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from temperament, there is nothing to be alarmed at. Lethargic heavy men experience this symptom just as the too susceptible suffer from the contrary one of too rapid erection and emission. A little seasonable advice and sympathy may often in such cases prevent much unhappiness and misunderstanding. Fitting medical treatment, moreover, can often insure some amendment, although of course nothing can alter the character and temperament of the man.
SECT. II.-ERECTION NOT LASTING LONG ENOUGH.
This is one of the disordered varieties of erection which is not unfrequent, and it gives rise to a great deal of annoyance. A man finds himself potent; he wakes with erections of a morning, and finds that they occur also under excitement, but to his chagrin discovers that when he attempts sexual intercourse the erection fails, and the act is imperfectly performed, because the organ all at once suddenly collapses.
In the opinion of the patient this is a very serious matter, but fortunately the medical man is able to give a very reassuring opinion. On investigating the causes of such failures, it will be found that this state of things depends upon causes that can be in most cases easily removed. I have known this form of disorder arise in many instances from the patient waiting too long.
varying different persons, and in some it can be maintained only a short time. Persons so circumstanced should not dally, otherwise failure is likely to occur. The treatment in these cases is of the simplest kind; I advise the patient not to attempt to repeat the act for twelve or twenty-four hours, or until strong desire recurs; then let him take care not to delay the act, and he will find that the erection will suffice. The occurrence, however, particularly if it occur in married men, should prove to them that age is advancing, and that the sexual power thus gives evidence of failure. To the prudent man, under these circumstances, it is a sign that he must economize his resources, and not give way to his passions, particularly if in youth he has committed excesses.
SECT. III.-IMPERFECT ERECTION.
This affection is much more common than is generally supposed, and requires more space than I have given to the subject in former editions of this book. When a patient consults me I generally am at some pains to ascertain if the sufferer at any time of the night or morning has a perfect erection. An answer in the affirmative shows the case to be promising, and proves that nervousness, diffidence, or some general cause must intervene. When, however, the complainant admits he never has the erection perfect, the prognosis is less favorable, and we must look for some local cause interfering with the proper performance of the act.
Some light may be thrown on the best means of cure, by ascertaining the circumstances under which the imperfect erection occurred, and whether it may not have depended upon temporary causes, such as we have described in preceding sections. It is impossible to lay down any general rules as to what should be done; the treatment in each case must be guided by special circumstances, hereafter to be noticed; but the following observations may assist the surgeon who has not had large opportunities of treating this variety of the disease.
This form of impotence depends upon perversion of energy, according to Roubaud, and may be caused “by the nervous system having been excited beyond its proper limits; in some cases the excitement produced has not been able to attain a sufficient energy; it consequently follows that the nervous influence soon ceases to animate the penis, in consequence of the lassitude which the efforts made to produce turgescence of the organ occasion; and the blood no longer retained in the cavernous bodies, re-enters the general circulation."
We may occasionally discover a local cause for this imperfect erection, as in the following case:—W— came to me, complaining that erection was not perfect; to effect penetration, he was obliged to grasp the penis firmly with the hand, otherwise erection would not last, the penis falling into a flaccid state; I cauterized the urethra, but he subsequently told me that the operation was not attended with much benefit. In this instance Whad a slight curvature in the back, and he mentioned that in early life he had suffered from disease of the spine, with loss of motion in the lower extremities; from this he recovered by extention. He likewise confessed that he had been a great masturbator. I did not, however, ascertain if the affection of the spine preceded or followed the indulgence of this habit.
Writers on anatomy and physiology have given very little information which will assist the surgeon in the treatment of these cases; however, Köbelt thinks that indolent erections (that is to say, those which we notice in drunken people, in children, in old men and persons of debilitated constitutions) never extend beyond the corpora cavernosa of the penis, and they never affect the passive organ, that is to say, the glans penis and corpus spongiosum urethræ. The glans particularly, in such cases, never attains its full size, except when the other subordinate parts have been previously in a state of complete turgescence ; it will be hence understood why in certain conditions (notwithstanding the complete rigidity of the body of the penis), neither orgasm nor seminal ejaculation can be produced.—Köbelt, loc. cit., p. 60.
In many of these cases, where the imperfect erection has, in my opinion, depended upon want of support to the vessels, I have found great benefit from binding up the penis with strips of plaster, on the same principle that we treat varicose veins in the lower extremities, and I have been singularly successful. The occasional passing of a bougie, and even cauterization, has been likewise attended with remarkably successful results. In other instances galvanism, and even local stimulants, with the precaution mentioned at page 1€7, have proved very successful in my hands.
SECT. IV.-IRREGULAR ERECTION.
Again, the erection may be abnormal in nature and most painfully distort the penis while it lasts.
In March, 18—, a middle-aged gentleman called on me, and
stated that he was a married man, with several children. He complained that of late the penis, in erection, had been curved upwards, presenting a scimitar shape, without any assignable
Connection gave him pain, and he wisely indulged very little, fearing lest he should injure himself.
In another patient the penis was of the natural size, or, if anything, rather larger than usual, but it had a very marked, irregular curve. In the flaccid state, the whole organ curved forward, and at the same time to the left. The patient mentioned that in erection the penis had two curves, but he experienced no particular inconvenience from its unusual shape. The only explanation which I can offer of these strange anomalies is that, in consequence of violence, or from some other causes, inflammation of the spongy portion of the urethra has taken place, plastic lymph has been deposited, and that portions of the tissues being thus no longer distensible, but always firm and unyielding, these curvings necessarily arise on every erection. I have successfully recommended friction with iodine as a remedy. Equable compression, as described at page 201, with adhesive plaster has been very beneficial, leading, as this practice does, very considerably to cause absorption of any plastic lymph that may have been deposited.
Cases like the following not unfrequently comes before a medical man, and medical students are peculiarly the subjects of the complaint. The patient states that the erection, formerly natural,
has gradually ceased to appear of a morning, nevertheless he is otherwise healthy, and does not suffer from spermatorrhoea, and examination of the urine detects no spermatozoa. Such cases can be readily explained. A man studies hard, is out of health, and semen is not secreted. As a natural consequence erections are not likely to occur. Frequently no excess has been committed; unless the inordinate exercise of the brain, often shown by the deposition of phosphates in the urine, can be so considered. My reply to such a man is, “ be thankful that your studies are not interfered with by sensual thoughts.” I advise him to continue to work hard, but not to omit regular and daily gymnastic exercise. Observation teaches me that, after this long rest of the organs, the seminal fluid will be formed in great abundance as soon as the brain shall have ceased its inordinate demands upon the blood.
The antagonism of the nervous and generative system has not escaped the notice of writers on population. Spencer says
Thus, the fact that intense mental application, involving great waste of the nervous tissues, and a corresponding consumption of nervous matter for their repair, is accompanied by a cessation in the production of sperm-cells, gives strong support to the hypothesis that the sperm-cells consists essentially of neurine. And this becomes yet clearer on finding that the converse fact is true, that undue production of sperm-cells involves cerebral inactivity. Throughout the vertebrate tribes the degree of fertility varies inversely as the development of the nervous system.”
SECT. VI.—PRIAPISM, OR PERMANENT ERECTION.
Erection, again, instead of being absent or imperfect, may be only too frequently and readily excited and too persistent. This is what is called priapism. Fortunately for human nature, this terrible and humiliating condition, in its full extent, is by no means common. Every now and then, nevertheless, we meet with cases where, instead of the erection only lasting a few minutes,—the male organ again resuming its usual relaxed condition, the penis will, if the statements of patients can be believed, remain erect either permanently or during long periods.
It is to the condition of the spinal cord and brain that we must look for the source of this phenomenon. These, after all, are the primary sources of sexual excitement, and on them depend the entire processes of erection and ejaculation. Lallemand relates a case in which a patient could produce ejaculation by striking his head with his knuckles. Depuytren has long since