41 6 THE DISEASES OF THE SEXUAL GLANDS 



Four years ago, after operation for bilateral inguinal hernia there developed on each 

 side an enormous hematoma, which after some time disappeared. Only a few weeks after- 

 ward the patient noticed diminution of potency, which later disappeared entirely for a time. 

 The libido did not disappear entirely, later erections were again possible and coitus was 

 performed a number of times per month. According to statement, only a slight ejacula- 

 tion occurred. 



The cause of the atrophy of the testicles in these cases may very well be regarded as a 

 circulatory disturbance, whether through injury of the arteries, or compression due to 

 shrinking of scar tissue, whereby damage was done to the nutrition of the testicles. 



B. Cases that depend on an orchitis due to syphilis, gonorrhea, or mumps. 



Perhaps some of the cases described by Larrey belong to this group. 



Observation of Coffin. Male individual, afte.r bilateral luetic orchitis the testicles 

 shrank to the size of beans. The voice became higher, obesity developed, the beard 

 fell out, the muscular power diminished, erections and ejaculations ceased, the penis 

 became smaller, finally to the size of that of a six- or seven-year-old child. The breasts 

 became larger. 



Observation of Charcot. Soldier. After bilateral mumps, orchitis, atrophy of the tes- 

 ticles to the size of beans. Libido disappeared, complete impotence, the breasts in- 

 creased in size. 



Observation of Lereboullet. Twenty-seven-year-old man, skin pale, eunuchoid form, 

 breasts well developed, penis and testicles very small, impotence. Beard absent, the 

 patient was formerly very potent and the beard well developed. The voice mannish. 

 At twenty-four years, mumps with bilateral orchitis, later gradual atrophy of the testicles. 



Observation of Dalche. Thirty-six-year-old man. Color of face pale, hair of beard 

 abundant. Hairs of beard, axillae and genitalia, are entirely absent. Testicles very 

 atrophic, libido absent, complete impotence, intelligence weak, forgetfulness, tendency 

 to weep, apathy; often chills. At twenty years lues, at thirty years, bilateral orchitis, 

 since that time development of the genital atrophy. Later also slight swelling of the 

 legs and the face. Polyuria. In this case the eunuchoidism is certainly in the fore- 

 ground. But in addition there exist symptoms (and indeed chiefly symptoms of fail- 

 ure) on the part of the other ductless glands. 



Observation of Dupre. Forty-five-year-old man. Abundance of hair on head. Mus- 

 tache much reduced, very little pubic hair, pallor of the face; penis and testicles small, 

 soft, libido absent, impotence. Formerly gonorrhea and syphilis. At the thirtieth 

 year gradual testicular atrophy and development of the symptoms described. 



Observation of Gandy. Forty-six-year-old man. Color of face pale-yellowish, sec- 

 ondary sexual characters very sparingly developed. Genitals markedly atrophic, some 

 collection of fat on the trunk. Impotence. Formerly entirely normal, lues at the thirty- 

 third year. About this time beginning of the retrogression of the genitalia, and secondary 

 sexual characters, temporary polyuria (in the thirty-sixth year), also temporary swelling 

 of the face. 



Observation of Gandy. Forty-two-year-old man. Face very pale, wax-like, skin of 

 the forehead arranged in fine parallel folds, skin of the trunk delicate, voice monotonous, 

 no hair at all on lips or trunk, penis and testicles very small, prepuce long and folded, 

 cremasteric reflexes absent, no libido; impotence, memory somewhat weakened, apathy, 

 blood-pressure reduced. At thirty-two years of age bilateral gonorrheal orchitis; from 

 about this time began atrophy of the genitalia and impotence. At the twenty-ninth 

 year states that he is somewhat stronger; pad-like swelling of the skin of the face, the 

 hands, and the back of the feet. 



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