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TREATMENT.—If, then, the preceding remarks are borne in mind, the proper treatment is no longer a problem of extreme difficulty. Where impotence is curable at all, the general rules as to the requisite treatment can be comprised in a very few words. To give the system rest—to improve the general health, so that the nervous centres shall have time, opportunity, and encouragement to rally, if that be possible—to invigorate the muscular powers so that both voluntary and involuntary muscles may regain their tone—these are among the most important maxims to be borne in mind. At the same time it is necessary to avoid as much as possible any local or other stimuli which merely excite without strengthening. In the curable cases it is probable that the nervous system has merely been over-excited beyond the natural limits which the constitution imposes. The one object the medical man should have in view is to restore the nervous power, or rather to allow it to restore itself—not to excite or exhaust it still further. The diet should, I need hardly add, be of the most wholesome and nutritious kind, for we should not forget the true old proverb—“Sine Cerere et Baccho friget Venus."
Hitherto I have spoken of the general treatment of impotence; in other words, of the best means of improving the health. By doing this, the sexual organs will, probably, in all the milder cases, become, in common with other functions, equal to their duties. Some, however, not content with these simple means, have devised remedies for the purpose of stimulating the flagging powers. No doubt can exist that in certain persons, when the affection arises from some temporary cause-more especially in the timid and hypochondriacal, or those suffering from mental disquietude, the temporary employment of stimulants may be very proper. But though this treatment is occasionally justifiable and advantageous, it is most unscientific and dangerous in the majority of cases—particularly in those of general prostrationwhere the immediate effect of stimulating the organs can be no other than to produce emission. Here stimulants can have no other effect than to aggravate the mischief; whereas, had the general health been first improved, the local disorders next re
lieved, and subsequently a stimulant given, we could understand the formula. Such should be the true method of effecting a cure; and I shall attempt, in the following pages, to indicate the principles which should guide its application. Had these principles been more generally followed, many of the invalids we meet with would have been rescued from much physical and mental suffering.
Cantharides have been employed against impotence. They form the basis of the pastilles de Serail, as well as of the numerous pills, pastes, and opiates which constitute in the East the principal commerce of all those who sell drugs. The Spanish fly enters largely into the diavolini and other aphrodisiac preparations still too much employed in Italy.
Lallemand protests strongly against the use of this dangerous stimulant.
“The effect,” he says, "produced by cantharides on a healthy man, has induced persons to believe that they could restore virility lost from excesses. Thus, charlatans, and even many legitimate practitioners, have at all times prescribed cantharides as a traditional resource. For
my own part, I have seldom met with an impotent person who has not had cause to regret using this drug. The greater proportion have not even experienced the momentary benefit which they had expected; and in many cases the erectile tissues have become smaller than in the habitual state of repose. Some few have experienced erections more or less energetic, which have lasted a longer or shorter period; but the loss of semen has exasperated the symptoms instantaneously, or very shortly afterwards.”—Lallemand, vol. iii, p. 333.
No doubt can exist that the habitual employment of cantharides is prejudicial; but in the present day, when this substance is no longer given so indiscriminately as it was formerly, the surgeon may occasionally prescribe it with advantage. Thus, where the erection is feeble, when the fears of the patient exert much influence over his mind, or when there is doubt of his power to perform the copulative act, a few doses are very advisable. But after success, the remedy must be left off, for we do not want to excite the organs frequently, experience teaching us that the repeated shocks on the nervous system will often only further depress the vital powers.
Phosphorus is, in my opinion, one of those pharmaceutical preparations which the modern surgeon may most frequently employ in the treatment of impotence. The object is to supply that particular pabulum which the too frequent exercise of nervous force appears to exhaust. We may theoretically infer that in these complaints there has been great expenditure of phosphorus in its various combinations, and that there may be a deficiency of this substance in the system, just as in some other diseases, particularly chlorosis, we are well aware that there is a deficiency of iron. In either case we should supply the system freely with the element it seems to need, and in such a form as may be easily taken up and retained in the circulation. Practice, as well as theory, seems to sanction this treatment, and daily experience teaches me that phosphoric acid in combination with syrup of orange-peel, and syrup of ginger, is a most valuable adjunct, in all those cases where there is reason to suppose that semen is not secreted in sufficient abundance, where too rapid ejaculation attends the sexual act, or where connection is attended with serious nervous depression. (See Appendix A.)
Strychnine has been frequently recommended in the treatment of impotence, and I have found it a very valuable tonic in cases attended with great nervous depression, whether resulting from sexual excesses or any other cause. I have noticed it to be equally beneficial in those forms of impotence which depend upon weak or imperfect erection. I find that it is capable of increasing the general muscular energy, and in such cases I usually prescribe it, either alone or in combination with quinine, or in the form of pills combined with other remedies. (See Appendix A.)
Electricity must be classed among the modern remedies for impotence. I have had considerable experience of its powers, and I have every reason to be satisfied with the results. I find that it has answered best in those lethargic constitutions that require rousing, and simply demand a local stimulant capable of determining blood and nervous power towards the generative system.
If, however, I admit the value of this remedy in such cases, I must raise my voice against the indiscriminate and general employment of belts and other apparatus, so largely advertised. Hardly does a day pass but I find cases coming under my notice of patients wearing these appliances, who say they have derived no benefit, although they have worn them for months. Such a result is not surprising. If these batteries are efficient, they are always acting, and consequently are continually stimulating the sexual nerves. This, as I have above mentioned, has a most injurious effect.
It is one thing to rouse a lethargic constitution at periods when the stimulus is required, but quite another to keep the sexual organs in a constant state of nervous excitability. The consequence naturally follows that, at different and at long intervals, when the excitement is required, this valuable remedy ceases to exert any influence, and the most heart-rending effects are produced on the mind of the patient, who believing that a cure is impossible, relapses into a condition of desperation that no one can conceive, except those who have witnessed it. It is, moreover, difficult to rouse the nervous system a second time. The further objection to these batteries is that, as the patient can apply them himself, he does so at most inopportune moments, dispensing with the medical superintendence of the remedy which is necessary to secure a good result. I raise my voice most energetically against the public using either electricity or cantharides, without first taking the opinion of a medical man, as to whether such stimulants are applicable to the case, and also as to the dose, and the frequency and time of application.
Marriage has been classed among the remedies for the slighter affections of the sexual organs; and if I may credit the statements of patients, medical men, on being consulted, in the most off-hand manner, without inquiring into the particular symptoms or probable cause of the supposed impotency, at once say, “Oh! you are only nervous; go and get married—a wife will cure
In the milder cases, and in the instances where the patient only slightly suffers from too frequent nocturnal emissions, but in other respects is in good health, no advice can be better, and I am only too glad to corroborate it.
Amidst all the important questions, however, that come before a medical mari, I know of none which require more tact and knowledge than this:-“Am I in a condition to marry On the one hand you have, perhaps, the very timid, nervous individual, previously depicted in these pages, who may or may not have exaggerated his weaknesses until neither he nor his medical adviser can exactly say what is his condition. Often even in the slighter cases it requires all the knowledge acquired by long practice to arrive at a just conclusion as to what is real, what fanciful, in a patient's narrative. It is, in short, most difficult to say, off-hand, in such cases, whether a man may or may not marry. I must admit I am always disposed to take the sanguine view of the probabilities, as experience teaches me that the majority of adults are liable to perform the sexual act. It is a calamitous thing for a healthy adult to be told by a scientific man, unless on clear and sufficient ground, that he is so far impotent that he should not marry."
Although a professional man may almost invariably give this favorable opinion, he should recollect that the very fact of its being thought worth while to consult him affords primâ facie evidence that the patient feels that something is amiss; and experience teaches me that the healthy adult does not ask the opinion of a medical man without having pretty good reason to suspect that he is wanting in virile power. So convinced am I of this, that when a patient consults me on the advisability of
1 It not unfrequently happens that a young man, in consulting his doctor, appeals to his feelings, and says, “ Tell me the worst; I am ready to hear the statement that I may not marry, but do not let me marry and repent of it, and make two people wretched—at present I have only myself to care for, and I could bear the worst opinion you can give of me.” I may say that after thirty years' experience, I have hardly ever found myself compelled to pronounce a young man, otherwise healthy, to be impotent who held such language as this. I can most conscientiously state that in nine cases out of ten such complainants are only diffident men, who belong to the susceptible class so often depicted in these pages. I may lay it down as a general rule that those who are anxious to marry may do so without any dread of being impotent.