_Local Structural Changes._――Structural changes in the genital organs, in a chronic case of spermatorrhœa, are not a little interesting to the student of pathology. The scrotum is pendant, baggy and relaxed. The penis is flabby, cold and pallid. The veins are dilated and tortuous, and the organs are in a condition of anæsthesia or hyperæsthesia; and as irritability often exists, causing unnatural attention of the patient, and he finds much difficulty in dressing to suit his genitals. The spermatic cord is hypertrophied, and the epididymis enlarged and baggy. If the examination can be obtained when there is an erection, tenderness will be observed, along the entire course of the urethra. The urethral mucous membrane is thickened, and the canal is strictured throughout its length. The prostate gland is changed and tender to touch, congested, and its ducts relaxed. (See Prostatorrhœa.) The anus is sore to manipulate, and at stool, when scybala pass over the prostate gland, a sensation of pain is felt, and fluid is forced out of the ducts into the canal and drips from the end of the penis. The veins of the spermatic cord are varicose, the erections are deficient in power (see Impotence), and seminal fluid is thin and watery. The spermatozoa are deficient in size, shape, and amœboid movements. The urine is of a low specific gravity and contains a superabundance of urates. The orgasms are feeble and often imperceptible, and the proportion of spermatozoa to fluid is not great.
_Spermal Changes._――The only known detection of spermzoons is by the microscope, which only can detect the seminal from the prostatic fluid in this stage of disease. The reason that spermatozoa have not been detected oftener in the urine of spermatorrhœa patients, is simply from the fact that the urine was not examined more than once, perhaps twice. When I have watched for ten days, making daily observations, before discovering spermatozoa, I have then found them daily for as many days. The first object to be determined is, is the patient strictured, or has he a general narrowing of the calibre of his urethra? If so, then this is a good reason to suppose there may be spermatozoa in his urine, providing that he is losing semen; as the fluid is thin, and the walls of the canal are clumsy in performing those wave movements which are so essential in ejaculating semen or expelling the last drops of urine; therefore regurgitation may take place, and semen be found in the next discharge of urine. When nocturnal losses occur, a large portion may be expected in the urine at the next micturition. This is commonly the case in aspermatism, and may act as a cause of sterility.