Problems Of Young Men
( Originally Published Early 1900's )
IN this chapter I am taking up a variety of subjects which have not been covered in the chapters devoted to the more important matters.
Balanitis.—This is an inflammation of the inner side of the foreskin or prepuce, including the glans, with a purulent discharge. It is the result of uncleanliness and may be cured by cleanliness. Thorough and frequent washing with soap and hot water, with the prepuce drawn back, is necessary. If soap is too irritating, use a solution of boric acid.
Castration.—This is an operation for removing the testicles, resulting in sterility and impotence, though in a few instances, if not performed early in life, it may not produce complete impotence. I have referred to this subject in an early chapter. Slaves for service in harems in Oriental countries are often castrated, being called eunuchs. The operation prevents the normal change of voice, the growth of the beard and the development of the physical strength and mental vigor characteristic of virile manhood. Castration is the surgical treatment for cancer or tuberculosis of the testicles and for a syphilitic tumor involving them.
Circumcision.-This his is an operation which consists in cutting off a part of the prepuce or foreskin from the penis or generative organ. The practice is to cut off as much of this as can be drawn forward beyond the extremity of the organ. Ordinarily the head or glans is more or less protected by this sheath, but after circumcision it is uncovered and exposed. It is sup-posed that because this part is rendered tougher and less sensitive by the operation that the individual will be less liable to contract syphilis. The percentage of circumcised persons suffering from this disease, however, definitely proves it is by no means a sure preventative. So far as gonorrhea is concerned circumcision can have but little effect either.
This operation was originally a religious rite among the Jews and Mohammedans, and is still practiced as such among them. It is now recommended in occidental countries as a sanitary measure, although its relation to freedom from venereal disease is not apparent. It is justly claimed for it that it favors cleanliness generally. This usually depends, however, upon the habits of the individual, whether cleanly or the reverse. Only when the prepuce is too tight, so that the glans cannot be uncovered for thorough cleaning, is circumcision necessary. Inflammation is often caused by uncleanliness, and in such cases if the condition is due to an abnormality of the prepuce, no time should be lost in having the operation performed. Otherwise there is seldom or never any advantage in it.
When the prepuce, while large enough, seems to adhere to the glans, as it sometimes does in infants, it may usually be loosened with a little care. A good way to accomplish this is to force into the enclosure created by the foreskin a small quantity of water, preferably soapy water, by means of a rubber-tipped glass syringe, holding the opening firm around the syringe. Rinse well, using a boric-acid solution for the purpose, if there is inflammation. Repeat the treatment twice a day until the adhesion has been overcome.
Cold Water Injections, for Impotence.-See discussion of nitrate-of-silver treatment; in this chapter.
Confessing One's Past.—Should a man confess his past before being married? Should he demand that his intended wife tell her past?
This is a moot question. It is true that impulses of love, trust and confidence lead one to confess, when there is a "past." But it is partly a practical question, depending upon whether or not such a confession will be beneficial or destructive to the happiness and harmony of the home.
Will the knowledge of each other's previous indiscretions be used later as a basis of taunts and quarrels? Will either take advantage in this way of the confidence reposed in him or her? Or is it certain that both will be so broadminded that there will be no lessening of respect? Many of us have made mistakes. Is it not really the present rather than the past that counts? When a confession is likely to lead to future trouble, is it not foolish to take the risk just for sentimental reasons?
On the other hand, many will hold that there cannot be any real happiness without complete confidence.
There are cases in which it appears to be a man's imperative duty to inform his fiancee as to his past. If it has been such as to produce sterility, it is his absolute duty to tell of it. If there has been recent venereal disease, and even the slightest possibility of infection remaining, it is his duty to tell all. If the past has rendered him in any way unfit or partially unfit for the normal marriage relations, the confession should be made.
But when the dead past is buried with its dead, and no result remains—is it wise or unwise to confess? The question must be decided by the individual. When one is sure to be misjudged, when the revelation will result in misunderstanding, when the other party is prejudiced by conventional views, and bigoted on the subject, and there has been no harmful result of any kind, then the confession may cause loss of respect, unhappiness and possibly the breaking up of the home. It may be inadvisable in a case of that kind.
Foreskin, Adhering.-See Circumcision, this chapter.
Hematocele.—A swelling in the scrotum due to an effusion of blood or internal hemorrhage, resulting from accidental injury, wounds or violent straining. It differs from hydrocele in being opaque. The treatment is rest, quiet, lying on the back with hips raised, fasting, limited drinking, and the local application of cold wet cloths.
Hermaphroditism.—An hermaphrodite, colloquially often called "morphodite," is one sup-posed to have the organs of both sexes, though the fact is that such persons are rarely met with, usually having only some deformity which bears a remote resemblance to such a condition. The popular notion about persons who are half man and half woman, or both man and woman in one, in any degree of completeness, is almost pure superstition. Very rarely there are cases in which one may have the organs of the other sex in an exceedingly rudimentary form, and certainly these rudimentary parts do not function. The condition is doubtless the result of imperfect development, or lack of growth of the parts in an early period before birth.
Herpes of the Genitals.—An eruption of blisters or vesicles, similar to "shingles," usually on the prepuce. Probably the result of uncleanliness or irritating secretions. Wash frequently with boric acid. Constitutional, blood-purifying treatment is important.
Hydrocele.-A swelling or enlargement of the testicle due to an accumulation of fluid, more or less clear, in the serous sac, or tunica vaginalis, immediately, surrounding the testicle. It is often more inconvenient than painful. Sometimes mistaken for rupture, sometimes associated with rupture. It may be due to injury, infection, tuberculosis, obstructed veins or dropsy. It is sometimes congenital. The treatment should depend upon the cause. In some cases, rest on the back, the local application of cold wet cloths, fasting and limited water drinking will be sufficient. Tapping may be necessary in some instances.
Hypospadias.-A deformity in which the opening, of the urethra appears on the under side of the penis instead of at the end. It usually accompanies more or less deformity of the part. Surgical treatment may be useful in correcting the condition.
Milk Diet.—I have referred to the exclusive milk diet in several places in this book as being valuable in some cases of impotence, or wherever there is an extreme degree of debility, loss of flesh and neurasthenia in connection with sexual weaknesses or disorders. It is not wise to attempt the milk diet without a thorough understanding of the necessary procedure, and it might be well to have the supervision of some one who is familiar with it. It may be helpful, however, to give briefly a few of the important details.
The best results are always obtained by fasting from one to three days before commencing the milk diet, at the same time drinking water freely and taking one or two full enemas. Then take a glass of milk every half-hour through the day. It would be well to use only three or four quarts the first day, and' gradually increase the amount until at the end of three or four days you are able to consume from six to eight quarts daily. Sip it very slowly, taking five to ten minutes to consume one glass. Use nothing but the milk in this diet, except for lemon juice the first thing each morning, or at any time during the day when it is appetizing. The lemon juice may be diluted with a little water. If the milk is not appetizing, use more lemon juice, or fast half a day, drinking water freely. If there is constipation, increase the amount of the milk. If the patient is very weak, and the cold milk chilling, it may be warmed to the temperature of the body, like fresh drawn milk. Pasteurized milk is less satisfactory than fresh raw milk of good quality. Jersey milk is too rich in cream; the milk of other breeds is better. In most cases the best results are secured with the milk diet when used in con-junction with comparative rest.
Nitrate-of-Silver Treatment.- A word upon the subject of the nitrate-of-silver treatment for sexual disorders is necessary because of its very extensive use by specialists. The reader has al-ready seen that this antiseptic is often used for injections into the urethra in the treatment of gonorrhea, and also as a prophylactic measure to pre-vent this affection. It is also extensively used by physicians in the treatment of a congested, sensitive and irritable posterior urethra, such as often results from excessive masturbation, or may be found in connection with' prematurity or partial impotence. The theory upon which this treatment is based is that by commencing with a very weak solution and gradually increasing its strength, the mucous membranes involved are hardened and rendered less sensitive. The chief objection to it is that in most cases the solution employed is too strong. I do not believe that anything stronger than a two-per-cent solution should ever be permitted. Nothing that causes pain in the urethra can be beneficial, and it is a good rule not to inject into it anything so strong that it could not also be put into the eye.
I doubt whether any real or permanent benefit in sexual weakness is secured by such treatment, though its antiseptic and cleansing value is unquestionable when infection has entered the urethra. Usually the physician prescribes with the local treatment some general health-building measures, and it is probably these that produce the good results, if there are any.
I believe that in most cases the external use of cold water will accomplish better results. If internal treatment seems necessary, an injection of cold, sterilized (previously boiled) water would do as well as the nitrate-of-silver instillation. A saline solution (teaspoon of salt to a quart of water), or a weak boric-acid solution, prepared with sterilized water, would probably be better. The objection to these is the possibly detrimental effect of the cold water upon the bladder. It is a good, practical rule that all irrigations of the bladder should be hot or at least warm. That is the chief reason why I did not particularly recommend these cold injections in the chapter on impotence. Another reason is that some per-sons might be careless in neglecting to use sterilized water, or in using a syringe that is not aseptic. Boil the syringe, too, if you try it. If you can avoid having trouble with the bladder, these cold-water or cold saline injections into the urethra would be likely to have a very pronounced effect for the better in a case of impotence or prematurity. It is not wise for any one but the expert to dabble with the nitrate-of-silver treatment.
Phimosis: A condition of constriction or tightness of the prepuce or foreskin, such that the glans cannot be uncovered. Sometimes the opening is extremely small, and in rare cases it may be closed up, through adhesion. Circumcision is required. See Circumcision, also, for treatment of adhesion of the foreskin.
Paraphimosis is a condition of strangulation just back of the glans, or head of the generative organ, which may result when the glans has been forced through the narrow opening of the prepuce in a case of phimosis. Inflammation and swelling results. Oiling the parts will usually make it possible to draw the foreskin forward again over the glans. It should not be neglected, even if surgical help is necessary.
Priapism.—A disorder in the form of a continuous and persistent erection of the generative organ. It is sometimes due to some spinal disease, and is then very serious. In other cases it may be due to local irritation from prostate trouble or some other disorder, in which case treatment should be directed to the primary condition. Chordee is an erected condition with a marked downward curve frequently occurring in gonorrhea (which see).
Spinal stimulation and constitutional treatment are necessary. Hot and cold applications to the spine may be helpful in different cases. Plenty of active exercise, cold sitz-baths and local cold applications, if long continued, will be of value. A full bladder often aggravates the condition. General building-up is the most important remedial measure.
Rupture or Hernia.—There is no question that in many cases hernia has a weakening effect upon the sexual system, though it would often be nearer the truth to say that the general weakness is responsible for both hernia and sexual weakness. As a rule, hernia can be prevented by exercise that builds up the muscular walls of the abdomen, and in most cases it can be cured in the same way. Of course a properly fitting truss should be kept in place while executing such exercises, to protect the weakened part.
The question as to whether or not sexual intercourse should be avoided in this condition is one that depends largely upon the extent and seriousness of the hernia. If at all pronounced, it would be best to maintain strict continence until an improvement or cure has been brought about. Particularly in the case of a scrotal rupture is it advisable to avoid any sexual indulgence.
Satyriasis.—A condition of extreme and uncontrollable sexual desire, being the counterpart of the disorder in women known as nymphomania. In its more serious forms it is usually a symptom of brain or spinal disease, perhaps approaching insanity. Ii other cases, it may be a symptom of irritation or inflammation of parts of the generative system, especially the prostate gland or posterior urethra. Local treatment for these parts will be necessary. When the brain or nervous system is at fault, thorough constitutional and vitality-building treatment will be necessary. See the chapter on "How to Build Virility."
Sex Deformities.—Most deformities of the sexual organs are congenital (existing from birth) and little or nothing can be done for them, though in some cases surgical treatment may be advantageous. See hermaphroditism and hypospadias. The question of undersized or undeveloped organs is discussed in the chapter on impotence.
Testicles, Disorders of—Inflammation of the testicles may be the result not only of gonorrheal infection, but of mumps, typhoid fever, general pus or septic infection, syphilis or tuberculosis. When the epididymis alone is affected, the condition is called epididymitis, and is in most cases the result of gonorrhea. When the body of the testicle is involved it is called 'orchitis. Sterility may result in either case. Injuries naturally cause inflammation. Tubercular or syphilitic inflammations sometimes take a chronic form. Constitutional treatment is always desirable, to purify the blood and build up the health. Fasting and water-drinking are always helpful in inflammatory conditions of any kind. Hot sitzbaths are invariably best, though alternate hot and cold sitz-baths, or alternate hot and cold local packs, may sometimes answer the purpose better. Enemas are usually helpful. Rest is important.
Apparent absence of the testicles may mean simply that they are "undescended," or in other words, that they are still in the pelvic cavity, where they first form. In normal cases they descend into the scrotum a few weeks before birth. Sometimes they do so later. In a few cases they never do. They may function satisfactorily, even if undescended, in some cases, but more frequently their functional power is poor or lacking. If one is virile, and the sex instinct normal, in spite of the condition, one need not be concerned about it, and it is not wise to have an operation performed or to meddle otherwise. Complete absence of the testicle is ordinarily accompanied by a lack of development and vigor.
Atrophy of the testicles was discussed in the chapter on impotence. In swellings of the scrotum one should consider the possibility of rupture, varicocele, hydrocele and hematocele.
Tuberculosis and Continence.----It is a matter of common observation that consumptives are often inclined to sexual over-indulgence. In most debilitating and wasting diseases there is a marked decline in sexual power and activity. The apparent exception in consumption may be due in part to the fact that tuberculosis most frequently occurs fairly early in mature life, and still more to the fact that the consumptive usually follows a very full diet of milk and eggs, or its equivalent in meats and other heavy food, while at the same time doing little or no work. The rest cure is usual, and with a full diet of proteid foods it is perhaps only natural that sexual desire should be easily aroused.
However, vital vigor is the all-important factor in combating tuberculosis, and a strictly continent life is for this reason advisable in all cases. This disease is so serious and threatening in all cases that one cannot afford to jeopardize one's prospects of recovery by any devitalizing practice. A separate bed out of doors is imperative in the case of every consumptive.
Venereal Warts.—These are vegetations or cauliflower-like growths, technically known as papillomata, which may appear on the genital organs as a result of uncleanliness, irritation from foul secretions or venereal disease. They seem to be contagious. Antiseptic washes are advised. Strict cleanliness is necessary, together with blood-purifying measures. They are pain-less, grayish, and inclined to slough off easily. Surgical treatment may be advantageous.
Married Life After Middle Age.—What should be the character of the marriage relation-ship after middle age? Should a man expect to continue the habits of his earlier years, or should there be a gradual decline in sex activity?
It is well known that women experience, between the age of forty-five and fifty, a physiological change which marks the end of the reproductive period. This is really the end of true sex activity, even though it does not necessarily mean that the sex instinct is obliterated. The "change of life" has very little effect upon the sex impulse in the case of some women. In others it is practically lost after this time. The general rule is that there is a gradual decline in the sex instinct following the menopause.
Men, however, do not experience any sudden physiological change of this nature. It is only natural, however,` that there should be a decline in the force of the sex impulse after middle age, corresponding to a certain extent to the ending of the reproductive period in woman. It is true that in the case of a healthy man, virility should last as long as life, but it is a matter of common experience that the strength and power of the sexual urge is diminished from middle age on. And it is only natural that there should be a corresponding decrease in sex activity, even though one's vigor and virility are unimpaired. It is certain that excesses during this period of life cause one to age rapidly. It is even advisable in many cases to practice continence from the age of fifty or fifty-five years. A great many men are perfectly content with such a program, commencing even earlier in life. I have referred to this aspect of the question in the chapter on "Impotence," in discussing impotence in relation to old age.
It is wise for the young couple, therefore, to anticipate the coming decline in the sex instincts, and to prepare for their mutual enjoyment of the later years of life by strengthening the bonds of affection and companionship in other ways, There should be as many sources of mutual interest as possible, domestic, mental and social. Of course the strongest bond in many cases will be the children whom the couple may have raised. But usually the children leave home to establish homes of their own, and if the parents are still drawn to each other by their mutual interest in many things, in addition to the natural affection that has developed between them, it will make life much happier and more full of meaning. This does not necessarily mean that each one should not "live his own life," or that either should lose his or her individuality by having it merged into that of the other. But it is necessary that there should be a common interest in various departments of life, and mutual enjoyment of such things as music, the arts, literature, gardening, animal life, current events, business and various other matters, if the couple are to continue to enjoy each other's society during the later years of life.