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the shape of small, indurated masses. The deposition of this lymph in the coverings of the penis causes them to lose their elasticity, the organ becomes non-erectile, and the man becomes incurably impotent.
Tubercular Affection of the Testes.—In addition to the other disorders we have already spoken of, impotence may arise, in delicate constitutions, from tubercles deposited in the testis itself or in the epididymis. Impotence is occasionally found arising from syphilitic deposits in the testes. It is partial or entire, according as one or both organs are more or less deeply implicated, and in proportion as the deposits have existed for a longer or shorter time. Orchitis may more or less interfere with the functions of the testes, but the impotence arising from the inflammation set up in the parenchymatous structure may rapidly subside, and the organ recover its full function. When, however, hard nodules remain in the epididymis, and in spite of treatment are persistent in both testicles, a grave suspicion may arise whether the patient will ever regain his virile powers; if, however, only one organ is affected, complete recovery may, as a rule, be expected. Each case must be judged by itself, and the prognosis will depend upon a variety of circumstances that cannot be noted in these pages.
PROGNOSIS.—When we remember the variety of complex and consentaneous actions which perfect sexual congress requires, it seems really astonishing that impotence should not be more common than it is.
To make coition complete, there must be-1. Excitement of the glans penis. 2. Suffusion of blood through the organ. 3. Contraction of the bulbo-cavernosi and ischio-cavernosi muscles. 4. Welling back of the blood of the bulb in the corpus spongiosum urethræ.
5. Compression of the dorsal vein of the penis by the anterior portion of the bulbo-cavernosi muscles. Now, if any one of these phenomena is checked or prevented, practical impotence is the necessary result. Thus, if the venous plexuses which make up the spongy portion of the urethra present varicose tumours, or if the muscle is enfeebled or paralyzed, the blood not arriving in sufficient quantity at the glans, the primitive excitement will not exist, and the erethism will not occur, and, as the sensibility of the glans ceases, the erection will subside.
Considering, then, the nature of the causes of impotence, we can hardly be surprised that, in the face of any serious nervous or organic lesions, the prognosis must be generally unfavorable, especially in the more severe cases, or in those instances in which the affection bas been of long standing. Experience teaches us that, in many instances where the loss of power is due to early abuse, or to too great demands having been made upon the nervous system at a time when it was unequal to its duties, this condition can often be remedied, by strengthening the constitution generally, and allowing it to repose and rally; in fact, by pursuing the course exactly opposite to that which has brought about the complaint. In these cases, however, where there is no physical lesion or other condition rendering them hopeless, it is certainly not by a few doses of physic, or the administration of any stimulant or quack remedy, that we can expect restitution of power; and undoubtedly there is often great difficulty in applying even the proper treatment to these melancholy cases. The hardest part of the medical man's task frequently is to rouse the patient from the depression which impotence induces, and to convince him of the inutility of dwelling on the dreadful selfaccusation, which only tends to further unnerve him to complete the prostration of his system.
Lallemand remarks in his lively though rather overdrawn description of such cases —“In losing before the usual age the generative function, man loses the consciousness of the dignity of his essential character, because he feels himself fallen in importance in relation to his species. In consequence, the loss of virile power produces an effect more overpowering than that of honors, fortune, friends, or relatives ; even the loss of liberty is as nothing compared to this internal and continual torture. Those who suffer from injustice or misfortune can accuse their enemies, society, chance, &c., and invent or retain the consciousness of not having deserved their lot; they have, moreover, the consolation of being able to complain, and the certainty of sympathy. But the impotent man asserts that he can make a confidant of no one, that he can expect sympathy from no one. His misery is of a sort which cannot even inspire pity, and his greatest anxiety is lest any should penetrate his dismal secret.” (Vol. iii, p. 119.)
1 I have called this description rather overdrawn. Any symptoms so entirely hopeless are comparatively rare, and I must here again warn my readers against hastily applying to themselves any descriptions or cases which are after all exceptional. This caution is the more necessary, as I have often met with patients who seem to have read this as well as Lallemand's book apparently with the sole purpose of discovering such passages as the foregoing, and imagining that the most extreme cases really represent their own condition. It must be remembered that this volume is written for the profession, and in the course of its pages I have to describe severe typical cases as distinguishing different phases of the complaints bere treated of.
DIAGNOSIS.—Before marriage, it has been supposed that it is very
difficult for a medical man to decide whether an individual is truly impotent or not. Lallemand greatly exaggerates and indeed misrepresents the case, when he says that the power of easily maintaining perfect continence and entire quiescence of the sexual organs and desires “are fair grounds for presuming that there is little, if any, energy in the generative system, for if the semen was retained in the vesiculæ seminales it would produce from time to time energetic, or at least perceptible effects.” (Vol. ii, p. 245.)
So vague a test as this can be hardly ever applied with safety. For instance, if a healthy man has his organs well developed, suffers only occasionally from emissions, has never abused his sexual powers, and is subject occasionally, in the early morning, to erections; then I should have no hesitation in saying that, although he may have been always continent, and may have found it easy to be so, there is, nevertheless, little doubt of his capability of performing the sexual act.
There are, however, other cases which do not admit of such ready solution, as the following instance shows. A middle-aged man, with deep marks under each eye, came to ask me if he might marry. He was engaged to a person of about his own age, and they were mutually attached. He had abused himself early in life, but had never committed fornication, and, having read my book was anxious to have my sanction to his nuptials, as he doubted whether he ought to marry. Emissions, not very abundant, I found, took place once a week, and there were occasional erections in the morning. The testes were small and flaccid, although he had worn a varicocele ring; the penis was also small, being, as my patient stated, not large even when erection took place, so that all I could conscientiously do was to tell him that I had serious doubts as to the propriety of his marrying, but could not say positively that he ought not to marry. Unsatisfactory as such a dictum must always be, anything is better than the unjustifiable advice, putting aside its immorality, which some medical men are said to give to their patients, viz., to commit fornication in order to ascertain if they are competent to marry. . I would earnestly insist that such a test is not only fallacious, but often most dangerous. What, for instance, is more
1 The belief, or rather assertion, of the patient, that he can make a confidant of no one is most untrue, as my profession are admitted to be ever ready to hold out their sympathy to the afflicted; and there are, I believe, few clergymen who would not sympathize fully with their distresses if the sufferers would but make a confidant of them.
1 Since the last edition of this book was published a most unjustifiable attack has been made on the profession by Professor Newman, in the accusation that physicians of eminence recommend harlotry to their patients. The Emeritus Professor of University College, London, proceeds thus“I am further informed by a younger friend, who in his boyhood (through erroneous judgment in his father) was forbidden ordinary boyish exercise, but was a very diligent student,—that, when quite a youth, he suffered from an excess of this depletion to which I have referred, and went to an eminent London physician for advice. The reply was shortly this, ' The only cure is intercourse with women. You are too young to marry. I cannot advise you to take the risk of the streets; but you ought to keep a mistress. My friend, though then so young, was strongly religious, and revolted with horror from the thought.—After such information I was unable to suppose this theory confined to the disreputable members of the profession. Besides, I have in recent months received or seen letters from several ladies, bitterly complaining of the awful counsel given by doctors to young men, and deploring that so many women are overpowered by the doctors' authority, and settle down into the doleful depressing belief, that men must be immoral, for their health's sake. As others put it, women under the doctors' teaching are coming to a universal disbelief in male chastity. Some mothers have had vehement contest against doctors, in the effort to save their sons from immoral courses. Further, an intimate friend of mine, whose age must be near fifty, now tells If, however, real impotence is thought to exist, we must push our diagnosis further, and inquire whether it extends to the entire act of copulation, or only to some part of it, that is, whether the weakness depends upon something amiss in the acts of ERECTION, or EMISSION, or in the condition of the EJACULATED SEMEN, subjects which will be fully treated of in subsequent pages, as it is most important that the surgeon, in investigating the local symptoms, should discover which of these functions is imperfectly performed, otherwise he stands but a poor chance of relieving his patient's special complaint. me, that in his youth he consulted an eminent London physician, who, though the ailment had no relation whatever to the sexual system, volunteered to say that it was bad for him to remain chaste : and, in reply to some exclamation of surprise, explained that he must judge for himself how to act: the question of morality did not belong to the physician; but, that a man must not expect to be in health, if he neglected to exercise a natural function.'' Mr. Newman goes on to say—“Different in basis, but equally formidable to morals, is the notion, that it is useless to struggle for the entire purity of young men; and that their temporary unchastity (of course at the expense of women) is to be counted on. On all sides, a despair of moral influences is deplorably prevalent. It must be disowned, and a strict moral practice demanded ; else, more and more, we shall see fatal acquiescence in a most destructive vice. The European Continent gives us most awful warning. On the whole, I find it impossible to resist the conviction, that in all ranks of the medical faculty there is at least a fraction (highly dangerous, if only a fraction), which actively preaches deadly immorality.”—The Relation of Physiology to Sexual Morals, p. 23.
probable than that a nervous man, who, for the first time, meets a loose
woman, goes to a strange house, and is frightened by the disgrace which may attend any exposure of his folly, should find himself unable to perform the act. The only greater misfortune that can befal him is to be deluded subsequently and consequently into consulting the advertising quacks. If he does not end his days in a lunatic asylum he will be singularly fortunate.
1 As these pages were passing through the press a very lamentable case came under my notice. An officer returned from India, and, attracted by the advertisement of a notorious quack, consulted him. After a great number of visits, intercourse with a woman of the town was recommended, and the first attempt was followed by chancre, and this by secondary symptoms. Before his victim escaped, the quack had obtained from him 15001. Fortunately for himself, the patient sought other advice in time, and is now, I am happy to say, in a condition to perform his military duties efficiently.