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shown that lesions of the spinal cord produce priapism. I have witnessed several such cases, but ejaculation did not necessarily follow. It is a curious fact that this state of priapism co-exists with loss of motion and sensation in the lower extremities; and as the power in the limbs is regained the priapism ceases. however, an anomaly, and Lallemand thinks it shows that priapism does not depend on irritation of the lower part of the spinal cord; though, as he justly observes, injuries to this part of the spinal cord generally produce diminution, if not annihilation, of the virile power and of the generative functions.
The Montpelier professor mentions a curious case (vol. ii, p. 55) of a soldier who came under his care, having fallen on his sacrum ; there was loss of power in the lower extremities and loss of sensation in the glans, prepuce, skin of penis, and scrotum; catherism produced no pain, but there was catarrh of the bladder. The penis was frequently in a complete state of erection, but ejaculation never was induced, although the patient had attempted, by masturbation, to rid himself of the erection. On one occasion sexual intercourse was indulged in for several hours, but ejaculation did not occur; nocturnal emissions, notwithstanding, occasionally took place. This, Lallemand thinks, proves the special influence of the spinal and ganglionic nerves in inducing ejaculation and involuntary emission, as the cerebrospinal influence was completely annihilated; and this state, he thinks, is somewhat analogous to the condition of a man under the influence of wine or opium. Such extreme cases as these are not, of course,
common in practice, but still very distressing instances are not unfrequently met with.
Only a short time ago a young, highly sensitive, educated clergyman consulted me for such a condition. Walking, riding, even the friction of the trousers, would produce erection. He strove his utmost to prevent this, but in vain. On examining him I found the prepuce long, and he had not ventured to adopt customary measures of cleanliness, for fear of directing his attention or thoughts towards subjects he found so dangerous. The treatment I enjoined in this case was not so much moral discipline or self-constraint--which there was little need to inculcate,—but simply physical cleanliness, to accustom the part to feel water. I told him that, if ablution produced sexual feelings at first, not to mind, but to persevere, as these would cease immediately the morbid irritability had been got rid of. As soon as the external sensitiveness had been overcome, I gradually passed an instrument, and discovered the greatest morbid irritability of the urethra I ever met with. This, however, gradually declined, and the tendency to priapism disappeared.
The medical man, however, must not expect always to produce so speedy a cure as this. Indeed, as regards the treatment of this troublesome ailment, I must admit I have been much disappointed with most remedies, though I have tried nearly all those that have from time to time been recommended. Some years ago Sir Charles Locock made known, at a meeting of the Royal Medical and Chirurgical Society, what he considered a very important fact with regard to the treatment of some forms of epilepsy. He stated that in cases of hysterical epilepsy in young women connected with sexual excitement, and recurring at the periods of menstruation, he had found the bromide of potassium, in doses of from five to ten grains, remarkably efficacious. Of fifteen cases in which he had tried it, it had failed in only one. Sir Charles attributed the good effects of the bromide to its power of diminishing sexual excitement. In consequence of this recommendation I experimented with this salt pretty largely and in very various doses. In some instances I thought I noticed beneficial effects, but in other cases no amendmont followed; and I now depend upon local remedies and those applications which more especially influence the spinal cord, irritation of which seems particularly to promote priapism.
Erection again may be not only morbidly frequent and persistent, but connected with a maniacal sensuality that is one of the most awful visitations to which humanity can be subject.
Continual erections, immoderate desire for connection, and erotic delirium, have been given as the definition of Satyriasis.
I see, from time to time, patients who do vividly realize in their own persons the ancient fables concerning satyrs. One man, who exhibited the most distressing symptoms of this condition in unusual force, made a deep impression on me. young and in good circumstances, but was habitually untidy about his head and hair. His face was flushed, the cheeks and nose especially. His eyes were hollow, and had a haggard expression. The lips were thick and sensuous, the mouth wide. He was short and thickset, and of a full habit of body. I never saw a case in which the animal was so markedly prominent, although his intellect had not been altogether neglected. I learned that early in life he had masturbated himself, but had left off the practice only to commit excesses with women, of a nature and extent that were shocking to hear of. It may
be worth while to notice that this man-like others afflicted in the same way-showed no particular tendency to indulge in obscene talk, nor did his tastes lie in the direction of libidinous works or pictures. I believe the latter penchants are rather cultivated by nearly impotent or used-up debauchees. Refinement of vice is not sought after by the victims of satyriasis : it is quantity rather than quality that they require.
The probable explanation of such aberration is, that the brain or medulla oblongata has received some injury from excessive indulgence that seems irreparable. A low animal organization, with a strong hereditary disposition to lust, has been overtaxed by the enormous license the victim has permitted himself, or some undetectable lesion has taken place which puts the man at once beyond his own control, almost out of the category of rational or moral agents, and leaves him in a condition in which there seems, indeed, little hope of any restoration.
Admitting that the condition of satyriasis depends for its commencement upon uncontrolled lust, sometimes aided by local irritation existing in or about the generative organs, yet its ultimate and frightful extravagances seem always to depend on positive lesion of the nervous system. In many cases, recognizable irri
tation of the cerebellum exists to a degree quite sufficient to account for the most painful and deplorable symptoms.
Mr. Dunn, in 1849, brought before the Medical and Chirurgical Society an interesting case of death from apoplexy, attended with a softened, pulpy state of the right hemisphere of the cerebellum, in the midst of which was an apoplectic clot of the size of a pullet's egg. The patient's wife had observed that he had been subject to a constant desire for sexual intercourse. In the discussion which followed, Dr. Carpenter referred to a case mentioned to him some years ago by Mr. Turley, of Worcester, in which a man advanced in life became the subject of satyriasis to such a degree, that he would even practise masturbation in the presence of females, and after death a tumour of the size of a split pea was found on the pons varolii. (See “ Lancet,” vol. i, 1849, p. 320.)
A physician in the west of London was recently called in to attend a powerful man, of between fifty and sixty, who exhibited every indication of approaching homicidal mania. He found, on inquiry, that the present fit had been preceded by an extravagant indulgence in connection with his wife. The proper remedies were used, the patient became somewhat calmed, and the wife was solemnly warned on no account to permit any renewal of inter
She was a weak woman, and from time to time yielded, each indulgence being followed by a fresh outbreak on the part of the patient. At last, after a series of excesses, the homicidal fury broke out in full force, when, with considerable danger, the party was secured and conveyed to a lunatic asylum.
SMALL SIZE OF PENIS.
Before quitting the subject of erection, I must remark on the size of the intromittent organ. In the negro it is proverbially large, but, as in the case of whites also, who have the same pecu
liarity, does not proportionately increase in size on erection taking place.
Size, I may repeat, is no sign of vigor. One of the first characteristics of the perfect athlete of classic times was unusually small though well-shaped genital organs. Indeed, as I have before said, a large, flaccid penis is not unfrequently a result and an indication of masturbation having been indulged in to a dangerous extent. Veterinary surgeons, it is true, condemn a horse with an abnormally small sheath, as likely to be delicate in constitution. The rule, however, does not apply to human beings, though, undoubtedly, a shrivelled, atrophied condition of the organs is a pretty sure sign of the existence of partial or entire impotence.
There are few allegations more frequently made of by patients, than that they suffer under a diminished or diminishing size of penis. In nine cases out of ten there is no cause for alarm what
A nervous patient in bathing has seen another man with a larger organ, or from some other cause fancies that his powers must necessarily be deficient, because he thinks the external organ is not in him of what he considers usual dimensions. The size of the penis varies greatly, and it has been a great source of consolation to many patients to be told that the efficiency of the organ bears no relation whatever to its size. A small penis, indeed, is often a more more efficient organ than a large and massive one. A small penis, it should also be remembered, when in a state of erection often exceeds in size one which is larger while in a quiescent state.
An abnormal smallness of the penis can sometimes be successfully treated, as in the instance mentioned at page 174. There, as the pressure of the truss was taken off the penis regained its normal size. Marriage also will sometimes increase the size of the organ. Circumcision in cases where the prepuce is very narrow will tend to the same end.
In most cases, however, no treatment whatever is required, and the patient may be assured that the due performance of marital duties are fully compatible with a moderate-sized organ.