1842, to the 1st January, 1862, is insufficient to furnish any complete statistics of the disease. He therefore confines himself to three points: 1, the frequency of the occurrence of ulcer of the duodenum, compared with that of the stomach; 2, the sex; and 3, the age of the persons attacked.

1. As to the comparative frequency of the two affections, it would appear from the observations of Rokitansky, Jacksch, Müller, and from the records of Frederik's Hospital, that among 261 cases of corrosive ulcer or of cicatrices left by the same, 28, or 10.7 per cent., were found in the duodenum. The author remarks that probably these ulcers would be more frequently discovered if the stomach and duodenum were accurately examined in every post-mortem examination.

2. It is well known that ulcer of the stomach occurs much more frequently in females than in males: Brinton, who has collected the largest number of cases-namely, 654-makes the proportion as two to one, 440 having been met with in females, against 214 occurring in males. On the contrary, the corrosive ulcer of the duodenum is found five times more frequently in males than in females, the total number of cases on record in which the sex is mentioned being 54, of which 45 occurred in males, and only 9 in females. This contrast is the more striking, as these ulcers do not present any demonstrable differences, whether they are found in the stomach or duodenum.

3. Corrosive ulcer of the duodenum occurs most frequently in the age of manhood: about three-fourths of those attacked were between 30 and 60 years of age, and the average age was 42 years.

Having dwelt so long upon the more introductory portion of Dr. Trier's interesting and instructive essay, we shall now, as the course most likely to be useful and acceptable to our readers, instead of entering into the details of the twenty-six cases recorded in the work, quote at some length from the conclusions drawn by the author himself from the facts he has collected:

"In a clinical point of view," he observes, "the cases which present themselves fall into two principal groups, consisting of those which run an acute and those which run a chronic course. But on examination after death, it is found that the former can be called acute only when they are considered from a purely clinical point of view; anatomical examination shows that they almost always have really had a tolerably long duration.

"In the acute cases the disease almost invariably terminates in rapid peritonitis, the result of perforation. The ulcer, under such circumstances, is generally situated on the anterior intestinal wall.

"The chronic cases resolve themselves into two subdivisions: 1. Those where only isolated symptoms of apparently slight importance had preceded the fatal result. 2. Those in which more serious phenomena had long before appeared and might have excited a suspicion of this or of some other dangerous abdominal disease.

"To the first of these subdivisions the same observations in a certain degree apply, which were made with respect to the cases running an acute course. "The second subdivision affords especial opportunity for observing the results which ulcers in the duodenum of very long standing may induce in connexion with the surrounding organs. The ulcer may, according to its seat,

effect adhesions with, and corrosion of the liver, the biliary ducts, and gallbladder anteriorly; the pancreas, the vena portæ, the hepatic artery, the ductus communis choledochus, and the sub-peritoneal connective tissue posteriorly. It may also give rise to new formations of connective tissue around it, which by pressure, tension, and interlacement, may produce considerable functional disturbances. Among these, thrombosis in the vena portæ and occlusion of the ductus communis choledochus are the most important, which in the living body manifest themselves by symptoms of the hepatic affections produced by them, especially by jaundice. Sometimes the pains which the serous inflammations and their products cause by tension and interlacement give rise to nervous reflex actions of considerable violence (neuralgias, spasms). Besides these effects, ulcer of the duodenum in many cases produces considerable dilatation of the stomach with hypertrophy of its membranes.

"The diagnosis of chronic ulcer of the duodenum is based partly upon the peculiarities it possesses in common with ulcer of the stomach, and partly upon some which belong to it alone. The diagnosis from ulcer of the stomach, and especially from constriction of the pylorus, is, in the present state of science, and of our aids to diagnosis, impossible. As the most important grounds for the diagnosis we must mention: 1. Signs of dilatation of the stomach; 2. A sensitive tumour in the epigastrium, proceeding from_adhesion with the pancreas; and 3. Jaundice or other hepatic phenomena. It is especially the two last-named symptoms, which are peculiar to the ulcer of the duodenum, which nevertheless, under such circumstances, may be difficult to distinguish from cancer in the pylorus, and from diseases originally developed in the liver, its vessels, or excretory ducts. In the acute cases, and in those chronic cases which run a latent course, the diagnosis is impossible."

ART. IX.-Die Spermatorrhea nach ihren Körperlichen Verhältnissen, ihrer Anatomischen Grundlage und dem Heilverfahren in derselben, in Nerven-, Gemüths-, und Geisteskrankheiten. Von Dr. J. F. H.

ALBERS.-Bonn, 1862.

pp. 152.

On Spermatorrhoea, its Influence on the Body, &c. By Dr. J. F. H.

ALBERS.

THE subject of this treatise has fortunately of late years engaged the attention of several qualified medical men, who have partially rescued it from the domain of a set of infamous charlatans. Nevertheless, it has not sufficiently arrested the attention of the profession at large, and there is both a deficiency of precise and accurate information respecting the exact pathological conditions of Spermatorrhoea and very divergent views entertained as to the gravity of its consequences, particularly in reference to the mental powers. Dr. Albers, one of the professors in the University of Bonn, and well known by various medical works of repute, has undertaken, in the treatise under notice, to portray the varieties of spermatorrhoea in relation with the peculiar pathological conditions associated with them, and particularly to examine the disorder in its effects on the mental functions. He also devotes a section of his treatise to the consideration of treatment-a matter further illustrated by the history of several cases.

He recognises spermatorrhoea as existing under three primary conditions:-1. As simply an abnormal discharge of seminal fluid. 2. As associated with morbid changes in the seminal receptacles and

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ducts, and in the bulbus urethra and prostate. 3. As presenting a combination of the two foregoing conditions.

Altogether thirteen cases are recorded, the majority of them extracted from the essay of Lisle,* and accompanied with comments by the author. Although this plan, adopted by Professor Albers, of borrowing cases in illustration, and of comparing his own experience with those selected examples, may possess some advantages, it would in our opinion have been more satisfactory, looking upon his book as an independent treatise and not as a critique upon Lisle's essay, had the author presented us with his own clinical records to exemplify his views respecting each of the varieties of the disorder he takes into consideration.

Many have been unwilling to admit the directly mischievous results of spermatorrhoea on the cerebral functions insisted on so strongly by others, and have argued that the loss of the secretion can have no such dire results, inasmuch as many debauchees, given to great sexual excesses, apparently escape unharmed for a long time, though their seminal discharges are greater. This question is discussed by the author at page 55 and again at page 79; and his opinion is that in cases of spermatorrhoea, especially when present by day as well as night, there is greater exhaustion of the secretion; that it escapes with the urine and during the alvine discharges; that there is a morbid activity in the secreting organs and their ducts, and an abnormal fluid poured out defective in the true spermatic elements. On the other hand, we must remember that masturbation shows its ill consequences in the female almost equally as much as in the male, though no exhaustive discharge be induced; and we therefore entertain the conviction that the consequences to the nervous system and brain do not bear any intrinsic relation to the spermatorrhoea itself, but to the causes of that disorder, and to the nervous phenomena conjoined with them.

The deduction from Lisle's cases is, that involuntary seminal discharges, with irritation of the receptacles and ducts, exercise a very injurious influence upon the brain, and operate as a predisposing cause of insanity; and further, that the insanity so induced has features peculiar to itself whereby the physician may recognise it from other varieties of mental disorder, whilst the increase or decrease of the discharge is attended by a corresponding aggravation or amelioration of the malady.

Professor Albers calls particular attention to the fact that involuntary seminal discharges may occur without antecedent masturbation or attack of gonorrhoea, as illustrated in the third case he records; and further, that they are not always associated with impotence. Moreover, he concludes that both false and true spermatorrhoea depend much more on organic lesions and abnormal excretion of the bulbus urethræ, the ejaculatory ducts and the seminal vesicles, than on organic disease of the testicle and inertness of those parts concerned in the act of emission; and, lastly, that spermatorrhoea is commonly accompanied by an abnormally increased secretion of seminal fluid (p. 104).

* Archives Générales de Médecine, 1860.

He distinguishes three varieties of spermatorrhoea:-1, the tranmatic; 2, the onanistic; and 3, the gonorrhoeal. The first kind follows upon injuries, such as blows upon the perinæum, as instanced in the tenth recorded case. The second form is attended by greater loss of tone or power in the parts, with wasting and anæmia: the urethra is exceedingly sensitive, and particularly in the vicinity of the bulb; and an involuntary escape of urine is frequently found during sleep. The third variety follows after gonorrhoea, and in it there is considerable thickening of the bulb and parts connected, the ejaculatory ducts and the prostate; the ducts becoming also widened. The stream of urine is reduced in size, and micturition rendered somewhat difficult, and seminal evacuations often occur when urine is passed, or when the bowels are relieved. The seminal fluid is mostly deteriorated; contains mostly only glistening corpuscles similar to the heads of spermatozoa, with or without epithelial débris. The testicles and sexual organs are well formed, and the constitution is mostly vigorous. If the submucous tissue has not become so thickened as to produce an actual stricture, pollutio spuria is often present; and when the lesion has not farther advanced, productive cohabitation may be regained. On the contrary, when an actual stricture is formed there is no seminal discharge with the stools, and the author doubts whether any true spermatic fluid escapes under these circumstances, even with the urine. Moreover, when a stricture is present, and especially if the stream of urine be broken or divided by it, no effective copulation can occur.

Reviewing spermatorrhoea in connexion with the parts principally concerned in its production, Professor Albers treats of S. testicularis, S. vesicularis, S. prostatica, and S. urethralis, thus adopting in the main the pathological division of the disorder established by Dr. Marris Wilson in his treatise On Diseases of the Vesiculæ Seminales and their Associated Organs.' (London, 1856.)

He nevertheless attaches little practical importance to this division, for he remarks (p. 113) that, from his own observations on the genital organs of those who have for any length of time suffered, especially after gonorrhoea, it is not one part but many parts of the organs concerned in the elimination and discharge of spermatorrhoeal fluid which are involved simultaneously. However, he discusses each variety in detail, so that he may examine the operation of the several pathological changes in the development of the symptoms of spermatorrhoea and in the production of its results.

It is satisfactory to be able to report that Professor Albers has not neglected British medical authorities. The views and researches of Marris Wilson are duly recognised, whilst those of Prout, Henry Thompson, and others, are referred to where they have been relevant to the subject under discussion.

The treatment must be regulated by the knowledge of the intrinsic lesions connected with the discharge, and of the patient's general condition and habits. If inflammatory symptoms show themselves around the seminal vesicles and their neighbourhood, leeches should be applied to the perinæum, and ice with cold hip-baths. When there is swelling

and stricture, or chronic inflammation in the bulb or at the mouths of the ejaculatory ducts, caustic may be applied, according to the plan of Lallemand, Amussat, and Lisle. Digitalis, or digitalin, may be used internally to lessen the abnormal irritability of the nervous system. When pollutio diurna is a consequence of onanism, cauterization is usually very effectual; and for any urethral irritation that may be felt, camphor ointment or liniment rubbed in along the course of the passage is highly beneficial. In such cases likewise the introduction of bougies, prepared with camphor or tannin, proves advantageous, and Albers injects a weak solution of camphor in olive oil by means of a catheter into the sensitive urethra. The Faradization of the genital organs has been proposed by Dr. Clemens, of Frankfort, and Wilson recommends cauterization or counter-irritation to the perinæum, or the formation of an issue by means of potassa fusa.

Albers himself speaks in praise of tannin used by way of injection to produce constriction of the dilated mouths of the ejaculatory ducts and to lessen the abnormal secretion.

Such are the local and medicinal measures applicable in this sad disorder; it is unnecessary to dilate on the dietetic rules and moral treatment which must be enjoined with the former to render them efficacious.

This treatise by Professor Albers will repay perusal, not indeed on account of any originality in its teachings, but as a good description of spermatorrhoea, its symptoms and treatment, and particularly of its relations with mental disorder.

ART. X.-Etudes Pratiques sur les Maladies Nerveuses et Mentales, accompagnées de Tableaux Statistiques, &c. Par Dr. H. GIRARD DE CAILLEUX.-Paris, 1863. pp. 234.

Practical Studies on Nervous and Mental Diseases, accompanied by Statistical Tables. By Dr. H. GIRARD DE CAILLEUX.

THIS work is intended to convey the results of twenty years' experience of the author in one of the best asylums of France. M. Girard de Cailleux has earned for himself a high reputation in France, and an equally high one in this country also, having taken the van in the march of improved Asylum construction and management, and shown a more correct appreciation than most of his countrymen of the principles of treatment advocated and carried out in England. His long services as an asylum physician, as the originator and constructor of the far-famed asylum of Auxerre, and as its successful manager, have secured him the position of Inspector-General of Lunatics in the Department of the Seine. The first fruits of his labours in this new office are also contained in the present treatise, in the shape of two Reports to the Prefect of the Seine on the state of the insane treated in the great hospices of Paris, the Salpêtrière and the Bicètre, and in some "General Considerations on the Entire Service of the Insane in the Department of the Seine." Though others had previously worked in the same direction, yet these reports appear to have finally determined the