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at p. 170, must always be rather an alarming and suspicious circumstance. Unfortunately, in the majority of such cases the medical man is seldom consulted at an early period, as neither the patient nor his friends are aware that there is anything unusual in his condition until it is accidentally discovered. The surgeon appealed to will usually find that the individual is fat, without hair on his face, or even down on the pubes, the testes and penis are small, almost rudimentary, like those of a young child, there is no sexual desire, and the voice is often weak and almost falsetto in quality; in fact, the condition is much the same as that of the castrated individual or eunuch.2
In such a case it is clear that an imperfect development of the testes has resulted in a state of eunuchism, accompanied by many of the peculiarities which, both in animals and in human beings, follow on castration.
This partially undeveloped state of the reproductive system usually indicates itself, among other signs, by a marked indifference to manly sports and exercises, and a visible deficiency in virile attributes generally.
If, however, on examination, it should appear that the testes, instead of being merely small, are little more than rudimentary organs; if they are apparently mere nodules ; if this change of structure has followed an early attack of mumps or some inflammatory affection of the testes, or an accident which has injured them early in life, the case must, I fear, be considered as a hopeless one, and the patient should be treated as permanently impotent. Terrible as this doom may seem, it is singular to notice how indifferent such persons appear to their deficiency. They do not know the value of what they never possessed and never will possess, and they pass through life contented men, evincing neither aversion to, nor liking for, the opposite sex.
1 Dr. Davy has given the following post-mortem appearances in a patient who showed (according to the account given by his comrades) an aversion to the sex.
“ There was little hair on pubes or chin, the partes naturales were all small, the larynx was small, the skin delicate. A very minute portion of fluid only could be procured from the vasa deferentia, which under the microscope exhibited numerous small particles and a few larger globules, but no spermatic animalcules. The fluid of the vesiculæ was also small in quantity and destitute of animalcules; it was of a light-brownish hue, slightly opaque, containing some globules, and did not change the color of turmeric or of litmus paper.
The fluid from their fundus was most gelatinous and appeared to consist chiefly of mucus. The vesiculæ seminales in this instance and their contents resembled those of such castrated animals as I have hitherto examined.” (“Edinburgh Medical and Surgical Journal,” vol. 1, p. 7.)
2 Pope Clement XIV, in the eighteenth century, abolished castration of youths, which was then practised in Italy for the purpose of retaining the soprano voice. It is well known that the castrated preserve the shrill voice (voix aigue) of infancy, at the same time that the chest becomes fully developed, thus giving volume to the voice. Women were not allowed to sing in the cathedral or church services, hence this horrid mutilation, as it qualified the victims to sing soprano parts.
It may be some satisfaction for nervous patients who may read these pages to be reminded that the really impotent men are, as a rule, thus indifferent to their symptoms; and I may lay it down as a general rule that a man who is very timid about the existence of impotence is not likely to be impotent at all, but only fears he may become so.
I. ABSENCE OR DEFICIENCY OF POWER.-INABILITY TO
“True impotence," says Lallemand, “consists in want of power in connection, not once, but habitually; not only with courtesans, but with those whom we most love; not under unfavorable circumstances, but during long periods of time, say, five, fifteen, or twenty years, when married to lovely and handsome women, whose devotion to their husbands has never been questioned.” (Vol. ii, p. 242.)
That this lamentable state of things truly exists there can be do doubt, and in London those whose attention is devoted to diseases of the reproductive organs, occasionally meet with cases in which there appears to be complete annihilation of all the sexual feelings and actions, and in which the man is reduced to what Roubaud describes as generative syncope. Such instances, however, are rare. Usually it happens, at least in England, that the functional diseases requiring treatment consist in the absence of only one or more of the conditions necessary for coition. In the east, I am told, the Levantines are often perfectly impotent before they arrive at the age of thirty. If report speaks correctly, Hien Fung, the late Emperor of China, was in this condition.
The forms that impotence assumes are various, though the result is the same in all cases, viz., inability to perform the sexual act. Thus a man may be utterly impotent whether he has or has not erection attendant on desire. Again, there may be only a partial erection, lasting an insufficient length of time for penetration; or the erection may be so weak, or the emission so quick, as practically to render the man impotent; or a man may be impotent from emission not taking place at all; or emission may not occur until some time after connection has been attempted.
Causes.-I fear we must come to the conclusion that when there is desire, and merely a want of power, this state of things arises from abuse of the generative organs, aggravated in most instances by alarm, a guilty conscience, fear of not succeeding, habits of intemperance, or too free use of tobacco, from timidity, or from too frequent excitement without gratification.
The exact way in which these causes produce the effects of impotence is not certainly known, but it is most probably by occasioning lesions of the nervous system, and more especially of that portion which is under the influence of the sympathetic nerve or excito-motory system.
Non-descent of the Testes is a cause of impotence in some men, and it appears almost invariably to be attended by sterility. I do not pretend to say that every man who has an undescended testicle must necessarily be altogether impotent; a few cases are recorded of men whose testes had never descended into the scrotum having had families; but I have met with several instances, one of which I shall presently describe, where, I believe, impotence arose entirely from this cause. It is true that in the elephant, and some other animals, in the cetacea, in birds and reptiles, the testes are constantly found in the abdomen, side by side with the kidneys, lungs, &c. These facts point to the possibility that if the adult's testes are truly in the abdomen, they may secrete," semen as readily as when in the scrotum. When, however, they have been compressed in the inguinal canal, or in the groin, such pressure may have been, and probably has been, exercised on the glands as to impair their secreting powers.
Breeders look with great distrust on animals with undescended testes. The phenomenon of undescended testes has lately been investigated in France. M. Godard has written a very interesting account of this condition, which he has called Cryptorchidie. This author goes on to say, that in the case of a dog wolf he examined, in which both the testes were undescended, their structure was neither fibrous nor had they undergone fatty degeneration; the parenchyma was gray and drier than usual, although of a natural consistence; in size the gland was a third smaller than usual. The semen contained no traces of seminal animalcules, but simply epithelial cells. M. Godard further observes that, in the case of a man with undescended testicles, whom he examined after death, the section of the testes presented no peculiarity. The glandular parenchyma was of the ordinary color; the canals were healthy and pervious; the liquid which was pressed from them contained epithelial cells, blood, and fatty globules. The vasa deferentia contained a liquid composed of fatty globules of variable diameters. No animalcules, but epithelial cells were present. He personally examined the seminal secretion of many living men who had both testes in the abdomen,
1 I say may, for I believe that in the greater number of instances the testes, even if free within the abdomen, will not secrete spermatozoa or living animalcules. This subject has been repeatedly examined in France, and among others M. Goubax, professor of the veterinary school at Alfort says, “When the testicles remain within the abdomen of the animal they augment very little in size. The substance of the gland, although healthy, remains soft, as it is in the fætus. The semen which is contained in the vesiculæ seminales of the side corresponding to that on which the testes is in the abdomen, is found on microscopic examination to contain no spermatic animalcules, and observation and experience prove that the animals in whom double Cryptorchis is found are unfruitful or barren.” In corroboration of these views, Mr. Simonds, the Professor of Medicine at the London Veterinary College, kindly writes to me to say that "Up to the present my examination of the fluid obtained from the seminal ducts of the testes of the several domesticated animals, has shown an entire absence of spermatozoa. I believe that sterility, not unfrequently, is due to a cause of this kind.”
and his conclusion was that in the Cryptorchis no seminal animalcules are ever found in the secretion, although the ejaculated fluid has been frequently examined. He concludes that “men both of whose testicles are arrested in their evolution are sterile, but not impotent; that those who have for their generative apparatus only vasa deferentia are sterile, and nearly incapable of sexual intercourse.”—Comptes rendus des séances de la Société de Biologie, tome iii, série 2, 1856, p. 315.
My own experience in practice certainly is, that men with undescended testes have no family. I was consulted by a gentleman in 1861, in consequence of his wife having no children. My patient told me he had been married some years, and the lady presented all the external attributes of a person likely to have a large family, and I was aware that she had consulted a celebrated physician, at whose suggestion the husband had come to me. There was no suspicion on my part at the time that the testes were absent, or even imperfectly developed. However, on examination, it was impossible to detect any testicles in the scrotum, and pressure in the groin did not give the patient any peculiar pain. There was, nevertheless, abundant evidence that the testes existed, although they had not descended. In no other respect did the patient differ from other men, and he assured me that the sexual feeling was natural, and that he had connection once or twice a week, the emission being as abundant as he supposed it would be in other men. I must, notwithstanding, say that, as far as my personal observations go, I look with great suspicion on the procreative powers of any person with undescended testes.
Among other causes of impotence, or rather sterility, I may mention the influence of
Hernia and Trusses.-Since the fourth edition of this book was published, I have paid considerable attention to this subject, and I think I may now state confidently that trusses may
and often do most seriously interfere with the reproductive powers, and in a way that truss makers might readily obviate by adopting some improved construction. The object of mechanicians being solely to keep the hernia in place, the penis or testes are