, "86": {"fulltext": "CHAPTER V.\\nIMPOTENCE IN THE MALE.\\nBy the term impotence is understood a diminution or complete\\nloss of power to perform normal coitus. In the sexual act the\\nmost essential factors are the natural desire and a state of erection\\nof the penis, without which intromission is impossible.\\nNormal sexual intercourse varies very greatly in different indi-\\nviduals. In some men a condition of marked virility exists, while\\nin others the sexual appetite and power are much less fully devel-\\noped. As a broad, general rule, men having strong, robust consti-\\ntutions are sexually very potent, and in proportion as the general\\nstandard of health is lessened so are the sexual appetite and power\\ndiminished. Exceptions to this general average are sometimes\\nseen in neurotic and lustful persons, who, though not physically\\nstrong, have a constant desire for sexual indulgence. In these\\ncases, however, decline sets in sooner or later, and impotence in\\nvarying degrees may then be present.\\nSexual vigor, therefore, is a relative term, since what might be\\ncalled full virility in one man would feebly compare with the\\nmarked sexual capacity in another. In order to understand the\\nvarious features of sexual impotence in the male, it is necessary,\\nas I have already said, for the reader to have a clear knowledge\\nof the anatomy and physiology of the sexual organs, of the\\nmechanism of the sexual act, and of the nature of the seminal\\nfluid. (See Chapters II., III., and IV.)\\nBy the term impotence a number of closely connected condi-\\ntions and functions are included which demand a systematic\\nrecital. In the first place, the controlling influence or sexual\\ndesire must be present, and this requirement can only be fulfilled\\nwhen the brain is undisturbed and when the environment of the\\npatient is calm and satisfactory. The second essential is the erec-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0086.jp2"}, "87": {"fulltext": "IMPOTENCE IN THE MALE. 77\\ntion, which depends upon the integrity of the brain and the sexual\\nsystem and upon the harmonious working of the vascular and ner-\\nvous systems. When these intricate and correlated conditions are\\nin accord the consummation of the sexual act in orgasm and ejacula-\\ntion takes place, and the man may be said to be sexually potent.\\nImpairment of sexual desire may result from causes and condi-\\ntions soon to be considered. Imperfect erections may be due to\\nmental causes or to a number of physical conditions, which even\\nwith erection may interfere with the sexual act and render it pre-\\nmature, weak, or even prevent its consummation. When impo-\\ntence in the male is considered in detail it is found that 1, there\\nmay be absence or impairment of desire 2, absence of the power\\nof erection and intromission 3, absence or diminution of the\\npower of ejaculating the seminal fluid and, 4, a lowered standard\\nof or an entire absence of orgasm.\\nIn most cases of male impotence the fertility of the semen\\nremains intact, and impregnation of the female is reasonably\\nprobable if the male organ is sufficiently potent to discharge it\\nin the proper place. In the event of partial intromission, even\\nwhen of short duration, impregnation of the female may occur\\nbut when intromission is impossible a man naturally becomes\\nsterile, although his semen may be fertile.\\nWhen the whole subject of male impotence is carefully gone\\nover, it is found that the various cases may be conveniently sub-\\ndivided and arranged in four distinct groups. To the first, in\\nwhich brain-impressions play a prominent part, we may apply the\\nterm Psychical Impotence. The second class of cases, in which\\nsome damage, limited to one or more portions of the sexual sphere,\\nis the underlying cause, and the impotence a symptom thereof, the\\nterm Symptomatic Impotence is applicable. When impotence is\\ndue to impairment of the sexually controlling parts of the nervous\\nsystem, owing to various depressing causes, it may very properly\\nbe designated Atonic Impotence. And, fourthly, when any struc-\\ntural defect or disease so disturbs or cripples the penis that intro-\\nmission is interfered with or rendered impossible, the condition\\nmay be termed Organic Impotence.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0087.jp2"}, "88": {"fulltext": "CHAPTER VI.\\nPSYCHICAL IMPOTENCE.\\nThe term psychical impotence is applied to certain conditions\\nof sexual weakness or inability in which mental impressions inter-\\nfere more or less with sexual desire and with erection and ejacula-\\ntion. In many cases of this form of impotence the sexual organs\\nare in a perfectly normal condition in others there may be some\\nmild abnormality, but the dominating cause in all arises in the\\nbrain and in the impressions which it conveys. Whatever may\\nbe the condition operating on the mind, an inhibitory effect is pro-\\nduced upon the sexual centre, which impairs or paralyzes its action\\nand that of the nervi erigentes.\\nCases of psychical impotence are not uncommon, and are found\\nmore frequently in young men about the date of puberty, and\\nmuch less commonly in men up to the fiftieth year.\\nThese cases present very many and widely different clinical\\npictures, while the one underlying symptom is the sexual weak-\\nness or impotence.\\nIt is not uncommon for young men who have lived chaste lives\\nto find that at the first coitus they become so much excited that\\nthe penis does not become erect, and that it may even shrivel up.\\nIn some of these cases there may be partial erection and even a\\ndribbling ejaculation. The result of this dismal failure varies in\\ndifferent individuals. Some men look at the matter calmly and\\nphilosophically, reason with themselves that they are sexually\\nimpetuous, and they wait and try again. Others (and they are\\nin the majority) become very much depressed in mind and go\\npost-haste to the surgeon. In all these cases it is usually found\\nthat a little good advice and wholesome common-sense will put\\nthe man s mind at ease, so that he can soon perform the function\\nsatisfactorily. But in many cases a sense of timidity or fear is", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0088.jp2"}, "89": {"fulltext": "PSYCHICAL IMPOTENCE. 79\\ninduced, which, for a long or short time, renders the man sexually\\nweak or impotent. Such cases, if properly treated, can be cured.\\nSome timid men of a retiring disposition remain for long periods\\nabsolutely continent, and then fear that their penis is not properly\\ndeveloped, or that their testicles are inactive, and as a result they\\nbecome psychically impotent.\\nAnother class of cases of supposed impotence is found among\\nyoung men who constantly see and fondle their fiancees, and who\\nnaturally become sexually excited. As a result, such a person\\nnotices that a few drops of clear mucus escape from the meatus,\\nand that he may have queer but mild sensations in the penis and\\ntestes. In many of these cases the mind is not at all disturbed,\\nbut in some such is the sexual erethism and the impaired mental\\nstate that the man is unfitted for business and knows no comfort\\nor pleasure. He feels certain that he is losing semen, and as a\\nresult of his worry, his erections, which usually occurred in the\\nmorning and in times of loving dalliance, are no longer present\\nbut the so-called spermatorrhoea, which is only an escape of\\nnormal mucous secretion (urethorrhcea ex libidine), keeps up. In\\nthis state of mind he dreads the thought of marriage, and feels\\ncertain that he cannot perform the sexual act. In many cases\\nwhen the courtship is prolonged, and the courting seances are fre-\\nquent and protracted, the lot of these young men is a very unhappy\\none. They are constantly and regularly exposed to a sexual\\nerethism for which there is no legitimate relief at hand. After\\na time erections may not occur when in the company of his be-\\ntrothed, and they may or may not occur at other times. As a\\ngeneral rule, though erections are not experienced, the escape of\\nmucus occurs at each loving interview, and there may be pollu-\\ntions at night. Many young men thus tried remain steadfast and\\nloyal, and by the help of the surgeon (and sometimes by the\\npatience and tact of the wife) soon after marriage lose their fear\\nand enter into normal sexual life. Others, however, are less\\nscrupulous, and essay coitus with public women. In many cases\\nthat I have known these men have found relief, and have by\\npractice convinced themselves that they were potent, and they", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0089.jp2"}, "90": {"fulltext": "80 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nbecame correspondingly happy. Many of these backsliding men\\nI have known to become faithful and uxorious husbands and\\nhappy fathers of healthy children. Other men may have a less\\nfortuitous experience. They resolve to test their sexual capacity\\nwith some other female, and when the critical moment arrives\\ntheir morbid fear, increased, perhaps, by feelings of shame or\\nremorse at their unfaithfulness, so preys on their mind that sexual\\ndesire is absent and erection does not occur. The result is that the\\nman is still more unhappy, aud his fear troubles him incessantly.\\nIn many of these cases men have sexual desire and erections and\\nperhaps emissions when away from their prospective brides. To\\nsome this evidence of sexual activity is very reassuring, but to\\nothers the irregularity and abnormality of the condition are a\\nsource of even greater dejection. Under the stimulus of kindly\\nencouragement and by the aid of judicious advice these men sooner\\nor later may enter into a happy matrimonial state.\\nMany young men who have had more or less frequent and\\nnormal coitus before marriage, during courtship, become fearful\\nthat they may not be potent in the marriage-bed. They very\\noften go with their doubts to the surgeon, who should always\\nadvise them to entertain no fear in their mind, and should posi-\\ntively assure them that, notwithstanding they may have a few\\ninitial failures in their new relations, they will be competent. In\\nsome of these cases tonics and hygienic influences very often play\\na very useful part.\\nWe sometimes see cases in which nervous over-sensitiveness or\\nreligious scruples so act upon a man s mind that when he attempts\\ncoitus with a female he loses all desire and retires in disgust.\\nThen, again, some young men are so fastidious, and perhaps so\\nscrupulous, that they cannot associate, much less have sexual\\nintercourse, with public women. In general these cases in time\\nright themselves, but in some instances an abiding fear of sexual\\nweakness or impotence is left which may prevent a man from\\ncontracting matrimony. In none of these cases is there anything\\nseriously wrong, and a happy outcome can be induced if the\\npatient be properly advised and judiciously comforted. As a", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0090.jp2"}, "91": {"fulltext": "PSYCHICAL IMPOTENCE. 81\\nrule, marriage to a congenial helpmate soon leads to normal\\nsexual contact.\\nA goodly number of cases of sexual impotence are observed in\\nyoung and even middle-aged men who are submitted to severe\\nmental strain. In these cases there is usually an evidence of\\ngeneral ill -health, even of neurasthenia. Such men may be over-\\ntaxed in their professional duties (lawyers, civil engineers, mathe-\\nmaticians, etc.), or they, in their eager efforts to make money\\nquickly, are continually in a state of excitement and doubt, which\\ndisturbs their whole economy. As a result, they may lose all\\nsexual desire, and if they force themselves to coitus they experi-\\nence failure, or they may simply become sexually weak, and coitus\\nis with them unsatisfactory and feeble in character. In cases in\\nwhich the sexual organs were previously healthy this temporary\\ndisability ceases after a time, and the patient again becomes virile.\\nAVhen, however, the sexual tract has been the seat of inflamma-\\ntion (posterior urethra, prostate, ampullations, and seminal vesicles)\\nthe return to the normal state may be slow and halting.\\nA large contingent of impotent young men is composed of those\\nwho have been addicted to long-continued masturbation and to\\nsexual excesses.\\nThe impotence which follows in the course of masturbation is\\nsometimes very difficult to cure, and amounts to what may be\\ntermed irritable weakness. These patients have so long practised\\nthis solitary vice that it is often difficult to (as one may say)\\nswitch them off into natural habits. Xot only do they, in many\\ninstances, become averse to intimate relations with a woman, but\\nthey experience a sense of shame, and are very fearful that they\\nwill fail in coitus. Such men frequently have nocturnal pollu-\\ntions, which have a very damaging effect upon them mentally. In\\nthese cases there is very frequently more or less damage to the\\ndeep sexual parts, and as a result the disability is more pronounced.\\nIn very many cases of impotence incalculable harm is done the\\npatient by the mendacious exaggerations of quacks but this bad\\neffect is especially well marked in psychically impotent men who\\nhave practised masturbation.\\n6", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0091.jp2"}, "92": {"fulltext": "82 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nSexual excesses naturally lead to reaction in which the sexual\\ndesire is much less keen than formerly. This condition very often\\npreys on the patient s mind, and he fears that he has lost his virility.\\nIt is natural in these cases for a condition of sexual inertia to\\nensue, but except in very bad cases sexual power is not wholly\\ndestroyed. Rest and general hygiene usually bring the men out\\nof their slough of despond.\\nMen apparently vigorous in mind and body and of more advanced\\nage sometimes consult the surgeon for very insufficient reasons.\\nThey have had one or several attacks of gonorrhoea, perhaps, many\\nyears before, which in their cases have left no damage to the urethra\\nand prostate, but lately they had convinced themselves that their\\nsexual capacity was less vigorous than formerly, and that it must\\nbe due to their old trouble. In many of these cases the real con-,\\ndition is one of less keen sexual appetite and vigor, caused, in\\nmany cases, by mental and physical overtaxing, than was pos-\\nsessed in earlier years.\\nThe psychical effects of varicocele in inducing impotence are\\ndescribed in Chapter XX.\\nAs a rule, most men suffer from psychical impotence at some\\nperiod of their life for a longer or shorter time. Seeing that the\\nmind exerts such a far-reaching and controlling influence on the\\nsexual act, it can be readily understood that in the multiplicity\\nof disturbing causes which may operate on the brain a temporary\\nimpotence may be induced. Pleasant conditions and surround-\\nings are absolutely necessary for normal sexual contact, and when\\nin any manner these are disturbed the function is either interfered\\nwith or held wholly in check. Thus, a man may be disturbed\\nby ominous sounds, by unpleasant odors, by the necessity for\\nhaste, and by fear of discovery. Certain physical defects in the\\nwoman may abort all sexual desire. There may be a flabby vulva,\\nor a very large vagina, laceration of the perineum, or great red-\\nness of the vulva, or the presence of a purulent discharge. Ex-\\ncessive obesity in the female in many instances has been known\\nto cause irremediable impotence of the male consort. Warts or\\nred or eczematous patches in and about the labia majora and minora", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0092.jp2"}, "93": {"fulltext": "PSYCHICAL IMPOTENCE. 83\\nhave been known to cause a sudden inhibitory effect. The fear\\nof contracting a venereal disease often puts an end to the attempt\\nof a man at coitus with a public woman. Then, again, a man\\nmay be indifferent or may feel a repugnance to a woman, or a hus-\\nband may entertain a suspicion as to the fidelity of his wife. All\\nthese conditions may produce a disturbing effect on the brain and\\nsexual centre.\\nIn some cases the loss of a beloved wife or mistress so preys\\non a man s mind that for a time he has an aversion to the female\\nsex, and he may be temporarily impotent. Cases have been\\nreported in which men, in order to perform vigorous coitus with\\na woman to whom they were rather indifferent, have had to fix\\ntheir minds during the act upon the voluptuousness of another\\nand highly-prized consort. Many men are very vigorous with\\nsome women and can have only unsatisfactory coitus with others.\\nAlcoholics, as a rule, stimulate the brain and sexual centre, and\\nin cases of psychical impotence they (as we may say) help many\\na lame dog over the stile. A case, however, has been reported\\nin which a drunken man failed to copulate with a woman of the\\ntown, and when informed of the fact he was so depressed that for\\na time he was impotent. A curious case is on record of a man who\\nhad normal coitus with other women, but could only cohabit with\\nhis wife when he was much enraged. Many women have little\\nsexual desire to some sexual contact is unpleasant and even\\nrevolting while others reluctantly consent to it, and wonder at.\\ntheir husband s carnal lust. Such frigidity on the part of the\\nwife naturally reacts powerfully on the husband, who may become\\nsexually weak or even impotent.\\nSome men have a predilection for certain women one likes a.\\nblonde, another a brunette, while still others yearn for a fiery\\nauburn consort, and none of these men can have full and satis-\\nfactory sexual intercourse unless congenially mated.\\nWe occasionally meet with cases in which there exists what\\nmay be termed sexual apathy, due, perhaps, to some condition of\\nthe brain and sexual centre. In all of these cases (and I have\\nseen fully a dozen) the virility of the man has never been up to", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0093.jp2"}, "94": {"fulltext": "84 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nthe standard of normal development. As boys they may or may\\nnot have masturbated for a few times and generally at long inter-\\nvals, and very often as a result of curiosity inspired by other\\nboys. At and after puberty they may have infrequent sexual in-\\ntercourse, which gives them little or no pleasure then the sexual\\ndesire ceases, and they bother themselves no longer with the\\nmatter. In most of these cases the patients are hard workers\\nmentally or physically, or in both directions, but they never\\nbecome melancholic.\\nA number of very interesting cases of psychical impotence\\nhave been published in medical literature. A peculiar case is\\nreported of a gentleman who, while on a visit to the country, was\\nseduced by a lady in full walking costume. During a period of\\none year he continued to cohabit with the same woman, under\\nsimilar conditions. He later on married an estimable and healthy\\nwoman, and though in the full exercise of all his mental and phys-\\nical powers, he was unable to begin or even to complete the act.\\nHis previous intercourse with a woman in full dress had disturbed\\nhis equilibrium so much that he could not perform the act until\\nhis wife had her clothes on.\\nIn striking contrast with the foregoing case is that of a man\\nwho for years had had coitus successfully when in the seclusion\\nof his bed-chamber and without the accompaniment of dress. On\\nseveral occasions he endeavored to perform the act both with a\\nmistress and later with his wife when dressed, and he failed dis-\\nmally every time.\\nA remarkable example of psychical impotence was observed\\nin the case of a prominent mathematician who married a lady\\ncongenially suited to him. Both were in perfect health and de-\\nsired children, yet at every attempt to complete intercourse some\\nabstruse problem would force itself into the mind of the professor\\nand destroy at once all capacity for the performance of the act, so\\nthat he was compelled to give up the attempt. Again and again\\nthe same accident occurred. It seemed utterly impossible for him\\nto control his mind in the matter of mathematical problems suffi-\\nciently long to accomplish anything. The family physician finally", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0094.jp2"}, "95": {"fulltext": "PSYCHICAL IMPOTENCE. 85\\ncounselled him to get partially under the influence of alcohol and\\nthen try. He took the advice, and was enabled to reach the\\ndesired goal without any further trouble.\\nA case is on record of a man who was much enamored with a\\nlady whose right leg had been amputated at the thigh. He always\\nhad satisfactory coitus with this person, but was entirely impotent\\nwith perfectly formed women. Later on in life it was always\\nnecessary to his sexual gratification that he should have a consort\\nwho had only one leg.\\nIt is a matter of history that a man, at other times perfectly\\nvirile, who had been a member of the volunteer fire department,\\nwas never able to have coitus at night, for the reason that when-\\never he went to bed it was with the expectation that he would\\nhave to go to a fire.\\nOn this subject Howe 1 says Even in persons of vigorous\\nhealth, psychical impotence may result from fear. Impotence\\nhas been produced in a healthy man by a friend s recital of his\\nown surprising failure. The thought of the accident that befell\\nthe friend occurred at the time of intercourse, and he, too, failed.\\nA married patient of mine, a lawyer, with excellent physique, the\\nfather of two children, became temporarily incapacitated in this\\nway Reading in a medical journal that impotence might attack\\nhealthy persons, temperate in all things, and without notice, he\\nbecame impressed with the fear that a similar accident might\\nbefall himself. Curiously enough, the next time he attempted\\nintercourse the fear took complete possession of him, and he\\nbecame temporarily impotent.\\nFinally, there is a class of cases of men who are temporarily\\nimpotent for the reason that they have got out of practice. Thus,\\na husband is away for a long period from or loses a beloved wife,\\nand for a time so cherishes her memory that his sexuality is dor-\\nmant. Or a man may lose a very congenial mistress, and for a\\ntime sexual desire seems extinct. Then, again, for various causes?\\nsome men suddenly cease to have sexual intercourse, and for a\\n1 Excessive Venery, etc. p. 85 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0095.jp2"}, "96": {"fulltext": "86 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nlonger or shorter time are much occupied mentally or are greatly\\nworried. In these cases very often a feeling of doubt and timidity\\nis developed, and the man refrains from sexual intercourse. Accord-\\ning to my observation, in the course of time most of these men?\\nwhen not very old, find congenial females as wives or consorts,\\nand then the supposed sexual incapacity soon gives way to gratify-\\ning vigor.\\nThe prognosis in these cases is good.\\nTreatment. In all cases of psychical impotence the surgeon\\nshould seek out the cause and then give directions as to its removal.\\nPatients thus affected need kindly advice, encouragement, and a\\nplain statement of the exact facts in their case. They should be\\nfirmly assured that they are in no danger of losing their virile\\npower, and that they must under no circumstances give way to\\ndoubts and dreads.\\nIn the cases of men who become much excited and have a\\nmucous discharge while near or fondling women, speedy marriage\\nshould be recommended. It is always most important that ex-\\ncesses in coitus should not be indulged in, and that when the act\\nis performed the surroundings should be pleasant and satisfactory.\\nGood hygiene, avoidance of exposure to sexual excitement,\\nplenty of fresh air, out-door exercise, and wholesome food, will\\ncontribute largely to the patient s well-being. In many cases\\nrelief from all business cares and occupations, with entire relaxa-\\ntion, is productive of great benefit. According to indications,\\nmassage, cold douches, salt-water bathing, electricity, and stupes\\nmay be employed\\nIron, quinine, coca, kola, arsenic, and the animal extracts may\\nbe used when the necessity for them is indicated. In some cases\\ntincture of cantharides (10 to 15 drops three or four times a day)\\nhas seemed to be very beneficial. With due restraint as to inor-\\ndinate alcoholic indulgence, it may on occasions be necessary to\\nstimulate a man s flagging energy by means of whiskey, brandy,\\nchampagne, or Burgundy.\\nIn all cases it is incumbent on the surgeon to carefully explore\\nthe whole genital tract, in order to ascertain whether any part is", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0096.jp2"}, "97": {"fulltext": "PSYCHICAL IMPOTENCE. 87\\nin a morbid condition. This examination should be very thorough\\nand the condition of the meatus, urethra, prostate, seminal vesicles,\\nand ampullations should be clearly ascertained. In addition, a\\nthorough examination of the bladder, anus, and rectum should\\nbe made.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0097.jp2"}, "98": {"fulltext": "CHAPTEK VII.\\nSYMPTOMATIC IMPOTENCE. 1\\nIn a considerable proportion of cases of impotence certain\\nmorbid conditions of the end of the penis, of the bulbous urethra,\\nof the prostatic urethra, and prostate gland, and perhaps of the\\nseminal vesicles, so react on the sexual sphere that a condition of\\ndiminished vitality and function is induced. Unfortunately, in\\nthese cases we possess no facts derived from the post-mortem\\nstudy of the conditions of the sensory sexual nerves or of the\\nsexual centre.\\nOur knowledge of the morbid changes in the sexual tract is\\nquite full and tolerably clear, but how these changes operate\\non the nerves and the spinal cord centre, and what structural\\nconditions they produce, are mysteries to us\\nWhatever the morbid change may be the effects in many cases\\nare very apparent, and the thought suggests itself that some tem-\\nporary damage has been done to the sensory nerves or the sexual\\ncentre by which their function is more or less impaired.\\nImpotence being symptomatic of the above-mentioned well-\\ndefined morbid conditions of the sexual tract, it seems to me\\nmore natural to designate this disability as symptomatic impo-\\ntence rather than as atonic impotence the term which is used\\nby several authors.\\nWe are certain as to the symptoms, but we do not know about\\nthe atony. A clear and systematic presentation of this subject\\ncan only be given by adopting an anatomical basis by which the\\nvarious sources of irritation may be studied seriatim, and their\\neffects may then be lucidly traced.\\n1 See also Chapters XVI., XVII., and XVIII.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0098.jp2"}, "99": {"fulltext": "SYMPTOMATIC IMPOTENCE. 89\\nPERIPHERAL IRRITATION.\\nImpairment of the sexual function, even to the extent of de-\\ncided impotence, may be due to congenital and acquired malfor-\\nmations of the prepuce and glans penis. The following case\\npresents interesting features\\nA man, twenty-six years old, who had never had gonorrhoea,\\nand who had practised masturbation very slightly, was married\\nto a very attractive and congenial lady of his own age. During\\na period of six months the man had many times indulged in coitus,\\nwhich on no occasion was satisfactory. His erections were at first\\nnearly normal, but ejaculation was always premature, and the\\nsexual act was never completed. This state of affairs went on\\nuntil just before the patient consulted me. He was then very\\nmuch worried, and physically was below par. Examination of the\\nurethra, prostate, and seminal vesicles showed these parts to be in\\nnormal condition. But the condition of the distal part of the\\npenis demonstrated the cause of the trouble. The prepuce was\\nlong and tight, and its orifice, which was very much reddened,\\nwas abnormally small. When by some force the prepuce was\\nretracted a reddened, pouting condition of the meatus was found,\\nwhich extended into the urethra. The glans penis was red and\\nvery tender. The diagnosis of extreme peripheral irritation of\\nthe penis was made, and circumcision was, with the patient s con-\\nsent, performed. Within six weeks erections became normaland\\ncoitus was satisfactorily indulged in. In this case there was not\\nany subsequent impairment of the sexual power.\\nI have seen several cases in which erections were flabby and\\nejaculations were premature, which resulted from adherence of the\\nprepuce, which had existed from birth and which gave rise to\\nvenous stasis of the prepuce and glans.\\nIn like manner I have several times seen a short, fibrous frse-\\nnum, with long, tight prepuce, give rise to symptoms which con-\\nvinced the patient that he was impotent. Smallness of the meatus,\\nboth congenital and acquired, from chancroidal or syphilitic ulcera-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0099.jp2"}, "100": {"fulltext": "90 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ntion, not infrequently, in my experience, has caused such impair-\\nment in the commencement of the sexual act that its full per-\\nformance became impossible. In this connection it is well to add\\nthat in the case of a nervous young man who had a halo of soft,\\nsmall vegetations in the coronal sulcus, such was their tenderness\\nthat on intromission of the penis the erections instantly ceased\\nand ejaculations took place at once.\\nAs a rule, cases of partial or complete impotence, due to these\\nmalformations of the penis, are promptly cured by operation, and\\nthe probable existence of these causes shows how important it is\\nin every case to carefully examine the virile organ.\\nIn these cases just considered there may be little or no mental\\nsuffering, or the patient s condition may give him serious concern.\\nBut, as a rule, operation gives such prompt and decided relief\\nthat mental depression is soon dispelled.\\nUnfortunately, in some of these cases of irritation of the pre-\\npuce and the glans there is a history of early, energetic, and long-\\ncontinued masturbation, which has caused chronic congestion in\\nthe posterior urethra, together with emissions and imperfect erec-\\ntions. In these cases relief is sometimes somewhat slow in coming\\non, and, besides operations on the prepuce and glans, careful treat-\\nment of the urethra is necessary.\\nIt happens, though quite rarely, in some of these cases that a\\ncondition of morbid fear remains for some time, which prevents\\nnormal coitus but cheering and comforting advice, supplemented\\nby tonics, fresh air, and sea and cold baths, generally tend to\\nrestore the confidence and virility of the patient.\\nCHRONIC BULBOUS URETHRITIS AND STRICTURE.\\nChronic inflammation of the bulbous urethra alone furnishes\\nquite a large contingent of sexually weak and impotent men.\\nThese patients may or may not have been addicted to masturba-\\ntion and sexual excesses. They usually give a history of an early\\nand severe attack of gonorrhoea, followed by a more or less per-\\nsistent gleet, and perhaps other attacks of gonorrhoea. They are", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0100.jp2"}, "101": {"fulltext": "SYMPTOMATIC IMPOTENCE. 91\\nusually men between thirty and fifty years of age, and they pre-\\nsent themselves with a history of waning erections, premature\\nejaculations, and lessened desire. Many of these men say that\\ntheir attention was first called to the disturbed sexual function by\\ntheir inability to promptly produce normal ejaculations. The\\nsexual act in these cases is at first somewhat prolonged, and this\\ndilatoriness gradually becomes more pronounced. Then deficiency\\nin erection is noticed, together with feeble, flabby, and perhaps\\npremature, ejaculations and very often nocturnal emissions. I\\nhave many times been much surprised at the patience and equa-\\nnimity with which these patients regarded their disability. In\\nmy experience in this particular class of cases mental worry is\\nnot often observed, and sexual neurasthenia is very exceptional\\nindeed.\\nIn many of these cases we find submucous cell-infiltration\\naround the bulbous urethra, which may be contracted to 25 or\\neven 20 of the French scale. In some cases the new cell-forma-\\ntion is soft and succulent in others it is more dense. I have\\nvery many times carefully examined these cases as to the condi-\\ntion of the anterior and posterior urethra, and found that the\\nmorbid process was localized in the bulbous urethra, and that the\\nprostate and seminal vesicles were healthy.\\nAs a rule, these patients can be benefited and cured if they will\\nrefrain from sexual excitement and excesses in other directions\\nthan coitus, but not otherwise.\\nA more pronounced class of cases is seen in men who have true\\nstricture at the bulb. The less severe class of cases is found, as a\\nrule, in men about thirty to thirty-five years of age, in which the\\nstricture tissue is not, as yet, very firm and dense. The severer\\nform includes those cases in which much fibroid infiltration, even\\nto the extent of nodulation, is present.\\nIn many of these cases, before the difficulty in urination is ex-\\nperienced, or when it is very slight and mild, the patients begin\\nto experience the same sexual debility that sufferers from chronic\\nbulbous urethritis complain of, as we have already seen. In this\\ncondition gradual dilatation is indicated, and, if well borne, with", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0101.jp2"}, "102": {"fulltext": "92 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nthe increasing size of the canal improvement in sexual desire and\\npower is induced sometimes in a surprising degree but in some\\nmen, particularly those in whom the sexual appetite has never\\nbeen very active, the desire and power in coitus return slowly\\nand with halting intervals. When the stricture is very dense\\nand tight the return of sexual activity may be quite slow but,\\nin general, a guardedly favorable prognosis may be ventured.\\nWhen the stricture is very small an impediment to the escape\\nof semen is produced, and then, in addition to impotence, the\\npatient is aspermatous.\\nCHRONIC BULBOUS AND POSTERIOR URETHRITIS.\\nChronic inflammation of the bulbous and posterior urethra is\\na not uncommon cause of sexual weakness and impotence. This\\ncondition is well shown in the following case\\nA man, aged thirty-two years, thin, nervous, and somewhat\\nworried, had masturbated from his seventeenth year until shortly\\nbefore his marriage, two years previously, having had gonorrhoea\\nin a mild form and of short duration when he was twenty-four\\nyears old. Several months before the ceremony he began to suffer\\nfrom emissions, which occurred several times a week. He found\\ncoitus impossible, though he had partial erections in the morning.\\nPhysical examination showed intense congestion of the bulbous\\nand prostatic urethra, with considerable thickening of the former\\nand a scanty mucopurulent secretion. Rectal examination of the\\nprostate gave no results. By the careful use of moderate-sized\\nsounds, beginning with one of calibre 24, French scale, chilled in\\nice-water, and nitrate of silver instillations, together with hygiene\\nand tonics, this unpromising case slowly improved. At first the\\nerections were not perfect and were of short duration, but later\\non they became normal.\\nAs a rule, cases of sexual debility like the foregoing, in which\\nthe bulbous and posterior urethra is involved, are quite refractory\\nto treatment, and they demand much care and attention from the\\nsurgeon.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0102.jp2"}, "103": {"fulltext": "SYMPTOMATIC IMPOTENCE. 93\\nCHRONIC BULBOUS AND POSTERIOR URETHRITIS\\nWITH PROSTATITIS.\\nA more advanced class of cases is sometimes observed in which\\nthe bulbous and posterior urethra, as well as the prostate, is in-\\nvolved. This combination and its effects are well shown in the\\nfollowing case\\nA man, aged thirty-two, of good physique and sound mind,\\nhad indulged freely, and at times excessively, in sexual inter-\\ncourse since his eighteenth year. He had mild gonorrhoea when\\ntwenty years old, and again when twenty-eight. For two years\\nprior to his first visit to me he had noticed a small mucopuru-\\nlent globule at the meatus every morning, and had felt an uneasy,\\ndull, burning pain in the perineum and near the anus. There were\\nincreased frequency of urination, and moderate discomfort at the\\nend of the act. His sexual desire and activity had been going\\nfrom bad to worse for a year. The first jet of urine contained\\nthreads of pus, mucus, and epithelium. Examination of the\\nurethra revealed great tenderness in the bulbous and prostatic\\nportions, with so much thickening of the walls as to hug quite\\nfirmly a bougie a boule, No. 25, French scale. The prostate was\\nsomewhat enlarged and tender in all directions, particularly on\\nthe left side, and after massage a milky, mucoid fluid peculiar to\\nchronic tubular prostatitis escaped from the meatus. In this case\\ncold sounds of increasing size, with nitrate of silver instillations,\\nalternating with moderate lavage of the posterior urethra with a\\nsolution of permanganate of potassium (1 2000), cured the local\\nprocess, and coincidently the sexual function became more vigor-\\nous until the normal standard was reached.\\nIn the foregoing case there was only a moderate amount of\\nmental uneasiness regarding the urethral and sexual troubles. In\\nsome of these cases, however, the mental trouble is quite severe,\\nand in exceptional instances true sexual neurasthenia is observed.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0103.jp2"}, "104": {"fulltext": "94 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nCHRONIC POSTERIOR URETHRITIS.\\nCases of sexual debility and of impotence are sometimes observed\\nin which the underlying morbid process is seated in the posterior\\nurethra, and in which the prostate itself is not involved. Post-\\nmortem examinations have clearly shown that gonorrheal inflam-\\nmation may be strictly limited to the epithelium and the submucous\\nconnective tissue layer of the posterior urethra notably that por-\\ntion covering the venimontanum. I have carefully examined the\\nurethra and the urine of very many cases in which all signs pointed\\nto posterior urethral involvement alone, and the most thorough\\nexamination of the prostate by the aid of the finger in the rectum\\nfailed to reveal any evidence of disease. To further confirm the\\ndiagnosis, the urine passed after the prostatic massage was micro-\\nscopically examined, and the characteristic tissue elements and\\nphosphatic salts were not found. I am thus emphatic and precise\\nin details, for the reason that there is a tendency on the part of\\nsome writers to ascribe all symptomatic (or, as they term it, atonic)\\nimpotence to lesions of the prostate, and to deny to posterior\\nurethritis any pathogenic influence.\\nCases of sexual debility and impotence in which chronic poste-\\nrior urethritis is found as the probable morbid factor, present, as\\na rule, the symptoms peculiar to that disease. Such patients give\\na history of gonorrhoea which has left in its wake a tendency to\\nfrequent micturition, with, perhaps, more or less uneasiness at the\\nend of the act. In some cases there is, besides, a history of recur-\\nrent slight hematuria in others, of a sensation of deep pelvic\\nand rectal uneasiness. Some of these patients have noticed that\\ntheir urine, particularly that which is first passed in the morning,\\ncontained gonorrheal threads. In these cases the development\\nof the sexual debility is usually slow, and it begins with feeble\\nerections, protracted sexual act, and dribbling and perhaps pre-\\nmature ejaculations, without or with a diminution in the intensity\\nof the customary orgasm. Beginning in this manner the disability\\nbecomes more or less pronounced until an impotent state is reached.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0104.jp2"}, "105": {"fulltext": "SYMPTOMATIC IMPOTENCE. 95\\nPatients who suffer from this form of impotence are usually\\nmen of thirty years and beyond even to fifty years. It is\\nsometimes seen in men between the ages of twenty and thirty.\\nAs a rule, this form of impotence is more or less promptly\\nrelieved by treatment and although some men suffering from it\\nbecome worried and dejected, and even neurasthenic, in my ex-\\nperience they, in general, regard the matter quietly and philo-\\nsophically, and aid the surgeon in his efforts to cure them.\\nMany of these patients have been guilty of sexual excesses, and\\nsuch subjects should be made to clearly understand that a return\\nto their old practices will be followed by more permanent impo-\\ntence.\\nKnowing, as we do, that so many sensory nerves end in the\\nverumontanum, and that this part is so constantly and severely\\ninvolved in chronic posterior urethritis, the question suggests\\nitself whether this form of impotence is caused by the irritation\\nof the ends of these nerves, which is conveyed backward to the\\nsexual centre, and there, after a period of excitation, produces a\\ncondition of sedation?\\nCHRONIC PROSTATITIS.\\nA very large proportion of the cases of symptomatic impotence\\nare found in men who are suffering from chronic prostatitis. In\\nalmost all of these cases the disease of the prostate has been caused\\nby early and long-continued masturbation, by sexual excesses, by\\nsexual excitement without natural relief, by coitus reservatus, and\\nas a result of gonorrhoea.\\nThe patients suffering from this form of impotence may be\\nyoung (and they are in the majority), middle-aged, or old. They\\ncomplain of various conditions of disability namely, of lack of\\ndesire (and in some impetuous desire), of imperfect erections or\\nabsolute want of erections, of feeble and protracted coitus, or of\\npremature ejaculations. They often have nocturnal emissions, and\\nsome have fairly good erections when they are not near women,\\nbut these usually fail them when they come to close quarters.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0105.jp2"}, "106": {"fulltext": "96 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nYoung men in particular who are thus affected constitute the\\nlarge army of sufferers from so-called spermatorrhoea. They\\ncomplain that their semen escapes either after urination and defe-\\ncation, and during severe physical exercise, or involuntarily. In\\nmany of these cases, particularly in young and middle-aged sub-\\njects, there are observed mental worry, hypochondriasis, and even\\nneurasthenia.\\nMany of these cases are very amenable to treatment, others\\nyield less readily, while not a few are very refractory. In some\\ncases intense sexual erethism is very persistent and damaging in\\nits effects. Such patients may endeavor to force themselves to\\ncoitus, and usually fail, or they may subject themselves to sexual\\nexcitement, or to unnatural practices, and always with bad effect.\\nIt is only necessary here to give this general outline of what we\\nmay call prostatic impotence, and to refer the reader to the chapter\\non Chronic Prostatitis for more minute details as to the varieties\\nof cases and their symptoms.\\nINFLAMMATION OF THE SEMINAL VESICLES.\\nThere is a tendency nowadays to ascribe many cases of sexual\\nweakness and impotence to inflammation of the seminal vesicles,\\nand to deny that the prostate is in any way a pathogenic factor.\\nIn order to gain true and clear views as to the probable influence\\nof spermato-cystitis on the sexual functions, I have made many\\nobservations and examinations, and have supplemented them by\\nlong-continued and extended microscopical study of the urine, of\\nthe semen, and of abnormal discharges from the urethra in these\\ncases. These studies have been unbiased by any theory, and have\\nnot been prejudiced by any peculiar ideas or views my aim has\\nbeen not to theorize, but to put a proper interpretation on the facts\\ncarefully elicited and the appearances presented. As a result of\\nextended observations and close study, I am led to believe that\\ndisease in the seminal vesicles is rather rare, and that seminal\\nvesiculitis plays a subsidiary role in the production of impotence.\\nIt is rather uncommon to find any trouble beyond the prostate in", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0106.jp2"}, "107": {"fulltext": "SYMPTOMATIC IMPOTENCE. 97\\nyoung and impotent men, particularly in masturbators and those\\nwho have not suffered from chronic gonorrhoea and if the seminal\\nvesicles seem involved, it is only as a concomitant, or, perhaps we\\nmay say, a complication of chronic prostatitis. In a number of\\nmiddle-aged men, and in some past fifty years of age, who have\\nsuffered from impotence, I have found direct evidence of chronic\\ninflammation of the seminal vesicles, but in every case there was\\nunmistakable evidence, either on rectal palpation or in the micro-\\nscopic examination of the expressed secretion, that the prostate\\nwas also the seat of disease. In the light of my present experi-\\nence I am led to think that in some (not numerous) cases of mas-\\nturbation and gonorrhoea in young impotent men the prostate and\\nseminal vesicles are involved, but that in general this symptom-\\ncomplex is found in men of forty years of age and beyond, who\\nhave been masturbators, have had chronic posterior urethritis,\\nand who throughout life have been very vigorous sexually or have\\nindulged to excess and perhaps abnormally. In this restricted\\nmanner I am disposed to look upon seminal vesiculitis as a cause\\nor factor in the development of symptomatic impotence.\\nIt must be remembered that in this chapter only a general sur-\\nvey of the subject of symptomatic impotence is given, but that it\\nis further fully elaborated in the matter of clinical history and\\ntreatment in Chapters XVI., XVII., and XVIII., to which the\\nreader is referred.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0107.jp2"}, "108": {"fulltext": "CHAPTEE VIII.\\nATONIC IMPOTENCE.\\nSexual weakness and even impotence are not uncommonly\\ncomplained of by patients who have suffered from various ady-\\nnamic diseases and by those afflicted with brain or spinal-cord\\ndiseases, and they are said by some authors to be more or less\\nremotely caused by the action of a number of drugs.\\nThis form of impotence has been described by some authors as\\nsymptomatic impotence, but I think the term atonic impotence\\nis more correct, for the reason that in these cases there are im-\\npaired nervous function and stimulus, due to devitalizing causes,\\nbrain and spinal cord lesions, and the depressing action of drugs.\\nIn all cases the underlying cause is the atonic state of the brain,\\nspinal cord, and sexual centre.\\nIn the various forms of anaemia such is the general lowered\\nstandard of the vital processes and of metabolism that the func-\\ntion of no organ is perfectly performed, and with the resulting\\ndepression to the cerebro-spinal system the sexual function is\\nmore or less torpid, and it may even be temporarily extinguished.\\nEn neurasthenia the supply of nervous force required for the essen-\\ntial vital functions (chiefly circulation, respiration, and alimenta-\\ntion) is so much drawn upon that none is left for a function like\\nthat of copulation, which is only occasionally called into use, and\\ncan, without detriment to the patient, be absent or in abeyance for\\nvarying periods. After diphtheria, erysipelas, influenza, typhoid\\nfever, pneumonia, rheumatic fever, and in the course of malaria\\nand uraemia, sexual weakness, more or less pronounced, is often\\nobserved, and the question suggests itself to one s mind whether\\nthe underlying cause is the impaired or depressed nutrition of the\\nnervous centres or whether the toxemic condition incident to these\\ndiseases is the essential cause", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0108.jp2"}, "109": {"fulltext": "ATONIC IMPOTENCE. 99\\nMany persons who suffer severely from gastric and gastro-\\nintestinal disorders are not infrequently weak sexually, and their\\nimpotent condition is readily explained by the malnutrition, which\\nproduces nervous atony, which in itself is increased by the worry\\nincident to these affections.\\nIn some cases of diabetes a well-marked and even permanent\\nstate of sexual impotence may be produced, being sometimes a\\nfirst and premonitory symptom, caused, in all probability, by the\\ngeneral bad state of nutrition of the patient. In some of these\\ncases, coinciding with the diminution in the amount of sugar in\\nthe urine and the general improvement in health (when it occurs),\\nthe sexual function may become more or less active. With the\\nsevere development of the general systemic disorder this function\\nsoon becomes less active, and then perhaps extinct.\\nIn many functional and organic affections of the brain a more\\nor less complete and permanent form of impotence is sometimes\\nseen. In cases of cerebral excitement and exhaustion from various\\ncauses, of spinal irritation, cerebro-spinal meningitis, spinal menin-\\ngitis, syphilis of the brain and spinal cord, myelitis and locomotor\\nataxia, the abatement of sexual power is soon seen, sometimes after\\na period of great erethism, and in the course of time it is entirely\\ndestroyed.\\nSexual excess, and particularly the indulgence in abnormal\\ncoitus, very often produces atonic impotence by their damage to\\nthe general nervous system and the sexual centre. The same\\nmay be said of excessive masturbation.\\nIt is not uncommon to observe patients who suffer from atonic\\nimpotence who may be said to be sexually worn-oat. Such\\npatients may or may not have had gonorrhoea or syphilis, but\\nwere in their early days virile and persistent in sexual inter-\\ncourse. Living, as they usually do, a fast life, they keep late\\nhours, drink and smoke to excess, and are in many instances im-\\nmoderately given to sexual excesses in unnatural methods (chiefly\\ncoitus ab ore), and also naturally. Toward forty-five and fifty years\\nof age (and sometimes earlier) these men begin to decline in sexual\\npower (in some the retrograde process is slow, in others rapid),\\n*f C.", "height": "4217", "width": "2420", "jp2-path": "practicaltreat00tayl_0109.jp2"}, "110": {"fulltext": "100 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nand, as a rule, in spite of careful treatment and general reforma-\\ntion, they lose desire and power until the end is reached in utterly\\nincurable impotence.\\nAn old, persistent syphilitic dyscrasia, in combination with\\nalcoholism and the indulgence in sexual excesses, leads in many\\ninstances to permanent impotence.\\nIt is said that in the East Indies there is scarcely a virile man\\nover twenty-five years of age. The sexual decay in these men is\\ndue to the practice of long-protracted coitus. While in the act\\nthey keep ready at each hand a basin of cold water or some cold\\nobject, with which they constantly cool their hands just before the\\norgasm comes on. In this way they greatly prolong the sexual\\nact, and in so doing wear out their sexual centre and perhaps\\ndamage other nervous parts.\\nIn America the unnatural prolongation of coitus (for the alleged\\nreason of greater gratification to the female) is very often the cause\\nof a more or less persistent form of atonic impotence, and also of\\nneurasthenia.\\nIn chronic morphine- and opium-addiction loss of sexual desire\\nand power is an early result, and it remains as long as the use of\\nthe drug is continued.\\nBromide of potassium has been claimed as a frequent cause of\\nsexual weakness and decay, but our knowledge of its action in\\nthis direction does not rest on a solid basis. Cases undoubtedly\\nhave occurred in which it seemed probable that the long-continued\\nuse of the drug had impaired the sexual function, but sufficient\\nprominence has not been given to the morbid conditions for which\\nthe therapeutic agent was administered and to the probable\\nanaphrodisiac influence of these morbid states. It is very prob-\\nable that decline in the sexual function may follow the long-\\ncontinued use of this drug in a healthy individual, for the reason\\nthat it acts as a sedative to the sexual organs, but on this point\\nwe have no reliable information.\\nLarge and long-continued doses of iodide of potassium are said\\nto cause atrophy of the testes and sexual impotence. Here, again,\\ndo distinction is made between the action of the drug and the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0110.jp2"}, "111": {"fulltext": "ATONIC IMPOTENCE. 101\\naffection for which it is administered. While, therefore, it is\\nprobable that iodide of potassium may, when used for long periods,\\ncause diminution in a man s virility, we have not to-day sufficient\\ntrustworthy evidence to prove the point.\\nAlcoholic excesses at first increase the sexual desire, but later\\non this stimulant ceases to stimulate, and it produces an obtunding\\nand devitalizing effect on the nerves of generation.\\nIn chronic lead-poisoning sexual impotence is said to be a quite\\nconstant and prominent symptom. The use of camphor and tur-\\npentine is said to produce an anaphrodisiac effect. It is claimed\\nthat excessive use of tobacco and cigarettes may cause sexual\\ntorpor and inability, and if it does, it is by reason of the depress-\\ning effect of the poison on the nervous centres.\\nThe excessive use of coffee and absinthe has been cited as a\\ncause of impotence, but it should be remembered that when such\\nclaims are made full details of the alleged cases are absolutely\\nnecessary.\\nNervous impressions transmitted to the sexual centre from the\\ntestes undoubtedly have much influence upon the sexual function,\\nalthough our knowledge of its action is very limited. Structural\\naffections of the testes and the vasa deferentia may lead to\\nazoospermatism, and it is very probable that when mild or severe\\nmorbid changes take place in these organs a depressing effect is\\nproduced in the spinal cord and the sensory nerves. In cases of\\nexhaustion, of overwork, and of adynamic disease the structural\\nvitality of the testes is much interfered with, and it is probable\\nthat the nerve impressions conveyed to the body under these\\ncircumstances in a greater or less degree produce a condition of\\nsexual torpor or impotence. This point is worthy of careful\\nthought. We have become so accustomed to look for causes of\\nimpotence in the sexual tract itself that we really pay little heed\\nto the probable depressing effects of testicular troubles upon the\\ncentral nervous system.\\nIn the newly proposed operation of castration for prostatic\\nhypertrophy the fact has been clearly brought out that in some\\ncases the removal of the testes is followed by mental depression", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0111.jp2"}, "112": {"fulltext": "102 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nand unbalancing, as if a normal stimulus had been suddenly with-\\ndrawn. This fact suggests to us that very probably in health and\\ndisease some indeterminate impressions are conveyed from the\\ntestes to the central nervous system which are necessary to its\\nfull integrity.\\nSexual vigor usually grows less active with the advancing age\\nof the patient, in some men earlier than in others. Such cases are\\ngenerally due to sexual inertia, particularly to gradual exhaustion\\nof the sexual centre. They are really cases of senile atonic im-\\npotence.\\nTreatment. As atonic impotence is only one of many symp-\\ntoms incident to anaemia and various other adynamic conditions,\\nbrain affections, and chronic systemic poisoning, the first indica-\\ntion is to determine what is the morbid factor, and when discov-\\nered to treat it on general medical principles.\\nIn some of these cases much mental and perhaps some physical\\nbenefit may follow the judicious instillation of strong nitrate of\\nsilver solutions (of strength varying from 1 to 5 per cent.) into\\nthe prostatic urethra. Likewise the passage of a warmed sound\\nonce a week or more frequently may be of benefit.\\nDamiana has failed to prove an efficient aphrodisiac remedy,\\nand cantha .rides is so irritating to the stomach and the urinary\\ntract that, as a rule, it cannot be given in sufficiently large doses\\nto excite the sexual centre. In some cases, however, it seems to\\nact beneficially on the sexual centre.\\nIn some cases much benefit is produced by the ingestion of a com-\\nbination of atropine and strychnine. The initial dose of atropine\\nis one one-hundredth of a grain in water three times a day, and\\nthat may be increased to one-sixtieth or one-fiftieth of a grain.\\nThe usual dose of strychnine is one-thirtieth of a grain, which\\nmay be gradually and continuously increased to one-twentieth of\\na grain.\\nQuinine in three-grain doses, given three times a day, par-\\nticularly in combination with strychnine, and in very atonic\\ncases with atropine, is sometimes of markedly beneficial effect. An\\nexcellent preparation is the following", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0112.jp2"}, "113": {"fulltext": "ATONIC IMPOTENCE.\\n103\\nB\\nFerri et quininae cit.\\nFl. ext. cocas\\nTr. gentianae co.\\nTr. nucis vomicae\\n3\u00c2\u00abj-\\ngtt. ccc.\\nAquae\\nOne teaspoonful in a win?\\nmeals.\\nglass of watei\\nthree\\n3S..-M.\\ntimes a day one\\nhour\\nafter\\nAnd the following prescription, taken in the same dose and\\nmanner, may be administered\\nR.\\nQuiniae sulph.\\ngr. lxiv to xcvi\\nTr. ferri muriat.\\ngtt. cccxx.\\nTr. nucis vomicae\\ngtt. ccc.\\nSyr. simple\\nlij-\\nAquae\\nq. s. ad |jiv. M.\\nA preparation composed of various animal extracts, known as\\nphospho-albumin, acts as a decided sexual tonic in some cases.\\nChloride of gold and sodium, administered in the form of\\npills, in doses of one-twentieth of a grain three times a day, have\\nbeen vaunted by several authors as having marked aphrodisiac\\npower.\\nPhosphorus proves to be in many cases of anaemia and atonic\\nsexual exhaustion a most effective remedy. It is best given in\\ngelatin-coated pill form, the initial dose being one one-hundredth\\nof a grain three times a day, and the dose may be gradually and\\ncautiously increased to one-twentieth of a grain. Care as to the\\ncondition of the stomach must be exercised in cases where this\\ndrug is taken.\\nPhosphide of zinc, in doses of one-tenth of a grain three\\ntimes a day, may be given.\\nNutritious and easily digested food should be taken, together\\nwith a moderate amount of Burgundy or claret.\\nMany local remedies act well as general and local stimulants\\nin atonic impotence. Cold sitz baths and cold affusions to the\\npenis, testes, and lumbar region, carefully administered or used,\\nmay often prove very invigorating. Systematic cold bathing and\\nsalt-water bathing in combination with active internal medication\\nshould be employed in all cases. Mental relaxation, physical rest,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0113.jp2"}, "114": {"fulltext": "104 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nfresh air, change of scene, together with moderate ont-door exercise,\\nshould be insisted upon, provided they are practicable. Massage\\nmoderately administered and local and general faradization may\\nproduce excellent stimulant effects.\\nIf any affection of the meatus, urethra, prostate, seminal\\nvesicles, or testicles be present it should receive proper atten-\\ntion.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0114.jp2"}, "115": {"fulltext": "CHAPTEE IX.\\nOEGANIC IMPOTENCE.\\nMany cases of impotence depend on certain structural defects,\\nanomalies, changes, and distortions of the penis, which are of con-\\ngenital or acquired origin.\\nIn many cases of malformation of the penis coitus is impos-\\nsible in others, intromission is more or less interfered with\\nwhile in still others the urethra is so misplaced backward that\\nfecundation cannot be accomplished. In this division are included\\ncases of absence of the penis, hypospadias and epispadias, abnor-\\nmalities in size, and double penis.\\nUlcerative and other destructive processes in some cases so\\ndamage and distort the penis that a man may become actually\\nimpotent as a result. Then, again, the size, structure, and shape\\nof the organ may be rendered so abnormal by benign hyperplastic\\nprocesses and by malignant new-growths and preputial calculi that\\ncoitus cannot be performed. En this morbid category belong cases\\nof destructive lesions of the skin of the penis and of the whole\\norgan, exuberant vegetations, horny growths, lymphoid connec-\\ntive tissue hyperplasia, and cancer of the penis.\\nIn another class of cases of organic impotence we find degen-\\nerative and hyperplastic changes in the corpora cavernosa, and\\nmorbid conditions of these structures due to curvature and frac-\\nture of the penis.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0115.jp2"}, "116": {"fulltext": "CHAPTEE X.\\nORGANIC IMPOTENCE FROM CONGENITAL DEFECTS AND\\nMALFORMATIONS OF THE PENIS AND VARICOSITY OF\\nITS DORSAL VEINS.\\nA max may be rendered impotent by certain organic and con-\\ngenital conditions of the penis which impede or wholly prevent\\nintromission and fecundation. He is, however, not necessarily\\nsterile, since the functional activity of the testes may not be at all\\nimpaired. He therefore preserves the procreative power (potentia\\ngenerandi), while he lacks the faculty and power of performing\\ncoitus (potentia coeundi).\\nIn this form of organic impotence are classified cases of absence\\nof the penis, hypospadias and epispadias, abnormalities in the size\\nof the organ, and some cases of double penis. Some men having\\ntwo penes, however, are perfectly able to perform coitus, in some\\ninstances with both organs seriatim.\\nABSENCE OF THE PENIS.\\nThis anomaly, when congenital, is very rare, while cases of\\nrudimetary penis of the infantile type are not especially uncommon.\\nGoschlerV case of congenital absence of the penis is very inter-\\nesting. The patient was a well and otherwise fully developed man\\nof twenty-seven years of age. The scrotum was well formed, and\\nthe testes and cords were normal (the left testis was at time of\\nobservation inflamed). No trace of the penis could be discovered,\\nbut on the anterior wall of the rectum, about four inches above\\nthe anus in the median line, was a rounded orifice from which\\nurine escaped. A sound introduced into the rectum could be\\n1 Vierteljahresschrift fur Prakt. Heilkunde. Prague, 1857, vol. lxiii. pp. 89\\net seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0116.jp2"}, "117": {"fulltext": "ORGANIC IMPOTENCE.\\n107\\npassed through a urethra one and a half inches long into the\\nbladder. In front of the anus was a fold of skin which consisted\\nlargely of erectile tissue, and which became turgid in sexual ex-\\ncitement. There was no incontinence of urine in this case.\\nRevolatV case was that of a new-born child in whom there\\nwere no external genitals. There were spina bifida and umbilical\\nhernia, below which the urine and meconium escaped through a\\ntransverse opening.\\nFig. 23.\\nAbsence of penis due to syphilitic phagedena.\\nNelaton 2 has reported a case of a child, two years old, in which\\nthere was no penis, though the scrotum and testes were present.\\nThe urine was passed through the rectum. Cases similar to this\\nhave also been reported.\\nCases of apparent absence of the penis have been reported. In\\nBouteiller s case the penis could not be seen, though on careful\\n1 Journal de Sedillot, vol. xxxii. p. 370.\\n2 Demarquay Maladies Chirurg. du Penis, 1877, p. 539.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0117.jp2"}, "118": {"fulltext": "108 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nFig. 24.\\nAbsence of penis from gangrene.\\nFig. 25.\\nAbsence of penis from cancer and cancerous bubo with secondary nodules.", "height": "4097", "width": "2420", "jp2-path": "practicaltreat00tayl_0118.jp2"}, "119": {"fulltext": "ORGANIC IMPOTENCE.\\n109\\npalpation a small, worm-like body was felt beneath the skin, which\\ndissection showed was a small penis. Murphey 1 records a some-\\nwhat similar case, in which there was a well-formed scrotum and\\napparently no penis, the urine escaping from the lower part of the\\nabdomen. Deep pressure revealed a body which, when dissected\\nFig. 26.\\nDouble hydrocele with invagination of the penis.\\nout, proved to be a small penis, for which the reporter ventured to\\nentertain the hope that it would later on be equal to all requirements.\\n1 British Medical Journal, 1885, vol. ii. p. 62.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0119.jp2"}, "120": {"fulltext": "110 SEXUAL DJSOEDEIiS OF THE MALE AND FEMALE.\\nAbsence of the penis may result from the phagedena of hard\\nand soft chancres (see Fig. 23) and from gangrene (see Fig. 24).\\nIn cancer of the penis more or less of its continuity is removed\\nby amputation. (See Fig. 25.) Strangulation of the penis by\\nself-inflicted ligature has been known to produce absence of the\\norgan.\\nIn some cases of enormous hydrocele (see Fig. 26) and of\\nscrotal hernia, and in some cases of enormous enlargement of the\\nFig. 27.\\nElephantiasis of the scrotum (and leg) with invagination of the penis.\\ntestes, the penis is forced backward, and appears to be absent.\\nIn some of these cases the organ is so enveloped that even in\\nerection intromission is rendered impossible. This condition also\\nobtains in elephantiasis of the scrotum. (See Fig. 27.)", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0120.jp2"}, "121": {"fulltext": "ORGANIC IMPOTENCE.\\nIll\\nHYPOSPADIAS AND EPISPADIAS, AND TORSION OF\\nTHE PENIS.\\nThese rare malformations will not here be described in full,\\nbut will be considered only in their relation to the sexual act.\\nHypospadias really consists of a greater or less deficiency of\\nthe corpus spongiosum and of the urethra. When the urethra\\nends at the base of or in the glans the condition is called balanic\\nPerineoscrotal hypospadias. (Dolbeau.\\nhypospadias. In this condition the semen may be discharged into\\nthe vagina and impregnation may result.\\nWhen the urethra ends in the course of the penis, provided it\\nis not too far back, the condition, which is called penile hypos-\\npadias, may not prevent fructification of the female ovule, as the\\nsemen is then discharged into the vagina. When it ends quite\\nfar back the semen escapes over the external genitals. This also", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0121.jp2"}, "122": {"fulltext": "112 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\noccurs in penoscrotal hypospadias, in which the urethral orifice is\\nseated at the angle formed by the penis and scrotum.\\nIn scrotal and perineo-scrotal hypospadias the semen does not\\ncome near the genitals of the woman, hence it has no opportunity\\nfor fructification. Men thus affected are necessarily sterile. (See\\nFig. 28.)\\nIn epispadias the urethra opens on the upper surface of a mal-\\nformed penis, either in its glandular portion, in the continuity of\\nthe organ, or just at the symphysis pubis. (See Fig. 29.) In\\nFig. 29.\\nEpispadias of glans and corpus spongiosum. Dolbeau.\\ncases of glandular epispadias impregnation of the female may\\noccur, and the chances of this event become more remote in pro-\\nportion as the opening of the urethra occurs at points further\\nback. When the urethra opens at the symphysis pubis the semen\\nis thrown outside the vulva, and as a fecundating fluid it is lost.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0122.jp2"}, "123": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0123.jp2"}, "124": {"fulltext": "PLATE VI,\\nRudimentary Penis with Cryptorehism.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0124.jp2"}, "125": {"fulltext": "ORGANIC IMPOTENCE. 1 1 3\\nTotal absence of the urethra is a very rare malformation. Occlu-\\nsion of the canal when it occurs near the glans is remediable by\\noperation, and even when seated further back the calibre of the\\ncanal may be so restored that on intromission fecundation of the\\nfemale ovule may result.\\nTorsion of the penis is a very rare condition, complicating\\nhypospadias and epispadias. The penis is so twisted on its axis\\nthat the urethral orifice is abnormally placed.\\nABNORMALITIES IN THE SIZE OF THE PENIS.\\nCases of rudimentary penis have been recorded as well as those\\nof the infantile type they are, however, of rare occurrence. A\\ncase of bifid penis, in which the glans and a part of the body of\\nthe organ were split and the urethral opening was seated back\\nand behind the bifurcation, is on record as a classical illustration\\nof this rare anomaly.\\nRudimentary penis is of rare occurrence, and is usually coex-\\nistent with cryptorchrsm or some other sexual anomaly.\\nA striking case of rudimentary penis accompanied with crypt-\\norchism, the testes being in the abdominal cavity, occurred in the\\npractice of my friend, Dr. Piffard. In this patient the corpora\\ncavernosa and corpus spongiosum were present, and erection was\\npossible. The man, however, had little sexual desire. (See Plate\\nVI.)\\nA case has been recorded by Dummreicher in which a boy of\\ntwelve had a penis which was only three-fourths of an inch long\\nand as thick as a goose-quill. The corpora cavernosa were absent.\\nWe sometimes meet cases of men of various ages in which the\\npenis is no larger than that of a child, and in which, as a rule, the\\ntestes are very small. In some of these cases a decided increase\\nin the size of the organ takes place when coitus is regularly in-\\ndulged in. I have seen a number of instances of decidedly under-\\nsized penes, Avith long, tight prepuce, which became much larger\\nafter the parts were circumcised.\\nCases of enlargement of the penis so that it constitutes a mon-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0125.jp2"}, "126": {"fulltext": "114 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nstrosity are relatively rare. I know of an individual in whom\\nthe organ when erect was said to be fourteen inches long and pro-\\nportionally thick. This man had two wives who died of uterine\\ndisease, while a third applied for divorce very soon after marriage.\\nMany years ago I had under my care a case which, to my mind,\\nis unique. The man before his injury had a penis of the ordinary\\nsize. During the Civil War the man was shot in the base of the\\npenis and in the left inguinal region. After the wound healed it\\nwas noticed that the man s penis began to grow, and this hyper-\\nFig. 30.\\nEnormous hypertrophy of whole penis.\\ntrophy continued for years. When he came under my observation\\nhis penis was, when flaccid, fully twelve inches long and propor-\\ntionally longer when erect. This case was not a simple example\\nof traumatic elephantiasis, which is not uncommon, for besides the\\nincrease in the connective and lymphoid tissues there was commen-\\nsurate enlargement of the glans penis, the corpora cavernosa, and\\ncorpus spongiosum. When erect, according to the man s story,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0126.jp2"}, "127": {"fulltext": "ORGANIC IMPOTENCE. 11 5\\nthe penis was of monstrous size, and he was forever barred from\\ncoitus. (See Fig. 30.)\\nIn the average run of cases of penis of excessive size the man\\nmay have connection with some women without injury to them,\\nprovided care and tact are observed. I had under my care many\\nvears ago a man who had been shot in the groin in a drunken\\nbrawl, and in whom injury to the lymphatics had been produced.\\nFollowing this wound the penis began to swell and grow in\\nlength until it measured eleven inches in the supple state. In\\nthis case there was no hypertrophy of the erectile tissues what-\\never, but enormous hypertrophy of the integument and lym-\\nphatic tissues.\\nElephantiasis of the penis leads to large deformities. In\\nphimosis, particularly when intrapreputial chancres and chan-\\ncroids are present, the penis often becomes of large size. When\\nthe hard oedema of syphilis attacks this organ it becomes greatly\\nenlarged in all directions.\\nDOUBLE PENIS.\\nThis anomaly is very rare, and is usually found in cases of that\\nmonstrosity called foetal inclusion.\\nIn Fig. 31 are portrayed the genital organs of a man 1 who was\\nexhibited in all the large clinics of France and Spain.\\nIt will be seen that between the two legs a third hangs down,\\nthe insertion of which is seated between the scrotum and anus.\\nThis supernumerary limb is atrophied and its joints are ankylosed.\\nThere are two well-developed penes, and to each one a scrotum\\ncontaining a normal testis is furnished, the two sacs being joined\\nin the median line. These penes became erect at the same time,\\nand either one could be used in coitus. Ejaculation or micturi-\\ntion occurred from each organ synchronously.\\nA case has been reported in which there was no foetal inclusion.\\nIt was that of a healthy man of forty-two, who had two distinct\\n1 Kevue Photographique des Hopitaux, 1869, vol. i. p. 103.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0127.jp2"}, "128": {"fulltext": "11(5 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nFig. 31.\\nDouble penis.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0128.jp2"}, "129": {"fulltext": "ORGANIC IMPOTENCE. 117\\npenes of normal size, each attached by its root to the pubic sym-\\nphysis. Each penis was well developed, and the two were enclosed\\nas far as the base of the glans in a common integumentary sheath.\\nThe right meatus was normal, the urine escaping from it and also\\nfrom a point behind in the perineum. On elevating the penes the\\norinGe of a large, healthy canal was seen just where the root of the\\nscrotum should have been attached. On the right side of this\\norifice was a prominence which contained a rather under-sized\\ntestis, while the left organ lay over the tendon of origin of the\\nadductor longus in the left groin. Both penes became erect at\\nthe same time. In this case the left lower limb was shorter than\\nthe right, a deformity which was congenital.\\nENLARGEMENT OF THE DORSAL VEINS OF THE\\nPENIS.\\nIt has been claimed by several authors that in some cases there\\nis abnormal enlargement of the dorsal veins of the penis, and that\\nerection and intromission are impaired and even aborted by the\\nblood in these varicose canals being emptied too promptly and\\nmuch more rapidly than the arteries can fill them.\\nIn order to remedy this mechanical form of impotence it has been\\nproposed to ligate the dorsal veins of the penis, and the results\\nare said to be excellent in the hands of some authors. In one\\ncase reported the effect of this operation is little less than miracu-\\nlous The author had faithfully used the various aphrodisiac\\nremedies, which had utterly failed in a rather obstinate case, so\\nhe then resorted to operation upon the dorsal veins of the penis.\\nHe says\\nI therefore determined to ligate a couple of the larger sub-\\ncutaneous veins at the base of the penis and watch the effect.\\nThis was very easily done by the use of cocaine. A vein on each\\nside of the penis was exposed, ligated in two places and severed\\nbetween the ligatures. A dressing was lightly applied and held\\nin position by a strip of adhesive plaster placed longitudinally.\\nThe result was immediate. In less than five minutes after leaving", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0129.jp2"}, "130": {"fulltext": "118 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nmy office he had an erection. That night he was awakened by a\\npowerful erection, which made the bandage so painfully tight that\\nhe was obliged to jump out of bed onto the cold floor to subdue\\nit. Primary union was prevented by the frequent erections, but\\nthe success of the operation was certain.\\nTwo months later he reported himself well, mentally and\\nphysically his sexual appetite had returned, and since the opera-\\ntion his power of maintaining erections had been as good as ever.\\nIt is well to lay emphasis on the fact that this procedure has\\nnot been thoroughly tested, and that it has not as yet received\\nauthoritative indorsement.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0130.jp2"}, "131": {"fulltext": "CHAPTER XI.\\nOEGANIC IMPOTENCE FEOM DESTRUCTION OF THE INTEGU-\\nMENT OF THE PENIS, AND FEOM BENIGN AND MALIG-\\nNANT NEW-GEOWTHS AND PEEPUTIAL CALCULI.\\nDESTRUCTIVE LESIONS OF THE INTEGUMENT OF\\nTHE PENIS.\\nThe integument of the penis may, in consequence of disease\\nor traumatism, be so much destroyed that when cicatrization is\\ncomplete intromission of the organ may be either much impaired\\nor wholly prevented.\\nChancroidal Ulceration.\\nChancroidal ulceration may be so severe and extensive that\\nmuch of the tegumentary sheath of the penis is destroyed. In\\nFig. 32 is portrayed a penis which had been the seat of several\\nlarge chancroids. After healing, the organ was so curved down-\\nward and twisted at its end that coitus was practically impossible.\\nI have seen many instances of this kind, some of which were more\\npronounced than the one here mentioned.\\nPhagedena in Syphilis.\\nPhagedena may attack the initial lesion when seated on the\\npenis, and so destroy or distort that organ that coitus is rendered\\nimpossible. In general, the destructive action occurs in the glans\\npenis or in the prepuce, and the process is arrested before serious\\ndamage is produced. It sometimes happens, particularly in cases\\nof phimosis, that a subpreputial initial lesion becomes attacked\\nby phagedena, and, owing to want of care, or poor care, more or\\nless of the organ is destroyed. In these days of strict antisepsis", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0131.jp2"}, "132": {"fulltext": "120 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nphagedena is not a common complication of primary syphilitic\\nlesions, and in the event of its occurrence it is much more promptly\\nchecked than it was twenty years ago.\\nFig. 32.\\nCicatrization of integument of the penis following chancroids.\\nPhagedena has been known to attack the urethra and to run\\ndown the canal for short or long distances, even to the peno-scrotal\\nangle. In these rare cases, of which I have seen several, organic", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0132.jp2"}, "133": {"fulltext": "ORGANIC IMPOTENCE.\\n121\\nimpotence was produced. I have several times been able to avert\\nthis process before it had extended much beyond the meatus. In\\nthese latter cases a dense fibrous stricture is usually produced.\\nGangrene of the Penis.\\nIt usually happens that gangrene primarily attacks and destroys\\nsome part of the integument of the penis and also the glans,\\nFig. 2\\n\\\\m*\\nGangrene of the integument ot the penis.\\nwith perhaps some of the tissue beyond. The result of gangrene\\nof the penis is well shown in Fig. 33, in which the greater por-\\ntion of the skin of the organ, beginning near the preputial orifice\\nand extending almost to the abdomen, Avas destroyed. When full\\nhealing had taken place in this case the penis was so pushed back-\\nward to the abdomen by the sclerosing cicatrization that erections", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0133.jp2"}, "134": {"fulltext": "122 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nwere abortive and penetration was rendered impossible. I have\\nseen other instances in which gangrene of the penis w T as followed\\nby such deformity that coitus became difficult or incomplete.\\nTraumatism.\\nInjury to the integument of the penis, beyond mere bruises, is\\nnot very common. Laceration of these parts is of very infrequent\\noccurrence.\\nFig. 34.\\nShowing destruction of the integument of the penis resulting from traumatism.\\nIn Fig. 34 is shown an example of a lacerated wound of the\\npenis of much extent and severity. As a result of his being\\nstruck by a revolving wheel, the penis of this patient was nearly", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0134.jp2"}, "135": {"fulltext": "ORGANIC IMPOTENCE. 123\\ndenuded of its integument in its whole circumference. In cases\\nlike this the resulting cicatrix is so dense and firm that the organ\\nbecomes somewhat twisted, and on erection it is so distorted that\\nintromission is either very difficult, painful, or impossible.\\nIn these cases the affected surfaces are so studded with micro-\\norganisms that skin-grafts will fail to take root. Then, again, the\\nmobile condition of the penis is such that a perfect result is ren-\\ndered impossible.\\nVEGETATIONS OF THE PENIS.\\nVegetations are papillary new-growths, due to hyperplasia of\\nthe connective tissue and of the epidermis. They are developed\\non the mucous membrane of the penis and at its junction with the\\nskin, in consequence of the irritation produced by decomposing\\nsecretions and by pus. The hyperemia left by chancres and chan-\\ncroids on the glans or prepuce may lead to the development of\\nvegetations.\\nThese lesions begin as little red spots, which soon become salient,\\nand from a papular condition they grow rapidly and exuberantly\\nuntil papillomatous or cauliflower-like growths are produced.\\nThey may be rounded and sessile, or pedunculated, or Indian-\\nclub-shaped. They form masses like strawberries, and large\\naggregations of them very much resemble cauliflower growths.\\nIn color they may be very red, or of a pink or even grayish tint.\\nThe sites more frequently attacked by vegetations are the cor-\\nonal sulcus, the inner surface of the prepuce, the region of the\\nfrsenum, and the lips of the meatus.\\nWhen small these lesions may not cause impediment to coitus\\nbut when they become large, and constitute fungating masses\\nand cauliflower excrescences, they render intromission impossible.\\nIn cases of long and tight prepuce they often lead to phimosis,\\nwhich may end in perforation of that appendage and to gangrene\\nand hemorrhage.\\nIn Fig. 35, vegetations of the coronal sulcus, the whole of the\\nmucous layer of the prepuce, and of the meatus are clearly shown.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0135.jp2"}, "136": {"fulltext": "124 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nIn this case coitus was impossible and urination was much hin-\\ndered.\\nI have several times seen cases in which men were unfitted and\\nincapable of fructifying coitus with their wives by reason of nearly\\nFig. 35.\\nVegetations of the glans and prepuce.\\ncomplete stenosis of the preputial orifice by reason of its natural\\nsmallness and of the blocking up of the penis by vegetations.\\nThis condition is well shown in Fig. 36. In this case after circum-\\ncision the man s wife promptly became pregnant.\\nThe diagnosis of warts is usually very readily made. In some", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0136.jp2"}, "137": {"fulltext": "ORGANIC IMPOTENCE.\\n125\\ncases of condylomata lata papillomatous exuberance may occur,\\nand the lesions may look like simple vegetations. Since condylo-\\nmata lata are usually found about and around the anus and the\\ninner surface of the thighs and on the scrotum, it is well when\\nlarge, flat warts are found on these sites to inquire into the history\\nof the case in order to determine whether syphilis may be present\\nas a morbid factor.\\nFig. 36.\\nVegetations of tlie preputial orifice, causing almost complete stenosis.\\nThe prognosis of warts of the penis is usually good, provided\\nintelligent treatment is instituted. In old subjects, both male\\nand female, the occurrence of warts about the genitals should\\nalways suggest to the mind of the surgeon the predisposition of\\nthese lesions to malignant degeneration, and their removal should\\nbe promptly accomplished.\\nTreatment. The treatment of warts of the penis when they\\nare small is very simple. The penis should be thoroughly cleansed", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0137.jp2"}, "138": {"fulltext": "126 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nand anesthetized with cocaine and the lesions removed with the\\ncurette or small curved scissors. Absolute cleanliness and dryness\\nof the penis are necessary to prevent a relapse. Destructive cau-\\nterization by the acid nitrate of mercury, tincture of iodine, solu-\\ntions of chloride or subsulphate of iron, chloro-acetic or lactic\\nFig. 37.\\nHorns of the penis. (After Pick.\\nacid may be employed when the warts are very small and sharply\\nlocalized, particularly when patients are very nervous and fidgety\\nas to operations.\\nWhenever possible the curette should be used but when the\\nLesions are large, hard, and densely hypertrophied it may be", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0138.jp2"}, "139": {"fulltext": "ORGANIC IMPOTENCE. 127\\nunfavorable to remove them with the curette, and in this event\\nthe galvano-cautery acts very efficiently, and if carefully and\\nslowly operated no hemorrhage follows.\\nWhen the meatus is the seat of warts care should be taken that\\nthe lips be not damaged, since stenosis may follow^. After removal\\nit is nece^iry to use dry powders, such as zinc oxide, nosophen,\\nan( erin .ol, and to keep the parts covered with absorbent gauze.\\nHORNY GROWTHS OF THE PENIS.\\nThis form of new-growths on the penis is very rare, but its\\nexistence always proves a bar to coitus.\\nHorns of the penis take their origin on the corona in the coronal\\nsulcus and on the inner aspect of the prepuce, particularly near\\nthe frammn. These horns are usually developed from warts in\\npersons in whom there has been some chronic irritative process on\\nthe prepuce or glans.\\nIn Figs. 37 and 38 are portrayed the features of the remark-\\nably striking case of Pick. 1 The large horn sprang from the pre-\\nnuce and glans, its base being embedded like a nail in its matrix\\nuxi the right side down toward the frsenum. From its base the\\nrn jutted downward and upward to the left and in front of the\\nmeatus. From the base of the glans several small horns sprang\\naud showed a tendency to come upward in front of the glans.\\nAVhen the penis was placed in line with the abdomen the large\\nhorn presented an appearance not unlike the crest of a dragoon s\\nhelmet. The horn was two and a half inches long. In other\\nreported cases these excrescences have been noted as being one-\\nha f to one and three-quarter inches in length. Their breadth\\nis usually less than an inch, and they are generally somewhat\\nperecl in shape toward their ends, which are usually truncated.\\nIn color they are brown, greenish-brown, and black, and in struc-\\nture hard, firm, and brittle.\\nTreatment. These growths should be thoroughly removed,\\nand more or less of the glans should be ablated if necessary.\\n1 Yierteljahr. fur Derm, mid Syphilis, 1875, Band. ii. pp. 315 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0139.jp2"}, "140": {"fulltext": "128 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThey sometimes return after removal, and they are rather infre-\\nquently the precursors of malignant degeneration.\\nFig. 38.\\nHorns of the penis. (After Pick.\\nELEPHANTIASIS OF THE PENIS.\\nIn some cases elephantiasis of the penis exists independently\\nof the scrotum, in others the two parts are attacked. The scrotum\\nalone is involved in some rare cases. In such cases there is an\\nimpediment to the sexual act, and in many its accomplishment is\\nutterly impossible.\\nThe penis becomes much enlarged, so that it may reach to the\\nknees, and its diameter is many times increased. The skin becomes", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0140.jp2"}, "141": {"fulltext": "ORGANIC IMPOTENCE.\\n129\\nmore dense and thicker than normal, has a firm, brawny feel, and\\nis channelled by numerous furrows, which run in various direc-\\nFig. 39.\\nElephantiasis of the penis.\\ntions. The prepuce becomes involved early, and the glans recedes\\nbehind its opening and cannot be pushed through it. (See Fig. 39.)", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0141.jp2"}, "142": {"fulltext": "130 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nElephantiasis of the scrotum consists of a lymphoid and fibrous\\ninfiltration into the entire thickness of the tissue. The sac be-\\ncomes large and heavy and drags down the abdominal skin, and\\nas the morbid process goes on the penis disappears and is slowly\\nengulfed in the scrotal mass. In this event the prepuce forms\\na fictitious urethra, which ends in a depression in the median line of\\nthe scrotum, in which is formed a gutter for the passage of the urine.\\nElephantiasis of the genitals occurs in tropical countries in an\\nendemic form, and very rarely in colder countries in sporadic\\nform, usually as a result of some traumatism or irritation.\\nTreatment. The treatment of this deformity, which renders\\nsexual intercourse impossible, is the ablation of the redundant\\nparts according to the topography, with the purpose of producing\\nas symmetrical a penis and scrotum as possible.\\nCANCER OF THE PENIS.\\nCancer of the penis, as a rule, is an affection peculiar to advanced\\nlife, but less frequently is found in men between the ages of twenty\\nand fifty. Between the fortieth and fiftieth years it is far from\\nuncommon.\\nCancer of the penis usually begins in an insignificant manner,\\nas a little wart, a thickened patch of epithelium, and as a small\\nchronic ulcer or fissure. As a rule, the primary lesion is so devoid\\nof symptoms that it causes no mental or physical uneasiness, and\\nits development is usually very slow.\\nIt begins either in the coronal sulcus or on the corona near the\\nfrcenum, on the inner surface of the prepuce, and very exception-\\nally in the uretkua. When the prepuce is long there maybe mild\\npruritus or a sensation of heat, due to the irritation of the secre-\\ntions of the parts. Usually after a chronic period of quiescence\\nluxuriant growth occurs and the penis becomes much enlarged\\nand distorted toward its end by fleshy masses and exuberant cauli-\\nflower-like tumors. As a result, deformities and distortions of\\nvarying appearance are produced (see Figs. 40 and 41), coitus\\nbecomes impossible and urination is much impeded.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0142.jp2"}, "143": {"fulltext": "ORGANIC IMPOTENCE.\\n131\\nWhen epithelioma of the penis becomes fully developed, lanci-\\nnating and persistent pains are complained of and hemorrhage,\\nmore or less severe, may occur. As time goes on the general\\nhealth is undermined and the patient dies of marasmus, or, very\\nFig. 40.\\nShowing epitheliomatous degeneration of glans penis bursting through the\\nprepuce, which was phimotic.\\nrarely, of metastasis into some of the viscera. As the lesion of\\nthe penis progresses implication of the inguinal ganglia occurs,\\nand palpation shows these organs to be large, hard, painless, and\\nindolent.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0143.jp2"}, "144": {"fulltext": "132 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThe diagnosis of cancer of the penis when fully developed is\\nusually very easy. Any chronic nodule or ulcer with hard and\\nperhaps exuberantly developed base or surroundings, particularly\\nin men over forty years of age, should be regarded with much\\nsuspicion, carefully watched, and treated early. It is necessary\\nto remember that in younger men the initial lesion may be very\\nexuberant, dense in structure, and perhaps more or less fungating\\non its surface, and that it may be mistaken for cancer.\\nFig. 41.\\nShowing the under surface of case shown in Fig. 40, with new-growth\\nand stenosed preputial orifice.\\nThe prognosis of cancer of the penis depends entirely on the\\nfact of its early recognition and thorough removal, together with\\nall the ganglia in the groins and perhaps in the thighs.\\nThe treatment of cancer of the penis, according to the extent\\nand severity of the lesion, consists in either amputation or extirpa-\\ntion, with the removal of the lymphatic ganglia. (For a full ac-\\ncount of this affection, see my work A Practical Treatise on Genito-\\nurinary and Venereal Diseases and Syphilis. Philadelphia, 1900.)", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0144.jp2"}, "145": {"fulltext": "ORGANIC IMPOTENCE.\\n133\\nINDURATING (EDEMA OF THE PENIS.\\nIndurating oedema of the penis is a somewhat exceptional com-\\nplication of hard chancre of this organ, and owing to its chronicity\\nand its hyperplastic tendency, it may in some cases lead to per-\\nmanent deformity and to organic impotence.\\nIndurating oedema begins in a slow, paiuless manner around the\\nmargin of the initial lesion or lesions of syphilis. It is noticed\\nFig. 42.\\nIndurating oedema of the penis with hard chancre on the outer layer\\nof the prepuce. Great enlargement of the organ.\\nthat the tissues begin to swell and present a dull-red or purplish\\nhue, and a density of structure a little less compact than that\\nof a typical hard chancre. Usually the hard chancre is seated on\\nthe prepuce or the prepuce and glans, and from these foci the\\nhyperplastic process may gradually creep upward, and in severe\\ncases involve the whole penis (see Fig. 42), and exceptionally it", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0145.jp2"}, "146": {"fulltext": "134 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nmay involve the penis and the scrotum. (See Fig. 44.) In rather\\nrare cases when the hard chancre begins on the cutaneous envelope\\nof the penis, this indurating complication may occur in these parts,\\nand then it usually first travels downward to the preputial region\\nand shortly afterward upward toward the pubis. (See Fig. 43.)\\nFig. 43.\\nHard chancre with very extensive oedema of the penis. Great enlargement\\nof the organ.\\nIn most cases want of proper and prompt treatment of the hard\\nchancre, injurious and intemperate cauterization, and uncleanliness\\nare the causes of irritation of the initial syphilitic lesion. It is gen-\\nerally observed that when active measures are promptly adopted\\nfor the cure of the indurating process before much tissue has been\\ninvaded, resolution may quite speedily set in but that when the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0146.jp2"}, "147": {"fulltext": "ORGANIC IMPOTENCE.\\n135\\ntreatment has been delayed (particularly if the parts are irritated)\\nand the lesion is well under way, its tendency to further extend is\\nvery^great, and its resolution is long delayed.\\nFig. 44.\\nIndurating oedema of the penis and scrotum from hard chancre of the inner\\nlayer of the prepuce.\\nIt is this sluggish chronicity of the lesion of the penis which\\nleads to the great hypertrophy of the organ and its frequent and\\nmore or less permanent distortion.\\nUnder vigorous treatment resolution may occur in even severe\\ncases in several or many months, and during this period coitus is\\nusually impracticable. In some cases such an elephantine hyper-\\ntrophy of the penis is produced that the patient is rendered\\norganically impotent.\\nTreatment. In these cases active internal and local treatment\\nis imperatively demanded. After careful antiseptic cleansing the\\norgan must be kept enveloped in strong mercurial ointment, freely\\nspread on lint, which is to be held in place by gutta-percha tissue.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0147.jp2"}, "148": {"fulltext": "136 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nInternally an energetic and efficient inunction course should be\\nadopted, and in the event of prompt resolution not being observed,\\nresort should be had to the ingestion of the mixed treatment in\\nfull dose.\\nPREPUTIAL CALCULI.\\nA peculiar form of distortion of the penis which, when well\\nmarked, produces organic impotence is caused by the presence\\nof calculi in the preputial sac. There may be one, two, or three\\ncalculi present, and the distortion of the organ varies according\\nto their number and size. As a rule, intromission of the penis\\nbecomes impossible and coitus so painful that it is usually not\\nindulged in by these sufferers.\\nFig. 45.\\nPreputial calculi. Natural size.\\nPreputial calculi may be seated side by side, and may then be\\nsymmetrically faceted to each other, or one stone may be seated\\non the top of the other in a concavity in which the convex base\\nof its upper fellow is smoothly placed. It is said that preputial\\ncalculi are not very uncommon in China, particularly in the per-\\nsons of the natives. In Fig. 45 are well shown two preputial\\ncalculi, which were removed from a Chinaman in Canton, China,\\nby my friend, Dr. J. A. Andrews.\\nI have seen two instances in which such a large quantity of\\ndried smegma was present in cases of phimotic prepuce that\\nintromission was difficult or impossible.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0148.jp2"}, "149": {"fulltext": "CHAPTER XII.\\nORGANIC IMPOTENCE DUE TO DEGENERATIVE, HYPER-\\nPLASTIC AND TRAUMATIC CHANGES IN THE CORPORA\\nCAVERNOSA.\\nIn this category are included ossification of the penis, fibroid\\nsclerosis, syphilitic nodes, together with curvature and fracture of\\nthe organ.\\nOSSIFICATION OF THE PENIS.\\nThis affection is very rare, and is denominated calcification by\\nsome authors. It occurs in middle-aged and old men hence, as\\na rule, it does not cause much mental disturbance, though it may\\ninterfere with and even entirely prevent coitus. The parts in-\\nvolved are the sheaths of the corpora cavernosa and the septum\\npectinif orme. The bony growth may be in plates, as it is usually\\nfound in the superfices of the corpora cavernosa, or in rod-shape\\nwhen the septum pectinif orme is attacked.\\nOssification of the penis, which is always partial, takes place\\nvery insidiously and without pain, and the patient first becomes\\naware of its existence by the impediment it offers to coitus or the\\ncurvature which it causes to the organ. In a case reported by\\nMacClennan, 1 in which there was so much distortion of the penis\\nthat urination was accomplished with the greatest difficulty, the\\nwhole length of the septum was ossified, and coitus was rendered\\nimpossible. This bony mass was dissected out and a fairly good\\nresult was obtained in remedying the curvature and restoring the\\nfunction of the organ. In Fig. 46 is well shown an example of\\nlongitudinal bony growth in the median line of the penis, which\\n1 Phila. Monthly Journal of Medicine and Surgery, 1827, p. 256.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0149.jp2"}, "150": {"fulltext": "138 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nwas observed by Demarquay 1 in the Pathological Museum of\\nVienna. No facts concerning the case were obtained.\\nThe curvature produced by ossification of the penis may be\\neither upward or downward. In this affection erections are\\nFig. 46.\\nBony growths ot the penis, shown as white bands in the middle of dorsum.\\n(After Demakquay.\\npainful, manipulation of the penis causes suffering, and in its\\nquiescent state the organ is more than normally sensitive.\\nAccording to Demarquay, there is a case on record in which an\\noxdriver had a penis which was wholly ossified, always in erec-\\ntion, and the cause of great suffering to his wife. The same\\n1 Op. cit, p. 353.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0150.jp2"}, "151": {"fulltext": "ORGANIC IMPOTENCE. 139\\nauthor mentions a case observed by Velpeau, in which a bony\\ngrowth sprang from the pubic bone and invaded the left side of\\nthe penis for a distance of fifteen lines.\\nTreatment. Nothing but removal by means of the knife is\\nindicated in these cases, and it is probable that the cicatrix result-\\ning from the wound may lead to bad distortion of the penis. The\\naffection is practically incurable.\\nIn some of these cases, when the plates are superficial and the\\nbony median cords accessible to the knife, removal may be effected\\nby operation, and improvement of the patient s condition may\\nresult. Internal or external medication is worse than useless.\\nFIBROID SCLEROSIS OF THE CORPORA CAVERNOSA.\\nThis affection has heretofore been described under the title of\\nchronic circumscribed inflammation of the corpora cavernosa, an\\nobvious misnomer, since no one has ever observed any inflamma-\\ntory condition connected with it.\\nThis affection begins slowly, painlessly, and insidiously, and, as\\na rule, is first recognized by the patient as a little bean-like lump\\nor plate of tissue in the theca of the corpora cavernosa, which\\nmay be slightly painful on pressure or during erection.\\nIn exceptional cases I have noted that the patient complained\\nof pain in the penis, particularly on erection, when on careful pal-\\npation no change in the corpora cavernosa could be made out, even\\nafter several examinations. In these cases the only evidences of\\nlesion were the tendency of the penis to curve upward and the\\npresence of pain when an attempt was made to straighten the\\ncurved organ. In these cases the fibroid proliferation was well\\nunder way, but it had not become sufficiently compact to cause\\nsuch a change in the tissues as to be perceptible to the fingers.\\nAs a rule, the sclerosis is tolerably well advanced when the\\nsurgeon is consulted, and he finds a hard, firm plate of tissue a\\nline or two in thickness, perhaps the size of one s thumb-nail or\\nlarger, seated in the superficial portion of the corpora cavernosa,\\nabout equally on each side of the median line, like a saddle. Its", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0151.jp2"}, "152": {"fulltext": "140 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nmargins are usually sharply defined and regular, or they may ex-\\nceptionally be uneven, slightly nodulated, and perhaps thickened.\\nThe deeper parts are, as a rule, free from the disease, but excep-\\ntionally we find that the morbid process has extended downward\\ninto the trabecular The induration of the plate is variable in\\nthe early stages it is usually not very dense, but in older cases it\\nmay be of cartilaginous hardness. Usually these plates have a\\nkind of elasticity which gives to the finger a sensation quite dif-\\nferent from that offered by the bony and cartilaginous plates\\nsometimes found here. As, however, these plates grow old, they\\nmay become very dense and wholly inelastic.\\nThe lesion may occupy one corpus cavernosum, or both but\\nit almost always seems to begin on the dorsum of the penis, par-\\nticularly near the median line. I have recently seen four cases in\\nwhich the plates began on the sides of the penis near the line of\\napposition of the corpora cavernosa with the corpus spongiosum.\\nIn two cases symmetrical plates over an inch long were found,\\none on each side of the penis. In a third case there was a large,\\nfirm plate on one side, and a smaller and more elastic one on the\\nother side of the penis. In the fourth case there was but one\\nsmall plate on the left side of the penis. In all these cases the\\ncurvature of the penis was well marked and downward in direc-\\ntion.\\nIn general, these plates are found to be the shape of a saddle,\\nusually symmetrically placed over the cavernous bodies and well\\nwelded together in the median line. While this arrangement is\\nthe one most commonly found, I have seen two exceptional cases,\\nin which there seemed to be a little sulcus directly in the middle\\nline of the penis, where the two plates met but did not join to-\\ngether. This depressed line seemed to be composed of unaffected\\ntissue, and it acted as a hinge upon which either of the two plates\\ncould be slightly moved or tilted upward or downward.\\nThe smaller plates are ovoid, and they have been found as long\\nas two and even three inches and as small as half an inch. As a\\nrule, the sclerosis attacks the corpora cavernosa, but quite excep-\\ntionally it involves the corpus spongiosum. This is shown in", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0152.jp2"}, "153": {"fulltext": "ORGANIC IMPOTENCE.\\n141\\nFig. 47, which is a schematic representation of a case once under\\nmy care, in which on each side of the penis there was an offshoot\\nextending around to the frsenum along the course of the lym-\\nphatics.\\nIn some rare cases in which the lesion is unilaterally developed\\nits inner edge usually impinges on the median dorsal line of the\\npenis.\\nAs a rule, we find but one saddle-like plate, but in some in-\\nstances I have seen two, one just behind the glans penis, and the\\nother further up the organ, near its root. Another anomalous\\nform of this affection consists in the usual saddle-like lesion with\\nFig. 47.\\nFibroid sclerosis of the corpora cavernosa.\\none or two small plaques seated on one or both sides of the cor-\\npora cavernosa.\\nThese plates may grow in all the directions of their margin, but\\nusually to a greater extent in an antero-posterior direction. They\\nnot infrequently remain stationary for a long period, but usually\\nextend quite slowly and insidiously.\\nIn the majority of cases the lesion runs its course in the flat,\\nsuperficial manner just described but in some instances the scle-\\nrosing process extends deeper into the trabeculated tissue of the\\ncorpora cavernosa and produces nodular masses of varying size.\\nThis affection interferes more or less with erection, according to", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0153.jp2"}, "154": {"fulltext": "142 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nthe size of the plaque. If this is small it may cause but slight\\ndistortion of the penis but as it grows larger it so interferes with\\nthe proper erection of the organ that it is bent exceptionally almost\\nto a right angle, but usually upward and toward the affected side,\\nor it may be somewhat twisted. In most cases the erectile tissue\\nunderlying the lesion in the whole length of the organ becomes\\nhard and firm during erection. When, however, the trabeculated\\ntissues have been attacked by these sclerotic infiltrations, the penis\\nbeyond them is not at all congested, while the erection in the\\nproximal part is complete. In this event the organ may resemble\\na flail, the firm part near the body being the handle, and the distal\\npart or swingle hanging flaccid, perhaps nearly at a right angle.\\nIn general, patients having plates in the dorsum of the penis\\ncomplain that when erect the end of the organ stands so near the\\nabdominal wall that intromission is rendered impossible, and any\\nattempt at straightening it out is attended with severe pain. This\\nfeature is shown in the schematic drawing made by a patient of\\nhis own penis when erect. (See Fig. 48.) In this case a very\\ncurious and exceptional condition existed namely, the organ be-\\ncame distended and erect in its distal and unaffected four-fifths,\\nwhereas at its proximal sclerotic portion near the body it became\\nmuch less distended and was somewhat limber. In this condi-\\ntion intromission was only possible (and then with much difficulty)\\nwhen the vagina was very large and moist.\\nThe appearances presented by another exceptional case are\\nshown in Fig. 49, which is taken from a drawing furnished by\\nthe patient of his penis in a state of erection. The distal third\\nof the corpora cavernosa behind the glans was the seat of two\\nlong plates, which greatly reduced the size of the penis and gave\\nit a decided upward curvature. The unaffected part behind be-\\ncame normally enlarged, but engorgement never took place in the\\nglans penis. In his description of his case this patient said that\\nhis penis when rigid resembled a plucked turkey, the head being\\nthe glans, the affected portion the neck, and the body being the\\nproximal part of the penis, which swelled out during erection.\\nIn this case intercourse was painful and unsatisfactory. In some", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0154.jp2"}, "155": {"fulltext": "ORGANIC IMPOTENCE.\\n143\\ncases the glans and the penis itself may feel cold, and the glans\\nmay be so anaesthetic that there is no vigor in coitus, and as a\\nFig. 48.\\nV\\nFibroid sclerosis of the corpora cavernosa.\\nresult such a patient may be aspermatous by reason of the non-\\noccurrence of ejaculation.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0155.jp2"}, "156": {"fulltext": "144 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThis affection is peculiar to those of middle and advanced age.\\nI have seen it once at thirty, in another case at thirty-five, and in\\nseveral cases at the fortieth year. As a rule, these patients pre-\\nsent themselves when about fifty years old, and from that time\\non to sixty or seventy years.\\nEtiology. We have no precise knowledge as to the cause of\\nthis affection. By some it is thought to be the result of a gouty\\ncondition, and by others that it is caused by diabetes. Notwith-\\nstanding that Verneuil and Tuffier 1 in twenty-six cases found\\nFig. 49.\\nFibroid sclerosis of the corpora cavernosa.\\nfifteen patients to be gouty and eleven to be diabetic, it does not\\nfollow that these conditions were true etiological factors. I have\\nseen so many cases of this affection in absolutely healthy men,\\nwho were not gouty and whose urine did not contain sugar, that I\\nam very skeptical as to the influence of a diathesis in producing that\\npeculiar sclerosing process. In all probability the origin is local.\\nThe euphemistic diagnosis of gout in the penis is very gratify-\\ning to some old men.\\n1 Annales des Mai. des Org. Gen.-urin., 1885, pp. 401 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0156.jp2"}, "157": {"fulltext": "ORGANIC IMPOTENCE. 145\\nClose interrogation of intelligent patients thus affected usually\\nbrings out no facts as to its origin. In some exceptional cases\\nthere is a vague recollection of traumatism, but, as a rule, nothing\\ncan be learned from the patient as to the cause of his trouble.\\nPathology. According to Turner and Leloir, these nodules\\nresemble microscopically keloid, there being a fibrous network of\\ntissue like that of scars, with few vessels and islets of embryonic\\ncells, showing a tendency to fibrous transformation. In short,\\nthe process is a chronic fibroid sclerosis. The statement that this\\naffection is caused by thrombosis of the venous spaces is not sup-\\nported by any scientific evidence.\\nTwo cases have been reported in which, after the exsection of\\nplate-like masses from the penis macroscopically similar to fibroid\\nsclerosis, the microscopical diagnosis was said to be that of a malig-\\nnant new-growth called endothelioma. As these cases were not\\ncritically studied and the full facts concerning them have not\\nbeen published, it would be unwise at this time to claim that\\nfibroid sclerosis is of a malignant nature. I have observed very\\nmany such cases over a long stretch of years, and I have never\\nseen in them at any time whatever any evidence of malignant\\ndegeneration. It is important that this point should be clearly\\nremembered in order that unnecessary operations and mutilations\\nshall not be performed on one suffering from fibroid sclerosis of\\nthe corpora cavernosa.\\nPrognosis. The prognosis of this affection is very unsatisfac-\\ntory. There is no case on record in which this sclerosis has dis-\\nappeared. It has been stated that in some cases the affection\\ncrept backward, and then interfered less with erections than it\\ndid when it was more distally placed. In the very many cases\\nI have seen and studied no such auspicious turn of affairs took\\nplace. As this trouble is peculiar to men who are growing old,\\nand who are in general no longer eager for sexual activity, it is\\nin most cases complacently borne, and the patients do the best\\nthe} can in their crippled condition.\\nTreatment. Little can be done for this affection. Most patients\\ndesire at least to make an effort to remove their disability. In\\n10", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0157.jp2"}, "158": {"fulltext": "146 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nthis spirit mild blisters, mercurial inunctions, applications of iodine,\\niehthyol ointment, and the use of the constant current may be tried,\\nand for a time iodide of potassium may be given internally. Such,\\nhowever, is the uncertainty of ultimate favorable results that one\\nis not warranted in causing these patients inconvenience or suffer-\\nSYPHILITIC NODES IN THE CORPORA CAVERNOSA\\nAND CORPUS SPONGIOSUM.\\nIn the tertiary, and very exceptionally in the secondary, period\\nof syphilis the erectile tissues of the penis may be attacked by\\nlocalized gummatous infiltrations. The parts attacked are the\\ncorpora cavernosa and the corpus spongiosum. The involvement\\nof these structures by syphilis is very rare, and one part is attacked\\nabout as frequently as the others.\\nWhen the corpora cavernosa are attacked usually one of the\\nbodies is the seat of the lesion, and very exceptionally two are\\ninvolved. As a rule, the patient experiences no pain, and he finds\\nby accident a nodule of the size of a pea or a nutmeg, or even of\\nlarger dimensions, in the meshes of the erectile tissue. These\\nnodules are sharply denned, of roundish shape, of firm consist-\\nence, and they may even reveal a quite dense hardness. Usually,\\nin this, as we may term it, syphilitic cavernitis the theca of the\\nparts is not involved, and the nodule can be felt as a deep-seated\\ntumor. Exceptionally, I have seen such a nodule adherent to a\\ngoodly sized plaque in the theca, and still more exceptionally I\\nhave seen a flat, gummatous infiltration into the theca, with pro-\\ngressive involvement of the areolae of the cavernous tissue.\\nPea-sized or nutmeg-sized nodules of the corpus spongiosum,\\nin most cases involving the whole of the circumference, and ex-\\nceptionally limited to the upper or lower wall, are also somewhat\\nrarely seen. These lesions are quite firm, but not cartilaginous\\nin consistence, and their outline can usually be quite sharply de-\\nfined by the fingers.\\nAll these lesions run an indolent course, and, as a rule, do not\\nsoften and form abscesses. They cause trouble and disquietude", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0158.jp2"}, "159": {"fulltext": "ORGANIC IMPOTENCE. 147\\nto patients by reason of the curvature of the penis which they\\nproduce, which may be upward or downward or to the sides.\\nThus interference with coitus may be produced, and in many in-\\nstances intromission may be rendered impossible.\\nThese lesions of the corpora cavernosa run an indolent course,\\nwith little tendency to involution. In some cases they soften and\\nare gradually absorbed, and then distinct loss of tissue is left.\\nIn other cases the breaking-down of the tumor leads to an abscess\\nwhich may be slow in healing. In either of these events loss of\\ntissue and curvature of the penis result. If the case is seen early\\nand vigorous treatment is instituted, these nodules promptly show\\nsigns of resolution, and they may disappear without perceptible\\ndamage to the part. In some cases a slight fibroid thickening\\nmay be felt.\\nSyphilitic nodules of the corpus spongiosum run a similar course\\nto those of the cavernous bodies. In the event of spontaneous\\nresolution, of softening, or of abscess formation, there is danger\\nof the formation of a dense fibroid stricture of the urethra. If,\\nhowever, the case is seen early, the treatment may promptly cause\\nthe absorption of the infiltration, and little, if any, damage to the\\nurethra and spongy body may be left. In some cases slight thick-\\nening of the urethral wall is produced.\\nDiagnosis. In general, the deep-seated nodular form of\\nsyphilitic infiltration in the corpora cavernosa is so well marked\\nthat no mistake in diagnosis will occur. When there is a plaque-\\nlike infiltration of the theca of the cavernous bodies the exist-\\nence of fibroid sclerosis may be suspected. In all cases of doubt\\nwe must depend on the history and on the results of anti syphilitic\\ntreatment, which is usually promptly curative in the specific\\naffection and powerless in that of simple origin. The nodules\\nof the corpus spongiosum, as a rule, readily disappear under\\ntreatment.\\nPrognosis. When these syphilitic nodules are seen early and\\nare vigorously treated they will promptly undergo resolution, and\\nperhaps leave little damage. In old, neglected cases the integrity\\nof the tissues is more or less impaired.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0159.jp2"}, "160": {"fulltext": "148 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nTreatment. An active mixed treatment should be adminis-\\ntered internally, and mercurial ointment or plaster should be kept\\nover the site of the lesion.\\nCURVATURE OF THE PENIS.\\nThis condition is sometimes found in patients whose organ has\\nnot been injured. In some cases the curvature is slight and\\nupward in others, moderately downward, while in some there\\nis a decided twist of the organ, usually to the left. In none of\\nthese cases is there any material interference with coitus. I have\\nseen decided lateral twists in the penis in confirmed masturbators,\\nwhich were probably due to the abuse to which the organ had\\nbeen subjected.\\nVarious abnormalities of the penis may be accompanied by\\ncurvature of the organ. The most common cause of slight\\ncurvature is shortness of the frsenum, which, as a rule, is readily\\nrelieved by operation.\\nIn some rare cases the septum of the corpora cavernosa forms\\na distinct string or cord just above the corpus spongiosum, and it\\ndraws down the penis toward the scrotum. This condition also\\nmay be relieved by operation.\\nHypospadias, with adhesion to the scrotum, is a rare condition,\\nand is usually complicated with curvature of the penis, due in\\nsome cases to the cord-like condition of the septum of the corpora\\ncavernosa. This condition may be much improved or relieved by\\nplastic operation.\\nCongenital adhesion of the penis without hypospadias is some-\\ntimes found. In this state the penis is either wholly enveloped\\nby the scrotal tissue or it is attached by its inferior surface to the\\nbag by means of a webbed band of integument. The glans is\\nusually free, and from the meatus the urine dribbles downward.\\nThe penis being thus bound down, when it becomes erect it is\\ncurved downward, and intromission is impossible. (See Fig. 50.)\\nCurvature of the penis from shortness of the corpus spongiosum\\nis (mite rare. A dense and inelastic condition of the spongy body,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0160.jp2"}, "161": {"fulltext": "ORGANIC IMPOTENCE.\\n149\\neither congenital or the result of gonorrhoea! inflammation, in some\\nrare cases leads to downward curvature, which cannot be thoroughly\\nrelieved by operation.\\nInjury to the corpora cavernosa from abscess, gummatous infil-\\ntration, partial or complete fracture, and thrombosis may result in\\ncurvature of the penis. In fibroid sclerosis and ossification of these\\nstructures this deformity is a permanent symptom.\\nFig. 50.\\n^HBI\\nCongenital curvature of the penis and adhesion to scrotum. (After Weir.\\nTemporary curvature of the penis may occur during phimosis\\nand paraphimosis and from chordee.\\nWithin the past twenty years, in which extremely large incisions\\ninto and over-dilatation of the urethra have been so extensively\\npractised, it has not been uncommon to see many distressing cases", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0161.jp2"}, "162": {"fulltext": "150 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nof curvature of the penis, in some of which intromission was im-\\npossible, while in others coitus could be indulged in with great\\ndifficulty and discomfort. In many of these cases the distress of\\nthe patient was increased by the resulting sexual debility, which\\nin some cases amounted to impotence. As a rule, curvature of\\nthe penis, the result of intemperate instrumentation, is permanent\\nand wholly refractory to medical and surgical treatment.\\nFRACTURE OF THE PENIS.\\nThis accident is quite uncommon, and generally occurs in coitus\\nand exceptionally during sleep. It may be complete, in which\\ncase the cavernous bodies and spongy body are totally broken or\\nincomplete, in which condition one cavernous body or the spongy\\nbody alone may be fractured.\\nThe first symptom is a sudden stabbing pain, and then swelling\\nof the organ rapidly supervenes. When the corpora cavernosa\\nare involved the swelling is on the dorsum and sides of the penis,\\nand, according to the amount of extravasation of blood, is large\\nor small. Pain, distention, and unwieldiness are prominent symp-\\ntoms. In some cases the fractured ends have been found, and on\\nmotion crepitation was produced. Veazey 1 reports the case of a\\nyoung man who, in violent coitus, fractured the penis, except its\\nintegument, so that the two fragments could be moved over each\\nother, and when pulled apart a distinct sulcus could be felt. I\\nhave had under my care a similar case.\\nFracture of the corpus spongiosum may occur as the result of\\na blow on the penis when curved in chordee it more commonly,\\nhowever, is the result of violent efforts in coitus, sometimes in the\\nbridal bed, but generally as an incident in a drunken debauch.\\nIn the case of fracture of the spongy body the parts rapidly\\nswell, owing to the escape of blood, and, unless prevented by the\\nprompt use of the catheter, extravasation of urine occurs, in which\\neven the penis is greatly swollen from the base to the glans. In\\n1 New Orleans Medical and Surgical Journal, October, 1884.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0162.jp2"}, "163": {"fulltext": "ORGANIC IMPOTENCE. 151\\ncases of urethral rupture retention of urine is a frequent and\\ntroublesome symptom. The retention may occur as the result of\\nswelling and the resulting pressure on the canal, or it may be due\\nto the valve-like action of the torn mucous membrane.\\nThe local disturbance and the consecutive symptoms vary in\\ndifferent cases. In all there is more or less hemorrhage, and\\nwhen the urethra is involved there may be, in addition as just\\nstated, extravasation of urine. Fever is usually present in a pro-\\nnounced form, and in some cases pyaemia, even so severe as to\\ncause death, supervenes. As local effects, abscess, destructive\\nulceration of the tissues, and gangrene may occur, in which events\\nurinary or urethral fistulse may be left.\\nFracture of the penis is observed in young and old subjects. In\\nadvanced life the sheath of the corpora cavernosa is sometimes more\\ncondensed and brittle than normal, and it is more liable to frac-\\nture. I saw such a case in the person of a very old man, who,\\nduring sleep, rolled over on a very erect penis and broke the\\ncorpora cavernosa as sharply as if they had been cut with a knife.\\nThe prognosis of fracture of the penis varies according to the\\nextent and seat of the injury. When the cavernous bodies, one\\nor both, are fractured, the parts may heal, and erections may\\nthereafter be perfect, or erection may only occur in the proximal\\npart of the penis, while the distal part remains flaccid. Veazey\\nnoted in his case that this condition was present at first, but that\\nlater on perfect erections occurred.\\nThe outcome in cases of rupture of the corpus spongiosum is\\nusually a traumatic stricture of rapid growth and much density.\\nTreatment. In mild cases rest in the recumbent position and\\nthe application of cooling lotions or ice-water may be all that is\\nnecessary, except the introduction of a soft catheter to empty the\\nbladder. In the severe order of cases when the extravasation of\\nblood is extensive, it may be necessary to make a free incision,\\nand then perform external urethrotomy and establish bladder\\ndrainage. Ulceration and gangrene of the parts should be treated\\non the regular surgical lines. All collections of pus should be\\nincised and the parts antiseptically dressed.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0163.jp2"}, "164": {"fulltext": "152 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nRupture of the corpus spongiosum usually requires the regular\\npassage of a catheter, and perhaps its retention for a longer or\\nshorter period. Free incisions should be made when extravasa-\\ntions of urine has occurred, and when blood-extravasation is\\nextensive, particularly when it exerts injurious pressure. As the\\nswelling in these cases is usually so great that the urethra cannot\\nbe reached and promptly stitched, it is necessary to await events,\\nand when the stricture is forming to endeavor to restore the\\nurethral calibre by the introduction of sounds, and, in the failure\\nof this effort, to resort to internal urethrotomy.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0164.jp2"}, "165": {"fulltext": "CHAPTER XIII.\\nSTERILITY IN THE MALE.\\nIt is only within the past twenty-five years that the subject of\\nsterility in men has been carefully studied and that clear ideas\\nhave been entertained concerning it. In earlier years unfruitful\\nmarriages were generally, by common consent, ascribed to the\\nfault of the wife, who in many instances was energetically and\\nneedlessly submitted to much gynecological treatment, discomfort,\\nand trouble. In those earlier days, if a man seemed well devel-\\noped sexually, if he was able to copulate properly, and if he had\\nwhat seemed to be normal ejaculations, he was deemed potent, and\\nif he was married and without issue, the fault was not laid at his\\ndoor. But with the advance in medical science, the condition of\\nthe semen and of the seminal tracts has been carefully studied,\\nwith the result of proving that in many cases, although to the\\nunaided eye this secretion seemed normal, yet by the aid of the\\nmicroscope it was found to contain unfertile spermatozoa or no\\nspermatozoa at all, although all the other constituents of the secre-\\ntion might be present. As a net result of the observations of many\\ninvestigators, it may be stated, in general, that in cases of unfruit-\\nful marriage the husband is the sterile partner about one time in\\nsix.\\nTwo conditions have been found to be the cause of sterility in\\nthe male. The first is called azoospermatism, in which, although\\nthe man can properly perform the sexual act, his semen is unfer-\\ntile, for the reasons 1, that it is lacking in spermatozoa 2, that\\nthese highly vitalized bodies are of imperfect development or,\\n3, that they cannot reach the sexual tract. When the cause of\\nthis condition is investigated it is found to reside in some struc-\\ntural change in the testes and the epididymes, by which the secre-\\ntory function of these glands is either destroyed, or temporarily", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0165.jp2"}, "166": {"fulltext": "154 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nimpaired, or that an impediment is offered to the escape of the\\nspermatozoa, either in the epididymes or in some part of the vasa\\ndeferentia.\\nThe second condition producing sterility in the male is called\\naspermatism, in which, although the power of normal coitus exists,\\nthere is no ejaculation of semen, or the quantity of semen is de-\\nficient, or its emission is imperfect or impeded. Aspermatism is\\ncaused by a blocking up of the sexual tract in some part between\\nthe seminal vesicles and the ampullar and the meatus urinarius or\\nthe preputial orifice.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0166.jp2"}, "167": {"fulltext": "CHAPTER XIV.\\nAZOOSPERMATISM.\\nThe term azoospermatisni is applied to that condition in which\\na man retains the power of copulation, while in his ejacula-\\ntions spermatozoa are either wholly absent or present in small\\nquantity, or they are so poorly developed, or functionally inactive,\\nor uufertile that he is of necessity sterile. Azoospermatous men\\nmay, therefore, possess the potentia coeundi and lack the potentia\\ngenerandi. In azoospermatisni the absence of spermatozoa is due\\nto some abnormality of the testes or to some blocking up of the\\nvasa deferentia as far up as their ampullation. Azoospermatism,\\ntherefore, differs decidedly from aspermatism, in which condition\\nthe obstructive changes take place in the seminal tract between\\nthe seminal vesicles and deferential ampullations and the meatus\\nurinarius.\\nAzoospermatism results from a variety of abnormal and morbid\\nconditions of the testes. In the front rank of abnormal states are\\nthe various forms of testicular misplacement and of absence of\\nthe testes or some part of their excretory canals. Gonorrheal\\ninflammation plays an important part in this form of disorder by\\nthe stenosing and destructive lesions which it produces in the\\nepididymes, testes, and vasa deferentia. True azoospermatism is\\ninduced when the organs of each side are involved but in the\\nevent of the trouble being unilateral it then constitutes a menace\\nto the man s future virility, since he has but one testis left, and\\nthe function of this one may be and is very frequently destroyed.\\nSyphilis is very often an important factor in this condition, since\\nit may attack any or all portions of the testis or cord.\\nChronic testicular inflammation, due to some lesion of the gen-\\nital tract or to some infective process, is very often the underlying\\ncause of a man s sterility, which may also result from orchitis due", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0167.jp2"}, "168": {"fulltext": "156 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nto muscular effort or strangulation of the cord and gangrene of\\nthe testis.\\nThe functional activity of the testes may be so impaired, or\\neven destroyed, by the existence of hydrocele or hematocele that\\na man is temporarily or permanently azoospermatous.\\nTuberculosis of the testis is a not uncommon cause of destruc-\\ntion of the organ, while under various circumstances and in dif-\\nferent conditions atrophy of these glands may result in the loss\\nof their function. Tuberculosis of the prostate and of the seminal\\nvesicles and ampullations may so alter or poison the secretions of\\nthese organs that the spermatozoa are killed.\\nWhile it is true that many of the conditions thus outlined may\\nattack but one testis, in which event a man is not azoospermatous,\\nthere is always a liability that the second organ may become in-\\nvolved, either by the original morbid process or by one of different\\nnature and origin. These considerations have convinced me that\\nthe subject of azoospermatism can best be satisfactorily presented\\nby a clear and concise description of all abnormal states and\\nmorbid conditions which may lead to the impairment or destruc-\\ntion of the functions of the testes and of their canals.\\nECTOPIA TESTIS.\\nIt is necessary to recall to mind that in cases of abnormal posi-\\ntion of the testis, known under the general term ectopia, the organ\\nis either retained in the abdominal cavity or it becomes misplaced\\nin its descent. This condition is also called cryptorchism, espe-\\ncially when both testicles are misplaced, and the bearers of this\\ndeformity are called cry p torch ids.\\nThus we find the testes in abdominal ectopia either near the\\nposterior wall of the abdomen or in one of the iliac fossse. In\\ncases of imperfect descent it may be retained 1, in the inguinal\\ncanal 2, in the fold between the scrotum and the thigh or, 3, it\\nmay pass under Poupart\\\\s ligament through the crural ring and\\nbecome lodged in the thigh or, 4, it may pass down and become\\nfixed in the perineum in front and to the side of the anus.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0168.jp2"}, "169": {"fulltext": "AZOOSPERMATISM. 157\\nThese misplaced testes, all of which are usually abnormally\\nsmall, seem to be rather prone to undergo malignant degeneration.\\nEctopia testis has been by some authors considered to be an\\nundoubted cause of sterility, assuming that the function of the\\nother or free testis has been damaged. Curling 1 reports several\\ncases in which no spermatozoa were found in the semen after very\\ncareful microscopic examination. The facts of the case are, how-\\never, as stated by Monod and Terrillon 2 and by Monod and\\nArthaud. 3 In early years the spermatogenetic power of the re-\\ntained or misplaced organ is unimpaired, but as time goes on the\\ntissues either decay by fatty degeneration or by fibroid infiltration,\\nand the function of the gland is then destroyed.\\nEctopia of the testis, therefore, may lead to such disorganiza-\\ntion of the gland that spermatozoa are no longer developed in it.\\nIf in such a case the other testis is in any way diseased or de-\\nstroyed the bearer is sterile. This point is well brought out by a\\ncase reported by Godard, 4 in which a man having an undescended\\ntestis had a child by a mistress, and who, after an attack of epi-\\ndidymo-orchitis on the opposite side, was twice married and had\\nno progeny. Many years after this man s semen was found to be\\ndestitute of spermatozoa.\\nIn the rare cases of congenital absence of the testes, or of part\\nof the vasa deferentia, the subject is azoospermatous.\\nTreatment. This consists in cutting down on the misplaced\\ntestis, if accessible, and in anchoring it by sutures in the scrotum.\\n1 Diseases of the Testis. London, 1866, pp. 434 et seq.\\n2 Traite des Maladies du Testicule, etc. Paris, 1889, pp. 45 et seq.\\n3 Contribution de l Etude des Alterations du Testicule Ectopique. etc. Arch.\\nGen. de Med., 1887, Tome ii. pp. 641 et seq.\\ni Etudes sur la Monorchidie et la Cryptorchidie chez rhomme. Mem. de la\\nSociete de Biologie, 1857, p. 105.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0169.jp2"}, "170": {"fulltext": "158 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nCHANGES IN THE EPIDIDYMIS, TESTIS, AND VAS\\nDEFERENS DUE TO GONORRHCEA.\\nGonorrhoeal Epididymitis.\\nAs a result of the gonorrhoeal process in some cases certain\\nstructural changes take place, principally in the epididymis, and\\nalso in the vas deferens, which either temporarily or permanently\\nprevent the escape of spermatozoa from the testis. In these cases\\nsterility may result if both epididymes are attacked, or if the affec-\\ntion is unilateral and the other one is otherwise damaged.\\nThe most important post-mortem studies and microscopical ex-\\naminations into the testicular structures and into the condition\\nof the semen in cases presenting these lesions has been made by\\nGosselin, 1 Liegois, 2 and Terrillon, 3 and their essays furnish a basis\\nfor the study of this subject.\\nGonorrhoeal inflammation usually attacks the lower part or tail\\nof the epididymis or globus minor, and less commonly the head\\nor globus major, and gives rise to an indurated mass which may\\nobliterate the efferent canal, which at this part of the organ con-\\nsists of one very much convoluted tube. When this condition is\\nproduced no spermatozoa can pass into the vas deferens so long as\\nit lasts. If the head of the epididymis is attacked with indurating\\nhyperplasia, there is a chance that some of the numerous vasa\\nefferentia may not be involved, in which event the escape of sper-\\nmatozoa may not wholly be prevented. For these reasons, there-\\nfore, induration of the tail of the epididymis is a much more\\nserious matter than implication of its head.\\nIn cases where obliteration of the spermatic canal has occurred,\\neven when both sides are attacked, no perceptible change seems to\\ntake place in the testes.\\n1 Nouvelles Etudes sur 1 obliteration des Voies Spermatiques et sur la Sterilite\\nconsecutive a l epididy mite bilaterale. Arch. Gen. de Med., September, 1853.\\n2 Influence des Maladies du Testicule et de Fepididyme sur la composition du\\nSperme. Annales de Dermat. et de Syphiligr., 1869, pp. 410 et seq.\\n3 Des alterations du Sperme dans l epididymite blennorrhagique. Ibid., 2d\\nSeries, Tome i. pp. 439 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0170.jp2"}, "171": {"fulltext": "AZOOSPERMATISM. 159\\nIn cases where both epididynies are attacked patients seem to be\\nsexually unaffected, being capable of coitus and having complete\\nerections and ejaculations. The semen, however, is destitute of\\nspermatozoa, and, therefore, is unfertile.\\nIn the early stage of this form of testicular trouble the semen\\nis less viscid than normally, and it has a yellowish or yellowish-\\ngreen tint, due to the admixture of pus-cells and granular globules,\\nthe origin of which is not known.\\nTerrillon observed this yellow tint of the semen in a case of\\nunilateral induration of the spermatic canal, and when this fluid\\nwas examined under the microscope spermatozoa were seen vigor-\\nously wriggling around among pus-cells.\\nAs the induration in bilateral cases grows older and necessarily\\nbecomes more stenosing, the pus-cells gradually disappear, but the\\nspermatozoa do not reappear. The man, the ref ore, though capable\\nof coitus, is sterile. When, however, one testicle has remained\\nunaffected the bearer possesses the power of fecundation.\\nIt has been claimed by some authors that gonorrhoea^ tuber-\\ncular, and other morbid affections of one testicle or epididymis\\nmay in some occult way so affect its fellow that it also becomes\\nincapable of producing spermatozoa, and that as a result the man\\nbecomes sterile. There is, however, no scientific evidence to sup-\\nport this contention, which probably is the outcome of faulty clin-\\nical investigation and deduction.\\nLiegois has very clearly shown by his studies that in propor-\\ntion as the induration of the globus minor softens and disappears\\nspermatozoa show themselves in the semen in increasing numbers\\nuntil the normal condition of that fluid is reached. This author,\\namong three hundred cases of epididymitis, did not observe a single\\ncase of genuine atrophy of the testis, although he observed a slight\\ndiminution in volume in six or seven instances. In only eight\\ncases did he note loss of virile power, while in several it was\\nnotably increased.\\nThe conclusions, therefore, warranted by the foregoing consid-\\nerations areas follows 1. In all cases of unilateral epididymitis\\ntreatment should not cease with the decline of the acute stage, but", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0171.jp2"}, "172": {"fulltext": "160 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nactive measures should be taken to cause the absorption of the\\ninduration. 2. When bilateral epididymitis exists, even if of pro-\\nlonged duration, energetic and long-continued treatment should be\\nadopted, with the hope of dissipating the induration. 3. In cases\\nof recent involvement much hope may be entertained of perfect\\ncure.\\nMy experience has convinced me that the existence of chronic\\ngonorrheal epididymitis, unilateral or bilateral, even with unfer-\\ntile semen, may in many instances be so much relieved that virility\\nis restored to the man.\\nLuckily for the human race, the tendency in most cases of gon-\\norrheal epididymitis is toward resolution, at any rate, to the degree\\nof rendering the spermatic canal patulous.\\nPost-mortem investigations in cases of gonorrheal induration\\nof the epididymis have confirmed the facts brought out by clinical\\nobservation. Hardy endeavored to force an injection-fluid through\\nthe tail of an indurated epididymis, and failed. 1 In like manner\\nDelaporte 2 was unsuccessful in a case of epididymitis which had\\nonly existed five weeks.\\nGonorrheal Orchitis.\\nThough its occurrence is denied by some authors, there can be\\nno doubt that in some cases of gonorrheal epididymitis there is\\ntrue inflammation of the testis proper. In the majority of cases,\\nhowever, of so-called gonorrheal epididymo-orchitis there is simply\\na hypersemic and quasi-inflammatory condition analogous to the\\ncongestion of the prostate, which may occur in acute gonorrheal\\nposterior urethritis.\\nAs a rule, testicular involvement in gonorrheal epididymitis\\nquickly disappears, and the gland seems normal upon palpation.\\nIn some cases, however, chronic parenchymatous orchitis is de-\\nveloped, which may lead to the disorganization of the gland. The\\n1 Etudes sur l inflammation du testicule et principalement sur Pepididymite et\\nl orchite blennorrhagique. These de Paris, 1860, p. 15.\\n2 De l orchite aigue blennorrhagique. These de Paris, 1866, p. 12.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0172.jp2"}, "173": {"fulltext": "AZOOSPERMATISM. 161\\nessential change is cell-proliferation into the connective tissue\\naround the seminal tubules, as a result of which the development\\nof spermatozoa ceases and the tubules become filled with granular\\nmatter and cholesterin crystals. While at first the gland is more\\nor less increased in size, as the degenerative changes grow old,\\ncondensation and atrophy occur even to the extent of destroying\\nall evidence of glandular structure and transforming the organ\\ninto a mass of dense fibrous tissue. I have seen two well-marked\\nexamples of atrophy of the testis from acute gonorrhoea, and Rona 1\\nhas published the history of a very interesting case.\\nGonorrhoeal Funiculitis, or Deferentitis.\\nIn some cases the gonorrhoeal process does not reach the epidid-\\nymis, but centres itself in a segment of the vas deferens, usually\\nnear the testis, or at any part up to the external abdominal ring.\\nIn such cases a goodly sized, round or oval tumor is formed, which\\nis the seat of pain. After the inflammation subsides a hard nodule\\nis left, which may block up the calibre of the canal, and if the\\nresulting stenosis is permanent spermatozoa cannot pass from the\\ntestis. When this condition exists in the course of both vasa\\ndef erentia the bearer is sterile. Such cases, however, are very rare.\\nThe vas deferens may be attacked within the pelvis, and more\\nor less damage to its lumen may follow. Instances of this affec-\\ntion are very uncommon.\\nTreatment. Active efforts should be made to cause the absorp-\\ntion of the cellular infiltration, wherever it may be. In some cases\\nrepeated small blisters with cantharidal collodion are beneficial.\\nAs a rule, strapping the testis should be practised until it is\\ndemonstrated that good results follow or that no effect is pro-\\nduced. Applications of mercurial ointment, of iodine ointment,\\nof iodide of lead ointment (one drachm to one ounce of cerate),\\nor of ichthyol ointment (one drachm to two drachms of cerate)\\nmay be tried, and their use should be persisted in. These prepa-\\nrations may be spread on layers of absorbent cotton, which are\\n1 Monatshefte fur Prak. Dermat, 1886, Band v. pp. 360 et seq.\\n11", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0173.jp2"}, "174": {"fulltext": "162 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nplaced over the scrotum, over which is one thickness of gutta-\\npercha tissue, and the whole held up snugly by a suspensory ban-\\ndage.\\nIodide of potassium may be given internally.\\nIn every case the condition of the urethra should be ascertained,\\nand if chronic inflammation be present it should be thoroughly\\ntreated.\\nCHANGES IN THE EPIDIDYMIS, TESTIS, AND VAS\\nDEFERENS, DUE TO SYPHILIS.\\nSyphilitic Epididymitis.\\nSyphilis may attack the epididymis, both in its early and late\\nstages. In the early months of the infection it is not uncommon\\nto find the globus major, and less frequently the globus minor, of\\nthe testis to be swollen, hard, and moderately painful, especially\\nwhen compressed. This condition also occurs at any time during\\nthe first and second years of the disease.\\nThe size of the tumor, which has a smooth surface and firm\\nconsistency, varies between that of a pea and a hickory-nut. Un-\\ninfluenced by treatment, this indurated nodule will remain in an\\nindolent condition for a long period, and will ultimately produce\\ndisorganization of the head of the epididymis. But if local and\\ngeneral treatment is promptly adopted, resolution soon follows,\\nand the integrity of the parts is restored.\\nIn some cases both epididymes are attacked, either simultane-\\nously, or, as more commonly occurs, after a longer or shorter\\ninterval.\\nIt sometimes happens that an epididymis previously indurated\\nby gonorrheal inflammation becomes attacked by syphilis, in\\nwhich event resolution may be very slow, and in the end some\\ncondensation of tissue may remain.\\nThe diagnostic point that gonorrhoea attacks the tail of the\\nepididymis, and that syphilis is more prone to invade the head,\\nmay be observed in the greater number of cases.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0174.jp2"}, "175": {"fulltext": "AZOOSPEBMATISM. 163\\nIn late secondary and in tertiary syphilis the epididymis is some-\\ntimes attacked in a slow, painless way by a chronic infiltrative\\nprocess, which leads to a smooth or nodular bulbous expansion\\nof the affected segment, usually the head of the appendage.\\nThis late form of syphilitic epididymitis is usually unilateral,\\nbut it may be bilateral. Tertiary syphilitic inflammation may\\nattack an epididymis the seat of gonorrhoeal induration, and then\\nstenosis of the spermatic canal is to be feared. Late syphilitic\\nepididymitis does not yield to treatment as promptly as the early\\nform does therefore, it is important that medication should be\\ncommenced as early as possible, and pushed with care and vigor.\\nIn very rare cases syphilitic nodules form in the vas deferens\\nin the scrotum, and they may, if left aloue, lead to stenosis of that\\ntube.\\nWhen occlusion of one spermatic canal is produced by the fore-\\ngoing processes a man s virility is not destroyed, provided the\\nother testis is competent but if permanent stenosis of both sper-\\nmatic canals is developed, sterility inevitably follows. In these\\ncases much hope can be entertained, hence treatment should not\\nbe precipitately abandoned.\\nSyphilitic Orchitis.\\nLate in the secondary and during the tertiary period the body\\nof the testis may become attacked by a slow, painless, and in-\\nsidious fibroid or gummatous infiltration. The organ becomes\\nuniformly swollen, hard, firm, less sensitive than normal, and\\nusually smooth on its surface. In some cases large nodular masses\\nmay be found in the organ as a result of gummatous infiltration.\\nAs a rule, the testis at first retains its normal shape, but as\\ntime goes on it enlarges very considerably, even to the size of a\\nbig fist, and becomes of a decidedly pear- shape, or ovoid or glob-\\nular. Usually one testis, but not infrequently both glands, are in-\\nvolved. (See Fig. 51.)\\nThis form of orchitis, or sarcocele, as it is called, runs a chronic,\\nuneventful course if left to itself but it will yield in a surprising", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0175.jp2"}, "176": {"fulltext": "104 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nmanner if treatment is instituted early. The danger in the affec-\\ntion is that the seminal lobules will be destroyed by the fibroid or\\ngummatous tissue which develops in the fibrous stroma in which\\nthey lie. When this occurs the development of spermatozoa in-\\nevitably comes to an end. In addition, the efferent tubules may\\nbe destroyed by fibroid stenosis or degeneration. Therefore, this\\nFig. 51.\\nDouble syphilitic orchitis, or sarcocele.\\naffection is a very serious one, as it tends from the first to destroy\\nthe spermatogenetic capacity. Degenerative changes may occur\\nand abscess may be produced, or the testis may be transformed\\ninto a fungating mass fungus testis.\\nIn exceptional cases the testis in tertiary syphilis becomes sud-\\ndenly swollen and painful, and presents points of resemblance to", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0176.jp2"}, "177": {"fulltext": "AZOOSPEBMATISM. 165\\ngonorrhoeal epididymo-orchitis, except that the epididymis is very\\nrarely attacked. This syphilitic orchitis 1 of brusque invasion is\\nusually attended with pain in the groins and loins. The acute-\\nness and severity of the symptoms may last a week or two, and\\nthen the process gradually subsides until the typical indolent con-\\ndition is observed. In these acute cases involvement of both\\nglands is to be very much feared. Effusion of fluid into the tunica\\nvaginalis is sometimes to be found in cases of this testicular lesion.\\nThis form of orchitis is very likely to lead to destruction of one\\nor both testes and to partial or total sterility.\\nNearly all patients suffering from syphilitic sarcocele become\\nvery anxious and apprehensive, fearing that as a result they may\\nbecome sterile. When but one testis is attacked the patient s\\nejaculation will contain fertile spermatozoa, provided the other\\ngland is unaffected and competent. Even when both glands are\\nattacked it is often surprising to see how promptly resolution\\noccurs and how soon the semen again becomes fertile. I have\\nseen many such cases, in which, after bilateral syphilitic sarcocele,\\na cure has been produced and the man has begotten healthy chil-\\ndren. In these cases, therefore, it is well to be very hopeful, and\\nto press the treatment as vigorously as possible, since a perfect\\ncure and restored virility may occur even when the case appears\\ndesperate. It seems remarkable that the seminiferous tubes may\\nbe so profoundly and chronically affected, and yet they may regain\\ntheir function perfectly. However, when syphilitic sarcocele has\\nexisted for very long periods, such as one or several years, there\\nis danger of the destruction of the function of the organ, and that\\nod resolution atrophy may result.\\nIn all cases in which syphilitic sarcocele is complicated with\\nexuberant fungoid development the spermatic function of the\\ngland is destroyed.\\n1 Broca has published an interesting case of this kind (Syphilis testiculaire\\nbilaterale a debut brusque et douloureux Gazette Hebdom., 1883, Tome x. pp. 181\\net seq. and Carsine has published a number of cases (Du Sarcocele Syphilitique\\na debut innammatoire et douloureux These de Paris, 1886) in which the testic-\\nular lesion was accompanied by severe secondary manifestations.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0177.jp2"}, "178": {"fulltext": "166 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThere is a class of quite rare cases, to which attention was first\\ndirected by Laroyenne, 1 of syphilitic men who, without perceptible\\nlesion of the testes, are sterile. In these cases there is no history\\nof testicular involvement, nor are there any symptoms pointing to\\ndisturbance in the gland. I have examined the semen in several\\nof these cases, and have been struck by the entire absence of sper-\\nmatozoa in that fluid. This azoospermatism may be seen in persons\\nin the secondary stage of syphilis and in those in whom the infec-\\ntion had not shown any evidence for a few or many years. Laro-\\nyenne thinks that in these cases syphilitic cell-infiltration of a mild\\ndegree has so compressed the tubules that the function of sperma-\\ntogenesis is destroyed. This view is also entertained by Bryson, 2\\nwho, in a series of cases, found absence of spermatozoa in the\\nseminal fluid.\\nAs a rule, in this form of syphilitic azoospermatism treatment\\nfails to afford any relief but in one case I was surprised and\\npleased at the reappearance of spermatozoa after an absence of\\nthree years, in consequence of a prolonged and vigorous course of\\ntreatment.\\nSyphilitic Funiculitis, or Deferentitis.\\nSyphilitic infiltration in and around the vas deferens is very\\nrare, and shows itself as nodular or moniliform swellings of indo-\\nlent course. If left to themselves these lesions undergo degen-\\neration and the lumen of the canal is occluded.\\nHereditary Syphilis of the Testis.\\nIn syphilitic infants and young children the testicle may become\\nindolently and painlessly swollen to the size of a pigeon s egg or\\nof a walnut. The epididymis may also be synchronously attacked,\\nand in very rare instances the vas deferens is enlarged to a greater\\nor less extent. These testicular alterations, due to hereditary\\n1 De l infecondite* d origine syphilitique. Lyon Medicale, 1875, No. 4.\\n2 Syphilitic Azoospermism. St. Louis Courier of Medicine, 1882, vol. vii. pp.\\n495 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0178.jp2"}, "179": {"fulltext": "AZOOSPEBMATISM. 167\\nsyphilis, may, if promptly treated, end in full resolution. In\\nsome cases, however, atrophy, necrosis, abscess, and fungoid de-\\ngeneration lead to the incompetence of the gland as a factor in\\nthe sexual function. In these cases a round or irregular nodule\\nof fibrous tissue remains, and the virility of the person, should\\nhe reach puberty, depends upon the integrity of the remaining\\ntestis. Unfortunately, in hereditary syphilis both testes frequently\\nmay be attacked, and with their destruction the ultimate sterility\\nof the patient is inevitable. In some cases of syphilitic orchitis in\\nthe young subject tubercular infection attacks the affected tissue,\\nand thus adds a factor of malignancy to the case.\\nLewin 1 reports the case of a lad, eighteen years old, who was\\npuerile in demeanor and very boyish-looking, whose testicles were\\nof the size of those of an infant, as a result of hereditary syphilis\\nin infancy. Reclus 2 speaks of the case of a patient (age not given),\\nconsidered by Parrot and Fournier to be the victim of hereditary\\nsyphilis, in whom a testis of the size of a small nut, and of great\\nfirmness, was present. I have seen a case in which the gland\\nwas reduced to a small mass of fibrous tissue. When we find\\nsuch a sequela in an adult the suspicion of antecedent hereditary\\nsyphilis of the testicle is warranted.\\nTreatment. In all cases of syphilis of the testis and epididy-\\nmis an energetic and prolonged treatment by mercury and iodide\\nof potassium should be adopted. In these cases the local use of\\nmercury in the form of blue ointment should be instituted at once\\nand persisted in. It is a good rule to begin with goodly doses of\\nthe iodide of potassium (10 to 20 grains ter in die), and to increase\\nthe quantity until two or three drachms are taken three or four\\ntimes a day. This drug may also be given in combination with\\nbiniodide of mercury the so-called mixed treatment. Testicular\\nlesions in infants should be treated in the same manner, except\\nthat smaller doses should be given. Many brilliantly successful\\nresults follow active treatment.\\n1 Berl. klin. Wocliens., 1876, Xos. 2 and 3.\\n2 De la Syphilis du Testicule. Paris, 1882, pp. 149 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0179.jp2"}, "180": {"fulltext": "168 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nCHRONIC ORCHITIS AND EPIDIDYMITIS.\\nThe testis and the epididymis are liable to be attacked by such\\na degree of chronic inflammation in young, middle-aged, and old\\nsubjects that the function of the gland may be destroyed by the\\nindurating and atrophic processes which supervene. In many of\\nthese cases there has existed as a starting-point gonorrhoeal epi-\\ndidymitis, or epididymo-orchitis in some, however, the gland\\nhad previously been healthy.\\nIn some cases of chronic posterior urethritis and of stricture of\\nthe urethra, usually in careless sexually indulgent subjects, the\\nepididymis is attacked by a mild form of inflammation, which\\ndoes not cause the patient to go to bed or the epididymis to be-\\ncome much swollen or painful. Such an attack usually soon\\nsubsides, and is followed at a greater or less interval of time by\\na recrudescence, which in its turn is followed by another attack,\\nand so the case continues for years. Some relapses are more severe\\nand inflammatory than others. When examined, such an epidid-\\nymis is found to be enlarged usually in its whole length, the swell-\\ning being quite uniform and diffuse, and not nodulated at any\\npoint. Thus is produced a hard, firm, perhaps painless, sclerotic\\ncrescent, which is attached to the back and upper and lower part\\nof the gland. The lesion not being of a tubercular nature, degen-\\nerative changes, such as abscesses and necrosis, are not observed,\\nbut as time goes on the sclerosis gradually destroys the efferent\\nspermatic tubes and produces azoospermatism of one and not in-\\nfrequently of both sides. The testis may become rather larger\\nthan normal or it may decrease in size. As a rule, patients thus\\naffected being young and well, and observing for a long period\\nno diminution in their sexual desires and in their ability for copu-\\nlation, pay little heed to their testicular trouble. Later on, in cases\\nof double epididymitis or epididymo-orchitis, the sexual appetite\\nand the capacity for coitus may begin to wane, and the affection\\nbecomes a source of anxiety and apprehension. In the case of\\nunilateral involvement there may be no functional impairment\\nunless the unaffected testis becomes diseased from any cause.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0180.jp2"}, "181": {"fulltext": "AZOOSPERMATISM. 169\\nThis form of chronic epididymo-orehitis being so persistent,\\nso liable to undergo exacerbation, and so rebellions to treatment,\\nis really a serious affair, and it calls for careful local and urethral\\ntreatment.\\nThe clinical picture above portrayed will apply to cases of\\nyoung and old subjects usually having chronic gonorrhoea or\\nstricture of the urethra, in whom it is necessary to pass for long\\nperiods of time urethral instruments also to cases in which lith-\\notrity, litholapaxy, and lithotomy have been performed. In these\\ncases, however, abscess of the testis may occur.\\nIn some old men having hypertrophy of the prostate, cystitis,\\nand that low-grade form of chronic urethritis which is not\\nuncommon, a slow, usually painless fibroid enlargement of the\\nwhole epididymis, and perhaps of the testis, may not uncommonly\\nbe observed. When double, this affection soon extinguishes the\\nprocess of spermatogenesis, and coincidently the sexual desire may\\nbecome less keen. When the trouble is unilateral there may be\\nno perceptible impairment of the sexual function for a long time.\\nThe tendency of this affection is to produce permanent sclerosis\\nof the parts attacked.\\nORCHITIS AND EPIDIDYMO-ORCHITIS, DUE TO\\nGENERAL INFECTIVE PROCESSES.\\nTesticular inflammation is not uncommonly observed as a com-\\nplication of a number of infective processes, and it may lead to\\nsuch structural changes that the integrity of the testis, of the\\nepididymis, or of both, may be destroyed. These infective testic-\\nular lesions, as a rule, attack but one gland, but it is not uncom-\\nmon to see both glands affected. As a rule, the testis is the part\\nattacked, and with it the epididymis may be involved. It is not\\ncommon to find infective epididymitis without involvement of the\\ntestis.\\nMump Orchitis.\\nDuring the course of mumps the testicle, especially in young\\nsubjects, may be attacked by severe inflammation, and the clinical", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0181.jp2"}, "182": {"fulltext": "170 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\npicture of blennorrhagic epididymo-orchitis may then be counter-\\nfeited. The invasion of this affection is brusque and its course\\nrapid. Occasionally, the two testes are attacked. Full resolu-\\ntion may occur, but it is not at all uncommon to observe total\\natrophy of a gland, and, exceptionally, of both glands. Many\\nmen become sterile owing to the destruction of one testis by\\nmumps and of the other by some other morbid change. The\\nreciprocal relation between the testes and the parotid glands is\\nshown in certain rare cases, in which, after the removal of these\\nglands, the parotids become acutely swollen and inflamed.\\nTonsillar Orchitis.\\nThis condition may occur during the course of tonsillitis, with\\nacute invasion and usually with prompt resolution. Abscess may\\ndestroy the testis.\\nVariola Orchitis.\\nIn some cases of smallpox the testis, epididymis, and tunica\\nvaginalis may become rapidly and severely inflamed. Resolution\\nusually occurs, but in some cases atrophy or abscess of either or\\nall of these structures ensues.\\nScarlatina Orchitis.\\nThis form of orchitis may occur in children and adolescents,\\nand it is usually of an active type. Resolution may take place,\\nbut atrophy may result.\\nMalarial Orchitis.\\nDuring the course of malaria the testis may become inflamed,\\neven in subjects who have not had gonorrhoea and its testicular\\ntrouble. Iu the cases thus far reported it has been noted that\\nexceptionally atrophy of the testis and induration of the epidid-\\nymis have followed this malarial phlegmasia.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0182.jp2"}, "183": {"fulltext": "AZOOSPERMATISM. 171\\nGrip Orchitis.\\nInvolvement of a testis which previously had been healthy, or\\nwhich had been the seat of gonorrheal inflammation, has been\\nobserved in quite a number of instances. Resolution usually\\noccurs, but atrophy, epididymal induration, and gangrene are\\nliable to follow.\\nDuring the course of whooping-cough, pneumonia, typhoid\\nfever, pyaemia, and of grave phlegmonous inflammation of bones,\\nthe testis and perhaps the epididymis may become the seat of in-\\nflammation. In such cases resolution may take place or degen-\\neration of the testis or of the epididymis may be produced.\\nThe danger of these infectious testicular inflammations lies in\\nthe fact that they occur chiefly in young subjects, and that when\\nthey are severe destruction of the gland is complete. Should the\\nunaffected testis later on become involved by one of the many\\nmorbid conditions which are liable to attack it, the result is ster-\\nility in its bearer.\\nThe treatment is that used for gonorrheal epididymo-orchitis.\\nORCHITIS DUE TO MUSCULAR EFFORT.\\nThis form of traumatic orchitis is moderately common. It\\nmay be a simple and ephemeral condition, or such changes may\\nbe produced by the injury that the epididymis may be much\\nenlarged and indurated, or the testis may be so disorganized that\\natrophy may result. In either of these events unilateral azoosper-\\nmatism may follow the injury to the epididymis or the testis.\\nThe clinical picture of orchitis from muscular effort is that of\\ngonorrhoeal epididymo-orchitis, usually with a preponderance of\\nthe testicular trouble. Under the influence of rest and suitable\\nlocal applications resolution usually occurs quite promptly, but\\nthe testis may remain tender and somewhat swollen for some time.\\nTerrillon 1 reports a case of this form of orchitis in which atrophy\\n1 Annales des Mai. des Org. Gen.-urin., 1885, Tome iii. p. 239.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0183.jp2"}, "184": {"fulltext": "172 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\noccurred, and this process was attended by so much pain that\\ncastration was resorted to.\\nIn all probability orchitis from muscular effort is due primarily\\nto sudden and strong abdominal pressure upon the spermatic plexus\\nof veins in persons who have lifted heavy weights, who have slipped\\nwith violence, or who by any means have been rudely shaken, as\\nin jumping a great distance, or even hurriedly alighting from a\\ncar in motion. Tenuity of the walls of the veins may be the\\nunderlying condition favorable to the development of this accident.\\nIt is only in severe cases that this traumatism may cause degen-\\neration of the testicle, which of itself would not lead to sterility\\nif the other testis be sound. The lesion produced in the testis\\nand epididymis is, first, effusion of blood, and, second, the changes\\nproduced by the compression thus exerted.\\nThe treatment is the same as that employed in acute epididymo-\\norchitis.\\nSTRANGULATION OF THE TESTIS AND EPIDIDYMIS\\nFROM TORSION OF THE CORD.\\nThis form of traumatism is very uncommon, and occurs in\\nsubjects (mostly young ones) whose testicular apparatus is some-\\nwhat malformed. There is usually a history or evidence of\\nundescended or imperfectly descended testis consequently, as a\\nrule, the swelling is found in the inguinal canal or just within the\\nupper part of the scrotum. There are present localized swelling,\\noedema, and redness, and such subjective symptoms as may point\\nto strangulated hernia, traumatism, or appendicitis. The position\\nand quite sharp localization of the tumor, the absence of the testis\\nfrom the scrotum, and the history of the case will usually point\\nto its nature. The diagnosis, however, is, as a rule, confirmed\\nwhen an exploratory incision has been made. Then the testis\\nand epididymis are found to be swollen, of a deep blue or even\\nblack color, and sometimes they are gangrenous. In most cases\\nthe testis is entirely destroyed.\\nIn some cases excessive and violent strain causes a twisting of\\nthe cord, which produces this trouble. In others no exciting cause", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0184.jp2"}, "185": {"fulltext": "AZOOSPERMATISM. 173\\ncan be ascertained. The twist of the cord may be partial or com-\\nplete, or the cord may be twisted several turns. The essential\\nand underlying cause of torsion of the cord is disturbance in the\\ndevelopment of the vaginal process of the peritoneum, in which\\nthe mesorchium is either too slender or too long, and hence does\\nnot give the testis the necessary amount of fixation. The mesor-\\nchium then allows greater movement than normal, and the testis\\nmay, as a result, encounter difficulty in entering the inguinal canal\\nand impediment in traversing it. When it is in the inguinal canal\\nthe flat condition of the. testis militates against its replacement\\nand renders this impossible when inflammation has been estab-\\nlished. In the scrotum the torsion may be reduced. Usually\\nsuch a testis requires prompt extirpation. Provided the other\\ntesticle is competent, the sterility of the man is not lost.\\nHydrocele.\\nIn some cases of old hydrocele such pressure is exerted upon\\nthe testis and the epididymis that the spermatogenetic function is\\nmuch impaired, and it is even temporarily suspended. In some\\nold cases in which the tunica albuginea and the epididymis are\\nmuch thickened and contracted by fibrous hyperplasia, fertile sper-\\nmatozoa are no longer produced.\\nLannelongue 1 and Marimon 2 have in cases of old and volumi-\\nnous hydrocele found such alterations in the structure of the epi-\\ndidymis and the efferent tubes so injuriously compressed that the\\nescape of semen was profoundly interfered with. A very impor-\\ntant fact has been noted by Roubaud 3 in the case of a young man\\nwho had very large double hydrocele. He was then sterile, and\\nno spermatozoa were found in his semen. After puncture of the\\ntwo sacs spermatozoa reappeared in the semen, disappeared when\\nthey became filled and distended again, and reappeared after a\\nsecond tapping of the two hydroceles.\\n1 Bulletin de la Soc. de Chirurgie, 1873, 3d Serie, Tome ii. p. 421.\\n2 Kecherches sur l Anatomie pathologique des grosses Hydroceles. These de\\nParis, 1874.\\n3 Traite de l lmpuissance, etc., 1876, p. 576.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0185.jp2"}, "186": {"fulltext": "174 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nOut of twenty-three cases of hydrocele in which the semen was\\nexamined by Lannelongue no spermatozoa were found in five.\\nDesmaroux 1 reports the case of a man, fifty -seven years old,\\nwho had double hydrocele and was sterile, but who became potent\\nafter puncture and iodine injection of the tunica vaginalis. It is\\nwell, therefore, not to forget that hydrocele may be at least a tem-\\nporary and, exceptionally, a permanent cause of sterility.\\nTreatment. Palliative measures consist of tapping the vaginal\\ncavity as often as it becomes full. In all cases, especially where\\nthe function of the testis is impaired by hydrocele, the best pro-\\ncedure is to perform Yon Bergmann s operation, in which all the\\nparietal layer of the tunica vaginalis is cut away.\\nHematocele.\\nIn severe cases of hematocele such damage is inflicted upon\\nthe testicle and such injury is produced by the effusion of blood\\nand the subsequent changes that the function of the gland may\\nbe destroyed. If its mate, however, is competent, sterility does\\nnot necessarily follow, but in case it is damaged the bearer is\\nsterile.\\nKocher 2 has shown that the seminiferous tubules may be altered\\nand even obliterated by hyperplasia of fibrous tissue, and that\\nthe whole gland may undergo fibroid degeneration after hema-\\ntocele. Pilliet 3 has clearly shown that the sclerosis begins in the\\ntunica albuginea, and spreads inward and invades the coats of the\\ntubes and the vessels, and thus destroys the glandular structure.\\nIt is well, therefore, to bear in mind that besides being a source\\nof pain and annoyance hematocele may, if left untreated, lead to\\nsuch damage of the testis that its function will be wmolly lost.\\nTreatment. In recent acute cases rest in bed, suspension of\\nthe scrotum, and the application of cooling lotions are necessary.\\n1 Gazette des Hopitaux, 1883, Tome lvi. p. 762.\\n2 Die Krankheiten der Miinnlichen Geschlechtsorgane. Stuttgart, 1887, pp.\\n100 et seq.\\nNote sur l \u00c2\u00a3tat du Testicule dans 1 Hematocele Vaginale. Compt. rend, du\\nSoc. de Biologie, 1887, Series 8, Tome iv. pp. 324 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0186.jp2"}, "187": {"fulltext": "AZOOSPERMATISM. 175\\nWhen fluctuation can be distinctly discovered it is well to incise\\nthe part (after proper surgical preparation) and then to pack it\\nwith iodoform gauze. It is always well not to operate until the\\nindications therefor are very clear.\\nIn chronic cases compression may be tried and mercurial or\\nichthyol ointment may be employed. When the tumor remains\\nunchanged and uninfluenced by treatment it may be necessary to\\nresort to Volkmann s operation for hydrocele. When the tumor\\nis of very large size or when testicular disorganization is evident,\\nit may be necessary to remove the organ.\\nTUBERCULOSIS OF THE TESTIS.\\nTubercular infiltration is one of the most common affections\\nwhich attack the testis and destroy its function. It is observed\\nchiefly at and during puberty and in adult life, but may be found in\\ninfants, and much less frequently in middle-aged and elderly men.\\nIn all probability, tubercle of the testis is developed seconda-\\nrily to some other more or less remote focus of infection of the\\nbody, and it is chiefly noted as being found in association with\\ntuberculosis of the prostate, seminal vesicles, and bladder and\\nureters and kidneys. Though some cases, from a clinical stand-\\npoint, seem to be instances of primary testicular tuberculosis, it\\nis not well to venture such a diagnosis with much positiveness,\\nsince lurking and perhaps dormant foci of infection may exist in\\nsome part of the body which can only be detected by post-mortem\\nexamination.\\nAs to the avenues by which the testis is invaded, it may be\\nstated that clinical, anatomical, and pathological facts point to the\\nbloodvessels as the carriers of the infective material.\\nThere is no scientific evidence at hand in favor of the view\\nthat infection through the urethral canal may occur and lead to\\ntesticular invasion.\\nThere is good reason for supposing that infection of the seminal\\nvesicles and prostate may occur through the vesico-rectal peritoneal\\nfold from tuberculosis of the peritoneum.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0187.jp2"}, "188": {"fulltext": "176 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nIn clinical practice we find two quite clearly marked forms of\\ntubercle of the testis namely, the acute and the chronic forms.\\nBesides these forms we find mixed varieties, in which acuity and\\nchronicity are blended.\\nThe acute form of tuberculosis of the testis presents somewhat\\nthe same clinical picture as is offered by acute gonorrheal epidid-\\nymitis. The patient may have given evidence of tuberculosis in\\nsome other and perhaps remote organ he may or may not have\\ncomplained of bladder, prostate, or urethral disorder j and he may\\nor may not have suffered from gonorrheal epididymo-orchitis.\\nHe may have previously enjoyed good or fairly good health, or\\nthe testicular lesion may appear as the only local evidence of dis-\\nease in a man who is pale, weak, and sickly, and who, perhaps,\\nhas within a short time lost flesh. In many cases traumatism\\nseems to be the exciting cause.\\nUsually the first symptom is pain seated in the head or the tail\\nof the epididymis, and very soon the segment involved swells to\\nconsiderable size. In some galloping cases the whole epididymis\\nis much swollen in all directions, is either spontaneously painful\\nor on slight pressure, and is covered with an acutely inflamed area\\nof scrotal tissue in a day or two. In other cases several days, or\\neven two or three weeks, elapse before such an acute condition is\\nreached. In these cases there is usually more or less fever and\\nmalaise.\\nWhen palpated in this state the epididymis usually does not\\npresent any diagnostic points, and the conclusion may be reached,\\nif there is any evidence of urethral discharge, that the case is\\none of gonorrheal epididymo-orchitis in the declining or chronic\\nstage. When the entire absence of any urethral discharge or\\naffection is rendered clear the suspicion of tubercular invasion\\nmay be entertained.\\nIn a few days, or in a week or two, upon the subsidence of the\\nsevere inflammatory reaction (in cases in which an abscess has not\\nbeen formed, and in which vaginalitis has not developed), the\\nsurgeon can carefully examine the organ, and then, or perhaps\\nlater, a nodular or bossy condition of the head and tail and per-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0188.jp2"}, "189": {"fulltext": "AZOOSPEBMATISM. 177\\nhaps of the body of the epididymis may be clearly made out.\\nAt this time the testis may appear uninvolved, but later on it\\nmay become more or less enlarged, and on its surface small or\\nlarge nodulations, just as if small shot or split pease were seated\\nin the tissue, can be felt.\\nIt sometimes happens that the seminal fluid becomes of a rose\\ncolor from blood admixture, probably derived from some part of\\nthe testis.\\nAbscess may sooner or later develop, usually at the head of the\\nepididymis, and also at the tail. When the tail of the epididymis\\nis attacked it is not uncommon to find a mass of suppurating tissue\\nabout an inch or less from it and connected by a fibrous strand in\\nthe loose scrotal tissue. These extra-epididymal abscesses seem\\nto be due to infecting pus which escapes from the involved epi-\\ndidymis.\\nAbscess is the direct outcome of the caseation and softening of\\nthe tubercular inflammation. The non-vascular cellular nodules\\nproduced by the infective process, and the infiltration which sur-\\nrounds, compresses, and destroys the seminal tubules and leads to\\na chronic diffuse orchitis, break down and give issue through one\\nor several fistula? to a thin fluid streaked with pus and small\\ngrumous masses. The scrotal wall becomes of a deep red, even\\nof a bluish-red color, and the orifices of the fistula} look very\\nunhealthy. In the cases thus briefly described there is usually\\nmore or less destruction of the testis proper, but the function of\\nthe gland is promptly destroyed by the deadly infective invasion\\nwhich attacks it in its centre and on both flanks. The develop-\\nment of tuberculosis of the epididymis is well shown in Fig. 52,\\nand its extensive invasion of the testis proper is admirably por-\\ntrayed in Fig. 53. One testis may be thus attacked, but not very\\nfrequently the other one is sooner or later involved.\\nIn the chronic form of tuberculosis of the testis many clinical\\npictures are presented. In some cases, in apparently healthy or\\nin sickly-looking subjects, with or without coexisting urethral,\\nprostatic, and vesicular involvement, the epididymis (tail or head)\\nswells painlessly, and the patient by accident discovers a small\\n12", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0189.jp2"}, "190": {"fulltext": "178 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nFig. 52.\\na\\nTuberculosis of the testis.\\nThe larger portion of the epididymis lies on the right side. a. Cheesy epi-\\ndidymis, b. Whitish mass occupying the mediastinum. c. Isolated tubercle\\nwith cheesy centre, d. Small cyst at the summit of globus major, e. Larger and\\nsmaller opaque spots scattered over the surface of the testicle.\\npea-sized or hickory nut-si zed nodule of irregular outline. This\\ncondition may slowly increase, and as it does the infiltration\\nbecomes more rugose upon its surface, and it may extend to the\\nFig. 53.\\nTuberculosis of the testis.\\nThe testicle is cut so that the larger part of the epididymis lies in the right\\nhalf. a. Swollen and cheesy epididymis, b. Mass of confluent tubercles at the\\nmediastinum, extending outward into the testicle and united above with the\\nglobus major, c. Larger and smaller tubercles, some with cheesy centres, in the\\ntesticle tissues.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0190.jp2"}, "191": {"fulltext": "AZOOSPERMATISM. 179\\nwhole epididymis, converting it into a fibrous mass. In this\\npainless, indolent state it may remain for a long time months\\nor years or caseation, softening, and fluctuation may be discov-\\nered, or abscess or fistula may develop. On removal of such a\\ntestis the epididymis is found to be very tough and fibrous, with\\nhere and there cavities in which degeneration has occurred. Very\\noften no evidence of invasion of the testis can be found.\\nIn other chronic cases there may be synchronously observed\\nseparate nodules of small or large size in the head and tail of\\nthe epididymis, with what is then most common, the involvement\\nof the whole mediastinum testis. In these cases the disease may\\nremain latent and indolent for varying periods (often quite long\\nones), or exacerbations may occur, and the case in its course may\\nthen resemble those of acute development. In general, however,\\nthe infective process goes on, the chronic epididymo-orchitis keeps\\non its course, and then we find a much enlarged epididymis, which\\nis hard, knobby, and irregular. In some cases the lesion in the\\nepididymis preponderates, and then that appendage is very large\\nindeed, and the as yet uninvaded testis forms but a small portion\\nof the morbid tumor. Then, again, the growth in the testis keeps\\npace with the process in the epididymis, and a large mass is pro-\\nduced.\\nHydrocele is observed in about one-third of the cases of tubercle\\nof the testis. In some exceptional cases tuberculosis of the testis\\n(one or both) presents the same clinical picture as is offered by\\nsyphilitic sarcocele. By slow degrees, with some or little pain,\\nthe testis and epididymis enlarge and form an ovoid or pear-\\nshaped tumor, which has a smooth surface and hard, firm consist-\\nence, and which may be mistaken for syphilitic sarcocele or cystic\\nsarcoma of the testis. These tubercular testes may be as large as\\na good-sized pear or a large fist. They may remain intact for a\\nlong period, and they may become the seat of abscess and fistula\\nand of fungoid development. In some of these cases I have\\nobserved small and large rounded nodulations on the surface of\\nthe testis. It is always difficult and often impossible in this form\\nof tuberculosis of the testis to discover the epididymis or to settle", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0191.jp2"}, "192": {"fulltext": "180 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nin one s mind how much it contributes to the general swelling,\\nsince the parts are so intimately merged together.\\nThe life-history of patients suffering from tubercle of the testis\\nis that of tuberculosis in general. In some cases the patients live\\nfor years after the extirpation of the organ or organs in others\\ndeath follows sooner or later from extension of the disease to vital\\norgans.\\nBesides the strikingly well-marked features presented by the\\naffected testis, there is, in most cases, evidence of prostatic involve-\\nment in the shape of enlargement and large and small nodulations,\\nand perhaps of irregular infiltrations in the ampullated ends of the\\nvasa deferentia and of the seminal vesicles, which may be ascer-\\ntained by digital examination in the rectum.\\nIn many cases of tubercular testis the scrotal part of the vas\\ndeferens is more or less attacked. There may be slight thicken-\\ning and enlargement, circumscribed or diffuse, or the tube may be\\nso nodulated that it feels like a string of beads of various sizes.\\nA testis attacked by tuberculosis soon ceases to possess the sper-\\nmatogenic function.\\nIn all probability, tubercular invasion of the epididymis and\\ntestis destroys the function of the gland much sooner and more\\nfrequently than we have heretofore thought. It must be remem-\\nbered that even in mild and indolent cases the development of\\ntoxins occurs in association with the morbid tissue-changes, and\\nthese poisons permeate the structures of the testis and destroy the\\ndelicate arrangement by which the spermatogenic function is per-\\nformed. In very acute cases the extensive swelling and hyper-\\nemia are, undoubtedly, largely due to the diffusion of the poisons\\nthrough the whole gland. It is fair to assume that this condition\\ndestroys the function of the testis at once. Then, in addition to\\nthis diffusible poison, the cell-changes so destroy the integrity of\\nthe gland that it soon becomes useless as a producer of sperma-\\ntozoa.\\nInvolvement of the two glands carries with it sterility. The\\nforegoing considerations show what a widely deleterious influence\\ntuberculosis exerts upon the sexual function.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0192.jp2"}, "193": {"fulltext": "AZO 6 SPERM A TISM. 181\\nTreatment. The most important point in the management of\\ncases of tuberculous testes, and in which other organs and tissues\\n(lungs, kidney, bladder, prostate, vesicle, etc.) are attacked, is the\\nremoval of the patient to a suitable climate which is high, dry,\\nand sunshiny the Adirondacks, Southern California, and Colo-\\nrado. In all cases it must be remembered that climate is the chief\\ncurative factor, and that the action of drugs is only secondary.\\nBenefit, however, may result from the use of cod-liver oil, the\\nhypophosphites, creosote, iodide of iron, and tonics, all of which\\nshould be judiciously employed. The adoption of surgical meas-\\nures depends wholly upon the extent and seat of the tubercular\\nlesion.\\nIf there are indurated masses in the epididymis or in the testes\\nthese points should be incised, thoroughly scraped, and packed\\nwith iodoform gauze.\\nIf there are sinuses leading into the epididymis or testes they\\nshould be enlarged, scraped, and packed with absorbent gauze or\\niodoform ointment.\\nWhen the entire testis is extensively involved and broken down\\nit is necessary to resort to castration but in these cases the neces-\\nsity of climatic change should be forcibly impressed on the patient.\\nTUBERCULOSIS OF THE PROSTATE.\\nThe prostate is involved in the majority of cases of tuberculosis\\nof the genito-urinary tract. Its development may be primary or\\nsecondary to infecting foci in adjacent or remote parts. It is\\nmostly observed at puberty and in early life.\\nTuberculosis of the prostate may cause azoospermatism by the\\nobliteration of the ejaculatory ducts.\\nThe course of tuberculosis of the prostate may be acute, sub-\\nacute, or chronic.\\nIn the majority of cases the disease begins in the urethra, but\\nit is also found in the substance of the gland and on its periphery,\\nparticularly near the rectum.\\nIn cases of urethral involvement the symptoms are complained", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0193.jp2"}, "194": {"fulltext": "182 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nof quite early. The most prominent symptom is pain, particularly\\non urination, which may be very urgent, and it may be either con-\\ntinuous or intermittent. Invasion of the prostate is usually fol-\\nlowed quite promptly by extension to the bladder, with its cus-\\ntomary group of symptoms.\\nIn cases of prostatic tuberculosis there is usually a more or less\\nprofuse mucopurulent discharge, which may escape spontaneously\\nor on defecation. When the tuberculous nodules are seated in the\\nparenchyma of the prostate they may not give rise to pronounced\\nsymptoms for some time. This is particularly the case when the\\ncourse is very chronic. When the tuberculous nodules are seated\\ntoward the periphery of the organ they may occasion few, if any,\\nsymptoms, but when they are very superficially seated, particularly\\nnear the rectum, they may cause pain and uneasiness in those parts.\\nOn rectal examination the finger-tip may not encounter any\\nabnormality when the urethral part of the prostate is attacked.\\nWhen the nodules are seated in the parenchyma of the organ and\\nthey have become quite large, or when several have coalesced and\\nproject on the surface, their presence may be determined by pal-\\npation with the finger in the rectum.\\nThe diagnosis of prostatic tuberculosis may be made by exam-\\nination of the morbid secretion or of the urine. But in many\\ncases such examinations fail to reveal the bacillus tuberculosis\\nuntil digital pressure has been brought to bear on the gland and\\non the urethral canal.\\nTreatment. Tuberculosis involving the urethral canal may\\nbe benefited by prostatic and bladder irrigations of warm solutions\\nof bichloride of mercury (1 3000 or 1 8000). In the event of\\nthis treatment causing pain and urethral irritation it will be neces-\\nsary to discontinue it. In some cases iodoform and sweet oil (10\\nper cent.), in the form of injections, have seemed of benefit in\\ncases of ulceration of the urethra.\\nTubercular abscesses of the prostate near the rectum may be\\nreached by a crescentic incision made an inch in front of the anus\\nbetween the prostate and the rectum they are then incised and\\npacked with iodoform gauze.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0194.jp2"}, "195": {"fulltext": "AZOOSPERMATISM. 183\\nChange of climate (see section on Tuberculosis of the Testis,\\np. 181) is the main indication in these cases, which are usually\\nthose of more or less extensive distribution of the tubercular\\nprocess.\\nTUBERCULOSIS OF THE SEMINAL VESICLES.\\nThis condition is rarely, if ever, of primary development, but\\nis usually found synchronously with tubercular prostatitis and\\ncystitis. It is a disease of early life, and very frequently coexists\\nwith tuberculous infiltrations of other organs more or less remote.\\nBy rectal examination with the finger a nodular swelling is\\nfound continuous with and just above the prostate. The tissues\\ncan be felt to be much infiltrated and quite boggy.\\nIn many cases the ampullations of the vasa deferentia are in-\\nvolved, and they feel like brawny, insensitive swellings.\\nWhen the seminal vesicles are involved by the tuberculous\\nprocess their respective ducts are generally involved simultane-\\nously, and from these foci the morbid process may extend and\\nattack the ejaculatory ducts.\\nWhenever the seminal vesicles and the ampullae are the seat of\\ntuberculosis, a mucopurulent discharge, mixed with grumous\\nmasses and sometimes with blood, forms within them, which when\\nthe ducts remain patulous may escape through the urethra.\\nWhen these seminal sacs and the ampullations are the seat of\\ntuberculosis, sexual erethism may be complained of at first, but\\nlater on impotence is observed. When in these conditions the\\nmorbid tissue products become mixed with the normal secretions\\nof the parts, the spermatozoa are destroyed. It is very probable\\nthat when tuberculosis attacks the vasa deferentia the spermatozoa\\nare killed as they pass upward from the testes.\\nTreatment. The remarks already made on the necessity of\\nclimatic treatment (see page 181) hold good in cases of tubercu-\\nlous spermatocystitis. Care as to hygiene, diet, and suitable\\ntherapeutic measures should also be exercised.\\nSuch is the extent of tubercular infection in most cases that", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0195.jp2"}, "196": {"fulltext": "184 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nsurgical operations on the seminal vesicles alone are not indicated.\\nAbscess of these parts may be reached by a crescentic incision\\nabout an inch in front of the anus and carried down between the\\nprostate and vesicles and the rectum. The parts are, after careful\\nirrigation, packed with iodoform gauze, which is held in place\\nby a retentive dressing. Excision of the vesicles may be accom-\\nplished by means of Kraske s or ZuckerkandPs incision.\\nATROPHY OF THE TESTIS.\\nAs has been shown in some of the foregoing sections, atrophy\\nof the testis is very common, and it is due to a great variety of\\ncauses.\\nIn the young subject the gland may become dwarfed by reason\\nof abnormal retention and of malposition or ectopia. In old sub-\\njects, senile changes begin earlier in the testis than in other parts\\nof the body, and the organ may be reduced to a mere mass of\\nfibrous tissue without any trace of glandular structure.\\nArthaud 1 has shown that in the testes of men beyond fifty years\\nof age atrophic changes usually become established. The essen-\\ntial lesion is a peritubular sclerosis, which leads to the gradual\\ndisappearance of the epithelium. As a result the seminiferous\\ntubules are destroyed, and sometimes cysts are developed. The\\nunderlying causes are vascular interference and insufficient nutri-\\ntion of the glands.\\nDesnos 2 has further shown that in old men the periepididymal\\nveins become much dilated, and that this process slowly goes on\\nuntil the veins of the parenchyma of the epididymis are involved.\\nThe result of this pressure is the mechanical obliteration of the\\nefferent seminal vessels and the transformation of these structures\\ninto dense, fibrous tissue. Desnos further claims that hydrocele,\\nwhich is not uncommonly found in old men, causes by its com-\\npression atrophy of the testis.\\n1 Etude but le testicule senile. These de Paris, 1885.\\n2 Recherches sur l appareil genital des Vieillards. Annales des Mai. des Org.\\nGen.-urin., 1886, Tome iv. pp. 72 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0196.jp2"}, "197": {"fulltext": "AZO OSPERMA TISM. 185\\nBy way of recapitulation we may briefly refer to the following\\nfacts, and also call attention to several rather infrequent causes\\nof atrophy of the testis. As a complication in the course of a\\nnumber of infectious diseases the testis is not infrequently in-\\nvolved, and the outcome is very often atrophy or structural degen-\\neration.\\nGonorrhoea may, in rather exceptional cases, end in testicular\\natrophy, but its danger to the sexual capacity resides in its ten-\\ndency to occlude the spermatic tubes.\\nSyphilis is a potent and frequent factor in the production of\\natrophy of the testis and of the epididymis, and occupies a\\nprominent place in the category of causes of sexual impairment\\nand sterility.\\nHydrocele and hematocele may lead to moderate and temporary\\nor permanent azoospermatism by reason of the structural changes\\nwhich they produce in the testis and epididymis.\\nIt is doubtful whether varicocele produces true atrophy of the\\ntestis, except in very rare instances.\\nIn a certain number of cases of elephantiasis of the scrotum\\ntrue atrophy of the testis has been observed. In some forms of\\nhemiplegia, general paresis, and in some cases of traumatism of\\nthe skull, brain, cerebellum, medulla oblongata, and spinal cord,\\nwasting of the testes is observed. In these cases the spinal sexual\\ncentre is so affected that its function is destroyed. The long-con-\\ntinued use of iodide and bromide of potassium and belladonna\\nhas been stated to be the cause of atrophy of the testes.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0197.jp2"}, "198": {"fulltext": "CHAPTER XV.\\nAZOOSPERMATISM DUE TO ABNORMAL CONDITIONS\\nOF THE SEMEN.\\nAs has already been shown in a previous chapter, in healthy\\nmen each ejaculation of semen, after some clays of continence,\\ncontains many millions of spermatozoa. There is, as has already\\nbeen stated, much variation in the structure and vital activity of\\nthese bodies in different men. In the strong and vigorous they\\nare large and long and very lively, and from this standard (see\\nFig. 19) they decrease both in size and in vital energy. In all\\nprobability there are in man, as in animals, periods in which the\\nprocess of spermatogenesis is less active than at other times, and\\nthat intervals of rest may actually occur. In some men this func-\\ntion is most active and continuous, and as a result the sexual desire\\nis very keen. In others it is more sluggish, and has intervals of\\nrepose, and the sexual activity of the man is less pronounced\\nwhile in still others the production of spermatozoa is very slow,\\nhalting, and feeble, and these vitalized bodies are much less de-\\nveloped and active than they are in very vigorous men. We thus\\nfind that the development of spermatozoa represents a sliding scale\\nfrom full, vigorous structures down to puny and almost inanimate\\nbodies.\\nTHE EFFECTS OF REPEATED AND EXCESSIVE\\ncorros.\\nThe observation of Liegois, already quoted (see p. 68), which\\nhas the support of many other investigators, goes to show that\\nafter excesses in coitus there is for a time absence of spermatozoa\\nfrom the seminal fluid. Recovery from this condition is speedy\\nin some men and more or less delayed in others. In Liegois\\ncase it was found by the microscope that after abstinence from", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0198.jp2"}, "199": {"fulltext": "AZO OSPERMA TISM. 187\\ncoitus for three weeks large numbers of these bodies were\\nfound. The most extended series of observations as to the\\neffect of coitus upon the size and number of spermatozoa is that\\ncontained in the case reported by Casper/ which is very instruc-\\ntive. Casper says A vigorous naturalist, sixty years of age,\\na married man, and father of a large family, and accustomed to\\nthe use of the microscope, whom I had interested in this question,\\nexamined with me for some time continuously his own semen\\nafter coitus. Here we found the greatest variations, which were\\naccurately noted by both of us together. After coitus on the\\nthird day, reckoning from the last performance of the act, there\\nwas a large number of very small spermatozoa after renewed\\ncoitus on the fourth day, few and small after a pause of only\\ntwo days, none after a pause of only one day there was only a\\nwatery sperma, in which no zoosperms were found. At another\\ntime, on the fifth day after the last coitus, the zoosperms were\\nvery numerous another time, after a pause of six days, they\\nwere few, but large in size four months after the last examina-\\ntion, and seventy-two hours after the last act, the zoosperms were\\ncomparatively very small, and at another time, on the third day\\nafter the last act, they were innumerable. Immediately after\\ncoitus, and before emptying the bladder, the urethra was twice\\nexamined. Twenty-four hours after the last act a drop passed out\\nof the urethra exhibited numerous small zoosperms at another\\ntime, after a three days interval, there was not a single zoosperm.\\nIn the event of repeated coitus it is probable that the supply\\nof spermatozoa is exhausted after the first few acts, and that\\nthereafter in cases of excess the secretion comes from the seminal\\nvesicles (perhaps a little from the prostate) and from Cowper s\\nand the muciparous glands of the urethra. In the observation\\nreported by Guelliot, 2 in which a man had coitus eleven times in\\none afternoon, it is noted that after the eighth encounter the secre-\\ntion consisted only of turbid serosity (serosite louche).\\n1 Forensic Medicine. Sydenham Society s edition, 1864, p. 292.\\n2 Des Vesicnles Seminales, etc., pp. 214 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0199.jp2"}, "200": {"fulltext": "188 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThese careful observations have been fully confirmed by experi-\\nments upon animals by means of electrical stimulation of the spinal\\ncentre. It is reasonable to suppose from what has thus far been\\npresented that the semen of men who are addicted to long-con-\\ntinued sexual excesses is, as a rule, unfertile, and that the power\\nof fecundation (potent id gcnerandi) can only be repaired by con-\\ntinence and as the result of the restoration of vigorous health.\\nINFLUENCE OF THE PROSTATIC SECRETION.\\nAny morbid condition which interferes with the integrity of\\nthe prostatic secretion is liable to so alter the condition of the\\nsemen that its fructifying elements may become unfertile. These\\nmorbid conditions are mainly chronic posterior urethritis and\\nchronic inflammation of the prostatic tubules, and in the same\\ncategory may be included the plugging of the prostatic ducts\\nwith concretions, destruction, more or less great, of the gland fol-\\nlowing gonorrheal abscesses, and the late developing small cell,\\nsubmucous infiltration resulting from chronic posterior urethritis,\\nwhich so scleroses the tissues that the ducts cannot perform their\\nfunction. As causes of these morbid conditions, besides gonor-\\nrhoea, may be mentioned masturbation, excesses, and unsatisfied\\nsexual desire, which cause congestion of the prostatic tubules,\\nwith the consequent loss or impairment of their secretory func-\\ntion. Since all of these morbid conditions may lead to sexual\\nneurasthenia and impotence, a further impairment of the integrity\\nof the semen may arise in the exhausted condition of the system,\\nwhich for a time may hold in abeyance the process of spermato-\\ngenesis. I have myself made many observations upon this class\\nof cases, and have found that the spermatozoa are very small and\\ndwarfed in size, scanty in numbers, and very feeble and languid\\nin their movements. When, however, the integrity of the func-\\ntion of the prostate is restored, and with it the establishment of a\\nrenewal of health, the conditions of the zoosperms gradually change\\nuntil they assume normal proportions and become vigorously\\nactive.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0200.jp2"}, "201": {"fulltext": "AZOOSPERMATISM. 189\\nMy observations and studies have convinced me that to the nor-\\nmal chemical composition of the prostatic fluid, consisting largely\\nof phosphates of lime and soda, the healthy condition of the semen\\nis largely due.\\nIn the chronic subacute prostatitis which follows excessive\\nmasturbation and sexual excesses it is not uncommon to find the\\ngranular phosphates in superabundant quantity suspended in a\\nrather thick gelatinous mucus. Now, in the semen of many of\\nthese cases I have observed that the zoosperms were little, frail\\nbodies, having scarcely any activity. The pertinent question,\\ntherefore, suggests itself whether this great excess of alkaline\\nadmixture has a devitalizing effect on the spermatozoa Several\\nhusbands whom I have known to be thus affected were childless,\\nalthough they had vigorous and florid wives.\\nAbsence or scantiness of the prostatic secretion in the ejaculate\\nmay lead to sterility (impotentia generandi) by reason of the\\nnon-occurrence of the normal fluidity of the secretion. We have\\nalready seen that the dense, lumpy, viscid secretions of the am-\\npullations of the vasa deferentia and of the seminal vesicles are\\npartially liquefied by the admixture of the alkaline prostatic secre-\\ntion, and that then the spermatozoa have nothing to impede their\\nvital activity or to prevent their invasion of the genital canals of\\nthe female. When this partial liquefaction does not occur the\\nzoosperms are, so to speak, held prisoners, and they cannot go on\\ntheir way to the fertilization of the female ovule. I have seen\\nseveral cases in which men s ejaculate has been a little grayish,\\nlumpy mass, of considerable consistence, about the size of two\\npeas, in which, even when very recently voided, the spermatozoa\\nwere thin, puny, and almost lifeless. In these cases some of the\\nmen were in bad health, and in others there was chronic prostatic\\ninvolvement.\\nBeigel 1 has reported a case in which this variety of semen was\\npresent, and in which fecundation occurred as a result of throwing\\na small amount of warm water into the vagina after coitus. If\\n1 Krankheiten des Weiblichen Geschlechts, etc. Erlangen, 1874, B. ii. p. 791.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0201.jp2"}, "202": {"fulltext": "190 SEXUAL DISORD ERS OF THE MALE AND FEMALE.\\nthis measure is to be of benefit in the melting-down of the sem-\\ninal mass, it seems to me that the most rational solvent would be\\na very dilute, watery solution of phosphate of lime and soda\\n(1 100 or 1: 200) slightly warmed. In my cases benefit followed\\ntopical treatment of the genital tract.\\nPus-admixture.\\nIn acute gonorrhoea of the urethra the seminal fluid is more or\\nless contaminated by pus-admixture, and the spermatozoa are\\nfound to be lifeless or capable of very little motion, as I have\\nseen in numerous microscopic examinations. It is very probable\\nthat gonorrhoea or its toxins exert a deleterious or even deadly\\ninfluence on these frail bodies. Terrillon 1 has clearly shown that\\nin bilateral gonorrhoeal epididymitis the semen is mixed with pus\\nand that spermatozoa are absent. His observations go to show\\nthat as long as pus is produced in the epididymis, even in small\\nquantity, its effect is so lethal to spermatozoa that the semen\\nremains unfertile. In all probability healthy spermatozoa are\\nkilled in the female genitals by pus or its poisons. In some cases\\nfailure of impregnation undoubtedly is due to the presence of\\nthe thick, viscid plug of mucus or muco-pus in the uterine neck,\\nwhich, by its density, offers a barrier to the spermatic invasion.\\nThe extent of the influence of acute or chronic gonorrhoeal\\nseminal vesiculitis and gonorrhoeal inflammation of the defer-\\nential ampullations is really not Avell known, and most of the\\nreported cases of this morbid condition are fragmentary and unsat-\\nisfactory. Just after recovery from acute gonorrhoeal seminal\\nvesiculitis it is positively known, as I can affirm from observation,\\nthat the semen is a thin, turbid, yellowish secretion, more copious\\nthan in health, containing few, if any, spermatozoa, and more or\\nless pus. Now, in these cases it is probable that the spermatozoa\\nhave been killed by gonococci or toxins. How long this condition\\nlasts we are unable to say, but it is fair to assume that healthy\\nspermatozoa can only live in these secretions when they are nor-\\n1 Op. cit., p. 439.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0202.jp2"}, "203": {"fulltext": "AZOOSPERMATISM. 191\\nmal and free from toxic admixture. In chronic seminal vesiculitis,\\nthough the pus may be less in quantity and the toxins less viru-\\nlent, such is the effect of their presence that the nutritive media\\nof the spermatozoa (the secretions of the ampullations and the\\nseminal vesicles) are so altered that these organisms are either\\ndwarfed or killed outright.\\nWhether a purulent inflammation of the ejaculatory ducts can\\nso alter the composition of the semen as to render it unfertile we\\nare not able to say, but it is obvious that gonorrheal pus-admix-\\nture is a dangerous factor, even when present in small quantity.\\nWhen we reflect upon the foregoing considerations the convic-\\ntion forces itself on our minds that pus in the deep sexual parts\\nmay have much to do in causing temporary or permanent azoosper-\\nmatism.\\nBlood-admixture. Bloody Ejaculations.\\nThe semen may become mixed or streaked with blood, owing\\nto a morbid condition of some part of the sexual tract. It is\\ndifficult to determine how far blood-admixture tends to induce or\\nproduce azoospermatism. To settle the question it is necessary to\\nunderstand the nature of the processes which lead to or cause the\\nescape of the blood, and to ascertain whether this fluid can exert\\na morbid effect on the zoosperms. Experience and study seem to\\nshow quite clearly that a small amount of blood mixed with the\\nsemen does not destroy its fecundating property. Large amounts,\\nhowever, may so dilute this fluid that its germinative faculty is\\nlost, probably through dilution. In tuberculosis of the testis the\\nsemen may become thoroughly mixed with blood, and may then\\nresemble red currant jelly (rose semen). Such semen is, as a rule,\\nunfertile, as a result of toxin-action, and the blood-admixture has\\nprobably little effect on its integrity.\\nIn acute and chronic gonorrheal inflammation of the seminal\\nvesicles and deferential ampullations the escape of blood is not\\nuncommon. But in these cases there is an underlying virulent\\nprocess, which may by its poisons kill the spermatozoa. Bloody", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0203.jp2"}, "204": {"fulltext": "192 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nsemen in these conditions may have a fresh red color or it may\\nhave a decided rusty tint. The intermixture of blood and semen\\nis in these cases usually intimate and well blended. It is very\\nprobable, as claimed by Jam in, 1 that a passive congestion of the\\nseminal vesicles (and, I would add, the ampullations) may result,\\nwithout gonorrhoeal infection, from excessive coitus, masturbation,\\nand perhaps even from prolonged continence, and that this con-\\ngestion may give rise to little hemorrhages and blood-admixture.\\nWhen this occurs the semen has the rusty color already mentioned.\\nWe have no knowledge as to whether such semen is fertile.\\nIn cases of gonorrhoea involving the ejaculatory ducts small\\nhemorrhages in and around these tubes have been found, on post-\\nmortem examination, to have occurred. It is fair, therefore, to\\nassume that in some cases the semen may become streaked with\\nblood in its passage through these canals. In its acute declining\\nstage and in chronic gonorrhoeal posterior urethritis more or less\\ncopious hemorrhages may occur in coitus or in pollutions, and as\\na result the semen is streaked with bright-red blood. In like\\nmanner in acute or chronic gonorrhoea of the bulb of the urethra\\nhemorrhages sometimes occur in coitus or pollutions, and in some\\ninstances they are very copious. I have seven several men in\\nwhom the flow of blood was quite severe, and who when in coitus\\nthought it was due to incipient menstruation in the female.\\nIn all probability blood itself is not noxious to the vitality of\\nthe spermatozoa, but the gonorrhoeal process is distinctly so. In\\nlarge quantity, however, the blood may so dilute the seminal fluid\\nthat the fecundating power of the zoosperms is lost.\\nIt is very rare that lesions seated in the course of the pendu-\\nlous urethra cause enough bleeding to tinge the semen in transitu.\\nTHE INFLUENCE OF GENERAL MORBID CONDITIONS.\\nIn sexual neurasthenia it is not uncommon to find azoosperma-\\ntism, which may be due to the general malnutrition of the patient\\n1 Considerations Pathogeniques sur l Hemospermie d Origine non-inflamma-\\ntoire. Annales des Mai. des Org. Gen.-urin., 1891, pp. 765 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0204.jp2"}, "205": {"fulltext": "AZOOSPERMATISM. 193\\nor to the local lesion which is the main cause of the nervous state.\\nIn general, in this class of cases there is some form of chronic\\nprostatic affection or disease of the ampullations and of the sem-\\ninal vesicles which leads to an unfertile condition of the semen.\\nIt is no longer contended that all persons suffering from tuber-\\nculosis are azoospermatous, since spermatozoa have been found in\\nthe deep sexual parts of many men who died of phthisis. When\\nthe testes or epididymes are invaded by tubercular inflammation\\nthe spermatozoa are probably killed by the toxins developed. In\\nseveral instances I have seen such viscidity and lumpiness of the\\nsemen of consumptive men that I have been certain that the puny\\nand sometimes fatty degenerated spermatozoa were incapable of\\nimpregnation. I have seen several instances in which such men\\nhave cohabited for long periods with perfectly healthy women who\\ndid not become pregnant, although they had taken absolutely no\\nmeasures to avoid that condition.\\nIn all probability when phthisis causes azoospermatism it is\\nby its local lesions in the testes and epididymes, in the ampulla-\\ntions and seminal vesicles, and in the prostate or by its general\\nadynamic effect, which dwarfs the production of healthy zoosperms\\nand prevents the formation of a mucus of proper nutritive quality\\nand of normal specific gravity. The influence of syphilis on\\nspermatogenesis has already been considered. (See page 162 et\\nseq.) It may be added, however, that perhaps in the early stage,\\nwhen the poison is very active and abundant, it may interfere\\nwith the delicate process of zoosperm development. It is not\\nuncommon, however, to see men in whom syphilis is yet active\\nimpregnate healthy women, nor is it rare to see recently syphilitic\\nwomen become pregnant by healthy or syphilitic men.\\nWe have no scientific evidence as to the influence of general\\ninfective processes upon the formation of the semen. It is prob-\\nable that during the activity of the disease, and perhaps for some\\ntime afterward, spermatogenesis ceases.\\nXo general statement can be made as to the effect of old age\\nupon the production of semen, since there is so much variation\\nin the sexual activity and capacity of different men. In some\\n13", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0205.jp2"}, "206": {"fulltext": "194 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ninstances fertile semen is present in men of sixty-five, seventy-\\nfive, and even beyond ninety years. In general, however, a\\ngradual or rapid decline in the productivity of the testes begins\\nat or before the sixtieth year. In some men, however, the sper-\\nmatogenic function is lost much earlier in life.\\nAny cause, therefore, which deranges the structure of the testis\\nimpairs its function, and as a result spermatozoa may not be pro-\\nduced, and the seminal cells may be present in, or they may be\\nabsent from, the semen.\\nIn Plate VII. azoospermatous semen from a patient who suf-\\nfered from chronic gonorrhoeal epididymo-orchitis is depicted in\\nwhich seminal cells and granular phosphates are present.\\nWatery Semen and Colloid Semen.\\nThough special mention is made of these forms of semen, they\\nare in reality only symptomatic of some chronic affection of the\\nampullations of the seminal vesicles, of the prostate, or of the\\ntestes.\\nWatery semen is usually of a slightly yellowish, turbid color,\\nand consists of a thin mucus in which are suspended living or\\ndead spermatozoa in small quantity, with perhaps some pus-cells\\nand granular phosphates. In some cases it has been observed\\nthat watery semen is very copious, since as much as one or two\\ntablespoonfuls, or even two ounces, have been discharged at one\\nejaculation a condition which is called polyspermia. In such\\ncases impregnation can scarcely occur, since the spermatozoa\\ncannot obtain a hold on the vaginal mucous membrane, but are\\ncarried away in the flood.\\nWatery semen is the direct result of morbid changes in the\\nampullations and in the seminal vesicles, which so impair the\\nfunctions of the muciparous glands that a very diluted secretion\\nis produced instead of the normal viscid and heavy mucus. Fol-\\nlowing double gonorrhoeal epididymitis, watery semen may be\\nejaculated for varying periods of time.\\nA colloid condition of the semen is, as a rule, observed in cases", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0206.jp2"}, "207": {"fulltext": "PLATE VII\\nSeminal Cells and Granular Phosphates from\\nAzoospermatous Semen.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0207.jp2"}, "208": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0208.jp2"}, "209": {"fulltext": "AZOOSPERMATISM. 195\\nin which the prostatic secretion is not thrown into the nrethra at\\nthe time of emission. It is, therefore, the direct outcome of chronic\\nmorbid processes in the prostate gland. Normally, as we have\\nseen (page 69), the secretion of the ampullations and the seminal\\nvesicles is viscid and lumpy, as shown in Fig. 20, in which the\\nround, oval, and irregular, small, large, and very large masses of\\nglairy and glassy mucus are shown. This lumpy condition is\\nrapidly liquefied and broken up when the prostatic fluid is mixed\\nin the prostatic urethra with the secretions from behind e. g.,\\nfrom the ampullations and the seminal vesicles.\\nIn this colloid condition of the semen the movements of the\\nspermatozoa, even if healthy, are so hindered that they cannot\\nbring about their irruption into the uterine cavity, hence the semen\\nis, by reason of a mechanical cause, unfertile. With the cure of\\nthe prostatic infirmity and the re-establishment of the secretory\\nfunction of that gland the colloid condition of the semen ceases,\\nand it again becomes a fertile fluid. In the semen of persons\\naddicted to the opium-habit spermatozoa are either absent or\\npoorly developed.\\nDiminished Quantity of Semen.\\nWhen the spermatic ejaculate of a man is very small he is said\\nto be suffering from the condition uneuphoniously called oligo-\\nspermia. This condition is found in feeble and old men, in con-\\nsumptives, or persons who have committed sexual excesses, and,\\nexceptionally, in chronic, seminal-vesicular, and deferential dis-\\nease. In some men, even in those seemingly very healthy, the\\nsecretion of semen is normally very small, even to the amount of\\na few drops in others the quantity is larger, and so on the scale\\nrises until the normal free ejaculation is present.\\nPrognosis. In order to give a patient an intelligent and honest\\nforecast as to his sexual future in cases of disease or imperfect\\nsemen, it is absolutely necessary to get a full and accurate history\\nof his sexual habits, and to clearly ascertain the morbid condition\\nunderlying his infirmity. In cases of sexual excess of any kind", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0209.jp2"}, "210": {"fulltext": "196 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nthe prognosis depends entirely upon the docility and future good\\nconduct of the patient. When urethral, prostatic, seminal-ves-\\nicular, and ampullation morbid conditions are the direct causes,\\nthe future of the case intimately depends upon the accuracy of\\nthe diagnosis and the efficiency of the treatment.\\nIn tuberculosis we cannot hold out bright hopes of sexual resto-\\nration but in neurasthenia, in general debility, and in syphilis it\\nis fair to assume that appropriate treatment, together with good\\nhygiene in its broadest sense, will bring about improvement, and\\neven cure. In all cases in which gonorrhoea is an active factor\\nthe outcome depends on the ability of the surgeon to remove the\\nmorbid process.\\nTreatment. It is unnecessary here to do other than refer to\\nthe therapeutic sections of the chapters on diseases of the testes,\\non chronic posterior urethritis, prostatitis, and seminal vesiculitis.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0210.jp2"}, "211": {"fulltext": "CHAPTER XVI.\\nASPERMATISM.\\nThe term asperinatisin is applied to that condition in which\\nthe power of normal coitus exists, but in which the ejaculation of\\nsemen does not occur either in that act or during sexual excite-\\nment. In such cases the final period of the sexual act is absent.\\nPatients thus afflicted say that the contractions of the perineal\\nmuscles which complete ejaculation are absent. The term is fur-\\nther used to embrace cases in which there is a deficiency in the\\nquantity of semen ejaculated, and also those cases in which there\\nis impeded, defective, or imperfect ejaculation.\\nThis condition is much rarer than azoospermatism, and it depends\\non lesions seated between the deferential ampullations and the\\nseminal vesicles, and the meatus urinarius or the preputial orifice.\\nThe essential cause of aspermatism is the stenosis, or blocking\\nup, or destruction of some part of the sexual tract to such an ex-\\ntent that in the rhythmical movements of ejaculation the seminal\\nfluid is either directed from or dammed back in the course of the\\nurethra. The impediment may occur in the seminal vesicles, the\\ndeferential ampullations, the ejaculatory ducts, the prostate gland,\\nthe urethral canal, at the meatus urinarius, or the preputial orifice.\\nAspermatism may be either permanent and absolute or tempo-\\nrary and relative.\\nLESIONS OF THE SEMINAL VESICLES AND\\nDEFERENTIAL AMPULLATIONS.\\nAspermatism due to fistulous tracts passing from the seminal\\nvesicles to the rectum or bladder is so rare that such a case would\\nbe looked upon as a curiosity. Several such cases are on record\\nin which the fistulse resulted from bladder or lithotomy opera-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0211.jp2"}, "212": {"fulltext": "198 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ntions. In these cases the semen was ejaculated into the rectum.\\nIt is possible that sympexia may become lodged in the orifice of\\nthe seminal vesicle or in that of the deferential ampullations in\\ngeneral, however, the plugging up occurs in the ejaculatory ducts.\\nLESIONS OF THE EJACULATORY DUCTS.\\nA variety of morbid conditions may occur in and around the\\nejaculatory ducts which may result in aspermatism. The plug-\\nging up of these minute canals by sympexia is of rather rare\\noccurrence. A most striking instance of this accident is presented\\nby ReliquetV case. It was that of a man, aged thirty-five, who\\nin coitus was seized with a severe pain in the deep urethra which\\nradiated to the anus and perineum. Afterward defecation and\\nurination became painful, and coitus was so agonizing that it was\\nnot indulged in. By rectal examination the left seminal vesicle\\nwas found swollen. The man was examined by means of a litho-\\ntrite, and after withdrawal the patient experienced severe pain in\\nthe penis, which was followed by the discharge from the urethra\\nof a large quantity of sympexia. After this relief the perform-\\nance of the sexual function was perfect.\\nIt is very probable that in this and in similar cases the great\\ndistention of one ejaculatory duct blocks the other one up very\\neffectually, as these canals lie so close together in the prostate.\\nCases have been reported in which, on post-mortem examination,\\nthe ejaculatory ducts have been found to be plugged by concretions\\nas large as a pea or a cherry, which were composed of carbonate\\nand phosphate of lime, and mucus and spermatozoa. Chronic\\ngonorrhoea has been found to produce a stenosing condition of the\\nejaculatory ducts, chiefly by its round-cell infiltration of the sub-\\nmucous connective tissue of the verumontanum, which it attacks\\nmore severely than other portions of the posterior urethra. Round-\\ncell infiltration around the ducts producing stenosis has been found\\nin the dead subject.\\nDense fibrous bands upon and behind the verumontanum have\\n1 Picard Traits des Maladies de la Prostate. Paris, 1877, p. 129.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0212.jp2"}, "213": {"fulltext": "AS PER MA TISM. 199\\nbeen seen to so compress or distort the ejaculatory dncts that either\\nstenosis has been produced, or a deviation in the course of the\\nducts or of their orifices has resulted. In the former event the\\nsemen was dammed backward in the latter it was in coitus\\nthrown backward into the bladder.\\nArch-like bands of fibrous tissue have been found seated saddle-\\nlike across the summit of the verumontanum, and as a consequence\\none or both ducts were obliterated. Gonorrhoea may cause abscess-\\nformation in some or many of the prostatic tubules, which may\\nresult in such scar-tissue development that the ejaculatory ducts\\nare destroyed.\\nIn some cases of chronic gonorrhoea the involvement of the\\ntubules has ended in cystic degeneration, which was produced by\\nsclerosis of the tissues and obliteration of the ducts.\\nCases are on record in which traumatism of the prostate and\\nverumontanum, resulting from the passage of, or retention of,\\nsounds and catheters, has been so severe that the ejaculatory\\nducts have either been compressed or the direction of their orifices\\nhas been thrown so much out of place that they have looked back-\\nward to the bladder. This retroversion of the orifices may be\\npartial and only cause them to look upward, or it may be complete,\\nin which event the discharge of semen occurs directly backward.\\nDisplacement of the ducts and of the prostate has been known\\nto follow abscesses of and injury of the perineum (from falls,\\nblows, and infectious processes), which caused a dense fibrous\\ncicatricial mass to draw that gland downward and to much distort\\nthe ano-perineal and rectal regions.\\nIn tuberculous inflammation of the prostate the ejaculatory\\nducts may be compressed or destroyed.\\nIn old men these canals may, when the prostate becomes hyper-\\ntrophied, either be narrowed or entirely stenosed.\\nCalculi and concretions in the prostate may cause compression\\nor stenosis of the ejaculatory ducts, and aspermatism may result.\\nIt is probable that when many prostatic tubules and their ducts\\nare plugged up by lime, salts, mucus, and amyloid bodies, inju-\\nrious compression may be exerted upon the ducts.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0213.jp2"}, "214": {"fulltext": "200 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nAbscess of the prostate with its (in favorable cases) subsequent\\ncicatricial development and resulting contraction may utterly oblit-\\nerate these little canals. A very interesting case was reported\\nmany years ago by Dugas, 1 which is worthy of a brief summary.\\nA man, aged twenty-six years, was attacked after a long horse-\\nback ride with pain and tenesmus in urination and shooting\\ntwinges in the rectum. He had fever and was delirious. The\\nprostate was found, upon rectal examination, to be very large and\\npainful, and an abscess was suspected. The operator, with his\\nleft index finger in the rectum, firmly supported the prostate,\\nwhile with the other hand he introduced a sound into the urethra,\\nthe tip of which, on abutting against the abscess, ruptured it and\\na quantity of pus soon escaped. Two months after this the man\\ncomplained of an acute pain during ejaculation, and stated that\\nhis emission was only half as copious as it was before his sick-\\nness. In all probability one of the ejaculatory ducts of this\\npatient was obliterated, for it was noted after healing had taken\\nplace that the prostate had lost one-third of its volume.\\nDiminution in size and distortion of the shape of the organ are\\ngenerally found after abscess of the prostate.\\nIt is not uncommon for abscess of the prostate to open into the\\nrectum, into which the urine and semen are for long or short\\nperiods discharged. In this event temporary or permanent\\naspermatism may result. This may occur also when the ab-\\nscess opens into the bladder, the inguinal region, and the sciatic\\nnotch.\\nPerineal fistulas may result from abscess of the prostate, and in\\nthis event if the ejaculatory ducts be not obliterated the emission\\nwill probably pass through the false passages and ooze out at the\\nperineum.\\nPermanent aspermatism may result from injury of the ejacula-\\ntory ducts in the operations of lateral or bilateral lithotomy.\\nThere are a number of well-reported cases on record, and two\\nhave been added by Horwitz. 2\\n1 These de Montpellier. 1832.\\n2 Journal of the American Medical Association, April 8, 1893.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0214.jp2"}, "215": {"fulltext": "ASPERMATISM. 201\\nIu the rare event of congenital absence or atrophy of the pros-\\ntate semen cannot reach the urethra, for the reason that there are\\nno ejaculatory ducts to transmit it.\\nSTRICTURE OF THE URETHRA AND URETHRAL\\nCALCULI.\\nStricture of the urethra is not uncommonly the cause of asper-\\nmatism, and also of impeded or imperfect ejaculation. It is to\\nbe remembered that in normal coitus the semen having been\\nthrown into the bulbous urethra, the intrinsic and extrinsic\\nmuscles of this segment of the canal then forcibly contract and\\nthrow the ejaculate toward the meatus. (See page 59.) For the\\nproper performance of this part of ejaculation it is necessary that\\nthe integrity of the urethra outside of the triangular ligament\\nshould be retained. Whenever, therefore, any considerable con-\\ntraction of the bulbous urethra is produced (and it is generally\\ncaused by gonorrhoea) the ejaculatory act will be lame and halt-\\ning at this part. Thus it is not uncommon for men having soft\\nstrictures, down to 15 or 20 of the French scale, to complain of\\ndisability and a sense of some impediment being present at the\\nend of coitus in the bulbar region. In some of these cases the\\nejaculation is weak and prolonged in others it is more or less\\nincomplete, and as the penis becomes flaccid the emission slowly\\ndribbles from the meatus.\\nIn the case of a tight stricture at the bulb there may be no\\nemission at all in coitus, but a dribbling discharge may occur some\\ntime after the completion of the act. In this event the semen is\\ndammed backward in the membranous urethra and in the ante-\\nrior portions of the prostatic urethra, and it slowly flows forward\\nafter a short or quite long interval. Men thus afflicted sometimes\\ncomplain of pain, due to slight spasm of the compressor urethrse\\nmuscle and to the abnormal distention of the canal. In other\\ncases a sense of fulness is experienced, and such a check is pro-\\nduced in the rhythmical contractions of the sexual tract that the\\ntypical sensation is obtunded or is absent.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0215.jp2"}, "216": {"fulltext": "202 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nIn very old and extensive modular strictures of the bulbo-mem-\\nbranous junction there is no post-coitional flow of semen, and this\\nsecretion then passes backward into the bladder and is mixed and\\nexpelled with the urine, which then has a very milky appearance.\\nWhen these cases are complicated with one or more perineal fistulas\\nthe semen passes into the tracts and oozes over the ano-perineal\\nregion.\\nStrictures at the peno-scrotal angle in the anterior urethra cause\\nimpediment to the escape of semen in proportion to the smallness\\nof their calibre. When the contraction is very slight little hin-\\nderance to ejaculation is offered, but when it reaches the degree of\\nreduction in calibre of 10 or 15 French then imperfect and defec-\\ntive expulsion may be produced, and post-coitional dribbling may\\noccur. In these cases, even when the stenosis of the urethra is\\nquite complete, there is no reflux of semen into the bladder, and\\nit, when the parts become relaxed, slowly dribbles from the meatus.\\nIn several of these cases the patients have told me that after coitus\\nthey experienced a sensation of fulness in the perineum, which was\\nonly relieved by compressive manipulation, which caused the semen\\nto gradually escape forward.\\nIn those somewhat rare cases in which the whole anterior ure-\\nthra is the seat of tight stricture ejaculation is very imperfect and\\nhalting, and such subjects are practically aspermatous.\\nStricture at the meatus, which is the result usually of chan-\\ncroids, chancres, gangrene, warts, chemical and instrumental trau-\\nmatism, and perhaps of gonorrhoea, may lead to the various grades\\nof aspermatism, from slight and feeble discharge to post-coitional\\ndribbling, or even to the damming back of the ejaculate. In these\\ncases the urine usually escapes in a fine stream, but in coitus, with\\nits turgescence of the mucous membrane and a secretion of much\\ngreater density passing through the stricture, the conditions are so\\naltered that more or less perfect aspermatism results.\\nStenosis, or smallness of the preputial orifice, whether congen-\\nital or acquired, is not infrequently the cause of varying degrees\\nof aspermatism. Patients having this form of phimosis usually\\nstate that in their earlier sexual years ejaculations were satisfac-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0216.jp2"}, "217": {"fulltext": "ASPERMATISM. 203\\ntory, and, to their mind, unimpeded. As they grow old the stenosed\\ncondition usually becomes more pronounced, and with the dimin-\\nishing calibre of the preputial orifice the various grades of morbid\\nemission, from defective and impeded ejaculation up to complete\\nasperniatisru, are produced.\\nThe probable explanation of these cases of stenosis of the meatus\\nurinarius and of the prepuce, which are quite permeable to the\\nescape of urine, and which offer an impediment to spermatic emis-\\nsion, is that the urine is a much thinner fluid than the semen, and\\nthat in urination the vis a tergo is greater than in coitus.\\nIt is well to remember that after coitus, in almost all cases of\\naspermatism, there is the escape of a few drops of clear mucus\\nfrom the meatus, which is secreted by the urethral muciparous\\nfollicles and crypts and by Cowper s glands.\\nFig. 54.\\nUrethral calculus composed of phosphate of lime. Natural size. Calculus\\nconsisted of four articulated segments. (Dolbeau.\\nPreputial calculi may be the cause of organic impotence or of\\ntemporary aspermatism.\\nCalculi are sometimes found in the urethra, where they may\\nincrease to such a size that blocking up of the canal is produced.\\n(See Fig. 54.) In such cases the impediment to urination may be\\ntolerably well marked, but the escape of semen is so much retarded\\nthat incomplete or difficult ejaculations, or actual aspermatism,\\nmay result. These calculi may be seated in the bulbous urethra\\nat the peno-scrotal angle or in the course of the anterior urethra.\\nMany men suffering from priapism, while capable of intromis-\\nsion, fail in the act of ejaculation. They are, therefore, tem-\\nporarily at least, aspermatous.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0217.jp2"}, "218": {"fulltext": "204 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nANOMALOUS CASES OF ASPERMATISM.\\nTwo anomalous cases of aspermatism have been reported by Ultz-\\nmann. 1 The first was that of a man, forty years of age, who,\\nthough married, had never been able to produce semen. During\\ncoitus he experienced the sensation of ejaculation and felt a\\nkind of satisfaction. His testicles were small, but his genital\\norgans were pronounced by Ultzmann to be perfect. It was\\nproved by examination of the urine that the semen in coitus did\\nnot regurgitate into the bladder.\\nThe second case was that of a robust man, aged twenty-four\\nyears, who was potent as to coitus, but had never had an ejacula-\\ntion or a pollution. He had never had any sexual desire, and his\\ngenital organs were pronounced to be normal. He remained per-\\nmanently aspermatous.\\nBelkowsy describes the case of a man who, although married\\nfor four years, had never been able to perform the sexual act. In\\nspite of the fact that his genitals were normal in development and\\nhis general bodily condition was excellent, he was totally devoid\\nof sexual sensations, had never in his life had erections, and only\\nquite lately had he had some nocturnal emissions (consisting in\\nall probability of the secretion of Cowper s glands), accompanied,\\nhowever, by only imperfect erections. He was totally indifferent\\nto the female sex, but no trace of sexual perversion could be\\nobserved.\\nSuch cases as the foregoing are paradoxes, and the attempt to\\nexplain them on the ground of non-excitability of the reflex\\ncentre of ejaculation (the existence of which has not been proved)\\nis very unsatisfactory. Cases have been reported, however, in\\nwhich it is probable that disease or traumatism of the nervous\\nsystem resulted in aspermatism. Thus the old-time case of the\\nsoldier, who, as a result of concussion of the spine, was affected\\nwith complete anaesthesia of the external genitals, and asperm-\\natism in coitus, although he had nocturnal pollutions, presents a\\n1 Op. cit., pp. 116 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0218.jp2"}, "219": {"fulltext": "A SPERM A TISM. 205\\nclear and intelligible clinical picture. Other cases are on record\\nin which anaesthesia of the glans penis was the cause of temporary\\nasperntatisin, but they are so lacking in essential details as to\\npossess but little value.\\nIn fibroid sclerosis of the corpora cavernosa anaesthesia of the\\nglans sometimes occurs together with non-turgescence of the parts\\nin sexual excitement and coitus. In such cases ejaculation may\\nbe difficult, incomplete, or entirely absent.\\nIn cases of destruction of the distal portion of the penis from\\nchancroids, chancres, gangrene, and phagedena, such has been the\\nanaesthesia or the insensitiveness of the parts produced that more\\nor less complete aspermatism has followed, although the calibre\\nof the urethra was not injuriously stenosed.\\nMutilating Meatotomy and Damage to the Urethra.\\nI have seen two cases in which, after extensive and greatly de-\\nforming meatotomy, an aspermatous condition was produced which\\nthe patients accounted for on the ground of unnatural insensitive-\\nness of the glans penis. In several cases of so-called strictures of\\nlarge calibre, which were very much overdilated and deeply cut\\nby zealous surgeons, these patients, besides suffering from decided\\ncurvature of the penis, experienced such queer and annoying\\nsensations (tingling feelings and darting pains) in the urethra in\\ncoitus that partial ejaculation only occurred after very prolonged\\nand tiresome efforts.\\nPartial Aspermatism.\\nSome men are temporarily aspermatous in consequence of the\\ninhibitory action of the brain. In these cases men may have\\nsatisfactory coitus with some women and cannot complete the act\\nwith others. In other instances apathy, loss of affection, fear,\\ndisgust, peculiar environments and situations, unattractiveness of\\nor some objectionable condition or habit in the female so affect a\\nman s mind that, although erection occurs, ejaculation is impos-\\nsible. These cases resemble in some particulars psychical impo-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0219.jp2"}, "220": {"fulltext": "206 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ntence. (See p. 78 et seq.) In many of them the semen dribbles\\naway after sexual excitement has subsided.\\nDebility and Lack of Nerve-force.\\nThen, again, some men are so weak and so much debilitated or\\nmentally worried, that although erection, partial or complete,\\noccurs, there is not sufficient nerve-force in them to call into\\nvigorous action the intrinsic and extrinsic muscles of the sexual\\napparatus. This condition has been designated atonic asperma-\\ntism, and it is not of necessity of permanent duration. In most\\ncases it has been preceded by a period of full sexual activity.\\nDiagnosis. In every case of aspermatism it is absolutely\\nnecessary to get a full history of the symptoms and antecedents\\nof the case, and then to make a discriminating examination of all\\nthe segments of the sexual tract. In all cases a thorough exam-\\nination of the urine should be made. When the symptoms point\\nto lesions of the ampullaa and seminal vesicles, exploration of these\\nparts and examination of the urine are necessary. If the trouble\\nis seated in the ejaculatory ducts, the question arises, Has the\\npatient had gonorrhoea, or abscess of the prostate, or is the dis-\\nability due to plugging up by concretions or calculi An intelli-\\ngent and searching inquiry on these subjects will usually elicit\\nimportant information. Lesions of the prostate being so often\\nthe cause of aspermatism, inquiry into the antecedents of the case\\nand rectal examination of that gland are to be made.\\nIn most cases of stricture of the urethra symptoms referable to\\nthat condition will coexist with the aspermatism, and then a care-\\nful exploration of the urethral canal should be made. These same\\nremarks apply to instances of urethral calculi.\\nIn the cases which in this chapter have been denominated\\nanomalous the most searching inquiry into and exploration of the\\nsexual sphere should be made, in order to find out whether there\\nare any malformations or obscure conditions produced by disease.\\nIt is usually very easy to learn concerning nerve-traumatism, and\\nwhen mutilation or destruction of the penis exists careful exam-\\nination will reveal its nature and extent.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0220.jp2"}, "221": {"fulltext": "ASPERMATISM. 207\\nPrognosis. In general, the prognosis of aspermatism is not\\nencouraging, particularly if due to malformations. When great\\nstructural damage has been done (seminal vesicles, ampullae, ejacu-\\nlatory ducts, and prostate gland) little hope can be offered to the\\npatient of his reacquiring good sexual ability.\\nCalculi in the prostate or ejaculatory ducts can be removed by\\noperation. In the milder forms of stricture of the urethra, and\\neven in severe forms, cure of aspermatism can be brought about\\nby the re-establishment of the calibre of the urethra. In the very\\nold cases of nodular stricture at the bulbo-membranous junction,\\nparticularly when complicated by perineal fistulse, it is hazardous\\nto give a favorable prognosis.\\nWhen the meatus or the urethra has been permanently damaged\\nby ill-advised surgical procedures surgery offers very little in the\\nway of relief. In some cases of very extensive meatotomy the\\nparts may be restored by proper surgical technique.\\nTreatment. In all the foregoing cases in which serious struc-\\ntural changes are present in the deep sexual tract little of real\\nbenefit can be done by surgical means.\\nCalculi may be removed from the deep urethra, the prostate,\\nand ejaculatory ducts either by the urethral forceps, the lithotrite,\\nor by external urethrotomy.\\nStricture of the urethra, if of the soft variety, may be cured by\\ninstillations of nitrate of silver and by careful gradual dilatation.\\nInodular strictures and quite dense annular strictures call for either\\ninternal or external urethrotomy.\\nCases of aspermatism due to the inhibitory influence of the brain\\nshould be carefully inquired into, and when the exciting cause is\\nascertained, its avoidance or removal will, in all probability, be\\npromptly followed by normal ejaculation.\\nWhen severe stenosis of the meatus urinarius is present the\\nresulting aspermatism may be promptly relieved by a properly\\nperformed meatotomy. In like manner, in cases of pinhole-sized\\npreputial orifice, circumcision is followed by very gratifying\\nresults.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0221.jp2"}, "222": {"fulltext": "CHAPTER XVII.\\nCHRONIC INFLAMMATION OF THE BULBOUS AND PROSTATIC\\nURETHRA, STENOSIS, AND STRICTURES.\\nSo many cases of sexual weakness and impotence are due to\\nstructural changes in the deep portions of the urethra that a\\nknowledge of these morbid conditions and of the methods of their\\nscientific treatment is absolutely necessary.\\nCHRONIC INFLAMMATION OF THE BULBOUS\\nURETHRA.\\nIn the bulbous urethra the gonorrheal process shows a marked\\ntendency to become chronic, and its persistency causes it to be very\\nrebellious to treatment. In this part of the urethra the vascular\\nsupply is so great, the tissues are so succulent, and, we may say,\\nrelaxed, that every condition favorable to chronic inflammation is\\nthere present.\\nChronic urethritis of the bulbous urethra may give rise to no\\nsecretion visible at the meatus. Then, again, the pus may be so\\ncopious and fluid in consistence that it may glue up the meatus\\nin the morning and perhaps during the day, or may escape once\\na day or oftener as a decided drop. Owing to the fact that the\\nbulbous portion is in direct continuity with the membranous ure-\\nthra this portion may be the seat of hyperemia or inflammation\\nin bulbous urethritis.\\nChronic urethritis of the bulb runs a markedly protracted course.\\nFor a time there may be no impediment to urination, and the only\\nsymptoms may be the slight discharge, or even gonorrheal threads,\\nin the morning urine, and perhaps uneasy, even burning, sensation\\nin the perineum. In many cases early in the chronic stage there\\nmay be no disturbance in the sexual function but as time goes", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0222.jp2"}, "223": {"fulltext": "CHRONIC INFLAMMATION OF THE URETHRA. 209\\non, and the calibre of the bulbous urethra becomes lessened, more\\nor less sexual debility may occur. It is well, however, to empha-\\nsize the fact that in many cases in which the bulb is much involved\\nno sexual weakness is noted.\\nAt the bulbous portion of the urethra, with the expanded and\\nmuch thicker spongy body encircling it, the round-cell infiltration\\ninto the submucous connective tissue layer, caused by gonorrhoea,\\nbecomes more exuberant than elsewhere. The tissues are here\\nsoft and succulent, and the blood-supply is copious. Moreover,\\nthere is no firm, fibrous capsule around the bulb therefore, there\\nis not that hinderance to profuse hyperemia and inflammation that\\nthere would be if the parts were quite firmly invested in a capsule\\nof dense tissue. For these reasons the post-gonorrhoeal inflam-\\nmatory process is severe and long-lasting, and its resulting cell-\\ninfiltration exuberant and extensive. In the bulb, therefore, the\\ninfiltration is at first in the submucous connective tissue, and later\\non it becomes inextricably mixed with muscular and elastic fibres\\nand vessels, and the condition called soft stricture then results.\\nThe morbid condition then consists of round-cell infiltration with\\na tendency to the development of fibrous tissue. When this fibrous\\ntissue is developed, and when tolerably copious and intermixed\\nwith the round-cell infiltration, the resulting contraction is of\\nsemifibrous structure. Then, as time goes on and the morbid\\nprocess increases very decidedly in extent and depth, the newly-\\nformed fibrous tissue takes the place of the erectile and vascular\\ntissues, the areolae are obliterated, and the normal structure of the\\nparts becomes wholly lost and replaced by a uniform sclerotic and\\natrophic fibrous tissue, white, firm, and homogeneous in structure,\\nwhich constitutes what is called modular stricture.\\nIt will be thus seen that in the bulbous portion of the urethra\\nwe find varying grades in the extent and the intensity of the same\\nmorbid process. The determination of the existence of these mor-\\nbid stages is to be arrived at by means of urethral examinations\\nwith the bougie a boule or the olivary bougie.\\nXo precise statements can be made as to the rapidity of growth\\nof the gonorrhoea! infiltration into the bulbous urethra.\\n14", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0223.jp2"}, "224": {"fulltext": "210 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nIn sonic quite exceptional cases the cell -proliferation is quite\\nactive, and in about six months the calibre of the canal at this\\npoint may be reduced to 15 of the French scale, or even to\\nsmaller size. In cases of loss of calibre there may be experi-\\nenced some inability to normally expel the urine. As a rule, the\\nprocess grows quite slowly, and months, and even years, may\\nelapse before very marked contraction occurs. In many such\\ncases there may be some loss of sexual desire. In general, how-\\never, when these patients complain of an impediment in the\\nsexual function, they say that toward the end of ejaculation some-\\nthing seems wrong, and that the act is not performed so promptly\\nand satisfactorily as in earlier days. The reason for this func-\\ntional impairment is largely a mechanical one. As we have already\\nseen (see page 59), in ejaculation the secretion is thrown from the\\nprostate into the capacious bulb of the urethra, and that then the\\nintrinsic and extrinsic muscles contract powerfully and send the\\nejaculate out of the meatus. Now, in chronic urethritis of the\\nbulbous portion the walls of the canal at this part become more\\nand more rigid, and consequently less expansible, and the invol-\\nuntary muscular fibres, which usually exert a powerful action, lose\\nmore or less of their contractile force. Therefore, when the copious\\nejaculate reaches this segment of the canal the latter can only be\\nmoderately, if at all, expanded by the volume of the secretion,\\nand, thus crippled, can only exert a moderate, if indeed any, ex-\\npulsive force upon it. Thus ejaculation becomes lame and halting\\njust before its completion, and this impediment may cause much\\ndisturbance in the mind of the patient.\\nWith the increasing diminution in the calibre of the urethra at\\nthis point the difficulty in urination increases, and there is a total\\nloss of extensibility and of contraction of the canal during coitus.\\nAs the soft stricture tissue increases in quantity and density the\\nrigidity and inextensibility of the canal become more marked in\\nthe semifibrous and fibrous stages. Then, as the stenosis of the\\ncanal increases until an inodular stricture is produced, its calibre\\nbecomes so small that urine may escape with difficulty in a small\\nstream or in drops, and the seminal ejaculate in coitus may be so", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0224.jp2"}, "225": {"fulltext": "CHRONIC INFLAMMATION OF THE URETHRA. 211\\nbarred that it cannot go forward, and flows back into the bladder.\\nIn this event the patient is aspermatous.\\nIn many cases of this chronic, gradually stenosing inflammation\\nof the bulbous urethra, besides the increasing impediment to the\\nsexual act, there seems to be developed some peculiar reflex con-\\ndition, perhaps in the sexual centre, which results in a greater or\\nless condition of impotence. This form of impotence usually de-\\nvelops slowly, and in very many cases it disappears more or less\\npromptly when proper treatment is instituted and faithfully fol-\\nlowed up.\\nCHRONIC POSTERIOR URETHRITIS.\\nChronic posterior urethritis follows in many cases the subsidence\\nof the acute process. Owing to the complexity of structure of the\\nposterior urethra the symptomatology of this affection is often well\\nmarked. When there is simply uncomplicated chronic inflamma-\\ntion of the mucous membrane the symptoms may be negative or\\nvery slight in character. But when the prostatic sinuses, the\\norifices of the ejaculatory ducts, the utriculus masculinus, and the\\ncaput gallinaginis are, together or in part, the seat of trouble, we\\nfind a varied group of symptoms referable to the sexual apparatus\\nand its function.\\nIn chronic urethritis distinctly limited to the posterior urethra\\nthere is usually no escape of pus into the anterior portion, for the\\nreason that it is small in quantity and viscid in consistency. There\\nare, however, border-line cases in the extreme terminal stage of\\nthe acute affection in which the pus is still rather copious, and it\\nescapes through the membranous urethra and passes toward the\\nglans. The compressor urethral muscle does not, as claimed by\\nsome authors, usually contract the lumen of the urethra to a hair-\\nsized calibre, and in general it is a moderately patulous canal at\\nthis point. There certainly is not, in the majority of cases, such\\na tonicity of the compressor urethra? muscle as will keep back a\\nquite copious discharge. While in many cases, owing to its small\\nquantity, the pus may be retained in the posterior urethra by the\\ncut-off muscle, in some cases it certainly is not thus dammed back-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0225.jp2"}, "226": {"fulltext": "212 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nward. The cases of chronic posterior urethritis in which a dis-\\ncharge reaches the meatus are very rare, but they occur.\\nIn very many cases of posterior urethritis, there being no visible\\ndischarge and the patient complaining of no symptoms referable\\nto the deep urethra, the affection remains dormant, latent, and\\nunrecognized. Thus the cases may drag on for one or more, and\\neven five, ten, and fifteen, years without giving any indication of\\nlurking trouble. In some of these cases an exacerbation may\\noccur, and then the patient realizes that he has had an uncured\\ngonorrhoea. In many cases the first disturbing symptom is a\\ngreater or less loss of or defect in the sexual function, and exam-\\nination shows that chronic posterior urethritis has existed perhaps\\nfor a long time.\\nIn some instances the exacerbation of the posterior urethritis\\nis subacute in character, attended only with mild or insignificant\\nsymptoms, and its presence would not be suspected or sought for\\nhad not an attack of epididymitis or epididymo-orchitis developed\\nas a complication. In many cases of this deep-seated urethritis,\\nin which epididymitis or epididymo-orchitis is developed in the\\ninitial attack, recrudescences in the testicular trouble are frequently\\nobserved at late and remote periods as a result of an exacerba-\\ntion in the posterior urethra. In these cases sexual debility may\\nresult from the urethral trouble, while the recurring inflammation\\nof the testes and epididymis may cause azoospermatism.\\nIn somewhat rare instances chronic posterior urethritis, usually\\nas a result of excesses, become developed into a true acute attack\\nwith all its symptoms and its discomforts. It may then run its\\ncourse, but in some cases the inflammatory process extends forward\\ninto the anterior urethra, which also becomes the seat of an acute\\nphlegmasia. In these cases, when the discharge is well estab-\\nlished in the anterior urethra, the sufferings of the patient, expe-\\nrienced when the posterior segment alone was affected, cease, and\\nthe case then takes on the features of gonorrhoea of the totality\\nof the urethra in its declining stage.\\nSymptoms. The symptoms of chronic posterior urethritis are\\nmany and varied, mild and severe.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0226.jp2"}, "227": {"fulltext": "CHRONIC INFLAMMATION OF THE URETHRA. 213\\nThis affection was formerly rather vaguely understood, and to it\\nthe names of neuralgia of the bladder, neuralgia of the neck of\\nthe bladder, and irritability of the bladder have been given. In\\nthe light of modern study all these names may be dispensed with,\\nand the term chronic posterior urethritis may be retained.\\nCases of this affection may be, for purposes of study, separated\\ninto groups according to the nature and severity of their symptoms.\\nThere are found in practice a goodly number of cases in which\\na frequent desire to urinate and some uneasiness at the end of the\\nact, and sometimes at its beginning, are the only symptoms com-\\nplained of. In some of these cases the increased frequency in\\nurination is not much above normal in others it is well marked.\\nIn some cases the pain is slight and dull, or of a quick, stabbing,\\nbut very ephemeral character. In others it is dull, heavy, per-\\nhaps spasmodic, and radiates into the rectum, pelvis, testes, and\\ngroins. In these cases the act of urination may go on smoothly,\\nor it may be interrupted by slight or severe spasm of the com-\\npressor urethrae muscle or of the detrusor vesicae muscles. This\\ncondition has been called cysto-spasnius. It is liable to occur\\nafter coitus or difficult defecation. In other cases there is no dis-\\nturbance of urination at all, but patients complain of dull or aching\\npain in the perineum, deep in the pelvis and prostate, and in the\\nrectum. Sometimes these patients complain of pain over the\\npubes, and of uneasy, vague pains in the cord and testes. In\\nsome cases mild and even severe neuralgic pains are complained\\nof in the loins, groins, and thighs. These painful symptoms, par-\\nticularly when severe, are, fortunately, not always present. They\\nvary from day to day, so that the patient has intervals of com-\\nparative comfort.\\nChronic posterior urethritis may exist for many years (five to\\ntwenty), and yet the patient may regard himself as free from all\\ngonorrheal sequelae. In some of these cases sexual and alcoholic\\nexcesses excite exacerbations of the urethritis, which usually yield\\nquite readily to treatment. In other and exceptional cases the\\nfirst symptom of the existence of the chronic trouble is more or\\nless profuse haematuria, which, as a rule, occurs after or toward", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0227.jp2"}, "228": {"fulltext": "214 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nthe end of urination. In some cases the onset of sexual weakness\\nis the first sign of disease in the posterior urethra.\\nDiagnosis. The diagnosis of chronic posterior urethritis can\\nusually be clearly established by eliciting the history of an earlier\\nacute affection.\\nFig. 55.\\nShowing the microscopic appearance of the secretion of posterior urethritis.\\nIn chronic posterior urethritis the amount of morbid secretion\\nis usually very small, hence the two-glass test of the urine, which\\ngives such clear indications in acute posterior urethritis, cannot\\nbe relied upon as an infallible guide. If this test is used in the\\nchronic affection, the first part of the morning urine will contain\\nthreads, while the second will be clear but in such an examina-\\ntion it may occur that tissue-elements from the anterior urethra\\nwill also be present in the urine. The best plan is to carefully", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0228.jp2"}, "229": {"fulltext": "CHRONIC INFLAMMATION OF THE URETHRA. 215\\nwash out the anterior urethra as far as the triangular ligament\\nwith warm water then, when the urine is passed, if it contains\\nthreads, it is quite certain that they come from the posterior urethra.\\nIn this connection it is well to remember that small, comma-like,\\nfleecy plugs or threads, which are thought to be formed in the ex-\\ncretory ducts of the prostatic glands and voided with the last drops\\nof urine, being pressed out by muscular and prostatic contraction,\\nare quite diagnostic of chronic posterior urethritis. (See Fig. 55.)\\nPerhaps the most serious and, for the physician, trying cases of\\nposterior urethritis, even in those in which no trouble of the pros-\\ntate can be found on careful examination, are those in which there\\nis some disturbance of the sexual function. Some patients com-\\nplain of a severe stabbing pain at the moment of or after ejacu-\\nlation of the semen. Others state that all pleasurable sensations\\nare either absent or lessened in degree in sexual intercourse, and\\nthey are thereby much worried. In still other cases the ejacula-\\ntions occur before intromission or shortly afterward.\\nIn some cases pollutions are frequent, and with their occurrence\\ndiminution in the sexual appetite may be felt. Many of these\\npatients become weak, nervous, and apprehensive. Their diges-\\ntion becomes poor, and they suffer from constipation. Then the\\npassage of a hard fecal plug presses the prostate and expels the\\naccumulated muco-pus, which appears at the meatus, causing the\\npatient to think he is losing semen. In some of these cases some\\nof the secretion of the seminal vesicles is at the same time expelled,\\nand this also to many is convincing proof that they are suffering\\nfrom spermatorrhoea. Occasionally these patients are much alarmed\\nat the occurrence of bloody pollutions, which are due to great\\nhyperemia of the ejaculatory ducts and the prostatic and bulbous\\nurethra, and sometimes the seminal vesicles. In any of these\\ncases of disturbance of the sexual function we are liable to find\\nmore or less deterioration of the health. This may consist simply\\nof weakness and lassitude, and it may be a condition of great\\nnervousness, of melancholia, or even of true neurasthenia. Be-\\ntween these two extremes there are many degrees of bodily and\\nmental debility.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0229.jp2"}, "230": {"fulltext": "216 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThe foregoing symptom-complex may be found in cases in\\nwhich, as has been stated before, careful examination will show\\nthat the prostate is not synchronously the seat of chronic inflam-\\nmation. But in other cases true posterior urethritis with chronic\\nprostatitis may exist, and the patient may complain of the symp-\\ntoms as just now detailed.\\nPathological Appearances. The most constant morbid con-\\ndition seen in chronic bulbous urethritis is a rather deep-red, even\\npurplish, color of the mucous membrane, which is more or less\\nthickened. This redness may involve a segment of the canal or\\na limited portion on one or two sides. In these cases more or less\\npus, thin or inspissated, may be seen in the examination. Thick-\\nened, red, circumscribed spots or plaques of chronic inflammation\\nare very common. Another appearance quite commonly seen is\\ncalled by some granular urethritis. The membrane is thickened,\\nred, even purplish in streaks, and rough and studded with small\\nprojections, which consist either of epithelial hyperplasia or of\\nlittle eminences caused by the growth of new capillary vessels.\\nThis condition is frequently found in the bulbous urethra and also\\nin the pendulous portion.\\nThe morbid appearances of the mucous membrane of the poste-\\nrior urethra are conspicuously striking. They consist of thicken-\\ning, more or less papulation, together with increased redness.\\nFrequently the caput gallinaginis and the orifices of the prostatic\\nducts are seen to be swollen. The underlying pathological process\\nis precisely similar to that of the anterior urethra.\\nTreatment. It is better to give here the treatment of chronic\\nposterior urethritis from the period of decline of the gonorrhoeal\\nprocess than to begin with the very late stages of posterior ure-\\nthritis.\\nThe duration of the urethritis has an important bearing upon\\nits treatment. Let us first consider the cases in which the disease\\nhas lasted only a few months. Such patients may complain only\\nof the morning drop, or they may state that they seem well so\\nlong as they use an injection, abstain from coitus, and do not drink\\nbeer and alcoholics or eat highly seasoned food. When they cease", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0230.jp2"}, "231": {"fulltext": "CHRONIC INFLAMMATION OF THE URETHRA.\\n217\\ninjecting and indulge in creature comforts and excesses the morn-\\ning drop reappears, with perhaps a more or less profuse discharge\\nduring the whole day. Examination of the urethra in these cases\\nshows a catarrhal and exudative condition from the bulb forward,\\nperhaps nearly to the meatus. In many of these cases the poste-\\nrior urethra is also involved. The morning urine is rather cloudy,\\nlike turbid cider, contains much mucus and some long, thin or thick\\nthreads (sometimes three or four inches long). There may or may\\nnot be a few gonococci present. In these cases the best treatment\\nis irrigation of the posterior and anterior urethra, using at first\\nwarm solutions of alum and sulphate of zinc or permanganate of\\npotassium, beginning with a strength of 1 5000, and increasing\\naccording to the result obtained.\\nFig. 56.\\nReflux catheter.\\nFig. 57.\\nHand-syringe.\\nThe instruments necessary for these instillations of the bulbous\\nurethra are a soft-rubber reflux catheter of a calibre of about 14\\nto 16 French scale (see Fig. 56) and a hard-rubber hand-syringe.\\n(See Fig. 57.) The end of the catheter should be passed down\\nto the bulb, and then the nozzle of the syringe is inserted and the\\ninjection is given. For injecting the prostatic urethra the ordi-\\nnary soft catheter should be cut off so that it measures eight and a\\nhalf inches. (See Fig. 58.) This rubber catheter (10 to 12 French),\\nlubricated with glycerin or lubrichondrin, is passed down the", "height": "3980", "width": "2540", "jp2-path": "practicaltreat00tayl_0231.jp2"}, "232": {"fulltext": "218 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nurethra until its eye enters the prostatic urethra, which is usually\\nseveD or seven and a half inches down. The bladder being empty,\\npressure on the piston then throws the injection into the prostatic\\nurethra. It is well now to withdraw the catheter a little until its\\nend is in the membranous urethra then on pressing the piston\\ngently resistance will be felt and no fluid will flow. This tells\\nthe surgeon that he is in the membranous urethra, and that the\\nirritation of his procedure has caused the contraction of the com-\\npressor urethras muscle. Then push the catheter inward about\\nhalf an inch and inject again, when the fluid will readily pass.\\nBy this manoeuvre the eye of the catheter is placed just at the\\napex of the prostate and at the very beginning of the prostatic\\nurethra. The injection is then slowly thrown in, and it passes\\nthrough the whole of the prostatic urethra into the bladder. If\\nonly a rather small injection is to be given, about one-half of the\\ncontents of the syringe may be used posteriorly. Then, while\\nstill pressing the piston, the surgeon gently draws out the cath-\\neter, and finds that as its eye passes through the membranous\\nurethra the flow stops again, but is at once resumed when the\\neye reaches the bulbous urethra, which is then irrigated with the\\nremainder of the fluid.\\nFig. 58.\\nSoft-rubber catheter.\\nUsually one irrigation several times a week is sufficient, but per-\\nhaps one each day may be well borne. The sensations of the\\npatient and the condition of the urine are infallible guides as to\\nthe required frequency of treatment. As a general rule, after one\\nor two weeks treatment these irrigations seem to lose their efficacy,\\nhaving done some good, but not having produced a cure. Per-\\nhaps in these conditions permanganate of potassium irrigations", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0232.jp2"}, "233": {"fulltext": "CHRONIC INFLAMMATION OF THE URETHRA. 219\\n(always hot), 1 1000 or 1 2000, may bring about a cure. If this\\nremedy fails we resort to nitrate of silver, beginning with solu-\\ntions of the strength of 1: 16,000 or 1 8000, and sometimes even\\nweaker and this usually results in a cure if the tretment is care-\\nfully administered. If the morbid process is more severe in the\\nanterior urethra, the bulbous reflux catheter should be introduced\\nas far as the bulb, and one or two syringefuls of the irrigating\\nfluid should be injected. The posterior urethra should then be\\nsimilarly treated. Sometimes it is necessary to finish with quite\\nstrong, deep injections. In these cases much pain is frequently\\nproduced by the passing of sounds, particularly of large ones.\\nThis fact should always be borne in mind, since many patients\\nthus treated suffer severely, Avhile in others the disease is so\\naggravated that it becomes most difficult to cure. Some of these\\ncases are thus rendered practically incurable even when the most\\njudicious and prolonged treatment is followed. Too much attention\\ncannot be paid to the fact that in some cases of chronic gonorrhoea\\nsounds, particularly large ones, may be productive of incalculable\\nharm when used too early.\\nWhen the disease is limited to the bulbous portion, where it\\nshows a great tendency to remain indefinitely, the retrojections of\\nalum, sulphate of zinc, and nitrate of silver may be used. These\\ninjections will materially modify the morbid process, and some-\\ntimes cure it, but they often fail to bring about a thorough cure.\\nIn that event it is well to make direct local applications of solu-\\ntions of nitrate of silver, beginning with a solution of 1 2000,\\nand perhaps going as high as 1: 250 and 1: 125.\\nA very useful and perfectly effective syringe is the one gener-\\nally used by me. (See Fig. 59.) There is nothing whatever\\noriginal about this syringe. It is simply a well-made instrument,\\nvery easily worked, having a ring and shoulders for the thumb and\\nfingers, and a very conical nozzle, which will fit into a small, soft\\ncatheter. The piston is marked with numbers to regulate the\\ndrops. The injecting medium is any well-made soft-rubber cath-\\neter, 10 to 12 or 14 French, cut off to measure eight and a half\\ninches in length. When the catheter is introduced six or six and a", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0233.jp2"}, "234": {"fulltext": "220 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nhalf inches its end is in the sinus of the bulb, aud the very slight\\nImpediment it encounters there shows the operator that he is just\\nat the opening in the triangular ligament.\\nFig\\nAuthor s syringe.\\nThis little catheter, when slowly passed, causes no pain or irri-\\ntation. Then ten or fifteen drops of the silver nitrate solution\\nmay be thrown into the urethra. This treatment may sometimes\\nbe varied by using 1, 2, or 3 per cent, sulphate of copper solution,\\nor a 1 1000 permanganate solution. This treatment may be\\nadministered by the surgeon every five days or twice a week, and\\nperhaps oftener if the indications of the case point to the necessity\\nof increased frequency. In the intervals the patient may use mild\\nstimulant and astringent injections by means of a penis-syringe.\\nThis form of chronic urethritis being very rebellious, it is some-\\ntimes necessary to pass an endoscopic tube down to the bulb (see\\nFig. 60), and having ascertained the morbid appearances, to\\nsparingly apply on cotton at the end of an applicator a strong\\nsolution of silver nitrate (thirty to sixty grains to one ounce of\\nwater).\\nFig. 60.\\nEndoscopic tube.\\nIn the more chronic cases of anterior urethritis we find spots,\\npatches, and areas of inflammation at the peno-scrotal angle (some-\\ntimes seemingly caused by the pressure of the suspensory worn", "height": "3988", "width": "2480", "jp2-path": "practicaltreat00tayl_0234.jp2"}, "235": {"fulltext": "CHRONIC INFLAMMATION OF THE URETHRA. 221\\nduring the declining stage) and in the pendulous urethra as far as\\nits beginning.\\nThe first essential in the treatment of these cases is to locate the\\ntrouble and to determine its nature. Now, in this part we find\\nsubepithelial infiltration, with or without a greater or less epithe-\\nlial hyperplasia, erosions, and superficial ulcerations, always accom-\\npanied with submucous thickenings and follicular inflammation.\\nThe thickened mucosa may be granular, villous, or papillomatous.\\nThe urine can do little in enlightening us as to the exact nature of\\nthe morbid process unless it contains old flabby and fatty epithe-\\nlial cells, which point to an old ulcer which is in too atonic a con-\\ndition to heal of itself. In these cases much aid can be obtained\\nFig. 61.\\nBougie a boule.\\nas to location by the bougie d, boule. This instrument consists of\\na conical or acorn-shaped head with a well-marked sharp but\\ngently rounded shoulder, which is attached to a flexible gum-\\nelastic staff. (See Fig. 61.) For the cases under consideration\\nwe may need these bougies a boule in size ranging from 18 to 30\\nFrench. For strictures we may use the smaller sizes, which begin\\nas small as 8 or 10 French.\\nIn the treatment of posterior urethritis with or without anterior\\nurethritis great care is required to determine as nearly as possible\\nthe exact condition of affairs. In the more recent cases we some-\\ntimes find some evidence of bladder incompetence (the urine show-\\ning no involvement of that viscus), which shows itself by the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0235.jp2"}, "236": {"fulltext": "222 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nescape of a little (two drachms to one-half ounce or more) residual\\nurine when the eye of the catheter reaches the neck of the bladder.\\nIu these rather early cases mild irrigations of the astringents and\\nof permanganate of potassium may be used, and perhaps with\\nbenefit. The most uniformly effective agent here also is the\\nnitrate of silver, which may at first be used well diluted, 1 16,000\\nor 1 8000, in the form of hot irrigations.\\nFor older and very chronic cases of posterior urethritis the\\nstronger silver nitrate injections, 1 500 or 1 250, may be used.\\nIn my experience, fifteen drops or more of these solutions produce\\nbetter effects than a more sparing injection of stronger solutions.\\nThese injections should be given every third or fourth day. They\\nmay, however, produce benefit in some cases if made more fre-\\nquently. Daily injections are liable to cause acute suppuration,\\nw T hich means irritation, and that must be avoided.\\nPosterior urethritis, accompanied by sexual disability, premature\\nejaculations, pollutions, and absence of erections and loss of sexual\\ndesire, usually require the injection of a few drops of the stronger\\nsolutions just mentioned.\\nTreatment of Stenosis and Strictures of the Bulbous Urethra.\\nStenosis and stricture of the bulbous portion of the urethra may\\nbe soft, semifibrous, fibrous, and i nodular, all of which require\\nappropriate treatment.\\nSoft and semifibrous strictures should, as a rule, never be incised\\nuntil milder means have been tried and have failed.\\nThe diagnosis having been carefully made, the calibre of the\\nstricture is to be determined. Now, on this point no rule can be\\nlaid down, since cases differ so strikingly. Thus in some patients\\nthe canal may be reduced to 20 or 15 F., and yet these strictures\\nare of the soft variety. In others, with similar calibres, they may\\nbe semifibrous or fibrous. Then, again, it is not very uncommon\\nto find a urethra reduced to even 6 or 8 F. by an exudative hyper-\\nplasia, which we call soft stricture. These various and varying\\nconditions have to be ascertained, and as the surgeon grows in", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0236.jp2"}, "237": {"fulltext": "CHRONIC INFLAMMATION OF THE URETHRA. 223\\nexperience lie will become more and more expert in recognizing\\nthem.\\nGradual Dilatation. When the stricture in the bulbous urethra\\nis yet in the soft, or even in the semifibrous, stage, the aim should\\nbe to remove as far as possible the cell-infiltration, and thus, in a\\nmanner, to restore the mucous membrane to its natural condition.\\nThis can be done in many cases by careful and gradual dilatation.\\nSeeing that a soft stricture may contract the urethral lumen\\neven as low as 7 or 8 F., and that in many cases where the calibre\\nis 15 or 20 F. the infiltration is yet soft and succulent, it is always\\nwell to make the attempt to cure by the introduction of the bougie\\nor sound before the knife is resorted to. When, however, a fibrous\\nor modular stricture of small calibre is discovered our chief thought\\nis not toward gradual dilatation.\\nI have in so many instances been able to restore the urethra\\neven when contracted to 7 or 8, to 30 F., that I am always\\nloath to operate more radically.\\nIn the process of gradual dilatation much care, patience, and\\ngood judgment are necessary. The operation should always be\\ncarefully and slowly performed in a manner to cause no pain or\\nuneasiness and no damage to the tissues. By the pressure and\\nstimulation of the distending instrument we hope to cause the\\nabsorption of the exudation and to give tone and resiliency to the\\ndilated vessels. It will thus be seen that we are always liable to\\ncause inflammation, and this condition will either delay the cure\\nor perhaps thwart our efforts. In cases where the contraction is\\nas great as 7 or 8 F., and also where the calibre of the stricture\\nis much larger, there may be posterior urethritis or even urethro-\\ncystitis, and these conditions should then receive proper treatment.\\nBeginning with a small olivary bougie (see Fig. 62), the surgeon\\nshould gradually and slowly increase the size of the instrument as\\nthe progress of the case will indicate to him. In the early part\\nof the treatment the bougie may be introduced once a week, and\\nthen in favorable conditions the interval may be fixed at about\\nfive days. It is almost always well to allow this interval of time\\nto elapse between the seances of treatment. Many men have failed", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0237.jp2"}, "238": {"fulltext": "224 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nin this method of treating stricture by the too frequent introduc-\\ntion of the instrument, and many patients have not received the\\nbenefit they would have had if there had been less haste. In\\ngradual dilatation, particularly in the early stages, the sensations\\nof the patient should be carefully considered and the urine regu-\\nlarly and methodically examined. If the operation causes uneasi-\\nness and pain in the perineum and over the pubes, and continued\\nfrequency in urination, and if the parts resist the gradual increase\\nin the size of the instrument, it will be necessary to suspend the\\ntreatment temporarily, and perhaps permanently. In many of\\nthese cases local medication to the anterior and posterior urethra\\nwill put the parts in such a condition that gradually dilatation\\nmay again be resumed.\\nFig. 62.\\nFlexible olivary bougie.\\nIt will be generally found, when dilatation is commenced, in\\nthe form of stricture under consideration, with very small olivary\\nbougies, that at first the sizes may be increased quite regularly,\\nand no trouble, or perhaps very little, is experienced by the sur-\\ngeon until he gets up as high as 20 or 22 F. Then he will gen-\\nerally find that the dilating process goes on much more slowly,\\nand that it may be necessary to introduce sounds of one size\\nseveral times before larger ones can be used.\\nThe prompt and usually perceptible effect produced by the early\\nsystematic production of small bougies has much bearing on the\\nfuture of the case. Patients watch the progress made step by step,\\nand as they see that they are gaining in urethral calibre, and that\\nthey have lost their unpleasant symptoms (urethral or vesical), they\\nbecome sanguine of an eventful cure, and present themselves regu-\\nlarly for treatment. It is most essential in these cases that the\\npatient should have implicit confidence in the surgeon, and that he\\nshould keep his moral courage up in the ordeal through which he", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0238.jp2"}, "239": {"fulltext": "CHRONIC INFLAMMATION OF THE URETHRA. 225\\nis passing. Though these patients are neither hurt nor inconveni-\\nenced, the irksomeness of having at stated intervals to go to the\\nsurgeon is very trying to some. Others, and indeed the majority,\\nappreciating the infirmities and sufferings which strictures almost\\ninevitably lead to, resolve to keep on till they are cured. The main,\\nand indeed the only, valid objections to gradual dilatation are that\\nit is a slow process and occupies a quite long stretch of time. But\\nit must always be remembered that if it is followed up until the\\nurethra is restored to a calibre of 30 F., in the majority of cases\\nit will only be necessary to have sounds introduced once or twice\\na year thereafter whereas it can be said, without fear of contra-\\nction, that when a man s urethra has once been cut he has (if he\\nwould keep the channel open) to pass instruments at short inter-\\nvals all his life. All these considerations should be presented by\\nthe surgeon to his patient as the treatment goes on. Men often\\nget careless and even indifferent at the time when they may be\\nsaid to be about half -cured. In these circumstances the surgeon\\nshould use all his influence against faltering and backsliding.\\nFig. 63.\\nConical steel sound.\\nWhen in the course of this treatment the urethra will admit an\\nolivary bougie No. 20 F., it is well to resort to the curved steel\\nsounds (see Fig. 63), and with them finish the cure. In many\\ncases when the coarctation is extensive and involves the whole\\nlength of the bulbous urethra, the Beneque sound will produce\\nparticularly good results. (See Fig. 64.) Its double curve seems\\nto exert a beneficial pressure not obtainable by the use of the\\nordinary curved sound.\\nThe trend of thought as regards the treatment of urethral\\nstricture of late years has been so unswervingly toward cutting\\n15", "height": "3980", "width": "2462", "jp2-path": "practicaltreat00tayl_0239.jp2"}, "240": {"fulltext": "226 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\noperations that many surgeons are wholly unaware of the benefi-\\ncent and lasting effects of gradual dilatation. I am to-day more\\nthan ever convinced that cutting operations should be a last resort,\\nand that intemperate incisions and over-stretching are very fre-\\nquently the cause of never-ending suffering and inconveniences.\\nFig. 64.\\nBeneque s sound.\\nIt is impossible to state exactly the period of time necessary for\\ncure by gradual dilatation, since it varies in each case, and so\\nmuch depends on the regularity and sedulousness of the patient.\\nIn some cases the normal urethral lumen may be restored in three\\nmonths, and in others in six, nine, and twelve months. As a\\ngeneral rule, a six months treatment will be followed by better\\nresults than a shorter course.\\nThere is one point which deserves especial emphasis, and it is\\nthis To produce satisfactory permanent results by gradual dila-\\ntation the urethral canal must be brought up to the calibre of 30\\nor perhaps 32 F., and when this is attained the dilating process\\nmust be continued for some time, until these large sounds pass\\neasily and without any grasping.\\nContinuous dilatation is very rarely resorted to at the preseut\\ntime. In some cases where a filiform has after a long struggle\\nbeen passed through the stricture, it may be retained there for\\nsome hours, or perhaps for a day, in order to render certain the\\npassage of a larger instrument.\\nIn the majority of cases the process of cure by gradual dila-\\ntation is uneventful, but in a small minority certain complications\\nmay arise and give more or less trouble. These complications are\\n1, fever and chills 2, urethritis and urethrocystitis 3, a ten-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0240.jp2"}, "241": {"fulltext": "CHRONIC INFLAMMATION OF THE URETHRA. 227\\ndency to hemorrhage 4, temporary retention 5, rheumatism\\nand 6, pyamric abscesses. It is well to state in advance that since\\nthe beginning of the era of asepsis and antisepsis in surgery these\\ncomplications occur much less frequently than formerly, and they\\nare much less severe.\\nThe occurrence of chills and fever shows that there is a low\\ngrade of suppuration in the deep urethra, but it need not cause\\nthe permanent discontinuance of dilatation. Such cases should be\\ntreated on the lines laid down for chronic anterior and posterior\\nurethritis and urethrocystitis.\\nWhen the sound causes inflammatory reaction its use should\\nbe discontinued until appropriate treatment removes the tendency\\nthereto, as it will do in most cases. Exceptionally, however, it\\nhappens that the resulting inflammation is so great and so con-\\nstant that it is necessary to wholly abandon this form of treat-\\nment. In many such cases judicious topical urethral medication\\nafter a time brings about such a change that the sound may be\\nused again. In some severe and exceptional cases the expediency\\nof external urethrotomy will suggest itself to the mind of the sur-\\ngeon.\\nIn like manner, the tendency to slight oozing of blood after\\ndilatation can generally be checked by the instillation of a few\\ndrops of a solution of nitrate of silver (1 250).\\nAVhen in the course of gradual dilatation retention of urine\\noccurs once or at intervals it is perfectly certain that one or two\\ncauses are at work these are swelling of the mucous membrane\\nin and near the stricture and temporary spasm of the compressor\\nurethral muscle. In such cases there is need of topical urethral\\nmedication, and the intervals between the passage of the bougies\\nor sounds should be materially lengthened. AVhen carefully man-\\naged this complication may be overcome.\\nThe occurrence of rheumatism and of pyemic abscesses indi-\\ncates very clearly that, besides the stricture process, a decided\\nsuppuration of the urethra also exists, which can be cured by the\\nmeans described in the section on the treatment of chronic ante-\\nrior and posterior urethritis.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0241.jp2"}, "242": {"fulltext": "228 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nIt will be seen, therefore, that in the successful employment of\\ngradual dilatation the surgeon must be thoroughly conversant\\nwith all forms of urethral inflammation.\\nThe scope of this volume will not admit of the consideration of\\nthe treatment of strictures by internal and external urethrotomy,\\nbut, in a general way, it may be stated that undilatable stricture in\\nthe pendulous urethra requires internal urethrotomy, while those\\nof the bulbous and membranous urethra require external urethrot-\\nomy for full information concerning which the reader may con-\\nsult my work entitled A Practical Treatise on Genito-urinary and\\nVenereal Diseases and Syphilis. Philadelphia, 1900.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0242.jp2"}, "243": {"fulltext": "CHAPTER XVIII.\\nCHRONIC AFFECTIONS OF THE PROSTATE.\\nBy far the most frequent cause of sexual weakness and impo-\\ntence is chronic inflammation of the prostate gland. This morbid\\ncondition is produced by various causes, the most frequent prob-\\nably being acute and chronic gonorrhoea, the next in order being\\nmasturbation and sexual excesses, while in a less number of cases\\ntraumatisms, such as damage to the posterior urethra by sounds,\\nlithotrites, dilators, endoscopes, and very caustic deep injections\\nare the starting-points of the trouble.\\nIt is necessary to clearly understand the far-reaching effects\\nwhich acute and chronic gonorrhoea often exert upon the pros-\\ntate, since such knowledge renders clear the etiology of many\\ncases which might otherwise seem very obscure.\\nGONORRHEAL CONGESTION OF THE PROSTATE.\\nThe most common form of inflammation of the prostate in the\\ncourse of gonorrhoea is congestion of more or less severity. This\\ncondition occurs with, and is dependent upon, acute posterior\\nurethritis. In the latter condition the submucous connective\\ntissue is the seat of an acute phlegmasia, and as a result the sub-\\nstance of the prostate becomes hyperseniic. With this further\\nextension of the gonorrhoeal process the patient has still other\\nsymptoms besides those of the posterior urethritis. He complains\\nof a sensation of dull weight and pressure in the perineum deep in\\nthe pelvis, and an uneasy sense of fulness in the rectum or anus.\\nIn severe cases rectal tenesmus may add to the patient s discomfort.\\nThe vesical tenesmus may be increased, and often in defecation\\nthe patient experiences severe pain in the prostate when the fecal\\nmass passes under it. When there is much swelling the stools are\\nsmall and ribbon-shaped. Rectal examination reveals a swollen", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0243.jp2"}, "244": {"fulltext": "230 SEXUAL DISORDERS OF THE MALE AND FEMALE\\norgan, broader than normal from side to side, and bulging consid-\\nerably into the rectum. The finger-tip reveals the fact that the\\npart is hot and decidedly painful, and on its withdrawal vesical\\nand rectal tenesmus frequently ensues. In many cases pollutions\\nare a distressing symptom. The swollen state of the prostate\\ngenerally causes dysuria, or even such a condition of retention\\nthat it is necessary to remove the urine with a catheter.\\nIn the great majority of cases this congestion is temporary. It\\nmay last a few days or two or three weeks usually, however,\\nresolution takes place in about ten days. With the decline of the\\nposterior urethritis the swelling and tenderness usually subside.\\nIn some cases the involution of this congested condition of the\\nprostate occurs suddenly and unexpectedly a few days after its\\nonset.\\nFig. 65.\\nKemp s double current hard-rubber rectal irrigator.\\nCongestion of the prostate may be due to violence from sounds,\\ncatheters, lithotrity instruments, to the irritation of a stone in the\\nbladder or of a fragment of stone, or of small stones impacted in\\nits mucous membrane, and to stricture. It is not very probable,\\nas claimed by some, that injections used by patients in the ante-\\nrior urethra cause congestion of the prostate.\\nLong-continued masturbation is also a frequent cause of chronic\\ncongestion of the prostate.\\nTreatment. In the acute stage of congestion of the prostate,\\nrest in bed and antiphlogistic treatment are required.\\nWhen the congestion becomes chronic the condition may be\\ndiscovered by the finger-tip in the rectum, which finds the organ\\nsoft and boggy or swollen and tense. At this time gentle massage", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0244.jp2"}, "245": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 231\\nmay do much good, but it may cause distress, and then it should\\nbe stopped. Warm, hot, or cold saline solution irrigations of the\\nrectum may be given once or twice a day by means of Kemp s\\nprostatic cooler (Fig. 65), and are often of much benefit. This\\nuseful instrument is made of both hard and soft rubber, so the\\nsurgeon may have his choice. In chronic congestion of the pros-\\ntate, mercurial, ichthyol, or iodide of potassium suppositories may\\nbe used (vide infra). In all cases the condition of the urethra\\nshould be ascertained, and if diseased it should be treated.\\nCHRONIC INFLAMMATION OF THE VERUMONTANUM\\nAND PROSTATIC URETHRA.\\nThis form of chronic prostatitis is not very uncommon, and is\\nfound, as a rule, in young men from about eighteen to twenty-five\\nyears of age. The underlying causes are either prolonged mas-\\nturbation, or, rather less frequently, chronic posterior urethritis, or\\nboth may be factors. Patients thus afflicted may enjoy tolerably\\ngood health or they may be anaemic or even neurasthenic. (See\\nsection on Chronic Posterior Urethritis, with which this condition\\nis sometimes combined.)\\nThe first symptoms pointing to this prostatic disorder are refer-\\nable to the sexual system. In those patients who indulge in\\ncoitus it is first noticed that they suffer from premature ejaculations.\\nErections may be firm and desire may be great, but the sexual\\nact is aborted. Then, as time goes on, the erections become less\\nvigorous and the ejaculations are weak and dribbling. Unless\\nrelieved such patients become impotent. Besides these symptoms\\nnocturnal pollutions may trouble the patient, who may also observe\\nthe escape of mucus from the urethra after urination or defecation.\\nIn some cases a sense of weakness and depression follows the sup-\\nposed loss of semen. All these symptoms may be observed in\\nthose whose trouble originated in masturbation.\\nWhen the emission or ejaculate is examined under the micro-\\nscope it is found to consist of mucin and granular phosphates, as\\na rule (see Fig. 66), but in some quite chronic cases puny and", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0245.jp2"}, "246": {"fulltext": "232 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ndead spermatozoa may be seen in the fluid, together with cuboidal\\ncells, pus, and perhaps oxalate of lime.\\nWhen the urine is examined, if posterior urethritis exists, the\\nfirst few ounces will contain gonorrheal threads (see page 215 and\\nFig. 55), the second specimen will be clear, and iu some instances\\nthe third specimen will have a decidedly milky appearance, due\\nto the mucus and granular phosphates which have been expressed\\nby the contraction of the prostate. If, however, after the second\\nFig. 66.\\nGranular phosphates.\\ncylinder has been filled with clear urine and some of the residuum\\nis still left in the bladder, massage of the prostate will cause a\\nmore or less copious flow (one-half to two or three drachms) of a\\nmucus which may be thin and milky or as thick as condensed\\nmilk. This secretion may escape from the meatus or it may be\\nvoided with the urine. In any event, in this form of prostatitis\\n(and the same is seen in other forms) the dominating component\\nparts will be found to be mucus and granular phosphates. (See\\nFig. 66.) And it may be here stated that this combination is the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0246.jp2"}, "247": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 233\\none which, with more or less admixture of other crystals and of\\ntissue-elements, will be found throughout the course of the various\\nforms of prostatitis yet to be considered. Sometimes mucus\\nescapes which is not mixed with phosphates, but this is not of fre-\\nquent occurrence. It is most important, therefore, that the sur-\\ngeon should become thoroughly familiar with this muco-phosphatic\\nsecretion and with the urine which is so commonly voided by these\\npatients. The urine is usually of low specific gravity (1004 to\\n1010), of moderately neutral, alkaline, or not very acid reaction.\\nIts color is of a pale straw tint, and it is usually voided in con-\\nsiderable quantities. Much familiarity with these cases will enable\\nthe surgeon (if he were so disposed) to make a diagnosis simply\\nfrom inspection and microscopic examination of the urine. As\\nhas already been said, the dominating feature of the abnormal\\ndischarge is the combination of mucus and granular phosphates.\\nThese patients sooner or later complain of frequent urination\\nin some it occurs at night, in others in the daytime, and in still\\nothers both by day and by night. Some patients complain of\\npain in the passage of the urine as if it scalded, or as if a hot iron\\nwere in the canal, and it is not uncommon for these patients to\\nexperience a dull pain in the glans penis at the end of urination.\\nSome patients have a sensation as if their urine escaped, but\\nexamination of the penis shows that it is dry.\\nEndoscopic examination of these cases should not, as a rule, be\\nmade, since they are usually very painful, and the conditions\\nwhich they reveal can be determined by other and less severe\\nmeans. The facts already in our possession, derived from the\\nendoscopic study of the prostatic urethra in these cases, show very\\nclearly that the whole canal is very red and swollen, and this is\\nobserved particularly in the verumontanum and the adjacent sur-\\nfaces.\\nExamination of these cases with the bougie a boule shows the\\nsame state of affairs. As the bulb enters the prostatic urethra the\\nalready apprehensive patient may experience a severe and even\\nstabbing pain, which causes him to cry out, particularly as it\\nglides over the verumontanum. In many instances, on the with-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0247.jp2"}, "248": {"fulltext": "234 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ndra will of the instrument a little blood will be seen on the bulb or\\nat the meatus.\\nIn some cases when the steel sound is introduced there may be\\nsome impediment at the bulb, due to spasm of the compressor\\nurethral muscle. This, however, is soon and painlessly overcome,\\nand then the tip of the instrument passes into the prostatic ure-\\nthra, where it may cause at first as much pain as the bulb does.\\nIn some cases a powerful spasm of the prostate may be induced,\\nby which the sound is thrown out of the urethra, or an orgasm\\nmay occur, and the same result may be produced. As a rule, the\\ngreat sensitiveness of the deep urethra disappears under careful\\ntreatment, and the introduction of the sound then comes to be a\\nsource of comfort.\\nNow, when these cases are further examined by means of the\\nfinger in the rectum much important information may be obtained.\\nOn careful palpation of the prostate with the finger-tip the sur-\\ngeon may find no enlargement or perceptible change indeed, no\\npain may be produced unless deep pressure be made. If, how-\\never, the sound is left in the urethra, and then pressure by the\\nfinger-tip in the rectum is made, the patient may experience pain,\\nand even cry out in agony.\\nNow, by this study of the symptomatology, by the considera-\\ntion of the antecedents and age of the patient, and by the results of\\ninstrumental and urinary examination, we are warranted in draw-\\ning the conclusion which has been largely fortified by post-mortem\\nexaminations, that such patients are suffering from exudative\\ncatarrhal inflammation of the mucous membrane of the prostatic\\nurethra, and that the verumontanum, with its numerous contained\\nmucous tubules and copious nerve- and blood-supply, is the focus\\nof that process. This condition, which is now generally vaguely\\nalluded to as spermatorrhoea, to my mind is a distinct morbid\\nentity, and it may exist, I am positive, without any extension or\\ninvolvement of the environing prostatic substance or of the sexual\\nparts beyond. Careful studies of post-mortem subjects have\\nclearly proved this condition, which can readily be demonstrated\\nin life if the surgeon has sufficient experience and skill.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0248.jp2"}, "249": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 235\\nThis affection, as it becomes very chronic, may lead to catar-\\nrhal inflammation of all the gland-tubules, and then distinct en-\\nlargement of the organ can be readily made out.\\nPrognosis. As a rule, these cases are quite promptly benefited\\nby treatment, provided they will conform to the requirements of\\nsexual hygiene. Sexual and alcoholic excesses prove great draw-\\nbacks to a cure and materially interfere with the treatment.\\nIn anaemic and neurasthenic subjects this form of prostatitis is\\nsometimes very chronic, and the continuance of local inflamma-\\ntion leads to the intensification of the general low condition. In\\nmany cases, however, brilliant results follow a carefully adapted\\nmethod of treatment.\\nTreatment. The treatment in the main is that advised for\\nposterior urethritis. The health and morale of the patient should\\nbe improved as much as possible by all hygienic influences. In\\nanaemic and neurasthenic cases iron, quinine, and strychnine are\\nvery beneficial, and they may be combined with coca extract.\\n(See p. 103).\\nThis combination will be found useful in most cases of sexual\\ndisorder in which anaemia or neurasthenia coexists.\\nBut in all these cases the existence of the local inflammation\\ndeleteriously reacts on the sexual centre and the general nervous\\nsystem, and it is of prime importance to cure that. To this end\\nthe careful introduction of a goodly sized (20 to 30 French scale)\\nsteel sound (chilled in ice-water), two or three times a week, and\\nits retention in the urethra for three or four minutes, may be very\\nbeneficial or, should the surgeon prefer, he may use the now-\\nnearly-out-of-date psychrophor. 1 (See Fig. 67.)\\nInstillations and irrigations of nitrate of silver, permanganate\\n1 A double-current catheter without eyes, the two canals communicating near\\nthe point of the instrument. It is introduced into the urethra until its point\\nhas passed the pars prostatica, and it is then attached by rubber tubing to a\\nreservoir containing water of the desired temperature. On turning the stopcock,\\nthe water flows into one canal and out through the other. In this way the caput\\ngallinaginis and the entire mucous membrane are exposed to the mechanical\\naction of pressure and the sedative action of cold.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0249.jp2"}, "250": {"fulltext": "236 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nof potassium, or of alum and sulphate of zinc, may be used in\\nmost cases with much benefit.\\nGood results often follow the use of the cupped sound of a\\ncalibre of 24 to 30 French scale, which may be introduced once or\\ntwice a week. (See Fig. 68.) Into the little depressions on the\\ncurved part of the sound small portions of an ointment composed\\nof nitrate of silver and vaseline or simple cerate (5ss-5j to \u00c2\u00a7j) may\\nbe placed, which, when the instrument is in the urethra, will melt\\nand soak into the morbid tissues.\\nFig. 67.\\nPsychrophor.\\nFig.\\nCupped sound.\\nConstipation should be avoided, and coffee, liquors, asparagus,\\nand spiced dishes should not be indulged in.\\nBromide of potassium, belladonna, and hyoscyamus may be used\\nwith caution to meet the condition of erethism when it arises.\\nProstatic massage is not, as a rule, indicated in these cases.", "height": "4005", "width": "2480", "jp2-path": "practicaltreat00tayl_0250.jp2"}, "251": {"fulltext": "CHRONIC AFFECTIONS OF TEE PROSTATE. 237\\nCHRONIC CATARRHAL INFLAMMATION OF THE\\nPROSTATE.\\nThis condition is not very uncommon, and in order to fully\\nunderstand it it is necessary to be familiar with the general and\\nminute anatomy of the prostate. (See page 38.)\\nIn some cases gonorrhoea and in others masturbation is the\\nprimary cause. The essential lesions are, first, a round-cell\\ninfiltration and hyperemia in the connective tissue around the\\ngland-tubules and, second, simple catarrh of the lining mem-\\nbrane of the gland-tubules. This periglandular inflammation is\\nusually continuous with that of the mucous membrane of the pro-\\nstatic urethra but in some cases this latter condition may not co-\\nexist, or it may be only an insignificant feature.\\nHistological investigations have shown that in some cases of\\ninflammation of the prostatic urethra only the ducts of the glands\\nhave been involved, consequently the parenchyma of the prostate\\nescaped. It has also been shown that one or more groups of\\ngland-tubules may be attacked in an irregularly scattered manner,\\neither on one side or both, and that symmetrical involvement may\\nnot occur in one or in both halves of the prostate. The inflam-\\nmatory process may invade in an irregular manner several groups\\nof glands on one or both sides of the organ, and there may be\\nscattered here and there groups which remain unaffected. This\\npeculiarity of the prostatic inflammation is due to the anatomical\\narrangement of the tubules, which, in passing into the depths of\\nthe organ, remain separate from one another. Thus it happens\\nthat the inflammatory process, when attacking a tubule or a group\\nof tubules, runs down them to their blind ends, and thus limits\\nitself and shows no tendency to invade the peripheral parts. In\\nsome cases the whole mass of gland-tubules may be attached.\\nThis knowledge will explain to us why in some cases the whole\\ngland is swollen, why in others its surface feels nodulated and\\nlumpy, and in still others present the sensation as if many good-\\nsized shot were deeply embedded in the capsule of the prostate.\\nIn the first case the glands of the whole organ are quite uniformly", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0251.jp2"}, "252": {"fulltext": "238 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nattacked in the second case groups of glands are swollen and cause\\nnodulations and lumps on its external surface and in the third\\ncase individual glands scattered irregularly over the organ are the\\nseat of the inflammation which by its limited swelling gives the\\nfinger the sensation as if shot were seated in the tissues.\\nSuch are the anatomo-pathological facts and the resulting con-\\nditions which are revealed to the surgeon in examining cases of\\nchronic catarrh of the prostate.\\nThe pathological conditions here mentioned may lead to various\\nsecondary morbid states, which will be brought out later on.\\nChronic prostatitis is observed in the period between puberty\\nand middle age, but mostly between twenty and forty-five years.\\nIt occurs in all classes, in the poor and in the rich. Though the\\nmorbid conditions in the prostate are nearly the same in all cases,\\nthe symptoms presented vary considerably in different cases.\\nThis marked variation in the symptoms allows the classification\\ninto certain forms of the disease, the description of which will\\nlead to recognition.\\nTemperament, habits, and age have much to do with the diver-\\nsity of the symptoms but in the chronic course of the disease\\ncertain secondary conditions are developed and certain complica-\\ntions may be induced which also give rise to marked symptoms.\\nThus in many cases the symptom-complex is very striking.\\nSome patients suffering from chronic prostatitis experience little\\ntrouble, and they give themselves scarcely any concern about the\\nmatter. Other patients may be troubled more or less in mind,\\nbut their health is not seriously affected, while still others become\\nweak and nervous, and even truly neurasthenic. In some cases\\nprostatitis causes no symptoms, or if present they are unrecog-\\nnized until some failure of the health occurs from dyspepsia,\\nmental worry, grip, or acute adynamic diseases. After catching\\ncold, standing for a long time in the cold, or sitting on cold stones,\\nthe symptoms of chronic prostatitis have first shown themselves.\\nThere is clear evidence at hand that chronic prostatitis has lasted\\nmany years (five to fifteen) without having caused appreciable\\nsymptoms, and its existence was unsuspected by the patient.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0252.jp2"}, "253": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 239\\nChronic prostatitis runs a long and irregular course, with short\\nor long periods of exacerbation and of remission, in which the\\nsymptoms are insignificant, mild, and bearable.\\nMy experience and study have convinced me that the most cor-\\nrect and satisfactory division of chronic prostatitis is, first, that\\nform which is observed in patients between the twentieth and\\nthirtieth years, or thereabouts, and, second, a more advanced form,\\nwhich is seen mostly in patients beyond the thirtieth year. This\\ndivision is not at all arbitrary, but is based upon certain quite\\nuniform type-forms.\\nCatarrhal Prostatitis in Young Subjects.\\nThe symptoms which cause patients of this class to seek relief\\nat the hands of the surgeon may be arranged, for clearness of\\ndescription, into three categories First, those of patients who com-\\nplain of uneasiness in the prostate and perineum and rectum\\nsecond, those of patients who after defecation, urination, and\\nsevere muscular exertion notice a mucous discharge from the\\npenis and, third, those of patients who complain of some form\\nof sexual weakness.\\nIn some of these cases there is coexistent inflammation of the\\nverumontanum. (See previous section.)\\nPatients who complain of uneasiness and pain in the prostate\\nare mostly those who have masturbated immoderately, or whose\\ntrouble began in specific posterior urethritis. Very often the\\nsymptom is so slight that it causes no annoyance or impairment\\nof health. In some cases the worry and fret lead to anaemia, and\\nin severe cases neurasthenia may be induced. The pain or un-\\neasiness may be continuous or spasmodic, or it may only be felt\\nafter defecation, urination, and severe bodily exertion.\\nExamination of the prostate by means of the finger-tip in the\\nrectum shows various conditions, as follows the whole organ\\nmay be a little or much swollen in all directions, or but one-half\\nof it (and usually it is the left one) may be the seat of the con-\\ngestive infiltration. Moderate or severe pain may be produced", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0253.jp2"}, "254": {"fulltext": "240 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nby pressure, or such may be the extreme sensitiveness of the gland\\nthat the patient will not allow it to be touched. Then, again,\\none lump or many of them may be felt in most cases, I think,\\nlimited to one lobe, and in a smaller number found irregularly\\nscattered in both lobes. These lumps are more or less painful.\\nAnd, lastly, there may be found scattered over the whole prostate\\nhalf-pea-sized or large-shot-sized prominences, of which there may\\nbe two or three or even a goodly number seated on one or both\\nFig. 69.\\nGranular phosphates, oxalate of lime, spermatozoa, and pus-cells.\\nlobes. The discovery of these morbid foci clearly warrants the\\ndiagnosis of chronic prostatitis. (In some cases the existence of\\ntuberculosis may be suspected.) In any of the foregoing condi-\\ntions massage of the prostate will cause certain abnormal mucoid\\nsecretions to escape from the meatus or to appear in the urine.\\nThese secretions are as follows 1, that of chronic posterior ure-\\nthritis (see Fig. 55) 2, a clear, viscid mucus 3, mucus and\\ncylindrical prostatic epithelium (see Fig. 21) 4, mucus (thin or\\nthick and viscid) and granular phosphates (this is the secretion", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0254.jp2"}, "255": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 241\\nmost commonly found) 5, mucus, granular phosphates, and cylin-\\ndrical epithelium (these are usually found in very recent cases)\\n6, mucus, granular phosphates, dead and puny spermatozoa, and\\noxalate of lime (see Fig. 69) and, 7, mucus, granular phosphates\\nwith either triple phosphates (see Fig. 70) or crystalline phosphate\\nof lime (see Fig. 71). In any of these secretions there may be\\nat some time spermatozoa and pus present.\\nThe essential secretion of all chronic catarrhal prostatic inflam-\\nmation is mucus in which there is a greater or less admixture of\\ngranular phosphates. 1 (See Fig. 66.) This secretion in excess\\nattests the activity of the cylindrical epithelial cells lining the\\ntubules, whose function in health is to secrete a thin milky fluid,\\ntogether with the granular phosphates, which constitute the true\\nphosphatic fluid which plays such an important role in the produc-\\ntion of pure, fertile semen. (See p. 188.) In disease this normal\\nprocess becomes exaggerated, and as a result we see when examin-\\ning cases of catarrhal prostatitis the clear viscid mucus, the milky\\nsecretion, and that which looks as it escapes from the meatus like\\n1 In many cases the quantity of these salts in the urine, the ejaculate, or in the\\nexpressed secretion is not very large but in some it is surprising to see the very\\nlarge amount of these granular salts which have been voided in the third speci-\\nmen of urine, or have been pressed out by prostatic massage. In one instance,\\nafter urination into two cylinders, in neither of which any granular phosphates\\nwere present, the balance of clear urine was drawn off by means of a small soft-\\nrubber catheter, and four ounces of sterile water were thrown into the bladder.\\nThen, the prostate having been well massaged, the patient expelled the injected\\nwater, together with the expressed mucus. After settling, this liquid showed a\\nthick layer of granular phosphates, and when the whole were thrown upon a\\nfilter, and the salts were dried and collected, it was found that they weighed one\\nhundred and fifteen grains. These facts, which can be verified by anyone who\\nwill carefully examine his cases, very clearly show that very many cases which\\nare now classed under the title phosphaturia, and in which it is supposed that\\nsome disturbance of the nervous system causes the excess of phosphates, are\\nreally instances of chronic catarrhal prostatitis. These observations also very\\nclearly show that those authors who consider many sexual disorders to be sensory\\nand motor neuroses, due to some undefined nervous condition in which phos-\\nphates are found in excess in the urine, have confounded cause with effect. The\\ntruth is, the diseased prostate produces the phosphatic excess, and, acting on a\\ncentral focus of irritation, it, in all probability, reacts locally on the cord, and\\nthrough it upon the whole nervous system.\\n16", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0255.jp2"}, "256": {"fulltext": "242 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nFig. 70.\\nTriple\\n3, granular phosphates, and spermatozoa.\\nFig. 71.\\nCrystals of phosphate of lime and granular phosphates.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0256.jp2"}, "257": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 243\\na wormy mass of condensed milk. When the prostatic inflamma-\\ntion becomes still more chronic we find the other admixtures\\nwhich have just been enumerated. It may here be mentioned\\nand emphasized that in most cases of chronic catarrhal prostatitis\\nin young subjects the ejaculation in masturbation is composed\\nmostly of the above-mentioned abnormal prostatic secretion, with\\nor without the other salts or spermatozoa. Further, it is well to\\nbear in mind that the so-called nocturnal pollutions in these cases,\\nthe defecation and urination ejaculate, and the secretion which\\nescapes from the urethra after hard work, are all wholly or nearly\\ncomposed of mucus and granular phosphates. In some cases,\\nowing to causes to be mentioned a little later, some spermatozoa\\nmay be found in the ejaculate. With this statement of facts held\\nwell in mind (which I have verified in clinical observations and by\\nmicroscopic studies scores of times), the vague conception of that\\nold-time bugbear of medicine namely, spermatorrhoea really\\nbecomes an enlightened subject.\\nIn some of these cases there is increased frequency of urination\\nduring the day, and perhaps during the night, and there may be\\nmore or less uneasiness or pain at the end of the act. In some\\ncases at the end of urination there is marked tenesmus, which\\nmay radiate to the pelvis, rectum, and anus, and cause much dis-\\ntress of mind and suffering. These patients, besides uttering their\\ncomplaints as to prostatic pain and soreness, often become much\\nworried and nervous about their pollutions, which they think will\\nrender them permanently weak. Many of them sooner or later\\npresent evidences of declining sexual power.\\nUnless cured by proper treatment these patients continue in an\\nunsatisfactory state for months and years. Some may appear\\nruddy and healthy, even though they suffer somewhat, and\\nworry others become decidedly nervous and anaemic, while not\\na few really become neurasthenic.\\nIn proportion as the mental and physical reaction is severe, so is\\nthe case unpromising as to ultimate relief. In general, with the\\nimprovement in the urethral and prostatic trouble which proper\\ntreatment brings about, the mental and physical condition improves.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0257.jp2"}, "258": {"fulltext": "244 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nMany young men suffering from chronic catarrhal prostatitis\\nmake no complaint of symptoms which point to the prostate as\\nthe source of their trouble, but lay much stress upon their so-\\ncalled loss of semen after defecation and urination and bodily\\nexercise, and by nocturnal pollutions. In these patients, as a\\nrule, we find by rectal examination all the tangible conditions of\\nthe prostate already mentioned, and microscopic examination of\\ntheir urine, of their ejaculates, or of the expressed secretion of\\nthe prostate will reveal the appearances detailed in the preceding\\npages.\\nThis class of patients usually become very nervous and excited,\\nand from anaemia rapidly pass into a neurasthenic condition, and\\ncomplain of an infinitude of morbid symptoms. They become\\nsexually weak, while at the same time they are abnormally sex-\\nually excited, and the result is sometimes very depressing and\\ndiscouraging. In many instances great harm results to these\\npatients by their persistence in masturbation, futile attempts at\\ncoitus, and dalliance with women. The result in many cases is\\nphysical and mental exhaustion.\\nA certain number of patients suffering from this form of pros-\\ntatic disorder seek relief for their sexual weakness, which is the\\ndominating symptom in their minds. In some cases erections are\\nnormal, but coitus after prolonged effort does not result in ejacu-\\nlation. In other cases the act is performed in a weakly and un-\\nsatisfactory manner, and ejaculation is not attended with much, if\\nany, sensation, and it collapses in feeble dribbling. Then, again,\\nsome patients complain of moderate erections and premature\\nejaculations, while in some erections no longer occur. In many\\nof the cases thus summarized there is escape of morbid mucus\\neither in nightly pollutions or after urination or defecation. Many\\nof these patients are weak or anaemic, the majority of them are\\nmentally much worried, and some of them are decidedly neuras-\\nthenic. Unless relieved by proper treatment, these patients go\\nfrom bad to worse. The essential point to be remembered in all\\nof them is the necessity of the cure of the focus of the trouble in\\nthe prostate.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0258.jp2"}, "259": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 245\\nAs catarrhal prostatitis becomes chronic in some cases the\\nmorbid process creeps up the ejaculatory ducts and involves the\\nmucous membrane and that of the ampullae and of the seminal\\nvesicles. The direct result of this extension is a more or less\\nsevere catarrhal condition of these parts. But the most striking\\neffect produced is a condition of flabbiness of the outlet ducts of\\nthe ampullae and of the seminal vesicles and the development of\\nmore or less patulousness in the not very strong muscular fibres\\nof the ejaculatory ducts. The process which really takes place in\\nall these parts which normally safeguard the retention of the semen\\nand prevent its escape is one of weakness and of incompetence,\\nwhich allows the secretion to escape under various mechanical con-\\nditions (abdominal pressure, defecation, particularly with firm\\nfecal bolus, and urination). When, therefore, chronic prostatitis\\nis present with this, as we may term it, seminal incontinence, the\\nabnormal ejaculate is composed of prostatic mucus and some of\\nthe secretion of the ampullae and seminal vesicles. As a rule, the\\namount of this fluid lost at any time by these patients is very\\nsmall. The loss of this secretion per se is not the cause, of the\\ndeterioration of the health of the patient, as is so generally\\nbelieved. The real morbid factors are the local lesions and the\\nresulting mental unbalance and general depression of the economy.\\nCatarrhal Prostatitis in Older Subjects.\\nThere is no uniformity in the clinical history of the cases of\\nchronic prostatitis in patients beyond the thirtieth year. In some\\ncases the symptoms are few and not well marked in others they\\nare more pronounced, while in a few so striking is the symptom-\\ncomplex that prostatic inflammation at once suggests itself to the\\nmind of the surgeon. In these older patients we do not have to\\nlisten to so much persistence in the recital of their troubles con-\\ncerning sexual discharges and the multifarious symptoms of sexual\\nneurasthenia as we do in younger subjects. Older patients may\\nbecome anaemic, and even more or less neurasthenic, but they\\nrarely reach the deplorable condition so often seen in young sub-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0259.jp2"}, "260": {"fulltext": "246 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\njects. The older patients, as a rule, have started in sexual life\\nwith their organs in a healthy condition, and disease has set in\\nlater. In the younger subjects the integrity of their sexual organs\\nwas much impaired and damaged before and at puberty.\\nFig. 72.\\n-V/\u00c2\u00bbt\\nShowing prostate of a man in which senile changes are beginning to develop.\\nThis section was made through the posterior portion of the prostate. Here the\\nducts run forward, and they therefore appear in cross-section in the drawing.\\nThe lobulation apparent in the prostate of the young subject (see Fig. 7) is no\\nlonger distinct, owing to the development of fibrous and muscular tissue. Vol-\\nuntary muscle-fibres are prominently developed on the superior surface of the\\norgan. In the verumontanum the left ejaculatory duct is seen opening centrally\\ninto the prostatic sinus. The right ejaculatory duct shows as yet no communica-\\ntion with the prostatic sinus, but opens at a point further forward. (Drawn from\\nthe Edinger projection apparatus much magnified.\\nExamination of the prostate by means of the finger in the rec-\\ntum of these older patients gives somewhat different results from\\nthose found in young subjects. The whole prostate may be sym-\\nmetrically enlarged to as much as double its normal size only\\none-half of it may be more or less enlarged, or we may only find\\none or more well-defined large or small lumps, which, in excep-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0260.jp2"}, "261": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 247\\ntional cases, may have a soft structure. But in these cases, as a\\nrule, there is evidence of firm structure, even approaching true\\nhardness, and the finger-tip gives the surgeon the impression that\\nmarked cell-proliferation must have occurred in the organ. This\\nclinical fact is clearly explained by the results of histological\\nstudies, which have shown that with the chronicity of the inflam-\\nmatory process new connective tissue has been developed around\\nthe tubules to such an extent as to produce a semi-sclerotic condi-\\ntion of the gland. For a long time this new cell-growth causes\\nthe decided increase in the size of the gland which has been men-\\ntioned, but later on a cirrhotic condition sets in, by which the size\\nof the gland is materially decreased, even to the point of atrophy.\\n(See Fig. 72.)\\nIt is sometimes observed that when one lobe of the prostate is\\nattacked there is pain in the corresponding side of the rectum.\\nThis condition is also found in some cases of unilateral seminal\\nvesiculitis. In still other cases we find an enlarged, somewhat\\neburnated organ, which is the seat of firm, half -pea-sized nodula-\\ntions.\\nWith the continuance of the chronic catarrhal process the lumen\\nof the tubes in many cases becomes more or less plugged up by\\nphosphatic concretions, by desiccated masses of old, cast-off epi-\\nthelial cells, and by amyloid bodies. Some of. these abnormal\\nproducts may be sometimes observed in younger patients.\\nCatarrhal prostatitis in older subjects not infrequently gives rise\\nto very poorly marked symptoms. Some patients complain of\\nuneasiness, as they term it, at the neck of the bladder, and others\\nspeak of more or less deep pelvic pain, which they think is in\\nsome manner connected with the rectum. In some cases the pain\\nis felt on standing up, in others after muscular exertion, bicycle\\nexercise, and horseback-riding, while in still others it is felt when\\nin certain positions on sitting down, particularly on the edge of a\\nchair. In some cases the uneasiness is also felt in the perineum\\nand anus, and in other cases on one side of the body corresponding\\nto the side of the prostate involved. In some cases pain in one\\nhip-joint is complained of. In many of these cases there is fre-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0261.jp2"}, "262": {"fulltext": "248 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nquency of urination, and in some there is pain in the glans penis\\nat the end of the act. Most patients thus affected have some form\\nof sexual weakness, which is either mild or pronounced, and some\\nhave abnormal mucoid discharges.\\nThe uneasiness and pain in the prostate may be more or less\\ncontinuous, or mildly paroxysmal, or it may be rendered worse\\nwhen the bladder is much distended and when constipation or\\ndiarrhoea is present, in which instances there may be decided\\ntenesmus.\\nSome of these patients speak of a vague feeling of numbness\\ndeep in the pelvis and in the prostate, and this feeling may also\\nexist in the perineum. In these cases there may not be much dis-\\nturbance of the health, though some patients become ansemic and\\nworried.\\nIn marked contrast with the foregoing mild order of cases are\\nthose in which the symptoms are numerous, severe, and complex.\\nIn these cases there is more or less ill-health, and in some neuras-\\nthenia. Such patients first complain of vague and sometimes fugi-\\ntive pains in the back, loins, and pelvis. Inquiry then will\\nusually bring out the statement that there is increased frequency\\nof urination, and perhaps pain in the prostate and the glans at the\\nend of the act, and that their sexual capacity is rather weak.\\nSometimes it will be found that one lobe of the prostate has been\\ninvolved, and that the pain in the glans penis is referred by the\\npatient to the corresponding side of the prostate gland. There\\nmay be present either sexual apathy or erethism. These patients\\nsometimes notice the escape of morbid mucus, which may be thin\\nand milky, or clear and very viscid (like liquid glue), or it may\\nlook like condensed milk or very thick glue. (See Fig. 73.)\\nWhen in these conditions the ampullations and the seminal vesi-\\ncles are also involved, some of their secretion may escape and\\nbecome mixed with the prostatic mucus, in which event the secre-\\ntion is usually of a yellowish-brown color. It will generally be\\nfound, in these older patients, that when the secretion comes from\\nthe prostate it is white or slightly turbid, like liquid glue, or\\ngrumous, but that when it comes from the seminal vesicles or", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0262.jp2"}, "263": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE.\\n249\\nampullations it is of a yellowish-brown, or, exceptionally, of a\\ndark-brown tint. The diagnostic indications which are observed\\nby inspection of the color of the morbid mucus from the deep\\nseminal parts can readily be verified by microscopic examination.\\nThe urine of these patients is usually of rather low specific\\ngravity (1008 to 1013), of pale color, of feeble acidity, or perhaps\\nit may be quite constantly alkaline. It is, as a rule, rather opaque\\nand sometimes of decidedly milky hue, and upon its surface very\\nFig. 73.\\nSecretion of chronic prostatitis, showing granular phosphates, degenerated\\ncylindrical epithelial cells, and pus.\\nfrequently an iridescent pellicle forms. The phosphatic salts,\\nbeing in great excess, sometimes appear like a sheen of little\\nwhitish glistening particles. On standing in the cylinder or urine-\\nglass the sediment first collects throughout the specimen in little\\ncloudy tufts, somewhat resembling water which is slowly freezing.\\nThen, in a short time, the sediment sinks to the bottom of the\\nglass and forms a tolerably thick mass, which has a flocculent,\\ngrayish-white appearance, very different from that presented by\\npus.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0263.jp2"}, "264": {"fulltext": "250 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nIn some of these cases of chronic prostatitis in older subjects\\n(and it is sometimes seen in younger patients) a peculiar form of\\nemission or ejaculate is observed which needs description. Such\\npatients more or less frequently see, after urination or defecation\\nor hard work, a thick ropy, whitish mass escape from the urethra\\nwhich looks like plaster-of-Paris mixed with water. In some\\ncases the escape of this stuff is unattended with any unpleasant\\nsymptom, but in others there is a sensation of sickness at the\\nstomach and great weakness during and for a time after its\\npassage. In some cases there is a scalding sensation in the whole\\ncourse of the urethra, beginning at the prostate, and such may be\\nthe patient s suffering that he becomes pallid, is thrown into a cold\\nsweat, and he may be on the point of fainting. This discharge\\nmay occur at short or quite long intervals, and the fear of its\\noccurrence creates in the minds of some patients great apprehen-\\nsion and fear.\\nMicroscopic examination of these abnormal discharges shows\\nthat they are composed of mucus and granular phosphates,\\ntogether with (in some instances) triple phosphates and crystalline\\nphosphate of lime. (See Figs. 69, 70, and 71.) There may also\\nbe other components, such as pus-cells, prostatic epithelium (see\\nFig. 73), and some spermatozoa. Many of these patients think\\nthat they are suffering from a particularly severe form of sperma-\\ntorrhoea, and they may become much depressed in mind and even\\nmildly neurasthenic.\\nIn some cases of chronic prostatitis in older subjects there is at\\none time hyperesthesia of the prostatic urethra, in which event\\nthere may be much sexual erethism, some frequency of urination,\\nand more or less pain in the whole act. Ejaculation may be some-\\nwhat premature, but it is usually attended with unpleasant, even\\npainful, sensations, which may soon cease or which may last for\\nhours or for a day or two. In some of these cases of erethism\\nthe penis is often in a semi-erect condition, and prostatic mucus\\nflows from the urethra at times.\\nThe course of this hypersensitiveness of the prostate and pros-\\ntatic urethra, when uninfluenced by treatment, is much prolonged,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0264.jp2"}, "265": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 251\\nand it may be uneventful or be attended by marked exacerbations.\\nAs time elapses the erethism gradually ceases, and in some cases\\nit is followed by very decided anaesthesia in the parts, which may\\nextend throughout the course of the urethra, and in a mild form\\ninvolve the bladder. There may also be partial insensitiveness\\nof the testes, scrotum, perineum, and upper portions of the thighs.\\nIn some rather rare cases of prostatitis with involvement of the\\nampullae and of the seminal vesicles I have seen this queer asso-\\nciation of these numb sensations. In this condition there may be\\ninterference with the function of urination and with coitus. Such\\npatients state that sometimes they are not aware of the fact that\\nthe bladder is full, and when they attempt its evacuation, though\\nthe stream may be full in size, it is feeble and more or less halt-\\ning. Then, again, erections may be normal, but ejaculation is\\nfeeble, and the sexual act may suddenly collapse.\\nBy massage of the prostate thus affected we cause the escape of\\nseveral forms of mucus which present somewhat different features\\nfrom one another. This expressed secretion may consist of mucus\\nor mucus and glandular phosphates, perhaps combined with triple\\nphosphates and phosphate of lime, or it may contain degenerated\\nprostatic epithelium, pus, spermatozoa, phosphatic concretions,\\namyloid bodies, and cylindrical casts of the prostatic tube-glands.\\nIn these older cases it is very common to see (as we sometimes\\ndo in the secretion of younger subjects) the granular phosphates\\narranged in the shape of regular cylinders, which are straight or\\nmore or less curved. (See Figs. 66 and 73.) These cylinders\\nare formed in the tubules by the functional overactivity of the\\nprostatic epithelial cells. Phosphate of lime is formed in excess\\nat the same time that a thick, gluey mucus is proliferated. These\\ntwo component parts, remaining for a time in the tubules, become\\namalgamated, and the muco-phosphatic cylinders are the result.\\nThese granular phosphates also give rise in the prostate to certain\\nlittle oval or round bodies, to which the term prostatic concretions\\nshould, I think, be applied. They are small masses, composed\\nof the same structures as the cylinders namely, mucus and gran-\\nular phosphates. They are variously colored some are yellow", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0265.jp2"}, "266": {"fulltext": "252 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\n(and may be mistaken for urates, but chemical analysis will prove\\ntheir true nature), or they may be moderately red or of a deep\\npurple tint. (See Plate VIII.) These little bodies remain in an\\nindolent manner in the tubules (and undoubtedly cause pain and\\nuneasiness), and they may excite more or less hemorrhage, in\\nwhich event they become colored to a greater or less extent.\\nThese phosphatic concretions may become the nuclei of calculi.\\nIn some specimens of urine and of expressed prostatic secretion\\nwe find very firm threads, which are of a yellowish, a brown, or\\na purple color, and on examination are found to consist of gran-\\nular phosphates, mucus, and altered blood-cells. These threads\\nare undoubtedly the initial forms of the little colored phosphatic\\nconcretions.\\nIn some exceptional cases, particularly of old men, we find well-\\nmarked hyaline cylinders.\\nThese hyaline cylinders, which look like large hyaline renal\\ncasts, are undoubtedly due to the inflammatory exudation which\\ntakes place in the depth of the gland-tubules. They are some-\\ntimes quite long, wavy, of irregular contour, and in some cases\\nsomewhat bulbous on one end. They are not of constant occur-\\nrence, and are usually found in cases in which the painful symp-\\ntoms are well marked.\\nAmyloid bodies are not, as stated in the books, of frequent\\noccurrence. They are seldom seen in the prostatic secretion of\\nyounger subjects, and are rather exceptionally found in that of\\nolder patients. We cannot to-day state definitely what are their\\ncomponent parts, but they are in all probability composed of\\nmucus, desiccated albuminous matter, intermingled with phos-\\nphatic salts. These bodies present distinct and symmetrical stria-\\ntions, which are very clearly shown in Plate IX., which also\\nshows the structure and arrangement of the tubular prostatic\\nglands.\\nSmall prostatic concretions resembling mustard seeds may be\\nfound in the ducts of many tube-glands, and they may cause any\\nof the foregoing painful symptoms. These little round, brownish,\\nshot-like masses are largely composed of mucus and lime salts.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0266.jp2"}, "267": {"fulltext": "PLATE VIII.\\nConcretions of Chronic Prostatitis.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0267.jp2"}, "268": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0268.jp2"}, "269": {"fulltext": "PLATE IX.\\nAmyloid Bodies in the Prostatic Tubules\\nShown on Transverse Section.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0269.jp2"}, "270": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0270.jp2"}, "271": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 253\\nPhospliatic calculi may exist in the ducts or in the tube-glands\\nthemselves, and produce painful symptoms. These calculi are\\ncomposed of lime salts, sometimes in combination with oxalate of\\nlime. They are oat-shaped or bean-shaped, though sometimes\\nthey are round. There may be one calculus, or there may be as\\nmany as a dozen, or several dozens, in one prostate.\\nThere can be no doubt that these various concretions just\\ndescribed act as foreign bodies, which, by plugging up, destroy\\nthe function of the tubules, and by their presence give rise to the\\nuneasy sensations and pains complained of by these patients under\\nvarying conditions (sitting down, horseback and bicycle exercise,\\ngolf, urination, defecation, and copulation).\\nChronic prostatitis in older subjects, as in younger ones, may\\nbe complicated with chronic bulbous or posterior urethritis, and it\\nis not infrequently coexistent with chronic inflammation of the\\nampullae and of the seminal vesicles. When these sacs at the\\nbase of the bladder are involved there may be the same seminal\\nincontinence which is observed in young men. When this sem-\\ninal vesicular condition exists we may find in the urine, in the\\nexpressed secretions, and in that which escapes after urination and\\ndefecation or severe exercise, the tissue-elements depicted in Figs.\\n73 and 74.\\nPROSTATORRH(EA.\\nIn some rare cases of chronic prostatitis the discharge is so copi-\\nous that the term prostatorrhoea has been applied to them. In\\nthese cases, when they are well marked, there seems to be a con-\\ntinual production of mucus by the prostatic tubular glands there-\\nfore, the most constant symptom is the escape from the meatus of\\na clear mucous fluid or of a mucus mixed with pus and perhaps a\\nlittle blood. This mucous fluid may be scant in quantity, only a\\nfew drops appearing at the meatus in a day. It may also be\\nmore copious, and keep the end of the penis in a moist condition\\ncontinuously, and in very pronounced cases the escape is so exces-\\nsive that patients complain of a constant and annoying drip-\\nping, which may wet and stain a large part of their shirt-flap or", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0271.jp2"}, "272": {"fulltext": "254 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nof the handkerchief, which they instinctively make use of under\\nthese circumstances. The escape of this discharge in large quan-\\ntities occurs frequently during the act of defecation, particularly\\nwhen the fecal bolus is hard and firm. In some cases the escape\\nof the mucus causes a peculiar tickling feeling in the prostate and\\nurethra, while in others it produces pleasurable voluptuous and\\nlascivious sensations. Some patients claim that they can feel the\\nescape of the fluid from the prostate into the urethra. In rather\\nrare cases the escape of mucus, particularly after defecation, is\\nattended with a sickening sensation of great faintness, which may\\nlast for several minutes. Many of these cases have been treated\\nfor spermatorrhoea.\\nAlthough we have no pathological knowledge on the subject, it\\nseems fair to assume that in prostatorrhoea there is such an atonic\\ncondition of the compressor urethra? muscle that it cannot prevent\\nthe escape of the fluid into the anterior urethra. The next most\\nconstant symptom is increased frequency in urination, which may\\nbe very excessive or only about twice as often as the normal\\ndesire. There may be decided uneasiness at the end of the act,\\nand there may be a slight pain or decided scalding sensation,\\nwhich passes from the prostate to the end of the penis. In many\\ncases the stream is small and weak a condition which seems to\\npoint to an atonic state of the detrusors. A sense of dulness and\\nweight is often felt in the prostate and in the rectum, and pain\\nand uneasy sensations are experienced in the perineum, thighs,\\nand lumbosacral regions.\\nSome patients suffer from chronic prostatorrhoea without be-\\ncoming much disturbed in mind by it. But there are others to\\nwhom this affection is little less than a calamity. They become\\nexceedingly nervous about their trouble, even to the extent of\\nbeing melancholy. They lose flesh, strength, and appetite they\\nbecome irritable and incapable of mental and physical exertion.\\nIn fact, in some cases the whole morale of the man seems lost.\\nIn many cases of prostatorrhoea there is more or less disturb-\\nance in the sexual function. In some subjects it is morbidly\\nexaggerated in others there is much desire, much erethism, many", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0272.jp2"}, "273": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 255\\nerections, but very little is accomplished, owing to the precipitate\\nejaculations. In still other subjects there is little if any desire,\\neven as a result of much excitement, and the penis and scrotum\\nseem shrunken, cold, and lethargic.\\nRectal examintion of cases of prostatorrhoea reveals an enlarged\\norgan, usually jutting more or less backward on the gut, and being\\ndecidedly broader than normal. Very often only one lobe or a\\nportion of one may be involved. Sometimes it feels soft, and\\nagain it may seem decidedly indurated. There is commonly more\\nor less tenderness, even severe pain, on pressure by the finger-tip.\\nUrethral examination, even with a small and not stiff instrument,\\noften causes a great outcry from pain when the tip passes through\\nthe prostatic urethra.\\nDiagnosis. When the foregoing descriptions of clinical cases\\nare borne in mind the suspicion of chronic prostatitis will force\\nitself upon the surgeon s mind. Then rectal palpation will reveal\\nthe extent and severity of the local condition. At the same time\\nthe condition of the urine must be examined, and it, with any\\nexpressed mucus, must be carefully studied by means of the micro-\\nscope. If these requirements are fulfilled, a very satisfactory\\nestimate of the case can always be made.\\nIt may be well here to inform the beginner in the study of\\nchronic prostatic disease that all the pictures of microscopic appear-\\nances already enumerated will not be found, as a rule, in one\\nmicroscopic field. In the preparation of the specimens for these\\ndrawings I have carefully selected typical appearances offered by\\nmany microscopic fields, and have grouped them into one figure,\\nwhich contains all the type-forms and some rather unusual ones.\\nIn every instance the endeavor has been made to delineate nature\\ntruthfully and exactly.\\nChronic prostatitis may be caused by tuberculosis, and by the\\nexercise of care and skill a correct diagnosis can soon be positively\\nmade. The examination of the urine in these cases for the bacillus\\ntuberculosis will in many true cases be unattended with the detec-\\ntion of the micro-organism. It is absolutely necessary in these\\ncases to examine preferably the expressed or the escaped prostatic", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0273.jp2"}, "274": {"fulltext": "256 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nsecret ion after proper staining. Great care should be taken that\\nthe penis, and particularly the glans, be rendered absolutely sterile,\\nsince upon these parts the smegma bacillus lives and hibernates,\\nand the detection of this inert microbe might lead the unwary\\nexaminer to mistake it for that deadly bacillus which causes tuber-\\nculosis.\\nBut, in addition to the condition of the prostate, the surgeon\\nmust make himself familiar with that of the urethra, chiefly its\\nbulbous and prostatic portions, and also of the state of the seminal\\nvesicles and of the ampullations. In forming an estimate of a case\\nit is well to bear in mind that in young individuals a more or\\nless recent gonorrhoea may have existed, and that it is very com-\\nmon to find the damage quite sharply limited to the deep urethra\\nand prostate, and perhaps largely to that gland. It is exceptional\\nto find seminal vesicular involvement in young subjects. In older\\nindividuals the prostate and the seminal vesicles and ampullations\\nmay be the seat of chronic inflammation, and this complicated con-\\ndition can be clearly made out by rectal exploration and by micro-\\nscopic study of the expressed secretions or of the urinary sediment.\\nPrognosis. In very many uncomplicated cases of catarrhal\\nprostatitis most satisfactory results follow the adoption of proper\\ntreatment. In every case, if the patient persists in sexual or alco-\\nholic excesses or in any way transgresses against the rules of\\nsexual hygiene, his ultimate cure will be greatly retarded.\\nIn young men suffering from the effects of masturbation and\\nchronic posterior urethritis the prognosis is, as a rule, good, pro-\\nvided the patient is not very anaemic or neurasthenic. In those\\ncases in which the morale of the patient is much below par the\\nprogress toward cure is slow and often unsatisfactory and halting.\\nThe occurrence of cystitis by extension, particularly in chronic\\nmasturbators, is of serious import, for such cases are very refrac-\\ntory to the most careful forms of treatment.\\nIn very many older men an excellent prognosis may be given if\\nthey can control their sexual tendencies by moderation and will\\nnot overindulge in alcohol. The coexistence of chronic posterior\\nurethritis, of seminal vesiculitis, or of chronic inflammation of the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0274.jp2"}, "275": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 257\\nampullae is a rather serious drawback which may tax the skill\\nand patience of the surgeon. Very many of these cases, however,\\nare much benefited, and even unpromising ones can be cured.\\nTreatment. The first essentials in the treatment of chronic\\nprostatitis are a regular, quiet life, abstinence from alcoholics, and\\nthe avoidance of all kinds of sexual excess or excitement. A\\nbland, nutritious diet should be taken, and spices, coffee, cocoa,\\nhighly seasoned dishes, and asparagus should be avoided. The\\nrectum should be thoroughly emptied every day at least once, and\\nif the natural evacuation does not occur a mild aperient must be\\ntaken. These patients must avoid taking cold, and they should\\nnot take part in violent sports, nor should they indulge in bicycle\\nexercise.\\nModerate and rather infrequent sexual intercourse may be\\npractised, provided no ill effects are found to follow it.\\nWhen chronic bulbous or posterior urethritis is present active\\ntreatment must be instituted for the relief of these conditions,\\nwhich materially aggravate the case and render it more rebellious.\\nIn like manner strictures of the urethra should receive proper\\nattention and treatment. (See pp. 222 et seg.) Instillations of\\nnitrate of silver, irrigations with watery solutions of the same salt\\n(1 to 500, 1000, to 2000), of permanganate of potassium (1 to\\n4000 to 10,000), or of sulphate of zinc and alum (1 each to 500\\nto 1000), may be given every few days.\\nIn many cases the careful introduction of a steel sound cooled\\nin ice-water, every four to seven days, is most grateful and bene-\\nficial. The psychrophor may be used instead of the sound if the\\nsurgeon so desires.\\nDirect treatment to the prostate by the surgeon may be made\\nby means of the finger-tip in the patient s rectum. Preparatory\\nto beginning the treatment of massage of the prostate the surgeon\\nshould acquaint himself with the size of the organ and ascertain\\nwhat part is affected, or whether the totality of the gland is in-\\nvolved. Then the relative softness, bogginess, and hardness\\nshould be learned. When the conditions of the organ are ascer-\\ntained full details thereof should be noted down for future refer\\n17", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0275.jp2"}, "276": {"fulltext": "258 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nence and comparison. The main object is to reduce the size of\\nthe swollen organ, and by massage we press out pathological\\nproducts (vide supra), stimulate the tissues, and cause the absorp-\\ntion of more or less of the inflammatory exudation, by means,\\nprobably, of the increased circulation in the vessels and lym-\\nphatics. In addition to these changes, we undoubtedly give tone\\nand resiliency to the flabby bloodvessels and also stimulation to\\nthe relaxed muscular fibres. A certain healthy stimulus seems to\\nbe communicated to the nerves of the prostate by judiciously\\nadministered massage. The technique of the operation is very\\nsimple. The patient stands with his feet slightly separated and\\nbends the body forward at a right angle. Then the surgeon,\\nhaving liberally greased his forefinger with vaseiin, gently inserts\\nit until he reaches the prostate. Then, by means of extended\\nlateral and up-and-down gentle but firm pressure, he thoroughly\\nkneads the organ. Patients act and feel very differently while\\nthis operation is taking place. Some cry out with pain, particu-\\nlarly at the first seance, others suffer a little and make no com-\\nplaint, while others are entirely passive and perhaps say that the\\nsensation is a little unpleasant. In some patients partial or full\\nerections are produced, and in almost all of them there is inability\\nto urinate for several minutes after the operation. The secretions\\nwhich are expressed have already been described.\\nIn most cases prostatic massage produces much benefit and\\ncomfort, but in some it is necessary to proceed very guardedly,\\nlest irritation be set up. No absolute rule can be laid down as to\\nthe frequency of repetition of this treatment. In general, one mas-\\nsage in five or seven days, or even ten, will be found sufficient to\\nproduce good results. When there is concomitant chronic ure-\\nthritis of the bulb, posterior urethritis, or involvement of the\\nverumontanum, the patient may be more or less sensitive to this\\nprocedure, and it behooves the surgeon to proceed slowly and\\ncarefully. The indications for the continuance and the frequency\\nof the massage are the comfort and benefit the patient says he\\nexperiences, and also the moral effect, which in many cases trans-\\nforms a gloomy and worrying patient into a cheerful and hopeful", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0276.jp2"}, "277": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 259\\none. As a rule, when no ill effects are produced, as attested by\\nthe feeling of general and local comfort experienced by the patient,\\nwhen there is no abnormal desire to urinate, and when pus in un-\\nusual quantity does not appear in the urine, the surgeon may be\\ncertain that he is on the right track, and can continue. He can\\nalso gain much information by ascertaining from his records how\\nmuch involution in the prostate he has produced, and by repeated\\nmicroscopical examinations in auspicious cases he can convince\\nhimself that the pus, effete epithelial cells, granular phosphates,\\nperhaps tube-casts, prostatic concretions, and amyloid bodies are\\ngrowing less numerous as the patient improves in every partic-\\nular. During the massage treatment rectal irrigations with very\\nwarm water, administered by means of Kemp s instrument (see\\nFig. 65), are often of signal benefit in causing the involution of\\nthe swollen organ and the absorption of diseased products. In\\nsome cases, also, cold water thus administered seems to be very\\nbeneficial.\\nIn order to obtain the beneficial effects of heat in the rectum it\\nmay be necessary to use water of the temperature of 100\u00c2\u00b0 to\\n120\u00c2\u00b0 F. The increase in heat can be accomplished gradually\\nuntil the higher temperature of 130\u00c2\u00b0 F. is reached. When hot\\nwater is thus used, many patients from the very first experience\\ngreat relief and gladly consent to the elevation of the temperature\\nof the irrigations. It is probable that these hot rectal applications\\nprove beneficial by their stimulant action upon the nerves, the\\nbloodvessels, and lymphatics.\\nThe use of cold water by rectal irrigations should be carefully\\nwatched, and it should be discontinued at once if discomfort to\\nthe patient is produced. The temperature of cold irrigations\\nshould range from 50\u00c2\u00b0 F. to that of ice-water.\\nMany patients state that their sexual function is much improved\\nby the use of the very hot rectal irrigations.\\nI know of no morbid condition in which such reliable data can\\nbe obtained by physical and microscopical examinations of the\\npatient and of his urine as are presented by cases of chronic pros-\\ntatitis.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0277.jp2"}, "278": {"fulltext": "260 SEXUAL DISOBDEBS OF THE MALE AND FEMALE.\\nMany cases of chronic prostatitis are much benefited by tonic\\nmixtures which contain goodly doses of nitro-muriatic acid com-\\nbined with strychnine and quinine. The neurasthenia and weak-\\nness which very often occur in the course of chronic prostatitis\\nshould be carefully treated. Such patients should receive kindly\\nencouragement, and their general well-being should be sedulously\\ncared for.\\nIn addition to systematic local treatment, much benefit may\\nfollow the internal administration of full doses of fluid extract of\\nergot and strychnine. The muriate tincture of iron combined with\\nstrychnine is sometimes very efficient, particularly in debilitated\\nsubjects.\\nIt is also well to mention mercurial, ichthyol, and iodide of\\npotassium suppositories, which should be introduced into the rec-\\ntum every night. The inert basis of these suppositories is a mix-\\nture of cocoa-butter and white wax. In each suppository may be\\nincorporated twenty grains of strong mercurial ointment, fifteen\\nto twenty drops of ichthyol, and thirty grains of the iodide of\\npotassium.\\nIn all cases the surgeon should be on the watch for urethral,\\nvesical, and seminal vesicle complications.\\nHYPERTROPHY OF THE PROSTATE.\\nThe scope of this treatise precludes the full consideration of the\\nsubject of hypertrophy of the prostate, therefore, the genital and\\nsexual symptoms induced by this morbid condition will receive\\nmost attention.\\nIn all probability many cases of hypertrophy of the prostate\\ntake their origin in the chronic catarrhal processes already de-\\nscribed. In general, it may be said that this morbid state begins\\nto develop or to reveal itself by symptoms after the fiftieth year,\\nthough it may begin at an earlier date.\\nSuccinctly stated, hypertrophy of the prostate consists largely\\nin enormous overgrowths of the gland-tissue of the organ, together\\nwith increase in the muscular fibres and connective tissue of the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0278.jp2"}, "279": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 261\\nstroma. This overgrowth in most cases occurs in the path of\\nleast resistance, which is toward the bladder, but it also takes\\nplace laterally and backward, when it bulges more or less into the\\nrectum. With the lengthening of the lobes the urethra becomes\\nelongated, and with the growth of these parts the lumen of the\\ncanal is impinged upon, and it is rendered smaller, inextensible,\\nand very frequently tortuous. In some cases the so-called third\\nlobe becomes enlarged into a round or pear-shaped body, which\\nacts as a ball-valve at the vesical orifice. In some instances a\\ntrue bar across the lower part of the vesical neck is formed. With\\nthe increase of this overgrowth at the neck of the bladder, which\\nthen is no longer dilatable, more or less difficulty in expelling\\nthe urine is experienced, until in the end in many cases expulsion\\nbecomes impossible. Some patients state that their first knowl-\\nedge of the trouble was revealed to them by their want of power\\nto start the urinary stream.\\nIn many cases the development of enlarged prostate is very\\nslow and insidious and unattended with marked symptoms, while\\nin others its onset is quite rapid. The most constant symptom is\\nfrequency of urination, particularly at night. In stricture of the\\nurethra this symptom is mostly observed during the day, while\\nin old prostatic cases it is complained of at night. After a time\\nthe patient becomes conscious that the outlet or the neck of the\\nbladder is contracted, and that expulsion of the urine causes him\\nmuch greater effort than it did formerly. The stream of urine\\nis then small, feeble, often falls perpendicularly on his shoes, is\\nsometimes suddenly arrested, and ends in unsatisfactory dribbling.\\nWith the progressive development of this overgrowth the im-\\npediment to urination increases and the bladder may become over-\\ndistended, and then chronic incontinence with all its painful symp-\\ntoms and unpleasant features is observed. Synchronously with\\nthe overgrowth of the prostate certain hypertrophic changes take\\nplace in the bladder by which its walls are much thickened and\\nits inner surface is rendered rugose and much trabeculated. Early\\nor late a pouchy condition of the bladder behind the trigonum\\nforms, and a receptacle is thus made in which an increasing quan-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0279.jp2"}, "280": {"fulltext": "262 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ntity of urine accumulates which is termed residual urine. As\\nthe case grows worse the irritation of the neck of the bladder\\nbecomes more and more painful, and a burning, scalding sensation\\nis felt in the whole urethra, together with, in many cases, severe\\npain in the glans penis. After urination some prostatic mucus\\nmay drip from the meatus. Many patients suffering from hyper-\\ntrophy of the prostate give evidence of sexual erethism. Erec-\\ntions more or less perfect quite constantly occur, and nocturnal\\nemissions are not infrequent. In some rare cases these men\\nbecome in a measure sexually perverted, and, not being satisfied\\nby coitus, they indulge actively or passively in many unnatural\\npractices. As a rule, however, this period of eroticism sooner or\\nlater passes away and the man lapses into a condition of sexual\\napathy and permanent impotence. In other cases, happily the\\nmore numerous, as the hypertrophy of the prostate develops and\\nits incident sufferings increase, sexual desire slowly or quickly\\ndies out.\\nBesides the sexual symptoms some patients complain of pain in\\nthe penis, particularly in the glans, in the testes and scrotum, and\\nin the perineum. Many patients complain of uneasy sensations\\nand dull pains in the sacral, hypogastric, and lumbar regions,\\nwhich they wrongly attribute to rheumatism and lumbago. Pain\\nnear the rectum or anus or in the perineum, when in certain posi-\\ntions, or when the body is roughly jolted, or on sitting down, is\\nnot at all infrequent.\\nWith the progress of the case, when unrelieved, the health\\nsooner or later fails. In many cases cystitis becomes a most dis-\\ntressing symptom, and this bladder infection creeps up the ureters\\nand involves the kidneys. The cystitis causes urinary poison-\\ning, and the damage to the kidney prevents the elimination of\\nthe effete products of metabolism, so that the patient is really\\ndoubly poisoned.\\nAs his diseased conditions grow worse he loses his appetite and\\nhe becomes thin and sallow. He suffers from a peculiarly dry\\ntongue, and his breath has a urinous odor. Then chills and fever\\nand marasmus set in, and death ensues.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0280.jp2"}, "281": {"fulltext": "CHRONIC AFFECTIONS OF THE PROSTATE. 263\\nTreatment. Care should be taken as to the mode of life of the\\npatient. He should eat easily digested food in sparing quantities,\\nshould not overexercise, and should avoid taking cold. It is im-\\nportant that his bowels should move freely every day. Spirituous\\nliquors should be taken in great moderation.\\nIn the first stages of hypertrophied prostate in some cases much\\nbenefit results from the very careful and painless passage of sound\\nand bougies, which seem for a time at least to keep the lumen of\\nthe urethra patulous. Rectal injections of hot or cold water may\\nbe beneficial. In many cases warm irrigations of the bladder\\nand urethra with boric acid and hot water (two drachms to sixteen\\nounces) are very grateful and soothing, and the same may be said\\nof very mild warm solutions of nitrate of silver (1 to 5000 to\\n20,000), or of permanganate of potassium (1 to 8000 to 10,000).\\nAlkalies or acids, as the case demands, may be given internally\\nto render the urine bland. Urotropin should be given in decided\\ncases of alkalinity of the urine. These patients should be told\\nnot to try to hold their urine when the desire for expulsion comes\\non. Massage of the prostate may sometimes be very beneficial.\\nAs a rule, these patients have to resort quite early to the catheter,\\nthe use of which may make them comfortable for many years.\\nIn certain selected cases prostatotomy and prostatectomy, ure-\\nthral or perineal, may be performed. Castration and vasectomy\\nhave not proved to be the boons which they were expected to be*\\nIn many cases permanent perineal or suprapubic drainage may of\\nnecessity be resorted to. In appropriate cases Bottinr s operation\\nmay be resorted to. (For a full consideration of this subject, see\\nmy work A Practical Treatise on Genito-urinary and Venereal\\nDiseases and Syphilis. Philadelphia, 1900.)", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0281.jp2"}, "282": {"fulltext": "CHAPTER XIX.\\nINFLAMMATION OF THE SEMINAL VESICLES.\\nIn some cases seminal vesiculitis is the cause of sexual weak-\\nness, impotence, and of neurasthenia. This affection is really not\\nso frequent as it has been claimed to be, yet it is found in a goodly\\nnumber of cases. It is due to chronic gonorrhoea, masturbation,\\nand sexual excesses.\\nSeminal vesiculitis may be acute or chronic. The acute form\\nhas many points of analogy with epididymitis. Both affections\\nare almost always secondary to gonorrhoea, occurring in the third\\nor fourth week, or to hypersemia of the posterior urethra, due to\\nmasturbation and venereal excesses or to inflammation of this\\nregion, resulting from traumatism, catheterization, endoscopy, and\\nstrong injections. In both there are inflammation of the mucous\\nmembrane and hyperplasia of the connective tissue. In epididy-\\nmitis the testicle does not swell, and in seminal vesiculitis the\\nprostate is not usually affected. In both cases suppuration, in\\nthe sense of abscess-formation, is the exception and resolution the\\nrule.\\nSymptoms. The symptoms of the acute form of seminal vesic-\\nulitis are quite similar to those of posterior urethritis and to those\\ngiven as diagnostic of the severe varieties of prostatitis. The\\npatient first experiences pain, either of a dull or throbbing char-\\nacter, or a sensation of weight, which he refers to the deep portion\\nof the pelvis just within the anus or at the neck of the bladder or\\nin the perineum. There is markedly increased frequency of uri-\\nnation with tenesmus, sometimes mild, again quite decided, and in\\nsome cases very severe. As the bladder fills the painful symp-\\ntoms increase in severity, and there may be pain at the end and\\nsometimes at the root of the penis. There may be fever, chills,\\nand malaise. All these symptoms may be present in posterior", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0282.jp2"}, "283": {"fulltext": "INFLAMMATION OF THE SEMINAL VESICLES. 265\\nurethritis, so that the crucial test iu diagnosis is palpation of the\\nprostate and seminal vesicles by means of the finger in the rectum.\\nIf the case is one of acute posterior urethritis the prostate may be\\ntender, even painful, on pressure, and perhaps swollen. If\\nseminal vesiculitis is present and explored for early, one or both\\nvesicles will be found to be much enlarged in all directions in the\\nshape of a distended leech, hot, brawny, and exquisitely tender.\\nIn a few days the swelling may still further increase, and then\\nmoderate fiuctuation may be felt. In some of these cases the\\npatient presents a pitiable spectacle. He suffers from pain in the\\nperineum, rectum, bladder, and at the top of the sacrum. He has\\nfrequent desire to urinate, and the act is attended with much pain,\\nor, again, in some cases, there is very distressing dysuria. Defe-\\ncation is very painful, and perhaps complicated with rectal tenes-\\nmus, and may be attended with vesical spasms sleep is heavy\\nand unrefreshing, and often during the night painful erections and\\npollutions, perhaps bloody, may add to the patient s sufferings.\\nThe urine may contain pus and epithelial cells, but these tissue-\\nelements may be absent for hours or for days, during which the\\nurine is clear and in this feature acute seminal vesiculitis differs\\nfrom acute posterior urethritis, in which the discharge of pus or\\nblood is constantly seen. At the onset, and early in the course,\\nof seminal vesiculitis the gonorrhoea! discharge may disappear\\nentirely, and in this it resembles epididymitis. But in a short\\ntime the discharge reappears, and it may be more or less bloody.\\nIn seminal vesiculitis the blood is mixed with the pus or the latter\\nis streaked with it, whereas in posterior urethritis the blood fol-\\nlows the act of urination, or there may be a worm-like thread of\\ncoagulated blood with the first jet of the urine.\\nThe inflammatory stage of seminal vesiculitis usually pursues\\na course similar to that of epididymitis, and at the end of a week\\nor ten days the symptoms become ameliorated, and resolution\\ngradually sets in. In all probability, in many cases the parts\\nsooner or later become normal again. In some cases after resolu-\\ntion of the vesicular inflammation the urethral discharge reappears,\\nwhile in others the urethra is left in a healthy condition. In this", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0283.jp2"}, "284": {"fulltext": "266 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nacute stage of inflammation the morbid process resembles that of\\ngonorrhoea in the redness and swelling of the mucous membrane\\nand in the submucous cell-increase. When, however, the phleg-\\nmasia becomes intense a true suppurative process or abscess forms,\\nin which event the local and general symptoms are more pro-\\nnounced and the suffering of the patient greater. Rectal explora-\\ntion then reveals a large boggy, painful swelling at the base of the\\nbladder, beyond and to the outer edge of the prostate. This\\nswelling is very large when both vesicles are involved.\\nWhile the ejaculatory duct of the seminal vesicle remains patu-\\nlous the contained pus may escape, or perhaps may be milked, by\\nmeans of the finger-tip, into the urethra, in which event full reso-\\nlution without ulterior bad results may occur. If, however, the\\nduct becomes occluded by the swelling of its mucous membrane\\nor by being plugged up by sympexia or masses of mucus dislodged\\nfrom the diverticula of the vesicle, the abscess may attain a very\\nlarge size, and, if not promptly incised and its contents evacuated\\nthe pus may perforate its walls and burst into the ischiorectal\\nfossa or around the rectum into the bladder, the rectum, and the\\nperitoneum, sometimes causing death and generally leading to the\\nformation of fistulous tracts which are very difficult to cure.\\nIt is stated that the abscess never ruptures into both bladder\\nand rectum. In any of these very painful events examination of\\nthe parts is necessary, and from it the line of operative procedure\\nwill be arrived at. The intimate relations of the vas deferens,\\nthe ejaculatory duct, and the seminal vesicle are such that the last\\nstructures and the testicles may be involved at the same time. It\\nis probable that in some cases seminal vesiculitis and epididymitis\\ncoexist, but that the violence of the symptoms of the testicular\\ntrouble masks those of the vesicular affection. It is also very\\nprobable that the intrapelvic pain which so frequently accom-\\npanies acute epididymitis, and which we have been taught is due to\\na complicating phlegmasia of the pelvic part of the vas deferens,\\nis sometimes really symptomatic of involvement of the seminal\\nvesicle. The statement that this affection is a common accom-\\npaniment of gonorrhoeal epididymitis needs confirmation.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0284.jp2"}, "285": {"fulltext": "INFLAMMATION OF THE SEMINAL VESICLES. 267\\nIt can be readily understood, after a consideration of the fore-\\ngoing facts, why acute seminal vesiculitis has often been wrongly\\ndiagnosticated as posterior urethritis and acute prostatitis, and by\\nniany, under the influence of old ideas, as inflammation of the\\nvesical neck and floor of the bladder.\\nCHRONIC SEMINAL VESICULITIS.\\nThis form of seminal vesiculitis may result from the non-occur-\\nrence of resolution in the acute affection, and in this event the\\nclinical history is tolerably clear and striking. But in the\\nmajority of cases of chronic seminal vesiculitis it begins as a low-\\ngrade inflammatory process in persons, particularly of neurotic or\\nneurasthenic types, who may suffer from chronic subacute poste-\\nrior urethritis or chronic prostatitis, and in confirmed masturbators\\nand in those given to excessive venery and alcoholics. The diffi-\\nculty in the study of the chronic form of seminal vesiculitis is\\nthat in many cases the symptoms are so few and so vague, and\\npoint so indefinitely, if at all, to trouble in the vesicles, that\\noftentimes their origin is not suspected by the surgeon. Then,\\nagain, cases are seen in which the symptoms are very clearly and\\nstrongly marked, yet they may be with seemingly good reason\\nattributed to trouble in the posterior urethra and in the prostate.\\nCases of seminal vesiculitis which follow quite directly a recent\\nor more or less remote attack of gonorrhoea very often present such\\na group of symptoms that the surgeon is led to suspect their origin\\nin inflammation of the seminal vesicles, particularly if no trouble\\nis found in the posterior urethra. Such patients, who are usually\\nyoung men and not over thirty years of age, state that since an\\nattack of gonorrhoea or a relapse they have not felt well as regards\\ntheir sexual organs. Some complain that they are sexually weak,\\nthat they have little desire, or that they have premature and per-\\nhaps painful ejaculations, which in some cases are mixed with\\nblood. Others, again, are subject to a constant slight or profuse\\ndischarge, which is of a mucous or mucopurulent character.\\nAgain, this form of discharge may be intermittent. There may", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0285.jp2"}, "286": {"fulltext": "268 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nbe, however, a decided chronic seminal vesiculitis without any\\ndischarge which is perceptible. Not infrequently patients having\\na history of one or more attacks of gonorrhoea state that they\\nsuffer with a mild or moderately severe, even burning, pain or\\nitching, or a sense of weight in the course of the urethra, in the\\nperineum, bladder, anus, and rectum. In addition to this, they\\noften give a history of sexual erethism with or without gratifica-\\ntion in coitus, and sometimes of increased desire, while little relief,\\nand even aggravation of the symptoms, may follow the sexual act.\\nAll of these symptoms may be present in cases of chronic\\nprostatitis.\\nSecretion of chronic seminal vesiculitis.\\nChronic seminal vesiculitis in younger men consists in a sub-\\nmucous round-cell infiltration beneath the mucous membrane,\\nwhich gives rise to hyperemia and purulent catarrh. If care be\\ntaken to cleanse the urethra of the discharge from posterior ure-\\nthritis and from any form of prostatitis (if these morbid conditions\\ncoexist), a grayish or brownish mucus can be expressed in some\\ncases from the vesicles by the finger-tip in the rectum. This secre-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0286.jp2"}, "287": {"fulltext": "INFLAMMATION OF THE SEMINAL VESICLES. 269\\ntion may be very copious or decidedly moderate in quantity. It\\nis very viscous, and in the earlier days of the inflammation it may\\nbe tinged with blood or pus more or less abundantly. When this\\nsecretion is examined by means of the microscope it will be found\\nto contain vesicular mucus in large and small globules, granular\\nand perhaps crystalline phosphates, pus-cells (perhaps red cor-\\npuscles), and spermatozoa, which in most cases are lifeless. These\\nfeatures are well shown in Fig. 74, the secretion having been\\ngotten by massage from a patient and examined by myself. These\\nappearances are quite constantly found in the secretion of cases of\\nyoung men in whom, though the affection is chronic, it has not\\nyet reached its full development. In these cases, which, by their\\nclinical history and their secretion, seem to constitute a distinct\\nclass, the cell-infiltration and consequent thickening of the walls\\nand structural damage of the vesicles are not yet very great, and\\nthe prognosis generally is better than in more advanced cases.\\nMore Advanced Form of Seminal Vesiculitis.\\nIn the cases of pronounced masturbators, in old gonorrhoeics, in\\nthose given to excessive indulgence, particularly with the addition\\nof alcoholic excesses, chronic seminal vesiculitis may sometimes be\\nfound in a more severe form. These cases are often those of\\nanaemic, neurotic, and neurasthenic subjects who respond very\\nindifferently to treatment. Such patients, who are usually beyond\\nthirty years of age, in whom the affection is very chronic, may\\ncomplain of some pain or disturbance in the urethra, bladder,\\nanus, or rectum, and they may present a discharge then, again,\\nall these symptoms may be wanting. Most of them, however,\\ngive a history of disturbance in the sexual function similar to\\nthose just detailed. These disturbances are mainly of two forms\\nfirst, those of lowered power, and, second, those of erethism of the\\nsexual organs. In the first order of cases we find absence or\\nincompleteness of erections, emissions from slight causes, without\\nenlargement of the penis. In these cases there is often a haunt-\\ning desire for erection, with no response. Very often these\\npatients suffer from a constant dribbling of a dirty-gray or", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0287.jp2"}, "288": {"fulltext": "270 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nbrownish mucus, which may during the day be so copious as to\\nsaturate one or two pocket-handkerchiefs. Then, again, some of\\nthese patients have no such discharge, but an emission of a thin,\\ngray, watery, and sometimes brownish and even curdy fluid occurs\\ndaily or more frequently.\\nIn these advanced cases, particularly in subjects who are ap-\\nproaching middle life, the structural changes in the vesicles are\\nmuch more pronounced than they are in the earlier class of cases.\\nThe submucous infiltration will then be found to have thickened\\nthe walls of these sacs very much, and in some cases there will\\nbe found a very decided increase in the density and quantity of\\nthe perivesicular connective tissue whereas in the earlier class of\\ncases the vesicles to the touch feel like a distended leech, and are\\nyet compressible. In the most advanced cases these structures\\nare firm, perhaps very resistant, and they convey to the mind, by\\nmeans of the finger-tip, the impression that a well-defined, com-\\npact, perhaps indurated, mass has taken the place of a tolerably\\nsoft sac. The conglomerate morbid process then consists of epi-\\nthelial hypertrophy, submucous round-cell infiltration, general\\nincrease in the connective tissue stroma, and much hypertrophy of\\nthe perivesicular fibrous tissues. In these cases, as time goes on,\\ncontraction takes place in the newly formed morbid tissues, and\\nthe calibre of the chambers of the vesicles becomes much con-\\ntracted. In this event the muscular contractile function of these\\nsacs is more or less impaired or is wholly lost.\\nWhen a post-mortem specimen of the seminal vesicles in the\\nless advanced form of the morbid process is examined, it is often\\nfound that the calibre of the vesicles and of their chambers has not\\nbeen materially decreased, and that, although the walls are thicker\\nthan normal, they are yet compressible and tolerably extensible.\\nIn the older cases above mentioned the rigidity of the parts con-\\ntrasts strongly with the condition just now described.\\nThe normal secretion of the seminal vesicles is of a dull gray\\ncolor, perhaps slightly tinged with light brown. In disease this\\nsecretion becomes more and more brown. In the less advanced\\nclass of cases it is of a yellowish-brown color, and in the advanced", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0288.jp2"}, "289": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0289.jp2"}, "290": {"fulltext": "PLATE X.\\n\u00c2\u00b0\u00c2\u00b00-\\no\\nQ W\\nc\\n6)\\n\u00e2\u0096\u00a0Q\\nSecretion of Very Chronic Seminal Vesiculitis, Containing\\nPhosphatic Concretions, Granular Phosphates,\\nSympexia, Pus Cells, Mucoid\\nGlobules and Spermatozoa.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0290.jp2"}, "291": {"fulltext": "INFLAMMATION OF THE SEMINAL VESICLES. 271\\ncases it is of a very pronounced dirty, sometimes rusty, brown\\ncolor. In the diseased condition, as age advances, the secretion\\nbecomes much more viscid than it is normally.\\nThe dark color of the secretion in very chronic seminal vesicu-\\nlitis is due mainly to phosphatic concretions held together by\\nmucus and more or less stained with blood-pigment. Then we\\nalso find large round or oval masses of the dried mucus peculiar\\nto the vesicles, which seem to have become stained by blood and\\nto have become condensed into spheres. Further than this will be\\nfound large, flat, irregular plates of epithelial cells grouped together\\nin a chaotic mass and deeply tinged with yellow pigment derived\\nfrom the blood. These are the main constituents of the secretion\\nof very chronic seminal vesiculitis, and their presence is very con-\\nstant, as I have often observed. In addition, we find more or less\\ngranular phosphates, very often of a yellowish color, red blood-\\ncells, pus-cells in varying quantity, and spermatozoa, which are,\\nas a rule, dead.\\nIn Plate X. the secretion of very chronic seminal vesiculitis is\\nwell shown. The secretion used in the preparation of the plate\\nwas drawn by me from the seminal vesicles of a man, aged forty-\\ntwo, who died of alcoholism, and who in life suffered from chronic\\nseminal vesiculitis.\\nI have found in post-mortem specimens that the secretion of\\nthe seminal vesicles in health and in disease is exactly like that of\\nthe deferential ampullations, except that perhaps spermatozoa may\\nbe rather more numerous in the latter secretion. Now, as these\\nparts are so closely coapted, and as their function and structure\\nare precisely similar, it is very probable that the ampullations are\\nalso involved in some cases of seminal vesiculitis, and it may\\nhappen that the disease may be limited to the ampullations. In\\nthe living subject I can well conceive that it would be sometimes\\nvery difficult to diagnosticate, by means of the finger-tip in the\\nrectum, between chronic seminal vesiculitis and chronic inflamma-\\ntion of the ampullations. I have before me, as I write, the\\nseminal vesicles of a man which are the seat of advanced chronic\\ninflammation, and their structural condition and their secretion", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0291.jp2"}, "292": {"fulltext": "272 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nare precisely similar to those of the ampliations which lie in close\\ncontact at the inner side of the vesicles. If such a case were\\nexamined in life, in the light of our present ideas, the diagnosis\\nof chronic seminal vesiculitis would be unhesitatingly made. It\\nis probable, therefore, that in cases of chronic, and perhaps acute,\\nseminal vesiculitis the ampullae may also be involved by the same\\nmorbid change.\\nSuch is the erotic condition of some patients suffering from\\nchronic seminal vesiculitis, that the sight of a pretty woman, of\\nher breast or her ankle, throws them into a high state of nervous-\\nness and sexual erethism. I have known several instances in\\nwhich one woman only exerted this morbid influence upon the\\nman. Accidental slight contact, the glance of the eye, the sound\\nof the voice, and the grasp of the hand served to so excite and\\nexalt them sexually that an orgasm, with or without partial erec-\\ntion, would result. This erotic condition is also not infrequently\\nobserved in men suffering from chronic catarrhal prostatitis.\\nThese cases, as we may term them very chronic, run a some-\\nwhat peculiar course. In some the symptoms and conditions con-\\ntinue in a more or less subdued manner, and though they disturb\\nthe patients considerably, the latter arrive at a state of mind by\\nwhich they bear their troubles more or less philosophically. In\\nthis class of cases the affection runs on from year to year in a\\nmonotonous way. Such patients are neither healthy nor very sick.\\nBut cases are sometimes seen in which the chronic, uneventful\\ncourse of the affection is varied by the development of more or\\nless severe exacerbations. In this event the health becomes dete-\\nriorated, the patients lose their appetite and weight, and present\\nthe appearance of very weak and sick men. Concurrently with\\nthis condition the nervous system becomes much disturbed and the\\npatients present the symptoms of neurasthenia. A nervous appre-\\nhension and anxiety are very frequent concomitants. Such an\\nexacerbation may last months or years, and may lead to perma-\\nnent invalidism.\\nIn old men suffering from hypertrophy of the prostate a low\\ngrade of seminal vesiculitis is a not uncommon accompaniment.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0292.jp2"}, "293": {"fulltext": "INFLAMMATION OF THE SEMINAL VESICLES.\\n16\\nIn many of these cases the vesicular complication passes unnoticed,\\nfor the reason that it may give rise to no symptoms at all, or, if\\npresent, they are not pronounced in character. Then, again, they\\nmay be masked by the disturbances produced by the prostatic\\naffection.\\nDiagnosis. The diagnosis of seminal vesiculitis, in whatever\\nform it may exist, is to be arrived at mainly through palpation\\nof the parts by the finger inserted into the rectum. It has already\\nbeen shown how little light the subjective symptoms throw upon\\nthe nature of the trouble. It is not, as a rule, as easy as it is\\nclaimed to be by some to make out clearly the outlines and dimen-\\nsions of the seminal vesicles. In the examination some authors\\nstate that the patient should stand and bend the body forward\\nas far as he can, his feet being about a foot apart. It is always\\nwell that the bladder should be full, for in that condition the\\nvesicles are more readily detected. Then the finger is introduced\\nto the prostate, and, having defined its outline, the vesicles are\\nsought for above and to the outside of this body.\\nThis examination can also be made with the patient on his\\nback, in which event the bladder, being full, tends to sag down\\nin the pelvis. It is easy to conceive that in some patients in the\\nbending-forward-and-standing position the bladder may tilt for-\\nward toward the abdominal wall, and then the vesicles will be\\nmore inaccessible.\\nAt the prostate the two vesicles approach to within a finger s\\nbreadth of one another, and on the inner side of each one is the\\nvas deferens, which at this part becomes much enlarged and\\nampullated. I ruyself think that very often the ampullation of\\nthe vas deferens, which may be increased in size by the gonor-\\nrheal or chronic hyperaemic process, is mistaken for enlargement\\nof the seminal vesicles. It certainly is next to impossible to say\\nfrom rectal examination in life that the vas deferens is not swollen\\nand the vesicle is. These parts are in such intimate juxtaposition\\nthat it is nearly impossible to distinguish between the two. It is\\nimportant, also, to have a good knowledge of the structure and\\nphysical characters of the vesicles in their normal state. To this\\n18", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0293.jp2"}, "294": {"fulltext": "274 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nend study on healthy men is necessary. The seminal vesicles in\\nhealth have a firm, somewhat resistant structure, which, while not\\npresenting a brawny feel to the touch, give the sensation of having\\ntolerably thick Avails. Therefore, the surgeon must not enter upon\\nthe examination with the idea that he is to always feel two oblong,\\nrather soft, and readily compressible little bladders.\\nIf diseased, the seminal vesicles will, in the acute stage, feel\\nmuch swollen in all directions, tender, perhaps hot, and may\\npresent a doughy sensation, like that of the over-filled leech. In\\nthe stage of abscess the swelling will be great, the pain intense,\\nand the symptoms severe and pointing to intrapelvic trouble.\\nIn the chronic forms a quite firm tumor may be felt. If both\\nvesicles are involved, the base of the bladder beyond the prostate\\nis the seat of the tumor, which is usually of goodly size, often\\nvery large. Abdominal pressure, exerted deep down and toward\\nthe pelvis, may often afford much aid in these examinations. Some\\nauthors lay stress upon the presence of a sound in the bladder,\\npushing its base downward toward the rectum, as being of great\\nhelp to the finger in the rectum. Perhaps in some cases this pro-\\ncedure may be admissible or practicable, but it should never be\\nresorted to without due thought concerning the nature of the case\\nand the state of the deep urethra and prostate. In all acute cases\\nthe introduction of the sound as an accessory aid to diagnosis is\\nstrictly interdicted. In chronic cases the surgeon must always\\nremember that the posterior urethra may be the seat of a low\\ngrade of inflammation, and that the prostate may also be at least\\nhyperaemic. This same caution applies very strongly to the cases\\nof old men who are suffering from enlargement of the prostate and\\nalso from a chronic inflammatory condition of the seminal vesicles\\na complication, as we have seen, which is sometimes met with.\\nExamination and manipulation of the seminal vesicles by means\\nof the finger-tip cause a flow of pus, with perhaps blood, into the\\nurethra Avhen the inflammation is recent and active. In the sub-\\nacute eases the discharge is mucopurulent and mucoid.\\nPathology. In the acute gonorrhoeal stage it is probable that\\nthe lesion of the mucous membrane is similar to that of gonor-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0294.jp2"}, "295": {"fulltext": "INFLAMMATION OF THE SEMINAL VESICLES. 275\\nrhoea of the urethra. This is a field worthy of careful study.\\nAs yet the observations have been macroscopical rather than\\nmicroscopical. In the main, the morbid process consists of swell-\\ning of the mucous membrane and small-cell thickening in the sub-\\nmucous connective tissue. The vesicles then may be much dilated,\\nor, again, they may, by contraction of the newly-formed tissue,\\nbecome much shrivelled. Within the vesicles a brownish mucus,\\nmuco-pus, spermatozoa (alive or dead), sympexia, and calcareous\\nconcretions may be found.\\nPrognosis. In the acute form of this trouble resolution usually\\ntakes place. In the chronic forms amelioration and cure may be\\nobtained. In some cases, however, the morbid process goes on to\\nthe formation of large tumors which require operative measures.\\nTubercular infiltration of the seminal vesicles may perhaps undergo\\nresolution or lead to cicatrization or caseation, but in most cases it\\nis continuous with or concomitant to a similar affection of other\\norgans, and in the end death results. In malignant new-growths\\na lethal outcome is inevitable.\\nTreatment. When recognized in the acute stage seminal vesic-\\nulitis is to be treated on the general principles which govern the\\nmanagement of all acute phlegmasia? of the genital and urinary\\norgans. In some cases it is well to apply a large number of\\nleeches upon the perineum and the margin of the anus. Injec-\\ntions of cold water may be used, and the rectum may be packed\\nwith ice if the procedure is pleasant to the patient, or hot irriga-\\ntions may be administered by means of Kemp s rectal cooler.\\n(See Fig. 60.) These applications may be used once or twice a\\nday, or even more frequently. Opium in suppositories, diluents,\\nand saline cathartics may be administered as necessity requires.\\nShould an abscess form it may be reached by means of a curved\\nincision in the perineum just anterior (about three-quarters of an\\ninch) to the anus, great care being taken that the membranous\\nurethra, the prostate, and the rectum are not cut. In this opera-\\ntion much aid will be given by means of the finger in the rectum\\nand a sound in the urethra. The incision may be made in the\\nmedian line laterally, or, if both vesicles are the seat of acute", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0295.jp2"}, "296": {"fulltext": "276 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nsuppuration, it may be crescentic. Then the dissection between\\nthe base of the bladder and the rectum must be cautiously made.\\nThe resulting cavity should be treated on general surgical prin-\\nciples.\\nIn the treatment of chronic seminal vesiculitis, in which we may\\nfind distended, pouchy, or brawny vesicles, it is well to carefully\\nmassage the parts. This procedure is accomplished by the finger-\\ntip gently but firmly pressing or kneading as much of the organ\\nas is within reach from above downward, so as to express the con-\\ntents through the ejaculatory duct into the prostatic urethra. The\\npatient should lie on his back, or if in the erect position he should\\nbend his body at a right angle to his lower extremities, and in\\nthis position the surgeon introduces the finger, all the Avhile\\nmaking counter-pressure on the abdomen, the bladder being, if\\npossible, well filled. As has already been said, it is no easy matter\\nin many cases to reach the vesicles and clearly define their size\\nand shape, even when every favoring condition is present. Then,\\nagain, at the best, only the lower half of the vesicle is really ac-\\ncessible to the massaging process. Further than this, it must be\\nclearly remembered, as has already been pointed out, that the\\nseminal vesicles are made up of blind-ended tubes or diverticula,\\nand that they have not the structure and arrangement of racemose\\nglands, firm pressure on which will cause the contents to exude\\ninto the excretory duct. An inspection of Fig. 9 will clearly\\nshow that it is a physical impossibility to cause the contents of\\nthe third tube or, as we call it, the handle of the jack-knife to\\nexude into the urethra, for the reason that it is a blind sac or\\npouch, its non-patulous part ending downward near the pros-\\ntate. This portion of the vesicle is fully as large as the other\\ntwo-thirds are, and the contents of this large part cannot in any\\nway be extruded into the urethra. For anatomical reasons it will\\nbe clearly seen that the utmost that can be accomplished in mas-\\nsaging a vesicle is to act upon about one-quarter of its whole struc-\\nture. In theory, massaging the vesicles seems to be a rational treat-\\nment, in that it seeks to rid these organs of retained chronic inflam-\\nmatory matter and to restore the tone in muscular and mucous", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0296.jp2"}, "297": {"fulltext": "INFLAMMATION OF THE SEMINAL VESICLES. 277\\ntissues which have become relaxed and flabby. Undoubtedly, in\\nmany cases benefit does result from the procedure.\\nThe treatment of the cases of chronic seminal vesiculitis in\\nwhich there are neurasthenia, debility, and often great mental\\ndepression, belongs largely to the domain of general medicine.\\nSuch cases require good hygiene, and, if possible, an entire change\\nof scene, rest, and pleasant surroundings. Tonics, combined with\\nmix vomica and ergot, produce much benefit. Iron, quinine, and\\ncocoa are also indispensable in some cases. The urethra, bladder,\\nprostate, and seminal vesicles should be very carefully examined\\nby instruments and by inspection of the urine and expressed secre-\\ntions. If there is, as so frequently happens, a coexistent posterior\\nurethritis or prostatitis, these morbid conditions should be properly\\ntreated.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0297.jp2"}, "298": {"fulltext": "CHAPTER XX.\\nVAEICOCELE.\\nVaricocele is that varicose condition of the spermatic veins\\nby which a localized or generalized swelling of the scrotum is\\nproduced.\\nAs a rule, when the tumor is small it is a simple, painless affec-\\ntion but when the swelling is large it may cause sensations of\\ndragging weight which extend to the parts beyond, and are more\\nsevere in hot weather and after bodily exertion. In some cases\\nthere is a dull, aching, intermittent pain in others the pain is\\nsharp and crampy.\\nTo the eye and to digital examination varicocele reveals itself\\n(1) as an elongated, diffuse swelling, which extends from the\\nexternal abdominal ring down to the testicle, and is larger higher\\nup than lower down (2) as a diffuse tumor surrounding the tes-\\nticle, particularly its upper part, and extending half-way up to\\nthe external abdominal ring, and (3) as a goodly sized tumor just\\nbelow the ring and extending half-way down to the testis.\\nWhen a varicocele is palpated a sensation is conveyed to the\\nfingers like that of a mass of earthworms, and this simile is some-\\ntimes rendered all the more striking by the contraction of the cre-\\nmaster muscle. Very often the scrotum is lax and dependent,\\nand in its walls tortuous, flaccid veins can be distinctly seen.\\n(See Fig. 75.) Under the influence of cold the scrotum and its\\nvaricocele contract materially, while heat and excitation tend to\\nproduce laxity and elongation of the parts.\\nVaricocele is mostly observed on the left side of the scrotum\\nexceptionally it is found on both sides.\\nThe causes of varicocele are the entrance of the left spermatic\\nat right angles into the corresponding renal vein, pressure on the\\nspermatic vein by rectal and intestinal distention, and by tumors", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0298.jp2"}, "299": {"fulltext": "VARICOCELE.\\n279\\nin the groin and within the abdomen. Incompetence of the cre-\\nmaster mnscle may act as a contributory cause.\\nAlthough in former years it was claimed that varicocele was the\\ndirect cause of atrophy of the testis, this view to-day has few sup-\\nporters. The truth of the matter is that, as a result of varicocele,\\nFig. 75.\\nVaricocele and varicose enlargement of the veins of scrotal walls\\nthere is usually at the time of testicular increase in the years\\npreceding puberty an arrest of development. As a result, we find\\nsmall, soft, and sometimes quite insensitive testes, which are ill\\nfitted to produce spermatozoa. It is very probable that, owing to\\nthe disturbance in the circulation of the organ by the backward\\npressure of the blood, its spermatogenic function is interfered with", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0299.jp2"}, "300": {"fulltext": "280 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nand perhaps held in abeyance. The organ is not necessarily\\nsterile with the removal of the varicocele by operation the nutri-\\ntion of the testis will become re-established, the organ will grow\\nin size and firmness, and its function will soon be restored. I\\nhave seen this result so often, and there are so many well-attested\\nreported cases in proof of the statement here ventured, that I\\nmake it without hesitation or reserve. In all probability, in those\\neases in which atrophy of the testis has been found associated with\\nvaricocele of the same side, the mischief has been produced by\\nsome antecedent cause, such as hereditary syphilis, gonorrhoea\\n(which is found even in infants and young children) tuberculosis,\\nor traumatisms. In many reported cases of atrophy of the testis\\nthere is evidence of want of thorough clinical investigation, and\\nthe impression left on one s mind is that the surgeon jumped to\\nthe conclusion that the varicocele was the morbid factor. Some\\nauthorities, however, are willing to admit that very exceptionally\\natrophy of the testis may result from uncomplicated varicocele.\\nIn most cases varicocele causes its bearer very little, if any,\\nmental disturbance. This is the case usually in subjects who are\\nmentally and physically in good condition, and who are not\\naddicted to masturbation. In weakly, lascivious, and neurotic sub-\\njects this condition of the spermatic veins causes a, state of mind\\nwhich is to be described presently. I have several times observed\\nthat when in excellent health subjects having varicocele gave\\nthemselves no concern regarding the affection, and that in a state\\nof debility and worry from business or other troubles their minds\\nbecame fixed on the scrotal tumor, and they gave way to apprehen-\\nsion and anxiety.\\nThere is no evidence at hand to prove the contention that vari-\\ncocele is a result of masturbation. The occurrence of the venous\\nanomaly in the persons of confirmed masturbators is no proof that\\nthe deformity was produced by this bad habit. When boys or\\nmen have been addicted to masturbation the development and\\ndetection of varicocele sometimes cause in their minds much dis-\\nquietude, and even worry, and they often very wrongfully asso-\\nciate the two as effect and cause. Indeed, the reverse of what is", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0300.jp2"}, "301": {"fulltext": "VARICOCELE. 281\\ngenerally believed is true. The irritation of the varicocele and\\nthe condition of disturbed nutrition in the testis lead to much\\nsexual irritation and increased desire, and as a result of these the\\npatient may fall into the bad habits of masturbation and other\\ndepraved practices. This erethism of the sexual parts occurs at\\na very bad time for the patient namely, when he is in the pro-\\ncess of evolution from the condition of the child to the maturity\\nof puberty, at which time his sexual apparatus is vigorously grow-\\ning and when his inclinations to coitus are beginning to be felt\\nvery keenly. As the habit of masturbation increases an irrita-\\ntive hyperemia develops in the prostate, ejaculatory ducts, and\\nperhaps as far back as the seminal vesicles and deferential ampl-\\niations. This syndrome of morbid conditions then further includes\\npollutions and abnormal seminal discharges. Thus, beginning in\\nlocal testicular irritation, the whole sexual apparatus may be\\nthrown into a seriously morbid state by reason of the masturba-\\ntion and the disturbed mental condition which ensues. Many of\\nthese patients become much worried and depressed, while others\\nbecome very melancholic, and some even show evidences of mild\\nmonomania.\\nIn young men who are engaged to be married, and who pass\\nmuch time in the society of their fiancees, sexual erethism and un-\\ngratified coitus may be so severe and protracted that the mind or\\nthe health of the individual may be somewhat disturbed. These\\nyoung men come to the surgeon complaining of a sense of weight,\\nfulness, or even of pain in the spermatic veins. If there is a\\nmoderate or pronounced varicocele present, the patient may give\\nhimself up so much to worry and anxiety that his life becomes a\\nburden. These patients are prone to think that impotence is im-\\npending, and that they will be unable to consummate matrimony.\\nIf in this unhappy state of mind nightly emissions occur, or if,\\nwhen in the presence of their fiancees, a glycerin-like mucus\\n(urethorrhoea ex libidine) escapes from the meatus, their cup of\\nwoe becomes filled to the brim. Yet in these cases the mental\\ncondition is really their only source of danger, since the physical\\ncondition can be relieved. Plain, sensible, kindly advice and a", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0301.jp2"}, "302": {"fulltext": "282 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nlittle treatment usually bring these patients out of their sorrowful\\nposition. Iu some instances the moral effect of removal by opera-\\ntion of the varicocele is most gratifying.\\nThe simple existence of a very small varicocele in some patients\\ncauses much depression and dejection, and in some well-marked\\nneurasthenia, such as we see in subjects who imagine that they\\nhave some deep-seated sexual disorder or some undefined or un-\\ndefinable rectal trouble.\\nThen, again, the presence of varicocele so operates on the minds\\nof some patients that they imagine they are impotent, and this\\nstate leads to no end of worry and dejection. In this frame of\\nmind they may try to indulge in sexual intercourse, and they\\nusually fail signally. As a result, such patients become almost\\nunalterably convinced that they are impotent, and their distress of\\nmind and general unhealthy, cachectic, and woe-begone appear-\\nance really make them pitiable objects. This state of mind is\\nvery often further increased by the base misrepresentations of\\nquacks. Patients in this deplorable state require very careful\\nmanagement. They should, first of all, be assured that the impo-\\ntence is only temporary, and that it is largely due to their unbal-\\nanced state of mind. Then proper attention should be given to\\ntheir general health, to their sexual hygiene, and also to their\\nlocal disturbances.\\nTreatment. For the less developed class of cases cold-water\\naffusions, used night and morning, and a nicely fitting suspensory\\nbandage worn during the day, will give the patient comfort and\\ncontentment.\\nWhen radical measures are necessary the open operation, with\\nligation and ablation of the venous mass, is by all means to\\nbe commended, since it always produces beneficial results. In\\nall cases of varicocele the condition of the patient s mind must\\nbe taken into consideration. In such cases good, kindly, reas-\\nsuring advice, with the regulation, as far as possible, of sexual\\nhygiene and coitus, will bring back health and gladness to the\\nsufferer.\\nThe radical cure of varicocele can be effected by a number of", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0302.jp2"}, "303": {"fulltext": "VARICOCELE. 283\\nsurgical procedures, many of which are complicated and attended\\nwith difficult after-treatment, and need not be mentioned.\\nThe two operations now mostly employed are Howse s opera-\\ntion for excision, and its modification by Bennett. The results of\\nthe open operation are conspicuously and uniformly good. The\\nparts are so clearly exposed, the ligatures can be applied with\\nsuch precision, and there is so much simplicity about the operation\\nthat it cannot be commended too highly.\\nIt is necessary to remember that the veins to be excised are\\nthose of the pampiniform plexus, which are surrounded by a well-\\ndefined connective tissue sheath. These spermatic veins lie well\\nin front, while the vas deferens with its artery and veins are fur-\\nther backward and inward in the scrotum. If the testis is care-\\nfully pulled downward, the vas is put on the stretch, and it can\\neasily be felt, it being hard and firm like a whip-cord. The vas\\nand the deferential artery and veins should be carefully avoided.\\nOnly by gross carelessness will they be included in the ligation of\\nthe veins. In that event there may be sloughing of the testicle\\nfrom want of blood-supply.\\nExcision of the Spermatic Veins. The patient is properly\\nprepared for the operation and placed under the influence of ether.\\nThe hairs of the abdomen and genitals must be thoroughly shaved,\\nand the parts the scrotum especially well washed with soap\\nand water, then with alcohol and ether, and then with bichloride\\nsolution (1 2000). An assistant holds the testicle firmly and\\ndraws it horizontally downward between the thighs. The parts\\nare then tense, the veins can be distinctly felt, and under them\\nthe vas is very perceptible. An incision is then made for an inch\\nand a half in the longitudinal direction and over the prominence\\nof the veins. The edges of the wound are then separated by re-\\ntractors, and the coverings of the cord are carefully dissected until\\nthe sheath of the veins comes into view. It presents a shining,\\nwhitish-gray color, through which the purple veins are seen.\\nThis sheath of the pampiniform plexus, which must not be cut\\ninto, is then isolated with the knife, aided by the fingers, and\\nthen the ligatures, of good, strong catgut, are to be applied by", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0303.jp2"}, "304": {"fulltext": "\u00e2\u0080\u00a2284 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nmoans of an eyed probe or aneurism-needle about an inch and a\\nhalf apart. The lower ligature is tied first, and then the upper\\none. The vessels are then cut with scissors about a quarter of an\\ninch from the ligatures. The wound cavity is then copiously\\nirrigated, and put on the stretch, so as to bring the two edges of\\nthe scrotum in coaptation. This can be done with the fingers or\\nby means of two blunt hooks, one at each end of the wound.\\nFive or six, or perhaps more, catgut sutures are now applied,\\nthus firmly fixing the parts. A small opening in the dependent\\npart of the wound is left for drainage. Usually no drainage-\\ntube is necessary. The continuous or interrupted suture may\\nalso be used.\\nBennett s modification of the foregoing operation is the one I\\nnow most commonly employ, since its results are so uniformly\\nsatisfactory. I can do no better than to quote Mr. Bennett s\\nwords. He says The precise extent of the varicocele which\\nit is desirable to resect in any given case is best determined by\\nplacing the patient in the standing position and roughly estimat-\\ning with the eye or, better, by measuring with a tape the\\ndegree of elongation of the cord for instance, should the testis be\\nthree inches lower than normal, then certainly not less than three\\ninches of veins should be included between the two ligatures, as\\nit will be desirable to excise at least two inches and a half.\\nBennett dissects down to the sheath of the fascia, which he also\\nsays should not be opened then he passes his two ligatures, ties,\\nand leaves them quite long. Then he cuts out the segment of\\nthe veins included between the ligatures. The cut-ends of the\\nstumps left by the division of the varicocele are then brought\\ntogether and retained in permanent apposition by knotting the\\nends of the upper ligature to those of the lower, thus at once rais-\\ning the testis to about its natural level. The ligatured ends are\\ncut off quite short.\\nThen, after the operation, the wound may be dusted with iodo-\\nform and a sterile gauze dressing, and a spica bandage may be\\napplied. The first dressing may remain on for several days.\\nPerfect healing usually occurs as early as seven and as late as ten", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0304.jp2"}, "305": {"fulltext": "VARICOCELE. 285\\nor twelve days very rarely is it delayed longer. When healing-\\nhas occurred a callous mass will be felt at the point of juncture\\nof the ends of the veins. This will gradually be absorbed, and\\nin the end a little firm nodule will be felt. It is well to cause\\nthe patient to wear a suspensory bandage for a short time after\\nany of the radical operations for varicocele.\\nThe patient is usually confined to his bed for a week.\\nSubcutaneous ligation for varicocele is an inexact and unsur-\\ngical operation, and is to-day practically obsolete.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0305.jp2"}, "306": {"fulltext": "CHAPTER XXI.\\nMASTURBATION IN MALE SUBJECTS.\\nCertain morbid conditions of the genital tract and disturb-\\nances of the sexual function, with more or less lowering of the\\nmorale of the patient, have their origin in excessive and long-con-\\ntinued masturbation and sexual excesses. Much exaggeration has\\nbeen indulged in, and an unnecessary amount of sentiment has\\nbeen bestowed by lay and medical writers, and notably by quacks,\\non the habit of self-abuse therefore, it will only be treated of\\nhere in a purely scientific manner.\\nIt is a great mistake to claim that among the majority of boys\\nexcessive indulgence in masturbation is very common, since the\\ntruth is that such is the exception rather than the rule. There are\\nboys whose nervous system is not stable, and those who are pre-\\ncocious in their mental processes, who like to seclude themselves\\nvery much from the games and sports of their comrades, and who,\\nhaving indulged in self-abuse, keep up the bad habit until it pro-\\nduces harmful results. But, as a rule, boys like to be up and\\ndoing, and each feels that he likes to stand as high in all pursuits\\nof early life as his fellows. This generous rivalry tends to ele-\\nvate the moral nature of the boy. Thus it is that a healthy\\nmoral status exists which tends to keep boys in the right path.\\nIf, perchance, a boy has indulged unnaturally, he, as a rule, sees\\nthe error of his ways, and he leaves off his bad habit, or indulges\\nin it quite infrequently. Undoubtedly, in many cases the exag-\\ngerated accounts of the ills which follow masturbation have a\\ndecidedly deterrent effect. While in the main the foregoing sur-\\nvey of this subject holds good for the better classes of our com-\\nmunity, it must be confessed that among the poor and squalid,\\nwho are closely herded together, the moral tone is low and the\\nhabit is more wide-spread.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0306.jp2"}, "307": {"fulltext": "MASTURBATION IN MALE SUBJECTS. 287\\nIn boarding-schools and reformatories it is said that masturba-\\ntion is very common among the male subjects, but in the long run\\nvery few suffer from the habit.\\nMasturbation has been observed in quite young children. In\\nsome cases there seems to be some nervous defect, of which sexual\\nprecocity is a prominent symptom. Then, again, phimosis, bala-\\nnitis, adherent prepuce, congenital stricture, stone in the bladder,\\nretained smegma, uncleanliness, dermatitis of all forms about the\\ngenitals, and thread-worms in the rectum cause erections, and thus\\nthe child contracts the bad habit. Stone in the bladder may also\\nbe the cause of sexual excitement in the infant. Then, again, it\\nis not uncommon for nurses and care-takers to fondle and titillate\\nthe penis of the child in order to keep him quiet, and thus the\\nbad habit is engrafted upon him.\\nEpileptics, hydrocephalic infants, and those suffering from many\\nforms of nervous disease, are said to be prone to commit mastur-\\nbation. In older subjects, the victims of cerebral and spinal\\naffections, masturbation is frequently a distressing symptom.\\nAs a rule, these subjects are seen to constantly handle their\\ngenitals and to produce erections, and they commit the self -abuse\\nby peculiar movements of the thighs, by rubbing up against firm\\nobjects, or by rolling on their stomachs on the floor.\\nIt has been observed that flogging of young boys upon the back\\nand buttocks has in many instances caused erection of the penis\\nand ejaculation. This fact should act as a warning to both\\nteachers and fathers. Many boys have been known to wilfully\\nmisbehave in order that they should be flogged upon the buttocks\\nby young and pretty female school-teachers.\\nInfantile onanists soon become sickly, flabby, peevish, and irri-\\ntable. Their gastro-intestinal functions become much impaired,\\nand as a result their nutrition is much lowered.\\nYoung boys are either taught this bad habit by older boys or\\nthey acquire it by exploratory inquisitiveness. In many cases,\\nparticularly among boys approaching puberty, the morbid stimula-\\ntion of the imagination by reading lewd books or by the inspection\\nof lascivious pictures leads to more or less confirmed masturbation.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0307.jp2"}, "308": {"fulltext": "288 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nCertain facts regarding masturbation have been very forcibly\\nbrought out by the late Dr. J. W. Howe 1 in the remarks now\\nquoted There are certain gymnastic exercises provocative of\\nmasturbation. These exercises are common in all gymnasiums\\nand in many school-grounds. My attention was first called to\\nthis subject by the history which a confirmed masturbator gave\\nme of his first experiences. He entered school at the age of seven\\nyears. The day after his admission he visited the school gymna-\\nsium. His attention was attracted to the swinging pole around\\nwhich a number of boys were enjoying themselves. He took\\nhold with the rest, sustaining the whole weight of the body by\\nthe hands, swinging himself around the circle for some time. In\\na few minutes he had such peculiar sensations about the genitals\\nthat he was forced to discontinue the movement, and rest. Again\\nand again he swung himself around until he experienced the same\\neffect, the sensations becoming more positive and intense. The\\nnext day, on trying the same experiment, the tingling sensations\\nterminated in an orgasm. This led him to a closer examination of\\nhis organs, and also to new methods of increasing the same excite-\\nment, until finally he became a confirmed masturbator.\\nAnother, a patient now under treatment, said that the first\\ntime he ever felt pleasurable sensations in his genitals was while\\nhe was engaged in sliding down the mast of a whale-boat. The\\nfirst repetition of the exercise produced an orgasm, and from that\\ngrew the habit for which he was under treatment. A somewhat\\nsimilar history has been given me by others, one a female, who\\nlearned the art by sliding down the stair-balusters. Lallemand\\nrelates the case of a boy who commenced masturbating by strad-\\ndling down transverse bars, and another who excited himself\\nwhile hanging by the arm, and thus sustaining the whole weight\\nof the body.\\nAs a result of excessive unnatural indulgence these subjects\\nlose their manliness, moral courage, and frankness of expression.\\nThey become secretive and seek seclusion rather than exercise and\\n1 Excessive Venery, etc. New York, 1884, pp. 65 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0308.jp2"}, "309": {"fulltext": "MASTURBATION IN MALE SUBJECTS. 289\\nsports in the open air with their companions. In these cases the\\nmind becomes centred on the genital organs, and the effect is to\\ndebase the moral standard. Some of these boys after a time be-\\ncome depressed in mind by the knowledge that they are victims\\nof the indulgence in a secret habit. In perhaps the majority of\\ninstances, when the environments are favorable and the surround-\\ning influences are in the right direction, the bad habit is discon-\\ntinued, and the whole morale of the boy undergoes a total change.\\nIt is very probable that the emissions which occur from mastur-\\nbation have little, if any, lowering effect upon the general health\\nof the subject. In very early years the ejaculate is simply pros-\\ntatic and urethral follicular mucus, and its loss per se is not\\nserious. Later on true semen may be emitted, but in most cases\\nthe amount lost at each indulgence is very small indeed, and most\\ncommonly it is simply the secretion of the seminal vesicles and of\\nthe ampullae.\\nIn exceptional cases the bad habit is persisted in, and then more\\nor less serious mischief is produced. Probably 2 per cent, of all\\ncases seen at venereal clinics are those of young men who suffer\\nfrom the results of masturbation. The first and most obvious bad\\nresult of masturbation is lowering of the moral standard, as we\\nhave already seen.\\nIt is well to remember that in masturbators the normal sexual\\ndesire is absent, and the orgasm is produced by artificial friction\\nand by brain-effort, which results from libidinous thoughts. The\\nnatural stimulants to sexual desire are also absent, and the act is,\\ntherefore, forced, unnatural, and abortive, and is very commonly\\nfollowed by much temporary mental oppression and nervous agita-\\ntion.\\nIt must also be borne in mind that this act is committed by\\nboys when the sexual apparatus is in a state of growth and devel-\\nopment and when the sexual centre has not yet been thoroughly\\ndeveloped by time and healthy processes. The growing prostate\\nand the developing seminal vesicles and ampullae are thus acted\\nupon by abnormal stimulation and by actual nervous shocks.\\nThis naturally explains why excessive and prolonged masturba-\\n19", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0309.jp2"}, "310": {"fulltext": "290 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ntion in the young is more disastrous in its effects than it is in\\nolder subjects whose sexual organs have attained full develop-\\nment without damage during youth.\\nThe actual physical damage which results from masturbation\\noccurs, therefore, in the sexual tract. The first morbid effect is\\nhyperemia of the bulbous urethra, which is soon transformed into\\ntrue catarrhal inflammation. This morbid state creeps backward\\nand involves first the mucous membrane of the prostatic urethra,\\nthe verumontanum, and the sinus pocularis, and may attack the\\nprostatic tubules in part or in totality. Then, in bad cases the\\nmorbid process extends through the ejaculatory ducts and attacks\\nthe ampullae and the seminal vesicles. Thus there is produced a\\nlow grade of catarrhal inflammation, which extends from the bulb\\nbackward to the seminal vesicles and tends to lower the tonus and\\nresiliency of these parts.\\nThe mucous membrane becomes thickened and of a deep red\\nand even purplish color, and from it a thick mucous secretion\\nescapes. In some of these cases blood follows the onanistic act\\nor is observed more or less constantly after urination.\\nIn somewhat exceptional cases of confirmed and inveterate\\nmasturbation, particularly in boys approaching or during puberty,\\nthe orgasm is produced not by manipulation by the hand, but by\\nthe introduction into the urethra as far down as the bulb or the\\nprostatic urethra of some flexible instrument, which by titillation\\nirritates the parts, particularly the verumontanum. The instru-\\nments used are sounds and bougies, pieces of wire bent so that\\nthey can be introduced, or pieces of white wax moulded in the\\nform of bougies.\\nIn many cases there is more or less just complaint of relaxation\\nand numbness or oversensitiveness of the scrotum and of a sense\\nof softness of the testicles. Darkness of the skin of the penis,\\nthickening of the mucous membrane of the prepuce, and density\\nof the corpora cavernosa are found in many chronic masturbators.\\nThen, again, the unnatural orgasms act as damaging shocks upon\\nthe nervous system, which then becomes deranged in its totality,\\nand as a result the whole economy is more or less thrown into an", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0310.jp2"}, "311": {"fulltext": "MASTTJRBA TION IN MALE S UBJECTS. 291\\nabnormal state. With the development of the lowered nervous\\ncondition, and as a result of the irritation transmitted backward\\nfrom the prostatic urethra, veriunontanum, and prostate the integ-\\nrity of the sexual centre is disturbed, and it is thrown into a con-\\ndition of excitation and of decided irritability and incompetence.\\nAll these sexual and mental disturbances result in a vast array of\\nmorbid symptoms, physical and psychical.\\nMany cases are on record in which the habit of masturbation\\nis but one of the symptoms of men who are decidedly weak in\\ntheir mental and moral conditions. As an instance of depravity,\\ndue to central nervous disorder, the following case 1 is very striking\\nThe patient was a gentleman, twenty-two years old, who was seem-\\ningly healthy, but disposed to be taciturn and retiring in his\\nhabits. He came of perfectly healthy stock. One evening after\\na generous dinner he retired to his room and locked the door.\\nHis mother, anxious in consequence of his behavior when at the\\ntable, followed, and through the keyhole saw him, erect and fully\\ndressed, engaged in the act of violent masturbation. This com-\\npleted, he threw himself on his bed in his clothes and slept.\\nThe mother informed the father of what she had seen, and there-\\nafter the young man was closely watched.\\nXine days afterward the patient left his friends at a picnic party\\nin the woods, and this time the father followed him and witnessed\\nthe same scene as before. After returning home in the evening\\nthe parent sternly reprimanded his son for his misconduct, when\\nthe latter informed him that he was very miserable, that for more\\nthan a year he had been subject to attacks of a furious sort in\\nwhich masturbation became an irresistible necessity. He begged\\nhis father s forgiveness and promised that w T hen he next had pre-\\nmonitions of his trouble he would inform his friends, who might\\nthen secure his hands behind his back.\\nAfter dining a few days later he notified his father that he was\\nabout to be affected as before, and would soon be almost uncon-\\nscious of what he was doing. His hands were immediately bound\\n1 L Annee Medicale Caen, Xo. 1, Tome ii. p. 7, December, 1876.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0311.jp2"}, "312": {"fulltext": "292 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nfirmly behind his back, when he was at once seized with a convul-\\nsion that lasted for ten minutes. He fell to the ground, his respi-\\nrations became accelerated, his face pallid and satyr-like. He\\nalso uttered hoarse cries in a strange voice. His father, thoroughly\\nalarmed, hastened to liberate his son s hands, when the latter at\\nonce arose, and in the presence of both his parents proceeded to\\nperform the act of masturbation in the most furious manner,\\nwithout pausing an instant. This over, he burst into tears, and\\nconcluded by falling asleep as usual.\\nThis man had no sexual desire. The first intimation he would\\nhave of the attack would be an insupportable pain in the back\\npart of the head, occurring sometimes an hour or two before,\\nsometimes immediately after meals then there would be an erec-\\ntion of the penis and unconsciousness of subsequent events, so\\nthat the presence of strangers presented no bar to the execution\\nof the act. On one occasion of this sort, when observed by his\\nphysician, the latter describes his condition as very disgusting\\nhis face was pallid, his features distorted, and saliva escaped from\\nhis mouth. Under careful hygiene and symptomatic medication\\nthis man recovered. Leeches were regularly applied to his neck.\\nA striking instance of periodical insanity with intense sexual\\nimpulse is worthy of brief mention. The father of the victim\\nwas a neuropathic and addicted to sexual excesses, who died of\\ncerebral disease. The patient up to his twenty-ninth year was\\nsexually normal. At that time he suffered from concussion of\\nthe brain due to a fall. After this accident every three or four\\nmonths the man was seized with such an intense desire to mastur-\\nbate that wherever he happened to be, and no matter who were\\npresent, he at once exposed his organ and frantically performed\\nthe act. The sight of women seemed to cause the morbid seizure.\\nWhen the frenzy passed away he would become calm, regain his\\nself-control, and sorrowfully regret the act. He was sent to an\\nasylum for a time, but was later on discharged. This really was\\na case of exhibition insanity with intense sexual fervor. 1\\n1 Krafft-Ebing Psychopathia Sexualis. Stuttgart, 1891, pp. 298 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0312.jp2"}, "313": {"fulltext": "MASTURBATION IN MALE SUBJECTS. 293\\nSymptoms. In the first place, the function of urination is more\\nor less impaired. Frequent micturition is very commonly com-\\nplained of, and in many patients there is more or less mild incon-\\ntinence or dribbling of urine after the act. In very bad cases\\nsuch is the hyperemia of the mucous membrane of the bulbous\\nand prostatic urethra that the passage of urine causes a severe\\nscalding sensation (sometimes compared to the insertion of a hot\\niron in the canal), and toward the end of the act a more or less\\ncopious flow of blood. In some cases at the end of the act there\\nis decided pain in the prostate, resulting from its physiological\\ncontraction. Examination of the affected portions of the urethra\\nby means of the endoscope shows a thickened and inflamed con-\\ndition of the mucous membrane, very often with marked swelling\\nof the veruniontanum aud of the orifices of the sinus pocularis\\nand of the ejaculatory ducts. In these cases the passage of goodly\\nsized bougies a boule (24 to 30 French) causes great pain in the\\ndeep urethra, and very often a flow of blood.\\nWhen the finger is introduced into the rectum and the pros-\\ntate is carefully explored, it is usually found that this organ is\\nin part or in whole swollen and sensitive, and that pressure upon\\nit causes the escape of mucus from the urethra. (See pp. 240\\net seq.) If the examination is pushed further it may be dis-\\ncovered that the ampullae and seminal vesicles are tender and\\ndistended.\\nAs a result of these lesions of the sexual organs and of the\\nnervous disturbances there is usually more or less impairment of\\nthe sexual function. Such patients, when attempting coitus, find\\nthat they are sexually weak, although they may have normal de-\\nsire. Their erections are either absent or incomplete, or, if normal,\\nthey last but a short time. As a result, the power of intromission\\nis more or less lost, and, when present, the performance of coitus\\nends in premature ejaculation. In some of these cases vigorous\\nerections occur at times when the patient is not near a woman,\\nbut they fail utterly when in close proximity.\\nSuch cases form a large contingent of the class designated under\\nthe title symptomatic impotence.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0313.jp2"}, "314": {"fulltext": "294 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThese patients are further tormented with nocturnal emissions,\\nwith or without erotic dreams, also with daytime pollutions, which\\nmav follow defecation or urination, or be caused by muscular\\nefforts, or by the simple presence of a woman.\\nThe ill-health which is developed in consequence of excessive\\nmasturbation may be expressed by the terms anaemia and neuras-\\nthenia. Neurasthenic masturbators never cease complaining of\\nall forms of morbid symptoms. The following list taken down\\nverbatim as it was rattled off by the patient may serve as a good\\nspecimen of these wails. He said he suffered from insomnia, pain\\nin the head (occipital and frontal), in the eyes, back, down legs\\nand feet, and in the body felt nervous when he walked or\\nworked was more tired in the morning than at night, and felt\\nmentally depressed had frightened dreams at night his memory\\nwas failing had ringing of bells in his ears and palpitation of the\\nheart on the least exertion, and often suffered from shortness of\\nbreath fever flashes at night, and then he feels hot and feverish\\nhas cold, clammy hands and feet gets very dizzy if anyone looks\\nat him in both eyes, and has no appetite and is troubled with consti-\\npation. He wound up by claiming that he had very sensitive and\\nalso numb spots and blotches over the whole body. Many cases\\nare much less severe and the patients only complain of a few\\nsymptoms.\\nIn more severe (and we may say desperate) cases the symptoms\\nare more accentuated, the psychical condition is much worse, and\\nmarked hypochondriasis may develop. In some of these cases\\nthe mental condition of the patient is rendered infinitely worse\\nby the persistency of the pollutions and the unceasing loss of\\nerections and power of intromission.\\nIn some cases in which masturbation has been moderately in-\\ndulged in, and in which no permanent harm has been done to the\\npatient, the recollection of the early transgression may cause want\\nof confidence and timidity in attempting coitus. In such a case,\\nthough there may be one or two preliminary failures, the patient\\nshould not be discouraged, since success will come by repetition,\\nespecially if warm encouragement is given by the surgeon.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0314.jp2"}, "315": {"fulltext": "MASTUBBA TION IN MALE SUBJECTS. 295\\nIn later life the recollection of early indulgence in masturbation\\nvery often comes to a man s mind, and is wrongly considered the\\ncause of sexual weakness, which is usually due to conditions\\nwhich developed long afterward.\\nTreatment. Infants addicted to masturbation should be treated\\non a mechanical basis that is, such measures and appliances\\nshould be adopted as will prevent the child from touching his\\ngenitals.\\nIn young boys the indications are to break up the habit as\\nsoon as possible. To this end much careful watching is neces-\\nsary, and reprimand and good counsel should be judiciously used.\\nIt is always well, when this habit is suspected, not to allow the\\npatient to sleep with another boy. In such cases the boy should\\nnot be kept closely at his studies, but should be encouraged to in-\\nterest himself in sports and games and out-door pastimes. It is\\nnot well to terrify these boys, since good, wholesome advice and\\nkindly treatment, persuasion, and sympathy will do more toward\\nbreaking up the bad habit than fear and punishment will. In some\\nbad cases, however, it may be necessary to apply every night an\\nadjustable apparatus made out of tin or wire, like short drawers,\\nwhich will cover over the genitals and buttocks and can be locked,\\nso that the patient s hands cannot reach his penis. By this pro-\\ncedure much benefit may be produced.\\nIn the cases of masturbators suffering from nervous, cerebral,\\nand spinal diseases the central condition should receive most atten-\\ntion. Such cases, however, are very rarely benefited by any form\\nof treatment, either moral, coercive, pharmaceutical or mechanical.\\nIn some incorrigible cases of old and insane masturbators ex-\\ncision of a portion of the nerves of the penis near the root of the\\norgan may cause the cessation of the habit. Clark 1 reports the\\ncase of a man thus operated upon who was thereby much benefited.\\nBoys at and beyond puberty usually are afflicted, as we have\\nseen, with diseases of the sexual apparatus, and these should\\nreceive especial attention in the way of careful and continuous\\nlocal treatment.\\n1 Lancet, September 23, 1898.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0315.jp2"}, "316": {"fulltext": "296 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nPeripheral irritation very often leads, as we have already seen,\\nto more or less confirmed masturbation. When the patient is\\nfound to have phimosis he should be promptly circumcised.\\nAdhesions of the prepuce and smegma retained in the preputial\\nsac should receive proper surgical treatment in most cases, prefer-\\nence being given to circumcision. In the rather rare cases of\\ncongenital stricture of the urethra, internal urethrotomy should\\nbe performed. Erections caused by stone in the bladder call for\\nproper surgical relief.\\nBy local treatment to the urethra and prostate much can be\\ndone for the relief of these patients. When the urethra is the\\nseat of chronic congestion, irrigation with weak solutions of nitrate\\nof silver, beginning with a strength of 1 to 10,000 and gradually\\nincreasing them to 1 to 5000 and 1 to 1000, will be very benefi-\\ncial. When the irritability of the urethra has become less marked\\ninstillation of the silver salt, 1 to 500 to 1 to 250, may often be\\nresorted to with excellent results. When the prostate has been\\naffected it will be necessary to treat that condition according to the\\ndirections given on page 257. In many cases the occasional intro-\\nduction of the cold steel sound will tend to allay urethral erethism.\\nThe indications for general methodical treatment in boys and\\nmen are, as far as possible, to restore the health and to improve\\nthe moral tone of the patient. Such drugs as have a decided tonic\\naction should be given, such as iron, quinine, strychnine, phos-\\nphorous preparations, arsenic, and perhaps the animal-extracts by\\ninjection. Bromide of potassium is sometimes beneficial when\\nthere is great erethism and to prevent pollutions. Belladonna,\\nconium, gelsemium, cannabis indica, piscidia erythrina, antipyrin,\\nand hyoscyamus may also be used in these conditions. Sea and\\nmountain air, cold baths, healthy out-door sports should be advised,\\ntogether with faradization and massage.\\nSuch patients should eat good, wholesome food without much\\nspicing they should eat sparingly at night should sleep on a\\nhard mattress, with light covering, and in a cool, well- ventilated\\nroom. They should retire when they are tired and sleepy, and\\nget up as soon as they awake in the morning.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0316.jp2"}, "317": {"fulltext": "CHAPTER XXII.\\nSEXUAL EXCESSES AND SEXUAL ERETHISM.\\nTo sexual excesses much more harm to the economy is attributed\\nthan the facts of the case really warrant. In many cases sexual\\nexcesses are committed by persons who previously had suffered\\nfrom the effects of masturbation, and then the consequences may\\nbe severe.\\nYoung men, particularly those newly married, are sometimes\\nguilty of over-indulgence in coitus, and as a result they may be-\\ncome debilitated or perhaps neurasthenic. But in these cases the\\npassion is spasmodic, and it generally ceases with the loss of\\nstrength. Then, as a rule, moderation in sexual matters is\\nobserved, and the condition of the health receives proper atten-\\ntion, and in the end no permanent harm may be done to the\\nsystem or the genital tract. The same remarks apply to over-\\nindulgence in young unmarried men.\\nIt is well to remember that sexual capacity varies greatly in\\ndifferent individuals, and that what would be excess in one person\\nmay be considered by another to be about the average of normal\\nindulgence.\\nAs some men grow older they may indulge to excess sexually\\nas well as with alcoholics, and as a result ill-health is induced.\\nIn these cases a general reform is usually followed by the resto-\\nration of health, if the patient is not also suffering from the\\nphysical effects of early masturbation. When, with the maturity\\nof the man, the sexual apparatus and the nervous system are per-\\nfectly healthy, he, as a rule, can undergo, without permanent\\ndamage, severe and prolonged sexual and alcoholic indulgence,\\nprovided these excesses do not extend over too long a period.\\nIn these cases nature often shows remarkable powers of recupera-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0317.jp2"}, "318": {"fulltext": "298 SEXUAL DISORDERS OF THE MALE AND FEMALE\\ntion, and unless she is too severely overwrought, she can, in time\\nand by means of care on the part of the patient, efface the effects\\nof over-indulgence. The truth of this statement will be obvious\\nto those who have seen many such cases, in which it seems remark-\\nable that a man can retain his health and virility in spite of pro-\\nlonged and excessive sexual and alcoholic indulgences.\\nIn those cases in which men thus put a strain upon nature year\\nafter year, as time goes on sexual weakness may develop, and\\nbeyond the fortieth or fiftieth year they may become partially or\\nwholly impotent. But in these cases there are often other factors\\nin the decay besides those just mentioned. Such men may lead\\nirregular lives, they may also tax their nervous system by engross-\\ning projects and schemes which involve worry, doubt, and fear, so\\nthat in also every particular their course of life is unhygienic. It\\nis natural, therefore, that in the resulting physical and mental\\nunsoundness the sexual function should be more or less im-\\npaired.\\nSexual excesses by means of bestial practices, especially coitus\\nab ore, in many instances lead to ill-health, and in some cases to\\ngeneral paresis. But in these cases, as a rule, too much promi-\\nnence, I think, is attributed to the sexual errors, and other damaging\\nfactors are not fully considered. As a rule, men who thus over-\\nindulge err in almost every direction of life. They are irregular\\nin eating, drinking, and in going to bed sit up late in stuffy rooms,\\nplaying cards and drinking, and they do nothing whatever in the\\nway of hygienic reparation. It can readily be seen that under such\\nconditions sexual excesses may ultimately lead to the man s down-\\nfall. But there is still another powerful factor at work in many of\\nthese cases namely, chronic syphilis (in many cases there may\\nbe antecedent arterial or connective tissue degeneration in the\\nbrain and cord) the influence of which should be thoroughly\\nborne in mind. According to my observation, the nervous and\\ngeneral break-down of men which is commonly attributed to sexual\\nexcesses, and particularly to immoderate coitus ab ore, has, as pow-\\nerful contributory factors, first, a general unhygienic mode of life\\nsecond, alcoholic over-indulgence and, third, chronic syphilis. It", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0318.jp2"}, "319": {"fulltext": "SEXUAL EXCESSES AND SEXUAL ERETHISM. 299\\ncan readily be seen that excessive sexual strain in snch individuals\\nwill inevitably lead to mental and perhaps physical decay.\\nTreatment. The first indication is to bring about a cessation\\nof the excesses and then to establish a condition of normal sexual\\nhygiene. The general health of the patient should be carefully\\nlooked into, and any morbid condition should be promptly cured.\\nThe surgeon should lay stress upon the avoidance of all sources\\nof sexual excitement (lewd women and men, lascivious pictures,\\nobscene books, etc.), and should pay particular attention to im-\\nproving the morale of the patient. A careful and searching phys-\\nical examination should be made, and if any part of the sexual\\ntract is found to be damaged it should receive careful topical treat-\\nment. Little can be done to cure men suffering from nervous\\ndecay from the causes just mentioned.\\nSEXUAL ERETHISM.\\nThe intensity of sexual desire and passion varies markedly in\\ndifferent individuals. In some it is very moderate, in others it is\\nmore pronounced, while in a few it is very strong and enduring.\\nIn cold and moderate climates, as a rule, the sexual appetite is\\nnot excessively fervent, whereas in hot countries it is a constant\\nand dominating force. As a rule, among Americans the sexual\\nappetite is fairly well developed, and in the majority of cases it\\nis held well under control. In some exceptional instances we find\\nyoung men who are in a constant condition of sexual erethism, to\\nsuch an extent that it impairs their usefulness in life. Thus, we\\noccasionally meet with cases of young men who, when they asso-\\nciate with young women in business affairs and in social life, be-\\ncome so sexually excited that their condition is betrayed, or who\\nfrom fear retire from such association. Some young men employed\\nin shoe stores have been kuown to lose their heads when fitting\\nshoes on ladies feet and in other pursuits and businesses the asso-\\nciation of the sexes is often interfered with by the abnormal sexual\\nerethism of the male. This rather abnormal state is not at all\\ncommon in the female.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0319.jp2"}, "320": {"fulltext": "300 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nGuelliot 1 reports a very interesting case of sexual erethism. It\\nwas that of a highly nervous man of twenty-three years of age.\\nFrom his fifteenth year such was the excitability of his genitals\\nthat the least touch on the glans penis produced ejaculation. At\\nthe age of twenty-three this man had coitus eleven times in one\\nafternoon without fatigue with a woman suffering from nympho-\\nmania. It is stated that from that time on this man could undergo\\nseven ejaculations a day.\\nIn many of the colored race such are their brutal licentiousness\\nand the exaltation of their sexual appetite that negroes are con-\\nstantly conniving at the commission of rape.\\nI once saw a gentleman who suffered from persistent sexual\\nerethism for years until he voided an oxalate of lime calculus from\\nhis prostatic urethra.\\nWe also see instances in which men beyond fifty or fifty-five\\nyears of age become the victims of an annoying sexual desire,\\nand, strange to say, many of them are able to indulge in coitus\\nwith all the vigor and reserve force of a man of thirty. In all\\nprobability the irritative structural and degenerative changes\\nwhich are taking place in the prostate are at the root of this\\nsenile sexual erethism.\\nThere is a class of cases of inordinate sexual desire in the\\nmale, to which attention was first directed by Beard, 2 which de-\\nserves special mention. In the majority of these cases the sub-\\njects of this trouble are educated, intellectual, moral, and religious\\nmen, of exceeding sensitiveness of nature, most of whom shrink\\nin horror at the contemplation of their condition. I have had a\\nnumber of such cases under my care from time to time, but none\\nof them gave such a graphic account of their condition as that\\npresented by one of Beard s patients, which I will transcribe.\\nBeard says A clergyman, aged forty years, came to my office,\\nand, after long delay and marked hesitancy and confusion of\\nmanner, related substantially the following history I am/ he\\nsaid, i in a most lamentable, even desperate, condition. I fear\\n1 Op. cit., p. 214. 2 Sexual Neurasthenia, pp. 273 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0320.jp2"}, "321": {"fulltext": "SEXUAL EXCESSES AND SEXUAL ERETHISM. 301\\nthat my memory is deserting me, and that I bid fair to become\\nboth a mental and physical wreck. He appeared healthy, and\\nhis mind, when directed from his trouble, was as vigorous as ever.\\nHe had been married but five years, and by mutual agreement,\\nbased on their ideas of personal purity and religion, and perhaps\\nalso on an almost complete lack of sexuality on the part of his\\nwife, he had to a considerable degree suppressed sexual inclina-\\ntions that were naturally very strong. He did not, however, be-\\ncome unbearably annoyed through these efforts of repression until\\nsome two years ago, when priapism would occur and continue for\\nhours, diverting his mind from study and irresistibly directing his\\nthoughts in such licentious channels that he became at times over-\\nwhelmed with anguish and despair. Intercourse brought only\\npartial and temporary relief, and sometimes he would lie awake\\nfor hours, after a repetition of this natural effort for relief, with\\nerections that would not subside. He was in constant fear that\\nhe would commit some act of folly when alone with certain of\\nhis female parishioners, and for this reason resorted to methods\\nand excuses to avoid meeting them alone that he thought might\\nseem to them strange and inexplicable. This worried him greatly\\nalso. This patient had been operated upon, without result, for\\nredundant prepuce. He had mild hemorrhoids and varicocele.\\nHe was treated by good hygiene with bromides and bitter tonics,\\nand assurances of recovery were held out to him.\\nAs a result of treatment he says I have a good, healthy\\nimagination, almost free from voluptuous images. Again, instead\\nof the unsatisfied burning desire for sexual intercourse which came\\nagain and again during the day and night, the desire is now very\\nmoderate and at times not perceptible. Instead of repeated erec-\\ntions when alone, all seems comfortable and quiet. Only one of\\nthe symptoms I spoke of still remains, and that is the insane\\ndesire to take hold of women (who perhaps tempt me), to caress\\nand fondle them, and play with them. The presence of certain\\nwomen excites my passions, but by no means in the same manner\\nas before. Please remember that I never took liberties with\\nwomen in former years, and that I have not yielded to this de-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0321.jp2"}, "322": {"fulltext": "302 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nsire, no matter how strongly tempted, yet I find it remains. My\\nwife is a very chaste woman, and she regards my desire to fondle,\\nlook at, and admire her form as signs of manly weakness. She\\nthinks yielding to these things only hurts me and excites my pas-\\nsions. The desire to look at and fondle women is much stronger\\nthan the longing to have intercourse with them. If this terrible\\nlonging is clue to some disorder of my system, I want the physi-\\ncian s help if it comes from a wicked heart, I ll fight it till the\\nday of my death. You perhaps can help me to decide. In this\\ncase Beard says that good advice and the sedative effects of the\\nbromides produced a cure. My own experience in these cases\\nhas taught me that in general there is some deep-seated trouble\\nin the sexual tract, which has been caused by early and chronic\\nmasturbation (perhaps by chronic gonorrhoea) and by the conges-\\ntion of the sexual parts which results from prolonged indulgence\\nin libidinous thoughts and from dalliance with women without\\ncoitus.\\nTreatment. In all cases a thorough examination of the patient\\nshould be made as to his general condition mental and physical.\\nCare should be taken that the general nervous system is improved\\nby fresh air, healthy out-door exercise, cool bathing, change of air\\nand scene if possible, and by the use of good, simple, nutritious\\nfood. A thorough examination of the genito-urinary tract should\\nbe made, and if any structural damage is discovered it should be\\ntreated on the general lines laid down for the management of\\nchronic urethritis, prostatitis, and seminal vesiculitis. Vide\\nsupra.) Bromides and sedatives may produce temporary relief,\\nbut they can hardly be expected to cause a cure.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0322.jp2"}, "323": {"fulltext": "CHAPTEE XXIII.\\nSPEKMATOKKHCEA.\\nIn the light of our present knowledge of the morbid conditions\\nof the prostate, deferential ampullations, and seminal vesicles, and\\nchronic urethral inflammation, the subject termed spermatorrhoea\\ncan be lucidly elaborated in a few pages, whereas in the past, when\\nthe scope and exact nature of this symptom were not clearly\\nknown, many pages and even volumes were required to tell what\\nwe really did not know. In the past spermatorrhoea has been\\nthe bugbear alike to the layman and the surgeon, while to-day the\\nterm itself is a misnomer as applied to most cases, and when used\\nin any connection it is unprecise and unscientific.\\nAs has already been shown in the chapters on Chronic Prosta-\\ntitis and on Masturbation, the abnormal discharges observed in\\ncases belonging to these categories are, as a rule, not of seminal\\nfluid, but of a morbid prostatic mucus with perhaps a few zoo-\\nsperms. Patients who have masturbated excessively in youth,\\nand who have damaged their prostates, ejaculatory ducts, and\\nthe seminal vesicles, fall into a condition of ill-health in which\\nhypochondriasis and neurasthenia are prominent symptoms. The\\nphysical and moral tone of these individuals is very much low-\\nered their thoughts are centred on the genital organs during the\\nday and they dream of erotic subjects at night. In this mild state\\nof moral degradation the whole economy seems to go wrong, and\\nsuch patients complain without ceasing of an infinitude of morbid\\nsymptoms. They talk and reason, as a rule, in a prolix and in-\\ncoherent manner, and are, day by day, thrown into a condition of\\npanic by the escape of a small amount of prostatic mucus, which\\nthey speak of as seminal fluid, the loss of which they regard as so\\nserious and so devitalizing to their health. Now, these cases may\\nbe summed up in the following way First, young men who, as a", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0323.jp2"}, "324": {"fulltext": "304 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nresult of masturbation and perhaps gonorrhoea, notice after urina-\\ntion, defecation, or hard labor, and in their sleep, the escape of a\\nfluid which comes from the prostate. Second, cases in the same\\ncondition, plus a little discharge, due to relaxation from chronic\\ninflammation of the ejaculatory ducts, the ampullations, and the\\nseminal vesicles. Third, older men, in whom gonorrhoea and\\nsexual excesses have reacted on all the seminal parts, and who,\\nspontaneously or in urination, or at stool, or in excesses, notice a\\nquite copious secretion, which consists, in some cases, of prostatic\\nmucus (see p. 248). and also of the secretions of the seminal vesicles\\nand of the ampullations. In these three categories may be in-\\ncluded all the cases to which the term spermatorrhoea may in any\\nway be applied. As we shall see a little further on, more or less\\nperfected seminal fluid may escape in some individuals, but the\\nunderlying conditions are not those of disease. The so-called\\npollutions and emissions of chronic masturbators are, as a rule,\\ngrossly exaggerated as to their copiousness and frequency of occur-\\nrence. These patients come to the surgeon with a sorry story of\\nthe great extent of their seminal losses. The truth is that in\\nmost cases the morbid mucus which escapes during the day or\\nnight is very small in quantity. Sometimes it consists of only\\na few drops, and rarely, if ever, amounts to half a teaspoonful.\\nThe tendency to morbidly exaggerate these so-called seminal losses\\nis so prevalent that the truth can hardly be obtained by the sur-\\ngeon. I have for several years investigated this subject under\\nvarying conditions of difficulty, and I have reached the conclusion\\nalready stated.\\nTo my mind, the terms defecation-spermatorrhoea and urination-\\nspermatorrhoea are unscientific and unnecessary, and they do harm\\nby reason of their ominous significance. The real facts are that\\ncertain mechanical conditions (the chief of which is abdominal\\npressure) cause a little morbid mucus to escape from a damaged\\nprostate or in consequence of a relaxed condition of the seminal\\nparts above. In like manner, I think that that ill-sounding term\\npollutions is a sort of a pathological scarecrow. These, for the\\ntime, unbalanced boys and men have in their prostates and deep", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0324.jp2"}, "325": {"fulltext": "SPERMATORRHEA. 305\\nseminal parts a focus of irritation which may during sleep disturb\\nthe sexual centre, already in a condition of erethism, and this dis-\\nturbance reacts in its turn badly on the unstable nervous system.\\nThe erotic dreams that are so much written and talked about are\\nmerely the result of a damaged sexual sphere and a general nervous\\ndepression. What is needed in the management of these cases is\\nthe recognition of the morbid condition of the sexual organs, and\\nwhen a correct diagnosis of the case has been made there is no\\nnecessity for refinement and elaboration in the details of unpleasant\\nsymptoms the importance of which is always unduly magnified.\\nMost of these cases are much troubled about their loss of man-\\nhood (and quacks foster this idea), and they are really made worse\\nby the perusal of the ordinary treatises on spermatorrhoea, with\\ntheir unsavory symptom-complex. My experience has taught me\\nthat a great step is gained if by scientific methods we can demon-\\nstrate to these worried individuals that they are deceiving them-\\nselves as to the quantity of morbid mucus lost, and that sperma-\\ntozoa are not commonly found in it, and, if found, only in small\\nquantities.\\nWith our more precise knowledge as to the nature of these\\ncases, and our more practical methods of treating them, we shall,\\nno doubt, as time goes on, see less chronicity of their course and\\nvery much less of the resulting mental depression and lowered\\nhealth.\\nMany continent men notice at times, owing to abdominal press-\\nure or severe exercise or straining, the escape of a mucoid fluid\\nfrom the meatus. In many instances this secretion is simply\\nprostatic mucus, and in others it comes from the ampullations and\\nseminal vesicles. This condition is a very simple one, being only\\nthe partial removal of a plethora. When it occurs frequently it\\nmay, in nervous individuals, cause anxiety and dread, but it\\nspeedily ceases with the adoption of a rational sexual hygiene.\\nA large amount of loose statement and exaggeration has been\\nmade regarding nocturnal pollutions and their supposedly disas-\\ntrous effects. The pollutions of young or older masturbators are,\\nas we have seen, the complex outcome of sexual damage, and\\n20", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0325.jp2"}, "326": {"fulltext": "306 SEXUAL DISORDERS OF THE MALE ALD FEMALE.\\nspinal cord and general cerebral depression and weakness. Now,\\nit is obvious that in healthy men these conditions do not exist,\\ntherefore the occurrence of an occasional emission is not followed\\nby harmful results. According to my experience, most men who\\nhave these emissions seek and obtain the remedy in coitus. Some\\nmen, of a timid and nervous temperament, however, who have\\nmoral scruples, will not indulge in sexual intercourse, and, in\\nsomewhat exceptional cases, their genital centre becomes irritated\\nand the general health lowered. These cases, however, are not\\nvery numerous, and by proper advice can be benefited and cured.\\nIt is impossible to say what number and what frequency of\\nemissions may occur without damage to the individual, since some\\nmen are sexually vigorous and others are the reverse. I have\\nknown many men to have several emissions a week for a long\\ntime, and yet their health was not at all affected whereas in\\nothers I have seen one such discharge in a week, or ten days, or\\nless, followed by mental depression and physical debility. When\\na man is mentally and physically strong and vigorous, and is up\\nand about in a lively way, a few and perhaps many nightly ejacu-\\nlations will do him no harm. But a weakly, neuropathic man\\nwith a worrying tendency, who shuns society and does not in-\\ndulge in healthy exercise, may become much reduced. In these\\nparticular cases, however, the mind, by dwelling on the seminal\\nloss and the portent of possible impotence, is the chief factor of\\nill-health. In all cases it is important to establish a wholesome\\nstate of sexual hygiene.\\nIMAGINARY SPERMATORRHEA.\\nMany young men who have indulged even moderately in mas-\\nturbation imagine in subsequent years that, as a result of their\\nformer habit, they are then suffering from spermatorrhoea. This\\nidea is mendaciously set forth in the pamphlets of and in personal\\ninterviews with advertising quacks, and it causes in many patients\\nmuch worry and anxiety. Some of these patients have no symp-\\ntoms except those they conjure up in their minds, while in others", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0326.jp2"}, "327": {"fulltext": "SPERMATORRHOEA. 307\\nsome slight deviation from a normal condition is magnified into a\\nserious evil.\\nIn most men in periods of sexual excitement a perfectly clear,\\nviscid mucus escapes in small or large quantity from the meatus.\\nIt is the secretion of Cowper s glands and of the urethral fol-\\nlicles therefore, it is perfectly normal in every respect. After\\ndalliance with women men notice this secretion, and some become\\nmuch alarmed, as they think they are losing semen. In young\\nand strong courting men (when the engagement is rather long\\nand the mutual affection between lover and fianc e is very intense)\\nsexual excitement in the male is often so great, and this Cowper s\\ngland secretion occurs so constantly and so copiously, that much\\ndisquietude of mind is felt by them. Some men even become\\nhypochondriacal and neurasthenic. The trouble in these cases is\\nthat the excitement cannot be allayed by coitus. It cannot be too\\nclearly understood that this condition is a perfectly harmless one,\\nand that it will cease at once when marital relations are established.\\nThis condition is called urethorrhcea ex libidine. In some cases\\nthis secretion escapes during erections at night.\\nSome patients, having recovered from gonorrhoea, may see for a\\ntime a little harmless, clear mucus within the meatus, and others\\nwho have not had gonorrhoea may see the same. They run to the\\nsurgeon, milk out with more or less firm squeezing a little secre-\\ntion, and then look the picture of woe, and claim that they are\\nlosing their manhood. In other cases the declining and scanty\\ngonorrhoeal secretion which escapes from the urethra, or the few\\nthreads which yet may be seen in the urine, are looked upon by\\nmany as loss of semen, and they are more or less unhappy. Dur-\\ning the condition of involution which occurs after the subsidence\\nof congestion of the prostate a little harmless prostatic mucus\\nmay escape from the urethra, particularly after defecation, and\\nthis may by some be looked upon as a sign of evil omen.\\nNervous and worried patients bring to the surgeon specimens\\nof urine which they erroneously think contain spermatozoa.\\nSome overworked and neurotic young men who may not have\\na full, liberal diet, and who eat a preponderance of vegetables,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0327.jp2"}, "328": {"fulltext": "308 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nnot infrequently bring to the surgeon specimens of slightly acid\\nurine of low specific gravity, which has a peculiar opaque color\\nbordering on a milky tint. The constant passage of this phos-\\nphatic urine, and perhaps the thought that in boyhood he had\\nmasturbated, result in convincing the patient that he is losing\\nseminal fluid. Others become likewise worried about the presence\\nof urates in their urine. Quacks find these individuals pliant and\\noft-returning victims. In these cases it is important for the sur-\\ngeon to remember that a condition of lowered health may exist,\\nand that in some instances these patients are somewhat neuras-\\nthenic. The most convincing evidence for such individuals is the\\naddition in their presence of a little acetic acid to the urine, which,\\nif it contains much earthy phosphates, is rapidly rendered clear,\\nand if it also contains carbonates there is an additional marked\\neffervescence. This little chemical test, together with wholesome\\nadvice and tonic treatment, will soon put these patients in a better\\nstate of mind, and then under favorable circumstances the health\\nmay be restored.\\nHorseback-riding, cycling, and severe jolting may sometimes\\ncause the escape of a little prostatic mucus or of the secretion of\\nthe seminal vesicles. In some cases the fluid seems to come from\\nCowper s glands. As a rule, these little discharges cause no worry\\nto healthy and vigorous men but nervous, worrying, and neuras-\\nthenic individuals may be very much troubled in mind.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0328.jp2"}, "329": {"fulltext": "CHAPTEE XXIV.\\nSEXUAL WORRY AND HYPOCHONDRIASIS AND SEXUAL\\nNEURASTHENIA.\\nSEXUAL WORRY.\\nMany individuals become worried about the condition and\\nthe function of their genital apparatus, or of some part of it,\\nwhile others become possessed of a groundless, morbid fear of\\nsome abnormal state or disease of these parts which does not\\nreally exist. In the majority of cases men or boys of average or\\nmarked intelligence, not knowing exactly what is normal, com-\\nplain of simple, harmless conditions or of appearances which they\\nthink may lead to something more or less dangerous to the func-\\ntion of the parts. As a rule, cases of this category are simply\\ninstances of sexual worry, which may be more or less acute and\\nprolonged, but rarely present a formidable condition. On the\\nother hand, some individuals become really sexually hypochon-\\ndriacal and fall into a morbid state of mind.\\nIn the category of sexual worry there is an infinitude of com-\\nplaints. A man consults the surgeon because one testis hangs\\nlower than the other, and he fears ill consequences may result.\\nAnother convinces himself that his penis is too small, or that his\\ntestes are ill developed, and that he may not be able to indulge in\\ncoitus. Such slight affections as simple red spots (perhaps microbic\\ninvasion) on the glans and scrotum sometimes send a man post-\\nhaste to the surgeon, thinking that something very bad has hap-\\npened. The normal redness of the meatus is not uncommonly\\nthe cause of much mental uneasiness. Then, again, the smegma,\\nnatural to the prepuce, may be regarded as an evidence of disease\\nfor which a man may anxiously seek treatment. One of the most\\npersistent victims of sexual worry that I have ever seen was a", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0329.jp2"}, "330": {"fulltext": "310 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nrobust young man in whose coronal sulcus a few little crypts, not\\nas large as the head of a pin, caused by the invagination of the\\nmucous membrane, were to be seen. Notwithstanding that the\\nman was told impressively several times that his penis was in\\nperfect condition, his worry caused him to come back a number\\nof times a year for several years, in order to obtain fresh reassur-\\nance that he was all right.\\nIt sometimes happens that the coronal collar or expansion of\\nthe glans penis possesses a deeper hue than normal, even a deep\\nred color, and that sometimes the part appears minutely papillated.\\nI have several times had this condition shown to me by men in an\\nanxious state of mind, and in some a deep-rooted fear of ulterior\\ncancerous development was entertained.\\nA phimotic condition of the prepuce, moderate or well devel-\\noped, is a not uncommon cause of worry, and mild or severe\\nbalanoposthitis has, in my experience, several times been the cause\\nof much anguish of mind.\\nSome men become worried because they find their scrotum\\nstudded with many little, harmless, unchangeable milia (those\\nminute white papulations which are so common), and it was diffi-\\ncult in some instances to comfort them. One man who had\\nseveral small wens seated in the scrotal tissues was firmly con-\\nvinced that his spermatogenic function was entirely out of order,\\nand that these tumors were evidences of a vicarious activity which\\nmight lead to sterility. Notwithstanding the absurdity of this\\nassumption, it required several interviews to convince the man\\nthat he had nothing but little harmless tumors.\\nSome men come to the surgeon complaining that their meatus\\nis unnatural in some, from their stand-point, its lips are too\\nflaring and the orifice is too patulous in others the lips are natu-\\nrally in close coaptation, and that must be wrong. I have seen\\nmany instances in which sensible men have worried over these\\nabsolutely normal conditions.\\nEczema and psoriasis of the penis very often induce a worried\\ncondition of mind, and much apprehension has been entertained\\nby many regarding signs of eczema marginatum of the thighs,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0330.jp2"}, "331": {"fulltext": "SEXUAL WORRY AND HYPOCHONDRIASIS. 31 1\\ncrural fold, and scrotum. Simple perspiration at the peno-scrotal\\nangle and in the crural fold has caused many men to think that\\ntheir sexual apparatus was entirely out of gear.\\nMinute spots or patches of pigmentation about the genitals\\ncause in the minds of some individuals much uneasiness, aud the\\ndiscovery of small superficial nsevi of recent growth has sent the\\nbearer to the surgeon in a condition of panic.\\nStrange to say, the equanimity of patients suffering from hydro-\\ncele, even when the tumor is large, is rarely even moderately dis-\\nturbed whereas varicocele may cause such worry that a hypochon-\\ndriacal or neurasthenic condition may result. (See Chapter XX.)\\nStrange as it may seem, many men, particularly young and\\nhealthy ones, become thoroughly convinced that they are suffer-\\ning or have suffered from gonorrhoea, although they have never\\npresented any symptoms of that infection. These men are usually\\nold masturbators or sensitive men who are continent for long\\nperiods. They express by diligent efforts a little clear mucus\\nfrom the meatus, and offer that as undoubted evidence of the\\ncorrectness of their statements. These patients very often assert\\nthat they experience vague, dull pains in the region of the pubis\\nand in the course of the pendulous urethra. Pain at the end of\\nthe penis is also frequently complained of by them, and it causes\\nthem much worry. Such patients are prone to fall into the hands\\nof quacks, who usually put them through a fearful ordeal in the\\nway of cutting operations, sounds, and injections. I have seen\\nseveral cases in which these patients had been under the care of\\nregular but ignorant practitioners, who had proposed meatotomy\\nand other wholly unnecessary and, to them, harmful procedures.\\nIf these patients are submitted to a careful urethral examination\\nas well as a thorough examination of their urine, taken at different\\nperiods of the day, especially early in the morning, and they are\\nfound to be free from gonorrhoea, it is usually easy in one or two\\ninterviews to convince them that they are only the victims of\\nsexual worry. In such cases moderate coitus regularly indulged\\nin is very beneficial, and, as a result, these men soon cease to\\ncomplain of pains in the genitals.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0331.jp2"}, "332": {"fulltext": "312 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nThen, again, more or less pronounced worry may occur in cases\\nof obstinate chronic urethritis. Such patients continually squeeze\\nthe glans penis from behind forward, to see whether they can pro-\\nduce a drop of secretion. They are on the lookout, bright and\\nearly, for the morning drop, and they freely provide themselves\\nwith glass vessels, into which they frequently urinate and then\\ncritically examine for urethral threads. In some cases this worry\\nis so prolonged that a mild neurasthenic condition is produced.\\nThen, again, patients will come to the surgeon bringing speci-\\nmens of urine laden with phosphates and carbonates or urates,\\nand claim that their sexual and urinary apparatuses are seriously\\nout of order. If by a strange coincidence there is present any\\nof the foregoing harmless structural conditions, if there is more\\nor less imaginary pain felt in the testes, scrotum, penis, or in-\\nguinal or hypogastric region, the patient may fully convince him-\\nself that his health is in a very critical condition. Many of\\nthese cases fall very readily into the hands of quacks, by whose\\nignorance and rapacity they are often greatly injured and cruelly\\ndespoiled.\\nIn all the foregoing cases the worry of mind results from some\\nharmless condition or from some affection which is readily curable.\\nThe root of the trouble is that patients have gotten their minds\\nfixed upon their genital organs, and for a time more or less con-\\nstantly this thought dominates their existence. In many instances\\nno effect on the health is produced in others the mental and\\nphysical vigor are somewhat impaired while in still others dys-\\npepsia, mild sleeplessness, and moderate cachexia may supervene.\\nAs a rule, however, all these cases can be relieved, ameliorated,\\nor cured by sensible, kindly advice and encouragement or by\\nwell-directed treatment, local or systemic.^\\nSEXUAL HYPOCHONDRIASIS.\\nIn my experience true hypochondriasis, originating in some\\nimaginary sexual disorder, is very rare. Perhaps the specialist\\nin nervous diseases may see more of these cases than the genito-\\nurinary surgeon does. In the cases I have seen the mental dis-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0332.jp2"}, "333": {"fulltext": "SEXUAL WORRY AND HYPOCHONDRIASIS. 313\\nturbance hinged on the early and vigorous practice of masturba-\\ntion, on the memory of sexual excesses, or on the fixed thought\\nthat an antecedent gonorrhoea had never been cured. In some\\ncases there was an abidingly haunting religious fear that in sexual\\nindulgence and excesses an unpardonable sin had been committed.\\nIn somewhat rare cases in continent men nocturnal emissions have\\nled to a markedly hypochondriacal state of mind. In these hypo-\\nchondriacal cases morbid fears are not uncommonly a marked\\nsymptom. These patients are always in a state of excitement\\nand worry about their digestive organs, in which they claim\\nvague radiating pain or a dull heaviness is present about catch-\\ning cold, and the weak, distressed, and painful state of their lungs,\\nand about the atony and cold sensations, or tingling and pricking\\nfeelings, which are experienced in their genital organs. They\\nimagine they are going to suffer or are suffering from softening\\nof the brain, paresis, locomotor ataxia, or any disease which they\\nhear of. In their recital of their imaginary ailments they are\\ntediously prolix, and frequently enter into details which are really\\ndisgusting. They are most exacting, sometimes exasperating, in\\ntheir requirements of the surgeon, and at each interview insist\\nthat a thorough physical examination be made of nearly every\\norgan of the body, as well as of the secretions. They are often\\nhypersensitive, and imagine that they are the objects of ridicule\\non the part of friends and others. They can apply their minds\\nto no useful purpose, and they are incapable of well-directed\\nphysical effort.\\nSEXUAL NEURASTHENIA.\\nThe term sexual neurasthenia, or nervous prostration, is to-day\\nwidely employed in an indiscriminate manner as designating a\\nlarge and heterogeneous class of cases in which there is more or\\nless ill-health, together with some trouble, mild or severe, of the\\nsexual apparatus. Too much latitude has been given to the use\\nof this term, and very frequently the inquiry into the etiology of\\nthe cases designated as neurasthenic has been too superficial and\\nof a routine character. There can be no doubt that certain sexual", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0333.jp2"}, "334": {"fulltext": "314 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nirregularities, excesses, and morbid states so weaken the nervous\\nsystem that a serious condition of ill health is produced but, on\\nthe other hand, this identical morbid state may be induced by\\nother causes, which in their turn more or less directly lead to\\nsexual debility.\\nThough the existence of neurasthenia as a definite morbid entity\\nhas been denied by some authorities, there can be no doubt that\\nthere exist many cases in which the symptoms of impairment of\\nthe nutrition of the nerve-centres and of their lowered function\\nare sufficiently definite and common as to warrant the retention of\\nthis term in our nosology. While, therefore, neurasthenia cannot\\nbe called an absolutely well-defined disease, like diphtheria or\\ntuberculosis, it may be considered a well-marked morbid condi-\\ntion, having a wealth of symptoms which are tolerably constant,\\nand most of which are present in the majority of cases. The\\nfact of the matter is, that when one has become fully acquainted\\nwith this weakly and irritable condition of the whole nervous\\nsystem, blended with anaemia and chlorosis, its recognition is\\nusually very easy.\\nThe main causes of neurasthenia are severe mental and bodily\\nstrain and overwork, anxiety, worry, excitement, uncertainty of\\nmind, and mental emotion of a depressing character. Certain mor-\\nbid conditions, such as typhoid fever, malaria, syphilis, and influ-\\nenza, may leave in their wake a state of the nervous system which\\nthis name properly expresses. In this condition the drain on the\\nnervous system required by the vital processes is so great that there\\nis not at any time a reserve supply of nerve-force to call upon\\nhence it can readily be understood that sexual debility, inability,\\nor apathy may soon develop. In this event, however, it is not\\ncorrect to class such a case as one of sexual neurasthenia. The\\nsexual debility is the result of the ill-health, and not its cause. On\\nthe other hand, sexual excesses, unnatural prolongation of coitus,\\nbuccal coitus, conjugal onanism, or withdrawal, masturbation\\n(particularly in men at or near middle life, also in younger sub-\\njects), and long-continued sexual erethism with unsatisfied desire,\\nnot infrequently induce a condition of ill-health in which the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0334.jp2"}, "335": {"fulltext": "SEXUAL WORRY AND HYPOCHONDRIASIS. 315\\nclassical symptoms of neurasthenia are present. Such cases, there-\\nfore, reasonably come under the category of sexual neurasthenia.\\nAn important question in the etiology of neurasthenia now pre-\\nsents itself for consideration. We quite commonly see young or\\nmiddle-aged men who have chronic anterior and posterior gonor-\\nrhoea, chronic prostatitis from masturbation or gonorrhoea, or\\nchronic inflammation of the seminal vesicles and deferential\\nampullations, and even from imaginary or real rectal disease,\\nwho fall into such a condition of ill-health with mental unrest\\nand debility which no other term than neurasthenia will concisely\\nexpress. In these cases the condition of the sexual apparatus\\nseems to be the dominating influence in the long morbid chain,\\nand the condition is strikingly one of marked sexual disorder.\\nThe question then presents itself Are these cases primarily due\\nto irritation which is reflected from the morbid area back to the\\ngenital centre, and from there to the spinal cord and brain, in\\nwhich it sets up a condition of malnutrition or are worry and\\nmorbid fears induced by the genital trouble the cause of the\\nmental and physical decay These questions can only be par-\\ntially answered by ingenious theories which may at will be elab-\\norated in support of either contention. Seeing that we have no\\npathological facts and observations to guide us, the more rational\\ncourse, to my mind, is to wait until, little by little, definite and\\nscientific knowledge is acquired upon this very obscure subject. 1\\nOne practical point, however, here suggests itself namely, that\\nin most of these cases relief of the local trouble is promptly\\nfollowed by improvement of the mental and physical health of\\nthe patient. Such cases are typical instances of sexual neuras-\\nthenia.\\n1 The result of researches of Hodge (Journal of Morphology, 1892, vol. vi. p.\\n95) are very interesting as tending to throw some light on the pathology of neu-\\nrasthenia. This observer found that prolonged electrical stimulation and fatigue\\nproduced in the brain-centres of certain animals and birds marked degenerative\\nchanges in the nuclei, cell- protoplasm, and cell- wall when present. These\\nchanges disappeared slowly under rest and quiet, and after a lapse of time the\\nnormal structure of the parts was re-established. Perhaps in neurasthenia the\\nmolecular nerve-changes are the underlying pathological causes.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0335.jp2"}, "336": {"fulltext": "316 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nSymptoms. The onset of sexual neurasthenia is usually slow\\nand insidious. The most common symptom is a dull, heavy feel-\\ning in the head (frontal or occipital), sometimes with a sense of\\nconstriction, which is worse in the morning. Such a patient, after\\na troubled night, awakes, unrefreshed, in very much the state of\\na man who had indulged to excess in alcohol the night before.\\nThen the appetite becomes capricious, and it may be nearly lost.\\nThe digestive functions become labored and slow, and constipation\\nis apt to result. At this time a marked change in the morale of\\nthe man can be noted. He is indisposed to perform his work,\\nand has to force himself to keep up to his duties. His mind is\\nless acute, his memory less accurate and may become very defec-\\ntive, and his disposition becomes altered. He angers easily, and\\nany slight cause irritates and worries him. Troubles of any kind\\nwhich in the normal state would be soon thrown off are brooded\\nover, and severe mental depression may follow. Then sleep be-\\ncomes much more disturbed and unpleasant, and perhaps erotic\\ndreams keep the patient in a restless state during the night. In\\nthe day the discomfort of the patient is very great by reason of\\nthe weakness, the mental unrest, and the torpidity of the gastro-\\nintestinal processes. In a short time the facies of the sufferer\\nbecomes much altered. A pallor with a dull, worried expression\\nis often very noticeable, together with some or much emaciation\\nof the face. In some cases these patients soon come to look like\\nsickly or weakly old men. General loss of weight soon becomes\\nnoticeable and adds another source of worry to the patient s\\nmind.\\nThe foregoing description applies to very bad cases, and must\\nnot be considered as absolutely typical. Thus we see cases in which\\nmen seem to be a little anaemic or run down others as if they\\nwere somewhat overworked, or too much confined in-doors, or who\\ndo not have sufficient sleep. In none of the cases can the patient,\\nfrom his appearance, be said to be really sick. Then, again, we\\nsee men who appear well-nourished, and who have a fairly good\\ncolor in their faces, who surprise us by their wealth of neuras-\\nthenic symptoms. As a rule, however, the man carries in his", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0336.jp2"}, "337": {"fulltext": "SEXUAL WORRY AND HYPOCHONDRIASIS. 317\\nface the stigmata of a nervous system the nutrition of which is\\nvery considerably impaired.\\nThe tale of woe which sexual neurasthenics pour into the sur-\\ngeon s ears or those of anyone else who will listen to them is\\nalmost endless and of infinite detail and variety. They complain\\nof vertigo, of dull pains in the head, spine, back, and legs, and\\ninsist that they have painful areas all over the body, especially\\nover the trunk. They are graphic in their descriptions as to how\\nhot and cold flashes dash and radiate all over the body, and as to\\nthe acnteness of certain pricking or itching sensations or of a feel-\\ning as if water were flowing over their limbs. They also complain\\nof cold feet and hands, which, when felt, present a disagreeable,\\nclammy sensation. They perspire on slight exertion, suffer from\\nlocal hyperidroses, and sometimes from a profuse general sweating\\nwhich exhausts them greatly. In the recital of their cardiac and\\nlung troubles they are very diffuse and insistent. They sometimes\\nhave a dull, heavy precordial sensation, with a sense of suffoca-\\ntion and sometimes of pain, reminding one of angina pectoris.\\nPalpitations of the heart, with a frequent, thin, wiry, and irregular\\npulse, can very often be found by the surgeon. These patients\\nsometimes claim that they suffer severely in their lungs. They\\nsomewhat uncommonly are attacked by such a sense of suffocation\\nthat asthma is simulated (asthma sexuale). I have seen several\\ncases in which there was much emaciation, and in which the\\npatients so pertinaciously insisted that they had severe pains in the\\nlungs and cough, together with night-sweats, that a suspicion of tu-\\nberculosis was for a time entertained. As Gray 1 pertinently says of\\nthese cases,. the prolonged nervous depression diminishes the good\\nsense and increases the bad judgment and lack of self-control.\\nIn considering the foregoing rich but sad symptomatology, in\\nwhich the peace of mind and the health of the patient are so seri-\\nously disturbed, it can be readily seen that the victim is incapable\\nof applying himself to any work, bodily or mental, and that all\\nthe enjoyments of life are lost to him. He becomes irritable and\\n1 Medical News, December 16, 1899, pp. 788 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0337.jp2"}, "338": {"fulltext": "318 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nexcitable, and is anything but an agreeable companion. To the\\nsurgeon he is often a sore trial, and in his importunities for relief\\nhe taxes his patience and endurance to the utmost. In some bad\\ncases I have observed an abiding spirit of marked ingratitude,\\nnotwithstanding the sufferers had received much kindly and patient\\nattention, together with proper advice and treatment. Their ail-\\nments and sufferings and demands for relief are always poured\\nforth into the surgeon s ears, and no attention is paid to his good\\noffices previously extended.\\nThe attempt has been made in the foregoing description to de-\\npict the severer class of cases of sexual neurasthenia. It must\\nbe remembered, however, that this disordered condition of the\\nnervous system varies in different individuals. In some it is\\nmild, and only a few of the clinical symptoms are present in\\nothers the condition is more severe and the symptom-complex\\ngreater, while in the very severe cases the whole economy seems\\nto be deranged.\\nThe local or sexual symptoms are numerous, and have their\\norigin in some part of the sexual tract. In some cases, when ill-\\nhealth brings back memories of early masturbation and the patient\\nbegins to brood over the imaginary ill consequences or the sinful-\\nness of the act, sexual symptoms seem to spring up as if by magic.\\nNeuralgia of the testis, or a heavy, distended condition of these\\nglands, is complained of. Darting or dull, heavy pains in the\\nscrotum, groins, and urethra are said to be frequent and severe.\\nThe penis, testicles, and bladder seem to have lost their life, and\\ndesire for coitus is more or less blunted. These patients complain\\nthat their genitals are cold or clammy or wet, and that they are\\ncertain that these organs are growing small or are withering up.\\nProstatic and bladder pains are also complained of. Coitus not\\nbeing indulged in, emissions, mostly nocturnal, with or without\\nerections, occur and become the source of great worry. Any\\nescape of mucus from the urethra is looked upon as a dangerous\\nomen, and convinces the patient that he is becoming devitalized.\\nIn the cases where there is tangible lesion of the sexual tract there\\nmay be a chronic urethral discharge, especially in the morning.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0338.jp2"}, "339": {"fulltext": "SEXUAL WORRY AND HYPOCHONDRIASIS. 31 9\\nThere may be increased frequency in urination, and exceptionally\\npost-mictional hematuria, pain in the glans penis at the end of the\\nact, pain or burning sensations in the urethra and perineum, and\\ndeep in the pelvis from involvement of the ampullations of the\\nvasa deferentia and seminal vesicles, or the pain may be referred\\nto the rectum itself. (For further information on these subjects\\nthe reader is referred to the chapters on Masturbation, on Chronic\\nPosterior Urethritis, Chronic Affections of the Prostate, and\\nInflammation of the Seminal Vesicles and of the Deferential\\nAmpullations.)\\nDiagnosis. In sexual neurasthenia the disorder in the sexual\\napparatus so dominates the patient s mind that if the surgeon is\\nsufficiently familiar with the trouble he can readily make a diag-\\nnosis. In all cases it is very important to make one s mind per-\\nfectly clear as to whether the general morbid state had its origin\\nin some imaginary or real sexual disorder, or whether in neuras-\\nthenia the man s mind became disordered as to the condition of\\nhis sexual apparatus and its function. When the sexual tract is\\nthe seat of morbid change a thorough, painstaking investigation\\nshould be instituted, in order to determine the location of the\\ntrouble as well as its nature, extent, and severity. Upon the\\naccuracy and fulness of this investigation the intelligent treat-\\nment of the case and its outcome largely depend.\\nI have seen several cases of sexual neurasthenia in which the\\nsymptom-complex seemed to point to the existence of the opium-\\nhabit or cocaine-habit or to secret chronic alcoholism.\\nPrognosis. In sexual neurasthenia, as a rule, a good prognosis\\nmay be given, since the disease, though chronic, does not lead to\\ndeath. Such is the markedly beneficial effect produced on the\\nmind by the relief of symptoms and the cure of morbid sexual\\nconditions that the patient s health in general becomes appreciably\\nbetter at once. In some neuropathic and hypochondriacal cases,\\nand in some patients with an inherited unstable nervous system,\\nsexual neurasthenia may be very persistent, and a long period of\\ntime months or years may elapse before a cure is brought\\nabout. Such cases, however, are not very common, and recovery", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0339.jp2"}, "340": {"fulltext": "320 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nin most instances occurs in a few months or in less than a year.\\nThe return to vigorous health may be slow.\\nTreatment. In sexual neurasthenia, as we have seen, the\\nmorale of the patient is most improved when he experiences ame-\\nlioration of his local symptoms. With this fact in mind, the\\nsurgeon should enter upon a mild and conservative course of\\ntreatment directed to the part of the urethral canal which is\\naffected. It is important that heroic measures or new fads should\\nnot be used in these cases, and that exacerbation of the underly-\\ning chronic inflammation of the parts should not be induced.\\nThe patient watches the progress of the case with such tireless\\nscrutiny, and is so easily depressed if matters do not run smoothly,\\nthat we cannot be too careful in the use of topical applications\\nor of instruments. Very often these patients are importunate, and\\ntry to bully the surgeon into a change of treatment or to the\\nadoption of more stimulatiug applications. The course to pursue\\nin such an event is to placate as far as possible, but not to resort\\nto measures of doubtful value or those which may do even mod-\\nerate harm.\\nThe general management of a Case requires much care and cir-\\ncumspection. The condition, disposition, and surroundings of the\\npatient must be fully studied then-^ careful and grateful system\\nof hygiene should be established. The patient should be kept\\nquiet and at rest, and all cares and anxieties and obligations should,\\nas much as possible, be kept from him. The condition of the\\nstomach and bowels should receive much attention, and, if neces-\\nsary, medication to aid digestion and prevent constipation should\\nbe sparingly administered. Pepsin, peptenzyme, bismuth, nux\\nvomica, rhubarb and soda, pancrobilin pills, and mild aperients\\nshould be kept in mind and used as the occasion seems to demand.\\nThe food should be simple, bland, and nutritious, and should never\\nbe taken in too large quantities. Milk in abundance, if assimi-\\nlated, is excellent, as also are rare red meats in moderation, with\\nstale bread, rice, and hominy. Tea, coffee, and cocoa are, as a\\nrule, harmful, and are liable to disagree with the patient or to\\nmake him more nervous.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0340.jp2"}, "341": {"fulltext": "SEXUAL WORRY AND HYPOCHONDRIASIS. 321\\nThe condition of the kings and of the heart should be carefully-\\nwatched and treated symptomatically. In all cases, however,\\ndrugs should be used sparingly, and their action should, as a rule,\\nbe regarded as secondary to the general system of management of\\nthe case. It is well to bear in mind strychnine, arsenic, iron,\\nquinine, cocoa, preparations of phosphorus, and the hypophos-\\nphites but never to use them in a careless and routine manner.\\nAlcoholic liquors in general are not beneficial, but a mild claret or\\nBurgundy, or some pale ale or beer, may at times, chiefly at meals,\\nbe of benefit if taken in limited quantity. The use of tobacco\\nshould be reduced to a minimum, and cigarette-smoking should\\nbe firmly interdicted.\\nIn some cases the bromides, cautiously administered, have a\\nvery sedative effect. Much care should be exercised if a prepa-\\nration of opium is used, lest addiction to the drug should be in-\\nduced. Antipyrine, phenacetin, trional, and all heart-depressants\\nshould only be employed at certain urgent times.\\nIt is well to keep these patients at rest and to aim at tranquillity\\nof life. As pointed out by Gray, 1 it is seldom necessary to put\\npatients to bed for three to six weeks, as was at first proposed.\\nAs a rule, it will suffice to keep them there ten or twelve hours\\nout of the twenty-four, and to have them avoid fatigue when they\\nare up.\\nSexual neurasthenics brood over their trouble so much, if left\\nalone, that it is well that they should have mental diversion and\\nthat one or two compatible and companionable people should be\\nwith them. Bathing is of much beuefit, particularly at the sea-\\nshore, but care should be exercised that the temperature of the\\nwater be not too low. Then, again, fresh-water baths should\\nnot, as a rule, be too hot. Sponging the body and mild rubbing\\ndown with a rough towel are very beneficial. The faradic cur-\\nrent (the slowly interrupted form) may produce good effects if\\nadministered in short daily seances. Massage carefully r adminis-\\ntered for short periods once or twice a day usually leads to seda-\\n1 Loc. cit.\\n21", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0341.jp2"}, "342": {"fulltext": "322 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ntion, and, later on, invigoration but it must be remembered that\\nin some cases patients are really made worse, hence it is necessary\\nto use caution in this procedure. Change of scene and of air is\\nof the highest importance in these cases. Sea voyages, short or\\nprotracted, restful quiet in the mountains or in some pleasant\\ncountry place, and camping out, offer sources of much relief, and\\noften lead to marvellous improvement.\\nIt is well to remember that very pronounced anaemic patients\\nneed careful feeding with nitrogenized matter in the form of raw\\nbeef cut up finely or of well-made beef -tea.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0342.jp2"}, "343": {"fulltext": "CHAPTEE XXV.\\nCOITUS EESERVATUS VEL INTERRUPTUS WITHDRAWAL,\\nOR CONJUGAL ONANISM.\\nA not infrequent cause of ill-health and of well-marked neu-\\nrasthenia, particularly in the male in youth and in middle age,\\nbut also in the female, is that unnatural method of coitus which\\namong us is called conjugal onanism, or withdrawal, and by Ger-\\nmans, coitus reservatus vel inter ruptus. This harmful practice is\\nmostly followed by well-to-do, refined, and educated people, and\\nthere is medical evidence at hand to prove that it is a rather\\nwidely spread custom, both in the married and the unmarried.\\nThe main object of this mode of coitus is to prevent concep-\\ntion, and beyond that there are many underlying reasons and\\npurposes. In some cases it is done without the woman s consent,\\nand she, in her simplicity, thinks the method is proper. Between\\nsome men and women the arrangement for this procedure is de-\\nliberately made, while in some cases the man wishes it, and in\\nothers it is followed at the woman s instigation. The underlying\\nmotives are various the wife or husband may not desire chil-\\ndren the wife may fear that pregnancy will spoil her beauty or\\nruin her good figure, or she may wish to avoid conception in order\\nthat she may not be removed from society s pleasures and obliga-\\ntions or from the various functions into which many women enter\\nwith much zeal and enthusiasm, such as church and parochial\\nduties, charitable objects, literary and scientific clubs, bicycle\\npractice, etc. Then, again, painful and dangerous parturition,\\npuerperal fever, puerperal eclampsia, post-partum dementia, and\\nthe ill-health of the wife are the reasons why pregnancy is often\\nfeared and unnaturally avoided and, further, in illegitimate\\ncoitus the fear of conception causes the adoption of this procedure,\\nwhich also may be followed for economical reasons. In many", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0343.jp2"}, "344": {"fulltext": "324 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ncases the absence of the fear of conception leads to too frequent\\ncoitus.\\nMost persons have no knowledge whatever of the harmfulness\\nof this procedure.\\nIt would be rash to say that this bad habit is invariably detri-\\nmental to the health of the man or the woman, since there is\\nabundant evidence to prove that many men and women practice\\nwithdrawal for long periods without any perceptible discomfort or\\nresulting deterioration of the health. Indeed, there is the widest\\nvariation in the effects of the habit. In some men it induces ill-\\nhealth very promptly in a few months, or a year or more, while\\nin others the practice may extend over several or many years before\\nits baneful effects begin to show themselves.\\nThe resulting harmful effects of withdrawal may be summed up\\nunder the head of neurasthenia, which varies very much in severity\\nand duration in different cases. A perusal of three of my cases\\nwill give a good general idea of the harmful results of this practice.\\nCase I. A man, aged twenty-nine, of excellent physical and\\nnervous condition, and with no previous damage to his sexual\\nsystem, had practised coitus reservatus with his wife for three\\nyears. He then began to lose flesh, and became pallid, suffered\\nfrom mild dyspepsia and constipation, and was restless, irritable,\\nand despondent for trifling reasons. In this way he remained for\\nnearly a year, the various symptoms gradually becoming more\\npronounced. A sea voyage, a sojourn in Switzerland, and gen-\\neral tonic treatment, together with baths and electricity, produced\\nscarcely any benefit. In my examination of this man I learned\\nhis sexual history. Under a general invigorating regimen, with\\nthe use of tonics and with sexual rest, this man became perfectly\\nwell in about two months.\\nSeveral years after he again fell into his bad habit, and experi-\\nenced a mild relapse of his former symptoms. This time he was\\ncured by sexual rest and out-door life in the mountains. After\\nboth sicknesses there was decided sexual impotence, which in\\neach instance gradually ceased and left the man in a perfectly\\nvirile condition.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0344.jp2"}, "345": {"fulltext": "CONJUGAL ONANISM. 325\\nCase II. A man, aged forty-two years, had in general enjoyed\\ngood health and was not in the least neuropathic. He had suf-\\nfered at puberty from pollutions induced by masturbation, and\\nwhen thirty-two years old had suffered from chronic posterior\\nurethritis. When thirty-six years old he married a strongly\\nbuilt, passionate young woman, and had with her practised with-\\ndrawal for six years. About five years after the commencement\\nof this unnatural coitus he began to observe that his health was\\nbreaking down. He had been under the care of a number of\\nphysicians for about a year when he came to me. He then was\\nthin, pallid, and sallow, and had an anxious facies. He com-\\nplained of a multitude of ailments with incessant volubility. He\\nslept badly, had bad dreams (sometimes erotic), awoke in the\\nmorning with a dull, heavy head, pain over the eyes, and much\\nvertigo. As the day wore on these symptoms became less marked.\\nHe was generally depressed in mind, and sometimes decidedly\\nmelancholic. His memory was very defective, and so great was\\nthe physical and mental inertia that he could not attend to busi-\\nness or fix his mind for any length of time on a subject. There\\nwere general well-marked torpor of the stomach and intestines\\nfrequent urination, with pain in the prostate at the end of the\\nact deep-seated pelvic pain, tenderness in the perineum, and a\\nburning sensation at the anus were the symptoms referable to his\\nsexual apparatus. His erections were weak, his ejaculations were\\nfeeble, and after difficult defecation a mass of mucus and pus\\nescaped from the urethra. Examination showed that the poste-\\nrior urethra was chronically inflamed and exquisitely tender, and\\nthat his prostate was much swollen in all tangible directions, and\\nvery sensitive to slight pressure, after which manipulation a\\nworm-like plug of glairy, gray mucus escaped from the meatus.\\nAs a result of well-regulated sexual hygiene and local treatment\\nto the prostate and posterior urethra this man s health improved\\nsurprisingly, and he became in a few months perfectly well in all\\nrespects. In this case tonics and sea bathing acted as valuable\\nadjuvants to the treatment of what at the start seemed a very\\nunpromising case.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0345.jp2"}, "346": {"fulltext": "326 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nCase III. A man, aged thirty-two, of fairly good physical\\nstructure, but whose nervous system was never vigorous, had\\nsuffered in early years from pollutions following long-continued\\nmasturbation, which he began when twelve years old. He recov-\\nered from the morbid condition and remained in good general and\\nsexual health for several years. When thirty years old he in-\\ndulged freely in coitus reservatus with an amorous mistress. In\\nabout a year he noticed that his health was impaired, and he\\nsought relief in taking all kinds of tonics, with no perceptible\\neffect. When he came to me he presented a sorry appearance.\\nHe was pale, emaciated, and haggard, and his symptoms were\\nlegion. Utter weakness, loss of sleep, mental depression, lack of\\nmemory, gastro-intestinal inertia, palpitations, and profuse sweat-\\ning at slight cause were the principal symptoms. He complained\\nbitterly of great and paroxysmal oppression to his breath, with a\\ndry cough and vague pains in his lungs. He was very nervous\\nand the subject of an abiding unrest. He had pains in his head,\\nall down the spine from the occiput to the sacrum, had a sense of\\nconstriction around the abdomen, painful spots over the thorax,\\nand there was decided paresthesia of the legs and forearms. On\\nseveral occasions he had had attacks of severe cardialgia, which\\ncaused him much anxiety. He had imagined that he was suffer-\\ning from pulmonary tuberculosis, or from incipient locomotor\\nataxia or paresis, and had consulted men experienced in lung-\\ntroubles, who found those organs healthy, aud neurologists, who\\nsaid that he was neurasthenic. Carefully directed treatment had\\nfailed to give him any relief. The recital of this exuberant\\nsymptom-complex convinced me that the man was suffering from\\nthe effects of coitus reservatus. This suspicion was confirmed\\nby the patient, after much fencing and hesitation, on my exam-\\nination.\\nDiscontinuance of the bad habit, and the establishment of\\nproper sexual relations, together with change of air and tonics,\\ndid much to improve this man at once. His convalescence, how-\\never, was slow and sometimes halting, but to-day he is free from\\nhis symptoms and may be called a well man. Further transgres-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0346.jp2"}, "347": {"fulltext": "CONJUGAL ONANISM. 327\\nsions, even for a limited time, would probably throw him back into\\nhis former condition.\\nThese cases give a quite clear idea of the average run of mild\\nand severe forms of this morbid state which are not of very fre-\\nquent occurrence.\\nAt the risk of some slight repetition of what has already been\\nsaid in the chapter on sexual neurasthenia, owing to the great im-\\nportance of clearly understanding the effects of this bad habit, the\\ncategory of its resulting morbid symptoms will be further dilated\\nupon.\\nAs a rule, the onset of this trouble is slow and insidious with-\\nout any dominating symptom or symptoms pointing to the origin\\nof the trouble. In the main, the early symptoms most commonly\\nobserved are weakness, more or less loss of flesh, and pallor,\\nnervousness, irritability, unrest, dyspepsia, and constipation, to-\\ngether with a dull, heavy sensation in the head, likened by many\\npatients to the feelings experienced after alcoholic indulgence.\\nThese bad symptoms are worse in the morning, and in a measure\\nwear off as the day progresses. In general the nervous debility\\nand ill-humor increase, insomnia becomes persistent, and the\\npatient becomes irritable at the slightest cause, despondent,\\nmorose, melancholy, and even monomaniacal. There are often\\nobserved failure of memory and such an apathetic condition of\\nmind that the slightest exertion is shrunk from. In most cases\\nthere is lack of sexual vigor, and there may be even decided im-\\npotence. The performance of the sexual act is followed by much\\nweakness and nervousness, together with a sleepy tendency in-\\nstead of the normal vigor and alertness of mind.\\nIn some cases nocturnal erections, erotic dreams, and pollutions\\nare observed, particularly in those whose sexual apparatus has\\nbeen damaged by excessive coitus, masturbation, or gonorrhoea.\\nThe wearing-out of the nervous system which obtains in these\\ncases shows itself in a large number of morbid phenomena. In\\naddition to the many head-symptoms already mentioned, in vari-\\nous cases we find evidence of faulty innervation in the cardialgia,\\npalpitations, and rapid and small pulse, which are so frequent", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0347.jp2"}, "348": {"fulltext": "328 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nin the shortness of breath and sense of suffocation (the so-called\\nasthma sexuale), which are such prominent, but not common\\nfeatures in the spinal pain, general or local (spinal irritation)\\nin the painful spots and joints in the numbness and the various\\nparesthesia? in the sense of constriction, resembling girdle-pain\\nin the excessive sweating, local or general, on very slight exer-\\ntion in the nervous contraction of the larynx and oesophagus,\\nand in the general gastro-intestinal inertia. The symptoms refer-\\nable to the sexual sphere may be slightly marked or obtrusively\\nprominent in mild cases, in which there has been no previous\\nsexual disorder, there may be simply an uneasy sensation in the\\npenis a feeling of moisture together, perhaps, with relaxation\\nof the scrotum. Neuralgia of the testes is not uncommon, and\\nthe pain may be dull, heavy, or aching, or lancinating, or there\\nmay only be present a sense of distress and fulness in these glands.\\nIn one of Peyer s 1 cases the pain in the testes was so severe that\\nwhen it came on the man had to go to bed or lie down on the\\nspot on which he stood when he was attacked. There is also\\npain, deep and circumscribed, in the pelvis, in the groins, and in\\nthe lumbar and sacral regions, which is more or less constant.\\nIn some cases aching and burning pains are experienced in the\\nperineum and anus. There may also be increased frequency in\\nurination, with pain in the act, especially at its end, and in the\\nglans penis. In some cases mild hematuria has been observed.\\nIn some cases there is a more or less constant state of erethism\\nof the genitals, which has the effect of producing a desire for\\nfrequent coitus.\\nIn nearly all cases erections are less firm and enduring than in\\nthe normal state, ejaculations are less vigorous, the seminal fluid\\ngenerally escaping in a feeble stream or by drops.\\nThe morbid effects of this unnatural mode of coitus produce in\\nsome women (but not in the majority) a condition of ill-health in\\nwhich general debility, anemia, and neurasthenia are the chief\\nfeatures. As a rule, women are not so profoundly affected as\\nmen are.\\n1 Der Unvollstandige Beischlaf, etc., Stuttgart, 1890.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0348.jp2"}, "349": {"fulltext": "CONJUGAL ONANISM. 329\\nIn young women of poor fibre and of neuropathic tendency\\nwithdrawal in coitus and precipitate ejaculation on the part of\\ntheir male consorts sometimes give rise to distressing heart-symp-\\ntoms. The evil effect of the incompleted sexual act may show\\nitself simply in severe palpitation, which begins at once after the\\nact and ends in a few minutes or several hours afterward. As\\nthe case grows worse the irritability of the heart becomes more\\ndistressing and is continually present. Then these women become\\ndepressed and irritable and very emotional. They suffer from\\nheadache, indigestion, constipation, weakness, and vertigo, and\\nvery frequently they have fainting spells. Though the pulse is\\nweak, soft, and accelerated, and not infrequently intermittent and\\narhythmic, auscultation will reveal no structural lesion either in\\nthe heart or in the vessels. All these morbid phenomena quickly\\ndisappear when the bad habit is avoided and normal intercourse\\nis indulged in. Tonics and good general hygiene are valuable\\nadjuvants in the management of these cases. On this subject\\nKisch, 1 of Prague, has recently published an interesting essay.\\nA general consideration of what takes place in coitus reservatus\\nis now necessary in order that we may better understand the phys-\\nical and psychical damage wrought by this habit. The excitation\\nof both man and woman is in a great measure under restraint.\\nWhat should be absolutely spontaneous and untrammelled in the\\nway of desire and sensation becomes abnormal by reason of the\\nmental process by which the act is interfered with at its most\\ncritical stage. On this point the words of Eulenberg 2 are really\\ngraphic. He says The natural energetic sexual act experiences\\nfrom the beginning an essentially artificial change. The attention\\ndirected toward the postponement and prevention of the natural\\nintra vaginal ejaculation introduces an altogether heterogeneous\\narbitrary element in the process, which necessarily retards and\\n1 Herzbeschwerden der Frauen verursacht durch den Cohabitation- act.\\nMiinchen. med. Wochenschr., 1897, Band xliv. p. 617.\\n2 Ueber Coitus Keservatus als Ursache sexualer Neurasthenie bei Mannern.\\nInternat. Centralbl. fur die Physiol, und Path, der Harn und Sexual-Organe\\n1893, Band iv. pp. 3 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0349.jp2"}, "350": {"fulltext": "330 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nharms the proper working of the automatic reflex mechanism.\\nThe slower and less energetic friction, the weaker sexual feeling,\\nand the less complete and sudden dissolution of the sexual ten-\\nsion prevent the occurrence of such complete reaction as results\\nfrom the natural ejaculation, by which, on account of the neces-\\nsary energetic muscular action, a sudden emptying of the engorged\\nbloodvessels of the genital apparatus results. The centripetal\\nstimulus is set at naught, and through the disappearance of the\\ncentral innervation the entire genital apparatus becomes suddenly\\nand completely relaxed. In any case this act is most unsatis-\\nfactory both to the man and the woman, neither of whom experi-\\nences the complacency of mind and the gratification which usually\\nfollow the proper performance of the sexual function.\\nIt naturally follows from what has already been said that, in\\naddition to the general condition of ill-health induced, coitus\\nreservatus leads to more or less damage of the sexual apparatus.\\nWhen a man has not previously suffered from chronic gonorrhoea\\nor from the effects of masturbation, this bad habit produces a low\\ngrade of inflammation in the bulb of the urethra, in the posterior\\nurethra, and in the prostatic follicles, and it may extend further\\nand involve the ejaculatory ducts, the deferential ampullations,\\nand the seminal vesicles. In any case an irritable, flabby, and\\natonic condition is induced which is unfavorable to the proper\\nperformance of coitus. When any of the above-mentioned\\nparts has previously been the seat of chronic gonorrheal inflam-\\nmation, with its submucous infiltration and mucous membrane\\ncatarrhal condition, an intensification of the process is naturally\\ninduced.\\nWe have, then, besides a damaged mind and body, a local and\\noften deep-seated morbid state of the sexual apparatus.\\nIn forming an estimate of these cases it is necessary to take\\ninto consideration the general bodily and mental condition of the\\npatient, the condition of the genital apparatus, and the habits,\\nobligations, and surroundings of the patient. Further, we must\\nascertain how long the habit has existed, and how frequently the\\nsexual act has been performed. It is most important of all to", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0350.jp2"}, "351": {"fulltext": "CONJUGAL ONANISM. 331\\ndetermine the mental calibre of the patient, whether he is of a\\nneuropathic tendency, either acquired or hereditary.\\nThere can be no doubt, as maintained by Peyer, that the results\\nof coitus interruptus are variable, and that very many practice it\\nwithout experiencing bad results. Some particularly strong men\\n(mentally and physically) can with impunity indulge in normal\\ncoitus once or more daily for many years others reach their limit\\nwith one or two indulgences a week, and still others cannot attain\\nthat degree of frequency without suffering from bodily or mental\\nfatigue. In some cases of coitus interruptus a strong, well-bal-\\nanced nervous system is largely responsible for the immunity\\nwhich so many men enjoy. In many cases worry, mental excite-\\nment, and various dyscrasise are factors in the general break-down\\nof health. Ignorance of the baneful effects of this habit on the\\npart of some patients, and feelings of modesty or shame in others,\\nare the two principal causes of the difficulty of diagnosis of coitus\\nreservatus. When, however, the attention of the profession is\\nprominently directed to this habit and its symptom-complex is\\ngenerally understood, inquiries directed to its existence will be\\nadopted, and the truth will in all probability be revealed. Much\\ndifficulty is sometimes experienced in getting a true history from\\na patient, and the surgeon must exercise prudence and tact, and\\nhe must call to his aid all his acumen. Parenthetically, I may\\nremark that several patients have bitterly resented the mock, re-\\nligious, and sentimental interrogatories and admonitions to which\\nthey had been subjected by some surgeons. Several patients have\\nremarked to me that they have gone for medical and surgical aid,\\nand not for platitudinous moralizing.\\nThere is one point which should always be borne in mind\\nnamely, that most of these patients suffer from some or many\\nsymptoms referable to the sexual apparatus, and that inquiry\\ndirected to these parts may reveal the existence of this bad habit.\\nTherefore, it is necessary to examine the morning urine for the\\npresence of various tissue-elements, to carefully explore the\\nurethra, especially its prostatic portion, and by digital examina-\\ntion in the rectum to ascertain the condition of the prostate, and,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0351.jp2"}, "352": {"fulltext": "332 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nif possible, that of the deferential ampliations and of the seminal\\nvesicles.\\nTreatment. In the mild form of ill-health, simple discontinu-\\nance of the habit may produce a prompt and encouraging effect,\\nand general hygiene and tonics may also be of very much benefit.\\nIn all cases, when necessary, proper and efficient treatment\\nshould be directed to the underlying urethral or seminal lesion,\\nwherever it may be.\\nRelaxation from business cares, rest, and change of air are of\\nmuch value. Tonics, nutritious diet, carefully regulated, not ex-\\ncessive, muscular exercise (gymnastics, bicycle, golf, walking, etc.)\\nshould also be ordered as the indications of the case may point.\\nElectricity in some cases produces good results.\\nWhatever method of treatment is employed, it must be remem-\\nbered that no benefit will result until the sexual life of the patient\\nhas been brought back to its normal condition and until the integ-\\nrity of his sexual apparatus has been restored.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0352.jp2"}, "353": {"fulltext": "CHAPTER XXVI.\\nPEIAPISM.\\nWhile in the normal state erections last only a short time, in\\ncertain morbid conditions they are, on the contrary, of prolonged\\nduration, and constitute a condition to which the term priapism is\\napplied.\\nIn cases of true priapism the erections are painful, persistent,\\nand irreducible, and are unaccompanied by sexual desire. Much\\nlatitude has been accorded to the term priapism, since under it\\nhave been classed several orders of cases which really are only in-\\nstances of slightly prolonged and moderately painful erection, due\\nto an obvious cause.\\nConforming to usage, however, we may divide this affection\\ninto the following classes\\n1. Priapism observed in infants and children, induced by reflex\\naction in cases of long, tight, adherent prepuce, of stone in the\\nbladder or prostatic urethra, and of worms in the rectum.\\n2. Priapism in adult subjects, symptomatic of stone in the blad-\\nder, stone in the prostatic urethra, stricture, cystitis, and observed\\nduring retention. In these cases the uneasy or painful sensation\\nis felt in the glans penis, while the body of the organ usually is\\nonly moderately congested and sometimes curved downward or\\nlaterally. This condition disappears upon removal of the cause.\\n3. Priapism symptomatic of gonorrhoea, with perhaps involve-\\nment of the corpus spongiosum and downward curvature. This\\ncondition is painful and transitory, and may occur several times\\nduring the night. In cases of downward curvature of the penis,\\ndue to inflammatory engorgement of the corpus spongiosum and\\nspasm of the musculature of the urethra, the term chordee is\\napplied.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0353.jp2"}, "354": {"fulltext": "334 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\n4. Priapism due to ingestion of cantharides, which is a form\\nthat is seldom or never seen now, since this drug is so rarely used\\nin medicine.\\n5. Essential priapism.\\nIt is unnecessary here to consider the first four forms of so-called\\npriapism, as it is merely an intercurrent symptom, usually of short\\nduration, of well-known morbid or structural conditions, and, as a\\nrule, is relieved by operation or medical treatment.\\nAn attentive study of all reported cases, amplified by a consid-\\nerable personal experience, has convinced me that we may divide\\nessential priapism into four varieties\\n1. Priapism caused by injury to the spinal cord (either high\\nup or low down), and by blows or violence inflicted upon the\\nperineum\\n2. Priapism which is a symptom of cerebral or descending\\nspinal-cord disease\\n3. Priapism which occurs after alcoholic and sexual excesses\\n4. Priapism which attacks a person in ill-health, in whom it is\\ndifficult to obtain data as to local injury and causation, and in which\\ncases there is now a tendency to look upon leukaemia as the etio-\\nlogical factor.\\nPriapism after Spinal Injury.\\nIn this form of priapism the traumatism has been found as\\nhigh up as the cervical and as low down as the lumbar and sacral\\nregions. When the injury is in the cervical region it is probable\\nthat irritation of the nerves which pass down the cord to the\\nsexual centre is the cause of the trouble, and that the priapism\\nis due to excitation communicated to the erigentes. When the\\ndamage is inflicted low down it is probable that the sexual centre\\nis so irritated that it is thrown into a state of chronic excitation,\\nwhich shows itself in the engorgement of the penis. In these\\ncases, as a rule, there is not great distention of the organ, nor are\\nthe attendant symptoms of a marked character. Such patients\\nusually complain little of the condition of the penis, and they\\nhave no sexual desire.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0354.jp2"}, "355": {"fulltext": "PRIAPISM. 335\\nThe course of these cases depends upon the extent and severity\\nof the injury in some the integrity of the parts is restored and\\nthe priapism ceases in others death occurs sooner or later.\\nHunt 1 thinks that in the cases of traumatism of the spinal\\ncolumn and cord in which priapism is a symptom there has been\\ninjury to the sympathetic ganglia and nerves. He reports a case\\nin which this lesion was found after death.\\nPriapism in Cerebral and Descending Spinal Disease.\\nThe recorded cases of this variety of priapism are very few, and\\nin most neurological writings this symptom is not much dwelt\\nupon. In a case reported by Legros Clark 2 the patient, aged thirty,\\nhad suffered with hemicrania, during the violence of which he had\\nseveral attacks of priapism. He also had pain in the lower part\\nof the back, and in time became delirious, was attacked by epi-\\nlepsy, became dull and stupid, and died in coma. After death\\nthe liver and spleen were found to be enlarged, and there was\\ncongestion of the base of the brain. It is unfortunate that a\\nminute microscopical examination of the brain and cord were not\\nmade in this case.\\nIn Harwood s case 3 the man was twenty-eight years old, and\\nwas free from any disease. Following exposure to cold he had\\npriapism and pains in his back, which gradually extended down\\nhis legs. He then complained of pain in the perineum and of a\\nsensation as if he had a belt around his body. He died of cere-\\nbral symptoms, the priapism having lasted one hundred and six-\\nteen days.\\nIn this class belongs a peculiarly interesting case reported by\\nDukeman. 4 It was that of a man, aged thirty-five years, a fakir,\\nwho from early life had been a pronounced sexual pervert. He\\nwas anaemic, seemed to be laboring under severe mental depression,\\n1 Medical News, February 25, 1882.\\n2 St. Thomas Hospital Eeports, 1887, N. S., vol. xvi. pp. 19 et seq.\\n3 International Journal of Surgery, 1889, vol. ii. p. 7.\\n4 Pacific Medical Journal, 1889, vol. xxxii. pp. 480 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0355.jp2"}, "356": {"fulltext": "336 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nand practised hypnotism, in which art he was tolerably successful.\\nNo traces of spinal lesion could be found. For several years in\\nthe attacks, varying in duration between two and five months, this\\nman suffered from priapism. He died of tuberculosis.\\nI have had two cases of spinal syphilis in which there were\\ninco-ordination of the movement of the legs, girdle pain, and\\nhyperesthesia of the integument of the abdomen and back, in\\nwhich mild priapism was a symptom, and which were cured by\\nantisyphilitic treatment.\\nIn the cases of locomotor ataxia and of sclerosis of the poste-\\nrior columns of the cord in which priapism is observed the symp-\\ntom usually lasts during the early or middle stages, and ceases in\\nthe later periods.\\nStarr 1 reported the case of an ill-developed male, aged twenty-\\none years, who had lateral curvature of the spine and meningo-\\nmyelitis, who suffered from mild priapism for seven years.\\nPriapism Due to Sexual and Alcoholic Excess.\\nThe greater number of cases of priapism may be denominated\\nalcoholic-erotic cases, since the trouble usually has its origin in a\\ndrunken sexual debauch. As a rule, the greater number of those\\nwho suffer from this form are young and vigorous men, although\\nmedical annals show that men in middle and advanced life fur-\\nnish a moderate contingent.\\nThe mode of onset of erotic priapism differs. In some cases\\nthere is for a time increased frequency of erections, which are\\npremonitory and last a few or many minutes in others, after\\nsexual intercourse, the rigidity of the penis remains and becomes\\npersistent while in still others the patient, on awakening from\\nhis debauch, finds that he is suffering from priapism. In most\\ncases when the opportunity exists, these patients endeavor to re-\\nlieve themselves by coitus, and they always fail. In exceptional\\ncases orgasm and emission, without pleasurable sensations, occur\\n1 New York Medical Journal, June 15, 1887, p. 75.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0356.jp2"}, "357": {"fulltext": "PRIAPISM. 337\\nbut, as a rule, there is no sexual desire, and ejaculation is not pro-\\nduced. In fact, it is stated that in several cases the suffering of\\nthe patient was materially increased.\\nDuring attacks of priapism the state of the penis has been\\nfound to present several variations in different cases. In its most\\nsevere form the organ becomes much enlarged, tense, and com-\\nparable to cartilage in rigidity, and the seat of severe pain. The\\nglans may be double in size, much distended, and glistening, as\\nif it would burst. The corpora cavernosa are very dense and\\nunyielding to pressure in their whole length, including their\\ncrura. The corpus spongiosum is likewise hard and swollen,\\nand its bulbous expansion is in a similar condition.\\nIn some cases the perineal muscles can be felt as dense fibrous\\nbands, and the dorsal vein of the penis seems much distended and\\nfeels like a whipcord.\\nIn many of these cases attentive examination reveals very pain-\\nful spots or perhaps nodules in the corpora cavernosa, particularly\\ntoward their root or in the crura. Then, again, digital pressure\\non the bulb and over the perineal muscles may cause an agony\\nof pain. Spasm of the cremaster muscles may be present, and the\\ntestes then are drawn forcibly up to the internal ring. This\\nsymptom may be wanting. In some cases there is pain in the\\nlower part of the back and along the course of the spermatic\\ncords. Redness and swelling of the prepuce may be observed as\\ncomplications. As a rule, the integument of the penis retains its\\nnormal color. In this pronounced condition the sufferings of the\\npatient are very severe, and many authors apply the term atro-\\ncious to the pain which is seated in the virile organ. The patients\\nfear the least touch of their linen or of the bedclothes, and jarring\\nof the bed or heavy steps in the room cause them agonizing suf-\\nfering. They draw up their legs upon the abdomen, in order to\\nprotect the penis from the slightest touch. This organ may lie\\nrigid against the abdomen, or it may be more or less erect and at a\\nright angle with the body in the horizontal position. Very soon\\nthese patients become much worried and apprehensive, and their\\nfaces give evidence of anxiety and suffering. In these cases urina-\\n22", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0357.jp2"}, "358": {"fulltext": "338 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ntiou may be accomplished either with little difficulty, or the act\\nmay be painful, slow, and halting, with a small, sputtering stream,\\nor the patient may have to assume the knee-elbow position in order\\nto expel the urine from the bladder.\\nThe atrociously painful symptoms are usually spasmodic in char-\\nacter, but the attacks may be very frequent and much prolonged,\\nin which event insomnia, nervous exhaustion, and general prostra-\\ntion supervene. In this way the man suffers from day to day,\\nsometimes experiencing very little amelioration of his condition\\nfor days or weeks. In many cases, however, there are intervals\\nof comparative freedom from suffering, in which the hyperes-\\nthesia and turgidity of the organ are somewhat diminished and\\nthe patient may have some much-needed sleep.\\nThe duration of severe priapism may be from two or three\\nto six consecutive weeks, and even longer. In a hospital case\\nobserved by Birkett 1 it lasted five months.\\nThere is usually no fever, particularly in young, robust men,\\nbut in older subjects having leukaemia or visceral lesions pyrexia\\nmay be observed.\\nIn contrast to the foregoing very severe forms of priapism we\\nobserve cases in which the organ is less tense and distended, and\\nin which the mental and physical suffering is not very severe.\\nIn somewhat exceptional cases the patients suffer but little pain,\\nand the discomfort experienced in the turgidity of the organ is\\nthe chief symptom.\\nIt is not the rule to find priapism involving the corpora cavern-\\nosa and corpus spongiosum at the same time. Some cases have\\nbeen observed in which the glans and the whole corpus spongio-\\nsum have been lax and extensile j others in which the turgescence\\nof one cavernous body was very severe, while its mate was more\\nsupple, and others, again, in which the rigidity was unequally felt\\nin the length of the corpora cavernosa.\\nWhile, as a rule, the invasion of this trouble is prompt, even\\nsudden, and severe, its involution is always slow and often halt-\\ning, and attended with disheartening relapses. The first sign of\\n1 Lancet, 1867, vol. i. p. 207.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0358.jp2"}, "359": {"fulltext": "PRIAPISM. 339\\nimprovement is the diminished rigidity of the organ, which soon\\nbecomes less painful, and thus the case progresses until the normal\\nstate is reached. In that happy event the patient cannot be said\\nto be entirely out of danger, for the reason that recurrences may\\nfollow at short or long intervals, particularly if the patient is\\nguilty of sexual or alcoholic indulgence or excess, is subjected to\\nwet or cold, or is constrained to undergo severe bodily exertion.\\nFrom the records of the various published cases, the inference\\nseems to be warranted that in about one-half of the cases the\\npatient is left impotent. It would be unwise, however, to state\\nthis as a rule or law, since the publication of cases usually fol-\\nlows quite promptly upon their occurrence. It may be that per-\\nmanent impotence is induced, or the condition may be of tempo-\\nrary duration. In young and vigorous men it is to be presumed\\nthat their virility will later on be re-established.\\nEtiology. While the etiology of this form of priapism cannot\\nbe clearly stated, certain suggestions may be made as to its causa-\\ntion. In some cases there is strong evidence that damage has been\\ndone to the corpora cavernosa, particularly near their roots. This\\nis shown in the tender spots and the hard nodules left after invo-\\nlution of the affection. Then, again, in some cases there is a\\nprobability of blood extravasation into the areolae of the cavernous\\ntissue. Whether or not in these alcoholico-erotic cases there has\\nbeen irritation of the sexual centre and of the nervi erigentes,\\nor whether there has been injury to the sympathetic nerve, we\\ncannot say.\\nA number of cases have been reported in Avhich it was clear\\nthat priapism was caused by injury of the penis and perineum,\\nnotably that of Johnson Smith. 1 In all probability traumatism,\\nthough unrecognized, is the essential cause in all cases.\\nPriapism of Leukemic Origin\\nThere is a class of cases of priapism in young men, but particu-\\nlarly in men of middle and advanced life, in which, during and\\n1 Lancet, June 7, 1873, p. 804.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0359.jp2"}, "360": {"fulltext": "340 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nafter a more or less prolonged period of ill-health, this symptom\\nappears.\\nThe clinical history of this form is similar to that already por-\\ntrayed, but in general there is an absence of any data as to excesses\\nof any kind. In this form we find cases with the pronounced\\nagonizing group of symptoms and cases in which lesser degrees\\nof priapism and suffering have been experienced. In these cases\\nthere is a history either of neurasthenia, mental worry and de-\\npression, or of malarial fever and leukaemia, sciatica, hemicrania,\\nand numbness and cramps in the muscles.\\nOwing to the fact that leukemic blood-changes and enlargement\\nof the liver and spleen have been observed in most of these cases,\\nsome authors unhesitatingly accept leukaemia as the cause of the\\npriapism, although Peabody, 1 who leans to this view, makes the\\nguarded statement that it may be regarded as an occasional\\nsymptom of leucocythaemia (leukaemia). While I am not pre-\\npared to deny that priapism may be etiologically related to leu-\\nkaemia, I am free to confess that on the evidence thus far submitted\\nthis relation is in no manner made clear, and the suspicion forces\\nitself upon one s mind that perhaps the occurrence was a coinci-\\ndence. The trouble with the reported cases is that the antecedent\\nhistory of the patient has not been thoroughly gone into.\\nThe facts have not been established that there has been no\\nalcoholic or sexual indulgence, or in some cases that injury to the\\npenis has not occurred. Having the leukaemic explanation in\\nmind, this thought seems to have guided the various authors in\\ntheir estimate and treatment of the case, and they have failed to\\npursue channels of investigation which might reveal some local\\ninjury to the sexual tract. Therefore, while I am not disposed\\n1 New York Medical Journal, 1880, vol. xxxi. pp. 463 et seq., and ibid.-, 1881,\\nvol. xxxii. pp. 272 et seq. See also Klemme, Schmidt s Jahrbucher, vol. cxxxi.\\npp. 173 et seq.; Edes, Boston Medical and Surgical Journal, July 27, 1871; Lon-\\nguet, Progres Medical, 1875, Tome ii. pp. 447 et seq.; Matthias, Allg. med.Cent.-\\nZtg., 1876, Band xlv. pp. 1185 et seq.; Neidhart, ibid., 1876, Band xlv. pp. 681\\net seq.; Salzer, Berliner klinische Wochenschrift, 1879, Band xvi. pp. 152 et seq.,\\nand Wetherell, Medical Record, 1 880, vol. xviii. p. 192.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0360.jp2"}, "361": {"fulltext": "PRIAPISM. 341\\nto deny that this morbid blood condition may participate in the\\ndevelopment of this chronic turgescence of the penis, I hold to\\nthe opinion that this etiology should not be fully accepted, but\\nthat inquiry in all cases should be pushed into the sexual ante-\\ncedents of the patient, with a view of finding out whether there\\nhad been sexual excess or whether any part of the sexual sphere\\nhad been damaged. I can hardly understand why in some excep-\\ntional cases the genital centre and the nervi erigentes have been\\nthrown into a condition of severe and chronic excitation simply\\nfrom general blood changes without there being some lesion of the\\nparts under the control of or near to these nervous organs.\\nIn general, the facts concerning the troubles can be readily\\nelicited from boys and young men, but middle-aged and old men\\nare for various reasons less communicative as to their sexual habits\\nand life.\\nPrognosis. Few definite statements can be made as to the\\nprognosis of priapism of any form. In those cases in which in-\\njury to the corpora cavernosa or thrombosis can be made out,\\nincisions may greatly expedite the cure. The existence of spinal\\ndisease necessitates a guarded prognosis. In very much run-down\\nneurasthenic subjects, in sexual perverts, and in those suffering\\nfrom leukaemia the chances are that the priapism will be very\\npersistent, and when it disappears that it will be very liable to\\nundergo relapse.\\nTreatment. In surveying the results of treatment of the cases\\nof priapism already published one is forced to the opinion that\\nnothing like a routine method can be laid down. Eemedies\\nwhich have produced more or less good in one man s hands have\\nfailed in those of another. This much, however, can be stated\\nwith emphasis Chloroform narcosis has failed in every case in\\nwhich it has been used ice usually does more harm than good\\nelectricity has no value, and may even be harmful and leeches,\\nto the number of sixteen and forty, have failed to produce any\\namelioration in the condition of the penis, and have been inju-\\nrious in their depletory effects.\\nMy own preference, after a review of this whole subject, is to", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0361.jp2"}, "362": {"fulltext": "342 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nresort early to moderate and tentative incisions into the most\\nturgid part, or into parts the seat of continuous pain, or into\\nnodular masses, in all probability the result of traumatism. The\\nparts should be carefully prepared for operation and thorough\\nantisepsis should be employed. With a clean, incised wound we\\nneed not have the scarring, nodulation, or loss of the tissues of\\nthe cavernous bodies which almost always occurred in former\\nyears.\\nVorster 1 reports a case in which, after priapism had resisted\\nvarious methods of treatment for thirty-two days, a cure followed\\nfour days after incision.\\nIn Booth s 2 case, after six weeks of vain effort in relieving the\\npatient, five-gramme doses of the iodide of potassium four times\\na day gave immediate relief and caused the disappearance of the\\npriapism in two weeks. In Matthias case a similar good result\\nfollowed the use of this remedy, and in W. H. Taylor s 3 case cure\\nwas produced by the combination of a mercuric salt with iodide\\nof potassium. My own opinion is that it is always good practice\\nin priapism to use either the potassium salt alone or in combina-\\ntion with mercury when a history of antecedent or present syph-\\nilis is elicited.\\nBromide of potassium, chloral, belladonna, and morphine may\\nbe of benefit, especially during paroxysms lupuline, camphor,\\nand cannabis indica have been used with indifferent results, and\\nthe same may be said of ergot and strychnine.\\nOf local applications, the following may be found to be benefi-\\ncial hot baths, hot and cold spinal douches, sponging with very\\nhot water, spinal cauterization, anodyne poultices (belladonna,\\nstramonium, opium, hyoscyamus, and camphor), and perhaps, in\\nsome cases, ice-bags, but the latter must be guardedly used.\\nAny ephemeral or systemic disorder should receive appropriate\\nmedication.\\n1 Deut. Ztschr. fur Chir., 1887-88, Band xxvii. pp. 173 et seq.\\n2 Lancet, 1887, vol. i. p. 978.\\n8 Maryland Medical Journal, 1883-1884, vol. iv. p. 854.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0362.jp2"}, "363": {"fulltext": "CHAPTER XXVII.\\nSEXUAL PERVEESIOX.\\nIn the whole field of medicine there is no more melancholy\\nchapter to peruse than that which treats of those degenerates who\\nare victims of sexual perversion. This subject has of late been\\nexploited ad nauseam, and by reason of their prurient details cer-\\ntain psychological volumes on this morbid state have done much\\nharm. I shall here only give a general outline of the various\\ndivisions of this subject.\\nSadism is the association of sexual lust with cruelty and vio-\\nlence of varying degrees (biting, scratching, infliction of pain,\\ninfliction of injury and wounds, and even death). The sadistic\\nact is inflicted either during or after coitus, or with the view of\\nstimulating the declining sexual power. Lust-murder, or anthro-\\npophagy, is the severest form of sadism, and its perpetrator may\\nnot only kill his victim, but also eat a part of her. In some indi-\\nviduals the sadistic crime is the equivalent of coitus. In this\\nrevolting category are included the cases in which coitus is indulged\\nin with corpses (which might also be more or less mutilated), and\\nthose of men who can only have sexual intercourse when the live\\nwoman is laid out as a corpse with all funereal accessories.\\nThe mildest form of sadism is that in which a man has an\\norgasm when he surreptitiously cuts the hair of young girls, which\\nhe keeps as a sexual fetich. Under this division may be included\\nthe cases of individuals who have orgasms when they whip boys\\non the naked nates or when they see cruelty inflicted on animals.\\nSadism is very infrequently observed in women.\\nIn all probability vitriol-throwers are sadists.\\nMasochism may be defined as the desire for abuse and humilia-\\ntion as a means of sexual satisfaction. In cases of this form of\\nperversion the individual seeks every opportunity to be beaten or", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0363.jp2"}, "364": {"fulltext": "344 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ninjured by a woman. Such patients become sexually excited by\\nany blow, or by direct injury, by flagellation, and by being trodden\\nupon by women who have their shoes on.\\nFetichism is the association of lust with the idea of certain\\nportions of the female person, or with certain articles of feminine\\nattire, without which the performance of coitus is impossible. The\\ninanimate sexual fetiches are handkerchiefs, shoes, stockings,\\ngloves, beads, letters, locks of hair, articles of female underwear,\\nand flowers belonging to some woman whom the pervert loves or\\nhas sexual passion for.\\nThe parts of the female body which have been selected as\\nfetiches by these perverts are the eyes, the hand, and the foot.\\nIn their thoughts interest is concentrated on these parts, and not\\nupon the genitalia. In some cases the fetich may be a cross-eyed\\nwoman or one with the amputated stump of one leg. Cases have\\nbeen reported in which men were impotent unless the woman\\npresented these abnormalities or defects.\\nMild cases of this form of trouble are really instances of\\npsychical impotence.\\nHair-despoilers may be examples of the sadists and fetichists\\ncombined, since in the act of cutting they have a sexual orgasm,\\nand the stolen tresses afterward act as stimulants to sexual lust.\\nA mild form of fetichism is found in those individuals who are\\nonly sexually excited by a brunette and those to whom only a\\nblonde is congenial. In this same category may be included the\\ncases of men who, in order to become sexually excited, must see\\nwomen dressed in a peculiar manner or have upon them some\\narticle which has taken the fancy (furs, velvet, silks, and feathers).\\nHomo-sexuality is that form of perversion in which the sexual\\nfeeling for the opposite sex is diminished or absent, and in which\\nsexual desire is centred on one of the same sex. Thus men\\nbecome enamoured of certain men, and women of certain favored\\nones of their own sex.\\nUrnings are certain homo-sexual individuals who have in their\\nsexual life the same feelings as those experienced by normal sub-\\njects in hetero-sexual love.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0364.jp2"}, "365": {"fulltext": "SEXUAL PERVERSION. 345\\nKrafft-Ebing says of these cases The liming loves and\\ndeifies the male object of his affection just as a man idealizes the\\nwoman he loves. He is capable of the greatest sacrifices for him,\\nand experiences the pangs of the unfortunate often unrequited\\nlove suffers from the unfaithfulness of the beloved object, and\\nis subject to jealousy/ etc. The attention of the male-loving\\nman is given only to male dancers, actors, athletes, statues, etc.\\nEffemination and viraginity are forms of the perversion known\\nas urnings. In the male the subject likes to masquerade as a\\nfemale. He seeks to make of himself by sweetness, sympathy,\\ntaste for aesthetics, etc., a fit mate for his homo-sexual lover. He\\nendeavors to present a feminine appearance in gait, attitude, dress,\\nand mode of speech.\\nThe female urmng in early life tries in every way to act as a\\nboy, and avoiding girlish games and tastes, she adopts those of boys.\\nLater on she becomes mannish, and even amazonian in her manner.\\nThese homo-sexual perverts practice all kinds of sexual de-\\nbaucheries.\\nSodomy is a form of sexual perversion Avhich is said to be very\\nfrequent in most large cities.\\nMany individuals who are persistently addicted to masturbation\\nare really mild sexual perverts.\\nA mild form of sexual perversion is occasionally seen (mostly\\nin neuropathic and hysterical women) which is called exhibition-\\nismus. Women addicted to this vice are prone to cause upon\\ntheir breasts, abdomen (chiefly near the genitalia), buttocks, and\\nthighs, ulcers induced by severe caustic applications. They deny\\nstrenuously all self -mutilation, and for a time such cases may be\\nlooked upon as feigned eruptions. A peculiarity of these patients\\nis that they like to submit to physical examination, particularly\\nabout the breasts and the genitals. Such patients are, as a rule,\\nstrongly given to erotic thoughts and very commonly are addicted\\nto systematic masturbation. A marked instance of this form of\\nsexual perversion has been reported by Engmann and Schwab. 1\\n1 A Study of a Case of Feigned Eruption. Medical Review, September 2, 1899.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0365.jp2"}, "366": {"fulltext": "CHAPTEE XXVIII.\\nSTERILITY IN THE FEMALE.\\nMuch marital and domestic unhappiness is often caused by the\\nnon-occurrence of impregnation of the wife and the resultant\\nabsence of children in the family. As a rule, in the early years\\nof matrimony the want of children on the part of the two consorts\\nis not noticed, or, at least, is not keenly felt but as years go by\\nand no offspring appears, anxiety, discontent, unhappiness, and\\neven misery are experienced, and mutual recrimination may be\\nindulged in.\\nIn former years sterility was incontinently laid to the part of\\nthe wife, but careful observations of late years have quite clearly\\nproved that only in five cases out of six is she the consort at fault.\\nThis fact, that the husband may be the sterile partner in one-sixth\\nof all instances, therefore, puts him on trial as well as the wife.\\nTherefore, before a married woman shall be suspected of being\\nincapable of bearing children the husband and his semen must be\\ncarefully examined (vide supra) and pronounced virile.\\nSterility is very common in the human race, and is the outcome\\nor expression of many and varied morbid conditions. The sexual\\napparatus of woman is very complicated, and anatomical study\\nhas shown that even in health its mechanism is not thoroughly\\nadequate for the harmonious functional activity between the Fal-\\nlopian tubes and the ovaries. This point is often well illustrated\\nby cases in which the ovum does not fall into the tube, but into\\nthe peritoneal cavity.\\nIt is stated on good authority that conception is most likely to\\noccur a few days after the cessation of the menses, and that it is\\nnot liable to occur just before their appearance therefore, in seem-\\ningly healthy women who do not become impregnated, it is well to\\nascertain the facts as to the time of coitus.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0366.jp2"}, "367": {"fulltext": "STERILITY IN THE FEMALE. 347\\nIt is said in a general way that high conditions of civilization\\nand luxurious and indolent modes of life tend to cause sterility,\\nbut before we accept this unqualified and unsubstantiated state-\\nment it is well to ascertain whether, for obvious reasons, these\\nmarried people do not shrink from the cares incident to parturi-\\ntion and childhood, and whether they do not take measures to\\nprevent pregnancy.\\nThe absence of sexual desire and feeling in some women has\\nbeen urged by some authors as the cause of sterility but this\\ncontention is met with direct evidence which proves that many\\nwomen have borne children who never experienced sexual desire\\nand to whom an orgasm was an unknown sensation.\\nThough no direct pathological reason can be assigned for it, it\\nseems to be established beyond doubt that prolonged intermarriage\\nof blood relatives tends in the end to produce at least a relative\\nsterility, but it certainly does give rise to rather inferior grades of\\nhuman offspring.\\nSufficient evidence has been offered to prove that obesity, by\\nreason of its accumulation of fat in and around the internal sexual\\napparatus of the woman, and its interference with its functional\\nactivity, is really an important factor in the establishment of ster-\\nility in women. On this subject a very interesting paper has\\nrecently been published by Dr. J. V. Gaff. 1\\nIn anaemia, chlorosis, the adynamic conditions following grave\\ndiseases, and neurasthenia, temporary sterility may occur, which is\\ndue, in all probability, to the lowered functional activity of the\\novaries.\\nSyphilis in women causes frequent abortions, and in some of\\nthese cases sterility occurs but we are not yet in the necessary\\nscientific position to account for these pathological results.\\nThe sterility so commonly observed in prostitutes is, as a rule,\\ndue to chronic inflammation of the uterus, of the tubes, and of\\nthe ovaries. In this connection it is well to remember that\\ngonorrhoea is a potent and frequent factor in the production of\\n1 Journal of the American Medical Association, January 23, 1897.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0367.jp2"}, "368": {"fulltext": "348 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nuterine and pelvic inflammation. Parturition is frequently the\\nstarting-point of these diseased conditions, which are not infre-\\nquently caused by careless and meddlesome surgeons.\\nIn the case of the absence of the ovaries, of the Fallopian tubes,\\nor of the uterus, sterility is always found.\\nChronic oophoritis is a frequent cause of the suppression or\\ndestruction of the ovule, while in perioophoritis the theca of the\\novary becomes so thickened that injurious pressure is exerted on the\\nsecreting portion of the organ. In either event sterility is produced.\\nThe mechanical adjustment of the ovary to the fimbriated ex-\\ntremity of the Fallopian tubes may be impaired or destroyed by\\nfibrous bands left by peritonitis, and in this event the ovule can-\\nnot escape into the uterus, nor can spermatozoa find their way to\\nthe ovule, consequently fecundation is impossible.\\nOvarian cysts and various neoplasms may so destroy or distort\\nthe tissues of the ovary that it oan no longer produce ovules.\\nSalpingitis is a very frequent cause of sterility. In the catarrhal\\nvariety, with its hypersemic mucous membrane and the continual\\nescape of muco-pus into the uterus, the mechanical conditions are\\nsuch that the irruption of spermatozoa into the uterus and tubes\\nis rendered impossible therefore impregnation cannot occur.\\nIn hydrosalpingitis and pyo salpingitis an insurmountable bar-\\nrier to the upward migration of spermatozoa is formed by the\\ncollection of water and pus, and, as in these cases the ovaries are\\nusually diseased, it follows that a woman thus afflicted is irreme-\\ndiably sterile. Chronic interstitial salpingitis results in atrophy\\nand stenosis of the tubes, which are then no longer permeable.\\nAtresia of the uterus, congenital or acquired, renders impreg-\\nnation impossible.\\nAtresia of the cervix uteri, caused by overcuretting, caustics,\\nsyphilitic and chancroidal ulcers, and syphilitic cell-infiltration,\\noffers a barrier which spermatozoa cannot overcome. In like\\nmanner, the plug of dense tenacious mucus which forms in inflam-\\nmation of the uterine neck may act as a net which entangles the\\nspermatozoa. Ulceration of the cervix with inflammatory hyper-\\nplasia of the parts frequently render a woman sterile.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0368.jp2"}, "369": {"fulltext": "STERILITY IN THE FEMALE. 349\\nIn catarrhal endometritis and endocervicitis the mucous mem-\\nbrane is so altered that the necessary conditions for the fecunda-\\ntion of the ovum are absent. In these conditions the profuse\\ndownward flow of pus both kills and washes away spermatozoa,\\nand thus prevents conception.\\nFissures of the uterine neck frequently react so seriously on\\nthe condition of the uterus that it is rendered unfit for the func-\\ntion of conception.\\nHypertrophy of the cervix uteri, together with infiltrative\\nhyperplasia, simplex or specific, and elongation and conicity of\\nthe segment, in which stenosis of the cervical canal is a frequent\\nconcomitant, is a very common cause of sterility. Malignant and\\nsimple tumors of the uterus act as efficient barriers to conception.\\nIn superinvolution, inversion, and prolapse of the uterus such\\nabnormal conditions of structure and position exist that impreg-\\nnation is rendered impossible.\\nIn the rudimentary and undeveloped uterus impregnation is\\nimpossible.\\nIn anteflexion and retroflexion of the uterus such distortion of\\nthe lumen of the organ is produced that a barrier to the upward\\ninvasion of the spermatozoa is formed.\\nAnteversion and retroversion of the uterus so throw the organ\\nout of position that a purely mechanical impediment is offered to\\nthe efforts of spermatozoa to reach the interior of the organ.\\nRuptured perineum may cause so much disturbance in the sexual\\nparts of women that impregnation is prevented.\\nAbsence, atresia, prolapse, and cicatricial stenosis of the vagina\\nprevent intromission of the penis, and it follows that impregna-\\ntion cannot be effected. In some cases in which the vagina is\\nvery short the semen is lost and fecundation does not occur. The\\nsame accident is liable to happen to a woman with a very capacious\\nvagina, in which all the parts are flabby and relaxed.\\nIn purulent vaginitis the zoosperms may be killed by the secre-\\ntion or carried out of the paths of fecundation by it.\\nIn small and imperforate hymen such a barrier may exist that\\nimpregnation is prevented.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0369.jp2"}, "370": {"fulltext": "350 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nUterine fibroids may so distort the organ or cause such dis-\\nplacement that spermatozoa cannot find a habitat in the cavity.\\nIt is only intended in this chapter to give a general outline of\\nthe causes and conditions which produce sterility in women, which\\nmay form a basis for study and observation. To give full treat-\\nment of the various morbid conditions already mentioned would\\nrequire a very large volume therefore, for further details it is\\nbetter for the reader to be referred to the various authoritative\\ntext-books on gynecology.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0370.jp2"}, "371": {"fulltext": "CHAPTER XXIX.\\nVAGINISMUS.\\nVaginismus may be defined as an excessive hyperesthesia of\\nthe hymen and vulva, attended with such involuntary spasmodic\\ncontraction of the sphincter vaginae as to prevent coitus. It is\\na somewhat rare affection, and is found in varying degrees of in-\\ntensity in women from eighteen to forty years of age and beyond\\nthat period.\\nThe mildest cases of vaginismus are seen in young newly mar-\\nried women, particularly those of a nervous or hysterical nature,\\nin whom no vulvar or vaginal trouble can be found. In some of\\nthese cases on attempted intromission of the penis some pain is\\nproduced, which causes the woman to cry out in agony and the\\nsexual parts to become the seat of more or less spasm (sphincter\\nvaginae, sphincter ani and levator ani). In some instances, owing\\nto the self-abnegation and fortitude of the wife, the painful intro-\\nmission of the penis is borne, and then after a few or many trials\\nthe parts become so dilated that pain ceases and coitus can be\\nnormally indulged in. In other cases only imperfect coitus is\\neffected, on account of the bruising and perhaps laceration of the\\nhymen which has taken place at the first attempt. In these cases\\nthe thought of sexual intercourse throws them into a condition of\\nnervous dread and sometimes hysteria.\\nIt occasionally happens that in women who have had connec-\\ntion for years, and even in those who have borne children, a fissure\\nor fissures of the vaginal orifice may give rise to well-marked\\nvaginismus. In some of these cases the parts are so sensitive\\nthat the least touch by a finger-tip, a probe, or a feather causes\\ninvoluntary contraction and spasm of the vaginal outlet.\\nCases have been reported in which fissure of the anus has led", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0371.jp2"}, "372": {"fulltext": "352 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nto well-marked vaginismus, in which coitus was rendered utterly\\nimpracticable.\\nMild and severe vaginismus is seen in young women in whom\\nthe free surface of the hymen is thickened in its whole extent, or\\nin the form of small or large caruncles. Examination of the\\ngenital parts in these cases may reveal no abnormality whatever\\nin the tissue but in some cases the little growths have a whitish-\\npink color, and in others they are decidedly red and inflamed, and\\nthe contiguous parts of the hymen are in the same condition of\\nactive hyperplasia. In some of these cases sexual intercourse is\\npatiently borne by the woman, and the vaginismus gradually\\nceases but in others the act causes agony and terror, and women\\nutterly refuse to thus submit themselves.\\nThere is a form of modified vaginismus somewhat early seen\\nin young women who masturbate excessively and who use various\\nrigid instruments to titillate the vagina and produce orgasm. As\\na result of these practices the vaginal orifice or the hymeneal\\nfringe becomes the seat of hyperplasia in a nodular or annular form,\\nand great sensitiveness of the parts, with spasm and sometimes\\npain, is produced. In these cases very frequently hysteria is a\\nprominent symptom.\\nInveterate and exaggerated examples of vaginismus are, hap-\\npily, rather rare. They are usually found in married women who\\nin the early months of marriage have suffered from bruising or\\npainful tears on attempted, but not successful, sexual intercourse,\\nwhich has produced pain and spasm.\\nSome of these women still retain their virginity others have\\nmore or less damaged and torn hymen or vulvae but in none has\\ntrue intercourse been practised and perfect intromission accom-\\nplished. In some of these cases as many as twenty years elapsed\\nsince the attempted coitus, and in others the period was shorter.\\nIn these exaggerated cases the whole morale of the patient may\\nbe destroyed, and they become practically bed-ridden. The late\\nDr. Marion Sims 1 has left a very graphic description of a typi-\\n1 Clinical Notes on Uterine Surgery, New York, 1873, pp. 321 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0372.jp2"}, "373": {"fulltext": "VAGINISMUS. 355\\nthe son of Eleazar, was able to thrust his javelin through the man\\nand the Midianitish woman (vide Exodus) but the occurrence of\\nsuch cases as the above may offer a possible explanation.\\nTreatment. It is gratifying to be able to state that in most\\ncases of vaginismus a prompt cure may be produced. In the\\nmilder class of cases, in which intromission of the penis is im-\\npossible by reason of the pain during the attempt at coitus and\\nthe fear and nervous dread which results from these conditions,\\nit is best to follow the procedure employed by Sims namely, to\\nplace the woman under an anaesthetic and then allow the husband\\nto have intercourse with her. Usually this is the end of the\\ntrouble of these much worried consorts. Further treatment, how-\\never, may be necessary, owing to tenderness of the parts and the\\nabiding fear of the woman. It is well, then, to use frequent and\\ncopious vaginal irrigation of hot lead-water and to gradually and\\ncautiously dilate the vagina, either with a large- size Ferguson s\\ncylindrical speculum or by dilators of varying sizes, made for the\\npurpose, of glass. In these manipulations solutions of cocaine\\nor eucaine may be used to produce moderate anaesthesia, or sup-\\npositories of orthoform may be employed (cocoa-butter and white\\nwax with 10 per cent, of orthoform).\\nShould any painful spot or tab of hymen be felt which seems\\nto cause the vaginismus, it should be fully excised.\\nCases of painful vaginal caruncles should be promptly and ener-\\ngetically treated by a liberal excision of the parts under strict\\nantisepsis. In all these cases it may be well to follow the opera-\\ntion by carefully graduated dilatation of the vaginal orifice and\\ncanal. In some cases the use of absorbent-cotton tampons is\\nsufficient.\\nThe hyperesthesia of the hymen or vaginal orifice caused by\\nmasturbation may be cured by exsection of the nodules and hyper-\\nplastic fringes of the introitus vaginae.\\nToo much stress cannot be laid on the importance and the\\nnecessity for energetic surgical treatment in the cases of invet-\\nerate vaginismus. The topography of the vaginal outlet should\\nbe carefully studied, and then radical exsection should be per-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0373.jp2"}, "374": {"fulltext": "356 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nformed. The patient being anaesthetized and the external genitals\\nhaving been made surgically clean, all the free parts of the ostium\\nvagina?, hymeneal orifice, fissured hymen, nodular caruncles, and\\nmucous membrane tabs should be cut away well down to the\\nmargin of the orifice. It may also be necessary to make deep\\nlateral incisions into the bulbo-cavernous muscles. The parts\\nmay then be frequently irrigated with plenty of hot bichloride\\nsolution (1:5000 or 1:2000), and, if necessary, for a time a\\ncocaine suppository may be introduced. It is most important\\nthat systematic gradual dilatation should be kept up until all\\nsoreness and tenderness of the parts has passed away. For this\\npurpose the trivalve, quadrivalve speculum or Ferguson s specu-\\nlum, or glass dilators may be employed.\\nIn cases of what is known as superior vaginismus, in which\\nthere is spasm of the levator ani muscle and impediment to coitus,\\nthe woman should be thoroughly and antiseptically douched and\\nthen placed under ether. Then deep lateral incisions down into\\nthe muscle into the parts which were found to be the seat of stric-\\nture should be practised. After the operation dilatation by specula\\nor antiseptic tampons should be systematically employed.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0374.jp2"}, "375": {"fulltext": "CHAPTER XXX.\\nMASTURBATION IN THE FEMALE.\\nThough it is difficult to get at scientific testimony as to the\\nprevalence of masturbation in female children and young women,\\nthe statement seems to be warranted that this habit is not so fre-\\nquent and wide-spread as in the male sex, and that in general no\\ngreat harm is done to the system by the habit.\\nMasturbation is sometimes seen in infants and young children,\\nboth in those who come from healthy parents and in those who\\nhave a greater or less neuropathic tendency.\\nMasturbation in very young infants sometimes occurs, and unless\\nthe physician is thoroughly skilled in pediatrics the phenomena\\nproduced by the bad habit may not be understood by the attend-\\nant. For that reason I here transcribe the carefully prepared\\ndescription of a case which is graphically described by an accom-\\nplished observer\\nThe first indications of nervous trouble were noticed when\\nthe child was .fourteen months old. They were very slight and\\noccurred when the child was lying in its mother s lap. She sud-\\ndenly became pale, had a peculiar dazed expression, and her atten-\\ntion could not readily be attracted. On being raised up and moved\\nshe immediately became natural in looks and action. This was\\nrepeated a few times only, when the attacks changed in character.\\nIn addition to the appearance of the countenance already described\\nthere was much muscular rigidity the arms became quite stiff\\nand strongly resisted being flexed, and the hands were clenched\\nand the little fists firmly pressed into the iliac region on either\\nside. At the same time the legs were strongly extended at right\\nangles to the body, and there was a strong contraction of the\\nabdominal muscles, and a straining as if at stool. If the child", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0375.jp2"}, "376": {"fulltext": "358 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nwas held against one s breast she made strong pressure with the\\nknees, and up-and-down movements of the body. After a short\\nperiod a moment or two the respirations were quickened to a\\nrapid panting, and perspiration started freely from the head and\\nstood in drops about the mouth. The attacks often terminated in\\nsleep. There was at no time any spasmodic or convulsive move-\\nment, or unconsciousness, or mental disturbance beyond an appar-\\nent abstraction.\\nThe attacks came on irregularly at times with intervals of\\nsome days, and, again, they were repeated many times a day for\\nseveral days in succession, and sometimes for two or three hours\\nwith but slight intermission. They never came on during sleep,\\nbut usually when the child was sitting on the lap, and occasion-\\nally when on the bed or floor. If she was placed on the floor\\nearly in the attack, and amused with her playthings, it would\\nfrequently be broken up if, however, she was held till it was\\nfully developed and then put down she would lie upon her side,\\nand the attack would progress as described.\\nIt was further noted in these cases that the little girls were apt\\nto keep their thighs closely joined, to cross their legs, and to rub\\nthe limbs violently, sometimes until they became purple in the\\nface.\\nIn some of these young subjects such nervous phenomena as\\nepilepsy, Saint Vitus dance, idiocy, and stupidity have been\\nobserved.\\nSeveral authors divide the subject of masturbation in women\\nas follows vaginal masturbation and clitoridean masturbation.\\nIn most cases the vicious practice is performed by the girl or\\nwoman herself, but exceptionally a male or female confederate\\ncommits the act on the woman.\\nVaginal masturbation is mostly accomplished by manipulations\\nby means of candles and more or less rigid instruments made to\\nresemble the penis. This form of vice is usually solitary.\\nClitoridean masturbation is said to be frequently performed by\\na second person, male or female, and consists in friction on the\\nsurface of the prepuce of the clitoris or upon its glans.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0376.jp2"}, "377": {"fulltext": "MASTURBATION IN THE FEMALE. 359\\nIn some rare cases masturbation is performed by means of\\npeculiar manipulations of the face.\\nA case is reported of a young woman of twenty-two, of bad\\nfamily antecedents, who had been attacked with psychopathic\\nsymptoms coincident with menstrual derangement, and for some\\ntime had been in an asylum. The patient manifested choreic\\nmovements of the hands, sometimes of one hand, at other times\\nof both, terminating by curious manipulations of portions of the\\nface. The dorsum of the thumb was placed in the centre of the\\ncheek, then with the middle finger pressure was made alternately\\non the tip of the nose and the tragus of the ear. After manipu-\\nlating a few times in this way the patient would fold her hands\\nin her lap with a far-away, pleased expression on her face, lasting\\nsome five minutes. A thorough investigation elicited the fact\\nthat the patient could produce sexual excitement and satisfaction\\nby the manipulations before referred to. She did not seem to\\nhave any idea of wrong-doing, but was ashamed and surprised\\nwhen the nature of her act was explained to her. This case calls\\nattention to a possible explanation of many otherwise baffling\\npractices on the part of young children, and should keep the\\npractitioner ever on his guard in anomalous cases for possibly\\nhitherto unsuspected methods of inducing sexual erethism.\\nBy consulting many authorities we learn various facts as to the\\ncauses which lead to masturbation in the female, a general summary\\nof which will now be given. In many cases the natural passion-\\nateness of the girl or woman lead to the performance of the act.\\nIn many cases the too rapid completion of the sexual act in\\nthe man leaves the woman unsatisfied, and she as a result pro-\\nduces the orgasm upon herself at the first opportunity.\\nA very common cause of masturbation in girls and women is\\ndue to lack of care and cleanliness of the genital organs, which\\nas a result become irritated and are then scratched or rubbed. In\\nthis process pleasurable sensations are produced and the onanistic\\nhabit is formed.\\nEczema, psoriasis, dermatitis, and pruritus of the female geni-\\ntals are often the exciting cause of the vice.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0377.jp2"}, "378": {"fulltext": "360 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nMany cases are on record in which coitus has been painful to\\nwomen by reason of some structural peculiarity of the external\\ngenitals, such as small vaginal orifice, shortness of vagina, fissures\\nor tabs of the orifice, or of ruptured hymen, perineal fissure, and\\npartial prolapse of the uterus, and as a result they have resorted\\nto masturbation in place of sexual contact.\\nSeveral authors, particularly Frenchmen, make the statement\\nthat various spices, cloves, cinnamon, pepper, mustard, etc., may\\nlead to masturbation in the female, and that certain odors of per-\\nfume, such as musk and patchouli, cause in them erotic desire.\\nCantharides, phosphorus, and absinthe are generally regarded as\\naphrodisiac stimulants. It is generally well known that high\\nliving and alcoholic beverages act as sexual stimulants to women,\\nand may lead to masturbation\\nConstipation, by its mechanical congestion of the pelvic organs,\\nis said to produce sexual desire and lead to masturbation in chil-\\ndren and young women, and pin worms and round worms in the\\nrectum very often cause the same train of morbid conditions.\\nVaginal discharges of all kinds cause genital irritation and are\\nfrequently the starting-point of the onanistic habit.\\nAs a result of certain exercises in the gymnasium, horseback\\nriding, long-continued use of the sewing-machine, and bicycling,\\npelvic congestion and genital irritations are produced which lead\\nto masturbation. A sedentary life and long-continued sitting may\\nproduce the same result.\\nThe close herding of the sexes and the sleeping together of chil-\\ndren and girls with older people are frequently the cause of sexual\\nvice and masturbation.\\nMany women, young and old, become the victims of onanism\\nas a result of the inspection of lewd pictures and nude statues, by\\nreading obscene books, and by immoral conversation and gestures.\\nThe bad example set by one or more girls in a boarding-school,\\nin a reformatory, or in an asylum very often leads to an epidemic\\nof masturbation in which all the inmates become vitiated. Many\\ncases are on record in which female servants and nurses have\\ntaught masturbation to the young girls under their care.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0378.jp2"}, "379": {"fulltext": "MASTURBATION IN THE FEMALE. 361\\nSexual coldness of the husband, personal indifference, impo-\\ntence, and senility frequently lead to masturbation in young and\\npassionate women. Then, again, widowhood, the long absence or\\nperhaps illness of the husband, may cause them to produce orgasms\\nupon themselves. French authors have prominently mentioned\\nobesity in the woman as being a sufficiently frequent cause of\\nmasturbation. In these cases, for physical reasons, coitus is ren-\\ndered difficult or even impossible, a ad the woman resorts to\\nonanism or seeks others to perform the act for her.\\nUndoubtedly the condition of the clitoris has much to do with\\nthe production of masturbation in women. It seems to be pretty\\nconclusively proved that shortness of the clitoris may lead to\\nimperfect sexual connection by reason of the part not being\\ntouched and titillated in the sexual act by the penis of the male\\nconsort, hence no gratification occurs in the woman, and she,\\nbeing then excited and aggravated, has to resort to clitoridean\\nmanipulation to produce an orgasm.\\nIn some women the clitoris is highly placed well above the\\nupper margin of the vaginal orifice, and in coitus it wholly escapes\\nfriction from the penis, and as a result there is no orgasm. Such\\nwomen are prone to produce orgasms upon themselves.\\nAdhesions of the glans of the clitoris to its prepuce, partial or\\ncomplete, are said to be very common, and when present they\\nmay cause much disturbance. In the first place, they may be so\\nbound down or lifted up that in sexual contact no tit-illation is\\nproduced by the intromiting penis, and as a result the woman\\nhas no orgasm. In many cases a woman thus left unsatisfied\\nresorts to masturbation. On the other hand, it has been observed\\nthat the full development of the clitoris has been prevented by\\nadhesions, and as a result the function of this sexual appendage\\nhas been held in abeyance.\\nIn many cases in which there is no structural defect in the\\nclitoris it becomes irritated by the accumulation of smegma, par-\\nticularly in careless and uncleanly women. In such cases the\\nurine and vaginal and vulvar discharges produce much irritation\\nand erethism and lead to onanistic practices.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0379.jp2"}, "380": {"fulltext": "362 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nSeveral authors state that masturbation in women has been\\nsuperinduced by the aversion and repugnance of men to them,\\nowing to their naturally extreme ugliness or to the fact that they\\nhad been rendered strikingly hideous by physical deformities.\\nA very infrequent form of masturbation is termed nympho-\\nmania or erotomania, and is observed in degenerate sexual per-\\nverts and women with marked cerebral disease. In some women,\\nhowever, in whom there is no insanity, but who labor under\\nhysterical and neuropathic tendencies, this habit is sometimes\\nobserved in a rather milder form.\\nThese women suffer from inordinate and excessive sexual de-\\nsire, and many of them are frequently guilty of great foulness\\nand lewdness of speech and action. They unblushingly expose\\ntheir genitals to both men and women, and commit masturbation\\nwithout any attempt at concealment. They are usually women of\\npassionate nature and of nervous and excitable tendency.\\nNymphomania is said to follow as a result of prolonged mas-\\nturbation and sexual excess, but it is probable that an underlying\\nwant of nervous balance is the starting-point of these vicious ten-\\ndencies and habits. Cases are on record in which well-bred and\\nrefined women have in the course of nymphomania become so low\\nand degenerate that they have used the most obscene language and\\nhave committed the most libidinous actions.\\nIt is said that uterine and ovarian diseases tend to produce\\nnymphomania, also called furor uterinus, in some cases but in\\nall these instances it is most important to look carefully and fully\\ninto the condition of the nervous system.\\nIn some of the milder cases of nymphomania women develop\\na remarkable tendency to undergo operations upon and examina-\\ntion of the sexual organs.\\nSeveral cases have been reported in which women suffering\\nfrom marked sexual erethism have pretended to suffer from re-\\ntention of urine, and have been much comforted by the with-\\ndrawal of that fluid by means of the catheter of the surgeon.\\nAs a result of extended recent studies in nervous and mental\\ndiseases the conviction seems to be growing that excessive mastur-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0380.jp2"}, "381": {"fulltext": "MASTURBATION IN THE FEMALE. 363\\nbation is a symptom of nervous debility and disease rather than\\nthe exciting cause of these morbid phenomena.\\nIn the older books much stress was laid upon the facies of the\\ngirl or woman addicted to masturbation. As far as I can learn,\\nin most cases masturbation in women (which it is probable is not\\nvery frequent) is indulged in in moderation, and no untoward\\neffects are produced certainly none which will appear at all\\npathognomonic. Neither in their appearance nor in their actions\\ndo these women present any unusual condition.\\nIn some cases in which females indulge excessively in mastur-\\nbation, a deterioration in the health of the patient may be observed,\\nbut these women promptly get well under proper hygienic care\\nand on ceasing to indulge in the bad habit.\\nExcessive masturbation in women is said to show itself in\\npale, sallow, and expressionless face, sunken eyes surrounded\\nby blanched circles, and a secretive and hang-dog looking facies.\\nSuch women have cold, clammy hands, a generally poor circula-\\ntion, small, rapid pulse, and a tendency to shortness of the breath.\\nIndigestion, constipation, and insomnia are frequent and concom-\\nitant symptoms. It will be seen that there is nothing absolutely\\ncharacteristic in any of these symptoms, all of which are fre-\\nquently found in neurasthenics and hysterical women.\\nThe local effects of masturbation in women can be seen in\\nenlargement of the prepuce of the clitoris and of this organ itself,\\na pigmented condition and excessive development of the labia\\nminora, and perhaps hyperplasia and hyperesthesia of the orifice\\nof the vulva.\\nTreatment. In the management of young girls who are\\naddicted to masturbation the most careful surveillance and watch-\\nfulness on the part of the mother are necessary. When the symp-\\ntoms point to manipulation of the genitals the child should be\\nstopped at once, and she should be held in the lap with the\\nthighs extended. Any condition of ill -health should be carefully\\ntreated, and if any irritation of the external genitals is observed\\nit should be cured. When young girls are herded together at\\nhome or in boarding-schools, asylums, etc., it is important to", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0381.jp2"}, "382": {"fulltext": "364 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nt\\nwatch them carefully and prevent, if possible, the indulgence in\\nbad sexual habits.\\nIt is always well for mothers of young girls and boys to scru-\\ntinize carefully the habits and conduct of servants and nurses,\\nand to see that they do not teach the children bad habits and\\nthat they do not manipulate their genitals.\\nIn all cases irritation of any and all kinds of the sexual parts\\nof children should receive prompt attention and be thoroughly\\nremoved. When it comes within the province of the surgeon\\nin the various cases he should endeavor to prevent onanistic\\nhabits, which young women acquire in gymnastic exercises,\\nhorseback riding, in the use of the sewing-machine and of the\\nbicycle.\\nIn all cases the general hygiene and regimen of the patient\\nmust be looked into, and sound advice must be given.\\nThe condition of the clitoris must be carefully examined in all\\ncases of confirmed masturbation. If there is smegma seated on\\nthe organ and under its prepuce the parts should be regularly\\nand carefully cleansed, and for a time a little tuft of absorbent\\ncotton soaked with lead-water should be kept over the parts.\\nIrritation of the clitoris from any cause, such as uncleanliness,\\npediculosis, dermatitis, vulvitis, and vaginal discharges, should\\nbe at once treated and the cause removed.\\nIn all cases where adhesions of the prepuce to the clitoris,\\nwhether partial or complete, are present it is imperative to cor-\\nrect this defect at once. To this end it is first necessary to thor-\\noughly irrigate the vagina and vulva with hot bichloride solution\\n(1: 5000 or 1: 2000), then to cocainize the parts, and then by\\ngentle taxis or by manipulation with a probe or the handle of a\\nsmall bistoury to slowly disengage the enveloping tissues from\\nthe glans.\\nThis operation is very simple, and the subsequent treatment\\nconsists in the interposition of a little tuft of absorbent cotton\\ncovered with aristol or orthoform or soaked in lead-water. It\\nis well to keep the interposed cotton in the wound until full\\nhealing is produced.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0382.jp2"}, "383": {"fulltext": "MASTURBATION IN THE FEMALE. 365\\nCases of nymphomania are very distressing, and they tax the\\nsurgeon severely in its treatment. Locally in some of these cases\\nfull exsection of the clitoris (clitoridectomy) may be performed,\\nbut in these cases the surgeon should seek consultation with one\\nor two expert colleagues. The nervous condition of these patients\\nshould be fully and carefully treated.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0383.jp2"}, "384": {"fulltext": "CHAPTER XXXI.\\nNEW GROWTHS AND HYPERTROPHIES OF THE VULVA\\nWHICH MAY LEAD TO STERILITY.\\nIt is noticeable that in the various text-books on diseases of\\nwomen little if any information on broad ground is given con-\\ncerning hypertrophic lesions and simple new growths of the\\nvulva. In a number of scattered essays these important subjects\\nhave been considered, but no definite and systematic description\\nof them has been given. A fair presentment of the discordant\\nviews held to-day regarding simple (and by that I mean all pro-\\ncesses not included under the head of malignant degeneration)\\nhypertrophic and ulcerative vulvar lesions is as follows\\n1. That they are identical with lupus or the esthiomene of\\nHuguier and French authors generally. 2. That they are the\\nresult of essential and specific syphilitic processes. 3. That they\\nare the result of some indeterminate ulcerative process. 4. That\\ncertain cases may be the result of tuberculous infection.\\nIt may be further added that certain of those who do not\\naccept the lupus theory look upon these affections as being pecu-\\nliar and even extraordinary, and while some even regard them\\nas mysterious and specific, they only indulge in generalities in\\nspeaking of them.\\nThis being the condition of the uncertainty of opinion and of\\nthe inadequacy of systematic description, I availed myself, during\\na period of many years service at the Charity Hospital, of the\\nopportunity to study these lesions on many thousand cases of\\nwomen with sexual and genital disorders. As a result of these\\nobservations, supplemented by microscopical study, I have reached\\nthe following conclusions\\n1. That a large and perhaps the greater number of chronic\\ndeforming vulvar affections are due to simple hyperplasia of the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0384.jp2"}, "385": {"fulltext": "NEW GROWTHS AND HYPERTROPHIES OF VULVA. 367\\ntissues, induced by irritating causes, inflammation, and trauma-\\ntisms. 2. That chronic chancroid is a cause in a certain propor-\\ntion of cases. 3. That many eases are due to essential and spe-\\ncific syphilitic infiltrations. 4. That other cases are caused by\\nthe hard oedema which often complicates and surrounds the initial\\nsclerosis and perhaps gummatous infiltration. 5. That many cases\\nare due to simple hyperplasia in old syphilitic subjects who suffer\\nfrom chronic ulcerations of the vulva long after all specific lesions\\nhave departed. 6. That some cases also in old syphilitics are due\\nto simple hyperplasia without the existence of any concomitant\\nulcerative or infiltrative process, and seem to be caused by con-\\nditions which usually in healthy persons only result in vulvar\\ninflammation.\\nIn the foregoing categories the acting, contributory, and remote\\ncauses are briefly outlined.\\nThe systematic division of these new growths and hypertro-\\nphies is very essential in order that a clear and comprehensive\\nknowledge of them may be gained. My studies have convinced\\nme that this subject can most lucidly be treated of by the recital\\nof the facts presented by the smaller orders of lesions, which form\\nan excellent groundwork for a clear knowledge of the larger ones.\\nClinical observation shows that these lesions are divisible in the\\nfollowing categories\\n1. Small hyperplasia?, caruncles, and papillary growths. 2.\\nLarge hyperplasia? and hypertrophies. 3. Hyperplasia resulting\\nfrom acute and chronic chancroids. 4. The various forms of\\nhypertrophy induced by the induratiug oedema of syphilis. 5.\\nHyperplasia resulting from chronic ulcers, the so-called chan-\\ncroids, in intermediary and old syphilis. 6. Hyperplasia in old\\nsyphilitics, presenting no specific character and occurring soon\\nor long after the period of gummy infiltration, in some cases\\nbeing coexistent with specific lesions elsewhere.\\nThe foregoing affections have neither in their clinical history\\nnor their pathology any resemblances to lupus, nor do they par-\\ntake in any manner of the nature of lesions produced by tuber-\\ncular infection.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0385.jp2"}, "386": {"fulltext": "368 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nIn the last periods of many cases iu which ulceration and\\ndestruction are very great, evidences of pulmonary phthisis may\\nbe seen, but my observation convinces me that the tuberculous\\ninfection does not occur through the genitals, but in the lungs of\\nwomen worn and spent with disease. Many authors, particularly\\nFrench, have laid stress on the point that these vulvar lesions are\\nthe outcome of scrofula.\\nIn the following chapters these vulvar affections will be suc-\\ncinctly described.\\nIn many of these cases the walls of the vagina are also involved\\nto a greater or less extent and depth.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0386.jp2"}, "387": {"fulltext": "CHAPTER XXXII.\\nVEGETATIONS OF THE VULVA.\\nIx general vegetations of the vulva may be classed among the\\nsmaller growths, though they may become very large. These\\nsmaller orders of tumors are, first, papillary growths or vegeta-\\nFig. 76.\\nSmall vegetations in a young female child.\\ntions, commonly called warts, and, second, hyperplasias of the\\nvarious prominences, folds, and anfractuosities found within the\\nmore or less complete ellipse formed by the labia minora.\\n24", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0387.jp2"}, "388": {"fulltext": "370 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nVegetations of the vulva may occur singly or in various num-\\nbers, and are prone to develop in the vulvar sulcus, chiefly around\\nthe urethral and vaginal orifices, in children, and more frequently\\nin adults, at or beyond puberty. They are commonly seen on all\\nportions of the vulvo-anal region, and show no tendency what-\\never to localization to the vulvar ellipse. They are of a pinkish\\nor deep-red color, spear-shaped, digitate, sessile, pedunculated,\\ncauliflower-like, or they may resemble strawberries of various sizes.\\nThey are essentially papillary hypertrophies, and show a tendency\\nto exuberant growth. The latter feature and their tendency to\\nirregular and scattered development are points of diagnostic value\\nin separating them from hyperplastic lesions considered further on.\\nFig. 77.\\nExuberant vegetations of adult female genitals.\\nThese vegetations begin as very minute red spots of erosion,\\nwhich soon become elevated, and, if many are present, the mucous\\nmembrane at first presents a velvety appearance. In a short time\\nthese little masses become true warts with more or less papillated\\nexternal structure. Their appearance in early development is well\\nshown in Fig. 76. They rapidly grow larger, and coincidently\\nvery many new ones appear, until (if treatment or preventive\\nmeans are not adopted) the whole vulva and the surrounding\\nregions may be literally covered. The appearance of exuberant\\nvegetations on the female genitalia are portrayed in Fig. 77.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0388.jp2"}, "389": {"fulltext": "VEGETATIONS OF THE VULVA.\\n371\\nVulvar Hypertrophy Consequent upon Vegetations.\\nThere is a form of hypertrophy of the vulvo-anal region of\\nwomen which I believe has not heretofore been mentioned by\\nFig. 78.\\nShowing simple vegetations in process of change into fleshy tabs and\\nhypertrophic masses.\\nauthors. The initial stage of this form consists in the develop-\\nment of simple vegetations on any part of the external genitals.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0389.jp2"}, "390": {"fulltext": "372 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nOwing to neglect, want of care and cleanliness, and of surgical\\nintervention, these growths become enlarged, as they also usually\\nincrease in numbers. As they grow in height and breadth, par-\\nticularly those on the outer portions of the labia majora (where\\nthey are subject to continuous friction), they lose their warty\\nappearance and come to look like nodules, processes, or tabs of\\nskin. They are, as it were, polished off, losing entirely their\\ngranular, strawberry -like look, and taking on the appearance of\\nintegument. In Fig. 78 this form of hypertrophy, in its initial\\nand advanced stages, is well shown. The figure was taken from\\nlife, from a young pregnant woman who had suffered for a long\\ntime from leucorrhoea, the irritation of which led to the develop-\\nment of the new growths. In the depth of the vulva three rows\\nof typical vegetations may be seen, and on the outer edge of each\\nof the labia majora a string of fleshy masses, which had been\\nvegetations, but which had undergone the polishing-off process,\\nmay be seen. Over the perineum are a number of conical tumors\\nof like origin, and hanging over the anus are a large gourd-shaped\\nmass and several smaller ones, which had resulted from the trans-\\nformation of several clusters of very exuberant warts. Unless\\nablated, these tumors inevitably lead to great hypertrophy and\\ndisfigurement of the parts. They, acting as low-grade inflamma-\\ntory foci, induce hyperemia and hyperplasia in the vulva, and in\\nthe end lead to its great distortion. I have many times seen this\\ngeneral hypertrophy of the external genitals by warts, and I recall\\nan instance in which these growths, being very large, were ablated,\\nand in their stumps hyperplasia took place, which led to great\\ndeformity. The practical teaching of these cases is not only that\\nthese new growths should be thoroughly removed, but that great\\ncare should be taken that their sites shall not become the foci of\\nhyperplastic new formations.\\nHyperplastic Growths of the Vulva.\\nSimple new growths of the vulva have been variously called\\npolypi of the urethra and of the vagina, hypertrophied caruncles", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0390.jp2"}, "391": {"fulltext": "VEGETATIONS OF THE VULVA. 373\\nberry-like tumors villous growths, warty excrescences, and\\npapillary polypoid angeionia. Though there is much uncertainty\\nin the minds of medical men as to their real pathology, and though\\nthe most varied views are entertained as to their essential nature,\\nthe matter is a very simple one. In my studies of the larger\\norders of hypertrophies I included a consideration of the path-\\nology and clinical history of these smaller ones. As a result I\\nfound that, clinically, the larger growths were but exaggerations\\nof the smaller ones, and I also learned, through pathological and\\nmicroscopical studies, that the morbid process observed in small\\nlesions can be traced in progressive and undeviating development\\nthrough all sizes of these simple hypertrophies until the enor-\\nmously large ones are reached. I thus strongly state these facts\\nfor the reason that I have seen the affection begin in an insignifi-\\ncant manner on or within the labia minora, and in the course of\\nyears eventuate in the development of enormous vulvar hyper-\\ntrophy. Further than this, I have been able to confirm the clin-\\nical facts which I have observed by what I deem satisfactory and\\nconvincing microscopical studies of the small, intermediate, and\\nlarge lesions which I excised.\\nThe small growths of the vulva, which may properly be called\\nhypertrophied caruncles and simple hyperplastic tumors, are found\\neither singly or in numbers of from two to a dozen or more.\\nThey are sometimes very small, of the size of a large shot, or as\\nlarge as a pea or a strawberry, or even larger. They may pre-\\nsent a decided firmness of structure, or they may be soft and\\nvascular, and between these two extremes there are many grada-\\ntions. They may be of a pale-pink color, of a bright scarlet-red\\ntint, of a deep-red, or of a purplish hue. When they are very firm,\\nthe hyperplasia is composed of all the cell elements of the mucous\\nmembrane and fibrous tissue, and the new growth of vessels is\\nnot excessive but in the softer variety there is a greater amount\\nof new-vessel development, consequently they are more vascular,\\nof deeper color, and softer in structure. These facts will fully\\nexplain the varying clinical features of density and color. I may,\\nin passing, remark that these lesions may give rise to no uneasi-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0391.jp2"}, "392": {"fulltext": "374 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nness whatever, but may also be the cause of great suffering, par-\\noxysmal or continued.\\nUrethral Caruncles.\\nOn the lips of the meatus urinarius and within the urethra,\\nmore frequently on its posterior wall, one or more small or large\\nwarts are sometimes seen, and they are then called urethral\\ncaruncles. It is not uncommon for these lesions, even when\\nvery small, to become extremely sensitive, and even the seat of\\ngreat pain, particularly in urination. This pain may radiate to\\nthe parts around, and even down the legs. Not uncommonly\\nbleeding may occur from a caruncle, and during micturition there\\nmay be severe spasm of the vesical sphincter. Cases have been\\nobserved in which one little urethral caruncle has produced such\\npain, distress, and anxiety that patients have fallen into severe ill-\\nhealth and have suffered intolerable agony. Warts seated near\\nand around the introitus vaginae are also in some cases the seat of\\npain, and they may prevent coitus.\\nWhen vegetations are few in number they may remain isolated,\\nand as they grow they attain the size of strawberries, and they\\nmay resemble them in appearance or become of a dark-purple\\ncolor. In these instances they are sometimes regarded as cancer-\\nous, and in times past they have been diagnosticated as lupus-\\ngrowths. In young women these lesions are, as a rule, simple in\\nnature. As age advances one must be more guarded in prognosis,\\nsince in old persons simple warts have a tendency to cancerous\\ndegeneration, and epithelioma of the vulva very often begins in\\na lesion which resembles a simple wart. As a broad, general rule,\\nwarty lesions of the vulva before the fortieth or fiftieth year are\\nof simple nature after these periods their structure is often doubt-\\nful, and the surgeon should strongly suspect epithelioma, and at\\nonce have a microscopical diagnosis established.\\nIt must not be assumed that all small growths increase in size\\nand eventuate into larger ones. Many remain for years without", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0392.jp2"}, "393": {"fulltext": "VEGETATIONS OF THE VULVA. 375\\nany increase in size, others become larger and troublesome, and\\nare excised, and perhaps but few reach large proportions. Social\\nposition, personal cleanliness, and many other considerations tend\\nto determine the life-history of these growths. It should always\\nbe remembered that, as age increases, these benign growths are\\nvery liable to become malignant in character. This is particu-\\nlarly the case with the more vascular ones. Consequently, the\\nsurgeon should always recommend their ablation in women about\\nand beyond forty years of age.\\nTreatment. The indications for the treatment of vegetations\\nare their complete removal and the prevention of their return. In\\nevery instance the immediate and surrounding parts should be\\nthoroughly washed or irrigated with solutions of carbolic acid\\n(1:100) or of the bichloride of mercury (1:2000); then the\\nsurfaces and interstices of the warts should be thoroughly painted\\nwith an 8 per cent, solution of muriate of cocaine. In very\\nnervous women in whom the lesions cover a large or delicate sur-\\nface, mild chloroform narcosis or ether-narcosis may be required.\\nThis condition being induced, the necessary treatment can be\\nmore thoroughly and easily instituted.\\nIt may be stated as an axiom that surgical procedures for the\\nremoval of vegetations are much more rapid and effectual than\\ncaustics are. The latter, however, are useful under certain cir-\\ncumstances. When the vegetations are small they are readily\\nremoved by the dermal curette or Volkmann s spoon, the scraping\\nbeing carried well to the level of the tissues, which, however, must\\nnot be wounded. A solution of persulphate or perchloride of\\niron should be carefully touched to the bleeding points, and the\\nparts, when dry, quite firmly covered either with iodoform gauze\\nor absorbent gauze never with watery solutions. Such is the\\ntendency to recurrence of these growths that the cure cannot be\\nconsidered complete until the surfaces are smooth. In cases of\\nrecurrence, before the little growths have reached much salience,\\nchloroacetic acid, lactic acid, acid nitrate of mercury, nitric acid,\\nthe various solutions of iron just spoken of, and strong tincture\\nof iodine may be employed. Bichloride of mercury (thirty grains", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0393.jp2"}, "394": {"fulltext": "376 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nto the ounce of collodion) or salicylic acid (one drachm to the\\nounce of collodion) is sometimes a very effectual solution for\\nsmall warts and those for which curetting is contraindicated.\\nSessile or pedunculated warts of an area of an inch or more\\nmay be readily removed by strangulation with a silk ligature.\\nIn some cases this object may be accomplished by the elastic liga-\\nture, using the ordinary small India-rubber bands, fixed firmly\\naround the base of the warts still, in all cases in which it is\\npracticable, scraping is the best treatment.\\nWarts of larger area than an inch are best treated by the gal-\\nvano-cautery loop, and these cases are the only ones in which this\\nmethod of removal is really indicated. Their ablation must be\\nslowly and carefully effected with the least loss of blood. Their\\nfurther treatment is similar to that of the small growths. Rigid\\nantisepsis is required in every case.\\nThe utmost care must be observed in removing vegetations\\nabout the meatus, and when possible scraping or tying should be\\nemployed. The parts should be viewed in a clear light, and a\\nurethral speculum should be used in order that no new growth\\nmay escape. When curetting is impracticable salicylic or bichlo-\\nride collodion or tincture of iodine may be used very carefully.\\nThe idea is simply to remove the new growth and avoid damaging\\nthe parts and causing stricture of the urethra. As a rule, acids\\nare contraindicated in this region.\\nIn cases where operative procedures are not admissible, whether\\nowing to the size or situation of the warts it is well to apply freely\\nto them, after preliminary fomentations with very hot water, fol-\\nlowed by washing with bichloride or carbolic solutions, equal parts\\nof calomel and salicylic acid.\\nThere is a popular fallacy that warts in pregnant women should\\nnot be removed for fear of producing abortion. This view was\\nthe outcome of the old and now, happily, nearly obsolete treat-\\nment by vigorous and intemperate cauterization, which produced\\ngreat vulvar and vaginal inflammation, and sometimes rigidity,\\neven stenosis, of the genital tract. No such results are produced\\nwhen the growths are removed by curetting or other surgical", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0394.jp2"}, "395": {"fulltext": "VEGETATIONS OF THE VULVA. 377\\nmeans supplemented by rigorous antisepsis. Since vegetations\\nmay act as impediments to parturition by reason of their own\\nsize and position and of the oedematous hyperplasia which they\\ncause, they should always be promptly and thoroughly removed.\\nAfter removal the surgeon should explain to the patient the\\nconditions under which warts grow and luxuriate, with a view to\\nprevent their recurrence.\\nIn persons beyond forty years of age persistent recurrence of\\nan originally simple wart should always awaken suspicion of\\nmalignancy, and prompt and radical extirpation should be prac-\\ntised.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0395.jp2"}, "396": {"fulltext": "CHAPTER XXXIII.\\nLARGE HYPERTROPHIES OF THE VULVA.\\nThe larger orders of vulvar hypertrophies, like the smaller\\nones, may be found in early puberty, up to middle life, and are\\nless common in persons beyond fifty years of age.\\nThese hyperplasias are, as a rule, the direct result of some irri-\\ntation or of traumatism. Vulvar inflammation, whether simple\\nor the outcome of antecedent chancroids, vaginitis, herpes pro-\\ngenitalis, leucorrhoea, gonorrhoea, uncleanliness, masturbation,\\ntears in coitus and parturition, scratches, cuts, bruises, eczema,\\nand all forms of traumatisms have been found to be exciting\\ncauses.\\nIt is impossible to give a systematic and comprehensive descrip-\\ntion of these hypertrophies, since they all differ from one another.\\nThis is due to the fact of the very great variation in the confor-\\nmation of the vulva in women. In some the labia majora are\\nlarge, in others very small and exceptionally absent. The labia\\nminora are seen in an infinite number of sizes, shapes, and gen-\\neral configurations. Some are long and thin, some short and thick,\\nsome smooth on their free edge, others irregular and perhaps fes-\\ntooned and frilled. Then the structure of the vestibule, the con-\\ndition of the introitus vaginae, and the shape of the fourchette are\\nfound to vary so greatly that nothing like uniformity occurs. It\\ncan be readily seen, therefore, that a good-sized essay could be\\nwritten on all the varying appearances offered by these vulvar\\ngrowths, and then the limit would not be reached.\\nIn some cases there is simple enlargement of the natural parts,\\nbut in the majority there is more or less deformity, and even dis-\\ntortion. Very little of diagnostic importance is offered by a study\\nof the various shapes and sizes of these growths. A clear idea", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0396.jp2"}, "397": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0397.jp2"}, "398": {"fulltext": "PLATE XL\\nHypertrophy of the Right Nympha and Perineum.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0398.jp2"}, "399": {"fulltext": "LARGE HYPERTROPHIES OF THE VULVA. 379\\nof the appearance and history of them can best be given by the\\npictures and details of three cases. The first case (see Plate XI.)\\nshows the localization of the affection in one nympha, and its his-\\ntory is as follows\\nA woman, aged twenty-eight years, free from syphilis, had\\nsevere attacks of herpes progenitalis involving the right labium\\nminus. About six months later she had a profuse purulent vagi-\\nnal discharge for a time, and then noticed that the right labium\\nminus was sore and slightly inflamed. In a short time the in-\\nflamed part became noticeably enlarged and of a deep pinkish-red\\ncolor, until it reached the proportions shoAvn in Plate XI. It is\\nseen to be a flat tumor, semicircular in shape, quite deeply in-\\ndented on its free margin and limited sharply to the right labium.\\nIts color was of a whitish-pink when the patient was long in the\\nrecumbent position, and of a pronounced pinkish hue when she\\nwalked very much. She was very clear as to the fact that in its\\nearly days the tumor was of a rosy-red color, softer and thicker\\nthan now, and that as it had grown older it had become decidedly\\ncontracted and much firmer in consistence. At the base of the\\nenlarged nympha corresponding to the introitus vaginae were two\\nsmall superficial ulcers of simple character. The perineal rhaphe\\nwere somewhat thickened and ended in a thickened and flabby\\npouch-like mass of skin, which hung over the unaffected anus as\\nshe lay on her back. The inguinal ganglia were unaffected. Be-\\nyond a sensation of heat and pruritus, which occurred in short\\nparoxysms, the patient experienced no discomfort.\\nIt will be noted that the labial hyperplasia began in this woman\\nat the age of twenty-eight, and reached the size depicted in Plate\\nXI. in about two years.\\nIt is important here to call attention to the flabby, pouch-like\\ntumor at the anal orifice, since growths like it are so common in\\nall cases of vulvar hypertrophy, whatever may be their origin.\\nThese protrusions are not, strictly speaking, piles, for the reason\\nthat they are not of necessity connected with the anus, certainly\\nin their early stages. They seem to begin as hyperplasias of the\\nskin of the perineum, and as they grow to settle themselves on", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0399.jp2"}, "400": {"fulltext": "380 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nthe anterior margin of the anus. In the uncomplicated condition\\nthey do not impinge upon the anal orifice, but as they grow larger\\nand broader they involve that outlet more or less, at first on its\\nin tegumental part, and later, in very chronic cases, the rectal\\nmucous membrane may become affected by the hyperplasia.\\nThe second case shows still further vulvar involvement\\nA woman, aged twenty -five years, American, single, had cohab-\\nited with men from her sixteenth year, but was free from syphilis.\\nShe had had numerous attacks of mild vulvar and vaginal inflam-\\nmation, due to sexual irritation, but gave no history of gonorrhoea.\\nAbout a year before the date of operation she noticed that the\\ncaruncula? myrtiformes were rather red and tender, and that some\\nof them soon increased to the size of small peas, being firm and\\nsomewhat shotty to the touch. Then she noticed that her exter-\\nnal genitals were growing larger and protruded, whereas in former\\nyears the nymphae had habitually been closed in by the labia\\nmajora. In the early period of development of these vulvar\\ngrowths they were of a bright-red color, and from their inner\\nsurfaces bloody serum exuded at times. On one occasion a mild\\nhemorrhage took place, which lasted several hours. At this time\\nalso the thickness of the labia was much greater than it was\\nwhen the swellings became as large as shown in the figure. She\\nexperienced very little occasional heat and pruritus in the parts,\\nand only applied for relief when they became rather obstructive\\nto copulation. When first seen the nymphse and clitoris were\\nmuch hypertrophied. The left tumor was fully five inches long,\\nand by traumatism became gangrenous in its distal half, which\\nsoon fell off. The parts presented the appearance and color of\\nintegument, were firm, even leathery and resistant, not at all sen-\\nsitive, perhaps rather callous, and they had an irregular lobulated\\nand nodulated contour. They are well shown in Fig. 79. On\\nseveral occasions mild and ephemeral ulcerations had existed in\\nthe deep vulva, but they caused no uneasiness. Two weeks after\\nremoval of the hypertrophied parts the woman stated that she was\\nas well as ever, and left the hospital. In this case the irritation\\nfrom the myrtiform caruncles extended to the lesser labia, and", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0400.jp2"}, "401": {"fulltext": "LARGE HYPERTROPHIES OF THE VULVA.\\n381\\nthis led to their hypertrophy. In the early stage of the affection\\nthe parts were softer, more succulent, and redder as it grew old\\nthey became condensed and gradually lost their color, until they\\nFicx. 79.\\nShowing hypertrophy of both nyniphse and of the sheath of the clitoris.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0401.jp2"}, "402": {"fulltext": "382 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ncame to closely resemble ordinary integument. The general\\nhealth was wholly unaffected. There was no involvement of\\nthe inguinal ganglia.\\nIn this case, as a result of simple local inflammations, the myr-\\ntiform caruncles became inflamed, and then hyperplastic, and from\\nthese foci the new growth extended and involved the labia minora,\\nincluding the prepuce of the clitoris, and that organ itself, in hyper-\\ntrophy. The low form of inflammatory, red, oedematous infiltration\\nof the vulva which was observed early in the woman s medical his-\\ntory will be fully discussed later on. In this and the preceding\\ncase the limitation of the morbid process to the vulva and nymphse\\nis clearly marked. In them, also, the tendency of the affection\\nto push outward and downward is well shown. Later on, how-\\never, the deeper parts very often become invaded. This case,\\ntherefore, may be accepted as a typical one, showing the involve-\\nment of each and all of the parts of the vulva. Though the\\nintroitus vagina? was at the date of the operation thickened and\\nless supple than normal, this conditiou was undoubtedly due to\\nsymptomatic irritation, since in a few weeks after the operation\\nthe natural condition of the parts was restored.\\nIn Plate XII. we observe the acme of the hyperplastic process\\nof vulvar distortion, which centred itself in the prssputium clitor-\\nidis and a part of a nympha.\\nA woman, aged twenty-six, Irish, married, had not suffered\\nfrom any vulvar or vaginal affection. Six months before the\\noperation she had fallen upon a fence and wounded the mons\\nveneris and upper part of the vulva. These regions were the\\nseat of ecchymosis and pain for about two weeks. Shortly after\\nthe patient noticed a protrusion from the upper part of the vulva,\\nbut, as it was unaccompanied by pain or inconvenience, she paid\\nno attention to it. It, however, grew quite rapidly, until in about\\neighteen months the growth measured four inches, and, besides\\nbeing very inconvenient from its bulk and situation, it caused\\nuneasiness by its weight. The patient noticed that when she\\nwas on her feet very much the tumor was larger and of a deeper\\ncolor than it was if she remained recumbent. There was no", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0402.jp2"}, "403": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0403.jp2"}, "404": {"fulltext": "PLATE XII.\\nEnormous Hypertrophy of the Clitoris, with\\nPart of the Left Nympha.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0404.jp2"}, "405": {"fulltext": "LARGE HYPERTROPHIES OF THE VULVA. 383\\naffection of the inguinal ganglia. The mass is well shown in\\nPlate XII. It was rather more than four inches long and about\\ntwo inches at its widest part. It involved the prepuce of the\\nclitoris and a portion of the upper part of the left nympha. It\\nwas hard and firm in consistence, of a pinkish-white color, and\\nits surface was studded with lobulations and intersected with large\\nand small furrows. It was ablated and the woman left the hos-\\npital cured.\\nA special point of interest in this case is the rapidity of devel-\\nopment of this enormous growth. Assuming that the patient s\\nstory was correct (and great care was taken to get at the truth),\\nthe large mass was developed in about eighteen months. This\\nI may say is .very exceptional, for in several other cases I have\\nnoted that the time occupied in the growth of hypertrophy of the\\nclitoris has been two or more years. In the present instance the\\ntrouble began in trauma, but I have seen a number of cases in\\nwhich hypertrophy of the prepuce of the clitoris was due to mas-\\nturbation. I have now under observation a woman of twenty-two,\\nwho, since her twelfth year, has produced almost daily one or two\\norgasms by digital irritation of the clitoris, and yet the hypertro-\\nphied mass is not larger than the first joint of one s thumb.\\nIn this affection it is very probable that the hyperplastic pro-\\ncess begins in the prepuce, and that later on the body of the\\nclitoris is involved.\\nThese hypertrophic growths of the vulva have been wrongly\\ncalled elephantiasis, notably by Hildebrandt, and more recently\\n(1885) by Zweifel. Neither in their clinical history nor in their\\npathological anatomy do they in any way resemble true elephan-\\ntiasic growths, which are due to lymphatic inflammation with con-\\nnective tissue increase. They are elephantine only in size.\\nThere are a number of conditions relating to the early stages of\\nthese vulvar hyperplasia? which demand consideration. In many\\nsubjects, particularly young, cleanly, and healthy ones, these\\nhypertrophic growths run their course to full development with-\\nout any perceptible signs of inflammation. The growths in these\\nsubjects are, while increasing, of a pink or pinkish-red hue, and,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0405.jp2"}, "406": {"fulltext": "384 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nas they grow larger and push from between the labia majora, they\\nbecome blanched, and finally may look like integument.\\nIn another class of cases, particularly in unhealthy, uncleanly\\nwomen, in those subject to any vaginal discharge, and in women\\nabout and after the menopause, we see synchronously with their\\ngrowth a decided increase in their inflammatory and oedematous\\nfeatures. In these cases there is always more or less concomitant\\nvulvar hyperemia. The hyperplastic parts (when their mucous\\nmembrane is yet intact) are either of a deep-red or of a dull-violet-\\nred color. They have not the firmness of structure, perceptible\\nto the touch, of the less hypersemic growths, but are rather softer\\nand, we may say, more succulent a condition, in all probability,\\ndue to a correlated oedematous exudation.\\nIn this soft and succulent stage of the hypertrophies there is,\\nbesides the lesser degree of sharp limitation and of localization, a\\ndecided tendency to ulceration, particularly in the fissures, sinu-\\nosities, and anfractuosities which are found in them. In all\\nuncomplicated cases of these simple forms of hyperplasia it will\\nbe evident to a careful examination that the ulcerative process is\\nalways secondary to the hypertrophy. It is usually plain to the\\nobserver that the power of resistance of the morbid tissues to\\nirritation is greatly impaired, and that when pressure exists, as\\nfrom close coaptation of the parts, or when any irritation is ex-\\nerted, there will be found ulceration. These ulcers, however, do\\nnot present any pathognomonic features, and it is amusing to\\nperuse the descriptions of these lesions by those who lean to the\\nview that they are due to lupus. The writers see distinctly\\nthat the ulcers have not a lupoid look, and they go over point\\nafter point trying to reconcile in their minds the evident discrep-\\nancies.\\nWe find as concomitant features of these vulvar hypertrophies\\nsimple excoriations, smooth ulcerations, with or without slight or\\npronounced granulating tendency, indolent conditions, and some-\\ntimes sluggish ulcers covered with necrotic detritus. They are\\nalmost always, however, in uncomplicated cases, what we may\\nterm simple ulcers, having the most varied shapes \u00e2\u0080\u0094linear, penni-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0406.jp2"}, "407": {"fulltext": "LARGE HYPERTROPHIES OF THE VULVA. 385\\nform, irregular, and stellate and differ very markedly from those\\nwe shall study in the two following chapters.\\nBut simple as they are, they exert a very bad effect upon the\\ncourse of the new growths. They tend to increase the morbid pro-\\ncess itself, and they themselves very often grow and cause incal-\\nculable mischief. Thus they may burrow and cause fistulous tracts\\ninto the labia and urethra, work their way forward and cause\\nvesico-vaginal fistula, pass backward into the ischiorectal space,\\nand even into the rectum, forming a channel between it and the\\nvulva or vagina. Then, again, they frequently lead to necrosis of\\nsmall and even large hypertrophic growths by eating them away\\nat their bases.\\nThese ulcerations often cause mild and even severe hemorrhage,\\nwhich is usually readily controlled when they are superficial, but\\nwhich may be very intractable when they are deeply seated.\\nIt not uncommonly happens, when both sides of the vulva, as\\nis very common, are the seat of hypertrophy in the succulent\\nstage, that excoriation of the coapted surfaces occurs, and from\\nthem there is an oozing of bloody serum or blood. It is this\\ncondition, undoubtedly, which the older writers observed in what\\nthey called oozing tumors, and which later on has been labelled\\nhemorrhagic lupus.\\nIn favorable cases the succulent stage of these growths gradu-\\nally subsides and the parts slowly pass into the condition of\\ncondensation, until in the end a dense, leathery state may be\\nreached.\\nIn bad cases and they are generally in old women however,\\nthe trouble extends, and destruction of the vulva and its canals is\\nmore or less complete. In this event the patient gradually wastes\\naway from marasmus, dies of phthisis, or of chronic diarrhoea or\\ndysentery. For many years, however, the general health may\\nremain unchanged, and only when the destruction is great, and\\nthe natural outlets of the body more or less destroyed, do signs\\nof breaking up begin to show themselves.\\nWhen ulceration attacks these hypertrophies there is very often\\nmore or less enlargemeut of the inguinal ganglia.\\n25", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0407.jp2"}, "408": {"fulltext": "386 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nI have been particularly struck with the fact that I have never\\nseen cancerous degeneration of any of these hyperplastic growths,\\neven when they have become very old and when very much irri-\\ntated. The little red vascular tumors of the caruncles and vulvar\\nfringes may from irritation become epitheliomatous in women\\ntoward and beyond forty years of age, but when they have\\nreached the stage of condensation they, like their larger con-\\ngeners, may become much inflamed and ulcerated, may be the\\nseat of abscesses, aud may slough off, but they show no tendency\\nto become epitheliomatous. This is probably due to the fact that,\\nwith the thickening of the skin, it becomes impervious to the\\ninvasion of exuberant epithelial tissue from without.\\nIn some cases I have seen much ephemeral hyperemia and an\\nerysipelatous condition of the growths and parts around them,\\nparticularly in those who had become infected with gonorrhoea,\\nwho had vaginal discharges and were uncleanly, and also in women\\nwho had returned to the hospital after a protracted debauch.\\nIn their succulent stage these hyperplasia? might possibly be\\nmistaken for epithelioma, but the mistake should not last long.\\nEpithelioma is usually more localized, of a much greater density\\neven to stoniness, is productive of a large warty or papillomatous\\nand ulcerated surface, and is very soon accompanied by enlarge-\\nment of the inguinal lymphatic ganglia. The ulcerations of epi-\\nthelioma are upon the surface of the neoplasm, while those of\\nsimple hyperplasia are mostly found in the interstices and fissures\\nand at the bases of the simple hypertrophies. Epithelioma of the\\nvulva gives rise to pain of a lancinating character, while the sub-\\njective symptoms of the simple growths are not severe and consist\\nmostly of heat and pruritus. In any case, the diagnosis can be\\nmade at once by a microscopical examination of the morbid tissue.\\nPathology. The morbid process producing these hyperplasia?\\nis a form of inflammation with the production of new connective\\ntissue, while congestion and exudative products are almost if not\\nentirely absent, and is termed chronic productive or chronic cell-\\nafar inflammation. Productive inflammation in mucous mem-\\nbranes and transitional cutaneous mucous membranes produces a", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0408.jp2"}, "409": {"fulltext": "LARGE HYPERTROPHIES OF THE VULVA. 387\\nnew growth of connective tissue in the stroma, occnrring diffusely\\nor in the form of nodular polypoid outgrowths. A characteristic\\nfeature of this form of inflammation is its slow development and\\nits tendency to persist for a long time. These general character-\\nistics of productive inflammation agree very well with the clinical\\nhistory and physical properties of the vulvar growths already\\ndescribed.\\nThe foregoing description applies only to the anatomy of simple\\nhyperplasia?, which have thus been traced through all periods of\\ntheir development and course. But it must be remembered dis-\\ntinctly that hyperplasia in old syphilitic subjects presents precisely\\nthe same pathological appearances as in non-syphilitics. My aim\\nhas been to clear away all the darkness that has obscured these\\nvulvar lesions, by showing that the majority of them are in no\\nAvay specific or lupous in their nature, but that they are simple\\nhyperplasia? which, owing to their situation, have undergone\\nvarious changes. I have not attempted to portray the patho-\\nlogical anatomy of any of the syphilitic new growths, since that\\nhas been done by many, and it is not essential here.\\n(For further microscopical details as to this morbid process, see\\nmy essay On Chronic Inflammation, Infiltration, and Ulceration\\nof the External Genitals of Women, New York Medical Journal,\\nJanuary 4, 1890.)\\nTreatment. Thorough removal with the knife or with the\\ngalvano-cautery of these growths is always necessary, the incision\\nbeing made with the view of preserving the conformation of the\\nparts as much as possible. After operation, irrigation of the vagina\\nand care as to the cleanliness of the vulva are very necessary.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0409.jp2"}, "410": {"fulltext": "CHAPTEE XXXIV.\\nINFILTRATION AND DISTORTION OF THE VULVA FROM\\nCHRONIC CHANCROIDS.\\nHypertrophies of the labia majora and also of the labia\\nminora, and of the deeper tissues, as the result of chronie chan-\\ncroids, are far from uncommon in hospitals for women suffering\\nfrom venereal diseases. Anyone who has had large experience in\\nthe treatment of these ulcers in women will at once call to mind\\ncases where, after the healing of the ulcer or ulcers, a persistent\\nand rebellious thickening of the parts has remained. Time, care,\\nand appropriate treatment will, in most cases, cause the disappear-\\nance of this residual thickening. But when patients are careless\\nor refractory to treatment, uncleanly, and given to drink, the\\nhypertrophy, if it has attained a moderate degree and extent, will\\nalmost inevitably increase. Then, again, we constantly find it per-\\npetuated by gonorrhoea! and leucorrhoeal discharges. The foregoing\\nremarks apply to conditions secondary to what we may call acute\\nchancroids that is, lesions which have come and have disappeared\\nwithin one, two, or four months, for this form of ulcer is very\\npersistent in women.\\nIn like manner hypertrophy of the vaginal introitus, vulvar\\nand juxta-anal region is far from infrequent as a direct result of\\nchronic chancroids.\\nThe history of a case will throw light on the course of this\\nform of trouble\\nA domestic, aged forty-eight years, who never had syphilis, had\\na small chancroid just above the fourchette on the left labium\\nminus, which had lasted nearly a year, when she entered the hos-\\npital. It then was an elevated ulceration (ulcus elevatum) on the\\ninner side of the left nympha, about the size of a silver quarter.\\nIt showed no tendency to extend, but remained in an indolent", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0410.jp2"}, "411": {"fulltext": "INFILTRATION AND DISTORTION OF THE VULVA. 389\\ncondition, became hyperplastic and elevated. The corresponding\\nnympha was very much thickened, hard, and elastic, and the hyper-\\nplasia continued from it into the vagina for about an inch. The\\nappearances are well shown in Fig. 80, which was made from a\\nFig. 80.\\nShowing chronic chancroid of the left nympha, with hypertrophy of\\nthe deeper parts.\\nphotograph taken fifteen months after the chancroidal infection.\\nIt will be seen that the hyperplasia is well limited to the affected\\nnympha. Though this woman received the utmost care from my\\ninternes and nurses, the ulcer healed very slowly, and it required", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0411.jp2"}, "412": {"fulltext": "390 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\na full year s treatment (for, contrary to the custom of these patients,\\nthis woman remained continuously in the hospital) to produce per-\\nfect resolution in the nympha and to restore the elasticity of the\\nintroitus vaginae.\\nThe foregoing case was an especially auspicious one, as the\\nwoman was kept under treatment until she was cured. These\\nwomen are usually very bad patients, and will only submit to\\ntreatment for short periods of time.\\nThe painlessness of the genitals in this condition is very sur-\\nprising, and, although the ostium vaginae is often hard and rather\\nunyielding, these women may continue to have promiscuous coitus.\\nAfter the acute stage the hyperemia settles down into an indolent\\ncondition, which may thus remain indefinitely, or it may be suc-\\nceeded by an exacerbation of inflammation and ulceration due to\\ndrunkenness, debauchery, and general uncleanliness. Internal\\nmedication is powerless in these cases, and topical applications,\\nwhich are slow to heal the parts in the early stage of the career\\nof these women, in the latter periods have little and often no\\neffect. As the trouble becomes chronic the whole vulva, more\\nor less of the vagina, the anus, the rectum, the vesico-vaginal\\nseptum, and vagino-rectal space become inflamed and hyper-\\nplastic, and, as a result, ulcerated.\\nIn general, chronic chancroids on the clitoris and external por-\\ntions of the genitals heal readily, while those of the ostium vaginae,\\nof the inner surfaces of the labia minora, and of the fourchette are\\noften very difficult to cure, and they show a tendency to become\\nchronic and to induce hyperplasia and hypertrophy of the parts.\\nIn the chronic stage, in proportion as the ulcers are deep and inac-\\ncessible, and as they involve the natural outlets, they are menaces\\nto life by the disastrous conditions which they lead to.\\nLarge or small fleshy masses, the result of an extension of the\\ninflammatory process, may occur on the perineum or at the\\nmargin of the anus. Fleshy tumors and excrescences may also\\nresult from chancroids hidden in the puckered folds of the anus.\\nChronic chancroids with great vulvar hypertrophy are usually\\nfound in women beyond thirty and forty years of age. Such", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0412.jp2"}, "413": {"fulltext": "INFILTRATION AND DISTORTION OF THE VULVA. 391\\nwomen, so long as they are in any way attractive to the male sex,\\nremain in the hospital just long enough to become patched up/\\nas we may say. In the early years of their trouble their general\\nhealth does not suffer, and it is to the uninitiated a matter of sur-\\nprise to see women with distorted, disfigured, and ulcerated vulvae\\ncomplain so little, if at all, and seem so well. As time goes on,\\nhowever, things change. Ulceration may perforate the urethra,\\nthe bladder, the vagina, and the rectum, and may also burrow\\nand form large cavities which may open by fistulous tracts about\\nthe buttocks or thighs. Hemorrhages of greater or less severity\\nmay take place, and erysipelatous inflammation, beginning about\\nthe genital parts, may spread beyond and be accompanied by\\nsevere systemic reaction. Then, as years go by, signs of decay\\nshow themselves. The patients begin to cough and emaciate,\\nand a rapid phthisis may end their misery. They may become\\nattacked by affections of the kidneys and liver which prove fatal.\\nThen, again, we constantly see these women fall into a condition\\nof marasmus, over which treatment has no influence whatever.\\nAnd, again, we see life gradually sapped by rebellious chronic\\ndiarrhoea or dysentery. I have seen several of these women\\ncarried off by well-marked pysemic infection.\\nIn a general way, I should say that women suffering from these\\nsevere forms of chronic chancroids and vulvar deformity, with all\\ntheir dangerous concomitants, live from eight to fifteen years an\\naverage of ten years, I think, is quite constantly observed.\\nSome patients are more prone to inflammation and irritation\\nthan others, and they may become the subjects of vulvar hyper-\\nplasia. I have not been led to look upon a dyscrasia as an under-\\nlying cause of any moment in any non-syphilitic cases. In my\\nexperience the vulvar troubles begin when the women are well,\\nand ill-health overtakes them when the hypertrophies have led to\\nulceration, fistulas, deep abscess, fissures, and to strictures of the\\nurethra and rectum, and stenosis of the vagina.\\nIt is important to remember that, though we use the term\\nchronic chancroid, very many of the so-called ulcers do not pre-\\nsent the typical and classical appearance of these lesions when of", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0413.jp2"}, "414": {"fulltext": "392 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nrecent origin. Indeed, the term as applied to ulcers about the\\nvulva is one of great elasticity, since almost any good-sized in-\\ntractable ulcer is thus denominated. These ulcers present wide\\nvariations, since they may appear like ulcerated excoriations, they\\nmay present resemblance to the classic chancroids, and they may\\nbe covered with a greenish-brown or grayish-black film, or even\\nwith a layer of tenacious necrotic tissue. Their edges very fre-\\nquently present nothing pathognomonic, and their secretion of\\npus and pus combined with molecular detritus, and even blood,\\nwill be offensive to the nose in proportion as patients are uncleanly\\nand untreated. Some authors have laid much stress on the odor\\nof the secretions in these cases of vulvar hypertrophy, but my\\nexperience teaches me that it conveys nothing of diagnostic im-\\nport, but that all morbid secretions are exceedingly disgusting in\\nunclean persons.\\nIn many instances the origin of these ulcers in a contaminating\\ncoitus is readily ascertained, while in others they seem to develop\\nde novo. The truth of the matter is that in all cases of vulvar\\nhypertrophy, particularly in the succulent stage, ulceration is liable\\nto occur as a result of irritation or traumatisms of all kinds, and\\nthat they are undoubtedly caused by micro-organisms, which find\\na nutrient nidus in chronically inflamed tissues.\\nIn some cases we find hypertrophy precede ulceration, and in\\nothers that chronic ulceration leads to hypertrophy. As a general\\nrule, however, hyperplasia is by far the more active and the ulcer-\\native the less prominent process. It is remarkable to observe the\\ngreat chronicity and indolence of these vulvar ulcers. They, as\\na rule, increase very slowly, and may remain many months, and\\nsometimes one or two years, without any perceptible change. In\\nthese cases, however, the hyperplasia goes on more or less actively.\\nThe reason for the slow and indolent growth of these lesions lies\\nin the fact that the condensation of the hyperplastic tissue offers,\\nchiefly by its narrowing of the bloodvessels, a dense and unyield-\\ning soil for the destructive process.\\nThe inguinal ganglia in these cases are usually somewhat\\nenlarged and sometimes much swollen. In some cases no change", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0414.jp2"}, "415": {"fulltext": "INFILTRATION AND DISTORTION OF THE VULVA. 393\\nis noted in them, consequently they are not of much aid in diag-\\nnosis.\\nTreatment. When seen tolerably early chronic chancroids with\\nvulvar hyperplasia should be treated systematically by means of\\nfrequent and copious injections of some antiseptic solution.\\nWatery solutions of powdered borax (5iij to 5xxxij) with one\\ndrachm of carbolic acid should be used three times a day. The\\nnext essential is to keep the morbid surfaces separated as much\\nas possible and in a dry condition. To this end tampons of\\nabsorbent gauze dusted with iodoform, boric acid, or aristol\\nshould be carefully applied and frequently renewed.\\nWhen the surfaces of the ulcers are sluggish, fluid carbolic\\nacid may be carefully and sparingly applied, and then the tampon\\nmay be inserted. When the surface is very necrotic or fungoid\\nit may be necessary to curette the parts or to apply pure nitric\\nacid very carefully.\\nWhenever fleshy masses protrude so much that they cause\\ndiscomfort, they should be removed with the knife. Should\\ninfection of the cut surfaces occur, the continuance of the regular\\ntreatment will soon abort this threatened complication.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0415.jp2"}, "416": {"fulltext": "CHAPTER XXXV.\\nHYPERTROPHIES OF THE VULVA DUE TO SYPHILIS.\\nThe vulva and anal region are not infrequently the seat of\\nsyphilitic lesions in the secondary and tertiary periods of the\\ndisease.\\nCondylomata.\\nIn the secondary period it is not uncommon to find, particu-\\nlarly in uncleanly women, pinkish or red, broad, flat, fleshy\\ndisks of thickened tissue, which may become remarkably salient,\\nas shown in Fig. 81, and sometimes may present a warty surface.\\nFig. 81.\\nShowing condylomata of vulva and anus.\\nCondylomata in the female may give rise to a viscid malodorous\\ndischarge, which, escaping down the thighs, causes much irritation.\\nThese lesions begin as one or two red eroded spots, in which\\nhyperplasia soon develops, and then the condylomata increase in", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0416.jp2"}, "417": {"fulltext": "HYPERTROPHIES OF THE VULVA DUE TO SYPHILIS. 395\\nsize and in height, until large fleshy masses may be produced.\\nThese run an indolent course and may cause much distortion of\\nthe vulva and perineum. They usually yield quite promptly\\nto treatment. In some neglected cases they lead to vulvar and\\nvaginal deformity.\\nVulvar Deformities in the Early and Late Stages of Syphilis\\nDue to Indurating (Edema.\\nIn some exceptional cases the initial sclerosis occupies a whole\\nlabium and much enlarges it. In a decided number of instances\\nwe find that accompanying the initial lesion, either around it or\\nin its vicinity, a hard oedema of one labium or both labia occurs.\\nThis oedema, which has been called sclerotic or indurating, is very\\npeculiar, and is the sole appanage of syphilis. It usually begins\\nin an indolent aphlegmasic manner, without pain, and perhaps\\nwith no heat and pruritus, and becomes fully formed in from one\\nto three weeks. Then, again, in some cases its onset is quite\\nbrusque and rapid, and in a few days a labium may be greatly\\nenlarged. When such a labium is examined it may be found to\\nbe of double, even quadruple, its normal size. Its tegumentary\\ncovering may be normal in color or a little redder than usual,\\nwhile its mucous membrane is of a dull red. In some cases the\\ncorresponding labium minus may be affected, and its pinkish -red\\ncolor is then somewhat increased. There is no evidence of in-\\nflammatory engorgement, nor of soft oedematous swelling. The\\nparts are not unusually hot, not tender on pressure or otherwise,\\nas a rule, but they are of an extreme hardness, sometimes pre-\\nsenting a dense elasticity, like one s ear, and again a stony feel,\\nlike cartilage or sclerodermatous tissue. The impress of the finger\\nalways meets resistance. It may be that the whole labium or the\\nlabia (if both are involved) may be thus uniformly sclerotic, or,\\nas often happens, there may seem to be a central kernel of great\\ndensity surrounded by an atmosphere of elastic firmness. In\\nuncleanly women, during pregnancy, and as a result of trauma-\\ntism, this indurating oedema may extend beyond the labial limits.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0417.jp2"}, "418": {"fulltext": "396 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nWell-marked secondary symptoms are usually constant concomi-\\ntants.\\nThe appearances of indurating oedema of both labia minora in\\nlate syphilis are well portrayed in Fig. 82.\\nFig. 82.\\nShowing indurating oedema of both labia minora in late syphilis.\\nThough indurating oedema is more commonly seen in the primary\\nand early secondary stages of syphilis, it may occur later in the\\ndisease namely, in the first, second, and even third years. In\\nthese cases of late development, however, there is commonly a\\nmarked persistence and activity of the diathesis. While the in-\\ndurating oedema of the primary and secondary stages of the disease", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0418.jp2"}, "419": {"fulltext": "HYPERTROPHIES OF THE VULVA DUE TO SYPHILIS. 397\\nusually accompanies or follows the active lesions, that of the later\\nperiods may be unaccompanied by any previous or present syph-\\niloma. Though late oedema may be thus complicated by various\\nsyphilitic processes, it very often is developed by vaginal or\\nvulvar irritation, and also by traumatism.\\nFig. 83.\\nShowing indurating oedema of both labia majora, with warty and\\npapillomatous growths.\\nIn some cases very much enlargement and distortion of the\\nlabia majora are produced by indurating oedema, and rather ex-\\nceptionally the surface of the new growth becomes warty and\\npapillomatous. When this warty condition is found on these\\ndensely hard and indolent tumors the diagnosis of epithelial", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0419.jp2"}, "420": {"fulltext": "398 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ncancer may be made. In Fig. 83 a typical mass of indurating\\noedema is shown on which many warty growths had developed.\\nSeveral physicians who saw this case at first thought it was one\\nof cancer.\\nIndurating oedema runs a long, sluggish course, and yields very\\nslowly to treatment, which should be both local and general. In\\nsome cases ablation of the parts becomes necessary.\\nChronic Chancroids in Old Syphilitics.\\nWe frequently find in early syphilis and in later periods when\\nthe diathesis is active, and again when it is wanting, ulcers which\\nappear de novo, and from tradition we call them chancroids.\\nIt is to-day a generally accepted fact that chancroidal ulcers are\\ncaused by many forms of active pus, and that syphilis is a fre-\\nquent cause of the secretion which gives rise to these ulcers.\\nThere undoubtedly exists in syphilitics a vulnerability of the\\ntissues, showing itself in their tendency to ulceration and hyper-\\nplasia. About the female genitals this tendency is shown in the\\ndevelopment of chancroids upon parts irritated by uterine, vagi-\\nnal, and vulvar secretions, and especially upon any lesion of con-\\ntinuity, such as an excoriation, a tear, a fissure, or upon the seat\\nof vesicles. In their early stages these ulcers may resemble the\\nclassical chancroid, but as they grow older they lose more or less\\nof their typical appearance.\\nThese ulcers usually have sloping edges and fairly smooth bases,\\nwhich are covered with a greenish-gray or brownish-red film of\\npus, under which is a slightly papillated surface. They look in-\\ndolent, and their history proves that in general they are aphleg-\\nmasic, persistent, and chronic. They occur on all parts of the\\nfemale genitalia, and may remain without any perceptible exten-\\nsion for a long time, but yet they frequently cause great harm.\\nAs long as they remain they give rise to a very low grade of\\nsecondary inflammatory engorgement which leads to hyperplasia,\\nwhich may extend up the vagina or into the vulva, thickening\\nthe vaginal and often the rectal walls, attacking the labia minora", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0420.jp2"}, "421": {"fulltext": "HYPERTROPHIES OF THE VULVA DUE TO SYPHILIS. 399\\nby preference and causing their great hypertrophy, and also some-\\ntimes inducing similar change in the labia majora. All of the\\nclinical features of the vulvar hypertrophies which result from\\nchronic chancroids may be produced by these chancroids of syph-\\nilitic origin therefore, having already described them, repetition\\nis unnecessary. It, however, may be added with advantage that\\nwhere the syphilitic diathesis is active, and often even when it is\\nwanting, specific evidences of the disease may be seen elsewhere upon\\nthe body. The hypertrophies produced by these syphilitic ulcers\\nare similar to those of simple chancroids, except that we sometimes\\nsee a greater tendency to destructive ulceration, and in some cases\\nto phagedena. Though the clinical features of chancroidal and of\\nthis form of syphilitic sequelae are hardly sharply enough drawn\\nto warrant separate descriptions of their respective hyperplasia,\\nthe underlying facts must be stated, and this necessitates the divi-\\nsion I have made. Hypertrophy of the vulva, therefore, depend-\\ning on simple hyperplasia from chronic ulceration in syphilitic\\npatients, is far from uncommon.\\nDistortion of the Vulva in Old Syphilitics.\\nThere is a condition of the tissues in older syphilitics, and usu-\\nally in persons of the lower classes, which has not, according to\\nmy reading, been described by any author, but which, I am con-\\nvinced from years of study, is not extremely uncommon about\\nthe genitals of women, particularly as seen in large venereal ser-\\nvices.\\nThis condition consists in a simple hyperplasia of the tissues\\nof the genitalia, which results in more or less deformity. While\\nearly in the disease we so commonly see the tendency to ulcera-\\ntion, later in the diathesis it seems to engraft on these tissues a\\ntendency to a very low grade of inflammatory process by which\\norgans and parts are much thickened and distorted. This hyper-\\nplasia in syphilitics is microscopically the same as that of non-\\nsyphilitics, and cannot in any sense be considered as an essential\\nevidence of disease.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0421.jp2"}, "422": {"fulltext": "400 SEXUAL DISORDERS OF THE MALE AND FEMALE,\\nNo systematic description can be given of these vulvar distor-\\ntions, since no two cases are alike. In all cases the natural\\nshape and relations of the parts are more or less enlarged and\\ndisfigured.\\nOn Plate XIII. is well shown the condition of the external\\ngenitalia in a twenty-eight-year-old woman who had had syphilis\\nsix years before this vulvar distortion had developed. At this\\ntime the following conditions were noted by me The left labium\\nminus was very greatly increased in length and thickness, the\\nclitoris and its prepuce were much hypertrophied, and the right\\nlabium minus (which was originally much shorter than its fellow)\\nformed a long, fleshy process, which hung down nearly two inches\\nbetween the thighs. The appearances are well shown in the Plate,\\nthe hypertrophied growths being brought into prominence by\\nmeans of threads. The mucous membrane of these parts was\\nsomewhat thickened and similar to integument. The whole mass\\nwas of a deep violet or purple-red color. At the base of these\\ntumors were three shallow ulcers which might be taken for chan-\\ncroids. Eversion of the hyperplastic nymphse showed a thickened,\\nviolaceous condition of the whole vulva, with a decided narrowing\\nof the vaginal orifice by reason of the thickening of the tissues,\\nwhich extended into the vagina three inches. The orifice of the\\nurethra was obscured by a cluster of hypertrophied caruncles.\\nThe labia majora were also enlarged and swollen, and the very\\nshort perineum ended in a tab- like mass of integument, seated\\njust on the anterior border of the anus, but not encroaching upon\\nit. From the stenosed vaginal orifice a copious persistent dis-\\ncharge escaped. The hypertrophied nymphse presented a firm\\nresistance to pressure, and the tissues of the vulva, though rather\\nmore dense than normal, were, as we may term it, in a succulent\\ncondition from the hyperemia. The ulcerations were rather\\nsuperficial, of brownish-red color, smeared with pus, smooth of\\nsurface, without well-defined outlines, and their margins devoid\\nof any appearance of being undermined. There was little or no\\npain in the outer growths, though the vulva was rather tender,\\nand sometimes, when irritated, the seat of a stinging, smarting,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0422.jp2"}, "423": {"fulltext": "PLATE XIII.\\nHyperplasia of External Genitals in an Old Syphilitic", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0423.jp2"}, "424": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0424.jp2"}, "425": {"fulltext": "HYPERTROPHIES OF THE VULVA DUE TO SYPHILIS. 401\\nand itching pain. The sufferings of the patient, however, did\\nnot seem to be at all proportionate to the severity and extent of\\nthe morbid process. She had at times been treated energetically\\nwith antisyphilitic remedies with no effect whatever. I ablated\\nthe external tumors, greatly to the relief of the patient. Later on,\\nhot antiseptic injections and appropriate topical treatment cured\\nthe ulcers and lessened the vulvar hyperplasia. The woman left\\nthe hospital much improved.\\nIt is interesting to note that during the three or more years in\\nwhich the vulvar hyperplasia was going on in this woman she\\nsuffered very little from the local affection. The progress of its\\ndevelopment was slow, aphlegmasic, and unattended with any\\nconstitutional reaction. Microscopical examination of the re-\\nmoved masses showed that their structure was identical with that\\nof hyperplasia occurring in non-syphilitic women.\\nDistortion of the Vulva, with Destructive Ulceration.\\nWhen the genitals are the seat of hyperplasia in non-syphilitic\\nwomen ulceration may occur, but it is commonly limited in extent\\nand not very destructive in tendency, though from the nature of\\nthe parts such damage may be done in these cases as will lead to\\ninvalidism and death. In chronic chancroid the ulcerative ten-\\ndency is sometimes well-marked and even quite destructive. In\\nsyphilitic subjects with these hyperplasia? the acme of disintegra-\\ntion is often observed. In them, as a rule, the ulcerations are\\nmore active and extensive than in non-syphilitics. Xot only do\\nwe find severe ulceration in syphilitic subjects, but also phagedena,\\nwhich may cause terrible destruction of the affected parts.\\nIn Fig. 84 are shown the external genitalia of a woman, thirty-\\ntwo years old, who became syphilitic when twenty-two. Seven\\nyears after infection, not having suffered from any manifestation,\\nnor having presented any evidence of the disease for three years,\\nshe, after an attack of vaginitis, observed that her vulva became\\ngradually swollen. This hypertrophy went on for three years,\\nwhen it presented the appearances shown in Fig. 84. At this\\n26", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0425.jp2"}, "426": {"fulltext": "402 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ntime she became much debilitated and took stimulants and opiates.\\nWhile she was in this state ulceration began in the vulvar ellipse\\nand destroyed considerable of the hyperplastic tissue. Having\\nbuilt her up with tonics and generous diet, and nearly cured the\\nFig. 84.\\nShowing hyperplasia of vulva and perineum and destructive\\nulceration in an old syphilitic.\\nulcers, I removed the hypertrophied masses and obtained a very\\nfavorable result from cicatrization. Microscopical examination\\nof the new growths showed simple hyperplasia.\\nIn rare cases phagedena may attack these vulvar tumors, par-\\nticularly when the patient is getting on in years, is unhealthy, and", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0426.jp2"}, "427": {"fulltext": "HYPERTROPHIES OF THE VULVA DUE TO SYPHILIS. 403\\nuncleanly. The course and results of phagedena in an old syph-\\nilitic in whom vulvar hyperplasia was present are well shown in\\nFig. 85 and by the following details of the case A woman, aged\\nforty-seven, had had for years great hyperplasia of the vulva fol-\\nlowing syphilis contracted ten years before. When she was in a\\ndissipated and woe-begone condition, ulceration began about the\\nfourchette. This lasted several weeks, and then the parts began\\nto melt away from phagedena, with the result depicted in Fig. 85.\\nFig. 85.\\nShowing great destruction of hypertrophied vulva and perineum\\nof an old syphilitic.\\nUnder treatment, healing was induced, cicatrization took place,\\nand a fairly good condition of the parts was left, incontinence of\\nthe feces being the most distressing symptom.\\nThe ultimate outcome of hyperplasia of the vulva in old syph-\\nilitics is about the same as that already sketched of the declining\\ndays of patients suffering from chronic intractable chancroids of\\nthat region.\\nThe chronicity and inveterate course of these vulvar hyperplasia\\nare undoubtedly due to the structural peculiarities of the vulva,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0427.jp2"}, "428": {"fulltext": "404 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nto its excessive vascular and nervous supply, to the conditions to\\nwhich it is so constantly subjected, and to its dependent position\\ncompressed between the thighs. Except in the mouth (and that\\nvery rarely), we do not see such persistent and deforming low-\\ngrade inflammation and hyperplasia.\\nIn the past these chronic deforming lesions of the vulva, whether\\ndue to chancroids or in old syphilitics, were fancifully called by\\nthe following terms lupus hypertrophicus et tuber vsus, lupus ser-\\npiginosus, and lupus prominens, esthiomSne hypertrophique oede-\\nmateux et vege tant, perforating lupus, and esthiomSne perforant de\\nVanus et de la vidve.\\nTreatment. Condylomata lata of the vulva and perineum\\nshould be treated both locally and systematically. The first\\nessentials of treatment are absolute cleanliness of the genital\\ntract and a condition of dryness of the parts. Alkaline and anti-\\nseptic irrigations should be used freely and frequently. When\\nthe parts are dried they should be well dusted over with a powder\\ncomposed of calomel and oxide of zinc, of equal parts. Then care\\nshould be exercised in keeping surfaces which tend to coapt as\\nmuch apart as possible by means of sterilized absorbent-gauze.\\nWhen condylomata lata have become warty on their surface it\\nmay be necessary to apply very carefully and sparingly fluid car-\\nbolic acid, or even nitric acid in rebellious cases. When involu-\\ntion of the lesions is well under way a powder of oxide of zinc\\nand boric acid (equal parts) may be used.\\nSystemic treatment may be administered in the form of mer-\\ncury by the mouth or by inunction or injection, or by the use of\\nthe mixed treatment.\\nIndurating oedema of the vulva and the perineum is usually\\nvery persistent, even when active treatment is instituted. Clean-\\nliness and dryness of the parts are absolutely necessary. Mercu-\\nrial ointment, strong or mild, may be applied and kept on these\\ngrowths, and thus, with the internal use of mercurials, perhaps\\nin combination with the iodide of potassium, we may cause reso-\\nlution after a time. When indurating oedema attacks protruding\\nparts or those which can be removed without destroying the con-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0428.jp2"}, "429": {"fulltext": "HYPERTROPHIES OF THE VULVA DUE TO SYPHILIS. 405\\nformation of the vulva, therapeutics having failed, it is well to\\nresort to the knife, treating the case with all antiseptic require-\\nments.\\nChronic hyperplasias of the vulva, vagina, and perineum are\\nalways absolutely uninfluenced by local or general mercurial treat-\\nment. The best results follow the ablation of all prominent\\nmasses. Then healing may be induced, and though a more or\\nless stenosed vaginal orifice and vulva may be left, the patient is\\nat least more comfortable and not in so much danger of ulcera-\\ntion, abscesses, fistulas, and septic complications.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0429.jp2"}, "430": {"fulltext": "CHAPTER XXXVI.\\nTUBERCULOUS ULCERS OF THE VULVA.\\nThe fact is now so well established that tuberculosis not very\\ninfrequently attacks the skin that the probability of the develop-\\nment of the tuberculous ulcers upon the outer genitalia of the\\nfemale can no longer be called in question.\\nIt may be stated as a broad fact that tuberculosis of the female\\ngenitalia grows progressively more uncommon in occurrence as it\\ndescends from the ovaries, the tubes, and the uterus into the\\nvagina and vulva. Tuberculosis of the vagina by extension of\\nthe process from above can hardly be called very rare. In-\\nvolvement of the vagina alone is far from common, and when\\nit does occur in some cases the vulva may be more or less in-\\nvolved.\\nI have seen three cases in which ulcers began just beyond the\\nexternal genital regions, and in their extension involved the vulva,\\nand of which the clinical diagnosis was tuberculosis of the skin\\nand mucous membrane. These ulcers had finely and coarsely\\ngranular, papillomatous, and even fungating surfaces, and were\\nencircled by hard, somewhat everted, deep-red and even bluish-\\nred margins, with irregular and somewhat festooned outlines, and\\nthey secreted an abundance of pus. They began as round or oval,\\ndeep, violaceous red tubercles, which soon broke down into ulcera-\\ntion. In former years we classed these lesions under the head of\\nscrofulide tuberculeuse ulcSreuse, proposed by Hardy and Bazin.\\nTwo of my cases occurred before we knew of the existence of\\nthe bacillus tuberculosis, while from the third and more recent\\ncase I was unable to excise a portion of the morbid tissue for\\nexamination. The patient, however, had pulmonary phthisis.\\nPrimary tuberculosis of the vulva, however, is rare, and the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0430.jp2"}, "431": {"fulltext": "TUBERCULOUS ULCERS OF THE VULVA. 407\\nmost satisfactory case of it on record is that of Deschamps. 1\\nZweigbaum s case 2 has been spoken of as being rare and peculiar.\\nIt is rare in the sense that tuberculosis of the female genitalia is\\nrare. The details of it show that the morbid process began in\\nthe uterus and extended downward to the vulva. Chiari s case 3\\nseems to have been one of tuberculous infection of the vulva, with\\ninvolvement of the vagina.\\nIf it is worth while to preserve the term lupus of the vulva, it\\nmay be applied to cases of ulcers caused by the tubercular bacillus.\\nTreatment. These tubercular ulcers should be curetted and\\ndressed with balsam-of-Peru ointment. They heal very slowly\\nand are prone to relapse.\\nThe general tuberculous condition of the patient should be care-\\nfully treated, and if possible she should have an appropriate change\\nof climate.\\n1 Etude sur quelques ulcerations rares et non-veneriennes de la vulve et du\\nvagin. Archives de Tocologie, January, February, and March, 1885.\\n2 Ein Fall von tuberculoser Ulceration der Vulva, Vagina, and der Portio\\nVaginalis. Berlin, klin. Wochenschrift, May 28, 1888.\\n3 Ueber den Befund ausgedehnter tuberculosen Ulceration in der Vulva und\\nVagina. Vierteljahr. fur Derm, und Syph., 1886, Band xviii. pp. 341 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0431.jp2"}, "432": {"fulltext": "CHAPTER XXXVII.\\nA PECULIAR NEW GROWTH OF THE VULVA.\\nThere is a form of new growth of the vulva, which was first\\ndescribed by me 1 several years ago, which presents many peculiar\\nand interesting features. I have had three cases of this trouble,\\nbut I shall in this chapter only describe two, since they contain\\nall the essential facts. The first case was that of a woman who\\nwas perfectly healthy until her thirty-fifth year. From the time\\nof puberty she performed the duties of a domestic, and had inter-\\ncourse, more or less frequently, with different men. In July, 1876,\\nshe was treated in Charity Hospital for a suppurating bubo of\\nthe left groin, which, being incised, left a characteristic cicatrix.\\nThe patient had no knowledge of an ulcer upon the external\\ngenitals. Early in the year 1877 she again entered the hospital,\\nsuffering from a large chancroid in the sulcus between the left\\nlabia majora and minora. This ulcer was markedly persistent in\\nits course, but was finally healed. At this time she remained in\\nthe hospital eight months. Neither at that time nor in later or\\nrecent years could I discover any history or evidences of syphilis,\\nnor did the patient present any syphilitic lesions during a period\\nof over twelve years. It may be stated, therefore, as beyond\\ndoubt that she was free from that disease.\\nOn her discharge from the hospital in August, 1877, the patient\\nwas in excellent health she had no vaginal discharge, and a red-\\nness of the left side of the vulva was the only sign of her previous\\ntrouble. At this date she was rather more than thirty-six years\\nof age.\\nDuring the autumn of 1877 the patient suffered from excoria-\\ntions of the vulva about the seat of the already mentioned chan-\\n1 American Journal of the Medical Sciences, February, 1890, and January, 1894.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0432.jp2"}, "433": {"fulltext": "A PECULIAR NEW GROWTH OF THE VULVA.\\n409\\ncroid. This part was noticed to be red and tender, and to be the\\nseat of slight oozing of blood, particularly after hard work, fatigue,\\nand the menstrual epoch. In consequence of this irritated and\\nFig. 86.\\nShowing the new growth in period of full development.\\nsomewhat painful condition of the vulva the patient never after-\\nward had sexual intercourse.\\nDuring the succeeding nine years she worked as a domestic.\\nShe was fairly clean in her habits as a rule, but during periodical", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0433.jp2"}, "434": {"fulltext": "410 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\ndrunken debauches she was careless as to the condition of her\\ngenitals, and in consequence thereof she had numerous attacks\\nof varying severity of acute and subacute vulvitis. During all\\nthese years it seems clear from her story (which was elicited at\\nvarious times with careful minuteness) that she suffered from an\\ninflamed and excoriated condition of the left side of the vulva,\\nwhich was subject to exacerbations and periods of quiescence as\\na result of this long-continued condition of irritation an anomalous\\nform of new growth developed.\\nThe appearances of this peculiar new growth are well shown in\\nFig. 86, which was made about two and a half years after the\\ndate of its beginning. It will be seen that the normal appearances\\nof the vulva are wholly lost. There are no traces of the labia,\\nlarge or small. The clitoris is represented by a central mass of\\ncicatricial tissue, and the introitus vaginae looks like a ragged slit.\\nThe perineum is also invaded with processes of the new growth\\njutting backward. Extending from the vulva the disease is seen\\nto invade the pubes and the right groin, and to extend downward\\nover the skin of the fork of the thighs. In no place is there\\nevidence of tumor-like formation, as the new growth is every-\\nwhere developed en surface in other words, it is flat in structure.\\nThe surface of this neoplasm is of a maroon or chocolate color,\\nwith considerable glossiness. At times this morbid surface was\\nperfectly dry, and at other times it gave issue to a thin, scanty,\\nreddish serum.\\nThe parts present a firm but decidedly elastic feeling, as if the\\nnew growth possessed a fair amount of density. To the eye and\\nto the finger-tip it is evident that the vulvar and extragenital\\nportion of the new growth is uneven and thrown into slight irreg-\\nular folds a condition due undoubtedly to the natural conforma-\\ntion of the parts. Radiating from the clitoris region is a quite\\nwell-formed sheet of cicatricial tissue, and scattered on the outer\\nand upper parts of the new growth are irregular shaped islets of\\nthe same. Upon the lower part of the vulva and toward the\\nperineum the mode of extension of the new growth is well shown.\\nOn the right side it juts outward by an abrupt semicircular ele-", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0434.jp2"}, "435": {"fulltext": "A PECULIAR NEW GROWTH OF THE VULVA. 411\\nvated margin, while on the left side the morbid tissue ends in a\\nsimilarly sharp festooned outline. In the upper and older parts\\nof the morbid area the sharpness of the marginatum is lost in\\ncicatricial tissue, and elsewhere as a result of the treatment adopted.\\nAt the time the drawing from which Fig. 86 was made the morbid\\nprocess stopped at the orifice of the vagina, which, however, was\\nsomewhat contracted. Toward the end of life the new growth\\nbecame so copious and firm in this region that this orifice would\\nonly admit, and then with considerable pain, a soft bougie of about\\nNo. 26, French scale. There was never any evidence of stricture\\nof the urethra. Besides the foregoing appearances, there was evi-\\ndence in life of a marked condensation and contraction in all of\\nthe affected parts, which increased very slowly and imperceptibly.\\nThe salience of the vulva was, in the end, wholly lost, and ex-\\namination of the new growth en masse showed that it was quite\\nfirmly adherent to the deeper parts. When the patient was on\\nher back the genitalia had a peculiar, flat appearance, and, as she\\nstood up, it was evident that the labia majora no longer protruded\\nbetween the thighs.\\nThis new growth began as a thickened, slightly elevated patch,\\nof deep-red color, upon the left small and large labium. From\\nthis region it extended by peripheral increase toward the vaginal\\norifice, over the clitoris and upward and downward on the right\\nside, while on the left it jutted down to near the anal orifice. The\\nincrease in area took place slowly, and as the new morbid tissue\\nwas formed, the older portions remained without any visible\\nchange, ulcerative or reparative. A slight amount of heat, pain,\\nand pruritus were felt at irregular periods. The local symptoms,\\nhowever, were for a long time so mild in character that the patient\\nmade little complaint. She could sit, walk, move, and lie down\\nwith little discomfort. Later on this was all changed.\\nThis form of new growth, it seems, is not peculiar to mucous\\nmembranes alone. By its peripheral increase it involves the skin,\\nand by it its progress on this tissue may be accurately studied.\\nWe find on the integument the same flat form of new growth\\nseen on the mucous membranes. The surface is smooth, even,", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0435.jp2"}, "436": {"fulltext": "412 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nand glossy, and the color a decided maroon. The elevation of\\nthe patches is from one to three lines, and they end by a well-\\ndefined, curved or festooned border, which, rounding off sharply,\\nis lost in the sound skin.\\nThe elasticity of the infiltration remained for indefinite periods,\\nand was slowly and gradually replaced by a marked condition of\\ncondensation, particularly in the central vulvar region. The\\nresult was that the conformation of the genitals was more and\\nmore destroyed.\\nAs the new growth infiltrates the tissues it is noticed that, when\\ncondensation takes place, the morbid areas become more or less\\nattached to the bony or aponeurotic parts beneath until, in the\\nend, they may feel as if soldered to them. Along the vulvar\\nsulcus, where the disease originally began, the tissues presented\\nto the finger-tip an almost brawny sensation, whereas, at the\\nperiphery of the new growth, well-marked but still decidedly\\nfirm elasticity was noted.\\nOn the mons veneris and the thighs evidences of healing were\\nvery often noted. This process usually began in spots of pearly\\ncicatrization, which increased under favorable circumstances, until\\nsometimes large healed areas were produced. But the cicatricial\\ntissue always showed a great lack of vitality and endurance. So\\nlong as great care was observed, and the parts were kept scrupu-\\nlously clean and dry, the healed surfaces might remain intact.\\nBut any inattention (from indifferences of the nurse, during the\\nmenstrual epoch, or a drunken debauch) was inevitably followed\\nby retrogression. It was surprising to see how rapidly the cica-\\ntricial tissue melted away. A part which was pretty well healed\\none day might a day or two later present the most typical morbid\\nappearance. It was always evident that in healing, though the\\nsuperfices of the morbid tissue became cicatrized, the deeper parts\\nremained unaltered. Thus the disease oscillated between a cica-\\ntrized condition and the reverse month after month, in spite of\\nthe most careful treatment.\\nThe tendency to healing, however, was only observed in the\\njuxtagenital parts just mentioned. At no time could we produce", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0436.jp2"}, "437": {"fulltext": "A PECULIAR NEW GROWTH OF THE VULVA.\\n413\\nreparative changes on and within the vulva proper. There the\\nsecretions and the close coaptation of the parts wholly prevented\\ncicatrization, even though the greatest care was paid to place inter-\\nposing absorbent dressings. As time went on the condensation\\nof the vulvar and vaginal tissues was so great that the vulva was\\nconverted into a raw slit of tough tissue, the lips of which were\\ndrawn more and more tightly together, and the vaginal orifice\\nalmost completely stenosed. This state is well shown in Fig. 87,\\nFig. 87.\\nShowing the condition of the genitals three months before death.\\nwhich was taken about three months before death. It is inter-\\nesting to study this picture in connection with Fig. 86. It will\\nbe seen that in rather more than two years the disease has ex-\\ntended somewhat in an outward and backward direction. It is\\nevident, however, that the luxuriance of the infiltration shows\\nitself by involving the tissues in their whole thickness and depth,\\nrather than by peripheral extension. The new growth showed a\\ntendency to remain localized to the vulvar and juxtavulvar regions.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0437.jp2"}, "438": {"fulltext": "414 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nDuring its whole course this new growth showed no tendency\\nto luxuriate upon the surface. There was never any evidence of\\ntumor-like formation, since the infiltration never reached a greater\\nheight than three lines. There is never any evidence whatever\\nof ulceration, and though the morbid growth may, in more or\\nless degree, become less salient, the decrease in its height was due\\nto the slow and almost imperceptible melting away of its superfices\\nand to its inherent, slow, contractile tendency. Further than this,\\nit was observed that in the recesses of the vulva where the lesion\\nwas thrown into anfractuosities there was not the slightest ulcera-\\ntion between its clefts and folds. It never presented any appear-\\nance resembling papillomatous outgrowths.\\nThough this inflammatory and infiltrative process lasted many\\nyears, it did not seem to involve the contiguous lymphatic system.\\nIn both of my cases the ganglia were slightly larger than normal,\\nbut in none of them was there at any time any evidence of in-\\nflammation. There was an entire absence of erythematous and\\nerysipelatous complications.\\nThe disease shows no tendency whatever to malignant degen-\\neration, and of itself seems to have no direct influence upon the\\ngeneral economy.\\nAs I have already stated, the local symptoms were for a long\\ntime mild in character, and the patient made little complaint.\\nGradually, however, as the disease progressed without any abate-\\nment, the soreness in the parts was replaced by pain, particularly\\non the slightest movement. Walking became almost impossible,\\nthe erect position of the body could only be maintained with the\\ngreatest difficulty and discomfort, and as sitting became painful\\nand almost impossible, the patient was forced to take to her bed.\\nEven in the recumbent position all movements caused uneasiness\\nand pain. The swollen, contracted, and excoriated condition of\\nthe vulvar sulcus impeded urination the stenosis of the vaginal\\norifice prevented the use of cleansing and soothing injections and\\nimpeded menstruation, while the rigidity and irritated condition\\nof the parts prevented the application of absorbent tampons. In\\nthis hopeless, bedridden condition the patient was a pitiable object.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0438.jp2"}, "439": {"fulltext": "A PECULIAR NEW GROWTH OF THE VULVA.\\n415\\nHer sufferings, pain, and worriment of mind led to utter demor-\\nalization marasmus, and death.\\nA second case observed by me was in appearance and histologi-\\ncally the same as the one already detailed. It was that of a\\nwidow, aged twenty -five years, of remarkably healthy parentage,\\nFig. 88.\\nShowing the new growth of second case in its active stage.\\nwas well developed and tolerably strong, and measles in early in-\\nfancy was the only sickness she could remember. When twenty-\\ntwo years old she was married to a sailor, who seemed to her to\\nbe a perfectly healthy man. In the second year of her marriage\\n(fully four months after the accidental death of her husband) she", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0439.jp2"}, "440": {"fulltext": "416 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nnoticed a small pimple in the right inguinal fold at about the\\ncentre. This pimple gave her no pain and discharged no pus.\\nIn three months it had increased and formed a circular patch one\\nand a half inches in diameter, with an exulcerated surface, and\\nraised about an eighth of an inch above the normal plane of the\\nskin. This new growth steadily increased in size, running down\\non the outside of the right labium majus, and involving it and\\nthe corresponding nympha, then gradually it extended downward\\nand backward, encircling and involving the anus well in toward\\nthe sphincter. From this region it ran up the outer side of the\\nleft labium majus, attacking and destroying, or causing to melt\\naway, part of it and then the whole of the corresponding nympha\\nand ending at the left inguinal fold. The appearance of the parts\\nis very clearly shown in Fig. 88. The new growth was sharply\\nmarginated by an elevated border nearly a quarter of an inch in\\nheight, beyond which the skin was somewhat pigmented, but\\nseemingly healthy. The surface of the new growth was purplish-\\nred in its oldest parts and at the periphery, and of a dull pinkish-\\nred in its centre. The vulva was a raw, oozing slit, but it would\\nadmit with little uneasiness the first joint of the index finger.\\nThe anus was wholly involved, its tissues much condensed, and\\nit was raw, sore, and painful on defecation. The surface of this\\nnew growth was similar in its nature and character, but was\\nrather more uneven and more mammillated than the previous\\ncase. It gave issue to a scanty serous and serosanguinolent dis-\\ncharge. In its early months this new growth was the seat of\\nephemeral, throbbing pain, but in general, though it caused some\\ndiscomfort and uneasiness on urination and defecation, it could\\nnot be said to be painful.\\nEarly in her hospital days we gave this woman a thorough and\\nvigorous antisyphilitic course of treatment as a tentative measure.\\nShe bore the medication very well, but her vulvar lesion remained\\nunaffected. We tried all sorts of local applications antiseptic,\\nastringent, and stimulating without much success. We observed\\nsigns of improvement, and then came relapse. In this way about\\nten months slipped by, when, as a last resort, mercurial ointment", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0440.jp2"}, "441": {"fulltext": "A PECULIAR NEW GROWTH OF THE VULVA.\\n417\\nwas applied to the surface, and healing slowly but surely began.\\nIn two or three months the parts were fully cicatrized, but the\\nintroitus vagina? was very much lessened in diameter, and the\\nanus was rather rigid and less distensible than normal.\\nThe most thorough examination and searching inquiries were\\nmade to ascertain whether the case was of syphilitic nature, but\\nin the end I became convinced that the woman never had had\\nsyphilis.\\nFig. 89.\\nShowing a topographical view of the lesion.\\na. Epidermis irregularly thickened by ingrowths of the interpapillary portions\\nof the rete Malpighii.\\nb. Layer of granulation tissue.\\nc. Lymph-spaces of the deeper subcutaneous tissue filled with granulation\\ntissue.\\nMicroscopical Examination and Pathology. Portions of the\\nnew growth, in its fall thickness, excised by me from both cases,\\nwere examined by Dr. Ira Van Gieson, by whom the drawings\\n(see Figs. 89 and 90) were made. The tissue was composed of\\n27", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0441.jp2"}, "442": {"fulltext": "418 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nthree layers: (1) A superficial layer corresponding to the cutis,\\nwhich is irregularly thickened by a considerable ingrowth of the\\nMalpighian layer; (2) beneath this, replacing the corium and a\\nportion of the subcutaneous tissue, is a layer of tissue apparently\\nidentical with granulation tissue, except that in places it contains\\nlarge numbers of free red blood-cells and (3) a third layer corre-\\nsponding to the deeper subcutaneous tissue, whose lymph-spaces\\nare filled and distended with small round and small polyhedral\\ncells. (Fig. 90.)\\nFig. 90.\\nm\\nShowing the distention of the deeper subcutaneous lymph-spaces with the\\ngranulation tissue.\\nWhere the nodule became continuous with the surrounding\\nskin the cutaneous lymph-spaces were also filled with small\\nround and polyhedral cells.\\nThere were no bacteria of any kind in any of the numerous\\nsections.\\nThe results of this examination, therefore, seem to warrant the\\nopinion that this chronic and incurable lesion consisted of simple\\nlocal inflammatory tissue, which extended quite extensively into\\nthe subcutaneous lymph-spaces.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0442.jp2"}, "443": {"fulltext": "A PECULIAR NEW GROWTH OF THE VULVA. 419\\nWhen we consider the disastrous results produced by this\\ngrowth it seems almost incredible that it should belong among\\nthe recognized simple and benign new formations. Though pos-\\nsessing no malignancy, it led in the region affected in one case to\\nas much suffering and to as deadly results as true malignant new\\ngrowths are known to produce. The conformation of and the\\nconditions inherent to and acting upon the external female geni-\\ntals are undoubtedly the underlying causes of the chronicity of\\nthe inflammation.\\nOur knowledge of the behavior of inflammatory tissues in gen-\\neral may be used in the present instance in explaining the varied\\nconditions which are observed in the new growths. In its soft\\nelastic stage it consisted of the elements already mentioned.\\nLater on, where the conditions would admit of it, healing occurred\\nby the production of fibrous tissue out of the abundant infiltrating\\ngranulation cells. Upon the juxta-pudendal regions mons ven-\\neris and thighs this change resulted in true, but ephemeral cica-\\ntricial tissue. In the vulvar circle, fibrous tissue was formed out\\nof this granulation tissue, and it produced in the new growth the\\ndensity and contractility which were observed to appear as the\\nprocess grew old. But here surface-healing did not occur. How\\nfar the color of the new growth was due to the red blood-cells\\nwhich escaped from the new and thin capillaries we are unable\\nto say.\\nIt seems strange that such an active inflammatory process\\nshould increase so slowly and show such a slight tendency to\\ngrow outward.\\nEtiology. The exclusion of syphilis as the cause of this new\\ngrowth is warranted not only by the absence of any history of\\nthat disease, but by the anatomical structure of its tissues. Tuber-\\nculosis is, also, etiologically out of the question, by reason of the\\nclinical and microscopical facts adduced. Though prolonged\\nsearch was made for bacteria, none were found. For these reasons,\\ntherefore, we are warranted in concluding that the lesion was not\\na local expression of a general infective process, nor a result of\\na local infection.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0443.jp2"}, "444": {"fulltext": "420 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nMy studies convince me that the local inflammatory condition\\nengrafted upon the vulva by the chancroidal ulceration led to the\\noccurrence of chronic vulvitis, and that this affection was the\\nstarting-point of the inflammatory new growth of the first case.\\nAnyone who has seen a considerable number of cases of chan-\\ncroids in women will recall instances in which the resulting in-\\nflammatory thickening of the tissues was even more difficult to\\ncure than the original ulcers. Though I look upon the ante-\\ncedent chancroid in the first case as the pathological forerunner\\nof the new growth, in the second I could not discover any special\\nor specific cause whatever. The chancroidal ulceration induced\\na tendency to inflammation which remained long after it had lost\\nits virulent nature and had healed. A virulent, ulcerative, and\\ninflammatory process existed and was cured, but left in its wake\\na predisposition to simple local inflammation, which the nature\\nof the parts and the uncleanly and disorderly habits of the patient\\ntended to perpetuate. The resulting inflammation w r as in no\\ndegree complicated with an ulcerative tendency. In the second\\ncase the new growth began as a pimple in the groin, which was\\nprobably subjected to irritation.\\nDiagnosis. The clinical features of this new growth are pecu-\\nliar and distinctive. I know of no affection which resembles it\\nin course or appearances. At the first glance chronic serpiginous\\nchancroid may suggest itself to the mind. It was different in all\\nits features from syphilitic lesions of the skin and mucous mem-\\nbranes, and, though to superficial examination the idea of lupus\\nmight suggest itself, a little reflection would convince the observer\\nthat neither in development, course, clinical features, nor micro-\\nscopical anatomy was it like that disease. It has no appearances\\nin common with epithelioma. So well marked and peculiar are\\nthe characteristics of this new growth that anyone familiar with\\nits description will readily recognize it.\\nPrognosis. The outlook in this disease is far from satisfactory.\\nIt is possible that if seen in the early stage of its course it might\\nbe arrested and cured, but when it has attacked the deeper por-\\ntions of the vulva little hope can be entertained.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0444.jp2"}, "445": {"fulltext": "A PECULIAR XEW GROWTH OF THE VULVA. 421\\nTreatment. In the first case the new growth had attained\\nsuch proportions when seen that palliative or destructive methods\\nof treatment were out of the question. Various agents were used\\nto induce healing, the most efficient of which were iodoform and\\nbismuth and iodoform combinations. When perfect cleanliness\\nwas obtainable these drugs, applied on absorbent gauze and sup-\\nported by gentle but firm pressure of a bandage, usually did good.\\nUnfortunately, this treatment could not be efficiently used in the\\nvulvar sulcus, so that little progress was made there at any time.\\nThough cicatrization was very often induced upon the juxta-\\npudendal portion of the growth, it never lasted for a long period.\\nIn short, though of simple and benign nature, this new growth is\\nas rebellious to treatment as are the most malignant forms. It,\\nhowever, may be said with some satisfaction that it does not give\\nrise to the secondary metastatic growths which are such frequent\\ncomplications of the latter.\\nSystematic local and general antisyphilitic treatment was once\\ncarefully followed as a tentative measure, for some months, but\\nno improvement whatever was produced. In this first case the\\napplications of mercurial ointment increased the irritability of the\\nparts and the suffering of the patient.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0445.jp2"}, "446": {"fulltext": "CHAPTER XXXVIII.\\nKRAUROSIS VULVAE.\\nThis rather rare affection, which is also called serpiginous\\nvascular degeneration of the nymphse and progressive cutaneous\\natrophy of the vulva, is observed chiefly in women of advanced\\nlife, but cases have been reported in which the disease began about\\nthe thirtieth and fortieth years. It is a disease of chronic, persist-\\nently progressive development, and results in much destruction of\\nthe tissues of the external genitalia. During its course it renders\\ncoitus painful and often impossible, and when the destructive\\nchanges have become fully developed intromission of the male\\norgan is wholly impracticable.\\nThis morbid condition begins with soreness, pain, and pruritus\\nabout the small and large labia, which are either continuous or are\\nsubject to more or less severe exacerbations. In all cases the\\nparts are very sensitive to the touch. In some cases the pruritus\\nis so severe that the patients vigorously scratch and tear the parts,\\nand this leads to an intensity of their disorder.\\nIn most cases the disease begins about the region of the clitoris,\\nand from there extends over the whole external genitalia but in\\nsome cases its development is unilateral.\\nWhen first seen kraurosis of the vulva appears in the form of\\none or many rather small areas of thickened and reddened mucous\\nmembrane, which is of a bright-red and even purple color. These\\nchronically inflamed areas in the course of time become gradually\\nmore and more blanched, until in the end they are shiny white\\nand scar-like. As one group of these areas is becoming pale and\\natrophied, new red inflammatory ones form, until in the end the\\nwhole vulva is the seat of a firm fibrous membrane, which may\\nbe traversed by scar-like bands, which are particularly well\\nmarked around the vaginal orifice. The original intensity of the", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0446.jp2"}, "447": {"fulltext": "KRAUROSIS VULVAE.\\n423\\nmorbid process is in the tissues of the clitoris, around the urethral\\norifice, and the introitus vaginae. From these centres they\\nextend outward and forward toward the anus, which becomes\\nencircled by the atrophic process. When the inflammatory con-\\ndition attacks the small nymphse they are at first somewhat in-\\nFic;. 91,\\nShowing affected area, with contracted vaginal orifice.\\nAfter Baldy and AVilljams.\\ncreased in size, but when atrophy begins to develop they gradually\\nmelt away and become continuous with a similar condition of the\\ninternal surfaces of the labia majora.\\nA very graphic illustration of this destructive vulvar affection\\nis shown in Fig. 91. It will be seen that the urethral orifice is", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0447.jp2"}, "448": {"fulltext": "424 SEXUAL DISORDERS OF THE MALE AND FEMALE.\\nyet patulous, but that it is surrounded by the expanse of fibrous\\nmembrane, which has so stenosed the vaginal orifice that only the\\ntip of the little finger could be introduced a very short distance.\\nThe anal orifice was likewise contracted, but its function was not\\nimpaired.\\nEtiology. No scientific statement can be made as to the cause\\nof the affection. It seems certain that syphilis is not in any way\\nan etiological factor. Whether vaginal discharges or irritative\\nconditions of the external female genitalia, which may lead to\\npruritus and dermatitis and the consequent scratching and bruis-\\ning of the parts, are the exciting causes, it is impossible to say.\\nIt has been suggested that (1) removal of the uterine appendages,\\n(2) artificially induced menopause, and (3) disease of the periph-\\neral trophic nerve-filaments may be the etiological factors but\\nno precise statements can be made.\\nPathology. The disease is essentially a chronic hyperplasia\\nof the subcutaneous tissues and corium, which later on undergo\\natrophy, with the formation of scar-tissue and shrinking of the\\nvulva. An exhaustive study of this subject, illustrated with\\nmicrophotographs, will be found in the essay of Baldy and\\nWilliams. 1\\nTreatment. In the early stages of kraurosis vulvae care\\nshould be taken that all irritating secretions shall be systemati-\\ncally treated and that frequent antiseptic vaginal douches shall be\\nused. Locally soothing applications to pruritic and inflamed areas\\nshould be used in the shape of ointments or lotions of carbolic\\nacid, cocaine, eucaine, antipyrine, iodoform, ichthyol, according\\nto indications. In some cases watery solutions of nitrate of silver,\\nof the strength of 5 per cent., or of permanganate of potassium,\\n2 per cent., may give ease and comfort when pruritus and derma-\\ntitis are troublesome. When the disease is fully developed it may\\nbe necessary, after proper preparations of the patient under strict\\nantisepsis, to dissect out the scar-tissue from around the vaginal\\norifice as far down as the margin of the anus, and then to approxi-\\n1 American Journal of the Medical Sciences, November, 1899, pp. 528 et seq.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0448.jp2"}, "449": {"fulltext": "KRAUROSIS VULVAE. 425\\nmate the healthy skin and mucous membrane by means of continu-\\nous and interrupted sutures of silk or silkworm-gut. The vagina\\nshould be packed with iodoform gauze and sterile gauze, held in\\nplace by means of a T-bandage. The patient should be catheter-\\nized at each dressing. As a result of this operation the patulous-\\nness of the vaginal orifice has been restored and satisfactory coitus\\nhas been rendered possible.", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0449.jp2"}, "450": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0450.jp2"}, "451": {"fulltext": "INDEX\\nAMPULL ACTIONS, deferential, and\\naspermatism, 197\\ninflamed, secretions of, 271\\nof vasa deferentia, 50\\nAmyloid bodies in prostate, 252\\nAnaemia and sterility in female, 347\\nAnatomy of chronic bulbous ure-\\nthritis, 209\\nof Littre s follicles, 36\\nof prostate gland, 39\\nof prostatic urethra, 40\\nof seminal vesicles, 47, 70\\nAnterior urethra, 29\\nAnteversion and sterility, 349\\nAnthropophagy, 343\\nArteries of penis, 21\\nof prostate. 43\\nAspermatism, 197\\nanomalous cases of, 204\\nand debility, 206\\nand deferential ampullations, 197\\ndiagnosis of, 206\\nand ejaculatory ducts, 198\\nand lack of nerve force, 206\\nand mutilating meatotomy, 205\\npartial, 205\\nprognosis of, 207\\nand seminal vesicles, 197\\nand stricture of urethra, 201\\ntreatment of, 207\\nand urethral calculi, 201\\nAtonic impotence, causes of, 99\\nforms of, 98\\ntreatment of, 102\\nAtresia of cervix uteri and sterility,\\n348\\nof uterus and sterility, 348\\nof vagina and sterility, 349\\nAtrophv, progressive, of vulva, 422\\nof testes, 184\\nand varicocele, 279\\nAzoospermatism, 155\\nand hematocele, 174\\nand hydrocele, 173\\nAzoospermatism and morbid condi-\\ntions, 193\\nand tuberculosis of prostate, 181\\nof seminal vesicles, 183\\nof testes, 175\\nBEARD on sexual erethism, 300\\nBennett s operation for varico\\ncele, 284\\nBifid penis, 113\\nBottcher s sperma crystals, 72\\nBougie a boule, 221\\nolivary, 224\\nBrain disease and masturbation, 287\\nBu-b, sinus of, 33\\nBulbous urethra, 28\\nexpansion of, 32\\nstenosis of, treatment of, 222\\nstricture of, treatment of,\\n222\\nurethritis, chronic, 208\\nanatomy of, 209\\nsymptoms of, 210\\nand impotence, 208\\nsymptomatic, 90\\nCALCULI, preputial, and organic\\nimpotence, 136\\nand prostate, 253\\nCancer of penis and organic impo-\\ntence, 130\\ntreatment of, 132\\nCaput gallinaginis, 40\\nCaruncles, urethral, 374\\nCatarrhal inflammation of prostate,\\n237\\nprostatitis in older subjects, 245\\nin young subjects, 239\\nCatheter, reflux, 217\\nsoft-rubber, 218\\nCerebral congestion and masturba-\\ntion, 291", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0451.jp2"}, "452": {"fulltext": "428\\nINDEX.\\nCerebrospinal disease and priapism,\\n335\\nCervix, ulceration of, and sterility,\\n348\\nuteri, atresia of, and sterility, 348\\nhypertrophy of, and steril-\\nity, 349\\nChancre of penis and organic impo\\ntence, 108\\nChancroidal distention of vulva, 388\\nulceration of penis and organic\\nimpotence, 119\\nChancroids of vulva, chronic, treat-\\nment of, 393\\nin old syphilitics, 398\\nChlorosis and sterility in female, 347\\nClitoridean masturbation in female,\\n358\\nClitoridectomy, 365\\nClitoris, abnormal situation of, and\\nmasturbation in female, 361\\nadhesion of, and masturbation\\nin female, 361\\ntreatment of, 364\\nsmegma under, and masturbation\\nin female, 361\\nCoitus above and sexual excesses, 298\\ncohesion in, 353\\nexcessive, 187\\ninterruptus, 324\\nreservatus, 324\\nCompressor urethrse muscle, 31\\nspasm of, 32\\nCondylomata of vulva, 394\\nConjugal onanism, 324\\nEulenberg on, 329\\nand irritability of heart in\\nwomen, 329\\nmechanism of, 329\\nmotives of, 324\\nneuralgia of testis in, 328\\nPeyer on, 328\\nsymptoms of, in females,\\n329\\nin males, 327\\ntreatment of, 332\\nCord, torsion of, and strangulation\\nof testis, 172\\nCorpora cavernosa, fibroid sclerosis\\nof, etiology of,\\n144\\nand organic impo-\\ntence, 139\\npathology of, 145\\nprognosis of, 145\\ntreatment of, 145\\nCorpora cavernosa, structure of, 20\\nsympathetic nerves of. 23\\nsyphilis of, diagnosis of, 147\\nand organic impotence,\\n146\\nprognosis of, 147\\ntreatment of, 148\\nCorpus spongiosum, 21\\nstructure of, 21\\nsyphilis of, and organic im-\\npotence, 146\\nCowper s glands, 36\\nsecretion of, 37\\nCrista galli, 40\\nCrus penis, 21\\nCrypts of Morgagni, 35\\nCryptorchism and rudimentary penis,\\n113\\nCurves, subpubic, 34, 35\\nof urethra, 34\\nCylinders, hyaline, in prostate, 252\\nCysts, ovarian, and sterility, 348\\nDEBILITY and aspermatism, 206\\nDeferentitis, gonorrheal, 161\\nsyphilitic, 166\\nDiagnosis of aspermatism, 206\\nof chronic posterior urethritis,\\n215\\nseminal vesiculitis, 273\\nof new growths of vulva, 420\\nof prostatorrhcea, 255\\nof sexual neurasthenia, 319\\nof syphilis of corpora cavernosa,\\n147\\nDilatation, gradual, 223\\nDucts, ejaculatory, 52\\nand aspermatism, 198\\ncauses of distortion of, 198\\nfunctions of, 52\\nhemorrhage around, 192\\nlesions of, 198\\nplugging of, 198\\nsecretion of, 74\\nsituation of, 42\\nstenosis of, 199\\nstructure of, 51\\nECTOPIA testis, 156\\nEffemi nation, 345\\nEjaculation, mechanism of, 59\\nEjaculations, bloody, 191\\nin masturbation, 289\\nEjaculatory ducts, 52", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0452.jp2"}, "453": {"fulltext": "INDEX.\\n429\\nEjaculatory ducts and aspermatism,\\n198\\ncauses of destruction of, 198\\nfunctions of, 52\\nhemorrhage around, 192\\nlesions of, 198\\nplugging of, 198\\nsecretion of, 74\\nsituation of, 42\\nstenosis of, 199\\nstructure of, 51\\nElephantiasis of penis and organic\\nimpotence, 115, 128\\ntreatment of, 130\\nEndocervitis and sterility, 349\\nEndometritis, catarrhal, and sterility,\\n348\\nEndoscopic tubes, 220\\nEpididymis, 53\\nEpididymitis, chronic, 168\\ngonorrheal. 158\\nsyphilitic, 162\\nEpispadias and organic impotence,\\n112\\nErection, inhibitory nerves of, 22\\nmechanism of, 56\\nphysiology of, 57\\nErectores penis, 53\\nErethism, sexual, 299\\nand affections of deep sexual\\napparatus, 302\\nBeard on, 300\\nGuelliot, case of, 300\\ntreatment of, 302\\nErotomania, 362\\nEulenberg on conjugal onanism, 329\\nExternal genitals, sensorium com-\\nmune of, 23\\nFALLOPIAN tubes, absence of, and\\nsterility, 348\\ndislocation of, and sterility,\\n348\\nFetichism, 344\\nFibroid sclerosis of corpora cavernosa\\nand organic impotence, 139\\nFibroids, uterine, and sterility in the\\nfemale, 349\\nFollicles, Littre s, 35\\nanatomy of, 36\\nurethral, secretion of, 35\\nFossa navicularis, 28\\nFunctions of ejaculatory ducts, 52\\nof penis, 20\\nof prostate gland, 38\\nFunctions of seminal vesicles, 48\\nof sinus pocularis, 41\\nFuniculitis gonorrheal, 161\\nsyphilitic, 166\\nGANGRENE of penis and organic\\nimpotence, 108\\nGenitals, external, sensorium com-\\nmune of, 23\\nGland, prostate, 83\\nanatomy of, 39\\nfunction of, 38\\nstructure of. 38\\nGlands, Cowper s, 36\\nsecretion of, 37\\nof urethra, secretion of, 37\\nGlandulce Tysonii odortferce, 25\\nGlandular structure of prepuce, 25\\nGlans penis, structure of, 21\\nGonorrhoea of vas deferens, 158\\nGonorrhceal congestion of prostate,\\n229\\ndeferentitis, 161\\nepididymitis, 158\\nfuniculitis, 161\\norchitis, 160\\nGranular phosphates, 232\\nGranules, seminal, 64\\nGrave disease and sterility in fe-\\nmales, 347\\nGray on neurasthenia, 317\\nGrip orchitis, 171\\nGuelliot s case of sexual erethism, 300\\nHEAET, irritability of, in women,\\nand conjugal onanism, 329\\nHematocele and azoospermatism, 174\\ntreatment of, 174\\nHenle s triangular ligament, 30\\nHomo-sexuality, 344\\nHorny growths of penis and organic\\nimpotence, 127\\ntreatment of, 127\\nHydrocele and azoospermatism, 173\\nand organic impotence, 110\\ntreatment of, 174\\nHydro-sal pingitis and sterility, 348\\nHymen, imperforate, and sterilitv,\\n349\\nsmall, and sterility, 349\\nHypertrophic growths of vulva, 372,\\n379\\nHypertrophy of cervix uteri and\\nsterility, 349", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0453.jp2"}, "454": {"fulltext": "430\\nINDEX.\\nHypertrophy of penis and organic\\nimpotence, 114\\nof prostate, 260\\ncause of, 260\\ndevelopment of. 260\\nsymptoms of, 261\\ntreatment of, 263\\nof vulva, 381\\npathology of, 386\\ntreatment of, 387\\nHypochondriasis and masturbation,\\n294\\nsexual, causes of, 312\\nsymptoms of, 313\\nHypospadias and organic impotence,\\n111\\nIMPOTENCE, atonic, causes of, 99\\n1 forms of, 98\\ntreatment of, 102\\nand bulbous urethritis, 208\\nand chronic posterior urethritis,\\n211\\nin male, 76\\ngeneral considerations of, 76\\norganic, 105\\nand absence of urethra, 113\\nfrom absence of penis, 106\\nand cancer of penis, 130\\nfrom chancre of penis, 108\\nand chancroidal ulceration\\nof penis, 119\\nand curvature of penis, 148\\nand double penis, 115\\nand elephantiasis of penis,\\n115, 128\\nand enlargement of dorsal\\nveins of penis, 117\\nand epispadias, 112\\nand fibroid sclerosis of cor-\\npora cavernosa, 139\\nand fracture of penis, 150\\nand gangrene of penis, 121\\nfrom gangrene of penis, 108\\nand horny growths of penis,\\n127\\nfrom hydrocele, 110\\nand hypertrophy of penis,\\n114\\nand hypospadias, 111\\nand indurating oedema of\\npenis, 133\\nand ossification of penis, 137\\nfrom phagedena of penis,\\n107\\nImpotence, organic, and preputial\\ncalculi, 136\\nand rudimentary penis, 113\\nand syphilis of corpora ca-\\nvernosa, 146\\nof corpus spongiosum,\\n146\\nand torsion of penis, 113\\nand traumatism of penis,\\n122\\nand vegetation of penis, 123\\npsychical, 78\\ncases of, 84\\nforms of, 79\\nprognosis of, 86\\ntreatment of, 86\\nand sexual excesses, 298\\nsymptomatic, 88\\nfrom bulbous urethritis, 90\\nfrom chronic prostatitis, 93\\nurethritis, 93\\nfrom inflammation of sem-\\ninal vesicles, 96\\nfrom peripheral irritation,\\n89\\nfrom posterior urethritis, 92\\nfrom stricture of urethra,\\n91\\nInfective processes and orchitis, 169\\nInflammation, catarrhal, of prostate,\\n237\\nof seminal vesicles and symp-\\ntomatic impotence, 96\\nof verumontanum, 231\\nprognosis of, 235\\ntreatment of, 235\\nInhibitory nerves of erection, 22\\nInsanity, exhibition of, and mastur-\\nbation, 292\\nIntegument of penis, 24\\nInterstitial salpingitis and sterility,\\n348 _\\nInversion of uterus and sterility, 349\\nIrritation, peripheral, and symp-\\ntomatic impotence, 89\\nIschio-cavernous muscles, 53\\nKEMP S rectal irrigation, 230\\nKraurosis vulvae, 422\\nBaldy and Williams on,423\\ncourse of, 423\\netiology of, 424\\npathology of, 424\\nsymptoms of, 423\\ntreatment of, 424", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0454.jp2"}, "455": {"fulltext": "INDEX.\\n431\\nACUNA magna. 35\\nJj of Morgagui, 35\\nLeukemic priapism, 339\\nLevator ani, 53\\nLigament, triangular, 30\\nof Henle, 30\\nLime, phosphate of, 242\\nLittre s follicles, 35\\nanatomy of, 36\\nMALARIAL orchitis, 170\\nMale, impotence in, 76\\ngeneral considerations of,\\n76\\nsterility in, 153\\nurethra, structure of, 27\\nMasturbation in female, 357\\nand abnormal situation of\\nclitoris, 361\\ninfants, 357\\nand adhesion of clitoris,\\n361\\nand nervous diseases, 35S\\ntreatment of, 363\\nvaginal, 358\\nin males, ailments from, 294\\nand brain diseases, 287\\nfrom cerebral congestion,\\n292\\ndamage by, 290\\nand damaging shocks on\\nnervous system, 290\\neffects of, 287\\non genital organs, 290\\non sexual organs, 293\\nejaculations in, 289\\nextent of, 287\\nand hypochondriasis, 294\\nand ill-health, 294\\nfrom insanity, exhibition,\\n292\\nby means of mechanical im-\\nplements, 290\\nmorbid process in deep\\nseminal parts, 290\\nand neurasthenia, 294\\nand neuropathic antece-\\ndents, 292\\nperiodical, 292\\nand prostate, 289\\nstructural changes induced\\nby, 290\\nsymptoms of, 293\\ntreatment of, 295\\nand sexual perverts, 345\\nMasturbation and varicocele, 280\\nin young children, 287\\ncauses of, 287\\nMeatotomy, mutilating, and asper-\\nmatism, 205\\nMeatus urinarius, 21\\nstructure of, 27\\nMediastinum testis, 53\\nMechanism of ejaculation, 59\\nof erection, 56\\nof seminal vesicles, 49\\nMembranous urethra, 30\\nMesochism, 343\\nMicroscopy of semen, 65\\nMobility of urethra, 34\\nMorgagni, crypts of, 35\\nlacunae of, 35\\nMump orchitis, 169\\nMuscle, compressor urethrse, 31\\nspasm of, 32\\nischio-cavernous, 53\\nof prostatic urethra, 42\\nof sexual apparatus, 52\\nVf AVICULAR urethra, 28\\nNeoplasms of vulva, 408\\npathology of, 417\\nNerve force, lack of, and asperma-\\ntism, 206\\nNerves, inhibitory of erection, 22\\nof penis, 22\\nof prostate, 43\\nsympathetic, of corpora caver-\\nnosa, 23\\nNervi erigentes, 22\\nNervous disease and masturbation in\\nfemale, 358\\nsystem and masturbation, 290\\nNeuralgia of testes and conjugal\\nonanism, 328\\nNeurasthenia and masturbation,\\n294 g\\ncauses of, 314\\ndiagnosis of, 319\\netiology of, 314\\npathology of, 315\\nprognosis of, 319\\nsexual, 313\\nand sterility in female, 347\\nsymptoms of, 316\\nlocal, 318\\ntreatment of, 320\\nNocturnal pollutions, 305\\nNympha?, degeneration of, 422\\nNymphomania, 362", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0455.jp2"}, "456": {"fulltext": "432\\nINDEX.\\nABESITY and sterility in female,\\nV 347\\n(Edenia, indurating, of penis, and or-\\nganic impotence, 133\\nof vulva, 395\\nOlivary bougie, 224\\nOnanism, cases of, 324\\nconjugal, 324\\nEulenberg on, 329\\nand irritability of heart in women,\\n329\\nmechanism of, 329\\nmotives of, 324\\nneuralgia of testes in, 328\\nPeyer on, 328\\nsymptoms of, in female, 329\\nin male, 327\\ntreatment of, 332\\nOophoritis, chronic, and sterility,\\n348\\nOrchitis, chronic, 168\\ngonorrhoea^ 160\\ngrip, 171\\nand infective processes, 169\\nmalarial, 170\\nmump, 169\\nfrom muscular effort, 171\\nscarlatina, 170\\nsyphilitic, 163\\ntonsillar, 170\\nvariolous, 170\\nOrganic impotence, 105\\nfrom absence of penis, 106\\nof urethra, 113\\nand cancer of penis, 130\\nfrom chancre of penis, 108\\nand chancroidal ulceration\\nof penis, 119\\nand curvature of penis, 148\\nand double penis, 115\\nand elephantiasis of penis,\\n115, 128\\nand enlargement of dorsal\\nveins of penis, 117\\nand epispadias, 112\\nand fibroid sclerosis of cor-\\npora cavernosa, 139\\nand fracture of penis, 150\\nand gangrene of penis, 121\\nfrom gangrene of penis, 108\\nand horny growth of penis,\\n127\\nfrom hydrocele, 110\\nand hypertrophy of penis,\\n114\\nand hypospadias, 111\\nOrganic impotence and indurating\\noedema of penis, 133\\nand ossification of penis, 137\\nfrom phagedena of penis,\\n107\\nand preputial calculi, 136\\nand rudimentary penis, 1]3\\nand syphilis of corpora cav-\\nernosa, 146\\nof corpus spongiosum,\\n146\\nand torsion of penis, 113\\nand traumatism of penis, 122\\nand vegetations of penis, 123\\nOssification of penis and organic im-\\npotence, 137\\ntreatment of, 139\\nOvarian cysts and sterility, 348\\nneoplasms and sterility, 348\\nOvaries, absence of, and sterility, 348\\nOxalate of lime, 240\\nPATHOLOGY of chronic posterior\\nurethritis, 216\\nseminal vesiculitis, 274\\nof fibroid sclerosis of corpora\\ncavernosa, 145\\nof hypertrophy of vulva, 386\\nof kraurosis vulvae, 424\\nof neoplasms of vulva, 417\\nof sexual neurasthenia, 315\\nParturition and sterility, 347\\nPenile urethra, 29\\nlength of, 33\\nPenis, absence of, 106\\nfrom chancre, 108\\ncongenital, 106\\nfrom gangrene, 108\\nand organic impotence, 106\\nfrom syphilitic phagedena,\\n107\\narteries of, 21\\nbifid, 113\\ncancer of, and organic impotence,\\n130\\ntreatment of, 132\\ncaptivus, 353\\nchancroidal ulceration of, and\\norganic impotence, 119\\ncurvature of, and organic impo-\\ntence, 148\\ndouble, and organic impotence,\\n115\\nelephantiasis of, and organic im-\\npotence, 115, 128", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0456.jp2"}, "457": {"fulltext": "INDEX.\\n433\\nPenie, elephantiasis of, treatment of,\\n130\\nenlargement of dorsal veins of,\\nand organic impotence, 117\\nfracture of, and organic impo-\\ntence, 150\\ntreatment of, 150\\nfunctions of, 20\\ngangrene of, and organic impo-\\ntence, 121\\nhorny growths of, and organic\\nimpotence, 127\\ntreatment of, 127\\nhypertrophy of, and organic im-\\npotence, 114\\nindurating oedema of, and organic\\nimpotence, 133\\nintegument of, 24\\nnerves of, 22\\nossification of, and organic im-\\npotence, 137\\ntreatment of, 139\\nphagedena of, and organic im-\\npotence, 107\\nrudimentary, and cryptorchism\\n113\\nand organic impotence, 113\\nstructure of, 20, 24\\ntorsion of, and organic impo-\\ntence, 113\\ntraumatism of, and organic im-\\npotence, 122\\nvegetations of, and organic im-\\npotence, 123\\ntreatment of, 125\\nveins of, 22\\nPerineum, ruptured, and sterility,\\n349\\nPerioophoritis and sterility, 347\\nPeripheral irritation and symptom-\\natic impotence, 89\\nPerversion, sexual, 343\\nPeyer on conjugal onanism, 328\\nPhagedena of penis and organic im-\\npotence, 107\\nPhosphate of lime, 242\\nPhosphates, granular, 232\\ntriple, 242\\nPhysiology of erection, 57\\nPollutions, nocturnal, 305\\nPotentia cceundi, 155\\ngenerandi, 155\\nPrepuce, glandular, 25\\nstructure of, 24\\nTyson s glands of, 25\\nstructure of, 26\\nPreputial calculi and organic impo-\\ntence, 136\\nPriapism, 333\\nand alcoholic excesses, 336\\nand cerebro-spinal disease and\\nsexual excesses, 335\\netiology of, 339\\nforms of, 333\\nand leukaemia, 339\\nprognosis of, 341\\nafter spinal injury, 334\\nsymptoms of, 337\\ntreatment of, 341\\nPrognosis of aspermatism, 207\\nof chronic seminal vesiculitis,\\n275\\nof fibroid sclerosis of corpora\\ncavernosa, 145\\nof inflammation of verumon-\\ntanum, 235\\nof new growth of vulva, 420\\nof priapism, 341\\nof prostatorrhoea, 256\\nof psychical impotence, 86\\nof sexual neurasthenia, 319\\nof syphilis of corpora cavernosa,\\n147\\nProlapse of uterus and sterility, 349\\nof vagina and sterility, 349\\nProstate, amyloid bodies in, 252\\narteries of, 43\\nand calculi, 253\\ncatarrhal inflammation of, 237\\nconcretions of, 252\\ncongestion of, treatment of, 230\\ngland, 38\\nanatomy of, 39\\nfunctions of, 38\\nstructure of, 38\\ngonorrhoeal congestion of, 229\\nhyaline cylinders in, 252\\nhypertrophy of, 260\\ncourse of, 260\\ndevelopment of, 260\\nsymptoms of, 261\\ntreatment of, 263\\nmassage of, 258\\nnerves of, 43\\nsecretions of, 71\\nsenile changes in, 246\\ntuberculosis of, and azoosperma-\\ntism, 181\\ntreatment of, 182\\nveins of, 43\\nProstatic secretion, influence of, 189\\ntubules, 42\\n28", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0457.jp2"}, "458": {"fulltext": "434\\nINDEX.\\nProstatic tubules, seat of, 42\\nurethra, 28, 40\\nmuscles of, 42\\nProstatitis, catarrhal, in older sub-\\njects, 245\\nin young subjects, 239\\nchronic, secretions of, 249\\nand symptomatic impotence,\\n93\\ntreatment of, 257\\nProstatorrhcea, 253\\ndiagnosis of, 255\\nprognosis of, 256\\ntreatment of, 257\\nProstitution and sterility in females,\\n347\\nPsychical impotence, 78\\ncases of, 84\\nforms of, 79\\nprognosis of, 86\\ntreatment of, 86\\nPsychrophor, 235\\nPus admixture and spermatozoa, 190\\nPyosalpingitis and sterility, 348\\nRECTAL irrigation, Kemp s, 230\\nReflux catheter, 217\\nRetroversion and sterility, 349\\nRudimentary penis and cryptor-\\nchism, 113\\nand organic impotence, 113\\nuterus and sterility, 349\\nO ADISM, 343\\nO Salpingitis and sterility, 348\\nSarcocele syphilitic, 164\\nScarlatina orchitis, 170\\nSecretions of acute seminal vesicu-\\nlitis, 268\\nof chronic prostatitis, 249\\nseminal vesiculitis, 271\\ncolloid, 194\\nof Cowper s glands, 37\\ndiminished quantity of, 195\\nprognosis of, 195\\ntreatment of, 196\\nof ejaculatory ducts, 74\\nof glands of urethra, 37\\nof inflamed deferential ampul\\nlations, 271\\nmicroscopy of. 65\\nof prostate, 71\\nsemen, 61\\nof seminal vesicles, 69\\nof sinus pocularis, 74\\nSecretions, structure of, 61\\nof urethral follicles, 35\\nwatery, 194\\nSeminal granules, 64\\nvesicles, 43\\nanatomy of, 47, 70\\nand aspermatism, 197\\nfunctions of, 48\\ninflammation of, and symp-\\ntomatic impotence, 96\\nmechanism of, 49\\nsecretion of, 69\\nanatomy of, 70\\nstructure of, 43\\ntuberculosis of, and azo-\\nospermatism, 183\\ntreatment of, 183\\nvesiculitis, acute, 264\\nsecretions of. 268\\nsymptoms of, 264\\nadvanced form of, 269\\nchronic, 267\\ndiagnosis of, 274\\npathology of, 275\\nprognosis of, 275\\nsecretions of, 271\\ntreatment of, 275\\nSeminiferous tubules, 53, 62\\nSensorium commune of external gen-\\nitals, 23\\nSeptum pectiniforme, 20\\nSexual apparatus, muscles of, 52\\ndesire, absence of, and sterility\\nin female, 347\\nerethism, 299\\nand affections of deep sexual\\napparatus, 302\\nBeard on, 300\\nGuelliot s case of, 300\\ntreatment of, 302\\nexcesses, 297\\nand alcoholism, 297\\nand bestial practices, 298\\ncapacity, 297\\nand coitus ab ore, 298\\nand impotence, 298\\nand physical decny, 299\\nand priapism, 336\\ntreatment of, 299\\nin young men, 299\\nhypochondriasis, causes of, 312\\nsvmptoms of, 313\\nlust, 343\\nneurasthenia, 313\\ncauses of, 314\\ndiagnosis of, 319", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0458.jp2"}, "459": {"fulltext": "IXDEX.\\n435\\nSexual neurasthenia, etiology of, 314\\npathology of, 315\\nprognosis of, 319\\nsymptoms of, 316\\nlocal, 318\\ntreatment of, 320\\norgans, effects of masturbation\\non, 293\\nperversion, 343\\nand hair despoilers, 344\\nperverts and masturbation, 345\\nworry, 309\\nconditions inducing, 310\\ninstances of, 310\\nSinus of bulb, 33\\npocularis, 40\\nfunction of, 41\\nsecretion of, 74\\nstructure of, 40\\nSodomy, 345\\nSound, Beneque s, 226\\ncupped, 236\\nsteel, 225\\nSpasm of compressor urethras muscle,\\n32\\nSperma crystals, 72\\nSpermatic veins, excision of, in vari-\\ncocele, 283\\nSpermatoblasts, 53\\nstructure of, 62\\nSpermatogenesis, 62\\nSpermatorrhoea, 303\\ndefecation, 304\\nimaginary, 306\\nand urethrorrhceaexlibidine, 307\\nurination, 304\\nSpermatozoa, number of, 68\\nand pus-admixture, 190\\nstructure of, 64\\nSphincter ani, 53\\nSpinal injury and priapism, 334\\nSpongy urethra, 28\\nStenosis, cicatricial, and sterility, 349\\nSterility in the female from absence\\nof Fallopian tubes, 348\\nof ovaries, 348\\nof sexual desire, 347\\nof uterus, 348\\nof vagina, 349\\nfrom anaemia, 347\\nfrom anteversion, 349\\nfrom atresia of cervix uteri,\\n348\\nof uterus, 348\\nof vagina, 349\\nfrom capacious vagina, 349\\nSterility in the female from catarrhal\\nendometritis, 348\\nfrom chlorosis, 347\\nfrom chronic oophoritis, 348\\nfrom cicatricial stenosis, 349\\nof vagina, 349\\nfrom dislocation of Fallo-\\npian tubes, 348\\nfrom endocervitis, 349\\nfrom fissure of uterine neck,\\n349\\nfrom grave disease, 347\\nfrom hydrosalpingitis, 348\\nfrom hypertrophy of cervix\\nuteri, 349\\nfrom imperforate hymen,349\\nfrom interstitial salpingitis,\\n348\\nfrom inversion of uterus, 349\\nfrom neurasthenia, 347\\nfrom obesity, 347\\nfrom ovarian neoplasms, 348\\nfrom parturition, 347\\nfrom peri-oophoritis, 347\\nfrom prolapse of vagina, 349\\nof uterus, 349\\nfrom prostitution, 347\\nfrom purulent vaginitis, 349\\nfrom pyosalpingitis, 348\\nfrom retroversion, 349\\nfrom rudimentarv uterus,\\n349\\nfrom ruptured perineum, 349\\nfrom salpingitis, 348\\nfrom shortness of vagina, 349\\nfrom small hymen, 349\\nfrom syphilis, 347\\nfrom ulceration of cervix,\\n348\\nfrom undeveloped uterus,\\n349\\nfrom uterine fibroids, 349\\nsubinvolution, 349\\nin the male, 153\\nStricture of bulbous urethra, treat-\\nment of, 322\\nof urethra and symptomatic im-\\npotence, 91\\nStructure of corpora cavernosa, 20\\nof corpus spongiosum, 21\\nof ejaculatory ducts, 51\\nof glans penis, 21\\nof male urethra, 27\\nof meatus urinarius, 27\\nof penis, 24\\nof prepuce, 24", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0459.jp2"}, "460": {"fulltext": "436\\nINDEX.\\nStructure of prostate gland, 38\\nof semen, 61\\nof seminal vesicles, 43\\nof sinus pocularis, 40\\nof spermatoblasts, 62\\nof spermatozoa, 64\\nof urethra and aspermatism, 201\\nof utriculus masculinus, 40\\nSubpubic curve, 35\\nSymptomatic impotence, 88\\nfrom bulbous urethritis, 90\\nfrom chronic urethritis, 93\\nprostatitis, 93\\nfrom inflammation of sem-\\ninal vesicles, 96\\nfrom peripheral irritation, 89\\nfrom posterior urethritis, 92\\nfrom stricture of urethra, 91\\nSymptoms of chronic bulbous ure-\\nthritis, 210\\nposterior urethritis, 212\\nof conjugal onanism in male,\\n327\\nin women, 329\\nof hypertrophy of prostate, 261\\nof kraurosis vulvas, 423\\nlocal, of sexual neurasthenia, 318\\nof masturbation, 293\\npsychical, of varicocele, 282\\nof priapism, 337\\nof seminal vesiculitis, 264\\nof sexual hypochondriasis, 313\\nneurasthenia, 316\\nof varicocele, 280\\nSyphilis of corpora cavernosa, diag-\\nv nosis of, 147\\nand organic impotence,\\n156\\nprognosis of, 147\\ntreatment of, 148\\ncorpus spongiosum and organic\\nimpotence, 146\\ndistortion of vulva in, 399\\nhereditary, of testes, 166\\ntreatment of, 166\\nand sterility in females, 347\\ntreatment of, 404\\nof vulva and chronic chancroids,\\n398\\nSyphilitic difFerentitis, 166\\nepididymitis, 162\\nfuniculitis, 166\\norchitis, 163\\nphagedena and absence of penis,\\n107\\nsarcocele, 164\\nSyringe, author s, 220\\nhand-, 217\\nrFESTIS, 53\\nA atrophy of, 184\\nand varicocele, 279\\nectopia and azoospermatism, 156\\nhereditary syphilis of, 166\\ntreatment of, 166\\nmediastinum, 53\\nneuralgia of, and conjugal onan-\\nism, 328\\nstrangulation of, and torsion of\\ncord, 172\\ntuberculosis of, 175\\ntreatment of, 181\\nTonsillar orchitis, 170\\nTorsion of cord and strangulation of\\ntestis, 172\\nof penis and organic impotence,\\n113\\nTransversus perinei, 53\\nTraumatism of penis and organic im-\\npotence, 122\\nTreatment of adhesions of clitoris, 364\\nof aspermatism, 207\\nof atonic impotence, 102\\nof cancer of penis, 132\\nof chronic chancroids of vulva,\\n393\\nposterior urethritis, 216\\nseminal vesiculitis, 275\\nof condylomata of vulva, 404\\nof congestion of prostate, 230\\nof conjugal onanism, 332\\nof elephantiasis of penis, 130\\nof fibroid sclerosis of corpora\\ncavernosa, 145\\nof fracture of penis, 150\\nof hematocele, 174\\nof hereditary syphilis of testes,\\n166\\nof horny growths of penis, 127\\nof hydrocele, 174\\nof hypertrophy of prostate, 263\\nof vulva, 387\\nof indurating oedema of penis,\\n135\\nof inflammation of verumonta-\\nnum, 235\\nof kraurosis vulvas, 424\\nof masturbation, 295\\nin female, 363\\nof new growths of vulva, 421\\nof ossification of penis, 139", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0460.jp2"}, "461": {"fulltext": "INDEX.\\n437\\nTreatment of priapism, 341\\nof prostatorrhoea, 257\\nof psychical impotence, 86\\nof sexual erethism, 302\\nexcesses, 299\\nneurasthenia, 320\\nof stenosis of bulbous urethra\\n222\\nof stricture of bulbous urethra,\\n222\\nof syphilis of corpora cavernosa,\\n148\\nof tuberculosis of prostate, 182\\nof seminal vesicles, 183\\nof testis, 181\\nof vulva, 407\\nof vaginismus, 355\\nof varicocele, 282\\nof vegetations of penis, 125\\nof vulva, 375\\nTriangular ligament, 30\\nof Henle, 30\\nTuberculosis of prostate and azo-\\nbspermatism, 181\\nseminal vesicles and azo-\\nSspermatism, 183\\ntreatment of, 183\\ntreatment of, 182\\ntestes, 175\\nand azoospermatism, 175\\ntreatment of, 181\\nof vulva, 406\\ntreatment of, 407\\nTubules, prostatic, 42\\nseat of, 42\\nseminiferous, 53, 62\\nTyson s glands, 25\\nULCERATION, chancroidal, of\\npenis, and organic impotence,\\n119\\nof vulva, 401\\nUrethra, absence of, and organic im-\\npotence, 113\\nanterior, 29\\nbulbous, 28\\nexpansion of, 32\\nstenosis of, treatment of, 222\\nstricture of, treatment of,\\n222\\ncourse of, 29\\ncurves of, 34\\nglands of, secretion of, 37\\nmembranous, 30\\nmobility of, 34\\nUrethra, navicular, 28\\npenile, 29\\nlength of, 33\\nprostatic, 28\\nanatomy of, 40\\nmuscles of, 42\\nspongy, 28\\nstricture of, and aspermatism,\\n201\\nand symptomatic impotence,\\n91\\nUrethral calculi and aspermatism,\\n201\\ncaruncles, 374\\nfollicles, secretion of, 35\\nUrethritis, bulbous, and impotence,\\n208\\nand symptomatic impotence,\\n90\\nchronic bulbous, 208\\nanatomy of, 209\\nsymptoms of, 210\\nposterior, diagnosis of, 215\\nand impotence, 211\\npathology of, 216\\nsymptoms of, 212\\ntreatment of, 216\\nand symptomatic impotence,\\n93\\nposterior, and symptomatic im-\\npotence, 92\\nUrethrorrhcea ex libidine, 75\\nUrination spermatorrhoea, 304\\nUrnings, 344\\nUterine fibroids and sterility in the\\nfemale, 349\\nneck, fissure of, and sterility, 349\\nsubinvolution and sterility, 349\\nUterus, absence of, and sterility, 348\\natresia of, and sterility, 348\\ninversion of, and sterility, 349\\nprolapse of, and sterility, 349\\nrudimentary, and sterility, 349\\nundeveloped, and sterility, 349\\nUtriculus masculinus, 40\\nstructure of, 40\\nVAGINA, absence of, and sterility,\\n349\\natresia of, and sterility, 349\\ncapacious, and sterility, 439\\nprolapse of, and sterility, 349\\nshortness of, and sterility, 349\\nspasm of, 353\\nVaginal masturbation in female, 358", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0461.jp2"}, "462": {"fulltext": "438\\nINDEX.\\nVaginismus, 351\\nand caruncles, 352\\nand fissure of anus, 351\\nforms of, 352\\nmild, 351\\nsevere, 352\\nMarion Sims on, 352\\nsuperior, 356\\ntreatment of, 355\\nVaginitis, purulent, and sterility, 349\\nVaricocele, 278\\nappearance of, 278\\nand atrophy of testis, 279\\nBennett s operation in, 284\\ncause of, 278\\nand masturbation, 280\\nsymptoms of, 281\\nopen operation in, 283\\nsubcutaneous ligation in, 285\\nsymptoms of, 280\\npsychical, 282\\ntreatment of, 282\\nby excision of spermatic\\nveins, 283\\nVariola orchitis, 170\\nVas deferens, 53\\ngonorrhoea of, 158\\nVasa deferentia, ampullation of, 50\\nVegetations of penis and organic im-\\npotence, 123\\ntreatment of, 125\\nVeins of penis, 22\\nof prostate, 43\\nspermatic, excision of, in vari-\\ncocele, 283\\nVerumontanum, 40\\ninflammation of, 231\\nprognosis of, 235\\ntreatment of, 235\\nVesiculitis, seminal, 264\\nadvanced form of, 239\\nacute, 264\\nsymptoms of, 264\\nsecretions of, 268\\nVesiculitis, seminal, chronic, 268\\ndiagnosis of, 274\\npathology of, 275\\nprognosis of, 275\\nsecretions of, 271\\ntreatment of, 275\\nViraginity, 345\\nVitriol-throwers and sadism, 343\\nVulva, chancroids of, in old syphi-\\nlitica, 398\\nchronic, treatment of, 393\\ncondylomata of, S94\\ndestructive ulcerations of, 401\\ndistention of, from chancroids,\\n388\\ndistortion of, in syphilis, 399\\nhypertrophic growths of, 372\\nhypertrophy of, 366, 381\\npathology of, 386\\ntreatment of, 387\\nindurating oedema of, 395\\nneoplasms of, 408\\npathology of, 417\\nnew growths of, diagnosis of, 420\\netiology of, 419\\nprognosis of, 420\\ntreatment of, 421\\nprogressive atrophy of, 422\\nsyphilis of, treatment of, 404\\ntuberculosis of, 406\\ntreatment of, 407\\nvegetations of, 369\\nof exuberant growth, 370\\nand hypertrophic masses,\\n371\\ntreatment of, 375\\nin young female children,\\n369\\nWARTY indur.-tting oedema,\\nWatery semen, 194\\nWebbed penis, 148\\nWithdrawal, 324\\n397", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0462.jp2"}, "463": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0463.jp2"}, "464": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0464.jp2"}, "465": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0465.jp2"}, "466": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0466.jp2"}, "467": {"fulltext": "", "height": "3980", "width": "2420", "jp2-path": "practicaltreat00tayl_0467.jp2"}, "468": {"fulltext": "LIBRARY OF CONGRESS\\n021 062 623 2\\n1\\nm\\n^V\\nn\\nim\\nm\\nm\\nI", "height": "4332", "width": "2676", "jp2-path": "practicaltreat00tayl_0468.jp2"}}