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marriage I enter fully into details, and inquire into his antecedents. I generally find that he is not only suffering from too frequent emissions, but also that his fears depend upon facts which he is not all at once ready to disclose. The result of these inquiries too often proves that the patient, although a continent man, goaded by his fears, has made one or two unsuccessful attempts at sexual intercourse.
The pleasure with which these patients receive the announcement that they may marry must be seen to be appreciated, yet they can hardly believe that the opinion is unbiassed. As I have said elsewhere, diffidence is a marked characteristic of these men, and they again and again ask, “ Are you not taking too favorable view of my case ?” They display the most unselfish feelings, and reassert that they could bear their own miserable state of existence, but entreat the surgeon not to sacrifice the
As I have said above, most of these are not cases of true impotence, and it would indeed be a grievous error on the part of a medical man to condemn such patients to a state of celibacy, and if the appropriate treatment described at page 77 be followed, in a very short time a marked recovery may be observed, which surely progresses, until at length the patient becomes satisfied of his healthy condition. I am in the habit of assuring such patients that no one more than myself is convinced of the danger of recommending a man to marry who is physically unfit to do so. I fully agree in the truth of what the professor of Montpelier has nobly observed, “What has the young girl, who is thus sacrificed to an egotistical calculation, done, that she should be condemned to the existence that awaits her ? Who has the right to regard her as a therapeutic agent, and to risk thus lightly her future prospects, her repose, and the happiness of the remainder of her life ?”
“Until a man has contracted these indissoluble bonds, impotence the most complete can compromise the future of no one.
“It is precisely because marriage is the most sacred bond for individuals, as well as the most important for society, and because an iron law renders it indissoluble, that it is rational as well as moral not to contract it without the certainty that it will be perfect and complete.” (Vol. iii, p. 470.)
I can, however, affirm that in practice I have never known an instance of this sort of martyrdom where my sanction to a marriage has previously been asked and granted.
It often happens that when a medical man thinks it desirable for a patient to marry, his advice is frustrated by other considerations. In many cases, the patient is too young; in other instances, where sexual abuse has been indulged in, or nocturnal emission has been frequent, the dislike to marriage is such that every woman is alike distasteful to the sufferer, and we must first improve the patient's state of health.
Those nervous, hypochondriacal people who, from a bad conscience, a weak frame, the effects of depressed health, or some wild ideas of the possible requirements of the young lady,' on the subject of which all well-brought-up English maidens are ignorant, fancy that they are unfit to undertake the rational duties, of husbands and fathers, should be encouraged to marry and be happy.
In conclusion, I must add my firm conviction that when the surgeon has improved the health of these self-accusing nervous men, nothing is so likely to establish a permanent cure and therefore conduce to the happiness of individuals as marriage. But it will be well for the medical man, who thus advises marriage, to impress on the patient how necessary it will be that he indulge in no form of excess. Organs that have been temporarily weakened require to be exercised with great moderation.
THE SEXUAL ACT, ITS PHYSIOLOGY AND
We come now to the second of the main divisions of this part of the work. And first of all I propose to consider the several conditions and acts which go to make up the entire act of coition. 1st, I shall describe them as they occur in health or normally;
1 See page 162 in corroboration of this statement.
and 2dly, I shall point out in what way they may occur abnormally, preventing or interfering with the complete performance of the copulative act.
To the physiologist, but more especially to the medical man engaged in practice, a knowledge of the more intimate causes of potence or impotence is most important, and hardly less so to the thousands who suffer in one way or another, from some of the many causes that may hamper, or entirely prevent, the exercise of the reproductive functions.
To the due. performance of copulation three things are indispensable—namely, 1st, erection of the penis ; 2d, the power of emission or ejaculation; and 3d, a due amount of well-formed semen; all which it will be necessary to treat of in the three following chapters.
In pursuance of the plan which we have hitherto followed, we shall divide this chapter into two parts, in the first describing the normal act and its essential conditions, and in the second the disorders to which erection may be subject.
NORMAL ERECTION, OR CONDITIONS ESSENTIAL
This external sign of virility, as Buffon calls Erection, depends chiefly on the existence in the organ of certain tissues known as erectile tissues. Let us see what the most recent anatomical investigations have taught us regarding these important structures. The following remarks are extracted from the seventh edition of Kirkes' “Physiology,” by M. Baker.
“ ERECTILE TISSUES.-The instances of greatest variation in the quantity of blood contained at different times in the same organs are found in certain structures which, under ordinary circumstances, are soft and flaccid, but at certain times receive an unusually large quantity of blood, become distended and swollen by it, and pass into the state which has been termed erection. Such structures are the corpora cavernosa and corpus spongiosum of the penis in the male, and the clitoris in the female, and, in a less degree, the nipple of the mammary gland in both sexes. The corpus cavernosum penis, which is the best example of an erectile tissue, has an external fibrous membrane or sheath, from the inner surface of which numerous fine lamellæ pass into the interior of the body, dividing its cavity into small compartments, which look like cells when they are inflated.
“Within these is situated the plexus of veins upon which the peculiar erectile property of the organ mainly depends. It consists of short veins, which very closely interlace and anastomose with each other in all directions, and admit of great variation of size, collapsing in the passive state of the organ, but, for erection, capable of an amount of dilatation, which exceeds beyond comparison that of the arteries and veins which convey the blood to and from them. The strong fibrous tissue lying in the intervals of the venus plexuses, and the external fibrous membrane or sheath with which it is connected, limit the distension of the vessels, and during the state of erection give to the penis its condition of tension and firmness. The same general condition of vessels exists in the corpus spongiosum urethræ, but around the urethra the fibrous tissue is much weaker than around the body of the penis, and around the glans there is none. The venous blood is returned from the plexuses by comparatively small veins; those from the glans and the fore part of the urethra empty themselves into the dorsal vein of the penis, those from the corpus cavernosum pass into the deeper veins which issue from the corpora cavernosa at the crura penis, and those from the rest of the urethra and bulb pass more directly into the plexus of the veins about the prostate. For all these veins one condition is the same, namely, that they are liable to the pressure of muscles, when they leave the penis. The vena dorsalis penis may be compressed by the uniting tendons of the ischiocavernosi; the crura penis and the veins issuing from them are
under the same muscles, and the veins of the bulb are subject to the compression of the bulbo-cavernosi. (See Krause, lxxx, 1837; Köbelt, cxxvii and xxv, 1843, p. 58.)
“Erection results from the distension of the venus plexuses with blood. The principal exciting cause in the erection of the penis is nervous irritation originating in the part itself, or derived from the brain or spinal cord. The nervous influence is communicated to the penis by the pubic nerves, which ramify in its vascular tissue, and Günther (xcvi, 1828, p. 364) has observed that, after their division in the horse the penis is no longer capable of erection. It affords a good example of the subjection of the circulation in an individual organ to the influence of the nerves, but the mode in which they excite a greater influx of blood is not with certainty known.
“ The most probable explanation is that offered by professor Kölliker,? who ascribes the distension of the venous plexuses to the influence of organic muscular fibres, which he finds in abundance in the corpora cavernosa of the penis, from the bulb to the glans, also in the clitoris and other parts capable of erection. While erectile organs are flaccid and at rest, these contractile fibres exercise an amount of pressure on the plexuses of vessels distributed amongst them sufficient to prevent their distension with blood. But when, through the influence of their nerves, these parts are stimulated to erection, the action of these fibres is suspended, and the plexuses thus liberated from pressure yield
1 "The glans penis,” says Köbelt, " is the principal point of reunion of the sensitive nerves of the virile organ, no other part which it regulates can be compared with it in this respect. In respect to richness in nerves, the glans penis yields to no other part of the economy, not even the organs of sense.” (Köbelt, loc. cit., p. 10.)
2 Kölliker says, “ Erection is caused, as I have shown (Würzb. Verh.,' Bd. ii), by a relaxation of the muscular elements in the trabeculæ of the cavernous and spongy bodies, and of the tunica media of the arteries of those parts, in consequence of which the tissue, like a sponge which has been compressed, expands, and becomes filled with blood. The rigidity ensues so soon as the muscles are completely relaxed and the sinuses filled to the utmost, without there being any necessity that the return of the blood should be impeded and the circulation stopped. It ceases when the muscles again contract, the venous spaces become narrowed, and the blood is expressed from them.”