106 DISEASES OF THE MALE SEXUAL ORGANS. 



where the impotence depends on actual functional debility of the 

 sexual organs during the age of manhood. They are distinguished 

 from the above by the fact that, during sexual excitement, even when 

 there is no psychical impediment, there are no erections ; nor do these oc- 

 cur, as they usually do even in children, without a feeling of desire, when 

 the patient wakes up with a full bladder. Occasionally examination 

 of the genitals in such cases shows something abnormal : the testicles 

 are atrophied, small, and soft ; the scrotum hangs relaxed, or else the 

 penis is flabby and cool, or very small and hard. In other cases the 

 most careful examination of the genitals shows nothing abnormal. 

 Some years since, a farmer consulted me for his impotence. As he 

 was somewhat over thirty years old, and a strong, muscular man, 

 without excess of fat, and as I found nothing wrong about his gen- 

 itals, the penis being well-developed, the testicles large and hard, I 

 considered it certain that his impotence was of the first variety, and 

 consequently gave a good prognosis. But the case turned out differ- 

 ently from what I had expected ; and, after being married a year, the 

 man was divorced, the impotence having continued all this time. This 

 second form of impotence must also remain unexplained until OUT 

 knowledge of physiology and pathological anatomy advance beyond 

 their present state. 



We shall pass over the cases where congenital malformations, cas- 

 tration, or other imperfections, are the cause of the impotence, as well 

 as those where it is only one symptom of general debility in exhaust- 

 ing diseases, especially in diabetes, and shall only add a few words 

 concerning irritability with weakness of the male sexual organs. 

 Some authors include the form of impotence first described under the 

 head of irritable weakness, and, in fact, the persons there described 

 are on the one hand irritable, as they are very readily excited by con- 

 tact with women or other causes ; and, on the other hand, they are 

 weak, for the erections are not strong and do not last long. But by 

 irritability with weakness, in the strict sense, we understand a condi- 

 tion where, during sexual excitement, the ejaculation occurs before 

 actual copulation has taken place, or even before the erection is 

 perfect. This weakness also occurs chiefly among persons who have 

 previously masturbated. As long as strong erections still take place 

 occasionally, the prognosis in these cases is almost always good. Even 

 when, from masturbation, this affection has lasted for a long time be- 

 fore marriage, and continues during the first weeks of wedded life, it 

 generally disappears if the mode of life be regulated, and the sexual 

 desire be moderately gratified, but not artificially excited. 



In the first form of impotence the causal indications require chiefly 

 a psychical treatment. It is often enough to tell the patient of the 



