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often so carelessly thrust aside or pressed upon, that their functions are seriously interfered with.
When a case of the kind comes under my care, and the patient complains of want of sexual power, I always examine how the truss presses. If I see any reason to suppose that it can by any possibility be the cause of the symptoms, I attempt in the first place by diet and abstinence from certain articles to cause absorption of fat in the mesentery and omentum; this being done I attempt, but with great caution, to reduce the size of the truss. It is singular how often this can be effected with safety; I find that not only are the sexual powers often recovered when the pressure is thus relieved, but that the penis, when it is no longer thrust aside, regains its natural size where that has diminished.
I strongly object to springs crossing the abdomen, inasmuch as I think the procreative powers may very probably be interfered with when a double truss is worn; and in cases such as I speak of, where the impotence is the most marked feature, it becomes a serious question whether its use should be continued, particularly when, as in some instances, it has merely been sanctioned as a precautionary measure. I need not say, however, that if a truss on one side can be altogether dispensed with, the partial recovery of the reproductive powers will be more likely to be effected. I believe, moreover, that in many cases, great relief can be obtained by judicious alterations in the shape, size, and point of pressure, and in the method of attachment of the truss.
Varicocele, or enlargement of the veins of the chord, is another affection which, in its severer forms, if it does not produce impotence, at least aggravates it. Whenever a patient comes to me with this affection, I at once order a suspensory bandage, or what I prefer, a varicocele ring, an instrument formed of soft pliable metal, covered with washleather. These are made of different sizes, and can be procured at Furgusson's, surgical instrument maker, Giltspur Street, City; or of Bell's or Corbyn's, Oxford Street. These rings, in the majority of cases, answer the purpose admirably, but when the scrotum is very thin
or deficient in cellular tissue, they are liable to slip off. This may be obviated by tying a piece of thin twine to the ring, the other end of it being attached to the button of the drawers. The ring should be taken off at night, and only put on after the sponging-bath-it should be worn for some months.
Before leaving this branch of our subject, I shall remind the reader that all the practical results of impotence can be, and constantly are, produced by the mechanical effect of a
Stricture of the urethra, by preventing the emission of semen. The description of this form of disease of the reproductive organs is not within the scope of the present treatise. For further information upon it I may refer to my larger work on the “Urinary and Generative Organs," page 81.
Impregnation is, of course, rendered almost impossible by a serious stricture, as the semen, instead of being at once ejaculated, can only dribble away afterwards when all erection has disappeared. The act of connection, moreover, is often painful, the pain being generally felt during the ejaculatory act. This form of impotence is amenable to treatment, such as dilatation and other proper measures for removing the stricture.
Impotence arising from a similar cause is observed in sheep. The high-fed and high-bred rams, from which the best breeds are obtained, become subject to a kind of stricture arising from the deposit of calcareous matter in the urethra. The peculiar conformation of the organ in sheep conduces to this result.
i The glans penis of the ram consists of an oval and wrinkled swelling, divided horizontally at the end, looking like the head of a snake. From this glans projects a long, thin appendix, of a consistent character. This appendix, which shepherds call “the worm,” tapers to a point, and the canal passing through it is very small. A ram is sometimes observed to be very uneasy and apparently to be less and less able to micturate. On examination, the vermiform appendage is found distended and stiffened from an accumulation of calcareous matter within the urethral canal. This in some instances can be removed by slightly pressing and rolling the appendix between the fingers, which will at once relieve the strangury, and save the animal, but frequently either the ram has to be killed or part of “the worm " be removed. If sufficient is left the ram may still be able to breed. And even if complete connection is impossible, breeders still use these mutilated, animals, called teazers,” to excite the ewes, and so spare the valuable tups some fatigue.
Carpenter, in his “ Comparative Physiology,” particularizes—
Obesity or Corpulence as a cause of impotence; he says “it must be observed that there is a certain degree of antagonism between the nutritive and the generative functions, the one set being exercised at the expense of the other. The generative apparatus derives the materials of its operations through the nutritive system, and is entirely dependent upon it for the continuance of its activity. If, therefore, the generative activity be excessive, it will necessarily draw off some portion of the aliment destined for the maintenance of the fabric at large. It may be universally observed that where the nutritive functions are particularly active in supporting the individual, the reproductive system is in a corresponding degree undeveloped, and vice versa." That excessive corpulence tends to generative debility or impotence, is brought almost daily under my notice. It is likewise becoming very well known amongst breeders of the finest stock. At the Veterinary College I have had various opportunities of seeing this exemplified. It is noticed that impotence in bulls rarely occurs in the commoner sorts. Those that have been seen sent to the college, in consequence of not getting stock, are found to be the highly bred animals; a class of prize animals that are not prolific; the owners caring only to breed animals that produce fat readily. If we had the statistics of these high-bred cattle, we should find that the large prices obtained for them are fully warranted, as the sire and dams are anything but prolific; and the vulgar saying, "a lean dog for a bitch,” is a terse but significant mode of enunciating the same proposition.
There is every reason to suppose that in many of the prize classes first alluded to the testis has itself undergone fatty degeneration.
Impotence arising from corpulency is by no means a hopeless case, provided exercise and attention to diet can be, and are, observed.
The subject is so curious that it deserves the careful attention which Mr. Simonds, professor at the Royal Veterinary College in London, has bestowed on it, to whom I am indebted for much information on this and similar subjects.
That impotence then frequently depends upon the male becoming too fat may be considered as an established fact. There is every reason to believe that the same cause occasionally induces sterility in females.
I was lately in conversation with a gentleman, a large farmer in Suffolk. He told me that he is often disappointed when he wishes to breed from cart-mares. This year, out of his own working stock of twenty-eight horses, eleven mares did not stand, greatly to his disappointment and loss, as a yearling colt is worth twenty pounds, and the mare ceases work only during one month before and during one month after parturition. This sterility he attributes to the high condition his cattle are kept in by the carters, who, proud of their teams, do not care to see them in foal. To obviate it, fresh stallions have been purchased, and with as little success, sterility still prevailing. Amongst these eleven mares there were young as well as old ones, but none of them proved in foal.
The treatment of cases of Corpulence has within the last few years excited considerable attention, no doubt through the pamphlet of Mr. Banting, who, however, is indebted to Mr. Harvey, a member of our profession, for the plan he recommends. I have from the first strongly recommended the chief features of the system as beneficial for the general health, especially in the case of persons of a corpulent tendency. No doubt can exist that abstinence from, or extreme moderation in, fat, butter, milk, cream, bread, potatoes, sugar, and beer, will in one week considerably diminish the weight, and in fat persons remove many uncomfortable sensations. When a patient is over stout the weight may be fairly and safely reduced one or two pounds weekly. I have often found such treatment assist the recovery of sexual power in persons in whom it has been failing. This plan has been proved to work equally well with animals, and I have heard of several instances of over-fat bulls that had become impotent, recovering their procreative powers after being sent to work on the farm upon less food.
Abnormal condition of the Erectile Tissue.—Where, however, manifest impotence exists, which cannot be accounted for by the
accidental causes, so to speak, of early excess, or the predominance of the nutritive over the other functions of the frame, it is necessary to closely investigate the structure of the parts. It will generally be found that this kind of impotence depends on some lesion or imperfect development of the erectile tissue. The penis may be, for instance, of an unusual length, but thin, particularly at its base. It may be terminated by a large, fungiform glans, extending beyond the corpora cavernosa, and being almost always uncovered, or at least imperfectly covered by the prepuce. These massive penes, which seem to thin as they approach the point of their insertion, are almost invariably deficient in erectile power. In fact, the erections are rarely complete, particularly towards the base. Where, therefore, this peculiarity of formation is very marked, permanent and hopeless impotence may, and probably will be found to exist. On this subject Lallemand remarks—“ The firmness of the erectile tissues differs greatly in individuals of the same age, independently of their volume and form. When I have noticed the penis completely hanging on the scrotum, the corpora cavernosa empty, flabby, without any resistance or elasticity under the finger, I have always remarked that the function was, to say the least, not energetic, and a cure, if possible, difficult.” (Vol. ii, p. 187.)
A very small and shrivelled condition of the organs may equally produce permanent impotence. This is described by Lallemand thus :-" There is unnatural development of the prepuce, depending probably on the unusually small size of the penis. The rudimentary state of the erectile tissue, as well as of the testicles, necessarily allows of but little energy in the functions of these fundamental parts of the generative apparatus.” (Vol. ii, p. 185.)
Again, we find, on the other hand, that in some cases the penis is hard and inelastic, the coverings are firm and indurated, and not contractile. The cause of this state has been, I believe, recently attributed to abuse, or too frequent use, or to blood having been accidentally effused into the trabecular tissue of the organs. In other instances inflammation has caused the deposition of lymph, which has not been reabsorbed, but remains in