bodies, rather larger than the body of a spermatozoon, and nearly opaque from the numerous asperities on the surface of the investing membranes. These appear to be identical with the seminal granules described by Wagner107 and others.

344. Well-defined and often large octohedra of oxalate of lime (214) are of common occurrence in spermatic urine. The connection of this saline body with the presence of spermatozoa was first pointed out to me in a private communication with which I was favored by Professor Wolff, of Bonn. Very lately M. Donne has stated, as the result of his observations, that they frequently occur together, and that the presence of oxalate of lime is a constant indication of the existence of spermatorrhoea. This statement is quite opposed to my own experience, for although in the latter disease oxalate of lime often exists, yet this salt constantly occurs where no suspicion of an escape of semen can be entertained (248).

345. Pathological Indications.—Whenever spermatozoa, or spermatic granules are detected in the urine, it is quite certain that the seminal secretion must have been mixed with it. The causes of this admixture are numerous, for it must be recollected that if the bladder be emptied even some time after a seminal emission, a sufficient number of spermatozoa will remain in the urethra to be washed away with the urine, and cause it to assume the ordinary microscopic character. A certainly not unfrequent cause of the escape of semen is extreme constipation, for after the passage of hard and scybalous fæces, an oozing of fluid from the urethra, full of spermatozoa, is not uncommon. In some cases of stricture of the urethra, anterior to the orifices of the seminal ducts, an accumulation of semen may, upon sexual excitement, collect, and flowing into the bladder, be voided subsequently with the urine. An admixture of semen with the urine may occur occasionally in paraplegia, in persons reduced in health by excessive indulgence in intercourse, or by even less creditable modes of producing excitement of the sexual organs.

346. Therapeutical Indications.-The irritable state of the nervous system, the depressed general health, and in some cases the appearance of epilepsy, or of symptoms not unlike mild forms of delirium tremens, and characterized by the most abject melancholy and despondency, are familiar to all, as the effects of the too copious and frequent excretion of seminal fluid, whether excited or involuntary. To this ailment, spermatorrhoea, as it has been named, great atten

tion has been drawn, especially by M. Lalleland, and by several writers in the English medical journals. That the detection of spermatozoa in the urine will often enable the physician to detect a source of exhaustion previously concealed from him, and baffling his treatment, is unquestionable; but that this matter really merits all the verbose attention lately lavished upon it, is not so evident. I am quite sure that very great mischief has resulted from the publicity given to the reported results of spermatorrhoea, in the moral effects produced on weak-minded young men, who too generally read these reports with avidity; no less than in the encouragement given to a most atrocious class of quacks and empirics.

I hardly know any state of mind more difficult to treat than that which is so often present in patients who believe themselves to be the subjects of spermatorrhoea. Although, perhaps, there may be no reason to believe that losses of this kind are actually going on, the patient's mind is too generally made wretched, and his happiness blasted, by the iniquitous pictures drawn of the presumed results of spermatorrhoea by the miserable harpies who have so generally taken possession of this department of practice, and acquire the strongest hold over their victims by the threats and promises they alternately hold out. The patient's mind is so poisoned by the tales of misery and wretchedness poured into his ears by these persons, that it is often impossible to excite any hope of recovery, and they seem, indeed, to regard their imaginary impending fate with a sort of gloomy satisfaction.

347. In the treatment of spermatorrhoea it appears necessary to examine the therapeutic means to be employed in two points of view; as curative of the involuntary discharge, and of the habits keeping it up. The first indication is best fulfilled by attending to the general health, by cold hip-baths, or by dashing cold water over the genitals; by the use of astringent injections into the urethra, or the application of solid nitrate of silver to that part of the canal where the seminal ducts open, as recommended by Lallemand and Mr. B. Phillips. I may be permitted, however, to enter a strong protest against the reckless employment of this remedy. In the hands of experienced surgeons no injury is likely to follow its use, but unhappily this mode of practice has been adopted by the helots of our profession to whom I have before alluded. I have seen the most distressing results follow the use of the local application of the lunar caustic in the treatment of presumed spermatorrhoea. As an

example, I had under my care a case of intense cystitis occurring in the person of a previously healthy young farmer, who, being about to be married, began to be anxious on account of his observing an involuntary emission once in five or six weeks. His attention was arrested by one of the advertisements which too often disgrace our daily papers. He came up town, consulted the quack, whose name he had then discovered. He was declared to be impotent-the nitrate of silver was applied, and the result was cystitis, which placed his life in peril. The use of iron, persisted in for some time, with a little quinine, and a careful use of purgatives, will greatly expedite the recovery of the patient. Marriage also becomes a very important curative agent. The second indication is fulfilled by an influence on the moral feelings of the person, and if these have no effect, the application of a blister, or croton oil, to the prepuce, or in some cases circumcision, will be found available in breaking through an iniquitous and injurious habit.

CONFERVOID GROWTHS.

A. Torula Cerevisia.

348. It is well known that in all saccharine fluids undergoing the alcoholic fermentation, minute confervoid, or fungoid vegetations (to which M. Turpin gave the name of Torulæ cerevisia) appear, and pass through certain definite stages of development. There is, indeed, considerable reason to believe that these vegetations, to a certain extent, bear to fermentation the relation of cause and effect. The arguments lately advanced by Professor Liebig, in opposition to this opinion, do not, to my mind, afford a satisfactory answer to the observations previously made on this subject.

When urine contains but very small portions of sugar, too little even to affect its specific gravity materially, or to cause it to assume a diabetic character, certain phenomena are developed connected with the production of the vegetation of the genus Torula or Saccharomyces, which will at once point out the presence of sugar. These indications are of very great value as a guide to our treatment, as an occasional saccharine condition of the urine is, according to recent statements, not uncommon in some forms of dyspepsia in old age, when the health begins to give way.

349. When saccharine urine is left in a warm place, a scum soon forms on its surface, as if a little flour had been dusted upon it. This consists of minute oval bodies, which soon enlarge from the development of minute granules visible in the interior. These con

SACCHARINE URINE.

305

tinue expanding, and dilate the oval vesicle containing them into a tubular form; soon afterwards the internal granules become larger and transparent, and project from the exterior of the parent vesicle like buds. The whole then resembles a jointed fungoid or confervoid growth, which ultimately breaks up; and a copious deposit of oval vesicles or spores fall to the bottom. All these stages of development (Fig. 73) require but a few hours for their completion. If the deposited spores be placed in a solution of sugar, they rapidly germinate, and, exciting fermentation, produce a new crop of torulæ. During the growth of the torule, bubbles of carbonic acid gas are evolved, and the urine at length acquires a vinous odor, generally accompanied by that of butyric acid. There are two kinds of urine which may be mistaken for saccharine, by the occurrence of a kind of fermentation, not unlike that of fluids really containing sugar. I refer to the form of viscous 108 fermentation which occurs in urine, and ending in the appearance of much ropy mucus. This has occurred to me repeatedly in specimens of urine

Fig. 73.

a

containing cystine, the odor evolved being, however, disagreeable and sulphureous, quite distinct from the vinous odor of the alcoholic fermentation. Somewhat similar phenomena are occasionally presented by the urine of persons exhausted in health from scrofulous or syphilitic cachexia.*

*The two plates (Figs. 74 and 75) represent the growth of the torula; the first

350. Saccharine urine cannot be distinguished, by its appearance, from normal urine. Its specific gravity is generally high, and in consequence it becomes frothy on agitation; its color is pale, its odor fragrant, and its taste sweet. It is also generally transparent. The presence of sugar, however, once suspected, may be easily proved by analysis or the application of tests. 109 If a moderate quantity of sugar exists, the urine may be evaporated to an extract and digested in hot alcohol; when cold, the tincture should be decanted and allowed to evaporate spontaneously in a cylindrical vessel (a cupping-glass answers very well). In this way white granular masses of sugar will crystallize on the sides of the glass, whilst if the evaporation be expedited by heat, crystals are obtained with great difficulty, and often not at all, until the urea and other organic ingredients have been got rid of by a tedious process.

351. The most trustworthy tests for the detection of sugar in urine depend for their action upon the reducing action of sugar on salts of copper, or upon the decomposition of the sugar by alkalies.

A. Trommer's Test.-Add to the suspected urine in a large testtube just enough of a solution of sulphate of copper to communicate a faint blue tint. A slight deposit of phosphate of copper generally falls. Liquor potassæ must then be added in great excess; a precipitate of hydrated oxide of copper first falls, which redissolves in excess of alkali if sugar be present; forming a blue solution like ammoniuret of copper. On gently heating the mixture to ebullition, a deposit of red suboxide of copper falls if sugar be present.

Several objections have been made to this test, on the ground that mere uric acid is sufficient to reduce the copper, and thus introduce a serious source of fallacy. I confess that I have never met with any variety of urine which completely produced the above-described phenomena with the test unless sugar existed. I believe the solubility of the precipitate first produced by liquor potassæ in an excess of the precipitant, and its depositing a dense red cupreous precipitate by heat, not continued after the liquid has acquired the boiling temperature, to be quite characteristic of sugar. This dense red deposit is very different from the light orange-colored flocculent clouds which slowly subside when non-saccharine urine is employed.

(Fig. 74) is taken from Dr. Lionel Beale's work on the Microscope, and the latter from Dr. Otto Funke's beautiful Atlas; a, a, shows the first or vesicular form; Fig. 74, b, the germination, and Fig. 75, b, the appearance assumed about the eighth day.