_Impotence._――Some misapprehension as to the signification of this
term is prevalent, owing to the extent of weakness and the morbid
conditions to which it has been applied. The wrong application has been
very common; _i. e._, in using it to describe a condition of sexual
neurasthenia and temporary suspension of the sexual powers, from moral
shock. A young man who exercises a doubt as to his ability to copulate
may, upon the occasion, be unable to procure an erection; and yet he
may, after a time, secure his own confidence; or, when he the least is
thinking of it, be in full possession of his potence. The first attempt
at coition, after matrimony, may be unavailing for this reason, and no
trouble occur at any time afterwards.
The penis may be erect at first, and become flaccid before intromission
can be effected. Even this does not constitute, but may be only a
result of, nervous shock or impression produced upon the mind and
sexual instinct, from embarrassment, that may occur to any young man
who is not self-confident, and is no evidence of any permanent disease.
Impotence, as it should be defined and considered, is the
manifestation of a disease in which there is permanent and actual
impairment of the nerve-centres and, as a phenomenon of such centric
changes, inability to procure an erection of the penis, at any and all
times, sufficient to perform the act of coition. This is a chronic
malady, of slow advent, and when once established there is very little
tendency to recovery. The chagrin manifested in a man who is impotent
is at all times striking. He feels that to be impotent is to be worse
than dead. Men pride themselves on their ability to perform coition,
and feel the loss of sexual power more than mind. Money and time are,
therefore, expended exorbitantly to recover this lost power, that they
may feel themselves men once more.
The flabby organ is the centre of attraction. He handles it, and dotes
upon what has been in by-gone years, and mourns over his misspent
fortune only for the possibility of his obtaining relief from his
genital affliction through its influence.
The disease is complicated with spermatorrhœa at nearly all times, and
may be considered only an advanced period of the same neurosis. The
same conditions and types of diseased manifestations are to be studied
in impotence as in spermatorrhœa. Then, to spermatorrhœa we add the
phenomenon, impotence, and the accompanying changes, and we quickly
comprehend the position.
The condition is a loss of excitation-power of the nerve of Eckhard,
whereby all physiological irritation becomes impossible. This nerve
arises from the sacral plexus, any irritation of which, in a healthy
state, causes a flow of blood to the corpus cavernosa and spongiosa
of the penis; but the constant stimulation of this nerve produces a
loss of irritability and paralysis of the parietes of the arterioles
of the erectile bodies of the penis, and no relaxation of their valves
occurs at any time: a perfect vascular inactivity is the result. These
arterioles anastomose with corporal venules which are very tortuous
and sacculated and supplied with very large openings and very small
outlets compared with the magnitude of their calibres; but the often
turgesced condition of these venules causes a dilated condition of
the outlets, and any blood that may be conveyed into the corpora
through the arterioles will flow out so fast through the dilated
venule outlets, that the turgescence necessary to produce erection is
impossible. Again, the innate contractility of the trabecular substance
must antagonize, to a considerable extent, the erectile tendency of
surrounding tissue.
Then there is another condition so closely connected with impotence
that a mention of it will not be out of place. Impotence consists in
a lack of power to effect an erection; but there is a condition, not
always impotence, where the person has lost all desire for copulation,
and will not make an effort to obtain an erection. He does not attempt
to concentrate his will-power, and does not desire any relation
whatever with the opposite sex, although he may have been a debauché in
his early life. When such a condition has been congenital, there would
be reason to suspect deformity or congenital defect. Such person may
not be impotent, and if the desire returns it manifests itself in the
genitals as soon as the mind is allowed to dwell upon erotic thoughts;
and if erection does not occur impotence is present.
The loss of semen often subsides in the aged, and atrophy of the testes
is not an uncommon result; but some people live to be very old, and are
never troubled with senile-impotence.
The penis is at all times flaccid, if impotence be complete. Often
partial impotence will reveal itself, deviating peculiarly in its
character. Sometimes a man will, while entertaining erotic thoughts,
have an erection of the penis which is perfect in all appearance, and
when brought in contact with a female cannot sustain or even procure
the erection, and yet the erotic desire be just as intense as if he be
able to perform the act in a proper manner. These cases are practically
impotent, but the disease has all to do with the mind; and as soon as
the mind can be so corrected that self-control may be exercised as
well as self-confidence, just so soon will the impotence disappear;
and once the act is performed normally, the trouble will be at an end.
But there is a condition in which all the powers of mind and body,
exercised to control, will not impart either the power of erection or
the erotic desire――only a longing for that once felt erotic desire
exists. The condition often exists in which the patient cannot control
the mental impressions, so as to effect that peculiar concentration
of the nervous force which gives energy to the sexual organs; and yet
there may be no disease of such nerves themselves. It is the same
condition that will cause the mental operations to fail during any
course of anxiety, or turbulence of the emotions. A speech-maker may
fail in his efforts at first, even after he considered himself prepared
for every emergency; but as soon as allowed to collect his scattered
mental evolutions, he may compose himself.
Inability to perform the sexual act while suffering from any mental
derangement, or misunderstanding one’s own mental elaborations, is
not impotence; but there must be impairment of the integrity of the
nerve-substance that evolves the force that sustains the sexual organ
in its erect attitude, and also supplies the so-called physiological
irritation. If we attempt to name this peculiar disease from other
stand-points, we shall become confused; as it would only demonstrate a
function-disease, which is an impossibility and leads to confusion.
I have seen cases of so-called impotence from intestinal worms: while
impotence is not generally considered a symptom of worms, yet this is a
case which recovered as soon as the worms were expelled. I have known
two cases that supposed they were permanently impotent, both of which
obtained relief after the expulsion of a tænia solium.
These were cases of symptomatic impotence; which only means phenomena
that may exist in remote structural disease, or by mechanical pressure,
as from foreign bodies, lumbricoide, tapeworms, etc., pressing or
directly or indirectly infringing upon the nervous track that conveys
the force which supplies the erectile tissue of the penis. This is a
paralysis of the vaso-motor variety, in which the impotence is only a
symptom: the disease must be studied under nervous diseases.
To comprehend and study true impotence, the student will be attracted
to the brain and spinal cord; as there only can the pathology be
carefully comprehended.
Nearly all the descriptions of this perplexing malady have been
confined principally to the chronic flaccid penis and the general
nervous phenomena most likely to co-exist. I must say that our
knowledge is very limited beyond the superficial sources of
information; and we have to content ourselves with simply describing
the appearance, for the real disease itself; not but what structural
changes exist in the sexual organs, worthy of note, but such changes
are only secondary.
Depending upon organic disorganization of the nerve-substance, we have
all grades of loss of sexual power, from the simple chronic premature
ejaculation to advanced and perfect paralysis of the organ. Any male
who, from exhaustion of nervous force, cannot perform the act of
copulation in a normal manner, may be said to be in a degree impotent.
If he be able to effect intromission and then unable to complete
the act, from premature ejaculation――providing this is a common
occurrence――he may be said to be impotent. The continent may undergo
premature ejaculation and not be impotent. Neither is flaccidity likely
to follow ejaculation from such cause.
The more advanced cases of impotence are not even capable of procuring
erections; and often semen is discharged in the flaccid condition
without the knowledge of the patient: such may be the result of
spermatorrhœa and impotence combined.
The long-continued and frequent indulgence of masturbation must be
a most frequent cause of impotence. I have only observed a very few
whom I knew to have brought upon themselves this condition without the
habit of masturbation; and even then I am not positive in knowledge.
Yet they were rare debauchés, with money to squander and appetites so
salacious that the almost constant contact with women was their custom.
On the other hand, it seems that a male human being is constructed for
endurance of his sexual organs. A notorious polygamist in practice,
once living in the city of Elmira, New York, was known to lavish his
smiles on his “kept women,” whom he numbered by scores, and still he
was potent till he died in advanced life. We must have a most excellent
example in the famous President Young whose wives, we are inclined to
believe, must have kept him on the _qui vive_, as his children bear
evidence, as well as the fascination and attractiveness of his young
wives.
The exciting cause of impotence must combine a constant and
long-continued sexual debauch with the depraved chain of thought that
must necessarily accompany such degradation; and the practice of
self-pollution must be the most fruitful of all causes.
_Treatment._――In the management of impotence, the patient’s persuasive
influence must not in any way change the intentions of the physician,
or the fast hold of his mind, which is so indispensable to a cure,
will be lost. The patient is always in great haste, and constantly
urging the physician to make rapid progress. Too great firmness cannot
be exercised, and promises of speedy cure will invariably fail.
Time is one of the most important of all elements in the treatment,
as opportunity is afforded for the recuperative powers of nature or
physical forces to become poised.
Perfect confidence in the medical adviser is prerequisite to success,
as by this alone can the patient’s mind be manipulated, and his hope
constantly stimulated. If he has been much exercised in mind about his
case, from reading “self-abuse” literature, moral treatment will be
required to dispel from his mind the pictures there wrought. Not always
can the virile organ be restored to its normal vigor, but elevating the
general health should be first considered, and the patient’s mind kept
constantly thinking about his improving physical condition, instead of
watching for the first erection as he will most naturally do.
When the foregoing conditions cannot be secured, no benefit will result
to the patient. In no disease has mental influence so much to do with
recovery, as in impotence; and I do not hesitate to say, where I can
control my patient’s mind, that I can always effect a very satisfactory
relief. Employment is indispensable, and must be persisted in. The
patient should have no time to play, or brood over his disease, but
must be engaged so constantly that he will be even fatigued after he
has finished his day’s toil, and will sleep long and soundly from
his exhaustion. The most nutritious diet should be selected: meat,
eggs, oysters, milk, etc. Cold bathing at night, before retiring, is
a very important measure; as, first, it washes the parts of a cold,
clammy sweat, and the chill from the water after reaction, produces
a naturally warm feeling, and his attention is not attracted to the
parts by their otherwise doughy, unnatural feeling; and secondly, the
tonic properties of cold are of lasting benefit. The bathing should
extend to the back, perineum, scrotum, penis, and down the thighs. Such
constitutional measures should be resorted to as will favor any of the
imperfect processes in the body. The means should favor assimilation of
food and normal excretion, and the avoidance of stimulating diet and
alcoholic liquors.
For the neurosis upon which impotence depends, I have accomplished
very much by a single combination of medicine (see formula No. 1),
that this preparation has been, as it were, a “stand-by” for many
years; the patient gradually improving under its use, in nearly every
case. I can affirm that it has been tested in hundreds of cases, in a
great majority of which marked improvement has taken place, and many
have been permanently cured. Many were cured before I became familiar
with the importance of electricity in the treatment of such cases; but
since having extensive experience with the various methods of applying
electricity I confess I could not do well without it.
As to the beneficial results following galvanism and Faradisation,
there can be no question; but as to which of these forms should be
applied, I am not always able to say. I have used galvanism without
benefit, a certain length of time, and changed to Faradism with
immediate improvement; and _vice versa_.
I do not opine that either form, if used mildly, will often do harm;
and where improvement does not follow after a reasonable length
of time, I would advise a change. When the patient is wakeful and
restless, a pleasant effect is produced by Faradisation, which is often
a favorable sign, and may be continued with exalted expectations. In
very advanced cases, the galvanic current will oftener establish an
improvement, when a change to the Faradic current will continue the
improvement. I consider no means of the physician demanding so much
judgment and experience as electricity; and in the skilled operator’s
hand much good may be realized from its use.
A very natural manner of applying Faradisation in impotence, as well
as other forms of sexual neurosis, is to seat the patient upon a large
wet sponge, to which the negative is connected, bringing the scrotum
and perineum well in contact with the sponge, and stroking the spinal
column well with the positive, also using a wet sponge. The operator
will be governed by the patient’s sensibilities, as to time of sitting
and strength of current. The current should not be painful or very
unpleasant; and if twenty minutes produces any uneasy sensation, the
next application should not be continued longer than ten minutes.
The galvanic current may be used in a similar manner.
Beard & Rockwell’s method of general Faradisation is a most excellent
one for alternate applications.
A troublesome complication is often constipation of the bowels, which
may be overcome by the judicious use of rhamnus purshiana. Not too much
general bathing, but local bathing, as directed above, with stimulant
friction, is always beneficial.
Turkish baths, so often ordered, must be avoided, as great general
debility and languor often follow their use. No undue warmth can be
made use of, either in dressing or bathing, as the neurosis, upon which
all these unnatural phenomena depend, is aggravated.
The general treatment of neurosis, in impotency, differs very little
from that in the neurosis of spermatorrhœa, as the conditions are
very similar if not identical; only degrees of the same organic
cerebro-spinal changes. The beginning is perhaps only a neurasthenia,
but gradually increasing in intensity to spinal anæmia, or congestion,
finally softening.
Any changes of the genitals must be treated according to principles
mentioned under treatment of structural changes of the genitals.
_Clinical Illustrations._――It must not be expected that all cases
will be confined to one definite condition, or to one combination of
phenomena that may be grouped together and named. No one will so fully
comprehend this as the practical physician. Cases are constantly under
the care of the medical man, suffering with conditions too numerous
to mention, complicated with many strange lesions. Every case must
necessarily be studied from its own merits, in and of itself, or
success will not follow.
It is not uncommon to come in contact with spermatorrhœa and impotence,
both together, also complicated with organic disease of testicles,
prostate gland, and anus or rectum. At the same time the brain and
spinal cord may be drawn upon by a variety of organic lesions. By this
we shall see that a report of clinical cases will bear more upon the
practical than the theoretical, as regards adapting doses to nosology.
_Case._――J. S. consulted me in ’74. He was suffering from spermatorrhœa
and partial impotence. He had tenderness over last lumbar vertebra and
sacrum, anæsthesia of the genitals, dyspepsia, bowels constipated,
and at times very languid; was brooding over his loss of power and
involuntary discharges of semen, which were nocturnal, generally
accompanied by lascivious dreams. The urethral sound revealed
tenderness along the urethra and extreme soreness of the prostate
gland. His semen was thin and spermatozoa scanty and imperfect. He
was thin in flesh, and anæmic. His erections were imperfect, and he
could not perform the act of coitus. He was a masturbator. I directed
pills, formula No. 2, and continued until bowels became regular; also
No. 1, which was continued one year without change, with cold local
bathing and brisk friction over bowels, back, perineum and scrotum. His
recovery has been very satisfactory.
_Case._――J. W., when he first visited my office for examination
and advice, was emaciated, pallid, with his eyes sunken. He was
careworn and haggard in his expression, suffering from pain in his
back and limbs, almost constant pain through the top of his head;
palpitation, with accelerated pulse; formications over his back and in
his finger-ends; bowels constipated, and urine smelled strong like a
horse’s; tender spots along the spinal cord. The testicles and scrotum
were doughy and constantly moist and cold. His scrotum was long and
pendant: his penis was blue and flabby. He could only obtain partial
erections, very occasional. He lost semen often. His urethra was very
tender, also the prostate gland. He was restless and wakeful during the
night. I directed local cold bathing, Faradisation, formula No. 1, for
his general neurotic condition; pills――formula No. 2――for constipation.
He took chloral every night, to produce sleep, for 3 months; tr.
staphisagria, small doses, for prostatic irritation, and occasional
opium suppository. I discharged him after sixteen months, when he
married, and now has a healthy child.
_Case._――R. confided to me his history, which was, he had been a
debauché and masturbator. He was tall, slender, anæmic, beard thin;
was suffering from too much medicine, which he had received from
unprincipled specialists, as he had been three years in their hands.
There was spinal anæmia, judging from the spinal soreness, and
formication at times. He thought he would become paralyzed, as his
hands and feet often became numbed. He was impotent, and often lost
semen. His urine contained spermatozoa. As soon as his mind could
be put at ease he began to improve, under formula No. 1, with cold
local bathing, as directed, with Faradisation. I discharged him after
thirteen months.
_Aspermatism._――Since Roubaud’s description of this condition, and
especially the application of the above term, much has been said in
regard to the causation and true nature of this peculiar deficiency.
Whenever sexual orgasm occurs in the male, after puberty, without
ejaculation, the condition known as aspermatism may be said to exist,
and may be considered as a symptom of disease. This may be partial or
complete. I have known a number of individuals who failed to ejaculate
semen at the time of sexual orgasm, and the semen would pass away in
jets some time after the penis had become flaccid. These cases exist
where there is no sign of organic stricture of the urethra, or any
other organic trouble within the prostate gland or ejaculatory ducts.
Dr. Van Buren is the author of a paper which appeared in the _New York
Med. Journal_, November, 1868, in which he attempts to establish the
cause as a spasmodic condition of the urethra, forcing the seminal
fluid, by reflux action, into the bladder. I can not, at present, think
that this is always the case. Only a little attention to physiology
will familiarize any person with the calibre-contractions that follow
a column of urine from the bladder to the meatus. This same muscular
contraction exists in the veins, and is what constitutes the venous
wave. The same wave exists in the ejaculation of semen; and where the
muscles that perform accelerating movements are paralyzed, the natural
consequence must be, that the fluid will remain in its reservoir until
its place is supplied by new, and a portion is forced out along the
urethra, which drips away when the penis returns to flaccidity. Then, I
can but regard this condition, often, as one of paralysis, in which are
affected the muscles of ejaculation and acceleration. This condition
often exists where the genitals are not impaired as to potence. That
such a condition is present, should not be declared until after bougies
have proven, to entire satisfaction, the absence of organic stricture
or spasmodic contraction.
When such a lesion has come on gradually and is of long standing,
the prognosis is very unfavorable; as relapses will most generally
occur with the slightest indulgence. But when the condition has made
its advent suddenly, from inflammatory causes, the prognosis is very
favorable. A gonorrhœal orchitis will often produce this condition,
which is only transitory, or of a few months’ duration. This is only
symptomatic, and very much unlike the true aspermatism of a neurotic
origin.
A very extraordinary case has of late engaged my attention and
curiosity. No case of the kind have I been able to discover, in medical
literature or in the practice of my medical friends.
_Case._――A young married man consulted me with an affliction (as it
were), much to the discomfort of himself and to the great injury of
his wife. He never had passed the sexual orgasm, nor ejaculated semen
during coition. He is very erotic, and has no difficulty in performing
the marital act, but it is followed without the slightest satisfaction.
He continues in the act of coition until exhausted, and retires with
the wife very much in the same condition after repeated sexual orgasms.
He informs me that one hour is not an uncommon length of time for him
to occupy in the act of coition, participating in the sexual beatitude
during the entire period, until gradually becoming exhausted, when
the pleasure dwindles away, but his penis remains erect for some time
after. He says that he has often applied cold water to facilitate
flaccidity.
After the organ has been reduced he sometimes can detect semen, or
prostatic fluid, on the glans and meatus, and he is very soon ready
to perform the act again. I have often discovered spermatozoa in his
urine. His testicles are well formed, and his penis is normal in
appearance. He has never had a venereal disease, and has no stricture.
Treatment has given no relief as yet. It will be observed that
satyriasis is prominent in this case.
Galvanism will often be found of great service as a paliative measure,
with phosphide zinc and nux vomica. If a few years’ continence can be
obtained, a better prospect for recovery may obtain. When galvanism is
used, an insulated electrode should be passed to the orifices of the
ejaculatory ducts, with the anode attached, and the cathode applied to
the cord with wet sponge. I have derived some benefit from localized
and general Faradisation, after the manner heretofore mentioned.
* * * * *
FORMULÆ.
_No. 1._
℞. Fld. Ext. Nucis Vom.,
Tinct. Pulsatillæ,
Tinct. Canth., _aa_ f. ʒiij.
Acidi Phos. dil., ℥j.
Fld. Ext. Collinsoniæ, ℥ij.
Misce. Sig.: Dose, 20 drops, three times a day, in water.
_A nerve tonic and stimulant._
_No. 2._
℞. Podophyllin, grs. v.
Iridin (ol. resin), grs. xx.
Misce. ft. Pillulæ, No. 20.
Sig.: Dose, one to two, to be taken every night, and regulated to suit
case, as to quantity.
_Used to overcome constipation of the bowels. The iridin being slowly
soluble prevents the irritation so commonly known to follow the use of
podophyllin. Hyoscyamus may be substituted for the iridin or added to
the formula._
* * * * *
Transcriber’s Notes:
――Text in italics is enclosed by underscores (_italics_).
――A List of Chapters has been provided for the convenience of the
reader.
――Obvious punctuation and spelling inaccuracies were silently
corrected.
――Archaic and variable spelling has been preserved.
――Variations in hyphenation and compound words have been preserved.