PRIVATE LIBRARY of KIMBALL YOUNG SEXUAL IMPOTENCE THE PATHOLOGY AND TREATMENT OF SEXUAL IMPOTENCE BY VICTOR G. VECKI, M.D. FROM THE AUTHOR'S SECOND GERMAN EDITION, REVISED AND REWRITTEN PHILADELPHIA W. B. SAUNDERS 925 WALNUT STREET 1899 Copyright, 18H9, by W. B. SAUNDKRS. .-_ _____ umvaicsiTY OP PA* pro' JUNTA BARBARA PREFACE. WHEN the first German edition of this work was pub- lished, in 1889, there was some commotion in the ranks of old and young medical fogies, who were indignant that any one dared to resist their intellectual- tendencies, refused to worship their superannuated gods. The second German edition found the ranks of the same kind of professional formula-riders and bigots solid, though somewhat thinned. I have taken the liberty of preserving the indepen- dence of my altruistic opinions, and shall continue to fight against false and hypocritical quasi-scientific pre- tensions. The circumstance that my work has been given earnest consideration by authorities like Casper, Eulenburg, Fiirbringer, Krafft-Ebing, and others makes it easy to bear all the acrimonious aggressions dictated by the bilious nature of some of the " Dii minorum gentium." I wish to thank Professor A. A. D'Ancona, who kindly revised the manuscript and helped me in many other ways. THE AUTHOR. 22 GEARY STREET, SAN FRANCISCO, GAL. PREFACE TO THE SECOND GERMAN EDITION. Ix UK/ lapse of seven years passed since the publica- tion of the first edition of this work, we can record but very little progress in the theoretic as well as the practi- cal development of our subject. We know to-day just as much or, better, just as little about the physiology of the sexual act as we did seven years ago. Quite new, indeed, is an abundance of newly-forged mimes for old pathologic conditions. Some authors try to perpetuate themselves in this way. We can only hope that most of these new names will be short-lived. The therapeutics of sexual impotence has received sonic valuable additions, and we have in the method of suspensions a frequently efficacious, and in hypnotic suggestion an occasionally efficacious, remedy. It affords me special satisfaction that my monograph has not proved to be an ephemera, in spite of the many adversaries the liberal interpretation of some pertinent questions lias encountered. THE AUTHOR. SAX FRANCISCO, CAL., November, 1896. 9 CONTENTS. CHAPTER PAGE I.- INTRODUCTION " 17 II. ANATOMY 30 III. PHYSIOLOGY OF THE SEXUAL ACT 45 Sexual Maturity 45 Sexual Orgasm 47 Seat of the Sexual Instinct 50 Erection 51 Ejaculation 59 The Semen 61 IV. ETIOLOGY OF IMPOTENCE 79 V. FORMS OF IMPOTENCE . 87 Congenital Malformations and Defects of the Sexual Organs 87 Absence of Penis 87 Diminutive Size of Penis 88 Excessive Size of Penis 88 Absence of Prepuce 89 Superfluity of Prepuce 90 Hypospadiasis 91 Epispadiasis 91 Monorchis 92 Cryptorchis 92 Hermaphrodites 93 11 1 _> CONTENTS. .11 \I-TKR .lry///,v,/ />/<( hi the Organs <>f <;7 Acute Diseases !>7 Phthisis 98 Chronic Diseases 99 Diabetes 99 Obesity 99 Anemia 100 Diseases of Brain and Spinal Cord 102 Neurasthenia 103 Diseases of the Genital ia 108 Alcohol 113 Coffee, etc lie. Tobacco 116 Digitalis 117 Morphin, etc 118 Arsenic 119 Lead 120 lodin li'ii Mercury 120 Salicylic Acid, Antipyrin, etc 120 Inhfi-itfil Predisposition tn /iit/infr/icr 1 ~2'2 Sexual Weakness 123 Incontinence of Urine 124 Frigidity 126 Nervousness 127 Perverse Sexual Feeling 128 CONTENTS. 13 CHAPTER PAGE Neurasthenic ///////v//rv .............. 136 Excess in Venery ................ 137 After-Effects of Copulation ........... 148 Sexual Excesses, Consequences of ........ 152 Fiigidity .................... 153 Satiety of Ordinary Sexual Gratification ...... 154 Paralytic Impotence ....... ....... 156 Onaiiisin .................... 160 Causes of Onanism .............. 164 Consequences of Onanism ............ 171 Nervous Diseases ................ 172 Pollutions and Spermatorrhea ....... . . 174 Endoscopic Examination, Results of ....... 184 Abstinence ................... 188 Irritable Weakness ............... 192 Psychical Impotence .............. 195 Temporary Impotence ............. 198 Relative Impotence .............. 199 Professional Jn>j>otcce .............. 202 ft- n He Impotence ................. 205 VI. DIAGNOSIS ............... ...... 209 VII. PROGNOSIS .................... 214 VIII. PROPHYLAXIS ................... 216 IX. TREATMENT .................... 226 Psychical Treatment ............... 228 Removal of Morbid Influences ........... 230 Treatment of Spermatorrhea ........... 230 1 I CONTKXTS. CIIM-IKI: ////'//'//' ' I/' A/''///// ................ -''<('> NniirisliiiH'iil ................. --"'7 , etc. . .............. _';;:i I'llMSJlllMI-IIS ................ I'll) Xiix Ymiiira ................. _ 1 1 Oninin .................... !'_' Valerian Cocain .......... .......... -21'.', Scincus Miiriniis ............... -2\:\ Damiana ................... 1'44 Hydrotherapeutics ............... 244 Ablutions ................. :>4<> Friction and Similar Proceedings ........ 24(> Sponge-Baths ................. J47 Douches ................... 247 Sitz-Baths .............. ... :M7 Half-Halhs .................. ^4S Vapor-Baths ................. 248 River- and Sea-Baths ............. 248 Balneological Treatment ............ 24'.i Psychrophor ................. 249 Injections .................. 250 Carbon Douche ................ 2">0 - Tin i-iljn illicit ............... 251 Galvanic Current . . . 252 CONTENTS. 15 R PAGE Electro- Tlii'i-n/>t:i/Hr.-<. ( 'i,nfiii/il. Faradic Current ................. 253 Static Electricity ................ 254 Hydro-Electric Bath .............. jr,-t Loral I'ri'iitiiit'tit .................. ^")4 Cauterization .................. 254 Astringents ................... 258 Bougies and Sounds ............... 2(iO External Applications .............. 261 Sinapisms ................... 261 Acupuncture and Electropunctnre ........ 261 Surgical Operations ............... 261 M*i**age and ('///// />-flHii(/ .................... 262 Flagellation .................... 263 Aji/mrnfus and Instruments ............. 264 Regulation of the Sexual Life ............ 270 271 Inhalation of Oxygen ............... 273 Suspensions .................... 274 Hypnotic Suggestion ................ 277 X. SPECIAL THERAPEUTICS ................ 280 SEXUAL IMPOTENCE. CHAPTER I. INTRODUCTION To write on the much-scouted subject of sexual im- potence is a venturesome undertaking under all circum- stances ; but to write without the customary affectation and hypocritical rolling of the eyes, to speak the bare truth, surely requires even greater courage. Many an eminent medical man may have felt a secret desire to take the risk, but refrained from carrying out the reso- lution through fear of endangering his professional repu- tation. Some one not counted among the magnates of the medical realm may feel licensed to plunge to the very bottom, " to see what the gods have covered with darkness and horror," and may dare to relate to his colleagues what he sees and hears, without alteration or retouching. " No physical or moral suffering, no wound, however putrid it may be, should frighten him who devotes his life to the science of man ; and the sacred ministry which obliges the physician to see everything, to know every- thing, gives him also the right to relate everything." l 1 Tardieu, Etude medico-legale sur les attentats aux moeurs. Paris, 1878, p. 2. 2 17 18 SKXTAI, IMI'OTKM !.. It must be admitted that the- subject has never re- ceived the attention its preeminent importance deserves. The world over it seems to be considered the proper filing to treat the affair with supercilious nonchalance. Few medical men in Germany can boast of ever having had an opportunity to hear a clinical lecture on impo- tency; and the complaints and criticisms of authors prove that elsewhere the subject receives no greater favor. " The subject is thus not yet emancipated from the tenacious grasp of the most rampant charlatanism." l " Let us be frank from the first steps of our researches, because hypocrisy is the worm which in modern society attacks and corrodes the highest and most powerful plant of this life's garden. 1 ' 2 This somewhat serious neglect is no doubt to be at- tributed to the circumstances that those suffering from impotence can hardly be subjects for treatment in hos- pitals, and that the observation of the details and symp- toms of the disease is attended with unusual difficulties ; nay, is hardly possible at all. Recent indications seem, however, to point to a better future. Men of prominence in the learned world, with Eulenburg, Krafft-Ebing, Furbringer, Edw. Martin, and some others at the head, do not think it beneath their dignity to busy themselves with the solution of the per- plexing problems of the sexual life, and it is to be hoped that before long the conventional medical lies with which every book, every pamphlet on the subject is swarming, will disappear, and Mantegazza's satire 3 become obsolete. 'Campbell Black, On the Functional Diseases of the Urinary and Reproductive Organs. London, 1875, p. 6. 2 Mantegazza, Fisiologia dell'amore. Milano, 1882, p. 75. s Op. cit., p. 298. INTRODUCTION. 19 " Difficult problems cannot be solved if we run away from them or if we avoid them ; and still many a physi- cian, many a philosopher, tries to solve the most burn- ing questions of modern society in the manner of the baby who believes that he can escape the threatening- dog by closing his eyes." No one denies that the sexual function is of very great consequence to the individual as well as to society in general, although one does not care to make this a subject of conversation. "At any rate, the sexual function forms the most powerful factor in individual and in social life. It is a mighty impulse for bringing into action our most effec- tive energies, for acquiring property, for the foundation of a home, for rousing altruistic feelings for a person of the other sex first, and, later, for one's children, and, in a wider sense, for the whole human family." l The civil code of Austria correctly estimates the importance of sexual virility, Article 60 declaring that " the continued inability to fulfil the conjugal duty is a bar to marriage." The criminal code (Section 156) declares, " But if the crime has caused the loss of the procreative power of the injured man, then the punishment of imprisonment with hard labor is to be meted out for from five to ten years." Without virility there can be no procreation. That the semen of impotent men frequently contains spermato- zoa need not be taken into account in considering the propagation of the race, and, generally speaking, there are certainly but very few men who owe their lives to impotent fathers. 1 Krafft-Ebing, Psychopathia sexualis. Stuttgart, 1886, p. 2. 20 si:. \r.\l. IMPOTENCE. I If win) lias become preinaf urel y impotent is one of UK- must unfortunate creatures, his jiiisrorlunc being the greater as lie has to be ashamed of it, must conceal it, is pitied by no one, but scorned, and, alas, in exceedingly few cases can In- hope for recovery. I venture to assert (hat in many cases it is a better deed to restore to an impotent man the power, so precious to every individual, than to preserve a dangerously sick person from death, lor in many cases death is preferable to impotence. The energy of man, his courage, his enjoyment of work and life, all, with hardly any exception, depend on his sexual power. Here I leave out of sight the sundry vows of (-hastily made by persons who expect to be rewarded in the hereafter for their voluntary martyrdom here below. These people hardly seem to be enjoying their lives, and they call this world a vale of tears. Now, this world is not exactly a vale of tears or of grief; but let a man who has to labor and produce from early morning till evening, who must day after day begin ever anew the struggle for existence, lose that little bit of love and his pathway will lead through a vale of tears indeed. The difference between the view of things in general formed by old people and that formed by the young has its only explanation in the virility extinguished in the former and vigorous in the latter. Prematurely impotent people very often appear aged physically, and always mentally. Moreover, we must not forget that the sexual nervous system is closely related to all the rest of the nervous mechanism, including those parts essential to its physio- logical operations. " The feeling of sexual impotence is the most humiliating which can ever afflict a man ; be- cause it degrades him in his own eyes, and does not leave a single possible illusion, not a solitary moment of INTRODUCTION. 21 mercy. 11 * Eunuchs and the sexually impotent differ from their fellow-men who are in full possession of virile power in appearance and in conduct. Even though executed with talent and spirit, the work of an impotent man bears the stamp of impotence. In the year 1878 I happened to be in the Paris Salon with one of the most famous French painters. While contemplating some paintings, the great master, to whose w r ords a crowd of artists were eagerly listening, said, " That painter must be impotent. 11 To a question of mine the master replied that he was able to tell by a picture, not only whether it was painted by a young man or an old one, but also the condition of the artist's sexual power. To-day I give full credit to this assertion, as I am convinced that with some experience one can dis- tinguish an impotent man from a virile one merely by his looks, demeanor, ideas, words, and works. The exterior of an incurably impotent man, whether his impotence be real or imaginary, does not always sug- gest physical weakness ; on the contrary, many present a very healthy appearance, and are stout. The keen-eyed public have baptized this corpulency " capon-obesity. 11 In spite of the apparent healthiness, the impotent man is generally melancholy, discontented, and peevish. The prematurely impotent are, without exception, ill-hu- mored, cheered up with difficulty, and even then for but a short time. Most of them are grudging, cowardly, envious, and wicked. They are all very jealous, as may easily be understood. The younger they are, the hand- somer their bodies, the higher their social rank, the more pronounced is their bad character. 1 Lallemand, Pertes seminales, tome ii., l re partie, p. 132. _>_> SEXUAL I \lhiTK\VK. The character of M man must. as a mailer of course, IM- . ..iisiderably affected by the consciousness of impo- tence. No one is more severe than the impotent in passing judgment on his neighbor. No one so ruthlessly MI mercilessly condemns a misdeed, caused by passion, against tin- very wise prescripts of Ethics. Since he cannot join the virile in their enjoyments of life, lie makes a merit of his incapacity. The striving of a man to found for himself a home, a family, is a stimulus to work and to the accomplishment "I -real deeds in his sphere of life. Such a stimulus does not stir the impotent. Although they do not care for life, yet they are cowards. It is very seldom that an impotent man turns dare-devil and shows a contempt for death, due to despair. The impotent are incapable of love; for, as Krafit- Ebing says, "With all the morality which love needs to rise to its true and pure character, its most vigorous root is nevertheless sexual passion. Platonic love is a non- entity, a self-deception, a wrong designation for cognate feelings." 1 Similarly, ambition is closely dependent upon the sexual power, as it seldom makes its appear- ance before puberty. Finally, it must not be forgotten how wretched a part is played in matrimony and in every other relation to a woman by the man who is completely or even partially impotent. He must renounce the affection and regard of a woman. Galopin 2 is quite right in saying, " Without this good friend (the woman) the dawn and evening of life would be helpless, and its mid-day without pleas- 1 Kraffl-Ebing, Psychopathia sexualis. Stuttgart, 1886, p. 9. 1 Le parfum de la femme. Paris, 1886, p. 101. INTRODUCTION. 23 ure." With all the capacity for self-sacrifice which is inborn with the entire sex, women will nevertheless seldom soar to so high a degree of self-abnegation as to love an impotent man. It is the aim of every husband to hold a dominant position in his family ; the more so as the weight of his voice is less elsewhere. My object is not to examine whether such a position is in the interest of the man himself and of his family, but I wish merely to call attention to the fact that the influence of an impotent man must be very insignificant with a woman living with him. whether she be wife or mistress. I further wish to point out that many fallen women would have continued good and faithful had their hus- bands not been more or less impotent. The greater share of sexual appetite roused inconsiderately or igno- rantly remains unsatisfied, and much matrimonial hap- piness is ruined by the husband's impotence. " Tutavia la compagnia fra moglie e marito si conferma grande- mente per questo atto, e non puo far miglior cosa il marito per tenersi affettionata e pacificata la moglie. die questa e spesso. Perche a questa foggia, tutta la casa sta in pace, e tranquilla, e tutte le cose vanno bene." (Levinio Lennio.) l Now and then impotence leads to suicide. Marc 2 tells, for instance, of a young man who, before commit- ting suicide, had written down the words, " I am impo- tent, consequently I am good for nothing in this life." If impotence declares itself slowly and gradually, refuge is not so often taken in this safe though extreme remedy for all diseases ; but is applied more frequently 1 Mantegazza, Igiene dell'amore. Milano, 1881, p. 95. 2 Mantegazza, op. cit., p. 143. 1^| SMXr.M. I.MI'OTKXCK. when the c;il;iinily shows itself at once and without a stair of transition, so that UK- patient understands plainly that there is no help for his ailment, and he lias there- Core not the time to accustom himself to his misfortune. Jlicherand ' made the observation that after penis ampu- tation the patient becomes melancholy, and is conse- quently more subject to malignant wound fever, which often causes death, whilst other mutilations by surgical operations are borne with fortitude. Lallemand 2 tells of a man forty-five years old who. after penis amputa- tion, when on the point of leaving the hospital, received a visit, from his wife, after which he grew gloomy, mourn- ful, taciturn, and died suddenly. The most careful au- topsy failed to reveal any cause of death ; Lallemand ascribes the fatal result to despair. In this case the patient had so much the more reason for despair, as the sexual appelite had not vanished with the loss of the penis. The Russian Skop/.i after having been maimed sutler a complete change of character: they grow ego- istic, malicious, hypocritical, and covetous. 3 It is to be observed, however, that surgical operations performed on the genitals can cause genital reflex neuroses in the form of melancholia. 4 The fate of being impotent is borne with more stoicism when along with the loss of virility goes that of every de- sire for intercourse with the other sex. Here again we find in Lallemand 5 a typical example : A man about 1 Roubaiid, Traite de 1'impuissance. Paris. 1876, p. 66. 2 Op, cit., p. 38. * Mantegazza, Gli amori degli nomini. Milano, 188(5. p. 182. 4 Kurz, Zwei innere Urethrotomien, gefulj-'l vou Melancholic. Ret. drr ni.Ml.-rhir. Mimdschaii. Wien, 1887, Heft xviii. p. 683. 5 Op. cit., p. 41. INTRODUCTION. 25 thirty years of age, who, in consequence of an injury of the occiput, was left without sexual appetite, and whose testicles were atrophied, used to talk in a joking way and quite merrily about his injury and its sad conse- quences. No doubt the personal character is of great importance here, as each individual shows different characteristics in the reaction following injury. The impotent are misanthropic and distrustful. They are ever afraid that the defect of which they feel ashamed may be discovered. All this is aggravated by self-re- proaches of the worst kind, for almost every one be- lieves he has himself caused his misfortune. A reason for self-reproach is soon found, for who has not indulged in real or imaginary sexual excesses or self-abuse ? These people are so much ashamed of their deficiency that they will not acknowledge it, even to the physician, except in a most reluctant manner. It is, therefore, ad- visable to meet the communications of an impotent per- son with the required scepticism from the very begin- ning. This sense of shame is more intense with people of humble condition than with those of a higher social rank, who will not infrequently speak of their impotence in a joking tone, even where it might not be expected, in order thus to make you believe the contrary. I had an opportunity to observe a case where a member of the nobility was by every one considered as impotent. Under the cover of this reputation the nobleman was following up several intrigues, until at last it was discovered that this impotence was not to be relied upon. So far we have had under consideration the influence of impotence upon the mind, and have seen that it is of no slight degree. The influence of this disease upon the body is no less important. We shall here leave out of 26 si:\r.\i. IMI-MTKNCK. sight circumstances which ;iiv the cause. but not tin- consequence, of impotence, as well as circumstances which may be the consequence of spermatorrhea. The cessation of so important a process as the sexual function cannot occur without producing in and by it- self an essential change in the individual. According to Arndt, 1 there is no disturbance of any function of a man without change in the man himself. Real impotence has a powerful influence, primarily over the mind, and secondarily over the state of health of the entire body. It is conceivable that a person who is dull or mournful and always ill-humored, who is plagued by a bad thought, must by degrees lose his appetite, suffer from indiges- tion, and consequently must become physically ruined ; though, no doubt, one often meets, as previously said, impotent persons looking thoroughly well and healthy. Impotence besides being a very serious disease is also of frequent occurrence. " Experience proves that the large towns especially harbor crowds of persons suffer- ing from a diseased nervous system, who, in the different stages of life, are afflicted with sexual infirmities which throw a gloom over their existence. Youths who have scarcely stepped beyond the threshold of puberty, adults who are on the entrance or perhaps in the zenith of manhood, no less than individuals w r ho have already reached the autumn of their lives, make up elements of these numerous groups of the sexually discontented who are suffering from diseases of the nervous system as burdensome as they are unyielding. Victims of an un- equal fate, some more, some less severely wounded in the combat against untoward circumstances, unequally 1 Dip Neurasthenic. Wien und Leipzig, 1885, p. 3. INTRODUCTION. 27 furnished with chances for improvement, all these piti- able persons are nevertheless animated with the same desire, that of being once more admitted to the full en- joyment of life and being able to found a family.'' 1 " It is quite incomprehensible that there should still be physicians who almost absolutely deny the existence of impotence." z Every being instinctively longs for enjoyment. The desire for enjoyment is certainly justified, and only hypo- crites or people with limited views of things in general can demand that man shall work and fulfil duties with- out the moments of gladness and gratification that are so scarce in comparison to the bitterness of life. " La nature veut que nous jouissions.' ' 3 Sensual love and the so-called ideal love, which grows out of it, but which is quite an impossibility where there is no sexual vigor, are foremost among the few joys and gratifications. Those who are seeking help for their impotence are surely very pitiable subjects ; they feel themselves un- utterably unhappy, and, in most cases, entertain thoughts of suicide, though they seldom have the necessary cour- age to carry them out. A good man cannot refuse his assistance to them. It cannot be the physician's business to question whether one or another of them owes his infirmity to his own or somebody else's fault. Nor can it be expected from the medical man that he should in- vestigate what may be the object or aim of any patient 1 Rosenthal, Ueber den Einfluss von Nervenkrankheiten auf Zeugung und Sterilitat. Wiener Klinik, 1880, p. 136. 2 Lionel S. Beale, Our Morality. London, 1887, p. 34. 3 Renan, L'abbesse de Jouarre. Paris, 1886, p. 29. 28 SEXUAL IMPOTENT K. who is endeavoring to recover his virility. The physi- cian lias to keep in view this one object, that lie is in 1 1 ir presence of an unfortunate person whom lie must help it' he can. So much for the determining of my stand-point and to justify the total separation of impotence and sterility. And now the question suggests itself, Wht i* intjxt- f< ,,<; / It is well-nigh impossible to give a precise answer. Maximilian v. Zeissl, for instance, gives the following definition : " Impotency is a collective idea of the various pathological details which hinder a man in the carrying out of coitus, so that the ultimate purpose, viz., that of begetting a child, is not attained in spite of sexual inter- course with a fertile woman." l This definition is far- reaching, because, though we may include both the im- potentia coeundi and the impotentia generandi, it should yet be said that, in spite of sexual intercourse with a fertile woman, the begetting of a child "must" remain unattained. It is much easier to give a definition of sexual virility. Sexual virility is that condition of the body, of the nerves connected with the generative organs, of the centers of these nerves, and of the genital organs them- selves, which enables an individual to accomplish the sexual act with an acceptable woman always, under all circumstances, and within the limits set by nature. This ideal condition of virility is somewhat rare with men following the customary manner of life of our days, and in any given case it will generally last for but a short time. Every deviation from this ideal condition must, 1 Dr. M. v. Zeissl, Ueber die Impotenz des Mannes und ihre Behandlung. Wiener med. Blatter, 1885, Nr. 15. INTRODUCTION. 29 indeed, be reckoned as a starting-point of impotence. The lesser deviations are not taken into account, and are generally considered as in the nature of things. When virility is in full vigor the sight, the slightest touch, the first embrace of the desired woman must cause sexual desire and the erection necessary to the performance of the act. The individual is in the same degree approaching impotence when he requires longer preparations and longer and more intense excitation to produce the necessary sexual rousing. Of course, we leave out of question the repetition of coitus after short intervals. The reverse of this ideal condition is that state which we call total impotence, in which condition the individual can never have an erection or experience excitement, and can, therefore, never, under any cir- cumstances, perform the act of coition. As nature never progresses by leaps and bounds, so these two forms of sexual capacity do not pass abruptly from one into the other, but between them are numberless transitory forms of impotence. Although this essay is written for medical men only, who are conversant with the anatomy of the genitals and with the physiology of procreation, we shall devote a few pages to both Anatomy and Physiology. In the course of years and the throng of professional occupa- tions small matters escape the memory of the practi- tioner, and occasionally we may read again, with profit, that with which we are well acquainted. CHAPTER II. ANATOMY. WE shall now give a rough sketch of the male organs of reproduction. For more minute study we refer the n , i ler to the great number of excellent anatomical works. The male genitalia have been divided into different sections ; but as this separation contributes in nothing to the clearness of the subject, we shall simply discuss the different organs in their turn. The testicles (testes, testiculi, orchides. didymi) arc a pair of oviform, glandular organs. We shall first con- sider the coverings which protect and support thorn. Proceeding from the outside inward, we find first the outer skin starting from the perineum, from the inner surface of the upper thighs, from the root of the penis, and from the pubis, and forming the scrotum or purse. The whole of the scrotum appears asymmetrical, hang- ing a little lower on the left side. The slight enlarge- ment of the cutis forming the median raphe, which runs from the perineum forward to the inner surface of the prepuce (praeputium), separating externally the whole genital apparatus into two halves, and indicating the inner division on the scrotum, is not exactly in the median line, but draws somewhat to the left. At the scrotum we find the epidermis, cutis, and tunica dartos. The epidermis is distinguished by the amount of pigment it contains ; the cutis, by a strong 30 ANATOMY. 31 growth of hair, sudoriparous glands, and a rich rete of lymphatics. The tunica dartos is a fibrous, fleshy mem- brane, consisting of rather strong, smooth, muscular fibers, elastic, without fat, and ligamentous in character. Still proceeding inward, we next come to the tunica vag- inalis communis, which envelops the testicle and sper- matic cord. That part which surrounds the spermatic cord is loose and spongy, containing here and there adipose tissue, and is intimately connected with the spermatic cord and the scrotum. This part of the tunica vaginalis communis consists of three layers, an inner, an outer, and a median muscular layer. These layers or membranes are not in all parts distinctly sepa- rated from one another, because the musculus cremaster which separates them runs in isolated flat bundles down the spermatic cord ; between the bundles the two layers run into each other. These isolated flat fasciae of the cremaster pass in a fan-like manner downward, twining around the testicle. These muscular bundles have the power to draw the testicle upward and outward. Con- traction of this muscle ensues reflexly from violent movements of the abdomen ; also as the result of inde- pendent action. The testicle may, besides, be raised through the contraction of the muscular fibers in the tunica dartos. Immediately enveloping the testicle we find the tunica vaginalis propria, which may be divided into two layers, namely, the parietal membrane, which is connected with the tunica vaginalis communis, and the visceral membrane, which is united with the albuginea of the testicle and the epididymis. As the testicles produce the sperm, they are the most important part of the male generative organs. The tes- 32 SEXUAL IMPOTENCE. lie Irs lie side by side in the scrotum, hanging down be- tween the thighs, below the symphysis pubis, each in its own compartment, and separated from its fellow by a median membranous partition, the scphnn *<-roti. The testicles are in the abdominal cavity until the seventh month of fetal life, when they descend through the in- guinal canal into the scrotum. The left testicle hangs a little lower, this arrangement being very appropriate, as it prevents friction of the tes- ticles in case of the sudden pressing together of the thighs. In the testicle we have, first of all, to distinguish be- tween the testicle proper (Henle calls it testicular gland, others call it main or chief testicle) and the epidid- ymis. The testicles are oviform in shape, flattened laterally, with the greatest diameter four to six centimeters in length, directed obliquely from above downward, for- ward, and outward. The weight of the testicle is fifteen to 24.5 grams, its cubic contents twelve to twenty-seven cubic centimeters, its length five centimeters, its breadth 2.5 centimeters, its thickness three centimeters. Wri^lil and volume, length and breadth, are subject to great variations in different individuals, and fluctuate consid- erably even in the same individual. In spite of Henle's * opinion to the contrary, my experience teaches me that this fluctuation in the volume of the testicle corresponds to the amount of seminal fluid contained. It is true that the testicle does not collapse immediately after coition, but observation has convinced me that the volume in- creases after unusual abstinence ; so that I feel sure that 1 Handbuch der Anatomie. Braunschweig, 1874, p, 366. ANATOMY. 33 contraction of the scrotum is here not the main cause of variation. Having- noted that the testicle is an oviform body flat- tened laterally, we observe further two points, the upper and the lower, and two margins (anterior and posterior) connecting them ; also two flat surfaces, an inner and an outer. The superior point and the posterior margin are covered by the epididymis and the beginning of the seminal cord. Directly investing the testicular gland itself is the tunica albuyinea. This is a strong, fibrous membrane, brilliantly white, 0.6 millimeter thick, containing nu- merous ramifications of veins and small arteries, and becoming considerably thicker and more vascular to- ward the posterior margin. From its inner surface it sends off numerous bundles of connective tissue, and, at almost regular intervals, stronger flat transverse bun- dles, dividing the tissue of the testicle into numerous conical lobules, the number of which is placed by dif- ferent authors at from one hundred to three hundred. Each lobule contains a great number of very fine tu- bules, called xpermativ canals, or vasa seminalia. These have a volume varying, according to the degree of dis- tention, from 0.1 to 0.2 millimeter. They inosculate with one another, and are very tortuous, so that it is difficult to disentangle them. Their number is estimated at eleven hundred. As we have stated, the tunica albuginea becomes much thicker toward the posterior margin, this enlarge- ment forming what is called the corpus Highmori. Here the seminal tubes collect, three to six inosculating, and grow less arid less tortuous until they become almost straight and form the rete vasculosum (seu Halleri) testis. 3 34 SEXUAL IMPOTENCE. From this rete start about twenty larger tubes running almost in a straight line, and passing through the tunica albuginea into the epididymis ; there they form lobuli again, giving rise to that single tube with manifold con- volutions which constitutes, in the main, the parenchyma of the epididymis. Besides the seminiferous tubules, the parenchyma of the testicle contains comparatively large winding vessels with thick walls and a cellular mass, of the function of which we still know nothing positive, and which many anatomists and physiologists consider to be connective tissue. Before entering the epididymis the seminiferous tubules change in structure and become simply excretory ducts. The epididymis properly considered is merely an excretory duct of the testicle. It is a body weighing generally 1.5 grams, its cubic contents being 1.78 cubic centimeters. Its upper end is globular in form and tapers off to pass into the vas deferens. The epididy- mis is also invested with a tough albuginea, which has the same structure as the albuginea of the testicle, but is not so thick, its thickness being only 0.04 milli- meter. The inner surface of the albuginea of the epididymis also sends off septa of connective tissue into the parenchyma, dividing it into lobules, though super- ficially only. The unfolded vas epididymis has a length of about six meters, with a diameter of about 0.44 millimeter, and gradually dilates as it approaches the vas deferens. Be- sides this principal duct, the epididymis contains also one to three small blind canals, the vasa aberrantia and the so-called hydatis Morgagni, which are said to be remnants of embryonic conditions. ANATOMY. 35 At the lower point of the testicle the canal of the epi- didymis is turned directly upward in order to reach the orificium cutaneum canalis inguinalis ; it is then called the vas deferens, and, together with the vessels and nerves running in the same direction, forms the seminal cord (plexus spermaticus seu pampiniformis). The tortuosity of the epididymis continues into the first part of the vas deferens, but the tube becomes gradually more nearly straight, its walls at the same time increasing in thickness and extent. The total length of the seminal vessel is about fifty to sixty centi- meters. According to Henle, 1 the straight part is about three millimeters in diameter, one- sixth of which is taken up by the lumen, so that the thickness of the wall is 1.5 millimeters. On this thickness depend the firm- ness and cylindrical form of the vas deferens. Before the vas deferens unites with the seminal vesi- cle it forms the spindle-like ampulla of Henle. The lumen in this place becomes almost doubled in extent, the thickness of the wall increasing also. At the end of the ampulla the vas deferens grows thinner again, and has outlet in the inferior pointed end of the seminal vesicle lying at the outer part of the base of the urinary bladder, between the bladder and rectum. The end of the vas deferens forms with this pointed end of the seminal vesicle the ductus ejaculatorius. The seminal vesicles are really hollow glands of a very irregular form, resembling a very knotty, somewhat flat- tened club. Even in the same subject the two vesiculae seminales may differ in form and size. The length of the vesiculse seminales varies from four to 8.5 centi- 1 Op. cit., p. 382. 36 SEXUAL IMPOTENCE. meters, their diameter from 0.6 to 0.7 centimeter. The superior end is blunt, usually having a hump-like pro- tuberance, which, looked at from the outside, resembles a small hunch. The entire surface looks uneven or rough, the little hunch-like prominences corresponding to depressions on the inside. The interior of the seminal vesicles is still more pecu- liar, and varies just like the exterior. The mucous mem- brane is of a yellowish tint, infolded, has little pits, and forms depressions and longer or shorter divertimhr. The organ has altogether a cellular appearance. In the mucous membrane there are some peculiar glands, which, though the granular epithelium is different, have a struc- ture similar to that of the mucous glands, but produce a secretion essentially different from mucus, as it does not congeal in acetic acid. By the union of the vasa deferentia with the vesiculaB seminales the ejacufatory dud* are formed about the superior margin of the prostate gland, but with number- less variations in the share provided by the individual organs in this formation. The parietes of the ductus ejaculatorius are about 0.4 millimeter thick, the lumen one millimeter in diameter. While the lumen runs from two to three centimeters forward and downward through the prostate, it dimin- ishes in volume ; the mucous membrane, which at first resembles that of the vesicula seminalis, losing gradually its folds and its glands, as well as its yellowish tint. The two ejaculatory canals also frequently exhibit varia- tions with respect to form, course, convergence, and mutual contact. Even coalescence of the two ducts into one may take place. The ejaculatory canals lead into the prostatic part of the urethra near the verumontanum ANATOMY. 37 or colliculus seminalis, opening by circular mouths. The fact, minutely described by Henle, 1 that the muscular membrane of the ductus ejaculatorius within the pros- tate assumes the character of a cavernous tissue seems to me of special importance. The prostate, shaped like a chestnut or flattened cone, embraces with its anterior surface the neck of the blad- der and the first portion of the urethra, its posterior sur- face resting on the anterior wall of the rectum. Its texture is firm, the borders rounded off. The superior border or margin which surrounds the bladder is broader, slightly bent in the middle, while the inferior margin tapers off. The greatest diameter of the pros- tata measures thirty-two to forty-five millimeters; from the base to the point it is twenty-five to thirty-five milli- meters ; its thickness, fourteen to twenty-two millimeters. Its weight is estimated at seventeen to 18.5 grams. According to Henle, the prostate comprises three dif- ferent organs, or, rather, structures, a number of race- mose glands, the glandula prostatica ; a closing muscle of the bladder, composed of smooth muscular tissue, the sphincter vesicae internus ; and a transversely striped closing muscle of the bladder, the sphincter vesica3 ex- ternus. Besides these, w r e have to notice in the Avail of the ductus ejaculatorii, of the sinus prostaticus, of the urethra, and of the colliculus seminalis, the peculiar structure which sends off shoots into the substance of the prostata and also the exterior coat of the glandular portion, together with the separating walls or septa starting from it. The main substance of the prostata is the real gland, 1 Op. cit., p. 388. 38 SEXUAL IMPOTENCE. which does not reach complete development until after puberty, as the glandular ducts and vesiculae develop ^really al the expense of the substance of the connec- tive tissue, which predominates before puberty. They L:ive to the whole gland a yellowish-red tint and a spongy appearance. The relative proportion of the muscular fibers and the glandular substance in the prostate varies considerably in different individuals. In one subject the glandular spaces may be predominant, and in another their con- Iractible coatings, so that in one person the secreting function of the prostate may predominate, and with an- other the motory. 1 Unfortunately, we have, as yet, no observations to determine what influence this difference in the structure of the prostata has on the sexual life. The excretory ducts within the prostata unite into an indefinite number of stems, which open into the urethra at the colliculus seminalis anterior to the mouths of the ductus ejaculatorii. Two of the largest stems open al- most symmetrically, side by side, quite close to the openings of the ductus ejaculatorii ; the others, from seven to fifteen in number, open rather more in front, asymmetrically and with variations. The secretion of the prostata is of the nature of mucus, but with acetic acid congeals but slightly. We now r pass to a short description of the real organ of copulation, the penis, which, with its corpora cav- ernosa, is perforated by the urethra. The urethra, which runs from the neck of the bladder 1 Riidinger, Zur Anatomic der Prostata, des Uterus masculinus mil der Ductus ejaculatorii. Miinchen, 1883, p. 4. ANATOMY. 39 to the exterior orifice of the penis, is divided into three portions, the pars prostatica, pars membranacea, and pars cavernosa. The course of the urethra resembles the letter S, i.e., it has two bends or curves, of which the posterior retains its shape even during erection. The length of the urethra varies very much, and is from fourteen to twenty-two centimeters, the pars pros- tatica = two to 2.8 centimeters, the pars membranacea = 1.50 to 2.50 centimeters, and the pars cavernosa = 10.5 to 16.7 centimeters. There is a similar variation in the lumen of the urethra. It is narrowest in the pars membranacea, and of varying width, but least exten- sible, at the orificium externmn. In the pars prostatica the lower wall stands out, form- ing the colliculus seminalis (caput gallinaginis, verumon- tanum, crista urethralis). This is the most important part of the urethra, with regard to the subject we are treating, as it is the seat of many diseases. The caput gallinaginis begins, according to Henle, at the urethral mouth of the bladder, with two longitudinal folds, con- verging toward the median level space ; along with these two there is occasionally a third, the median fold. The caput gallinaginis may begin with a greater number of smaller folds. This crest reaches its greatest extent, in height and breadth, at about the middle of the pars prostatica, immediately before (under) the sharp bend ; it then decreases again even less abruptly, its transverse diameter diminishing at the same time. The anterior end extends, in the form of a narrow ridge, far into the pars membranacea, and often divides, toward the end, into fork-like branches at an acute angle. This description is very definite, indeed, and indicates clearly the great variations we meet in the structure of 40 SKMVI, I.MI'OTKNVK. the crista urethralis. These differences become still more numerous in consequence of disease or the frequent use <>r instruments. Age also may have a great inllunire on the formation of this organ, so that variations arc met with at every autopsy as well as at every endoscopir examination. The same thing may be said of the meas- urements of the breadth and height, stated to be about three millimeters. The mucous membrane of the crista gallinaginis is laid in small creases, which open out during erection. Besides the above-described openings of the duct us ejaculatorii and of the excretory ducts of the prostate, we find at the anterior slope of the colliculus seminalis a slender follicle without outlet, the sinus pi-o*f(itiriix (Morgagni, also utriculus prostaticus or vesicula pros- tatica). It can scarcely be determined what function, if any, this structure has. At any rate, the statement of Riidinger, 1 that the uterus masculinus has remained capable of contraction in a very high degree, in virtue of the smooth muscular fibers, which can be demonstrated in all parts, may perhaps seem to justify the assumption that it performs some functional, possibly a secretory, part or role. The pars membranacea (s. carnosa, s. isthmus) />/v7///vr is that part of the urethra which, leaving the prostata, penetrates into the diaphragma urogenitale to enter the corpus cavernosum urethra? at the inferior surface of the diaphragm ; from this point on it is called the pars cavernosa. Next to the posterior border of the diaphragm, be- tween the layers of the musculus transversus perinaei 1 Loc. cit. ANATOMY. 41 profundus, lie Cowper's glands, belonging to the racemose variety. These are two lobulated bodies, resembling a mulberry, spherical, sometimes pressed flat, and meas- uring from four to nine millimeters in diameter. Their excretory ducts, three to six centimeters long, converge and have their outlets close together in the urethra, at the end of the bulbous and somewhat dilated part of the pars cavern osa. The mucous membrane of the cavernous portion of the urethra is in longitudinal folds. Besides the outlets of Cowper's glands, it contains the very fine glands of Littr6 (0.1 millimeter average diameter) and the very small lacunce Morgagni, dot-like in appearance. The lumen of the urethra is dilated at both ends of the cavernous portion, corresponding to the bulbous part and the fossa navicularis. The entire urethra is lined with cylindrical epithe- lium, which in the fossa navicularis, and sometimes a little before, changes into pavement epithelium. Within the region of the pavement epithelium there are papillae sometimes 0.22 millimeter in height and of diverse forms. Vajda * declares that he has discovered vascular papillae of sundry sizes and shapes in the whole mucous mem- brane of the urethra, nearly as far as the pars bulbosa ; and that the pavement epithelium of the fossa navicu- laris extends over the whole surface of the urethra. The wall of the urethra consists of the mucous mem- brane, to which is annexed a layer of areolar tissue, the meshes of the latter being stretched in the longitudinal direction of the urethra. This areolar layer is, in the 1 Beitrage zur Anatomie des mannlichen Urogenital-Apparates. Wien, 1887. 42 sK.xr.w, IMPOTENCE. prostatic part, the membranous part, and the first por- tion of the cavernous part, enclosed by a layer of smooth muscular texture, with which many elastic fibers are interwoven. The areolar tissue, which constitutes the areolar layers of the ductus ejaculatorii, the pars prostatica urethra', and the pars niemhranacea urethne, is called by Henle oomtprearibU an-ulur ti^nc. in contrast with the erectile areolar tissue, of which the corpora cavernosa urethras et penis consist. The pars cavernosa urethra? is enveloped in a cylin- der of areolar tissue, which, toward the posterior end. gradually thickens to a club-shape and forms the so- called bulbus urethrae ; while the anterior part sud- denly spreads out, covers the anterior ends of the cor- pora cavernosa penis, and thus forms the glans penis. Each of the anterior ends runs off into a blunt point, which is covered by the anterior expansion of the corpora cavernosa urethras. The corpora cavernosa penis are a pair of bodies of cylindrical shape, slightly flattened on the inside. They come in contact in the even median surface, while their posterior ends, the so-called roots, diverge and fasten themselves on the inner surface of the lower border of the inferior branch of the pubis. The superior and lat- eral surfaces of the corpora cavernosa can be felt through the outer skin, while the inferior surfaces in their contact form the urethral furrow for the reception of the corpus cavernosum urethrae. We must be brief in the description of the corpora cavernosa, as details would lead us too far. Each cor- pus cavernosum has a ligamentous, brilliant white tegu- ment, consisting of connective tissue and elastic fibers, ANATOMY. 43 in which there are a few very sinuous blood-vessels. This cover, called albuyinea of the corpora cavernosa, is about two millimeters thick when the member is flaccid, but grows much thinner when the corpora cavernosa are filling. From this albuginea proceed into the interior of the corpora cavernosa transverse vascular bundles of con- nective tissue, consisting of elastic filaments and smooth muscular fibers, and parietes or septa, with small inter- stices between. Thus is formed the spongy texture of the corpora cavernosa. These small interspaces are coated with vein epithelium ; all are interconnected by emissaries. Henle asserts that these interspace's are vascular plex- uses between the ends of arteries and the beginnings of veins, as neutral in character as the capillary rete of other tissues. They may be considered capillaries which have dilated and run together at the cost of the inter- mediate tissue, partly through atrophy of the latter, and which have reduced the intermediate tissue to a number of transverse bands and leaf-like septa, in which run some supplying vessels as well as ordinary capillaries of the usual diameter. We omit as unnecessary a description of the cutis of the prepuce, the frenulum, and, in a word, of the exte- rior of the penis. Every physician is aware of the indi- vidual differences in the volume of the entire penis, of the length and form of the prepuce. The inner surface of the prepuce is devoid of hair, smooth, and shining. The surface of the glans when the member is flaccid is slightly furrowed, and conse- quently dull in appearance ; during erection it becomes even and shining. There are numerous sebaceous glands 44 SEXUAL IMPOTENCE. on the arched surface of the glans, on the prepuce, and around the frenulum ; moreover, there arc many papilla 1 HiH'tTing in number and size. Sometimes single papilla 1 are found also on the inner surface of the prepuce \vlnn it joins the corona. CHAPTER III. PHYSIOLOGY OF THE SEXUAL ACT. WE shall now consider the male sexual functions, leaving fecundation out of the question, and shall give our attention to a short sketch of the physiology of coitus alone, without mentioning the processes which cause fecundation. Besides, in the following chapters we shall pay due attention to the physiology of our subject. It is generally asserted that, with regard to procreation, nature has imposed on the woman all the burdens, and reserved only pleasure for the man. This is so, indeed, if we take into consideration that the woman, after con- ception, has to carry and nourish the fruit in her body for nine months and then undergo the labor of parturi- tion. So far as coitus is concerned, however, in and for itself, the greater part. devolves upon the man, and, more- over, in comparison with the woman, he is at a great disadvantage. I shall not dwell longer on this subject, as, strictly considered, it does not enter into the frame- work of our purpose, and I shall make the man alone the object of my discussions. Sexual Maturity. In order to perform normal coitus the individual must be in possession of all the qualities necessary ; in the first place, he must have attained puberty. In our climate males reach puberty, on an average, at the age of seventeen. Puberty announces itself by various exterior signs, the most striking being 45 46. SEXUAL IMPOTENCE. the alteration of the voice, which grows deeper and sounds rough and broken during the period of sexual development known as the age of puberty. This deepen- ing of the voice is caused by a certain series of < -liaises in the larynx : the processes vocales become cartilaginous, the' larynx larger and protruding, the vocal cords lengthened. Furthermore, the bones and muscles grow stronger, the lungs larger; the pubic region becomes covered with hair. But the greatest changes occur in the genitals, the testicles enlarging and beginning to secrete. The tissue of the penis, capable of enlarging, develops disproportionately, and the prepuce loosens from the glans. The sexual impulse awakens, and, if not satisfied, results in pollutions. This transition of the child into a pubescent man re- quires about two years for its accomplishment. Thus, generally speaking, the young man would be nubile ;il the age of seventeen. Here I must assert my opinion, in opposition to others, Roubaud, for instance, who says that spermatozoa are never found in the semen of youths under eighteen years of age. I have repeatedly discovered perfectly developed spermatozoa in the semen of Frenchmen. Italians, Croatians, and Hungarians hardly sixteen ye; us old. I must remark, however, that most of these were youths who sought for sexual gratification prematurely. About eleven years ago I performed the autopsy of a sixteen-and-a-half-year-old shepherd, who had been a< - cidentally drowned, and whom his comrades had de- clared to be an onanist. I found in the testicles, as well as in the excretory ducts, spermatozoa in every grade of development. I also found a great quantity of sper- matozoa in the semen of the second pollution of a Croa- PHYSIOLOGY OF THE SEXUAL ACT. 47 tian peasant boy, who was not quite sixteen years old, who was not an onanist, and who had not had sexual intercourse with the opposite sex. The individual retains his power to perform the sexual functions during a greater or less period of his life. There are people who, in their fiftieth year, become sexually useless in a quite normal manner, according to constitution, temperament, and habits. On the other hand, it is impossible to state any age at which there have not been or may not be -men sexually capable. The procreative power is, however, most likely to be extinguished after the age of sixty, whilst the capacity for intercourse is certainly preserved much later. Girault found that the spermatozoa change after the fifty-fifth year, the heads growing larger and the tails shorter ; this alteration certainly not contributing to their power of movement. Sexual Orgasm. The copulative power requires not only that the individual be virile and his sexual instinct unextinguished, but also that he be capable of having the sexual orgasm (libido sexualis), which is a combi- nation of centrally or peripherally roused fancies and pleasurable sensations associated therewith. The libido sexualis is very frequently in itself a peripheral excite- ment, and in the sexually virile the center of erection acts promptly through the afferent and efferent nerves. We shall see in our future considerations that there are many cases where the impotence is merely a consequence of complete or incomplete absence of sexual excitement. We shall see that anything capable of distracting the sexual excitement at the given moment, to divert the run of ideas from the sexual track, is also capable of causing sexual impotence, be it only for the moment. 48 s i:\r..\L IMPOTENCE. \Vliiit is il. then, speaking generally, that can cause the sexual orgasm ? If tlie human male is left to him- self and nothing comes to disturb the natural course, lln- first sexual rousing will not occur until he has reached tin- state of full sexual maturity; when the testicles, spermatic ducts, and vesiculae seminales are filled with sperm. This first sexual excitement would occur even if Hie individual should have no idea of sexual things, whirh, probably, would be exceptional. This is a proof that the accumulation of sperm in the seminal organs may and must occasion sexual excitement quite inde- pendently of the will of the individual. On the other hand, we see that sexual excitement takes place with persons whose seminal organs are anything but full of sperm. It is evident that here the sexual excitement comes about through mental impressions. The center for mental impressions is in the cortex cerebri. There- fore sexual excitement may be caused through the me- dium of the cortex cerebri, and this is generally the case. We see individuals whose sexual sense is deadened in such a wise that the psychical impressions alone can no longer bring about sexual rousing. Such people have generally no sperma in their spermatic organs to cause the rousing, and yet they are known to accomplish coi- tion. It is well known that these persons are in the habit of putting themselves into a state of sexual excite- ment by irritating the exterior part of the organ, and sometimes have recourse to the most loathsome manipu- lations. Indeed, we see that the most diverse irritations, prac- tised on the outer and the inner nerves of the sexual organs, cause libido sexualis. Thus, for instance, inci- dental friction of the genitals by too tight garments, the PHYSIOLOGY OF THE SEXUAL ACT. 49 introduction of a sound or a catheter, an inflammatory or catarrhal condition of the urethra, pressure of a full bladder or of the rectum, anal fissures or hemorrhoidal ulcers, irritation by worms or by urine containing some medicinal or certain alimentary substances, all these may cause hyperemia or secondary libido sexualis. Finally, it is known that from the most diverse organs sexual erethism can be aroused ; above all, from the organs of the senses, particularly the organs of sight, touch, and smell. It must be observed, however, that these cause sexual excitement indirectly only, by means of the central organ, the cortex cerebri. The sight of a beautiful woman, the touch of certain parts of the body of a woman, the agreeable odor of a woman, a lascivious picture, all are apt to bring about sexual excitement, but only in so far as such impressions on the senses give rise to some idea or recollection in the central organ. Sexual excitement may arise, therefore, in three dis- tinct ways: (1) reflexly and naturally, through the ac- cumulation of sperm in the seminal organs, in which case there is no intervention of the cortex cerebri, the seat of sensation and ideation ; (2) psychically, the most frequent way, through ideas, consequently through the activity of the cortex ; and (3) unnaturally, by means of direct excitation of the sexual organs. I leave out of question here single and rare cases, in which it is pretended that the sight of an object in no way related to sexual things, odors certainly not coming from a woman, the touch of objects not in any relation with woman, the eating of certain food not physically aphrodisiac, or even impressions on the sense of hearing, have produced sexual excitement. Obser- vations of this nature, if they do not belong to the prov- 4 50 SEXUAL IMPOTENCE. of table or arc not based upon error, can be made only upon individuals psychically abnormal, and in most cases can be traced to fancies or recollections. Thus we see that in sexual matters the (<>,!<.< <<,-< />/ -i n/nl tlic xcxual organs are in nnifiKif/i/ SKXUAL IMPOTENT!-;. explained. The researches on this subject by Kolliker, liou-el, L.niiici. Eckhard, Goltx, Loven, and Frey are hi- lily meritorious, it must be admitted, but the wrr/m ///*/// n/ erection has still its mystery. We know that erection is the result of an increased influx of blood into the areolar tissue of the corpora cavernosa, together with a decreased outflow of blood from the same bodies ; but we are far from understand- ing the cause of that afflux, often quite sudden, and of that checking of the outflow. At first an attempt was made to explain the process by the macroscopic ana- tomical relations. It was supposed that either the outer transversely striped muscles or the inner smooth mus- cles exercise a pressure on the efferent veins. Kolliker's opinion was that the relaxation of the smooth muscles caused erection. Opposed to this opinion is the theory that the smooth muscles in the walls of the cavernous spaces do not possess alone sufficient strength and energy to influence erection to such a degree ; for when the nervus dorsalis penis, which innervates the transverse fibrous bands of the areolar tissue of the penis, has been severed the erectile power is reduced. Eckhard has even painlessly irritated the nervous dorsalis penis of dogs under chloroform without producing an erection ; nor has an erection ensued after the excitalion of the central end of the severed nervus pudendus coin- munis of a dog. 1 If it were not for these experiments, much might be said for the opinion of Kolliker ; for, if these muscles were powerful enough, their contraction 1 Eckhard, Ueber den Verlauf der Nerven erigentes innerhalb des Rttckenmarke und Gehirns. Beitrage zur Anatomie und Physi- ologic, Band vii. Heft 1, p. 70. PHYSIOLOGY OF THE SEXUAL ACT. 53 would certainly prevent an erection. On the other hand, the fact that warmth causes a dilatation and cold a con- traction of the corpora cavernosa speaks with some force for the influence of the smooth muscles. However, this is not sufficient for an explanation of erection, and con- sequently other theories regarding- the physiological pro- cess of erection have always been sought. Thus, Eck- hard obtained, through his experiments upon animals, the following results : Erection can be caused in rabbits by faradization of the lumbar and cervical regions of the cord, the pons Varolii, and the peduncles of the cerebrum, while irritation of the cerebellum alone has no such effect. 1 Eckhard is therefore of the opinion that the seat of erection is in the cerebrum, and that the nerves which bring about erection, starting from the cerebrum, run downward in the medulla spinalis. Goltz, in his experiments upon dogs, cats, and rabbits, found that erection can be caused by excitation of the glans, bladder, and rectum, even after the spinal cord has been severed at the upper border of the lumbar region, and that it is also possible to cause ejaculation of sperma after destruction of the lumbar region of the cord, even though the capability of erection has been entirely extinguished. 2 The result of these experiments on animals corre- sponds with clinical observations in cases of injuries and diseases of the spinal cord. Further experiments have shown that in the cerebrum and in the uppor portion of the spinal cord there must be inhibitory nerves affecting 1 Eckhard, op. cit., p. 77. 2 Goltz, Ueber die Functionen des Lendenmarks des Hundes. Pfliiger's Archiv fiir die gesammte Physiologic, Band viii. Heft 8 u. 9, p. 464. ;-, I SKXTAL IMPOTENCK. eiv< lion; because, alter section of the cord at the upper border of the lumbar region, croc-lion can be caused more easily and more vigorously by means of electric irritation. \\'e have sreii Dial erection is caused by afflux of arte- rial blood and an obstructed outflow of venous blood. Krection cannot, however, be brought about by mere compression or ligation of the veins. That an increased flow of arlerial blood takes place is proved by the lower- ing of the blood-pressure in the neighboring inguinal arteries, and even as far as the artoria crural is. as shown by the manometer. How this increased arterial afflux is caused is not yet explained. Certainly the- accelera- tion of the heart's action which always takes place during sexual erethism can have but a very slight influ- ence. Possibly, the arteries of the penis, in consequence of the sexual erethism, become dilated, and thus admit more blood. The question is, Has this erethism a para- lyzing influence on the muscles of the walls of the vessels, or is it an invigorating effect, causing the contractions to become more energetic and more frequent, and the arteries to pump, so to speak, a greater quantity of blood into the mesh-like spaces of the penis ? Goltz endeavors to explain the act in this way : " I share the opinion of those who compare the connection of the nervi erigentes with the penis to that of the vagus with the heart, or the chorda tympani with the vessels of the glandula submaxillaris. The progress of blood through the penis is considerably hindered during, the time of physiological rest ; for then the small arteries of the penis and other vascular spaces are in a state of mod- erate contraction. Very likely this state of tension or firmness of the vessels of the penis is maintained by the PHYSIOLOGY OF THE SEXUAL ACT. 55 action of the small ganglia whose presence in the penis has been proven by Loven. The pressure of the in- going blood dilates the arteries ; when the resistance is removed the blood flows more freely through the areolar tissue into the erectile bodies, and puts them into a state of turgescence. Being, then, with Loven, inclined to consider the peripheral ganglia the tonic center of the vessels of the penis, we must suppose that the nervi erigentes during their activity paralyze or check these ganglia in the same way that the vagus checks the activity of the ganglia of the heart." * Goltz saw this opinion confirmed by the fact that he succeeded in proving ex- perimentally that reflex erection of the penis could be prevented by a more intense irritation of the nervus ischiadicus. 2 Such experiments, if continued, will no doubt at some future time result in a complete explanation of the mech- anism of erection, though for the present the practi- tioner can obtain but unimportant benefits from the above researches. Experience teaches us that erection can be either caused or checked by different impressions from the most varied parts of the body. It is certain, however, that the cerebrum is the place of origin of the sensations of sexual excitement. With this higher center is con- nected, by intercentral nerve-channels, an inferior, me- chanical reflex center, which has its seat in the lumbar region of the cord, and governs the performance of the 1 Goltz, op. cit., p. 466. 2 Compare : Prof. Dr. A. Spina (Prague) : Experimentelle Bei- trage zu der Lehre von der Erection und Ejaculation. Wiener med. Blatter, 1897, No. 10-13. 56 SEXUAL IMPOTENCE. act of copulation. 1 It is probable that from tin- spinal cord issue some special nerves which straighten the erectile vessels or else diminish their extensibility. 2 When erection is accomplished, the penis is in a con- dition that makes penetration possible. We shall now direct our attention to the process of coitus. Roubaud 5 describes it as follows : " The moment the membrum virile enters the vestibulum, the glans penis rubs itself first against the glandula clitoridis, which is situated at the orifice of the sexual canal, and can yield and bend in consequence of its place and of the angle it forms. After this first excitement of the two centers of sensa- tion, the glans penis glides over the borders of the two bulbi ; the collum and corpus penis are enveloped by the prominent parts of the bulbi, while the glans, having penetrated deeper, has come into contact with the line and delicate surface of the mucous membrane of the vagina, which itself is elastic by virtue of the erectile tissue between the membranes. This elasticity, which enables the vagina to surround the body of the penis closely, also increases the turgescence and, consequently, the sensibility of the clitoris, by conducting the blood, driven out of the vessels of the vaginal walls, to the bulbis and clitoris. On the other hand, the turgescence and sensibility of the glans penis are heightened by I he compressive action of the tissue of the vagina and <>f the two bulbi in the vestibulum, which tissue becomes more and more turgescent. Moreover, the clitoris, pressed downward by the anterior portion of the musculus com- 1 Goltz, op. cit., p. 473. 1 Eckhard, op. cit., p. 80. 8 Traite de 1'impuissance et de la sterilite. Paris, 1876. PHYSIOLOGY OF THE SEXUAL ACT. 57 pressor, meets the dorsal surface of the glans and cor- pus penis, and causes friction. This mutual friction at every motion during copulation affects both individuals, and leads finally to that high degree of orgasmus which induces, on the one hand, the ejaculation, and, on the other, the reception of the seminal fluid in the open orifice of the neck of the uterus. " The question has been asked and many earnest investigators have tried to answer it whether the greater share of pleasure falls to the man or the woman in these moments of the greatest intoxication. This question has received the most contradictory explana- tions, like all questions that rest on essentially different and varying bases. Indeed, taking into consideration all the circumstances which influence the sexual sense, I do not believe that it is possible to solve the problem a priori. If we consider how much the sexual sense is influenced by the temperament, the constitution, and a great many other circumstances, special as well as general, we shall be convinced that this question is far from being solved nay, is insoluble ; and this is so true that we meet with difficulties even if we want to draw a true and perfect picture of coitus : while with one indi- vidual the sensation of voluptuousness manifests itself merely by a slight quivering, it will reach, with another, the climax of exaltation, moral as well as physical. Be- tween these two extremes there are innumerable grada- tions. Increased rapidity of the circulation of the blood, violent pulsation of the arteries, the retention of venous blood in the vessels by the contraction of the muscles, in- creases the general warmth of the body. The stagnation of the venous blood becomes still more decided in the brain, on account of the contraction of the muscles of the neck 58 SI. XTAL IMPOTKXCK. ;ind because the head is bent backward. All this causes a Iransitory congestion of the brain, during which reason ami all the mental facilities an- lost. The eyes, reddened by the injection of the conjunctiva, become staring, the look becoming unsteady; or, as is more generally Hie case. Die eyes close convulsively to avoid contact with light. The respiration is gasping with some, whilst with others it is interrupted by a spasmodic contraction of the larynx; and the air, compressed fora time, forces an issue at last, in connection with disconnected and in- comprehensible words. The nerve-centers, as was just said, give confused impulses : movement and sensation are in indescribable disorder: the limbs are seized by convulsions, sometimes also by cramp ; they move in all directions, or stretch themselves and grow as stiff as bars of iron ; the jaws, pressed together, make the teeth gnash ; and some individuals go so far in their erotic delirium as to bite to bleeding a shoulder that the partner may have exposed incautiously. " This frantic condition, this epilepsy, this delirium, generally lasts only a short time, but sufficiently long to exhaust completely the strength of the organism, espe- cially with the man, where this hyperexcitation ends with a more or less abundant loss of sperm. Then fol- lows a state of exhaustion, the intensity of which is in proportion to that of the previous excitement. The sudden weariness, the general weakness, the inclination to sleep, which take hold of the man after copulation, are to be ascribed partly to the expulsion of spenna ; because the woman, however energetically she may have co-operated in the act, feels only a passing lassitude, which is far less than the weariness of the man, and which allows her, after a much shorter lapse of time, to repeat PHYSIOLOGY OF THE SEXUAL ACT. 59 the act. ' Triste est omne animal post coituni, praeter mulierem gallumque,' says Galien, and this axiom is, in substance, correct as far as the human race is con- cerned. "From this moment the further function of generation is not attended with consciousness ; the part of the man is at an end, and the woman begins now to bring her capabilities into action." I have quoted entire this classic description of the act of copulation, although I cannot agree with all the details expressed. The mechanical act being so universally known, further comment on it is quite superfluous ; in- deed, it would be difficult to say anything new or differ- ing from that already related by Roubaud. It would seem, however, incorrect to assume that the hyperemia of the clitoris should depend on anemia of the vaginal walls caused by the friction of the penis. If the act is normal that is, if there is not too great a disproportion in the size of the respective genital parts there cannot possibly be any such pressure exerted on the vaginal walls as to cause an anemia, on account of the great elasticity of the tissue. This observation is merely made incidentally, as this point does not enter into a consider- ation of our subject. Ejaculation. Coitus ends, for the man, with ejacu- lation, after which the erection gives way in most cases. Occasional exceptions occur, however, though this is contrary to the usual opinion. With particularly vigor- ous men the relaxation of the member is not so rapid, and an immediate repetition of the act is possible, and is actually practised by men who do not care particularly about cleanliness. If, after ejaculation, the man con- tinues the movements of coitus, it is done generally out 60 SEXUAL IMPOTENT!', of gallantry toward the partner; all that the man wauls after ejaculation is rest. Of coitus it may be said with full justice. " Finis coro- nal opus," for ejaculation, the end of the act, is also its most essential and decisive part. The process in ejacu- lation has been observed to some decree, but only in animals. The effect of the friction on the sensitive glans is communicated to the musculi ischiocavernosi, called by Visale erectores penis, and to the musculi bulbocaver- nosi, which contract and convey more and more blood to the glans. This superabundance of blood invades the prostate and the neck of the bladder also, thus com- pletely closing the bladder. By the continued irritation the contents of the ductus ejaculatorii, the prostata, and the seminal vessels are expelled, these fluids combined constituting the ejaculated sperma. It is probable that the muscles of the prostata and of the pars membranacea contract first, and then are immediately followed by the musculi ischiocavernosi and bulbocavernosi, which are much stronger and constitute the principal element in ejaculation. The center for ejaculation has been proven, by Budge, to be at the level of the fourth lumbar vertebra. With the contraction of the prostata begins an in- tensely voluptuous sensation, but, in case the move- ments of coitus cease here, the ejaculation can be re- tained, which possibility is frequently taken advantage of by persons expert in coition. Ejaculation takes place also in nocturnal pollutions. Here the excitation, caused by other conditions, leads also to a contraction of the muscles, and if the sleeper awakes before the musculi ischiocavernosi and bulbocavernosi are contracted, he may prevent the issue of semen. PHYSIOLOGY OF THE SEXUAL ACT. 61 Ejaculation is accompanied by an intensely pleasur- able sensation, which is dependent on the exciting of the sensitive terminal branches, or rami, of the nervus pudendus running out into the glans. A number of these rami end in the genital nerve-bulbs. The bulbi, irritated by the friction against the stretched surface of the glans, covered with delicate skin, lead this irritation toward the center. Ejaculation, as we have seen, is the physiological process by means of which the sperm is sent forth to- ward the mouth of the uterus. The Semen. We must now turn our attention finally to the product of the male genital organs, viz., the semen. Hippokrates considered that the whole body was em- ployed in the production of the semen. We know that this fluid is a mixture of the products of sundry glands within the sexual apparatus of the male, and that it con- sists of the secretions of the testicles, the epididymes, the vasa deferentia, the seminal vesicles, Cowper's glands, and the prostata. Ebner has very thoroughly studied the process of the preparation of the sperma in sections of the testicles of rats, and found that it proceeds from special cells, ending in lobules, and advancing like columns toward the inner portion of the canal. The cells are called spermafoblasts. Within a seminal canal are to be found, at the same time, all the different degrees of spermatic formation ; all the forms of development repeat themselves about twice within the space of from ten to fourteen millime- ters. Landois, who worked at the same time and indepen- 62 SEXUAL IMPOTENT I ]. dri illy of Ebner, obtained the same result. He calls these spermatoblasts spermatic ears or spikes. 1 Many dittnvul views prevail with regard to details in the preparation or production of spernia, and this sub- ject is far from having a satisfactory explanation. Quite new are some results to which von Bardeleben came in I lie course of his researches, which, if confirmed, will revolutioui/.e all our views upon the subject. The seminal ro/'y>//.s-r/rx are the product of the testicles. Every corpuscle shows three characteristic portions, viz., a head, a middle piece, and a tail. The head is stained by canniu, and therefore is to be considered the nucleus. The middle piece has the form of a deli- cate little rod, or of a cone, and connects the head with the thread-like tail. This middle piece is stained by iodin more than is the head. The whole semen cor- puscle measures 0.051 millimeter, of which the head forms 0.005, the middle piece 0.006, and the tail 0.04. The tail is the principal motor organ of these sper- matozoa, the mechanism of motion being explained dif- ferently by different investigators. The energy of motion of the individual corpuscles is variable. Hensen 2 esti- mates the time of half an oscillation at at least one- quarter of a second during the continuance of full vital power. The rapidity of the movement forward is be- tween 1.2 and '2.7 millimeters, or, according to others, 3.6 millimeters per minute. The semen corpuscles, formed in the testicles, remain 1 Landois, Lehrhuch der Physiologie. Wien und Leipzig, 1893, p. 1012. 2 Physiologie der Zeugung. Hermann's Handbuch der Physi- ologie, Band vi. Theil 2, p. 92. PHYSIOLOGY OF THE SEXUAL ACT. 63 there until they are discharged in the usual manner of seminal expulsion. It is hard to believe that spermato- zoids once formed are reabsorbed. There are, it is true, some isolated observations which seem to support the idea ; as, for instance, Schweiger observed spermatozoids of a young ram undergoing granular decay ; this and Kehrers experiments in applying ligatures to the vas deferens of rabbits are well-known cases. Finally, as a curiosity, may be mentioned the reabsorption of urine in the bladder, described in the British Medical Journal. 1 Recently the question of the absorptive power of the bladder has been ventilated cum studio, but somewhat, also, cum ira. While Alapy 2 comes to the conclu- sion that absolutely nothing can be absorbed by the bladder itself, Hottinger's 3 experiments seem to prove the contrary. If we remember that a limited absorp- tion can be accomplished even by the skin, it is hard to understand why the intact bladder should not, under favorable circumstances, be able to absorb" to some extent. Dr. Gerota, of Bucharest, 4 showed by a series of micro- scopic plates that, while there was imbibition on the part of the mucous lining of the bladder, there was no real active absorption. The philosophical discussions of Gosselin, Haller, and others show only that these men had no correct con- ception of the sexual functions of the man. 1 Black, On the Functional Diseases of the Urinary and Repro- ductive Organs. London, 1875, p. 157. 2 Centralblatt fur die Krankheiten der Harn und Sexual Organe, 1896, p. 328. 3 Ibidem, p. 333. * Medica-l Record, September 18, 1897. 64 SKXITAL IMPOTKMT, To me this theory of reabsorption of semen is com- parable l< Ihe notion that a cold can be caused by the absorption of perspiration, which Hebra, in his lectures, ridiculed whenever an occasion arose. Hensen 1 says, in referring to the above, "We require better proofs to establish a normal decay. Decaying of elements in UK sperma would of necessity be so unprofitable, even dangerous, for the race that some contrivance to excrete them would long since have formed." Hensen thinks that the sperma, being slowly formed, will gradually be driven or pushed out of the ductus ejaculatorius, in case pollutions alone do not favor the continued renewal of sperma. Hensen, therefore, supposes a physiological spermatorrhea. This also is an assumption which would likewise require demonstration. I, myself, during I In- years 1884 to 1888, made observations on this sub- ject, and, although they may not constitute a conclusive argument against Hensen's assumption, I will state them as an incentive to further investigations. During two years I have, with special care, repeatedly examined the urine and urethral mucus of two perfectly healthy and vigorous-men, aged twenty-nine and thirty- four, who were absolutely continent and had had no seminal emission ; and I have never found even a trace of spermatozoids. The younger of these men, a clergy- man, submitted to this examination on account of a friendship of long standing between us and his love of science. Before the first discharge of urine in the morning, for seventy-five successive days, I examined carefully, with the microscope, the urethral mucus, which was small in quantity, and then every discharge 1 Op. cit., p. 93. PHYSIOLOGY OF THE SEXUAL ACT. 65 of urine ; but never found as much as a trace of a sper- nmlozoid. I lay especial stress upon this as opposed to the assertions of Black, 1 who states that he had frequently found seminal filaments in the urethral mucus after alvine evacuations in healthy men. The above-mentioned man, thirty-four years of age, had been married, but his wife died of phthisis six years before I began my observations upon him. He had lost his two children by diphtheria in the same year. The unfortunate man grew melancholy and for some time felt no sexual desire. Later on he had pollutions and violent sexual desires ; but he overcame them, and after four years of absolute continence he seldom had erec- tions in the mornings, and thought no longer of sexual passions. He asserted that formerly he had been vigor- ous in coitus and had indulged daily. The twenty-nine-year-old man had masturbated at wide intervals from the age of sixteen to twenty-three. He struggled against this " sinful practice," as he called it. with all the power of his exceptionally strong char- acter. He finally mastered his passion. For two years his occasional pollutions grew less frequent, and for three years past he has had no emission of sperm in any way ; sexual desire visits him seldom, though he has erections every morning. Still more characteristic is the following observation. A professor at a university, thirty-nine years old, and of large and powerful build, has been married for fourteen years, enjoying good health. His wife, often sickly, dis- inclined to sexual intercourse, is absent for months ; hence a forced continence for long periods. As soon as 1 Op. cit., p. 63. 5 66 SEXUAL IMPOTENCE. this goes beyond a month there appears a slight but painful swelling of the testicles. He finds himself com- pelled to indulge in sexual congress at any cost, during which he emits unusually large quantities of sperm, and the swelling and pain in I lie testicles vanish as if by magic. I claim no conclusive credit for the above three obser- vations ; but they, together with a number of others, of which I may have to speak in connection with impotence as a result of continence, confirm me in the opinion that sperm once formed will, if it is not expelled in any of the usual ways, at first hinder, and finally stop, the pro- duction of new semen. It would indeed be interesting to know what becomes of this stored-up semen. The only chance for clearing up this question would seem to be an autopsy of persons who, after long continence, have died suddenly ; but such an opportunity will sel- dom be offered. The third observation of these three individuals seems to prove that, in some cases of conti- nence at least, the production of semen is not only not retarded but actually increased, so that the accumulation of sperm becomes so great that it causes the testicles to swell and become painful. What is commonly called semen consists of the sper- matozoids, formed in the testicles, to which are added the secretions of several glands situated in the terminal portion of the vasa deferentia, the so-called ampulla ; there is added also the secretion of the walls of the vesiculae seminales. The latter are not real glands but canals ; their inner surface is much increased by folds and villi, and their secretion helps mostly in diluting the sperm. It does not seem to me satisfactorily determined PHYSIOLOGY OF THE SEXUAL ACT. 67 whether the vesiculce geminates are secreting glands or merely receptacles for the sperm. The new experimen- tal researches about the physiology of the seminal vesi- cles by Rehfisch * are very interesting, but do not reveal any important or new points. It is probable that the vesiculae seminales and the ampulla? of the vasa defer- entia have two functions, viz., to serve as receptacles, and to produce an albuminous secretion that attenuates the sperm. The contents of the ampullae and of the vesicular seminales of fresh cadavers have all the char- acteristics of ejaculated sperm, but are poorer in sperma- tozoids. Henle 2 endeavors to explain this fact by sup- posing that at the last moment of coitus that portion of the vas deferens nearest to the ampulla evacuates its contents more quickly. To the semen, attenuated as above described, is later added the secretion of the prostata and of Cowper's glands. Eckhard obtained by irritation, from the prostata of a dog, a secretion which had the specific gravity of 1.012, one per cent, of albumen and 2.4 per cent, of solid constituents. The relation of the prostata with its secretion to the semen is not clearly demonstrated, as it is still a ques- tion whether the secretion of the prostata is added at all to the seminal fluid. Henle 3 is quite right when he says that the seminal fluid in the ampullae of the vasa deferentia and in the vesicula? seminales, although closely resembling the ejaculated semen, is poorer in sperma- Deutsche rned. Wochenschrift, 1896, No. 16. Op. cit., p. 389. Op. cit., p. 401. <;s SEXUAL IMPOTENCE. toxoids. Hence what needs explanation is not an atten- uation of the semen, hut an actual increase in sperma- loxoids. llenle says further: u It is scarcely reasonable to suppose that the function of the proslala is In aid n- ualr the semen, as the principal mouths of the prostatic duds are situated behind the summit of the colliculus scininalis, and 'the latter seerns to shut off the urethra during erection. Finally, as far as my knowledge ex- tends, the concentric concretions, which are seldom wanting in Hie ^lamlnla prostatica of old men, and which are often found in the outlets of the prostata, arc not found in the ejaculated semen." Henle asks, "Is 'the prostata connected perchance with erection, and does it furnish the mucous fluid which oozes from the mouth of the urethra after continued erection ?" Finally, it is held that the mucus of Co trj ><>'.< wr- vationscan easily be explained, inasmuch as examinations made on old men lead to different conclusions from those made on vigorous and perfectly virile young men. Before I refer to some of my own observations, I wish to observe that of necessity it has not always been possi- ble to make the microscopic examinations immediately after coition, nor at an equal length of time after copula- 1 Compare Ultzmann, op. cit., p. 4. PHYSIOLOGY OF THE SEXUAL ACT. 73 tion ; and, furthermore, the frequency of coition could not be regulated by the investigator. The sperma was invariably taken in the largest quantities possible, and was preserved in glass tubes, which were sealed and so placed that neither air nor light could affect the contents. All the microscopic examinations were made with a No. 3 ocular and a No. 7 objective of a Wetzlar microscope. OBSERVATIONS ON SUBJECT NUMBER ONE. A vigorous and perfectly healthy man, twenty-nine years old, who performed coition on an average once a day. The microscopic examinations gave the following results : From October 1 to October 9 one coition per day ; on October 9, examination of sperma nine hours after co- ition ; result, few spermatozoids, mostly dead, not well developed; but the few still moving are very lively, although mostly young forms. October 10. One coition ; sperma not examined. October 11. Sperma examined eleven hours after co- ition ; result, few spermatozoids, all dead. October 12. Examination nine hours after coition ; no spermatozoids. October IJf.. Coition after a lapse of forty-nine hours ; examination eight hours afterward ; result, about thirty spermatozoids, few alive, movement slow but very ener- getic. The coitus having been performed with a woman whose menses had begun, there is a blood-corpuscle (I could never discover blood-corpuscles in the ejacula- tions of so-called continent persons, as reported by Richard *) ; a few seminal filaments join the blood-cor- 1 Histoire de la generation. Paris, 1883, p. 159. 74. SEXUAL IMPOTENCE. puscle, but, after a momentary effort, push the corpuscle aside. October 17. Coitus after forty-eight hours' rest; ex- amination eight hours later; result, about fifty dead fila- liirllts. October 18. Coitus after sixteen hours' rest; exam- iimlion sixteen hours later; result, many spermatozoids had died, a few had been ejaculated dead. On the same day, the sperm of a coitus, being the third within twenty-four hours, was examined ten hours after coition ; result, very numerous spermatozoids, movement very energetic and as if with a purpose in view. October 20. One coition after an interval of forty- eight hours ; examination ten hours after ; result, fifty spermatozoids, all dead but a few. Second coition, one hour after first ; examination nine hours later ; result, spermatozoids very numerous and exceedingly lively ; scarcely one-third had died. October 21. Coition after an interval of twenty-three hours ; examination eight hours later ; result, numerous spermatozoids, all living. October 22. Coition after sixteen hours' rest ; exam- ination sixteen hours later ; result, fewer spermatozoids ejaculated alive, and, with few exceptions, all had died prior to my examination. October 23. Coition after thirty hours' rest ; examina- tion seventeen hours later ; result, very many sperma- tozoids, but nearly all had died ; besides a few ejaculated dead. Similar results from examinations of sperm from same individual on October 24 and 25. October 28. Coition after sixty-four hours' interval ; PHYSIOLOGY OF THE SEXUAL ACT. 75 examination eight hours later ; result, about sixty sper- matozoids, which had nearly all died, but one-third of them had been ejaculated dead. October 29. Coition after six hours' rest ; examination two hours later; result, very numerous, active sper- matozoids, only a few ejaculated dead ; very few had died. October 31. Coition after fifty-eight hours' interval ; examination sixteen hours later; result, spermatozoids few in number, nearly all ejaculated dead ; the rest had died. Xon'inbcr /. Coition after fifteen hours' rest; exami- nation one hour later ; result, rather more spermatozoids, nearly all alive, though not moving with energy ; others ejaculated dead. On same day, a second coition after fifteen hours ; ex- amination ten hours later ; result, spermatozoids numer- ous, lively, only a few ejaculated dead. SECOND SUBJECT FOR OBSERVATION. Powerful man, thirty years old, healthy, though in- clined to obesity ; enjoying life, very vigorous in sexual matters, and observes no rule at all ; offers himself for ten days' observation. February 10. Coition after forty- one hours' interval ; examination ten hours later ; result, spermatozoids few in number, but moving with energy ; few ejaculated dead, few died after ejaculation. Same day, second coition, one hour later ; examina- tion nine hours after ; result, spermatozoids very numer- ous, lively, and moving energetically ; without exception ejaculated alive, and only very few had died. February 11. Coition after twenty-three hours' rest ; examination ten hours later ; result, spermatozoids less 76 SEXUAL IMPOTENCE. numerous ; some moving, some had died, the rest ejacu- lated dead. /'rbniary 13. Coition after an interval of forty-three hours; examination fifteen hours later; result, sper- matozoids very few and most of them ejaculated dead ; none moving. February 1. Coition after thirty hours' rest; ex- amination and result, same as February 13. February 15. Coition after seventeen hours 1 rest ; examination sixteen hours later; result x spermatozoids numerous, moving energetically. Same day, second coition six hours later ; examination ten hours afterward ; result, spermatozoids not very nu- merous, but movement lively ; most of the forms young ; none were ejaculated dead. February 17. Three coitions within six hours; sper- matozoids of the third coition examined ten hours after ; very numerous, some of them still moving with energy ; many had died, only few were ejaculated dead. February 18. Coition after eleven hours, therefore fourth coitus within seventeen hours ; examination one hour after; result, spermatozoids less numerous, but moving with great activity and energy; few ejaculated dead, almost none died after ejaculation. February 19. Coition after fifteen hours ; examination ten hours later ; result, spermatozoids extraordinarily numerous, very well developed, with energetic and lively motion ; none ejaculated dead, and only isolated ones had died. THIRD SUBJECT FOR OBSERVATION. Age not quite thirty, healthy and vigorous, life very active, but finds time to enjoy it, and makes best use of his leisure hours for venery. PHYSIOLOGY OF THE SEXUAL ACT. 77 After fifteen days 1 abstinence, intercourse fourteen times within six days. The last ejaculation examined scarcely one-quarter hour after ; result, spermatozoids very numerous, many well developed, moving with energy and vivacity. The field of vision shows the picture that Ultzmann compared to an ant-hill. From these observations and many more I have made, it may be concluded that, with persons who have accus- tomed themselves to frequent intercourse and have the power to do so, the number of spermatozoids increases with the frequency of coition, instead of decreasing, as supposed by the older authors. It may be concluded also that the spermatozoids become very numerous, well developed, lively, and energetic only when coition is repeated. It is difficult to say to what this phenomenon is due, though it is probable that the sperm of the vesiculae seminales, which is poorer in spermatozoids, is evacuated first, and that only after that, by the repetition of coition, come the contents of the vasa deferentia, and last of all those of the testicles. This circumstance may be of special importance in the consideration of certain cases of sterility. Furthermore, such results justify the supposition that the spermatozoids which enter the vesiculae seminales for storage lose their vitality in that canal gradually. According to the results of my observations, however, they lose it rather quickly. I am still further confirmed in this belief by the fact that, although I have very often had the chance to examine the semen from nocturnal emissions, sometimes within an hour after such emis- sion, I have seldom found living spermatozoids in such sperma. Most of the spermatozoids, which were often 78 SEXUAL IMPOTENCE. found in groat numbers, looked as if they had been ejac- ulated dead, while only few had the appearance of having been ejaculated alive and of having died on ac- count of their low vitality. I must not omit the observa- tion that the first portion of a pollution scarcely ever contained a living spermatozoid, whilst the second was more likely to show living forms. In my numerous microscopic examinations of sperm I have made a few more discoveries, which I shall here adduce briefly. The energy of movement of a sperma- tozoon is most easily determined by gentle pressure on the cover-glass, which causes a current in the small quantity of seminal fluid between the two glass disks. If there are any spermatozoa moving with energy, they will swim unaffected by the current, and continue in their original direction, some swimming against the current. The forward movement of the spermatozoids seems to me to be produced not by a whip-like motion, as has been stated, but rather by a regular, rudder-like action on the part of the tail. This action is seen plainly when a dying spermatozoon is watched ; the movements grow slower and slower until they gradually cease altogether. It is very interesting to watch how spermatozoa often meet with premature death. A spermatozoon swim- ming along quite energetically suddenly strikes some obstacle ; the tail finds itself caught between masses of detritus, fragments of cells ; the spermatozoon makes desperate efforts, moves spasmodically, and seems thus to use up all its vital power in a short time, as it quickly dies. Sometimes the spermatozoon succeeds in disen- gaging itself, but usually it suffers some injury. I once saw one with a sharp bend in the tail close behind the head swim on in a lively manner. CHAPTER IV. ETIOLOGY OF IMPOTENCE. AMONG the circumstances that determine sexual vigor the foremost of all is the structure of the genitals. We shall not here take into consideration abnormal forma- tions, as they will be treated specially, but shall limit our attention to genitals anatomically normal. The appearance of the genitals varies considerably as regards size, form, and color. The differences are notice- able even in childhood, in which case they cannot be ascribed to extraneous causes. Small genitals are always a sign of insignificant sexual power, while large ones, remaining in proportional size during erection, indicate great power. There are genitals which during sexual repose show large dimensions, but which are flabby and appear large only in consequence of the extent of the vas- cular meshes of the cavernous tissue, and do not grow larger proportionally by the filling with blood during erection. In such genitals erections do not occur readily, and they accordingly indicate anything but sexual vigor. Such qualities belong to genitals which owe their size to sexual excesses committed before puberty. Together with the necessary dimensions the texture of the penis must possess firmness. The testicle must be sufficiently large, firm, and insensible to slight pressure. Besides this, the vascularity of the genitals is of im- portance. A pinky, transparent cutis of the glans and warmth of the penis indicate that a sufficient quantity 79 80 SKXUAL IMPOTENCE. of blood is present. A pale glans and ;i penis that feels cool indicate local poverty of blood as well as sexual weakness. Finally, the excitability