SEXUAL IMPOTENCE 
IN' THE 
MALE 
WILLIAM A. HAMMOND, M.D. 
SURGEON GENERAL U. S. ARMY (RETIRED LIST) ; PROFESSOR OF DISEASES OF THE MIND 
AND NERVOUS SYSTEM IN THE NEW YORK POST GRADUATE MEDICAL SCHOOL; 
PRESIDENT OF THE AMERICAN NEUROLOGICAL ASSOCIATION, 
ETC., ETC. 
“ Nam quicquid essentia dignurn est, id etiam scientia dignum •’ 
Lord Bacon 
NEW YORK 
BERMINGHAM & CO. 
1883 Copyright, 1888, by Wm. A. Hammond. TO 
THOMAS STRETCH DOWSE, M.D., 
OF LONDON, 
Fellow of the Royal College of Physicians in Edinburgh, etc., 
THIS LITTLE BOOK IS DEDICATED, 
AS SOME EVIDENCE OF MY REGARD FOR HIM AS A FRIEND, AND OF MY APPRECIATION 
OF THE LEARNING AND ABILITY HE HAS DISPLAYED IN 
NEUROLOGICAL MEDICINE. PREFACE. 
As its title shows, this little book relates .solely to 
sexual impotence as it exists in the male. 
At some future time I propose to enlarge its scope so 
as to include the subject of sterility, and to consider 
both these affections as they occur in men and women. 
43 West Fifty-fourth Street, New York. 
May 15th, 1883. CONTENTS. 
CHAPTER I. 
Absence of Sexual Desire. 
Original Absence of all Sexual Desire—Acquired Absence of 
Desire—Mental Preoccupation—Desire Extinguished by Mastur- 
bation—Desire extinguished by Perversion of the Sexual Appetite 
—Treatment. ii 
CHAPTER II. 
Absence of the Power of Erection and of Consequent 
Intromission. 
Early Sexual Excesses—Sexual Excesses in Adult Life—Partial Im- 
potence—Nocturnal Emissions—Diurnal Emissions—Obesity— 
Emaciation—Brain Affections—Affections of Spinal Cord—Dis- 
eases and Injuries of the Nerves—The Effects of Excessive Horse- 
back Riding—The Effect of Certain Medicines, as Iodine, Nitrate 
of Potash. Alcoholic Liquors, Bromides, etc.—Castration—Mental 
Causes—Excess of Desire—Superstition—Hypochondriacal Con- 
dition—Pathology—Treatment—Hygienic Measures—Marriage 
—Medical Measures—External Remedies—Internal Remedies. 93 
Absence of the Power of Ejaculating the Seminal Fluid 
into the Vagina. 
CHAPTER III. 
The Penis—Absence of—Smallness of—Great Size of—Bifurcation 
of—Suture of—Anomalies of the Urethra—Epispadias—Hypospa- 8 
CONTENTS. 
dias—Stricture of the Urethra—Spasmodic Stricture—Paralysis of 
the Compressor Urethrae Muscle—Priapism—Anomalies of the 
Prepuce—The Gians—The Testicles—Absence of—Arrest of the 
Development of—Atrophy of—Bodily Deformity or Peculiari- 
ty—Contractions of Lower Extremities from Disease of Spinal 
Cord—Tumors of Neighboring Parts—Excessive Corpulency. 216 
Absence of the Ability to Experience Pleasure during the Act 
of Copulation and during the Emission of the Semen. 
CHAPTER IV. 
The Emotion of Love—Sexual Indifference—Loss of Sensibility of 
Gians—Effects of Circumcision—Extreme Narrowness of Prepuce. 263 SEXUAL IMPOTENCE IN THE MALE. 
By sexual impotence is to be understood an impossi- 
bility or difficulty in the accomplishment of the act of 
copulation. Impotence in the male, to which division 
of the subject alone this treatise relates, implies the ex- 
istence of some malformation, disease, or derangement 
of the genital organs, either primary or secondary, by 
reason of which there is either 
I. Absence of sexual desire. 
II. Absence of the power of erection and of conse- 
quest intromission. 
III. Absence of the power of ejaculating the seminal 
fluid into the vagina. 
IV. Absence of the ability to experience pleasure 
during the act of copulation and at the time of the 
emission of the semen. 
As is seen, impotence relates altogether to the act of 
intercourse, and therefore differs from sterility, with 
which, however, it is often confounded—the latter refer 
ring only to the inability to beget offspring. A man 
may be impotent without being sterile, and sterile with- 
out being impotent. SEXUAL IMPOTENCE IN THE MALE. 
IO 
Under the heads as just given I propose in the fol- 
lowing pages to consider the subject of sexual impotence 
as it exists in the male of the human species. 
In so doing I shall endeavor to correct certain er- 
roneous theories which are very generally entertained, 
not only in regard to the normal exercise of the genera- 
tive organs, but also relative to the abuses of which they 
are the subject. And I shall especially consider several 
forms of impotence of mental origin, which, though 
probably common enough, have not yet, I think, re- 
ceived the attention which they deserve. CHAPTER I. 
ABSENCE OF SEXUAL DESIRE. 
Without venereal desire the act of sexual inter- 
course would probably be rarely if ever performed. 
Ambroise Par£,* with his customary plainness of 
speech, says: 
“ A certain great pleasure accompanieth the function 
of the parts appointed for generation ; and before it, in 
living creatures that are of a lusty age, when matter 
aboundeth in those parts, there goeth a certain fervent 
or furious desire; the causes thereof many, of which 
the chiefestis: That the kind may be preserved and 
kept forever by the propagation and institution of other 
living creatures of the same kind. For brute beasts, 
which want reason, and therefore cannot be solicitous 
for the preservation of their kind, never come to carnal 
copulation unless they be moved thereunto by a certain 
vehement provocation of unbridled lust, and, as it were, 
by the stimulation of venery. But man that is endowed 
with reason, being a divine and most noble creature, 
would never yield nor make his mind so subject to a 
* “The Works of Ambrose Parey, Chyrurgeon to Henry II., Francis 
II., Charles IX., and Henry III., Kings of France,” etc. London, 1691. 
Chapter xxix. “ Why the generative parts are endowed, with great pleasure,” 
P- 534- 12 
SEXUAL IMPOTENCE IN THE MALE. 
thing so abject and filthy as is carnal copulation, but 
that the venereous ticklings raised in those parts relax 
the severity of his mind; or reason admonisheth him 
that the memory of his name ought not to end with his 
life, but to be preserved unto all generations as far as 
may be possible by the propagation of his seed or 
issue.” 
I. Original Absence of all Sexual Desire.— 
That there are persons in apparent good health who 
have never experienced sexual desires is undoubted, 
though the number of such individuals in the male sex 
is exceedingly small. It is said that Sir Isaac Newton 
never had sexual intercourse, and the fact has been 
brought forward as an illustration of the point in ques- 
tion, but I think unwarrantably. In all my experience 
but two cases of the kind have come under my observa- 
tion, and these are of so interesting a character that 1 
do not hesitate to give the details in this place. 
Mr. W., aged 33, a strong, well-built, and apparently 
healthy man, consulted me, December 11, i860, in order, 
as he said, to ascertain if anything could be done for 
him. He stated that he had never experienced the 
slightest desire for sexual intercourse nor any venereal 
excitement, though the latter he had repeatedly, by 
reading libidinous books and association with lewd 
women, endeavored to produce. So far, however, from 
the wished-for effect resulting, the consequence was 
always the opposite, his repugnance increasing, and if 
the attempts were persevered with, nausea and vomit- ABSENCE OF SEXUAL DESIRE. 
13 
ing, accompanied with nervous and physical prostration, 
ensued. He declared that he had never practiced mas- 
turbation, but that since he had attained the age of 
seventeen he had had in his sleep what he supposed 
were seminal emissions, about once in two or three 
months. Upon one occasion he had persisted in the 
attempt at intercourse, notwithstanding the absence of 
desire and the unpleasant mental and physical phenom- 
ena which were produced; but though there was a 
vigorous erection caused by manual solicitation on the 
part of the Circe upon whom the attempt was made, 
this was at once dissipitated as soon as entrance was at- 
tempted. He was then about twenty-two years of age 
and the experiment taught him that there might be plea- 
sure in masturbation. As I have said, however, he was 
very emphatic in declaring that he had never indulged 
in this vice ; and as his language and manner were frank 
in the extreme I have no reason to doubt the truth of 
his declaration. Frequently, as he had informed me, 
he had endeavored to excite desire by imagining erotic 
scenes of various kinds, but though erections were pro- 
duced, there was no desire. On the contrary, feelings 
of repugnance and disgust were at once excited. 
Here apparently there was the ability to experience 
erections from psychical and tactile excitations, but 
the sexual appetite appeared to be undeveloped, and 
in addition there was the remarkable idiosyncrasy of 
disgust instead of pleasure being excited at the idea 
of copulation. But, for this latter circumstance, the 14 
SEXUAL IMPOTENCE IN THE MALE. 
patient could undoubtedly have mechanically gone 
through the act of intercourse, and perhaps have ex- 
perienced pleasure from the operation. 
There were many reasons why this gentleman should 
marry. There was a considerable property held in trust 
for any children he might have, but which without 
offspring of his would go from his family partly to 
people strangers to him and partly to certain charita- 
ble institutions. And again, strange as it may seem, 
he liked the companionship of women and was anxious 
to have a home of his own, and a wife with whom he 
might at least associate in a platonic way. In his pres- 
ent condition, he felt that all these things were impos- 
sible, and so he had come to me hoping that in the re- 
sources of medicine there might be something that 
would alter his nature so as to make sexual intercourse 
possible to him, even if the development of desire were 
out of the question. 
I saw no way of doing this, however, unless it might 
be possible for him to accomplish the sexual act not- 
withstanding the disgust, the faintness, the nausea and 
vomiting, and by perseverance to overcome the idio- 
syncrasy. He promised to make the attempt repeat- 
edly, but he reported about a month afterward that the 
plan of treatment was impossible. He went into the 
civil war, and was killed at either Antietam or Gettys- 
burg. 
In the other case the patient, a man 27 years of age, 
had never experienced sexual desire, though the or- ABSENCE OF SEXUAL DESIRE. 
15 
gans were of full size and well-formed. Erections were 
readily produced by frictions of the penis, or by the 
application of heat, or even by lying on the back; but, 
instead of the ordinary venereal desires being excited, 
there was an overwhelming inclination to drink alco- 
holic liquor in large quantities, and a drunken debauch 
was the consequence. Towards women there was a 
strong feeling of disgust, and a still more powerful dis- 
inclination to sexual intercourse. Many times the at- 
tempt to effect entrance had been made while an erec- 
tion existed, but at once the penis became flaccid. In 
this instance, there was the reciprocal effect of erec- 
tions being produced by the desire for alcohol, and 
under such a circumstance masturbation had often been 
practiced. This patient eventually died comatose dur- 
ing a severe attack of cerebral congestion. 
II. Acquired Absence of Desire.—There are vari- 
ous circumstances which exert an influence in abolish- 
ing the natural sexual desire of the individual. Among 
these are : 
a. Mental preoccupation.—It is well known that when 
the mind is intensely engaged with engrossing subjects 
of a character foreign to the animal passion, venereal 
excitement is not experienced. Every man is, more or 
less, familiar with this fact from his own experience, 
and in the majority of cases the impotence thus in- 
duced is of a temporary character—the desire return- 
ing with the cessation of the mental preoccupation. 
But, in some instances, the mind is so continuously ab- 16 
SEXUAL IMPOTENCE IN THE MALE. 
sorbed with other thoughts and emotions that the sex- 
ual appetite is altogether abolished, and does not return 
even if there be periods of intellectual or emotional re- 
laxation. Sir Isaac Newton, it is said, never had sex- 
ual intercourse. Perhaps it would be going too far to 
say that he never experienced the desire ; but, occupied 
as his mind was with subjects requiring the most severe 
and continuous thought, it is quite probable that he was 
from this cause practically incapable of copulation. 
The mere diversion of the mind, even for an instant, is 
sufficient, as Sterne has ludicrously reminded us, to 
render a man temporarily sexually impotent. 
Of this temporary impotence from a sudden cessa- 
tion of the desire by the thoughts being suddenly di- 
verted into another channel during the act of sexual 
intercourse, several interesting cases have come under 
my observation. 
A gentleman, a married man, and the picture of ro- 
bust health, consulted me for a trouble of the kind un- 
der which he labored. He had been recently married 
and was much attached to his wife, but for a year past 
whenever he had attempted sexual intercourse some 
thought often of a ludicrous character would take pos- 
session of his mind, and extinguish all desire at the 
very moment that the orgasm was beginning. At once 
the penis became flaccid and the act remained un- 
accomplished. As an instance, he informed me that the 
previous night he had made an effort to have connection 
with his wife. The erection was vigorous, but just as ABSENCE OF SEXUAL DESIRE. 
17 
the acme was being ceached a funny story he had read 
that day in a comic newspaper flashed through his 
mind. His desire at once vanished, the penis lost its 
turgescence and the emission did not take place. On a 
previous occasion, under similar circumstances, the 
thought of a purchase he had concluded occurred to 
him, and a like result ensued. 
These repeated failures and disappointments had 
created a great deal of mental disturbance. He had 
become low-spirited almost to the point of melancho- 
lia, and had several times entertained serious thoughts 
of suicide. 
In another case, the patient, a young man, whose 
mind was severely taxed by the nature of his occupa- 
tion, which was that of a professional gambler, experi- 
enced when his nightly work was over strong sexual 
desires which he was unable to gratify, for in the act of 
intercourse some technical matter connected with his 
business was sure to come up in his mind with the 
effect of extinguishing all desire and with it all power. 
In both these cases and in others which have come 
within the range of my personal experience, I found 
that the subjects were extremely impressionable individ- 
uals, and that the first occurrence of the kind which in 
most other persons would have made no lasting im- 
pression on the mind produced with them such an 
effect that at the next attempt at intercourse the fear 
was excited that a repetition of the disturbance would 
ensue, and as a consequence the apprehension was rea - 18 
SEXUAL IMPOTENCE IN THE MALE. 
lized. After that, on every similar attempt, there was 
a like fear that some thought would obtrude itself, and 
owing to the exercise of the principle of “ expectant 
attention,” the thing upon which the mind was concen- 
trated and which was so greatly feared occurred with 
painful punctuality. * It is an essential feature to the 
due performance of sexual intercourse that the man 
should have confidence in himself. If this is weakened, 
aud still more if it is destroyed, disappointment is sure 
to result, and a condition of impotence is established. 
In the treatment of cases of this nature, if is neces- 
sary in the first place to rid the patient of his ap- 
prehension, so that he will make the attempt without 
experiencing the slightest fear that anything is going 
to occur to interrupt the normal performance of the 
act. The only way with which I am acquainted by 
which this can be done is for the patient to abstain ab- 
solutely from all attempts for several months. By this 
course the appetite usually becomes so strong, in a man 
otherwise vigorous, that the desire overrides all possi- 
ble fears, and when once this result can be attained 
there is no longer any danger of a recurrence of the 
trouble. 
I therefore advised the married gentleman to occupy 
a separate room from that used by his wife, and on no 
account to attempt intercourse for three months; I 
expected by this course to break up the habit into 
which his brain had fallen of associating incongruous 
ideas with the act of intercourse, as well as to allow ABSENCE OF SEXUAL DESIRE. 
19 
the center for the sexual appetite, to acquire, by re- 
pose, increased strength. With similar objects in view, 
I advised the other patient to take a sea voyage 
he had in contemplation, and not to attempt intercourse 
till his return, which would not be for a period of 
nearly four months. The treatment was so perfectly 
successful with both subjects that there was not the 
least difficulty when the periods of probation had ex- 
pired. 
In another case, the patient, a civil engineer, and 
engaged in work requiring extensive mathematical cal- 
culations, found that his desires were altogether ex- 
tinguished. There was nothing very astonishing in 
this, for such studies are of all things most calculated 
to divert the mind from sexual matters and to extin- 
guish desire. So powerful is this influence, that MM. 
Grimaud de Caux and Martin Saint Ange * advise the 
reading of mathematical treatises as one of the most 
effectual means of subduing excessive venereal excite- 
ment. Moreover, Broussais f has observed that the 
genesic power is weakened by the mental concentration 
required in mathematical studies. In his lectures on 
phrenology delivered before the Faculty of Medicine of 
Paris, he not only insisted upon this point, but he ex- 
hibited two heads of eminent deceased mathematicians 
who not only were never married but who had an 
* “Histoire de la g6n6ration de l’homme,” Paris, 1847, p. 294. 
f “Cours de phrenologie,” Paris, 1836, p. 183. 20 
SEXUAL IMPOTENCE IN THE MALE. 
aversion to the female sex and who had never, as was 
said, had sexual intercourse.* 
But to return to the case of the engineer: while oc- 
cupied with the calculations requisite to the higher per- 
formance of the extensive work on which he was en- 
gaged, and which required about fourteen hours daily 
of severe mental labor, he experienced no sexual desire 
and did not for over a year, though a married man, 
attempt intercourse. Indeed, his repugnance thereto 
was so great that for fear he might be tempted he had 
induced his wife to make a visit to Europe, and she had 
been absent several months, and had just returned 
when the case was brought to my attention. 
Soon after her reappearance in his home, he had, so 
he informed me, more as a matter of duty and affec- 
tion, than from any venereal inclination on his part, 
attempted sexual intercourse, but had miserably failed. 
There was no desire, and it was impossible to reawaken 
an appetite that had long been extinguished. Such a 
state of affairs could not long continue without the 
peace and harmony which had hitherto existed in his 
family being in great danger of disturbance. Already 
he was fearful that his wife would attribute his impo- 
tence to excesses with other women, and so he had 
determined to take medical advice in regard to his 
disorder. 
I found, on examination, that there was no trouble 
* Op. cit. p. 180. ABSENCE OF SEXUAL DESIRE. 
21 
with the functions or structure of the genital organs. 
The penis was of full size, and the testicles were large, 
firm and free from disease. Nocturnal emissions oc- 
curred on an average about once a month, generally 
with, but sometimes without, lascivious dreams. Erec- 
tions often took place during the night, and were pain- 
ful, but were unaccompanied with desire. Apparently 
they were the result of congestion of the cord from 
lying on the back, and from distension of the bladder 
with urine. The patient was satisfied that if his desires 
could once be awakened there would be no difficulty in 
the physiological performance of the sexual act, and 
he was now anxious that they should be restored to 
their former degree of activity. For while there had 
never been excesses, there had, up to the beginning of 
the period mentioned, been a full degree of sexual in- 
clination and power. Conversation, however, with 
him, convinced me that there was no anxiety on his 
part for the restoration of his sexual health based upon 
any other feelings than a regard for the proprieties of 
the situation and a fear of the ultimate consequence to 
his health and his domestic felicity. As to venereal 
appetite there did not appear to be a vestige. 
Upon mature reflection I saw no way of materially 
benefitting the patient except by his giving up his work 
for a time and devoting himself entirely to the society of 
his wife. At the same time I advised the application of 
statical electricity to the nape of the neck with the view 
of obtaining its counter-irritant action, as well as its 22 
SEXUAL IMPOTENCE IN THE MALE. 
expectant effect on the mind of the patient. So strong 
were the motives by which he was actuated that he at 
once resigned his very lucrative situation and sub- 
mitted himself to the treatment advised. He purchased 
a little villa near the city, moved into it with his wife, 
and practically renewed his courtship of seven years 
previously. In accordance, further, with my advice, 
he made no attempts at intercourse, but waited patient- 
ly for the revivification of his desires. His restoration 
to health was not long postponed, for within three 
months he began to experience propensities to which 
for so long a time he had been a stranger, and after that 
the complete recovery was well assured. Aided by 
the good sense of his wife, to whom I fully explained 
the situation, and who, confident of possessing her hus- 
band’s affections, acted throughout with rare kindness 
and discretion, there was no interruption to the course 
of his restoration. He will not soon forget, however, 
that Urania is a more exacting and exhausting mistress 
than Venus herself. 
A case is cited by Grimaud de Caux and Saint Ange in 
which a celebrated mathematician was always diverted 
from the complete performance of the sexual act by the 
recurrence to his mind of problems of geometry, or of 
equations which had occurred to him during the day. 
The treatment was different from that which I have 
recommended in similar cases, and consisted in his wife 
being advised not to allow the approaches of her hus- 
band unless he was in a state of semi-intoxication. It ABSENCE OF SEXUAL DESIRE. 
2 3 
was hoped that by this means his intelligence would 
be sufficiently weakened to allow of the exclusive em- 
pire of the sexual appetite over his mind. It is sta- 
ted that entire success was the result. It appears to 
me, however, that the plan I have advised is on every 
account altogether preferable, especially as it has been 
uniformly successful. 
There is a good deal of sexual indifference, and con- 
sequently of impotence, existing among men whose 
whole heart and soul are in exciting business occupa- 
tions requiring all their mental energy and consequent- 
ly leaving nothing for the mere animal passions. Such 
individuals have no pleasures in life beyond those con- 
nected with the acquisition of wealth—society, the din- 
ing-table, the card-table, the theatre, the opera, litera- 
ture, amusements, good or bad, never allure them. 
If they are married they go to bed to sleep, if they can, 
for they are exhausted with the excitements and the anx- 
ieties of the day. If unmarried they return at evening 
to their solitary apartments to study the markets and 
to devise new combinations. Sexual intercourse is a 
matter of utter indifference; their desires are extin- 
guished. 
It is rarely the case that the physician is consulted 
by such people till, having accomplished their business 
objects, or failed in them, they find not only that they 
have no desire, but that it is impossible to re-arouse the 
sexual appetite. While it is true in other things that a 
man does not regret the loss of that which he does not 24 
SEXUAL IMPOTENCE IN THE MALE. 
value it is very different as regards sexual matters. 
And thoiigh a person such as that referred to cares 
nothing for his virile power as such, there are secon- 
dary considerations which he feels he cannot disregard. 
Among these are the fear that in losing his sexual appe- 
tite he is laying the ground-work for future paralysis, 
even if the loss be not one of the early signs of the ap- 
proach of that disease, the desire for offspring to 
whom he may transmit his wealth, and if single the 
wish for the comforts of a home and the society of 
some cultivated and refined woman. 
Such cases are, however, difficult to manage. The 
thoughts, the emotions, the appetites even, have for so 
long a time been concentrated toward one particular 
point, that the task of diverting them into other chan- 
nels is almost insurmountable. A second nature has 
been formed with objects in life and desires different 
from those originally inherent in the individual. Be- 
sides, with the diminution of the natural inclination for 
sexual intercourse there is very often, in these instances, 
a veritable loss of generative power, and the two con- 
ditions reacting on one another render the prognosis 
still more unfavorable. Still there are cases in which 
the power is simply deteriorated from its normal stand- 
ard. To such the society of agreeable and virtuous 
women may be recommended as constituting an effi- 
cient aid to the other measures proposed. These 
should consist of entire change of habits and the devo- 
tion of a considerable portion of the time to amuse- ABSENCE OF SEXUAL DESIRE. 
25 
ments, physical exercise, and pursuits tending to the 
development of emotions different from those which 
have previously actuated him. Nothing can be better 
than the entire cessation of business pursuits and the 
undertaking of a course of foreign travel. 
The treatment must be mainly moral and hygienic, 
but I think if there is the least suspicion of any impair- 
ment of the general health strychnia in small doses 
taken for a long time will be of service. I am quite 
sure I have derived benefit from the administration of 
a prescription consisting of one grain of the sulphate 
of strychnia to the ounce of water, the patient taking 
ten drops three times a day shortly before meals. 
Usually, even in mild cases, several months are re- 
quired before the extinguished sexual feeling is rekin- 
dled, and there is a still longer period before the normal 
degree of desire is obtained. In those instances in 
which there is also a loss of sexual power the prospect 
of recovery is, as I have said, still more remote; but 
the further consideration of this class of cases is more 
appropriate to the following chapter. 
b. Desire Extinguished by Masturbation.—The normal 
sexual appetite and a condition of impotence are in- 
duced by masturbation when carried to excess, and this 
altogether independently of the loss of power which in 
such cases eventually ensues. The imagination is al- 
ways a more potent excitor of the sexual desire than 
the physiological incentive supplied by nature. The 
masturbator relies on the fertility and extravagance of 26 
SEXUAL IMPOTENCE IN THE MALE. 
the lewd images presented to his mind for the increase 
of the pleasure derived from his act, and frequently he 
adds to the vividness by reading obscene books or look- 
ing at filthy pictures. As he goes on he finds, in obe- 
dience to a law of the organism, that gradually the 
visions which once sufficed to produce the requisite 
venereal excitement have lost their power, just as some 
strongly savored substance would, if eaten for a long 
time, fail to produce pleasant impressions on the gusta- 
tory papilke. Still more libidinous and unnatural repre- 
sentations are conceived by his mind and brought before 
his mental vision, and so on, till at last, should he at- 
tempt sexual intercourse, he finds that the reality is so 
much less than his imagination had led him to believe, 
that it is incapable of sufficiently rousing his appetite. 
He is, in fact, impotent to women ; he no longer desires 
intercourse, but abandons himself to his fatal habit, 
knowing the almost limitless resources of his imagina- 
tion in providing excitations to his desires. Such per- 
sons shun the society of women, become often true 
misogynists, and suffer an entire extinction of the sexual 
feeling. 
Such cases are to be discriminated from those, much 
more common, in which there is a loss of the power of 
erection, a condition which sooner or later is the conse- 
quence of continued masturbatory excesses. The one 
is altogether a mental, the other a physical phenomenon, 
though very often both states exist in the same indi- 
vidual. ABSENCE OF SEXUAL DESIRE. 
2 7 
A young man, whose father wished him to marry, 
had been continually putting off, on one pretext or 
another, acceding to the paternal wishes, till at last he 
confessed that he had no desire for sexual intercourse, 
and begged that in future he might be let alone. The 
father, alarmed for his son’s health, insisted on his con- 
sulting a physician, and at last, through much impor- 
tunity, succeeded in getting his consent, and he came 
under my observation. At his first visit to me the 
young man requested that his father would leave the 
room, and then as soon as we were alone he confessed 
that for several years he had practiced masturbation, 
but only in moderation, that occasionally he had had 
sexual intercourse, and, as he said, under circumstances 
favorable to the due physiological performance of the 
act, but that after a mature consideration of all the 
points bearing upon the case, he had arrived at the con- 
clusion that masturbation gave greater pleasure and 
was altogether less troublesome. In fact, that he had 
no desire whatever for sexual intercourse, but preferred 
to go on in the way he had begun and which he was 
frank enough to say was entirely satisfactory to him. 
I endeavored to point out to him the inevitable con- 
sequences of the course he was pursuing, so far as his 
sexual power was concerned, as well as the mental 
degradation that was certain to ensue; but all in vain, 
and when he left me I had made up my mind that his 
was one of those cases of sexual perversion, to the con- 
sideration of which I shall presently come, and that a 28 
SEXUAL IMPOTENCE IN THE MALE. 
cure by medical means was out of the question. The 
coolness and effrontery with which he conversed about 
the subject, and the reasons which he had to urge in 
his behalf, led me to this belief and also to the further 
conviction that there was a streak of insanity in his 
composition which would some day become wider and 
probably entirely overwhelm him. I neither saw nor 
heard anything of him until one day about a year after- 
ward he entered my consulting-room in company with 
a rather pretty young woman, whom he introduced as 
his wife. Requesting her, after I had congratulated 
him, to step into the adjoining room, he informed me 
that after leaving me a year before he had thought 
over seriously what I had said to him, and had finally 
arrived at the conclusion that I was right, and that he 
would endeavor to change his course. He went so far 
as to pay several visits to the young lady his father 
wished him to marry, but compliance in that direction 
he found was entirely out of the question. Then he 
had for a while frequented houses of prostitution, but 
had never been able to bring himself to the point of 
attempting sexual intercourse. He had his own ideas 
of morality and decency and in his way was very con- 
scientious, and these circumstances influenced him 
somewhat, but the main reason was that he had a deep- 
ly-rooted disgust for the sexual act and all its accom- 
paniments, especially, so he said, with women who 
made a trade of its performance. 
Then he had thought of forming permanent relations ABSENCE OF SEXUAL DESIRE. 
29 
with some one woman in order first to ascertain if he 
were capable of doing his part in the marriage relation. 
He took, as he said, one who he thought would answer 
the purpose, but after a week’s residence with her he sev- 
ered the association, having been unable to rouse suffi- 
cient desire to induce him to make any effort at con- 
nection. 
But about a month before his return to me he had 
visited a circus that was passing through a village at 
which he was staying with a friend. Here he had be- 
come suddenly enamored with a young woman, one of 
the performers, who rode a bare-backed horse with 
great agility and daring. He made propositions to her 
which she indignantly rejected, and finally offered mar- 
riage. He was at once accepted, the knot was tied the 
same day, and ever since then he has been the happiest 
of men. Upon the whole this was a better termination 
than might have been reasonably expected. 
c. Desire Extinguished by Perversion of the Sexual 
Appetite. It sometimes happens that the perversion of 
sexual appetite goes much further than it did in the 
case of this young man, and that infinitely more unnna- 
tural and degrading acts than masturbation take the 
place of the normal physiological function. Such cases 
have received a considerable amount of attention from 
writers on medical jurisprudence, more in fact than 
from those on impotence, though they are worthy of 
much attention in this relation. 
To begin with the most common example of the con- 
dition in question and which is more a vice in most 30 
SEXUAL IMPOTENCE IN THE MALE. 
instances than it is a disease, we find that those addicted 
to pederasty are as a rule devoid of desire towards the 
opposite sex. As just intimated, the practice in ques- 
tion is generally a vice resorted to by debauchees who 
have exhausted the resources of the normal stimulus to 
the sexual act and who in this new proceedure find for 
a while the pleasure which they can no longer derive 
from intercourse with women. But it is not to be ques- 
tioned that there are others in whom it assumes more 
the phase of a disease and who often lament the ten- 
dencies to which they are subject, and which they are 
powerless to resist. In the one class of cases there is 
impotence from want of desire, the condition having 
been induced by the acts of the individual, while in the 
other there is a like condition resulting from inherent 
perversion of the sexual instinct. 
Writing on this subject, Tardieu* says: “I do not 
pretend to explain that which is incomprehensible, 
and thus to penetrate into the causes of pederasty. We 
can nevertheless ask if there is not something else in 
this vice than a moral perversion, than one of the forms 
of psychopathia sexualis of which Kaan has traced 
the history. Unbridled debauchery, exhausted sensu- 
ality, can alone account for pederastic habits as they 
exist in married men, and fathers of families, and recon- 
* 
cile with the desire for women the existence of these 
impulses to unnatural acts. We can form some idea on 
* “ Sur les attentats aux moeurs.” 2me edition. Paris, 1858, p. 125. ABSENCE OF SEXUAL DESIRE. 
31 
the subject from a perusal of the writings of pederasts 
containing the expression of their depraved passions. 
“ Casper has had in his possession a journal in which 
a man, member of an old family, had recorded, day by 
day, and for several years, his adventures, his passions, 
and his feelings. In this diary he had, with unexampled 
cynicism, avowed his shameful habits, which had ex- 
tended through more than thirty years, and which had 
succeeded to an ardent love for the other sex. He had 
been initiated into these new pleasures by a procuress, 
and the description which he gives of his feelings is 
startling in its intensity. The pen refuses to write of 
the orgies depicted in this journal, or to repeat- the 
names which he gave to the objects of his love. . . . 
“ I have had frequent occasion to read the correspon- 
dence of known pederasts and have found them apply- 
ing to each other, under the forms of the most passion- 
ate language, idealistic names which legitimately be- 
longed to the diction of the truest and most ardent 
love. 
“ But it is difficult not to admit the existence in some 
cases of a real pathological alteration of the moral facul- 
ties. When we witness the profound degradation, the 
revolting salacity of the individuals, who seek for and 
admit to their disgusting favors men who are gifted both 
with education and fortune, we might well be tempted 
to think that their sensations and reason are altered, 
but we can no doubt on the subject, when we 
call to mind facts such as those I have had related to 32 
SEXUAL IMPOTENCE IN THE MALE. 
me by a magistrate, who has displayed both ability and 
energy in the pursuit of pederasts. One of these men, 
who had fallen from a high position, to one of the low- 
est depravity, gathered about him the dirty children of 
the streets, knelt before them and kissed their feet with 
passionate submission before asking them to yield them- 
selves to his infamous propositions. Another experi- 
enced singularly voluptuous sensations by having a vile 
wretch administer violent kicks on his gluteal region. 
What other idea can we entertain of such horrors, than 
that those guilty of them are actuated by the most 
pitiable and shameful insanity?” 
Cases of sexual perversion leading to indifference to- 
ward the other sex and impotence have been described 
by Servaes,* Kraft-Ebing,f Liman,:]: Le Grand du 
Saulle,§ Charcot and Magnan,|| and many others. Sev- 
eral instances have also been under my own observation. 
While it is not necessary to refer more fully to the dis- 
gusting details of all these cases, the description of some 
of them is indispensable to the thorough consideration 
of the subject under discussion. 
Among the cases of undoubted sexual perversion 
* “ Zur Kenntniss von der contraren Sexual-empfindung.” Archiv fur 
Psychiatrie und Nervenkrankheiten, 1876, p. 484. 
f “ Ueber gewisse Anomalien des Geschlechtstriebes,” u. s. w. Archiv 
fiir Psychiatrie, 1877, p. 291. 
| “ Caspars Lehrbuch, 6te Auflage, p. 509. 
£ “ Les signes physiques des folies raisonnantes” (Discussion). Annales 
mcdico-psycholoyiques, Mai 1876, p. 431 et seq. 
|| “Inversion du sens genital.” Archives de ATeurologie, No. 7, 1882, 
and 12, 1882. ABSENCE OF SEXUAL DESIRE. 
/ 
which have been reported, is an interesting one, in 
which, however, the condition, though undoubtedly 
existing, was not recognized, and the details of which 
have been given by Beck.* The instance is that of 
Sprague, who was tried in Brooklyn, in 1849, f°r high- 
way robbery, said to have been committed under the 
following circumstances: He was a printer by trade, 
and one morning left his home to go to his place of 
business, when he was seen to rush up to a young lady, 
throw her down, and then, snatching one of her shoes, 
to run away. Although she had on a watch and chain 
and other articles of value, he did not attempt to take 
them, nor to offer any other violence than that men- 
tioned. At his trial the defence of insanity was set up. 
“The principal witness was the defendant’s father, a 
clergyman of the highest respectability, whose testi- 
mony was corroborated in every particular by several 
other witnesses, indeed by all the court thought it 
worth while to bring forward. Charles Sprague's paternal 
great-grandfather, grandmother, great-grand-uncle, and 
three great aunts, being four out of a family of six, and a 
cousin, are, or have been, insane. He had himself, in youth, 
received several severe blows and falls upon the head, and 
within a year from the last fall he began to suffer headache, 
and his friends observed an unnatural prominence of the 
eyes. Simultaneously with this, Sprague began to ex- 
hibit a propensity to abstract and conceal the shoes of 
the female members of his family. In the majority of 
33 
* “ Medical Jurisprudence,” vol. i, i860, p. 732. 34 
SEXUAL IMPOTENCE IN THE MALE. 
instances one shoe only was missed, and it was usually 
found about the house, having been thoroughly soaked 
with water, twisted up like a rope, and then hid away 
between a feather and straw bed, or in the depths of a 
trunk, or hung up in a closet with garments conceal- 
ing it. 
“ Suspicion at once rested upon the servants, but the 
real agent being detected and questioned, remained si- 
lent, and on subsequent explanations, generally denied 
the possibility of his agency until within the last six 
years. During this period, when remonstrated with 
on his singular habit, he would admit that he must have 
taken the shoes, though he had no recollection of it, 
and did not know for what he wanted them. The in- 
termissions in this practice have at no time exceeded 
three or four months at one time. 
“ After the practice became established, Sprague’s 
mother and sisters and the female servants habitually 
locked up their shoes ; yet, occasionally one was missed 
and discovered twisted and crumpled after being wet. 
It was rumored at one time in the family that Sprague 
had attempted to remove the shoe from the foot of a 
domestic, and his sister alarmed her father at night on 
finding him abstracting her shoes from a locked drawer. 
In the early part of the year of the trial two females, 
one residing in Brooklyn, had a shoe or shoes taken 
from their feet while walking in the street in the even- 
ing, but the offender has never been certainty known.” 
A case similar to this, so far as the object of the ABSENCE OF SEXUAL DESIRE. 
35 
thefts is concerned, has lately been under my observa- 
tion, and will presently be more fully cited. 
Some years since, in the city of Leipzig, a number of 
young girls were assaulted in the streets by a man 
wrapped in a cloak, who stuck a lancet into their arms 
just above the elbow and then quickly disappeared. 
Finally he was discovered and arrested. It then came 
out that he had been actuated by a morbid sexual im- 
pulse, that the incision of the lancet had been ac- 
companied by a seminal emission, and that his whole 
existence had become absorbed in the alternate excite- 
ment and depression which preceded and succeeded the 
act.* 
In the discussion to which reference has already been 
made, M. Legrand du Saulle gives the particulars of a 
case which he had a short time previously examined. 
The patient was a young man of twenty years of age, a 
graduate of a college, of an aesthetic turn of mind, but 
of a cold and gloomy disposition, with contemplative, 
misanthropic and spiteful tendencies, who condemned 
himself to solitude, who fled from the world and exhi- 
bited the most decided repulsion, not only towards 
women in general, but towards all that could exhibit the 
least evidence of a feminine origin, or of the intervention 
or form of women. He felt himself, however, on the 
contrary, irresistibly drawn towards men and pictures, 
* “A Treatise on Mental Unsoundness, Embracing a General View 
of Psychological Law. ” By Francis Wharton,LL.D. Philadelphia, 1873. 
p. 600, § 623. 36 
SEXUAL IMPOTENCE IN THE MALE. 
statues, and images, representing man in a naked state 
He possessed anatomical plates depicting the genital 
organs of man,-the adjuncts to virility, and he was con- 
stantly looking out for a chance to see the penis of 
every man who stopped to urinate in his vicinity. He 
was one day arrested in a public urinal in the Place de 
la Bourse, where he and an old man were standing 
looking at each others’ genital organs. The young 
man was the son of a hysterical mother; he had phi- 
mosis and slight atrophy of the testicles. For the for- 
mer a surgical operation was performed, but for fear 
that some untoward event might take place, a statement 
of his condition before the operation was drawn up, 
dated and signed by M. Legrand du Saulle and M. Vi- 
dal, who had also examined the patient, in which it was 
set forth that the case was one of the most abnormal 
genesic perversion. 
The following case, the details of which are given in 
the patient’s own words, is reported by MM. Charcot 
and Magnan.* 
“ My sensual feelings were manifested,” he said, “from 
the time I was six years old, by an intense desire to 
see boys of my own age, or men, naked. It was not 
difficult for me to satisfy this inclination, for my parents 
lived near a barrack, and the soldiers put no restraint 
on the exhibition of their virile organs. One day I saw 
(I was then about eight years old) a soldier masturbat- 
* Op. cit., No. 7, p. 54. ABSENCE OF SEXUAL DESIRE. 
3 7 
ing. I imitated him, and experienced besides the pleas- 
ure of the imagination as to what the soldier was doing, 
the physical pleasure of the friction. T continued to 
give myself pleasure by exciting my imagination by the 
remembrance of naked men. My parents left N 
and went to live at B . There I saw that the sol- 
diers bathed in a little stream and in a completely naked 
state. I resolved, in order to obtain the satisfaction I 
wanted, to seat myself on the bank of the river, and to 
pretend to sketch the landscape, while, without appear- 
ing to do so, I could look at them. At about the age 
of, fifteen, puberty was attained, and I derived much 
more satisfaction from my acts of masturbation. More- 
over, I provoked erection and its results as much by 
imagination as by friction. More than once I had erec- 
tion, the sexual orgasm, and seminal ejaculation solely 
through seeing the genital organs of a man. At night 
my imagination was excited and the like results ensued. 
At the age of twenty I stopped masturbating, but I was 
never able, notwithstanding all my efforts, to control 
the excitation of my imagination. Strong, handsome, 
and young men always provoked in me a strong emo- 
tion ; a fine statue of a naked man also caused a like 
effect. The Apollo Belvidere excited me greatly. 
When I met a man whose youth and beauty excited my 
passion, I was tempted to please him, and if I had given 
a free rein to my feelings I would have shown him all 
possible kindnesses ; I would have invited him to my 
house, and written to him on perfumed paper. I would 38 
SEXUAL IMPOTENCE IN THE MALE. 
have sent him flowers and made him presents, and I 
would have deprived myself of many things in order 
that I might have rendered myself agreeable to him. I 
never did these things, but I was quite sure I was capa- 
ble of doing them. I thought by refraining I might 
conquer the desires I experienced. I knew how to 
overcome the inclinations of which 1 speak, but I was 
never able to subdue the love I felt. Fortunately for 
me my love was changeable. Work and my studies 
are a great assistance to me against my venereal 
thoughts, but often sensuality prevails, and I am obliged 
to stop in the midst of the study of an intricate question 
by the sudden appearance of a naked man in my imagi- 
nation. I have always fought as hard as I could against 
this sensuality, and I have often refrained from acts 
towards which I felt myself impelled, but I have never 
been able to extinguish the sensuality itself. The su- 
preme satisfaction of this sensuality has never extended 
beyond the sight of a naked man, and especially the 
penis of a man, and I have never felt any inclination to 
enter a man or to be the passive object of a man. To 
see the genital organs of a strong and handsome man 
has always caused in me the highest voluptuous feel- 
ings. 
“ As to women, however beautiful they may be, they 
never excite in me the least desire. I have tried to 
love one, believing thus to turn my ideas into their nat- 
ural channel, but notwithstanding her beauty and her 
assistance I have remained entirely unmoved, and erec- ABSENCE OF SEXUAL DESIRE. 
39 
tion, so easy with me at the sight of a man, has never 
even had a beginning. No woman has ever provoked 
in me the slightest sexual feeling. 
“ I admire the feminine toilet; I love to see a woman 
well dressed, for I am then reminded that if I should 
be a woman I would dress in that way. At the age of 
seventeen 1 dressed myself like a woman at a carnival, 
and I experienced an indescribable pleasure trailing 
my skirts on the floor, in arranging my false hair, and 
in putting on my low-necked dress. Until I had 
reached my twenty-second year I took the greatest 
pleasure in dressing a doll, and it affords me much 
pleasure even now. 
“ Ladies are astonished to find that I am as good a 
judge of the good or bad taste of their toilets, and at 
hearing me talk of things as if I were myself a woman. 
“ The love which I may feel for any particular wo- 
man passes quickly, for as another handsomer in my 
eyes makes her appearance the thought of the first dis- 
appears. 
“ For the last few months nocturnal emissions are 
not so frequent with me as they used to be. At pres- 
ent three weeks have elapsed since I have had one, but 
I continue to have my usual dreams and to desire 
always to see (nothing more) naked men.” 
MM. Charcot and Magnan give a good many other 
particulars in regard to this interesting case, some of 
which are of great importance from a neurological 
point of view, but which have no very direct bearing 40 
SEXUAL IMPOTENCE IN THE MALE. 
on the point at issue. He was advised to make the 
intellectual effort of substituting a woman for a man in 
the crises to which he was subject. He made many 
efforts in this direction, but his mind constantly turned 
to a naked man. Finally, however, after several 
months’ contest he succeeded to some extent, and even 
went so far as to establish sexual relations with a wo- 
man, from which he derived voluptuous sensations. 
The moral effect was excellent, and for several days he 
had some repose from his former sensations. Being 
obliged, however, to quit Paris for a time, and then 
being forced to fight his former inclinations with his 
reason alone, he began to feel his unnatural proclivi- 
ties again obtaining the ascendancy. 
In this case, in addition to the moral treatment, re- 
course was had to hydrotherapy (cold affusions and 
douching) and to the administration of the bromide of 
potassium, which, it is said, diminished the intensity 
and duration of his desires without lessening their fre- 
quency. 
The principal points of interest in the present con- 
nection which this case presents are the sexual excite- 
ment and ejaculation of semen produced by the sight 
of a naked man, a penis, or even of a nude statue, while 
at the same time there is absolute frigidity as regards 
woman. It is a true instance of sexual perversion, and 
of consequent impotence so far as concerns the female 
sex. 
In another case, reported at great length by MM. ABSENCE OF SEXUAL DESIRE. 
4i 
Charcot and Magnan, the subject had the sexual or- 
gasm by thinking of the nails in women’s shoes. It 
does not appear, however, that he was impotent as 
regards physiological sexual relations. 
But in the following curious case there was a tempo- 
rary state of impotence, and I therefore relate it as of 
interest in the present discussion. 
The patient was thirty-seven years of age and of good 
constitution, but came of an eccentric family. He was 
studious, but learned with difficulty what he studied. 
He changed his occupation frequently, and would de- 
prive himself of necessaries in order to purchase books 
and other articles to which he took a fancy. 
At the age of five years, having been sleeping for 
several months with a female relative thirty years old, 
he experienced for the first time a singular phenome- 
non, which was no less than a genital excitement and 
an erection when he saw his bedfellow put on her night- 
cap. At about the same time he had occasion to see 
an old servant woman undress herself and put on her 
night-cap, and at once sexual excitement and an erec- 
tion were produced. Later, the very idea of an old 
and wrinkled woman arrayed in a night-cap was suf- 
ficient to provoke the sexual orgasm. The sight of a 
night-cap by itself caused no disturbance, but contact 
with one caused erection and sometimes an emission. 
On the other hand he remembered that he had re- 
mained, at about his seventh year, absolutely irrespon- 
sive to attempts at masturbation made upon him by 42 
SEXUAL IMPOTENCE IN THE MALE. 
one of his school-fellows. He had never sought any 
abnormal relations, and the sight of a naked man or 
woman had no effect upon him. Up to his twenty-sec- 
ond year, at which time he was married, he had never 
had sexual intercourse. He had married a woman 
twenty-five years old, pretty, and for whom he enter- 
tained a real affection. The first night of his marriage 
he remained impotent by the side of his young wife. 
On the second night the same condition existed, when, 
becoming desperate, he called up in his imagination 
the old wrinkled woman with her night-cap. The re- 
sult was immediate, and he performed his marital du- 
ties effectively. During the next five years of married 
life he was forced to avail himself of this expedient, as 
he remained impotent till he recalled the image of the 
old woman and her night-cap. He deplored this sin- 
gular situation, regarding it as a sort of profanation 
of his wife, but he does not appear to have been able 
to alter it. Other symptoms of deranged cerebral ac- 
tion supervened. 
In another case, cited by the same authors, the sub- 
ject, who was of an insane ancestry and was himself 
of a strong neurotic temperament, was compelled to 
masturbate whenever he saw a white apron. He be- 
came so infatuated with white aprons that the thought 
of one was sufficient to cause the sexual orgasm. Final- 
ly he took to stealing them, and was repeatedly ar- 
rested for thefts of these articles of dress. He entered 
a convent in order to prevent himself yielding to his ABSENCE OF SEXUAL DESIRE. 
43 
impulses, but after staying there three years his relig- 
ious zeal flagged; he came out and at once began his 
old habits. A search was made of his premises, and a 
collection of white aprons, spotted with seminal stains, 
was found. He was then examined, and being found 
to be of unsound mind, was placed in a lunatic asy- 
lum. 
After about a year he was discharged, and then had 
ideas of suicide, and became melancholic. He stopped 
stealing white aprons and formed relations with a 
woman. He was unable, however, to have intercourse 
with her unless he called to mind at the time the 
appearance of a white apron, just as he had formerly 
done when he practised onanism. 
Cases in which the individual has the delusion that 
his or her sex is changed, are not to be confounded 
with those now under consideration. The first are 
veritable cases of intellectual monomania, and are not 
usually accompanied by any aberrant manifestations of 
the sexual appetite. I have considered them in another 
work,* and pointed out their characteristics, chief 
among which is their excessive modesty and decorous 
bearing, so far as the genesic function is concerned. 
The other class, in which the individuals, knowing 
themselves to be men or women, assume the dress and 
imitate, as far as they can, the manners and actions of 
the opposite sex, I have also alluded to in another 
* “ A Treatise on Insanity in its Medical Relations,” New York, 1883, 44 
SEXUAL IMPOTENCE IN THE MALE. 
work,* but propose to consider it at still further length, 
as well as some other phases of aberration, by giving 
the details of instances which have come under my 
own observation. 
A case presenting some analogies with that already 
given of the young man who had a penchant for steal- 
ing women’s shoes, was several years since under my 
care, and led me to the conclusion that in the one 
referred to there was also an aberrant sexual feeling as 
the basis of the acts. 
The patient, a man somewhere about twenty-four 
years of age, was a member of a highly neurotic 
family. One uncle on his mother’s side had died in an 
asylum, and his grandfather on his father’s side had 
also died insane. One sister was subject to epilepsy 
and another to severe attacks of migraine. His father 
and mother, though both very excitable and impres- 
sionable, were, as far as known, free from disease. 
While cutting his teeth he had had two or three con- 
vulsions, but had passed through the period of dentition 
without further trouble. 
When about seven years of age, a woman employed 
in the family as a servant taught him masturbation, and 
endeavored very frequently to cause him to have sexual 
intercourse with her. Upon one occasion she had 
practised friction on his penis with her foot without 
taking off her shoe, and this was the first time he had 
* “The Diseases of the Scythians (Morbus Foeminarum), and Certain 
Anagolous Conditions,” American Journal of Neurology and Psychiatry. ABSENCE OF SEXUAL DESIRE. 
45 
derived any pleasure from her manoeuvres. But from 
that time on, the sight of a woman’s shoe caused sexual 
excitement and erections, and in a short time the mere 
idea of the object was sufficient for the purpose in 
question. After a time, however, when he had learned 
masturbation, he used to practice the act, while his 
whole mind was fixed on images of women’s shoes of 
all kinds, and in all positions about him. There was 
scarcely a night, after he became eight or nine years of 
age, that he did not bring about the sexual orgasm by 
mental concentration. His school teacher was a 
woman, and while at school he was constantly en- 
deavoring to get a look at her shoes and thus procure 
for himself sexual pleasure. Girls attended the school, 
but their shoes did not have the effect upon him that 
those of a woman did. It appeared, too, that the fact 
that the shoes were concealed by the long dress worn 
bv a worpan had something to do with the effect upon 
his sexual feelings. 
One day, while at school, and the teacher was sitting 
on a raised platform at the farther end of the room, the 
idea occurred to him that his sexual pleasure would be 
greater if he could hold one of her shoes in his hand for 
a moment. He acted on the idea at once, and going to 
where his teacher was seated, fell down on his knees, 
seized one of her shoes, and at once experienced greater 
pleasure than he had yet felt. At the moment of touch- 
ing it the orgasm began. For this act, which was not 
understood, but was supposed to be a kind of insubor- 46 
SEXUAL IMPOTENCE IN THE MALE. 
dination, he was severely punished. This did not deter 
him, however, from repeating the performance the next 
day, with a like result, both as regards the orgasm and 
the flogging. He did not care for the latter. On the 
contrary, it prolonged his pleasure. 
But ere long the fact was recognized that something 
was wrong with him, and the teacher laid the matter 
before his parents. When asked why he had acted in 
such a disorderly manner at school, he simply replied 
that he could not help it, but gave no further explana- 
tion of his conduct. The result was, that he was 
removed from that school and sent to another kept by 
a man. 
Although the material means of excitement were 
removed, he formed mental images of the other school, 
of the teacher at the end of the room, and of his going 
down on his knees, seizing her shoe and experiencing 
the sexual orgasm. The remembrance was generally, 
though not always, sufficient to cause excitement, 
erections, and sometimes the orgasm. He had fre- 
quently, when the excitement had been high and es- 
pecially when he seized one of his teacher’s shoes, had 
emissions, but at about his fourteenth year they gener- 
ally, though not always, occurred during the orgasm. 
To produce this, he had only to practice friction of the 
glans, while he thought of a woman’s shoe; but about 
this time the idea was conceived, that if he used such 
an object for masturbatory purposes, the pleasure 
would be increased. He therefore took a shoe sur- ABSENCE OF SEXUAL DESIRE 
47 
reptitiously from a drawer in which one of the female 
servants kept her clothing, and made use of it in the 
manner which had suggested itself to him. 
This act gave him greater pleasure than any which 
he had yet performed, and, thereafter, formed his only 
method of producing the sexual orgasm. Then he 
varied the enjoyment, and at the same time augmented 
it, by using a different shoe each time. To get them, 
he had to resort to theft, but, generally, he returned 
them to their proper places, after they had served his 
purpose. Some young female friends of his sisters, 
who were at the time paying them a visit, unknow- 
ingly contributed to his libidinous desires, by his taking 
their shoes, which he often did at night, by entering 
their room while they were asleep. 
In all this time, he had never experienced the least 
sexual excitement, by thoughts of women, or by the 
sight of them, in a greater or less approach to complete 
nudity. Pictures of naked women, of their genital 
organs, or of men and women in the act of sexual inter- 
course, such, as in some schools, pass from boy to boy, 
never gave him any other feeling than one of intense 
disgust. It never occurred to him to think of the act 
of sexual intercourse, and no woman had ever caused 
him the slightest degree of amorous feeling. Nothing 
roused in him any sexual sensations, but the thought, 
the sight, or the use, of a woman’s shoe. 
When about eighteen years of age, he began a shop- 
keeping business in a small town, and among other 48 
SEXUAL IMPOTENCE IN THE MALE. 
things kept women’s shoes for sale. Here he derived 
great pleasure from fitting shoes on the women who 
patronized him, and in handling the shoes they had 
worn. Often he would experience the sexual orgasm 
while thus engaged, but nothing gave such intensely 
voluptuous sensations as the use of the shoe in mastur- 
bation. 
Strange as it may seem, he had, as yet, no idea that 
he was doing anything specially degrading or wrong 
in acting as he did, or that he was injuring his health; 
but, shortly after going into business, and while fitting 
a shoe on a young woman, during which he had a 
strong erection, but no orgasm, he suddenly lost con- 
sciousness, and had a severe epileptic paroxysm. 
A few days afterward, while engaged in masturba- 
ting in his usual manner, he had, immediately after the 
orgasm, another seizure, much more severe than the 
first, during which he bit his tongue severely, and 
bruised his face in falling, so that he was marked for 
several days. Becoming seriously alarmed, he deter- 
mined to make every effort to stop his disgusting 
practices. This was hard work at first, and there were 
many relapses, but, finally, he succeeded to such an 
extent that he would go several weeks—on one oc- 
casion four months—without ever masturbating. He 
never, however, was able to prevent sexual excitement 
and erections at the sight of a woman’s shoe, or the 
thought of it. He gave up fitting women with shoes; 
but, whenever one came into his shop to look at shoes ABSENCE OF SEXUAL DESIRE. 
49 
he experienced the usual manifestations of the idea. At 
last he gave up this department of his business, and 
began to turn his attention still more strenuously to 
the purpose of getting rid of the association, in his 
mind, between women’s shoes and the genesic func- 
tion. 
But now a new phenomenon made its appearance. 
He had never, to his knowledge, had a nocturnal emis- 
sion ; probably owing to the fact that he had practised 
masturbation so often that there was no excitability 
to be provoked. Occasionally, he had dreamed of 
women’s shoes, but the dream had, so far as he knew, 
never produced an emission. Now, however, with the 
stoppage of the voluntary excitations, a change in this 
respect had ensued, and almost every night he had 
vivid dreams of the exciting objects, accompanied by 
ejaculations of semen. He therefore reached the con- 
clusion that his efforts had all come to naught, and he 
was strengthened in this conviction by the fact that 
he had had several nocturual epileptic convulsions; at 
least, so he supposed, and there could be no doubt 
about the matter, from the fact that several times, on 
awakening, he had found his tongue sore from the 
wounds he had given it with his teeth, and blood- 
stained spots on the pillow. 
Although, as I have said, he had never had the slight- 
est sexual feeling towards women, or even associated 
with them, he determined to marry, in the hope that, 
by this means, he might be cured of his troubles. He 50 
SEXUAL IMPOTENCE IN THE MALE. 
accordingly, after a short acquaintance, made matrimo 
nial proposals to a young woman of attractive appear- 
ance, and shortly afterwards was married. He found, 
however, to his dismay, that he was impotent, so far 
as regarded normal physiological intercourse. If he 
thought of his wife’s shoes he had an erection, but as 
soon as he made the attempt at intercourse the penis be- 
came flaccid and entrance was impossible. A whole 
week was passed, night after night, in fruitless attempts 
to consummate the marriage, and then he decided to 
obtain medical advice. He came to me, and, with great 
frankness, gave me the full history of his case, as I have 
stated it. 
Upon examination I found the genital organs well 
formed and in every respect natural. He stated that 
every night since his marriage he had had a nocturnal 
emission, but that at every attempt to effect entrance 
the erection, however strong, had at once gone down, 
and he had failed. On two occasions emissions had 
occurred through the effect of his imagination and be- 
fore he could place himself in position, but they were 
from thoughts of women’s shoes, and not from any nat- 
ural excitation. The very idea of sexual intercourse or 
even of sleeping in the same bed with a woman was un- 
pleasant, and no blandishment of his wife had the slight- 
est effect in causing desire, unless he thought of the 
usual objects. Then erection occurred, but the diver- 
sion of the thoughts in another direction at once led to 
its dissipation. By no effort of his will could he con- ABSENCE OF SEXUAL DESIRE. 
5i 
tinue to think of the shoes and of the act to be per 
formed at the same time. 
I suggested to him that he should hang one of his 
wife’s shoes at the head of the bed and keep it in sight 
while he made the effort at intercourse and continue to 
do so till he had become habituated to his new relation. 
I also advised that he should keep his thoughts as much 
on his wife and to try to imagine her conversion into a 
woman’s shoe. At the same time I prescribed the bro- 
mide of sodium, to be taken in doses of fifteen grains, 
three times a day. I gave this as much for the relief of 
his epileptic condition as for anything else, though I 
was not unmindful of its power to lessen erethism of 
the sexual organs as well as of the brain. With instruc- 
tions to continue this plan of treatment for ten days and 
then to return to me for further observation, I dismissed 
him. 
At the expiration of the period named he again pre- 
sented himself, and I knew as soon as I saw his face that 
there was some success. In the first place, he had had 
no epileptic attack, and in the next, and what he con- 
sidered the most important, he had twice succeeded in 
having intercourse. He had gone somewhat farther 
than I had advised, and had taken his wife into his con- 
fidence relative to the influence of women’s shoes in 
causing sexual excitement and erections. I scarcely 
believe he told her the whole story, but he revealed 
enough to excite her sympathy and to procure her as- 
sistance, and the result was as I have stated. After 52 
SEXUAL IMPOTENCE IN THE MALE. 
this he had very little trouble, though occasionally he 
would fail. His wife became pregnant, but the child 
was still-born at the eighth month. There has been no 
subsequent pregnancy, though he tells me he has inter- 
course about once in ten days. He still has to think of 
women’s shoes, but is confident that he is growing in- 
different to that species of sexual excitation. He is 
still obliged to take the bromide for his epilepsy, though 
a nightly dose of thirty grains suffices to prevent the 
attacks. If he stops for longer than a week he is certain 
to have a paroxysm. He will, probably, have to take it 
during the rest of his life. 
The foregoing is certainly a very remarkable case, for 
it shows not only the perversity of some natures as re- 
gards the sexual passion, but it also exhibits how much 
may be done by intense mental effort, even by a person 
not of very strong intellectual development in bringing 
matters back to a normal channel. 
Dr. Cox, * of Colorado, gives the particulars of a 
case which, though not so remarkable as the one I 
have just described, is nevertheless sufficiently interest- 
ing, not only in its genesic, but in its psychological 
relations. I cite it in his own language. 
“This man has a wife and several beautiful children, 
and within the sanctity of his home, where he is al- 
ways to be found during the evening, his precept and 
example are so noble and pure and good, that his in- 
*“ Transactions of the Colorado State Medical Society”—quoted in 
The Alienist and Neurologist, April, 1883, p. 345. ABSENCE OF SEXUAL DESIRE. 
53 
fluence is felt and praised by all of his many friends 
and admirers. But at stated periods, away from home, 
he is a holy terror to the biblical standard of those who 
have the promise of seeing God, an angel of mercy to 
the fast women whom he patronizes, and an insoluble 
enigma to all mankind. 
“ He has never been known to cohabit with a lewd 
woman, or to speak an immodest word ; but he is a 
regular visitor, and, in his peculiar way, a liberal 
customer at certain houses of ill repute. His custom 
is to go early in the afternoon, select two or three of 
the largest girls in the house, and repair to a private 
room and lock the door. Here he divests himself of 
every stitch of clothing, from the waist upwards, but 
never removes his trowsers or boots. Then, lying 
prostrate upon the floor, with his hands lightly crossed 
over the abdomen and his eyes tightly closed, he com- 
mands his companions to walk over his naked chest, 
neck and face, taking care to stop at each step to 
grind his flesh with the heels of their boots. After this 
process has continued for some time, he begins to buy 
the wine for the girls to drink, but religiously abstains 
from taking a drop himself. 
“About the only noticeable interest he takes in the 
proceeding is an occasional demand for a heavier girl, 
or for some means by which they can increase the 
severity of the punishment. The tramping process 
goes on uninterruptedly for two or three hours, at the 
end of which time he will have ordered a dozen or 54 
SEXUAL IMPOTENCE IN THE MALE. 
more bottles of wine, besides paying the fair trampers 
handsomely for their time and trouble. 
“ One of his diversions is to make one of the girls 
stand on his chest with her entire weight on one boot- 
heel, and have the other girls spin her around till his 
flesh is torn and bleeding. He will also frequently 
direct a girl to place one foot across his eyes, with the 
boot-heel resting in one orbit and the other foot across 
his throat. He will keep her in this position for five or 
ten minutes, thus sustaining a weight of one hundred 
and fifty pounds or more. It would be impossible to 
mention all the means of torture that this man has in- 
vented and submitted to, but I merely mention these 
few facts as being samples of dozens which I have 
heard of. 
“ At the conclusion of one of these matinees, our 
hero puts himself through a course of rubbing his 
injured spots with his naked hands ; and a very strange 
part of the story is the fact that by this simple process 
his bruises, scars and ecchymoses will almost entirely 
disappear within a very few minutes. 
“ Having thus rubbed himself back to a state of pre- 
sentability, he resumes his clothing, pays his bill, and 
takes himself off to the marts of trade, but only to 
return and repeat the strange entertainment in about a 
week.” 
The rationale of such a case would be difficult to dis- 
cover, were it not for our acquaintance with similar 
instances, which teach us that by analogous methods ABSENCE OF SEXUAL DESIRE. 
55 
some men procure a species of venereal excitement, 
perhaps of a more exalted character than that to be ob- 
tained by the physiological and normal process of 
sexual intercourse. The fact, however, that this in- 
dividual had children, shows that he was, at one time 
at least, not incapable of copulation. It would be in- 
teresting to know how long he has been addicted to 
the practice described by Dr. Cox, and also the age of 
his youngest child. I am of the opinion that he is im- 
potent with women, and that his only means of obtain- 
ing the sexual orgasm is by subjecting himself to the 
treatment mentioned. There are men, or at least in- 
dividuals in the image of man, who never experience 
the orgasm unless it is excited by acts of cruelty and 
bloodshed, either performed upon others or upon them- 
selves. It appears to me that the subject of Dr. Cox’s 
communication is one of these, and that while he is 
being bruised and mangled he is experiencing intense 
sexual pleasure, with repeated acts of seminal ejacula- 
tion. 
Several cases of sexual inversion in which the subjects 
were disposed to form amatory attachments to other 
men, have been under my observation. They are even 
more distressing and disgusting than cases such as that 
the details of which I have just given ; but it is neces- 
sary for the elucidation of the subject to bring their de- 
tails before the practitioner. So long as human nature 
exists such instances will occur and physicians must be 
prepared to treat them. 56 
SEXUAL IMPOTENCE IN THE MALE. 
One of these was a young- man, a cigar-dealer of this 
city, who, from a very early period of his life had con- 
tracted the habit of introducing substances into the 
anus for the purpose of having sexual pleasure. He 
had been led to the practice by seeing, while yet a very 
young child, a dog coupled with a bitch, and supposing 
that the connection was by the anus, he had inserted a 
wooden lead pencil into the corresponding opening of 
his own body. This had caused him some local pain 
but it had also produced a singular but voluptuous sen- 
sation the exact location of which he was then not able 
to fix. 
At this time he was about seven years old. In a few 
days he repeated the operation with a like result, but 
on this occasion with the handle of a tooth brush well 
oiled. Again he experienced pleasure which was dis- 
tinctly referable to the penis. After this he often per- 
formed this act, using always the same article with 
which to accomplish his purpose. 
At about the age of ten he was initiated into mastur- 
bation and pederasty by the boys of a boarding-school 
to which he was sent. Masturbation, however, gave 
him no pleasure, neither did pederasty when he was the 
active agent. Indeed he had difficulty in getting an 
erection sufficiently vigorous for the purpose. His 
weakness in this respect was soon discovered, and he 
was relieved from that part of the performance very 
much in accordance with his wishes, as the role of the 
passive gave him more pleasure than that of the active ABSENCE OF SEXUAL DESIRE. 
57 
agent. Every night, therefore, he took part in these 
shameful performances and frequently to the extent of 
half a dozen or more times. On each occasion he ex- 
perienced the voluptuous sensations to obtain which 
was rapidly becoming one of the chief objects of his 
life. He remained at the school five years, and then left 
it to go into a tobacco mercantile establishment to learn 
the business, but, as he said, with his health shattered, 
his nervous system irritable, with almost constant head- 
aches, and with such a degree of relaxation of the 
sphincter ani as to sometimes make it impossible for 
him to hold his feces after they had once reached the 
rectum. 
At this time he formed an association for pederastic 
purposes with a young man who was to take the active 
while he himself took the passive part. Articles of 
agreement were drawn up between them in which each 
swore eternal fidelity to the other, and in which they 
were called, respectively, husband and wife. They took 
a room together and at night slept in one bed. There 
were two beds in the room and both were occupied for 
a few minutes so as not to excite suspicion, and then the 
one who was in this disgusting arrangement to act the 
part of the “ husband ” came to his “ wife’s ” bed and re- 
mained there during the night. Generally pederasty 
was practiced night and morning. 
Frequently the passive agent would array himself in 
female attire and would sit up at night waiting for the 
other to return home—sometimes he was kept out late 58 
SEXUAL IMPOTENCE IN THE MALE. 
by his business, which was that of a liquor dealer—and 
then would receive him with every demonstration of 
affection. 
These relations continued for three years, at the end 
of which time the passive agent went into business as a 
cigar dealer, and his associate was obliged to leave the 
city, in consequence of a difficulty with the police in 
regard to a gambling operation in which he was en- 
gaged. The connection was, therefore, broken up, 
though with much regret and many manifestations of 
grief on both sides. He then resumed his performances 
on himself, though he was constantly on the lookout 
for a man with whom he could establish rapports, such 
as those which had been interrupted. He frequently 
fell in love at first sight, but was afraid to make ad- 
vances, lest he should be refused, and perhaps exposed. 
All this time he had a very lively sense of the impro- 
priety and illegality of his proceedings. He knew 
that if detected disgrace and severe punishment would 
be the result. He endeavored, however, to reconcile 
his mind to his conduct, by endeavoring to persuade 
himself that he could not help doing what he did ; that 
the tendency was born in him, and, that though his body 
was that of a man, his soul was a woman’s. He grave 
himself a woman’s name, calling himself “Lida” when- 
ever he was operating on himself, and insisting on 
being called so by his acquaintances, telling them 
some story about its being an abbreviation of his real 
name. ABSENCE OF SEXUAL DESIRE. 
59 
In all his life, he had never experienced the slightest 
sexual feeling for women. Upon one occasion he had 
passed the part of a night with a prostitute, but was 
unable to have connection, or even to have an erection. 
Since about his fifteenth year he had had strong erec- 
tions while engaged in pederasty, and emissions of se- 
men took place at each performance, though without 
there being any contact with the penis. Indeed, this 
organ was in such a hyperassthetic state while the act 
was being performed on him, that he could not bear it 
to be touched. The least contact, even, with his cloth- 
ing, was sufficient to produce a semi-epileptic paroxysm, 
in which, while there was no loss of consciousness, there 
were involuntary contraction of the muscles of the face, 
arms, and legs of both sides of the body, and an imme- 
diate relaxation of the sphincter of the bladder, at- 
tended with discharge of whatever urine might be in 
the viscus. This condition of enuresis was often mani- 
fested during sleep, but more especially when there had 
been no sexual relations that night. 
Finally he formed a pederastic association with a man 
of about fifty years of age. As he said, it was not the 
kind he wanted, but he had, as he declared, no alterna- 
tive. This man proved to be very salacious, and some- 
times had relations with him three or four times in the 
course of the day and night. He had several times 
been under the charge of a surgeon of the qity for fis- 
sure of the anus, but had never revealed the real circum- 
stances to him. 6o 
SEXUAL IMPOTENCE IN THE MALE. 
About a year before he came under my observation 
he had had an epileptic fit during pederastic intercourse. 
This was after having had such connection four times 
in the course of one night, when he was greatly ex- 
hausted, and in an exceedingly hyperassthetic condition. 
During this attack he bit his tongue. After this he 
had repeated seizures, some taking place during the 
pederastic acts, and others just after they were ended. 
All were apparently directly connected with them, ex- 
cept the two last, which had occurred while he was in 
his shop, and engaged in his legitimate business. In 
the second of these he had fallen against a hot stove 
and burnt his hands and chest quite severely. It was 
for treatment for his epileptic convulsions that he came 
to me. 
As soon as he entered my consulting room, I was sure, 
from his appearance and manner, that there was some 
derangement of the genital system, but I was not pre- 
pared for the horrible instance of depravity the details of 
which, after some difficulty, I succeeded in eliciting from 
him. Here was a man about twenty-three or twenty- 
the four years of age who for nearly twenty years had 
had sexual orgasm in the strangely unnatural way men- 
tioned, more times than an average of once daily. He 
informed me that he had made a calculation, and was 
sure that he had either acted upon himself or been 
acted upon by others, at least ten thousand times ! He 
was exceedingly thin ; his eyes, black, were deep sunken 
in their sockets, his hair was black, thin, and dry; he ABSENCE OF SEXUAL DESIRE. 
61 
had no beard, and but a slight mustache ; his skin was 
sallow, and the expression of his face that of a person 
who has committed a crime, and is fearful of being dis- 
covered. While speaking, he kept his eyes cast towards 
the floor. After he had told me the story as I have 
given it, I proceeded to examine him more critically. 
I found that he had had repeated headaches, and at- 
tacks of vertigo ; that he had scarcely any appetite, that 
he suffered greatly from dyspepsia, that his bowels were 
sometimes constipated, and sometimes extremely loose; 
that he had pains in his back, and that he had had for 
several months past, sharp, shooting electric-like pains 
in his legs, which he had taken for neuralgic pains, but 
which, from the peculiar gait, the absence of the patellar 
tendon-reflex, and the presence of other symptoms, were 
certainly indicative of the existence of locomotor ataxia. 
He also had incontinence of urine, and the ordinary 
phenomena of incoordination, met with in the affection 
in question. On submitting him to ophthalmoscopic 
examination, I ascertained that the left pupil was very 
considerably larger than the right, that there was 
neuro-retinitis on both sides, and that on the left side 
there had been several retinal hsemorrhages. The field 
of vision was considerably restricted in that eye. At 
times there had been diplopia. 
Extending my examination to the genital organs, I 
found the penis extremely small, but the moment I 
touched it an involuntary shudder ran through his body, 
and, for the instant, he lost consciousness—the attack 62 
SEXUAL IMPOTENCE IN THE MALE. 
was clearly epileptic in character. Although he could 
touch and handle the organ with comparative impunity 
—though when he retracted the prepuce, there were 
slight spasms—it was, he said, impossible for any one 
else to touch it without an epileptic seizure being pro- 
duced. There was no phimosis. In its flaccid state, 
the penis was not larger round than a man’s little finger, 
and did not exceed two and a half inches in length. I 
suspected from this conformation that he had taken the 
active part in pederasty, as well as the passive, to which 
he had confessed, but he assured me, that he had never 
done so half a dozen times in his life and that his penis 
had always been as small as it then was. The testicles 
were of about the normal size, though, perhaps, some- 
what softer than they are usually found to be in the 
healthy state. The anus was extremely relaxed ; to 
such an extent, in fact, that it would have been per- 
fectly easy to have introduced the hand. 
He informed me that at times his inclination to- 
wards being a woman was so great that he had been 
repeatedly tempted to amputate the genital 
organs. He had been told by his paramours, however, 
that if he did so he would no longer be capable of ex- 
periencing pleasure in the pederastic act, and this had 
restrained him. 
But with this tendency to femininity, he had a dis- 
gust for women, so far as the sexual feeling was con- 
cerned ; and, as has been said, he had never felt in the 
slightest degree any venereal excitement in their pres- ABSENCE OF SEXUAL DESIRE. 
63 
ence and under circumstances calculated to produce 
the orgasm in normally constituted men. 
There was nothing to do for this patient, so far as I 
could determine, but to give him the bromide of sodium, 
with the view of lessening his reflex excitability and 
arresting the epileptic paroxysms, to which he was 
subject. He promised to abstain from further peder- 
astic acts, but I had no confidence in his protestations. 
Indeed, he said that he did not himself believe that he 
would be able to stop. He returned in about a week, 
better so far as the epilepsy was concerned, but with no 
improvement in other respects. He had committed 
pederasty, passively, five times in that period, a slight 
reduction from the average. I saw him, at intervals, 
for several months. So long as he took the bromide 
he was better, and his inclinations to his vice lessened 
in number and intensity. It had rendered him a little 
weaker in his legs, however, and he stopped taking it. 
His ataxic symptoms steadily became more profound. 
Finally in the winter of 1880-1881, he died of some 
lung trouble, in Cuba, whither he had gone for his 
health. 
There are few cases on record in which a more de- 
cided inversion of the sexual feeling has been exhibited 
than in this instance. The exact mechanism of the 
production of the orgasm by friction against the muc- 
ous membrane of the rectum, is, of course, easy of ex- 
planation ; but that it should have been put in action 
at so early a period, and without the ordinary physio- 64 
SEXUAL IMPOTENCE IN THE MALE. 
logical process being developed, are certainly remark- 
able facts. And again, that when the glans penis began 
to exhibit excitability, it should, when excited, instead 
of leading to the sexual orgasm, result in an epileptic 
paroxysm is another extraordinary phenomenon. 
In another case, the patient, a young man, twenty- 
eight years of age, consulted me for treatment for 
pederastic tendencies to which he was subject, and to 
which he had repeatedly yielded, though always after- 
wards experiencing the most intense feelings of re- 
morse. He had never had sexual intercourse with 
women, nor had desire in that way. He had attempted 
it repeatedly, in order that he might, by success, be 
diverted from his pederastic inclinations, but had never 
succeeded. No excitations in connection with women 
caused him any sexual excitement. He was absolutely 
impotent with them. 
This patient was of a different type from the other. 
He was well educated, had travelled extensively, and 
had ample means at his command. His family was of 
the highest respectability. All these circumstances in- 
creased the deep sorrow he felt at the tendencies 
which, in the most unaccountable manner,, had been 
developed in him, and which had produced in him a 
feeling of the most profound melancholy. 
The origin of the impulse was sudden, and occurred 
when he was about twelve years of age. He had been 
severely flogged at school for some boyish offense, and 
soon afterward experienced in the sexual organs sensa- ABSENCE OF SEXUAL DESIRE. 
65 
tions which he had never felt before, accompanied by 
an erection which lasted fully half an hour. That after- 
noon, he went into a river near by to bathe, in company 
with another boy, and, while in the water, he swam 
with his hands resting on the other boy’s shoulders. 
He had often done this before, without having any 
sexual excitement provoked, but upon this occasion 
his penis came in contact with the gluteal region of his 
companion, and, instantly, he felt just such sensations 
as he had experienced when he had been flogged, and, 
like them, accompanied by an erection. They were 
close to shore, and before he knew what he was doing, 
he was performing a pederastic act. From this time 
on, while at school, he continued the practice, some- 
times acting as the passive, but generally as the active 
agent. When he left school, he stopped for a long 
time, having become aware of the iniquity of his pro- 
ceedings, but the sight of a naked man, or even the 
pictures or statutes of such men, were sufficient to 
cause sexual excitement, but not teaching to the extent 
of emissions. 
While at college he studied hard, and during the 
four years of his attendance never once yielded to his 
inclinations. He, however, frequently practised mas- 
turbation, and during the act always directed his mind 
toward the subject of the gluteal region of man, of 
naked men, and images of men committing pederasty. 
There was scarcely a night that he did not commit self- 
pollution. Nocturual emissions, also, were common, 66 
SEXUAL IMPOTENCE IN THE MALE. 
and were always accompanied by lascivious dreams, of 
which pederastic acts were the principal features. 
All this injured his mind and weakened his genera- 
tive organs. He cursed himself for his inability to re- 
frain, and for the unnatural course which his sexual 
desires took. Several times he had attempted to turn 
them towards women, but in vain. They were abso- 
lutely incapable of rousing in him the least venereal 
■excitement. He read romances of an indecent charac- 
ter, in which women were made to act lascivious parts; 
he bought obscene pictures and looked at them, hoping, 
by these means, to provoke a natural desire ; but he 
was absolutely dead to all excitations of the kind. 
These things disgusted him, and, as he said, when he 
saw several naked prostitutes in obscene positions, he 
had a feeling of nausea that almost ended in vomiting. 
The society of virtuous women he could not bring him- 
self to seek, on account of the sense of his utter unfit- 
ness, by reason of his moral turpitude for such asso- 
ciations. He was fast becoming morbid and full of 
eccentric notions relating to sexuality. For instance, 
he spent the whole of one evening drawing the gluteal 
regions of the great men of the world, and imagining 
that he was having pederastic relations with them. 
Soon after leaving- college, while stopping at a hotel 
in this city, a telegraphic message arrived for him late 
in the evening, just as he had undressed, and was going 
to bed. The bell-boy of the hotel, who brought it to 
him, was a rather handsome lad, and excited the desires ABSENCE OF SEXUAL DESIRE. 
67 
of the patient to an inordinate degree. He offered him 
a considerable sum of money to remain with him all 
night, and, without much persuasion, consent was ob- 
tained. He had never experienced such intense vene- 
real excitement as he did that night, and he committed 
pederasty eleven times before morning. His remorse 
over this was very great and his physical suffering ex- 
cessive. He could not walk for several days; had con- 
stant headache, and could not sleep. He sent for an 
ounce of laudanum, intending to take the whole of it, 
but, on reflection, contented himself with a little less 
than a teaspoonful. This gave him sleep, and some 
measure of relief from his other nervous symptoms. 
He recovered, however, went to Europe, and there in- 
dulged several times. Then he returned to New York, 
indulging two or three times, and, finally, he came to 
me, as I have stated. 
I found that he was sincerely desirous of being cured 
of his tendencies, and of recovery. He had, with this 
latter end in view, formed the acquaintance of a young 
lady, but as he had never experienced any sexual incli- 
nations towards women, he was afraid to think serious- 
ly of matrimony. Thus far, there had been apparently 
no serious inroads committed on his health, except as 
regarded his mind. He was subject to severe fits of 
depression, during which he suffered the keenest feel- 
ings of remorse, and had thoughts of suicide. He had 
never before consulted a physician. 
I advised continuous association with virtuous women, 68 
SEXUAL IMPOTENCE IN THE MALE. 
and a system of severe study of subjects that would 
require abstract thought of the highest kind. I sug- 
gested mathematics. He at once agreed to pursue the 
exact course I marked out for him in these respects. 
I also recommended cold baths every morning, a 
liberal diet, and plenty of outdoor exercise, either of 
walking or horseback-riding. 
I cauterized the nape of the neck and the lower dor- 
sal and lumbar regions, and administered the bromide 
of sodium, in fifteen grain doses, three times a day. The 
cauterization was repeated every ten days. At the end of 
the third month there had been a very decided improve- 
ment. Bromism had been produced to a tolerably 
severe degree, and with its appearance, the unnatural 
proclivities towards men began to disappear. He no 
longer had images, such as had formerly haunted him, 
passing through his mind, and he could look at a nude 
statute of a man without feeling any sexual excitement. 
Occasionally, however, the impulse to pederasty would 
come over him, but it lasted only for a few minutes, 
and was never yielded to. He had not, however, had 
any inclination towards women. He had had but one 
nocturnal emission, and that was soon after beginning 
treatment. 
All this was very favorable, and I determined to con- 
tinue the treatment unchanged for another period of 
three months. 
At the end of this time there had been still greater 
amendment. Sleep had become regular and sound; ABSENCE OF SEXUAL DESIRE. 
69 
his melancholic disposition had almost disappeared; his 
abnormal sexual tendencies no longer existed. In fact, 
there was no venereal excitement of any kind. There 
were no emissions, no erections. Judging that the bro- 
mide had now been carried far enough, and that he had 
obtained such a degree of control over himself, as to 
prevent his returning to his former habits, I stopped its 
administration, and gave him, instead, the following 
prescription: 
IJ. Strychniae sulph gr. ij. 
Acid, hypophosph. dil § ij. 
M. ft. sol. Dose: ten drops three times a day. 
He took this without interruption for three months. 
During this period he had no relapse, The images, 
which formerly excited him now disgusted him, for he 
associated them with some of the most remorseful feel- 
ings a man could have, and he had begun to take pleas- 
ure in the society of respectable women. He had not, 
however, experienced any but the faintest evidences of 
sexual excitement, though occasionally he had felt 
slight normal desires. 
Over a year has now (March, 1883), elapsed, and he 
is still under treatment, though I have not seen him for 
two months. At that time he was strong and healthy, 
free from all pederastic tendencies; in fact, entertain- 
ing the liveliest disgust for it, and thinking seriously of 
marriage. He had had, several times, natural sexual 
desires, accompanied by erections, but a high sense of 
morality, which now exists in him, has prevented any 70 
SEXUAL IMPOTENCE IN THE MALE. 
yielding. He has nerve to keep himself perfectly 
chaste till his marriage, and then to use with discretion 
whatever power he may have. 
These cases will suffice to show two of the types of 
pederasts. There are others, but they are not essen- 
tially different from those that have been described, 
and the pen wearies of writing of such moral, physi- 
cal and hygienic iniquities. 
But there are other cases which require consider- 
ation, and which also lead to impotence, by causing 
a loss of the natural desire. Among these are those 
instances in which, without manual or other phy- 
sical interference, the act of ejaculation, with excite- 
ment, is accomplished by a simple act of the imagina- 
tion. A man, for instance, observes some woman, who 
proves to be capable of provoking sexual desire. He 
concentrates his attention on her, imagines the ap- 
pearance of her vulva, and that he is effecting entrance, 
and then, step by step, by an effort of the will, brings 
before his mind’s eye the successive stages of an act of 
sexual intercourse, and ends by experiencing the full 
sexual orgasm. There are men who never have any 
other form of orgasm but this; who cannot experience 
erections from the reality, but who accomplish this, 
and, in the way I have mentioned, readily, and often 
several times in the course of the day. As one of them 
said to me, “ We have the stimulating influence of con- 
stant change, which we could never get in real sexual 
intercourse. We have the pick of the handsomest ABSENCE OF SEXUAL DESIRE. 
n 
women in town, and the enjoyment is infinitely greater 
than any intercourse could be.” These men go into the 
street cars, the theatres and other public places, place 
themselves, so that they can fix their eyes on the centre 
of a woman’s body, and then give a loose rein to the 
imagination. In a half minute, or a minute at furthest, 
the orgasm supervenes. 
Three of these cases have come under my observa- 
tion, and I have heard of others through these three. 
There appears to be a sort of association, or fellowship, 
with signs, by which they know each other. They 
have a coarse name which they apply to themselves, 
and to each other, and which may be paraphrased as 
“ a man who has mental sexual intercourse.” They 
profess to be able to tell by sight whether or not a man 
is one of the class in question. 
One of the persons of the kind consulted ,me for epi- 
lepsy, which had been clearly brought about by the 
practice to which I refer. For several months he had 
had repeated attacks of fully developed epileptic parox- 
ysms, not only during the orgasms produced by the 
method mentioned, but at night during sleep. He in- 
formed me that several of his class had “fits.” This 
man had repeatedly had convulsions in the street, rail- 
way cars and other places. The last one had occurred 
in a picture-dealer’s, a favorite place, with him, to ob- 
serve nice-looking women. Having selected his “part- 
ner,” he fixed his mind on her strongly, and imagined 
her in various lascivious positions. He had no diffi- 72 
SEXUAL IMPOTENCE IN THE MALE. 
culty, he said, in bringing her image vividly before his 
mind in an entirely nude state. Then he went through 
a series of voluntary contractions of the gluteal and 
accelerator urinas, and, perhaps, other muscles, and in 
less than a minute, generally, the emission with the or- 
gasm took place. Sometimes, while mentally engaged 
with one woman, another would enter the apartment, 
handsomer or otherwise more attractive, and then he 
would change to her. He was able also to produce 
the orgasm by thinking of some woman whom he had 
previously seen, without the necessity of her being 
present before him. As to actual sexual intercourse, it 
gave him no pleasure, he was absolutely impotent with 
women and not even the imagination sufficed to awaken 
his desires in the attempt at connection. 
Latterly, he had been unable to restrain the disposi- 
tion to the production of the orgasm, which often took 
place at the mere sight of an attractive woman, and 
without being accompanied by an erection. At times 
there was no emission. Again, a painting or engraving 
of a woman, either clothed or in a nude or partially 
nude state, would cause an orgasm with or without 
erection or seminal ejaculation. 
In this case, the penis and testicles were apparently in 
good condition, and there appeared to be no hyperses- 
thetic condition of the glans. He complained, how- 
ever, of a burning sensation in the urethra whenever he 
passed his urine, and, on examination, I found an irrita- 
ble state of the prostatic portion of the canal. ABSENCE OF SEXUAL DESIRE. 
73 
I treated this patient with large doses of bromide of 
sodium, twenty grains three times a day, and with 
urethral injections of cold water. His mental condition 
was entirely cured in the course of a few months, and 
the epilepsy was prevented while he continued to take 
the bromide. After that time I lost sight of him and, 
therefore, do not know whether there was, or not, any 
improvement in regard to the impotence. Probably 
there was not. 
The other cases were similar in general features to 
this one. Epilepsy had been developed in each, but, as 
I only saw them once, I do not know the effects of the 
treatment. 
The particulars of an interesting case of sexual per- 
version and impotence have been given me by a medi- 
cal friend of this city, and with his permission I cite 
them here. 
The subject was a foreign gentleman, about thirty- 
five years of age, whose whole life had been devoted to 
the gratification of his sexual appetite, and who seldom 
kept less than three mistresses at a time. When thirty 
years old he had married, but soon afterward his wife 
left him in consequence of his failing sexual powers 
and her objections to his mode of life. 
Ordinarily he was unable to have an erection without 
obliging her to clothe herself in various fancy costumes, 
and to assume different positions, while he would sit 
and look at her till the desired result was obtained. 
Again, he would cause her to dress in a short, colored 74 
SEXUAL IMPOTENCE IN THE MALE. 
chemise, and colored silk stockings, and then while she 
lay on a lounge he would regard her sometimes for 
over an hour before erection ensued. After a time this 
procedure failed, and he then resorted to the expedient 
of dressing her in the costumes of different nations, Per- 
sian, Egyptian, Hungarian, Swiss, etc. That these ex- 
pedients also eventually failed there can be no doubt. 
A case is reported,* in which there was “ mental inter- 
course” similar to that referred to in the foregoing in- 
stances, and as the history is interesting in other re- 
pects, I cite it without abridgment. 
“ The patient is a highly cultivated gentleman of high 
moral character, the father of three or four healthy 
children, the result of an unusually happy marriage. 
‘ At an early age,’ said he, ‘ long before puberty, even, 
I had acquired a taste for indoor games, female pursuits 
and even attire, although the latter desire was never 
satisfied farther than wearing girls’ shoes. I was also 
an admirer of small waists in ladies and, at the age 
of fourteen, tried to procure or make for myself a pair 
of corsets. As I grew older, my fondness for female 
dress increased, but, having no sisters, I could find no 
opportunity to gratify it, farther than reading stories of 
female impersonations, etc. I composed several stories 
entitled ‘ Adventures in Hoops,’ and constructed stories 
founded on such plots. They were printed and exten- 
sively copied To this day I seldom miss an oppor- 
* “ Gynomania: A curious case of Masturbation.” The Medical Record, 
March 19, i88x. ABSENCE OF SEXUAL DESIRE. 
75 
tunity to see men take female parts on the stage, espe- 
cially the more refined ones, like Leon, etc.’ 
“ At the age of twenty-one years, he began the use of 
corsets, of which he is still very fond, and, although he 
laced himself very tightly for several years, he seems 
to have suffered no injury from it. He confessed that 
he had always derived a certain amount of sensual grat- 
ification from their use, and although, at first, he ex- 
perienced some pain in the pubic region, and erections, 
he has since found that as soon as his corsets are pulled 
quite tight, erections cease, and that coition, as well as 
voluntary discharges, are impossible when he is tightly 
laced. 
“ From fear of impotence or other evil that might re- 
sult from masturbation before marriage, he carefully 
avoided voluntary discharges of semen and remained 
continent before marriage. He recollects, however, 
having had three involuntary emissions while awake. 
The first occurred while horseback riding, and induced 
him to abandon this otherwise healthful exercise. The 
others happened while putting on a pair of very tight 
shoes (ladies’ boots, with French heels) and buttoning 
them. 
“ After marriage he abstained from corsets and other 
articles of female attire (with rare exceptions), until two 
children had satisfied him of his potency. 
“About this time our patient began to yield to the 
temptations which everywhere beset him, and returned 
to the very source whence he had first derived unlaw- 76 
SEXUAL IMPOTENCE IN THE MALE. 
ful pleasure. But I will let him tell it: ‘ I purchased,’ 
said he, ‘ a very stylish pair of ladies’ high boots, with 
French heels, which were at first tight enough to make 
me limp. These boots he boldly wore upon the prom- 
enade in fine weather, with trousers elevated to show the 
heel. In bad weather he was wont to put on these 
boots and button them in front of a long mirror, about 
once a week. This seldom failed to cause not only an 
erection, but also an emission. 
“ When this had lost its novelty, he purchased a pair 
of corsets, not having worn them since marriage. As 
often as practicable with concealment he wore these, 
and laced them sometimes to faintness. These two art- 
icles, buttoned boots and corsets, seemed to have a most 
peculiar infatuation for him. Often while riding in a 
street car, if a lady with a small waist or pretty foot sat 
opposite, he would have a sort of mental coition, he 
called it, with this innocent paramour—an emission. 
M. Roubaud mentions the only case at all similar, where 
a young man was impotent, except with a light-haired 
woman wearing corsets, high boots, and a silk dress. 
The last three articles had a powerful influence on our 
patient, whether they were worn by man or woman. 
“ After this he descended step by step down the ladder, 
purchasing various articles of female attire, until at 
length he bought a black silk dress, which he had made 
to fit him very tightly, and in which he took great pride. 
Curls and switches, false hair, earrings and breast pins, 
all aided in feeding this peculiar fire. He would even ABSENCE OF SEXUAL DESIRE. 
77 
sit for hours tightly laced, while a ladies’ hair-dresser 
curled and frizzed his hair like a woman’s. At length he 
went so far as to walk the city streets, and even attend 
church, wearing his new black silk dress, caught up on 
one side so as to expose a white fluted skirt, beneath 
which his high-heeled French boots were visible. With 
heavily padded chest, tightly squeezed waist, enormous 
bustle, his hair tortured into fantastic forms, his ears in 
screw-vises, and his feet crowded into the narrowest, 
and most uncomfortable boots, he would walk for miles, 
or dance for hours, with great pleasure. In fact, physi- 
cal pain seemed essential to his happiness, and he thor- 
oughly and deeply enjoyed it, if it were only the pain 
inflicted by female attire. He imitated women’s manner 
and habits to some extent, yet never used his disguise 
for improper purposes, except to excite an occasional 
emission. 
“ As before stated, he had always been an advocate 
of tight-lacing, had read extensively upon the subject, 
and collected all the literature that in any way favored 
or defended it. He several times tried to lace himself 
tightly enough to faint away, but never could. He 
even persuaded his wife to lace, and daily tightened 
her corsets, until he actually reduced her waist nearly 
six inches, which also gave him sensual gratification. 
A child born of her soon after was perfectly healthy and 
well formed. 
“ He showed me,” continues Dr. H., the physician who 
reports the case, “ several pictures of himself, in all 78 
SEXUAL IMPOTENCE IN THE MALE. 
sorts of dresses: as a ballet-girl, as Queen Elizabeth, as 
a Polish maiden, an old maid, the Goddess of Liberty, 
as Juliet, and in a plain street-dress, which he wore 
to church a few years ago. 
“ Many times he swore off, but in vain. Sometimes 
he would remain free from his peculiar vice for weeks 
and months, when it would return with renewed vigor. 
I found him eating largely of animal food, but not of fat 
meat. Nitrogenous food alone suited his palate. I ad- 
vised vegetable diet, but he found it distasteful to such 
a degree that I was forced to withdraw it. He used no 
stimulants except weak tea and coffee. Gave bromides 
for awhile and hope at length to conquer.” 
Sometimes there is, in individuals of a peculiarly im- 
pressionable nervous organization, sexual impotence as 
regards all women except those of a peculiar type, or 
clothed in a particular manner, or possessing some pe- 
culiarity, to which the person has become accustomed. 
Thus, in the case cited above from Roubaud,* the 
patient was impotent to all women different from the 
one with whom he had previously had sexual rela- 
tions. 
“ M. X., son of a general of the first Empire, was 
brought up at his father’s country seat, which he did 
not leave till he was eighteen years of age, when he 
went to the military school. During this long period 
of isolation in the country, he had been initiated, at the 
* “ Trait6 de l’impuisance et de la sterilite,” etc., Troisi&me Edition. 
Paris, 1876, p. 373. ABSENCE OF SEXUAL DESIRE. 
79 
age of fourteen, into an experience of the pleasures of 
love, by a young lady, a friend of the family. This 
lady, then twenty-one years old, was a blonde, wore 
her hair in the English style, that is to say, in corkscrew 
curls, and in order to lessen the liability of detection in 
her amorous intrigue, she never had intercourse with 
her young lover except when clothed in her day attire, 
that is to say, wearing gaiter boots, corsets and a silk 
gown. 
“ All these details I mention purposely, for they had 
greater influence, not only over the degree of excita- 
bility of the genital function, but over its very existence, 
in the case of M. X. 
“ The young lady was of strong passions, and as it 
appeared, exhausted the strength of the young neo- 
phyte, and the severe regimen of the military school 
was no more than sufficient to restore to the genital 
organs the energy which had been seriously affected 
by too early and too frequent indulgence. 
“ But when the period of his study had passed, and 
he was sent to a garrison, and was disposed to enjoy 
the rights which nature had restored, he perceived that 
sexual desire was only provoked by certain women, 
and with the concurrence of certain circumstances. 
Thus, a brunette did not produce in him the slightest 
emotion, and a woman in her night-dress was sufficient 
to extinguish and freeze every amorous transport. 
“ In order that he might experience the venereal 
desire, it was necessary that the woman should be a 80 
SEXUAL IMPOTENCE IN THE MALE. 
blonde, should wear gaiter boots, should be laced in a 
corset, wear a silk gown, and, in a word, fulfill all the 
requirements of the lady who had first caused M. X. to 
experience the sexual orgasm. 
“ And this was not by reason of any sentimental love, 
the magic power of which lasts through a lifetime. In 
his early sexual relations, M. X. had only been actuated 
by animal desire. His heart had never been touched, 
and after twenty-five years, in consulting me for his 
singular infirmity, he declared that he had loved with 
his heart but one woman, and to her he had never been 
able to render homage for, by a perverse coincidence, 
she was a brunette. 
“ His fortune, his name, his social position, made it a 
duty of M. X. to marry, but he had always resisted the 
solicitations of his family and his friends, for he knew 
that he would be incapable of availing himself of his 
marital rights, with a wife arrayed in the costume of 
the nuptial bed. Yet he was in good health, was of the 
sanguino-choleric temperament, was above the medium 
height and was of so strong a constitution that for fif- 
teen years he had been an officer in a regiment of heavy 
cavalry. 
“ Evidently his impotence was relative only, for, when 
the woman was blonde and when the other conditions 
specified existed, he accomplished the sexual act with 
all the ardor of a healthy man and one of an amorous 
disposition. 
“ Retiring to civil life, and tormented more than ever ABSENCE OF SEXUAL DESIRE. 
81 
by his family on the subject of his marriage, he was 
anxious to make a last effort, and accordingly consulted 
me.” 
This patient was cured by moral means, to which ref- 
erence will be more fully made hereafter. 
These cases of impotence as regards certain women, 
while there is full sexual power with others, are not in- 
frequently met with in medical practice, and, indeed, 
relative want of desire may be regarded as in some re- 
spects a normal phenomenon. A young man of strong 
passions, and yet educated and refined, will not be like- 
ly to exhibit desire toward an old, and ugly, and other- 
wise disagreeable hag. No matter how vigorous the 
animal part of his organism might be, or energetic the 
erection, both would give way, in presence of the ab- 
solute failure of sexual desire. But there are cases such 
as that cited from Roubaud, in which even trifling cir- 
cumstances or conditions, or the influence of some long- 
continued habit, abolishes all desire, and renders the 
individual, for the time being at least, impotent unless 
the situation is in every respect assimilated to that to 
which he is accustomed. I have already given in- 
stances in which this state existed in regard to all wo- 
men, and in which unless certain preliminaries were 
provided for, connection was not only impossible, but 
was often repulsive. 
The absence of desire on the part of a young man 
towards an old and ugly woman is an entirely natural 
phenomenon, and one, therefore, not calling for medical 82 
SEXUAL IMPOTENCE IN THE MALE. 
treatment, but cases like the following are certainly 
more or less abnormal, and are such as in regard to 
which physicians are often consulted. 
A married gentleman, who before entering into the 
matrimonial state, had been excessively given to sexual 
intercourse, but who had no reason to think that his 
powers were exhausted, or even materially weakened, 
found himself on his wedding night and for some days 
thereafter, absolutely incapable of consummating the 
marriage. His wife was a highly educated, intelligent, 
refined and beautiful woman ; he was devotedly attached 
to her, and on marrying had once and for all given up 
all the evil associations of his younger days. His passions 
were strong, but as soon as he attempted intercourse, 
the desire, which he had previously entertained, van- 
ished at the thought that it was a profanation for a 
man like him to subject so beautiful and pure a woman 
to such an animal relation as sexual intercourse. “ She 
is too good for me,” he would say to himself, “ I ought 
to have married a woman used to this sort of thing; or, 
better still, have remained single and gone on in the 
old way.” This happened several times, and then, in 
disgust with himself, he paid a visit to one of his former 
female associates, and in a short time satisfied himself 
that his powers were as good as ever. Again he es- 
sayed the act with his wife, and again he met with dis- 
appointment. 
He had now been married a week, and the marriage 
was still unconsummated. He then came under my care. ABSENCE OF SEXUAL DESIRE. 
83 
A case like his presented very little difficulty : I re- 
minded him of the fact that in all probability, however 
pure and noble his wife might be, there was no profa- 
nation in sexual intercourse, chastely undertaken; that 
she had sexual organs which were intended for the per- 
formance of certain functions; that these functions were 
all connected with the propagation of the human spe- 
cies ; that there was but one way that I knew of by which 
the species could be propagated ; that she had selected 
him as the one man who was to put her in the way of 
fulfilling her office in the grand scheme of nature, and 
that my advice to him was to lower his estimate of her 
angelic character, and to look upon her in the not less 
worthy light of a woman to be treated as other women 
are treated under like circumstances. He left, promis- 
ing to be less exalted in his appreciation, but the next 
morning returned with the information that it was no 
use: he had tried his best, his erections were strong 
and repeated, but as soon as he went further towards 
the object he had in view his desire became utterly ex- 
tinguished. “ She was too good, too delicate for a 
mere animal like him ; he could not desecrate her beau- 
tiful body by any such vile act,” etc., etc. 
From a few words which he let drop, I became con- 
vinced that the lady was not so platonic a creature as 
he thought, and, that if I could have a few words of 
conversation with her, I could probably end the matter 
to the satisfaction of both parties. I therefore expressed 
a wish to see his wife, and that afternoon, with his con- 84 
SEXUAL IMPOTENCE IN THE MALE. 
currence, called on her at the hotel at which they were 
stopping during their wedding tour to New York. I 
found her to be a very sensible woman, not at all 
etherial, but anxious to do her share towards relieving 
her husband from his embarrassing position, of which 
she only half comprehended the character. 
I requested her to be a little more free in her manner 
with her husband than she had yet been, and told her I 
thought that if she pursued that course there would be 
no further disappointment, but that she was not to act 
as though she had received any instruction from me, 
but rather as though she was disregarding what I had 
said to her. The details, of course, I left to her own 
good sense and womanly feeling. The plan was emi- 
nently successful, as her husband told me with great 
glee the next day. “She told me,” he said, “that she 
did not want any doctors about her; that she could set- 
tle this affair herself.” “The rest,” he continued, “is 
confidential between her and me, but, by Heaven, it re- 
minded me of old times!” It is scarcely necessary to 
add that there was no further trouble. 
In another case, the patient, a gentleman who had 
been married several years, and had lived happily with 
a wife to whom he was much attached, found himself 
absolutely without desire, in a new house he had built 
for himself. He had, when he consulted me, lived in 
his new mansion six or seven months, and in all that 
time had experienced no desire for intercourse. He was 
about thirty years of age, and his wife twenty-five. ABSENCE OF SEXUAL DESIRE. 
85 
He consulted me, supposing that there was some ner- 
vous trouble threatening the extinction of his virile 
powers. I found, however, on examination, that the 
organs were in a perfectly normal condition, that he had 
strong erections at times, and had had several nocturnal 
emissions. I suggested that, probably, he was like the 
boy who had spelt well in the old school-house, but who, 
when reproved by his teacher for retrograding in his 
orthography, replied that “ he could not get the hang 
of the new school-house.” At first, he doubted the 
correctness of this explanation, but upon reflection 
became satisfied that I was right. To “make assur- 
ance doubly sure,” he went, with his wife, to the 
other house, which was awaiting a tenant, and pass- 
ing a night there, was very soon convinced that 
the former state of affairs could be easily restored. 
What to do, however, was the next question. To go 
back to his old residence was out of the question, and 
to live, as it appeared to him, he would have to live in 
the new one, was not to be thought of. I advised that 
he should move all the bed-room furniture from his 
chamber in the old house to the one he occupied in the 
new, and to otherwise fit up the room as nearly as pos- 
sible like the one to which he had been so long accus- 
tomed. He at once saw the propriety of this sugges- 
tion, and, adopting it, had no further trouble. Piece by 
piece, after a few months, he displaced the old furniture, 
and this without any sacrifice of his normal desires. 
Besides these classes of impotents, complete and par- 86 
SEXUAL IMPOTENCE IN THE MALE. 
tial, from the absence of desire, there are others, in 
whom the condition is irregularly induced, through re- 
ligious observance or superstition, and in whom it be- 
comes permanent through a long continuance of sexual 
abstinence. Thus, members of the priesthood in certain 
denominations, who devote themselves to a life of celi- 
bacy and self-abnegation, eventually become absolutely 
free from desire, and consequently impotent. The same 
is true of whole sects, whose religious worship requires 
an entire abstinence from sexual intercourse. Before 
the stage is reached at which desire is abolished, great 
suffering is sometimes undergone, as was, for instance, 
the case with St. Anthony and others of those with 
whom the complete annihilation of sexual inclinations 
was considered an act agreeable to God. In regard to 
the Shakers, who profess to abstain from intercourse, 
and who probably do so, in most cases, the following 
account exhibits, to some extent, the state of mind and 
body thereby induced. 
“An old Shaker, called Father Abijah Worster (who 
had been anointed Father in Mother Ann’s day), a 
native of Harvard, Mass., and well known to the in- 
habitants of that town, told me, that one time some of 
his relatives entered and clung to him. I will relate 
his story; yet, if I had his words, I should lack the deep 
tone of thrilling horror which invariably accompanied 
the recital of such scenes by these visionary people. 
He says: 
“ As I was tossing, tumbling, rolling, jumping, throw- ABSENCE of sexual desire. 
87 
ing myself against the wall, the chimney, the floor, the 
chairs, in fact, everything that did not keep out of the 
way, I felt that my blood was boiling, and every bone 
in my body was being sawn asunder; my flesh pinched 
with hot irons, and every hair on my head was a sting- 
ing reptile. I had laid me down to die, when Mother 
Ann came along, saying, ‘ Why, Abijah, there are some 
of the worst looking spirits on your shoulders I ever 
saw in my life.’ I crawled along and laid me down at 
her feet, and prayed her, in mercy, to help me; she 
raised me up, and made a few resolute passes, from my 
head to my feet, with her hands, and I was relieved 
at once—and I have never doubted since; that,’ he 
added, ‘was the power of God in Mother.’ 
“This good old man died in 1839, upwards of ninety 
years of age; he related to me, as a Remarkable Fact, 
a few weeks before his death, that he had gained a 
complete dominion over all the passions of the first 
Adam. The young and beautiful, old and withered, 
were the same to him.” * 
A patient who had voluntarily reduced himself to 
impotence by restraining his desires, was, several years 
since, under my charge. Originally of strong passions, 
he had, when about attaining his majority, made a vow 
to follow the example of Mani, and to abstain from all 
voluntary sexual excitement. He devoted himself to 
the study of philosophy, with the view of founding a 
* Extract from an unpublished Manuscript on Shaker History. By 
an Eye-Witness. Boston, 1850. 88 
SEXUAL IMPOTENCE IN THE MALE. 
sect, which should be purer in their lives than any that 
had previously existed. He began by curbing the sex- 
ual passions, and proposed, by degrees, to suppress all 
appetites, except those absolutely necessary to the ex- 
istence of the individual, and these were to be indulged 
in to the lowest extent consistent with the preservation 
of life. As I have said, he was of strong sexual feeling, 
and for a long time he suffered very acutely. Libidi- 
nous images were constantly before him, and his dreams 
were only of sexual matters, of all possible variety. 
During this period, nocturnal emissions were common 
occurrences. The deprivation was soon calculated to 
excite disturbance, from the fact, that up to the period 
of his vow, he had indulged freely and had kept a mis- 
tress from the time that he was seventeen years old. 
Finally he succeeded in overcoming the sexual appetite, 
and he was able to pursue his studies with more assidu- 
ity than had previously been the case. He made a 
voyage to India, in order to perfect himself in certain 
branches of knowledge which he thought he could not 
study thoroughly at home. During his travels he was 
repeatedly thrown into company with attractive women, 
but he had so thoroughly conquered his sexual feelings, 
that they were to him, as he said, no more than logs of 
wood. He remained absent seven years, but had en- 
tirely abandoned all idea of forming a philosophical 
sect. Indeed, his travels had cured him, very effectu- 
ally, of a good many absurd notions which he had con- 
tracted ; among others, that of perpetual celibacy. As ABSENCE OF SEXUAL DESIRE. 
89 
he was a man of wealth, and his fondness for society 
had returned, he thought he would marry, but was ap- 
prehensive that he would not, owing to his lengthened 
period of continence, be able to perform the part of a 
husband in the marriage relation. During the whole 
time that he had been abroad he had had no connec- 
tion, no nocturnal emissions, no lascivious dreams, and 
no erections based upon sexual desire. He had no 
other object in marrying than to obtain a home and its 
comforts, but would forego the idea if he was incapable 
of intercourse. 
Upon examination I found that the genital organs 
were of normal form and condition, and, therefore, that 
no obstacle, so far as they were concerned, existed. 
Except for his assurance that he never experienced 
erections nor desire I should have pronounced him 
competent, but, in the face of his declarations, I was 
satisfied that he was suffering from mental impotence, 
and that his cure would have to be effected by moral 
means. I advised him to enter society, and to try to 
fix his affections upon some virtuous and attractive 
woman whom he would be satisfied to marry, and to 
wait patiently for the re-development of his sexual 
desires. He had no faith, however, in that plan of 
treatment, but went off, on his own responsibility, into 
all kinds of attempted sexual excesses. Several months 
afterward he returned, with the information that he 
was actually and permanently impotent. No excita- 
tions which he had employed had sufficed to induce 9o 
SEXUAL IMPOTENCE IN THE MALE. 
in him the slightest desire, and his condition, therefore, 
was a great deal worse than it had been. He had 
exhausted the means in an irregular way, which, had 
he followed my advice, would, there was reason to 
hope, have been gradually efficacious. Moreover, in 
his attempts at intercourse, he had contracted a 
chancre, and was already suffering from secondary 
manifestations. He was placed upon anti-syphilitic 
treatment, but soon afterward went to the Hot Springs 
of Arkansas, and, while in the West, married a prosti- 
tute, who wanted his money, and who had persuaded 
him she could cure him. I believe he is still living 
somewhere, but am quite sure there has been no return 
of sexual desire. 
In this case there was a loss of power as well as of 
desire, and hence a double cause for the impotence 
which existed. The origin, however, was clearly in 
abolition of desire, the loss of power being a secondary 
phenomenon. 
Treatment.—The treatment of cases in which, from 
any cause, the normal sexual desire of the individual 
has been lessened or abolished to such a degree as to 
render intercourse impossible, has been to a great ex. 
tent indicated in the preceding pages, when each case 
has been under consideration. In general terms, it 
consists in the use of the bromides, in those instances 
in which there has been excess in any unnatural direc 
tion, such as pederasty, masturbation, or mental inter 
course ; and in the employment of such moral means in ABSENCE OF SEXUAL DESIRE. 
9i 
them and in the other classes of cases as each particular 
instance may seem to require. Roubaud treated the 
case I have quoted from him by requiring his patient 
to take a full dose of tincture of cantharides, and then 
while under its influence to attempt connection with a 
dark woman who was without corset, gaiter boots and 
a silk robe. The attempt failed, but the effect upon 
the genital organs of the patient was such that he 
begged for another dose, satisfied that at the next ex- 
periment success would be attained. Fearful of excit- 
ing too intense a degree of cystitis, Roubaud, while 
pretending to give him cantharides gave him a potion 
free from this substance. The expectant attention of 
the patient was, however, so aroused that this dose had 
as strong an effect as the other, and he finally succeeded 
through the indirect influence (for it was absolutely 
inert), in effecting intercourse with a brunette without 
a corset. The confidence of the patient, however, in 
the medicine was so great that he was not willing to 
dispense with it, and though he continued to have 
sexual relations with dark women he always took his 
potion. 
In the employment of moral means or those acting 
through the mind of the patient, nothing is of more 
importance than to give him confidence in himself, and 
in the means which may be adopted for his relief. If 
this point can be secured the battle is half won; without 
it victory is always doubtful. 
And again, great delicacy is generally required in all 92 
SEXUAL IMPOTENCE IN THE MALE. 
efforts intended to act through the mind which may be 
directed to the re-awakening of the physiological desire 
for sexual intercourse. In my experience the society 
of respectable women is ultimately more efficacious 
than that of loose women and prostitutes. In cases of 
simple loss of desire, the power is not materially 
effected: it is the inclination alone which is wanting, 
just as a man may possess good digestive powers, and 
yet have no appetite. Now, the sexual feeling is much 
more apt to be provoked by a woman impossible to be 
obtained without marriage than by one who can be 
had for the asking, or for a sum of money. The 
appetite, like that for the good things of the table, is 
whetted by the difficulties that are in the way, and 
hence the object is obtained by natural means under 
the regulations which law and social life impose. Of 
course there are cases, such as some of those described 
in this chapter, for whom it is impossible to recommend 
the society of virtuous women. They are altogether 
too infamous in habits and principles for the physician 
to think of subjecting decent women to their companion- 
ship. But there are others to whom this stigma is not 
applicable, and who, but for the refuge which the soci- 
ety of virtuous women is capable of affording, and the 
prospect held out of making a marriage, would either 
go over to prostitutes or ruin themselves with mastur- 
bation or other irregular sexual practices. ABSENCE OF THE POWER OF ERECTION. 
93 
CHAPTER II. 
ABSENCE OF THE POWER OF ERECTION AND OF CON- 
SEQUENT INTROMISSION. 
There are many more cases of impotence met with 
under this head than all others combined. It is the 
trouble, therefore, with the great majority of men who 
consult a physician or surgeon in order that their virile 
powers may be restored to them. No cause is, accord- 
ing to my experience, so destructive to the happiness 
of the average man as the loss of his virile power, 
while his desire still exists not measurably impaired. 
He may be abstinent, but at the same time if he dis- 
covers that he is sexually impotent, though he may not 
care to exercise his powers once a month, his peace of 
mind is interfered with to an extent that no other 
disease is capable of causing. 
In impotence arising from the condition in question 
there is an impossibility of entering the vagina with 
the male organ owing to the fact that the latter re- 
mains in a state of flaccidity. This state may be the 
result of one or more of several causes, of which the 
following are the chief: 
Early Sexual Excesses.—Perhaps of all the causes of 
failure of sexual power in adult life the induction of 
the sexual orgasm during infancy or youth is the 94 
SEXUAL IMPOTENCE IN THE MALE. 
most frequent. The fact that voluptuous sensations 
can be excited in children who are yet in their nurses’ 
arms is well known to physicians, who are often called 
upon to treat affections of the nervous system which 
are the direct result of such excitation. Epilepsy, 
chorea, and spinal diseases, causing paralysis, some- 
times have this cause as their factor and the ground- 
work may be laid for still more deplorable conditions 
which are developed in after life. Into the considera- 
tion of these effects it does not come within the scope 
of this work to enter or to consider them at all except 
so far as they relate to sexual impotence. 
It is a law of the organism that any function which 
is over-exerted before the organs producing it are fully 
matured is certain to lead to the derangement or even 
extinction of that function. A child whose brain is over- 
taxed by studies, which are in advance of those suitable 
for an immature brain, runs serious risks of becoming 
epileptic or imbecile. Another, who is set to the per- 
formance of physical work of too severe a character, is 
arrested in its growth, and becomes puny and feeble; 
and it is equally certain that a like result, so far as 
regards the generative system, will follow on a too 
early excitation of the sexual organs. In very young 
infants it is sometimes the case that in order to sooth 
them nurses titillate the genital organs and thus pro- 
duce sensations which are agreeable and which are 
subsequently desired. Eventually the operation is 
performed by the child, and, being continued through ABSENCE OF THE POWER OF ERECTION. 
95 
the period of puberty, leads to complete impotence 
from loss of power, and often from loss of desire also. 
In such cases as these the ordinary manual excitation 
of the penis generally after a time becomes insufficient to 
produce an emission, and various processes are resorted 
to to provoke the requisite degree of excitability to 
cause a seminal ejaculation. From a very early period 
in the history of medicine the effects of early excesses 
have been thoroughly recognized. Hippocrates, in 
speaking of the disease now known as locomotor ataxia, 
or tabes dorsalis, says:* 
“ This disease attacks young married people or those 
given to venereal excesses. There is no fever, and 
although they may eat a sufficient amount of food, they 
become emaciated. They have sensations of ants 
crawling along them, and every time that they go to 
stool or urinate they lose a certain quantity of their 
seminal fluid; they are incapable of generation, and 
they often have the sexual orgasm in their sleep.” 
I cite this extract from Hippocrates merely for the 
purpose of showing that he recognized the fact that 
early sexual excesses lead to impotence, and not with 
the least intention of endorsing the rest of what he has 
said, much of which is clearly incorrect. This, how- 
ever, will engage our attention further on. 
Celsusf declares that the pleasures of love, if indulged 
* De Morbis, Lib. 2, Cap. xlix. 
f De Re medica, Lib. I, Cap. ix. 96 
SEXUAL IMPOTENCE IN THE MALE. 
in to excess, are always injurious to weak persons, and 
exhaust the vital powers. 
Aretasus * says: “Young people who are excessive 
in sexual matters acquire the appearance and diseases 
of the aged. They become pale, effeminate, indisposed 
to physical exertion, stupid and even imbecile. They 
are bent forward, their legs can no longer support 
them, they have a distaste for everything, they are 
incapable of everything and often they become para- 
lytics. 
Tissot,f among other evils of masturbation, calls atten- 
tion to the facts that the organs of generation experience 
a large share of the evils of which they are the first cause. 
Many patients become incapable of having erection, and 
with others the seminal fluid is discharged by the slight- 
est contact, and at the least approach to an erection. 
The same author, in referring to the early initiation 
of some children into the vice of masturbation, says: 
“ It is proper to state that onanism is particularly 
dangerous in the cases of infants, and at any time before 
the age of puberty. Happily, it is not common to find 
monsters of either sex who commit this outrage upon 
them, but it is too true that they often commit it them- 
selves. * Again, in reference to the intervention of impot- 
ence as the result of masturbation, he lays special stress 
* De Signis et Causarum. 
f “ L’Onanisme: Dissertation sur les maladies produites par la mastur- 
bation.” Paris, 1805, p. 21. 
% Op. cit., p. 81. ABSENCE OF THE POWER OF ERECTION. 
9 7 
upon the fact that a kind of paralysis of the organs of 
generation is produced, and hence an impossibility of 
procuring erections. 
Deslandes * relative to sexual excesses, says : “ As a 
final result the sensibility of the generative organs may 
be exhausted and may disappear. The manoeuvres, 
which in the beginning had led promptly to the de- 
sired result, become incapable of reawakening a sensa- 
tion, which little by little has become weaker, and at 
last annihilated. They may still be able to cause an 
erection of the penis, and even to produce a painful 
state of priapism, but they no longer cause the pleas- 
ure which they formerly induced. It would be better, 
when this kind of paralysis occurs, that the recollection 
of previous pleasures could be abolished, but it merci- 
lessly remains, and it is that alone which prompts the 
unhappy individual to continue abuses. Tormented 
by this remembrance, the blast! masturbator provokes 
his turgid organs. Obtaining no satisfactory results in 
his methods, he invents new ones, which are at the 
same time eccentric, monstrous, and horrible. The 
thoughts which he once entertained were candid and 
innocent compared to those which now fill his mind, and 
the onanism he once practiced is almost a praiseworthy 
act beside that in which he indulges. The bare hand,, 
which formerly sufficed to produce the orgasm, is no 
longer competent to that end, and the surface of the 
* “ De l’onanisme et des autres abus veneriens consideres dans leurs.. 
rapports avec la sante.” Paris, 1805, p. 274. 98 
SEXUAL IMPOTENCE IN THE MALE. 
penis, where previously the sensibility was situated, is 
now exhausted of its capacity to yield pleasure, and he 
is forced to seek it more profoundly where his hand 
has not yet reached; operations which would have 
formerly been regarded as causing torture are now 
performed without hesitation, at the dictation of the 
power within him. He wounds and tears the parts, 
recoiling at nothing, providing he can be made to feel. 
This condition lasts until these dangerous expedients 
in their turn fail, either because they eventually lose 
their power or because of the grave accidents which 
they produce.” 
Chopart relates the particulars of a case which is one 
of the most striking of the whole range of the clinical 
history of the subject, and which, as showing the terri- 
ble extremes to which masturbators may go, is worth 
citing in the present connection : 
A shepherd of Languedoc, Gabriel Gallien, aban- 
doned himself to masturbation at the age of fifteen, com- 
mitting the act as many as fifteen times a day. Event- 
ually he reached the point at which ejaculation rarely 
took place, sometimes continuing his efforts for an 
hour before emission occurred. It often happened 
to him to go into convulsions while he was perpe- 
trating the act of masturbation, and to emit a few 
drops of blood instead of semen. For eleven years he 
used only his hands, but at about his twenty-sixth year, 
not being able to produce the ordinary sensation bv 
this means, he adopted the expedient of introducing a ABSENCE OF THE POWER OF ERECTION. 
99 
piece of wood about six inches long into the urethra 
several times every day. For sixteen years he made 
use of this procedure, but finally the lining membrane 
of the urethra became hard, callous, and altogether 
insensible; the piece of wood no longer answered the 
purpose which it had accomplished; he had a contin- 
ual erection which nothing could dissipate. 
During all this time he had an insuperable aversion 
to women, a by no means rare circumstance with mas- 
turbators ; he became melancholic, neglected his work, 
and thought only of the means of satisfying his desires. 
Desperate, and attaining no success with the many expe- 
dients to which he had recourse, he one day decided to 
make an incision with his knife through the glans and 
in the direction of the urethra. This operation, far 
from causing him pain, procured him an agreeable sen- 
sation and produced an abundant seminal emission. 
From that time, happy in having made a discovery 
which permitted him to satisfy his inclinations, he often 
repeated the same experiment, and always with the 
same result. 
After having performed this horrible mutilation per- 
haps a thousand times, the unfortunate wretch found 
that he had divided the penis from the meatus to the 
symphisis pubis into two equal parts. When haemor- 
rhage was particularly great, he arrested it by tying a 
cord around the penis. The corpora cavernosa, sepa- 
rated as they were, were equally capable of erection, 
but they diverged to the right and left. When the pe- 100 
SEXUAL IMPOTENCE IN THE MALE. 
nis was divided as far as the symphisis the knife was 
no longer useful, and then there were new provisions, 
new chagrins, new attempts to obtain the pleasure he 
craved. Among the expedients to which he resorted 
was one with a piece of wood shorter than the one he 
had previously used, and which he introduced into the 
part of the urethra which remained to him. He thus 
succeeded in exciting the very orifices of the ejacula- 
tory ducts and in causing an emission of semen. For 
ten years this procedure satisfied him, until one day he 
was so careless in the use of his stick of wood that it 
escaped from his fingers and slipped into his bladder. 
At once he experienced great pain, and all the efforts 
he made to expel the foreign body were without suc- 
cess. Finally, after intense suffering from retention of 
urine and haemorrhage from the bladder, he consulted 
a surgeon, who was of course greatly astonished to 
find, instead of a single penis, two, each as large as the 
original. The great pain felt by the patient decided 
the surgeon to perform the operation of lithotomy, 
which having done he extracted the piece of wood— 
which from having been three months in the bladder 
was deeply incrusted with calcareous matter. After 
some serious drawbacks the patient recovered from 
the operation, but died about three months subsequently 
of phthisis, due to his long-continued and frequently 
repeated excesses. 
Other cases have been recorded in which wounds 
have been inflicted for the purpose of re-exciting an ABSENCE OF THE POWER OF ERECTION. 
IOI 
organ whose excitability to the ordinary stimulus was 
exhausted, but none on record equal this remarkable 
instance of the French shepherd. It is, however, from 
the more common examples that the greatest amount 
of knowledge is to be obtained and the proper deduc- 
tions drawn; and hence the relation of a few additional 
ones, as recorded by others, and one or two from my 
own experience, will not be out of place in the present 
connection. 
Deslandes refers to the case of a school teacher, 
who titillated the urethra by foreign bodies in order 
to obtain an emission. He generally used an iron 
wire, which he took the precaution to bend over at 
the end, so as to form a hook and thus avoid injury 
as far as possible to the lining membrane. One day, 
while engaged in the use of this instrument, and being 
a little more excited in his movements than usual, the 
hook caught in the wall of the canal and could not be 
withdrawn. He made many attempts, all of which 
failed; but still, notwithstanding his sufferings, shame 
prevented him from applying to a surgeon. He bent 
the distal end of the wire into the form of a ring so as 
to be able to exercise greater traction, but still he 
could not succeed, and in the midst of his exertions the 
ring was pulled off and the wire remained in the ure- 
thra. Driven then to despair and fearing death, he ap- 
plied to a surgeon, Monsieur Fardeau, of Saumur. 
The penis was found to be enormously swollen, as was 
also the skin of the scrotum. All the tissues which are 102 
SEXUAL IMPOTENCE IN THE MALE. 
found at the point of insertion of the penis to the pubis 
were also in a state of great tumefacation, hot and pain- 
ful. The abdomen was beginning to be tympanitic, 
there was a suppression of urine, the countenance was 
ruddy and the eyes suffused, the mind was beginning 
to wander, the pulse was hard, frequent, and small. 
Monsieur Fardeau took hold of the projecting wire, 
and, making traction on it, became satisfied that the 
other end was fast to some solid substance. Exploring 
the part with the greatest circumspection, he was not 
surprised to find that the hook was fixed in the internal 
border of the tuberosity of the ischium. An incision 
was made in this region, the hook was seen, and the 
wire was extracted by the perineum. The patient was 
at once relieved, and his health was completely re-es- 
tablished. 
t 
M. Saraille * reports the case of a man fifty years 
old, who for three years had masturbated with a darning- 
needle, which he introduced into the urethra. One day 
while using it, it escaped from his fingers and disap- 
peared within the canal. Eight days afterwards it was 
extracted by an operation, after the patient had under- 
gone much suffering. 
Several cases in which masturbation by the urethra, 
when the excitation of the glans no longer sufficed to 
produce the orgasm, have come under my notice. In 
all the act had been begun at an early age, and had 
been frequently performed daily before the sensibility 
* “Journal de med., chir. et pharm.,” t. xxviii. p. 290. ABSENCE OF THE POWER OF ERECTION. 
103 
of the glans was lost. In one of these instances the 
patient, a young man twenty-three years of age, had 
practised masturbation excessively from the time that 
he was nine years old. At about his fifteenth year the 
sensibility of the glans was nearly extinct, and, though 
emissions could be produced, the voluptuous sensations 
were almost nothing, and erection was very imperfect. 
He then began to make use of a penholder made of 
hard rubber, which he introduced to the extent of two 
or three inches into the urethra. In the course of 
three or four years this resource began to fail him. 
The lining membrane had also lost its sensibility, and 
had become thick and dense. He then procured a 
No. 3 gum-elastic catheter, which, being of less di- 
ameter than the penholder, admitted of being more 
readily introduced. This sufficed for several years, but 
eventually it also lost its power. During all this time, 
although he continued to work at his trade, that of 
plumbing, he suffered from many forms of derangement 
of his nervous system, such as headache, tremor, dim- 
ness of sight, deafness, and neuralgic pains in various 
parts of his body. He had never had sexual inter- 
course, and was altogether incapable of the act. At 
times he would suffer from violent erections, accompa- 
nied by intense pain in the genital organs and in the 
back, and occasionally by wandering of the mind; and 
in the course of ten or more hours these would be re- 
lieved by an emission of semen, usualty during the 
night, and without the accompaniment of a dream or 104 
SEXUAL IMPOTENCE IN THE MALE. 
any voluptuous sensation. For this condition he had 
consulted a surgeon, who had cauterized the spine with 
a white-hot iron, and given him the bromide of potas- 
eium, both very proper means. Finally, under the 
continued use of the bromide, he was greatly relieved. 
He had not recovered his virile power when he came 
under my notice. The penis was very small, and had 
not, so he informed me, been in the state of erection 
for over five years, not even the merely physical 
erection due to lying on the back or to an over-dis- 
tended bladder. He had now become a master plum- 
ber and was anxious to marry, and it was for the cure 
of his impotence that he came under my care. It may 
suffice now to say, what will be dwelt upon at greater 
length hereafter, that he regained a sufficient degree 
of sexual power to admit of his marrying and having 
connection. 
In another case the termination was not so fortunate. 
In this instance the patient had masturbated as far back 
as he could recollect, and when quite an infant was 
used by his nurse, a mulatto woman, to satisfy her 
sexual desires; frequently he would procure the org- 
asm a dozen or more times in the day, but after the 
age of puberty, when seminal emissions began to oc- 
cur, he did not practice the act so often. He never, 
however, that he could recollect, went a whole day 
without masturbating two or three times. 
At the age of twenty-one he was still practising the 
act, though with very little satisfaction, for the erec- ABSENCE OF THE POWER OF ERECTION. 
105 
tions were very feeble, and the emissions scarcely- 
caused the faintest voluptuous feeling. He began now 
to make experiments with himself, and at once obtained 
an increase of pleasure from the use of a hair glove 
which he wore, and which by its roughness served to 
produce a sufficient amount of sensibility in the glans; 
but finally this failed, as in their turn all devices do 
under such circumstances, and he was at a loss how to 
obtain the pleasure which was a craving night and 
day. 
At last he thought it would answer the purpose if he 
lubricated his hand with strong ammoniacal liniment. 
He at once acted upon the suggestion, and finding it 
to be successful, adopted the plan, generally, however, 
being obliged to increase the strength of the liniment 
by adding an additional quantity of ammonia to it. 
The sensation produced upon the glans penis by this 
agent, so far from being painful, was the chief source 
of his pleasure, but the local effects were such as to 
cause him a certain degree of anxiety. Inflammation 
attended with great swelling and redness set in from 
the first, and every time that he employed the applica- 
tion the manifestations of serious disturbance became 
more marked, and they were not by any means limited 
to the penis, for there were a high degree of fever and 
more or less mental implication, consisting of hallucina- 
tions both of sight and hearing. At last a large ulcer 
was produced, which involved the whole of the anterior 
surface of the glans, and which ultimately resulted in 106 
SEXUAL IMPOTENCE IN THE MALE. 
the sloughing of the prepuce, and of a considerable por. 
tion of the glans. The production of the orgasm, by 
some means or other, had, however, become absolutely 
necessary to him, and notwithstanding the fact that a 
gangrenous ulcer included more than one third of the 
penis he continued to apply strong ammonia to the raw 
surface and to obtain pleasure from the act. 
Hitherto he had managed to keep his proceedings a 
secret from his family; but about this time exposure 
took place from spots of blood and pus being observed 
on his linen, and which he had forgotten to wash off. 
On being detected he made a full avowal to his father 
and with much apparent contrition and mental suffer- 
ing begged that he might be cured of his infatuation. 
He left his home in company with his father to place 
himself under my care. At Fall River he got on board 
the steamboat that was just about to leave for New 
York, and at his request had a state-room apart from 
that of his father assigned him, pleading in excuse that 
the odor from his ulcer was such as to render it impos- 
sible for his father to be in close quarters with him 
without being rendered very uncomfortable. He 
pledged himself not to attempt masturbation. He 
entered the room at about nine o’clock at night, and 
that was the last that has ever been seen of him. In 
the morning the room was found empty, the bed not 
having been occupied. It was supposed by his father, 
who gave me the foregoing details, that he repeated 
the act of masturbation, and that, filled with remorse, he ABSENCE OF THE POWER OF ERECTION. 
icy 
had thrown himself into the water. During his whole 
life he had always manifested the most intense distaste 
for the society of women, and had informed his father 
that he had never felt the slightest desire for sexual 
intercourse. 
Of course the earlier sexual excesses are initiated, 
the greater is the probability that impotence will be 
the result in after-life. It it very certain that there is 
a much greater precocity in this respect even among 
civilized nations than is probably believed, but which 
a little reflection will suffice to convince one does really 
exist. The practice which prevails among the very 
poorest classes, of men, women, and children occupying 
the same room, and not infrequently the same bed, 
irresistibly leads to an undue and early development 
of the sexual appetite. I have myself seen in the city 
of New York, boys and girls three or four years of age 
attempt intercourse in the manner in which they had 
seen their elders perform it, and this without the slight- 
est idea that they were doing anything wrong, and in 
the very presence of their fathers and mothers, without 
any other reprimand than a laughing rebuke. In New 
Mexico, I have seen the like attempts made in the 
streets, and with the applause and encouragement of 
men and women. Acts of masturbation by mere chil- 
dren were at the time of which I speak, thirty years 
ago, commonly practised in the presence of adults with- 
out even attracting attention. The men of that Terri- 
tory were noted for their impotence, and were often 108 
SEXUAL IMPOTENCE IN THE MALE. 
subjects of incantations and other superstitious rites per- 
formed by old women who had the reputation of being 
able to cure the affliction in question. Many of them 
came under my own immediate observation, but instead 
of attributing the condition to its real cause they always 
charged it to some enemy acting through witchcraft, 
or to the direct agency of the devil. 
Godard * states that in Cairo he was informed that a 
little girl of six and a boy of five years of age had been 
seen in the act of sexual intercourse in the street, and 
that sometimes girls of three or four years old called to 
boys in the street to have sexual relations with them. 
It is not a subject for surprise, therefore, that precocity 
like this and other sexual excesses to which they are 
addicted render the men of the country impotent at an 
early period of their lives. 
Relative to the question whether masturbation or 
sexual intercourse is more readily productive of impo- 
tence, different opinions have prevailed, but I think there 
can be no reasonable doubt that the first is more influ- 
ential in bringing about the condition in question. This 
is not because it is in inself, so fas as seminal loss is 
concerned, any more injurious, but for other reasons 
which I will proceed to state with as much succinctness 
as possible. 
In the first place, the facilities for the performance of 
* “ Egypt et Palestine. Observations medicates et scientifiques.” Paris, 
1867, page 88. ABSENCE OF THE POWER OF ERECTION. 
iog 
masturbation are always to be obtained, and hence it 
allows of more frequent repetition than does sexual inter- 
course. The masturbator is always ready. He has 
only to retire to privacy for a few minutes and the act 
is accomplished. He can if he choose pollute himself 
a hundred or more times a day, and hence produce a 
degree of exhaustion impracticable if he restricted 
his acts to intercourse with women. If women were 
at his command, and he practiced copulation as fre- 
quently as he often does masturbation, there would be 
no difference so far as the orgasm and emission of semen 
are concerned. Indeed, the sexual act, as requiring a 
greater expenditure of muscular force not requisite in 
masturbation, would probably be the more injurious of 
the two. So far as relates to the orgasm and the semi- 
nal loss, it is a matter of no physiological or pathological 
importance where the semen is deposited, whether in 
the vagina of a woman, or in any other receptacle. It 
is the frequency of the act which tells so greatly as a 
factor for the destructive results in masturbation in 
comparison with those due to sexual intercourse. 
Thus a young man who found himself impotent at the 
age of twenty-two informed me that he had began to 
masturbate at the age of nine, and had often performed 
the act ten or a dozen times a day for a month at a 
time. Such indulgence in sexual intercourse would 
be impracticable in any civilized country. Perhaps in 
Turkey and other eastern countries, where large harems 
are kept, there would be no difficulty about the matter, no 
SEXUAL IMPOTENCE IN THE MALE. 
but certainly it would be impossible in London, Paris 
or New York, notwithstanding the facilities which these 
and other large cities afford for forming sexual relations 
with women. 
For this reason, mainly, it is that most of the cases 
of impotence which medical men have to treat are the 
result of excessive and premature indulgence in mastur- 
bation rather than in sexual intercourse. 
The effect of masturbation in causing impotence is 
greater than that of sexual intercourse for the reason 
that in the former the mind is more strongly brought 
in to assist in the production of the orgasm than it is 
in the latter. The mere act of friction on the glans 
does not suffice to produce in the masturbator the 
necessary degree of venereal excitement. He forms 
various lascivious images in his imagination, and has 
them vividly before him while performing the act. The 
consequence is that after a time the normal excitation 
of contact with the female generative organs does not 
provoke the orgasm. The reality is so far below what 
he has frequently pictured to himself while masturbat- 
ing that it is insufficient. He soon finds this out, and 
therefore often renounces the allurements of women, 
and devotes himself exclusively to his pernicious habit, 
from which, for a time at least, and a long time if he is 
temperate in the indulgence, he is certain to obtain the 
voluptuous sensations of which he is in search. 
Examples of this fact are constantly coming under 
the care of the physician or surgeon. Men who have ABSENCE OF THE POWER OF ERECTION. 
Ill 
for many years practised masturbation in moderation, 
and without any notable impairment of their general 
health, find themselves nearly entirely impotent in the 
marriage-bed. Such cases are especially apt to be met 
with in the persons of young men of strong passions, 
which they have been obliged to control either from 
the force of surrounding circumstances or because of 
their own sense of propriety so far as women are con- 
cerned, but who see no impropriety or loss of self-respect 
in the act of masturbation; or if they do, are too weak 
to resist the temptation. Such men when they marry 
find that sexual intercourse is far from satisfying their 
desire, and moreover, that it is less excitant of the gene- 
sic feeling than the habit in which they have indulged. 
They avoid it, therefore, and practise in secret the vice 
to which they are devoted, or give themselves up to 
conjugal onanism in its various forms, a practice fully 
as bad, if not worse for him, besides being unsatisfying, 
unnatural, and demoralizing to another being. 
Cases of this kind are especially frequent among 
students and other young men, who practise mastur- 
bation in early life, ignorant that they are injuring 
themselves, who subsequently discover their error, and 
who then make a determined and sometimes successful 
effort to overcome the habit. More frequently they 
only partially succeed, and continue the vice filled with 
remorse after each performance, vowing never again to 
indulge. Such persons are generally impressionable, 
and endowed with a high imagination besides; and yet 112 
SEXUAL IMPOTENCE IN THE MALE. 
are from these facts particularly liable to continue mas- 
turbation up to the period of their marriage. The idea 
of sexual intercourse with a lewd woman is offensive to 
them, an exalted feeling of erotism governs them, and 
they look forward to the time when they can marry 
and indulge their passion with a woman for whom they 
would entertain a sincere affection. Meanwhile they 
continue to masturbate, imagining to themselves that 
they are realizing the dreams they have long experi- 
enced. At length they marry, and to their extreme 
distress and surprise find that they are nearly or quite 
impotent, and that the material blessing which has 
been conferred upon them in the love of a pure woman 
whom they love in return is not what they were led to 
expect. The anticipation has been greater than the 
reality. Fortunately such cases are not usually difficult 
ones to manage. 
Thus a young theological student who began mastur- 
bation at school when twelve years of age, continued 
it up to his fifteenth year, when becoming aware of its 
deleterious effects he endeavored to stop. Previously 
he had indulged not over twice a day, but this for a 
person of his age (or even one of any age) was pernicious 
excess. After his determination he succeeded in reduc- 
ing the number to about one in a week, but in the mean- 
time he was troubled with repeated nocturnal emissions. 
Some one to whom he communicated the fact of the 
emissions told him that they occurred in consequence 
of the sudden decrease in the number of acts of mastur- ABSENCE OF THE POWER OF ERECTION. 
113 
bation, and that they were much more injurious. He 
therefore resumed the practice, and upon several occa- 
sions indulged as often as eight or more times a day. 
It was no uncommon thing for him to have the orgasm 
three times without ceasing his manoeuvres. In 
these exercises he always had in his mind an ideal, a 
lovely woman with light hair and blue eyes, one who 
exhibited towards him the most ardent affection. 
Things went on in this way till his eighteenth year, 
when he again made an effort to stop, and this time he 
succeeded better than on the former occasion. He 
now left college, and being religiously inclined, began 
the study of theology with the view of entering the 
ministry. Entering a theological seminary, he devoted 
himself to hard study, and had obtained so great a 
mastery over himself that he had not practised mastur- 
bation for over a year. He was, however, greatly 
troubled with nocturnal emissions three or four times a 
week at least, and for many weeks in succession as 
often as every night. There were many occasions in 
which he had two in a single night. 
In consequence of all this he fell into a condition of 
great nervous prostration, in which the chief feature 
was cerebral hyperaemia, and which was further charac- 
terized by wakefulness, pain in the head, twitching of 
the muscles of the face, noises such as roaring and hiss- 
ing in the ears, and an inability to concentrate his mind 
on the subjects of his study. At night his condition 
was particularly distressing, for he was afraid to go ta SEXUAL IMPOTENCE IN THE MALE. 
114 
sleep even when towards morning he felt sleepy, lest he 
should have a seminal emission. In sheer desperation 
he had while awake in the long hours of the night mas- 
turbated several times, one after the other, and then 
met with a degree of mental composure which other- 
wise was never present. It really seemed to him as 
though the act of self-pollution was, after all, the only 
thing that gave him relief, and but for the consciousness 
that he was doing wrong and the inevitable feeling of 
remorse which tormented him the following day, he 
would have given himself up without restraint to the 
deleterious habit. In all these acts and in all the lasci- 
vious dreams which accompanied the emissions at night 
it was always a lovely, pure and religious woman with 
light hair and blue eyes with whom the intercourse in 
imagination took place. Finally, after continuance of 
the condition for nearly four years, during which period 
he was several times on the point of renouncing his 
intention of entering the ministry, he took orders, and 
settled down in charge of a country parish, unfit either 
mentally or physically for the duties he had assumed. 
But he began to find that it was indispensable for his 
usefulness, and he was much disposed to think for his 
health also, that he should marry. He had never in his 
life had sexual intercourse, and had never experienced 
the erotic manifestations which some young men of 
vigorous health and strong sexual power are apt to feel 
when thrown into intimate relation with women. Still 
he had no reason, so far as he could determine, to sus- ABSENCE OF THE POWER OF ERECTION. 
H5 
pect the existence of any inability to enter the marriage 
state, and as there was a young lady in his congregation 
who very nearly fulfilled all the requirements of his 
masturbatory imaginings and his lascivious dreams 
which accompanied nocturnal emissions, he resolved to 
propose for her both as a measure of feeling—for he was 
much attached to her—as well as of expediency. He 
did so, was accepted, and the marriage in due time took 
place. The first night was passed at a hotel in the city 
of New York, and the next morning the young husband 
called upon me in utter despair and with the information 
that he was impotent. 
At first I thought his was one of those cases so 
frequently met with in young married men, in which 
there is temporary impotence from mere excess of de- 
sire or want of confidence, and which disappears in a 
few days under the use of some placebo ; but further in- 
quiry, which resulted in the elicitation of the historyjust 
given, convinced me that a much more serious instance 
of genesic disturbance existed. I was satisfied that 
there was a state of great sexual debility present, which 
was the direct result of the excesses he had commit- 
ted. Continual questioning led to the information that 
his desire had been moderately great, but that his sexual 
power had been utterly wanting. There had been no 
erection, or any approach to one, and the result was 
that after many attempts at intercourse in the expectation 
that success would attend the efforts, he had desisted, 
had gone to sleep, and during the night had had two 116 
SEXUAL IMPOTENCE IN THE MALE. 
seminal emissions. In the morning the attempts were 
renewed, and again without success. 
In this case there was no mental trouble, no senti- 
mental idea to be fulfilled, no intercurrent thought 
rushing through his mind and abolishing all desire. So 
far as the mind went there was nothing except that he 
had to admit that the real woman lying by his side was 
incapable of causing the same degree of sexual excite- 
ment as had attended his mental images awake and 
asleep. As a strongly sapid substance destroys the 
perception of the tongue for delicate flavors, so the 
vivdd images which had hitherto filled his mind had 
rendered the normal physiological stimulus of no avail, 
and in addition there was the loss of power consequent 
on excess, a result which is perhaps more clearly mani- 
fested in regard to the organs of reproduction than 
; those concerned with any other function of the body. 
The case was certainly a very unpromising one, but as 
the physical examination showed that the organs them- 
selves were in good condition, I could not make up my 
mind that is was hopeless. I advised that he should at 
once occupy a separate room from that of his wife, that 
for the present no further attempts at sexual intercourse 
should be made, and that he should stay in New York 
about a month for the purpose of receiving such local 
and other treatment as his case required. This was, he 
declared, impossible, and he accordingly took his leave 
disgusted with himself for the hapless condition into 
which he had fallen and with me and the science of ABSENCE OF THE POWER OF ERECTION. 
117 
medicine that he could not be cured in twenty-four 
hours. 
But on the fifth day he returned, having in the mean 
time utterly failed to consummate the marriage, and 
ready to agree to any terms that I might impose which 
were at all likely to result in a restoration to sound 
sexual health. On my certificate that he was affected 
with a serious disorder of his nervovs system, which 
required treatment, he readily procured a leave of ab- 
sence from his congregation, and then he put himself 
definitely under my care. He and his wife occupied 
separate rooms in the hotel at which they stopped, and 
he pledged his honor that on no account would he at- 
tempt sexual intercourse till I gave him permission. 
The first thing to do was to arrest the nocturnal 
emissions, of which he had had one, sometimes, more 
every night since his marriage. To this end I pro- 
hibited sleeping on the back, and enjoined the use, 
morning and night, of cold baths, with friction of the 
whole body after each with coarse towels. He was 
also to walk at least five miles every day, and to go to 
some place of amusement of a cheerful character every 
evening. Internally his food was to be of a highly 
nutritious character, of which fat in some form or 
other, preferably cream, was to constitute a large pro- 
portion. His dinner was to be taken not later than two 
o’clock and a couple of glasses of Burgundy were to be 
drunk with it. For medicine I prescribed the follow- 
ing: 118 
SEXUAL IMPOTENCE IN THE MALE. 
5 Sodii bromidi § i. 
Pepsin (Fairchild’s). 
Pancreatin (Fairchild’s) 55 3 iss. 
Glycerinae. 
Aquae 55 § ii. 
M. Dose, a teaspoonful in a little sugar and water three times a day 
after meals. 
My objects in giving this mixture were to lessen the 
reflex and automatic excitability of the generative sys- 
tem, to relieve the cerebral hyperasmia, and to promote 
the digestion of food. 
At bed-time he took a capsule of five grains of the 
monobromide of camphor. 
Every morning I applied statical electricity to the 
penis and testicles, and to the whole length of the spinal 
cord, drawing inch sparks from the former organs, and 
from three to four inch sparks from the spine. This 
was continued for about fifteen minutes. Though pain- 
ful the effect was all that could be desired: the blood- 
vessels of the penis became visibly distended, and the 
whole organ assumed a deeper red color than it had 
possessed, as he said, within his recollection. For 
several hours afterwards a warm pleasant glow was felt 
in the penis and scrotum. 
Twice a week I applied by means of a urethral 
electrode a galvanic current from eight cells to the 
membranous and prostatic portions of the urethra, with 
the object of diminishing the morbid excitability which 
evidently existed in those parts. I may say that examina- 
tion with the sound had previously demonstrated the ABSENCE OF THE POWER OF ERECTION. 
119 
hvperaesthectic condition of the parts in question. I had 
at first thought of cauterizing them with Lallemand’s 
instrument, but decided upon the galvanism as being 
the less painful and equally or more efficacious. In 
very severe cases, however, Lallemand’s procedure is 
preferable. 
Under this system of treatment the general health of 
the patient began to improve from the first. The noc- 
turnal emissions ceased entirely on the fifth night. On 
the first night he had one, but without a dream; on 
the second, two ; on the third, none; on the fourth, one ; 
on the fifth, none, and there were no more while he was 
under my observation. 
On every night after the second he slept for from six 
to eight hours, and in the morning he awoke refreshed 
and cheerful. On the morning of the eleventh day he 
had an erection, which, however, was due to a dis- 
tended bladder, but which nevertheless was the first of 
the kind he had experienced for several years. 
On the fifteenth night he had a lascivious dream in 
which the usual images did not appear, or, if they did— 
and upon reflection he was a little doubtful on the 
point—they were much less distinct than they had been. 
They were not accompanied by an emission. The next 
morning he had another erection accompanied by a 
slight desire, and every morning thereafter while he re- 
mained under my care he had an erection, sometimes 
with and sometimes without sexual desire. 120 
SEXUAL IMPOTENCE IN THE MALE. 
He had now been two weeks under treatment, and 
the general results may be summed up as follows : 
Sound sleep every night. 
Freedom from pain or other uncomfortable feeling in 
the head. 
A strong, hearty appetite, with good gastric and in- 
testinal digestion. 
Cessation of the nocturnal emissions and of the las- 
civious dreams. 
A return of the matutinal erections, and of normal 
desire in connection with them. 
Frequently during the day desire with erections. 
These, however, were not as yet strong, and I con- 
tinued my prohibition in regard to attempts at inter- 
course. 
On the fifteenth I suspended the administration of the 
bromide of sodium, continuing, however, the mixture 
with the other ingredients unchanged ; and in addition 
I prescribed the following solution: 
R Strychniae sulph gr. i. 
Acidi hypophos, dil | i. 
M. ft. sol. 
Dose, ten drops three times a day before meals in a 
teaspoonful of the fluid extract of coca. 
I gave this mixture for the reason that I know of no 
better tonic for the sexual organs, after the abnormal 
state of erethism into which they get by abuse has been 
relieved, than strychnia, hypophosphorous acid and 
coca. It is necessary, however, not to give it imme- ABSENCE OF THE POWER OF ERECTION. 
121 
diately before going to bed, as without this precaution 
it may produce seminal emissions. 
From this time on his condition continued to improve. 
He had gained over ten pounds in weight, was getting 
stronger every day and more cheerful, and altogether 
more normal in his mind. His erections were occasion- 
ally tolerably strong, but, as a rule, though he had 
several every day as a consequence of the very vivid 
desires which he experienced, they were not yet by any 
means of natural strength. He was very desirous of 
going home, being convinced that he could carry on 
all the treatment but the electric as well there as in 
New York. This was probably true, but as 1 attached 
a great deal of importance to this part of the manage- 
ment of the case, I declined to give my consent. He 
had now been under my charge for twenty days, and I 
felt confident that a week or two longer would com- 
plete the cure. On the night of the twenty-first day 
his wife left her bed and got into his, and he, in disre- 
gard of his pledge, attempted intercourse, and with a 
measurable degree of success. I judged, however, that 
the emission was premature. The next morning he 
was filled with remorse, and not only renewed his 
pledge, but promised, in addition, that his wife should 
go home and prepare the house for his return. This, 
however, was not what I wanted. I desired her pres- 
ence, under restraint, as a constant stimulus to him, but 
I did not want things to be carried to extremes again 
till he was strong enough to act his part in a physio- 122 
SEXUAL IMPOTENCE IN THE MALE. 
logical manner. There were, I have reason to believe, 
no further infractions of discipline. On the night of 
the thirty-second day he attempted intercourse with 
my partial consent. I knew he would do better if I al- 
lowed him to make the attempt with seeming reluc- 
tance than if I gave him full liberty to do as he pleased. 
In sexual matters, as in many others, the desire and the 
power are stronger with forbidden fruit than with that 
which can be had for the asking. The end fully justi- 
fied the means, for he informed me the next morning, 
with great satisfaction, that I was over careful with 
him, and that he believed he had done all that could 
have been reasonably expected of him. 
I then allowed him to go home, but continued all the 
treatment, excepting the electricity and the nightly 
dose of the mono-bromide of camphor. I thought he 
ought to continue the whole system, with the excep- 
tions mentioned, for three or four months. 
And I warned him in the most solemn manner that, 
under no circumstances, was he to have sexual inter- 
course more frequently than once a week for at least 
a year, and perhaps even longer. More than a year 
has now elapsed, and I have every reason to believe 
that he has strictly followed my injunction. He writes 
that he is determined not to go beyond the limit fixed, 
that his happiness is complete, and that neither he nor 
his wife are willing to exceed those moral and physio- 
logical bounds which nature has imposed ; that she is 
pregnant, and that they both look forward to the birth ABSENCE OF THE POWER OF ERECTION. 
123 
of the child as a sign that God has forgiven him the 
sins and indiscretions of his youth. 
I have dwelt upon this case and its treatment at some 
length for the reason that it is a type of a large class, 
showing the ordinary effects of early and excessive 
masturbation, and for the additional reason that it 
shows what are, I think, the therapeutical principles 
which should prevail in their treatment. It would be 
very easy to adduce similar examples from my own ex- 
perience, but as showing that the influence I speak of is 
distinctly recognized by other writers, I cite the follow- 
ing from Deslandes, which, although it relates to a mem- 
ber of the female sex, is equally applicable to males: 
“ Masturbation,” he says, “ instead of the natural 
feeling, may induce in the sexual organs an irritability 
quite different from that caused by the act of inter- 
course, and which leads to results that are far from 
being agreeable. This fact was strongly impressed 
upon me by the case of a young woman who was often 
under my professional care. At a boarding-school she 
was taught masturbation, and gave herself up to it 
without restraint. At seventeen she was married, and 
had formed the most voluptuous ideas of the pleasures 
she was about to enjoy. But what a disappointment! 
Marriage, instead of giving her pleasure, was the source 
of positive discomfort and infinite pain; or rather, what 
was most frequently the case, she was completely insen- 
sible to the caresses of her husband. Again, a state of 
spasms and convulsions supervened after any attempt 124 
SEXUAL IMPOTENCE IN THE MALE. 
on the part of her husband at intercourse, and lasted 
for some time afterward.” 
It is therefore an undoubted fact that masturbation 
is in itself more injurious to the integrity of the virile 
power than sexual intercourse, not only because it is 
more frequently repeated, but because it is generally 
effected through the influence of an exalted imagination, 
and not by the reflex irritation of distended vesiculse 
seminales, the only physiological incentive to copulation. 
But it is not only, as is generally supposed, to the 
loss of semen that the injurious effects of masturbation 
or of excessive indulgence are to be attributed. This is 
undoubtedly of some influence, but it is not, I think, 
the chief factor in causing impotence or other disturb- 
ances of the healthy condition of the system. The fre- 
quent production of the orgasm is of much more con- 
sequence, and it is to this cause that the various de- 
rangements of the nervous system, as well as weakness 
of the virile power, or its entire loss, are mainly to be 
ascribed. An idea is extremely prevalent that the loss 
of a few drops of seminal fluid causes more weakness 
of the system than the abstraction of a pint of blood: 
nothing could be more absurd. The seminal fluid is 
not secreted with any degree of rapidity, and if the 
orgasm be produced several times in the course of a 
brief period, it is after the second or third time, at fur- 
thest, unaccompanied by any emission of true semen. 
A patient of my own had intercourse eleven times 
during a period of less than eight hours. The first ABSENCE OF THE POWER OF ERECTION. 
125 
three times were accompanied by emissions, but the 
last eight were entirely free from any discharge, though 
the orgasm was complete in each. Shortly after the 
eleventh time he had an epileptic fit, and became per- 
manently impotent, never again experiencing an erec- 
tion. 
A young man, during an orgie at a house of prosti 
tution, masturbated nine times in the course of about 
an hour. The first three times there were emissions, 
the fourth time only a little thin fluid escaped. The 
other five times the orgasm was experienced, unaccom- 
panied by the slightest discharge of any kind. 
The next morning he had incontinence of urine, and 
subsequently locomotor ataxia was developed. The 
penis was completely paralyzed. 
These cases are sufficient to show that the evil effects 
of excess are not due to seminal loss, which in neither 
of the instances could have exceeded a teaspoonful in 
quantity. 
Moreover, masturbation in boys before the age of 
puberty, is unattended by emissions of semen, and yet 
the injury to the system is greater at this period than 
at any other. 
And in women the evil results of masturbation are 
fully as great as they are in men, and with them it is 
the orgasm alone that can do any damage, as there is 
no seminal discharge. Swediaur* cites the case of a 
* “Traits complet des maladies ven6riennes.” T. i., p. 160. 126 
SEXUAL IMPOTENCE IN THE MALE. 
woman under his care who suffered from frequent 
venereal orgasms in her sleep, and who in consequence 
became affected with tabes dorsalis. 
When we call to mind the immense disturbance of 
the nervous system consequent upon the development 
of the sexual orgasm, the mental vertigo, the muscular 
convulsion, the cardiac and respiratory excitement, the 
resemblance which all the phenomena have to those of 
an epileptic paroxysm into which they not infrequently 
pass by an almost imperceptible gradation, we can un- 
derstand how the too frequent repetition must lead 
not only to an extinction of the natural desire and 
power, but to a long train of other disorders of much 
greater importance to the life and health of the indi- 
vidual. The idea of ascribing all these deleterious re- 
sults to the loss of a few drops of seminal fluid is 
absurd. They would take place equally certainly, and 
probably with almost equal severity, if there were no 
seminal fluid at all; and, indeed, in some extreme cases 
of masturbation there is no seminal secretion in the 
true sense of the term, and yet the process of mental 
and physical decay goes on with even more sureness 
than in the early days of the victim’s practice of the 
vice. 
There are several conditions which may be induced 
by the immediate action of the orgasm which are in 
fact continuations of it, and which can in no sense be 
ascribed to the loss of semen. For the semen is as 
much out of the system when in the vesiculas seminales ABSENCE OF THE POWER OF ERECTION. 
127 
as the urine is out of the blood when in the bladder. 
The mere discharge of this from one receptacle to an- 
other cannot produce any effect upon the organism, 
the deleterious results being caused by the demand for 
the secretion of repeated quantities of semen, and not 
by the emission of a collection already secreted. When, 
therefore, we see, in addition to epilepsy, cerebral 
hemorrhage, chorea, insanity, neuralgia, and certain 
forms of spinal paralysis following the orgasm imme- 
diately, and, indeed, sometimes supervening synchro- 
nously with it, we cannot doubt its influence over the 
mind and body, or fail to perceive that its too frequent 
repetition must indubitably lead to grave disturbances 
of one or the other, or both. 
Probably the act of masturbation or of sexual inter- 
course is somewhat more injurious to males than to 
females. More cases of disturbances caused thereby in 
boys and men than in girls and women come under the 
observation of physicians, but this is to a great extent 
due to the fact that females do not indulge in the vice 
of masturbation to anything like the extent to which it 
is practised by males—that is, so far as number is con- 
cerned. In individual cases, when it is once begun, I 
am inclined to think that girls and women carry it to a 
fully as great, if not a greater, extreme than do boys 
and men. The demoralization is greater, the sense of 
shame is more thoroughly abolished; but the other 
effects are certainly less than in the male sex. Still, 
disorders of body and mind do occur in them as the 128 
SEXUAL IMPOTENCE IN THE MALE. 
results of continued excess, and not infrequently as the 
direct and immediate results of repeated orgasms with- 
in a short period. I have had two cases of paralysis of 
motion in both lower extremities occurring in women as 
the results of excessive coition during a single night, and 
very many of spinal irritation and other affections of the 
nervous system, the immediate effects of a like cause. 
Sexual excesses in adult life, though often leading to 
impotence more or less permanent in character, are not 
so certain to result in that condition as those which are 
practised before the age of puberty, or before the body 
has attained to maturity. Still, cases of the kind are 
common enough, and undoubtedly the fact that almost 
every man who indulges in sexual intercourse does so 
to excess, is the cause of the supervention of impotence 
at an age when the individual ought to be in the full 
possession of all his powers. It is no uncommon thing 
to meet with men of fifty, forty, or even thirty, years of 
age, whose desires are as strong as they ever were, who 
are absolutely incapable of intercourse, or else possess 
the faculty in a very faint degree, and in whom the 
existing condition is clearly the result of excess. 
It often happens that excess is committed without the 
individual being at all aware that he is exceeding the 
normal limits. The question then arises, what is ex- 
cess? There are men who think it entirely within 
bounds to have intercourse once every twenty-four 
hours; others, again, indulge regularly twice a week ; 
others once; still, others who think once a month suffi- ABSENCE OF THE POWER OF ERECTION. 
129 
cient. It is exceedingly difficult to lay down any rule 
in the matter which will be applicable for all men ; in. 
deed, the task would be insuperable, for all men are not 
alike, and what would be excess for one would be mod- 
eration for another. But it may be said unhesitatingly 
that intercourse to the extent of once every twenty-four 
hours is excess for the strongest men who ever lived. 
There are many who can practise it without marked 
deterioration of their powers for several years, but the 
time inevitably comes, in advance of the normal period 
of diminution of power, when impotence begins to make 
its appearance. Twice a week is certainly excess for 
the majority of men, and will certainly lead to earlier 
than normal extinction of the sexual powers. Once a 
week is more generally applicable, and can as a rule in 
healthy men be taken as a guide from the twenty-fifth 
to the fortieth year. Previous to the twenty-first year 
sexual intercourse should not be practised at all; and 
between that age and twenty-five, if indulged in, it 
should certainly not be more frequently than once in 
ten or twelve days; and it is a law to which there are 
no exceptions that the greater the excess the sooner will 
the natural power be lost. If the individual desires to 
retain his ability to a green old age, he will not tax it 
too severely in his youth. 
That the civilized man is in general excessive in the 
matter of sexual intercourse admits of no question, and 
we see the effects constantly in the early loss of the 
power. The reading of obscene books, the witnessing 130 
SEXUAL IMPOTENCE IN THE MALE. 
of sexually suggestive plays, the very impediments 
which society necessarily places in the way of the un- 
restrained indulgence of the passions, act with some 
men as direct excitations to sexual indulgence. In civi- 
lized communities it will always happen that such causes 
act with much greater force than among savages, where, 
in fact, they are scarcely exhibited at all, and where the 
promptings of nature are alone the incentives to the act 
of copulation. The consequence is, that, other things 
being equal, the civilized man becomes impotent at a 
much earlier age than his uncivilized brother. 
How many men of sixty years of age in the city 
of New York are capable of natural and satisfactory 
intercourse? Not one in twenty, and yet the power 
ought to be retained, and is, in the cases of those who 
have been temperate in its use up to, and even beyond, 
the age of three score and ten. Indeed, it is rare to 
find a man of fifty who has so husbanded his powers as 
to admit of his having sexual intercourse once a fort- 
night, and then the act is neither satisfactory to him nor 
the recipient. But at times a more serious evil than 
the comparatively early decay of the sexual power is ob- 
served as the consequence of excess, and this is the su- 
pervention of impotence either suddenly, after some 
extraordinary indulgence, or more gradually, in conse- 
quence of repeated excesses. In these cases the desire 
remains in as active a condition as it ever existed ; at- 
tempts at intercourse are made, these fail; renewed 
efforts are made, with extraordinary excitants to erec- ABSENCE OF THE POWER OF ERECTION. 
131 
tion; but all in vain, the penis remaining limp and flac- 
cid to every normal and abnormal stimulus, and the 
condition becoming more profound with each failure. 
The effect is by no means restricted to the generative 
organs. The patient becomes morbid, both from chag- 
rin which follows his futile attempts at intercourse, and 
the apprehension, which is generally entertained, that 
some serious mental disease—insanity or imbecility, for 
instance—will result from the “ softening of the brain ” 
which he thinks has taken place, or is about to be pro- 
duced. Besides this, he is the subject of regrets and 
remorse for his past offences against the laws of his 
being, and is just in that frame of mind which makes 
him an easy prey to the wiles of quacks and other medi 
cal impostors. He therefore runs from one to the other 
of these knaves and frauds: mesmerizers, clairvoyants, 
“ natural healers,” anatomical museums, layers on of 
hands, faith-curers, etc., etc., in the vain search for 
something that will enable him to recover the power 
he has lost, with no other result than to deplete his 
pocket, in the meantime making constant attempts at 
sexual intercourse by experimenting with one woman 
after another, and always with the same issue—failure. 
A careful examination of these cases, and full inquiry 
into the circumstances attending the condition, reveal 
the facts that there has been no erection at all, or else 
so feeble a one as to render the intromission of the 
penis into the vagina an impossibility. Sometimes an 
emission of semen has taken place, but this has been ex- I32 
SEXUAL IMPOTENCE IN THE MALE. 
ternal to the vulva, and has only served to render the 
state still more deplorable, for it has occurred without 
an erection, and only as a consequence of the extreme 
debility of the whole generative apparatus. 
And this brings us to the consideration of that partial 
impotence which is one of the most frequent results of 
sexual excesses, and in which the erection is so feeble 
and the erethism so great that emission and an imper- 
fect orgasm ensue either before an entrance has been 
effected, or so soon thereafter that the act of intercourse 
is unsatisfactory to both parties. This condition is 
often preliminary to the more complete loss of power, 
and again it may continue for an indefinite period, or 
may disappear under treatment. 
In other cases there is an erection, and the individual 
thinks, till he learns better by experience, that there is 
going to be no difficulty in accomplishing the act of 
sexual intercourse; but just as the attempt is made to 
effect entrance, although there may be no loss of desire 
and no mental difficulty in the way, the penis becomes 
flaccid, and again disappointment is the result, there 
being no emission and no orgasm. 
These states of partial impotence are very common, 
especially in those persons who have arrived at middle 
age, but in whom normally there ought to be almost as 
great a degree of power as there ever was. For it is to 
be noted that when in the course of advancing years 
the period is approaching in which, according to physio- 
logical laws, the individual may expect to undergo the ABSENCE OF THE POWER OF ERECTION. 
133 
natural loss of sexual power, which is the common lot 
of all men, the failure is shown, not by any imperfec- 
tion in the act, but by the healthy demand for its repe- 
tition coming less frequently. Besides, in this physio- 
logical impotence the desire disappears pari passu with 
the power, and the individual accordingly yields grace- 
fully to the merciless law of his being. In that impo- 
tence, however, which is brought about by the impru- 
dence of the individual in committing the act of inter- 
course more frequently than he ought, or with extrane- 
ous accessories, which heat the imagination for the 
time being and leave it a blank thereafter, the desire 
often remains unimpaired, while the power is dimin- 
ished or altogether lost, and there are consequently 
regrets, chagrins, disappointments, and a constant state 
of warfare between the flesh and the spirit. It may be 
laid down as a law, to which there are few, if any, ex- 
ceptions, that whenever there is desire, without full 
power, the resulting impotence is a veritable disease, 
and not a physiological condition coming in the regular 
course of life. 
In regard to the character of the excess that may re- 
sult in complete or partial impotence, it is generally, 
though by no means always, in adults, sexual inter- 
course rather than masturbation. The latter is more 
especially, as we have seen, a habit of childhood and 
youth, though there are many men who practice it to 
the exclusion of sexual intercourse, or in connection 
therewith. In all these cases the same remarks may 134 
SEXUAL IMPOTENCE IN THE MALE. 
be made in regard to it as were made in the previous 
chapter, with the additional observation, that it is 
equally as destructive to sexual power as it is to sexual 
desire, not, however, from any circumstance inherent 
in the act itself, but because it is certain to be more 
frequently repeated than it is possible generally to re- 
peat the act of intercourse. 
In addition, some men who find themselves impotent 
in all attempts to perform the sexual act, not from lack 
of desire, but from failure of power, are very apt to 
enter upon a systematic course of masturbation, a pro- 
ceeding in which, to a still greater degradation of the 
sexual instinct and abolition of power, an emission and 
an orgasm can be procured without erection. 
The same plan may be adopted by elderly men in 
whom natural desire and power have faded, but who 
reawaken both in an imperfect degree by lascivious prac- 
tices of various kinds or even by indulgence in libidi- 
nous thoughts. These cases are among the most la- 
mentable that come under notice, especially when the 
act is practiced so frequently and under such very dis- 
gusting accompaniments or excitants as tend to the pro- 
duction of various affections—such as epilepsy or cere- 
bral hemorrhage, for instance, of the nervous system. 
I have had under observation, the case of an old man 
of seventy-three, who every afternoon had two young 
girls visit him, and practice buccal masturbation upon 
him one after the other, with scarcely a quarter of an 
hour’s interval. Upon one occasion, on which the pro- ABSENCE OF THE POWER OF ERECTION. 
135 
cedure was being effected, he suddenly became para- 
lyzed on one side, and deprived of the power of speech 
as the result of the rupture of a blood vessel in his brain. 
In another case, the patient, a man of over seventy, 
was affected with paralytic tremor due probably to dis- 
seminated sclerosis of the brain, which was clearly the 
result of excessive masturbation of which he had been 
guilty for several years. In this instance the appetite 
was unnaturally excited by lascivious books and pict- 
ures, and although he never obtained an erection, he 
succeeded by this system of over-stimulation in caus- 
ing such a state of erethism that an imperfect emission 
and orgasm were produced. One day, while engaged 
in the act, he experienced a slight sensation of vertigo, 
and at once tremor began in the right hand. This be- 
came more severe, and gradually extended to the other 
hand, and the head and neck. Eventually both legs 
were similarly affected, and now he walks with a festi- 
nating gait and is evidently passing into a state of senile 
dementia. 
In my experience, in every case in which masturba- 
tion is practiced to any considerable extent—and ex- 
cess in these cases is the rule—by persons in whom 
the natural desire and power are in a state of physio- 
logical decline, more or less injury of the nervous sys* 
tem is entailed, and the life of the individual is 
rially shortened. 
Sometimes, however, it is the case that the tendency 
to such acts is the consequence and not the cause of the 136 
SEXUAL IMPOTENCE IN THE MALE. 
existing mental derangement. In several forms of in- 
sanity the proclivity in question is exhibited in an ex- 
treme degree and constitutes one of the most distressing 
manifestations. Many of the cases of sexual depravity 
witnessed in old men are prodromata of senile dementia, 
and in younger persons of general paralysis.* 
Another cause of impotence in adult life, the opera- 
tion of which may begin in youth and continue till the 
individual is well advanced in years, or engages in sex- 
ual intercourse, is the nocturnal emission of semen. The 
influence of this factor is, however, in general very much 
overestimated, it being rarely the case that it of itself is 
productive of any serious disturbance of the health of 
the reproductive organs. On the contrary, it is in the 
great majority of cases a perfectly normal phenomenon, 
and one more calculated to do good than harm to the 
system, but when too frequent or when existing in con- 
junction with sexual excesses, nocturnal emissions are 
capable of causing marked deterioration of the sexual 
power or adding to that which is already present. 
A few words in relation to the physiology of the sub- 
ject will not be out of place, inasmuch as they may serve 
to place the matter in its true light, and relieve the 
anxiety which many physicians not infrequently feel in 
regard to patients in whom the condition exists, and 
which all their medical treatment does not suffice to 
abolish. 
*A Treatise on Insanity in its Medical Relations. By William A. 
Hammond, M.D. New York, 1883. ABSENCE OF THE POWER OF ERECTION. 
137 
In young men of entirely chaste habits it generally 
happens that soon after the supervention of puberty 
nocturnal emissions begin to occur. So long as they 
are not more frequent than once in a fortnight, they are 
strictly within the limits of health, at least the health of 
civilized man. They show that in the course of the de- 
velopment of the reproductive system semen is being 
secreted, and that when the vesiculse seminales become 
full, nature steps in, and in her own way empties them. 
If the young man keeps his thoughts pure, avoids late 
suppers and exciting amusements, which create em- 
otional disturbance, and does not sleep on his back, noc- 
turnal emissions would be unusual in their occurrence, 
and would, probably, in a young man past the age of six- 
teen, not occur as often as once in six months. But in 
practice it happens almost invariably that the thoughts 
are not kept pure, amorous romances and plays, the in- 
termingling of the sexes, the sight of suggestive statues 
and pictures, association with other boys who indulge 
in lascivious conversations, the sight of animals copulat- 
ing, and many other factors, are all so many excitants 
of the genesic function which cannot vbe avoided, and 
which in many cases it is not proper to avoid, unless 
we would have our boys grow up without any emo- 
tional development. The chaste and well instructed 
boy does not masturbate. The idea of such an act is 
disgusting to him, but he goes to bed, and in his sleep 
has a dream in which the impressions made through 
the day are revived, and the cerebrum not then having 138 
SEXUAL IMPOTENCE IN THE MALE. 
the full control of the lower nerve centers, these act in 
accordance with the idea presented by the brain, and the 
sexual orgasm occurs. Such an event happening once 
in two or three weeks does no harm. But if by the 
reading of obscene books, looking at lascivious pictures, 
or what is perhaps still worse, immodest conduct or 
conversation with individuals of the other sex, the 
frequency of the emissions is materially increased, then 
the case is different, for not only may there then be 
general and nervous debility, and other evidences of 
bad health, but impotence more or less complete may 
be the result. If, in addition, masturbation be per- 
formed with all its accompaniments of lascivious ima- 
ges, nocturnal emissions are quite certain to ensue and 
to pass beyond a healthy standard as to frequency. 
Sleeping on the back, by allowing the blood to settle 
in the spinal cord and medulla oblongata, so as to pro- 
duce a state of passive congestion, and also by allowing 
these parts to become over-heated increases the reflex 
excitability of the generative organs, and hence predis- 
poses to the occurrence of nocturnal emissions. 
As stated, emissions during sleep are usually pre- 
ceded or accompanied by lascivious dreams, but this is 
not always the case, as they sometimes occur without 
any such excitation. This, however, only happens in 
cases of advanced sexual debility, or in those instances 
in which the desire of the individual is extinguished. 
In regard to diurnal emissions, physicians hear much 
from patients of their passing their semen when strain- ABSENCE OF THE POWER OF ERECTION. 
139 
ing at stool and of its escaping with the urine. Though 
perhaps such cases are possible, they are certainly ex- 
ceedingly rare. In my opinion not one case in a hun- 
dred of alleged escape of semen during defecation or 
urination is in reality an instance of such an event. 
In states of great constipation, in which the fecal mass 
is large and hard, a little prostatic fluid or urethral 
mucus may be squeezed out during severe straining, 
but the emptying of the vesiculas seminales by such a 
cause is the rarest of occurrences, and when it does 
happen it is no great matter. In the whole course of 
my experience I have seen but one case in which there 
was an escape of semen during defecation, and in that 
there was some approach to an orgasm. The patient, 
a middle-aged man, had practised masturbation since 
childhood, had in adult years been excessively addicted 
to women, and had, moreover, further reduced his 
strength by an inordinate indulgence in the use of 
alcoholic liquors. In this instance, when defecation 
took place, great muscular efforts were requisite in 
order to effect the process, and almost invariably an 
imperfect orgasm with an emission of semen took 
place. 
In regard to the passage of semen with the urine, an 
event which is supposed by some to occur in conse- 
quence of the secretion flowing back into the bladder 
and then being discharged during micturition, I am 
quite sure that this never happens in the way men- 
tioned. It is not uncommon to find spermatozoa in the 140 
SEXUAL IMPOTENCE IN THE MALE. 
urine first discharged after sexual intercourse, for the 
emission accompanying the orgasm always results in a 
little of the semen remaining in the urethra, to be 
washed out with the next passage of urine. But the 
notion of the semen, gradually and without orgasm, 
flowing back into the bladder and then being evacuated 
is the veriest nonsense in the world. 
Among points interesting in this connection, Sir 
James Paget* discusses the one now under notice, in 
the following words. 
“ As to semen passing with the urine, 1 am nearly 
certain that it never does so unless when an emission 
has lately taken place, or where there has been disease 
of a seminal vesicle. In the former case, some semen 
remaining in the walls of the urethra, or possibly 
having passed into the bladder, is washed out with the 
next stream of urine, and may be found in it with the 
microscope. I once examined, for many days in suc- 
cession, the urine of a patient who was persuaded that 
he passed semen with it, and semen could always be 
found when he had had a nocturnal emission, but never 
on any other occasion. A former colleague of mine 
assured me that he had often observed the same thing 
after copulation, and this I believe is the whole truth 
concerning semen passing with the urine; whatever 
may chance to be left in the urethra after an emission 
is washed out. But that which frightens the ignorant 
*“ Clinical Lectures and Essays” (Sexual Hypochondriasis). New 
York, 1875, p. 271. ABSENCE OF THE POWER OF ERECTION. 
141 
and the hypochondriacal is not even this: it is mucus 
of the urinary passages either quite healthy or in some 
trivial manner changed. This form of what is called 
spermatorrhoea, therefore, should be treated by in- 
struction, which the merely ignorant will receive, and 
the hypochondriacal very likely will not. 
“ Not much unlike this misunderstanding about vesi- 
cal mucus is another in which some people, chiefly 
middle-aged and elderly, with diminishing sexual 
powers, make themselves miserable. They find in 
their urine little flakes or threads of floating mucus, 
which they say are always washed out of the urethra 
at the beginning of the urine-stream, especially in the 
morning. They watch these with the greatest anxiety, 
and send them to you on bits of paper or of glass, 
begging you to examine them very carefully. I be- 
lieve that they are bits of prostatic mucus secreted in 
the night and washed out with the morning urine. But 
whatever they may be they are not of the least im- 
portance. You may find them passed by men who 
neither know nor care anything about them and whom 
they never harm, and even hypochondriacs go on 
month after month passing them and yet suffering 
nothing but their mental misery.” 
Cases in which this delusion is entertained are com- 
mon enough in the practice of every physician, and the 
subjects of it are encouraged to believe in its truth by 
the various quacks who pretend to cure them, while at 
the same time exaggerating the importance of every 142 
SEXUAL IMPOTENCE IN THE MALE. 
little out-of-the-way circumstance that may exist. They 
know well that their chief way to illicit gains is by 
frightening the patient in making him believe that he 
is on the high road to impotence, and softening of the 
brain, and that they alone recognize the danger he is in. 
In this way the patient is brought to a condition of 
what may be called “false impotence.” He is afraid to 
make the attempt at sexual intercourse lest in failing 
he should have his worst fears realized. 
Again, the patient supposes that he is subject to 
emissions of semen without the orgasm, and solely as 
the result of venereal excitement. It is true that in 
most persons, there is, under the condition in question, 
a slight glairy exudation from the meatus, but this is 
simply mucus secreted by the lining membrane, and its 
excretion is nothing more than a physiological pheno- 
menon without the least pathological importance. In 
regard to this subject Sir James Paget says: * 
“ Another subject of gloom and alarm to some is, that 
during sexual excitement, and, as they suppose, worse 
still, when they wake in the morning, they find a clear 
colorless fluid flowing from the urethra, or easily 
pressed from it. Here, again, the complaint is of that 
which is natural, and it will be quite as just if directed 
against tears during grief. The urethra naturally 
secretes mucus during sexual excitement; it secretes 
more or less in different persons, but some, I believe, 
in all: and as for the morning secretion, it is due either 
* Op. cit., p. 273. ABSENCE OF THE POWER OF ERECTION. 
M3 
to some sexual excitement during sleep, forgotten be- 
fore waking, or to the general condition of turgescence 
or erection of the sexual organs which in most healthy 
persons exists during sleep or some part of it. In no 
case is this clear urethral mucus a sign or conse- 
quence of disease, unless, indeed, where an excess of 
it is a residue of gonorrhoea. It is, I think, most abun- 
dant and most quickly formed in those whose sexual 
organs are more irritable than potent, but this is the 
worst that can be said of it; and even in these it is not 
the sexual organs, but some part of the nervous sys- 
tem, the brain or the spinal marrow, that is in the 
wrong. In no case does the secretion deserve to be 
called or treated as a disease.” 
These cases are almost as bad as those in which the 
subjects think they are becoming impotent because 
they have discovered that one testicle hangs lower than 
the other. 
But there are involuntary diurnal emissions in which 
the semen is discharged with an orgasm in consequence 
of friction of the penis against the clothing, or as the 
result of lascivious thoughts or acts. But these con- 
ditions show loss of power with increase of irritability, 
and are usually the results of great excesses. The 
individual in whom they occur is generally impotent to 
the physiological stimulus to sexual intercourse. 
In the first-named class of cases the patient may have 
emissions while walking, or especially while riding 
horseback. The emission is accompanied with an im- 144 
SEXUAL IMPOTENCE IN THE MALE. 
perfect orgasm, and the erection is usually very feeble. 
Indeed, in most cases there is nothing that can with 
propriety be called an erection, only a slight turges- 
cence of the penis being produced. 
In the second the like series of events takes place in 
consequence of some impression of a voluptuous char- 
acter being made upon the mind, not as in the cases 
described in the previous chapter, by his concurrence 
and action, but against his inclination. Indeed, in 
some instances the slightest reference to sexual matters 
in the presence of an individual of the class referred to, 
is sufficient to cause an emission. In one case that 
came under my observation, the patient, a man about 
forty years of age, who had exhausted his powers by 
great excesses, and had also brought the generative 
system to a state of great erethism, the sight of a 
woman getting into an omnibus and thus showing an 
inch or two of her ankles, or of another with bare neck 
and arms, was sufficient to cause an emission without 
erection and with scarcely the semblance of an orgasm. 
Both these causes may lead to impotence, though 
often they are accompaniments of this state, and like it, 
are evidences of the weak condition of the generative 
system. 
There are other factors besides excess which are 
capable of producing such a loss of virile power as to 
lessen or altogether abolish the capacity for erection, 
and consequently to render the individual impotent. 
Among these are various conditions and diseases both ABSENCE OF THE POWER OF ERECTION. 
145 
of a general and local character, of the generative sys- 
tem specially, or of other parts of the body. 
Obesity, due, as it often is, to defects in the processes 
of assimilation and elimination, may be accompanied 
by a feeble condition of the generative system. I have 
seen this fact markedly shown in the cases of two 
gentlemen, each of whom, though not exceeding five 
feet eight inches in height, weighed three hundred, and 
two hundred and eighty pounds respectively. There 
had never been excess in either case, both were mar- 
ried, and both, with the inception of the obese state, 
began to fail in the power of erection, till eventually 
sexual intercourse was, from this condition, rendered 
impossible. It will be understood here, that the diffi- 
culty was not a mechanical one of a protuberant abdo- 
men—that question will be considered in the ensuing 
chapter—but one which related entirely to the power 
of erection. y 
Eventually both these gentlemen were cured, and the 
result established the correctness of the opinion given, 
that the impotence was the result of a constitutional 
cause. By enjoining a diet from which sugar, starch 
and fat were rigidly excluded, the weight was reduced 
sixty pounds in one case and forty seven in the other, 
not only with the effect of restoring the virile power, 
but with greatly improved health in other respects. 
Emaciation, when extreme, is, even more than obesity, 
due to derangement of the nutritive system, and like it, 
may be productive of impotence. This condition is 146 
SEXUAL IMPOTENCE IN THE MALE. 
still more liable to result when, in addition to general 
emaciation, the testicles and penis become the subjects 
of atrophy. Then the loss of virile power becomes a 
permanent condition, to remain during the life of the 
individual. Fortunately for the patient, there is, in 
these cases, a loss of desire as well as of power, so that 
in general the state is not one in which there are end- 
less chagrins and disappointments. Exception, how- 
ever, must be made in the cases of some married men 
who are unable from the first to consummate the mar- 
riage, or whose wives are exigent of their uxorial rights. 
Thus, I was consulted in the case of a Hebrew gentleman 
in good general health, although somewhat emaciated, 
and who found it impossible to escape from a matri- 
monial engagement into which, while in the possession 
of full virile power, he had entered. Trusting that his 
condition might not be as bad as it seemed, and indeed 
ignorant of the extent to which it reached, he married 
and came to New York with his wife on his wedding 
tour. The morning after his arrival he came to see me 
in a state of great mental distress and with the informa- 
tion that he was absolutely incapable of doing the duty 
of a husband. Upon examination I found the testicles 
in a state of extreme atrophy, being soft and not larger 
or thicker than a twenty-five cent piece, and the penis 
cold, thin and extremely flaccid. The general emacia- 
tion was not extreme, and while it was evident that the 
absorption of the tissues of the genital organs had been 
more rapid than that of other parts of the body, I could ABSENCE OF THE POWER OF ERECTION. 
147 
discover no nervous or other affection of the parts to 
account for the state in which they were. I gave an 
unfavorable prognosis, and shortly afterwards the mar- 
riage was annulled in one of the Courts of Pennsylvania, 
from which State the couple came. 
In another case, the patient, a gentleman who had 
been married several years and had had three children 
by his wife, became the subject of phthisis and of rapid- 
ly advancing emaciation. With the decline in his health 
there was also a rapid loss of sexual power, due, as I 
found on examination, to atrophy of the testicles. These 
organs were soft, flabby and not more than one half 
the natural size when the patient first came under 
my observation. The penis was also greatly reduced 
in size. In this instance there were extensive demands 
made on the patient’s generative power, with which 
he was both indisposed and unable, even with the best 
intentions in the world, to comply. The prognosis 
was bad, and the patient died some two years after- 
ward without the least recuperation of the procreative 
faculty. 
Local emaciation of the generative organs may exist 
without the participation of the system at large, and is 
then due to some cause cutting off the nervous influence 
to the parts or depriving them of their due supply of 
blood. Certain brain affections, as, for instance, cere- 
bral hcemorrhage, are sometimes followed by atrophy 
of the testicles. This result has been asserted to be par- 
ticularly apt to ensue from injury or disease of the cere- 148 
SEXUAL IMPOTENCE IN THE MALE. 
bellum. Gall * observed several cases of the kind, and 
numerous other instances are referred to by Combe,f 
and other writers. in an elaborate 
sustains Gall’s theory, and adduces several cases in its 
support. In injury or disease of this part of the en- 
cephalic mass he asserts that, though in the beginning 
there may be an exaggeration of the sexual feeling and 
power, yet, as the morbid process advances, there will 
be a state of decided asthenia of the genital organs, 
combined with atrophy of the testicle of the side cor- 
responding to that of the diseased lobe of the cerebel- 
lum, or of both if the whole of this part of the cerebel- 
lum be affected. In support of his remarks Larrey 
cites the case of a young soldier who, in Egypt, was 
struck on the back of the head by a large splinter of 
wood. Inflammation, supposed to be located in the 
cerebellum, supervened. He eventually so far recov- 
ered as to be sent back to France. Several years 
elapsed before he again came under Larrey’s notice. 
It was then found that his genital organs were reduced 
* “ Cerebello vulnerato partes genitales sympathiam trahuntur. Gall, 
Vindobonnae Austriacorum, duos milites, e vulnerato occipite, impotentes 
fieri observavit, quorum unus, duobus post annis, veneris appetentiam et 
copulandi potestatem iterum recepit, puerosque genuit. Formey, Bero- 
linensis narravit nobis historiam cujusdam qui, occipite vulnerato, primum 
priapismo, dein impotentia vexatus est. Veruntamen sex post mensibus 
virilitatatem recuperavit.” “ Phrenology; or, the Doctrine of the Mental 
Phenomena.” By J. G. Spurzheim. Boston, 1833, vol. 1, p. 150. 
f A “System of Phrenology.” Boston, 1834, p. no. 
% “Observations on Wounds.” Translated from the French by E. F. 
Rivinus, M.D., Phila., 1832, p. 199. ABSENCE OF THE POWER OF ERECTION. 
149 
« 
in size to those of an infant a few months old. The 
power of erection was lost, and sexual desire had dis- 
appeared. 
In another case a soldier was struck by the ball of a 
blunderbus, which, grazing the occipital protuberance, 
tore away the extensor muscles of the head in its pas- 
sage from one side to the other. The patient imme- 
diately felt a violent pain in the occiput, and a sense of 
weight in the whole head, together with numbness of 
the lower extremities. His vision and hearing were so 
much impaired that he could hardly discern any large 
objects or understand the most piercing words. His 
testicles became reduced and wasted away, and his 
penis diminished in the same proportion and lost the 
power of erection. 
The third case was that of a man who had received a 
sabre-cut through the occipital bone and dura mater, 
so that the right lobe of the cerebellum could be readily 
seen and touched. When the finger was pressed upon 
it ever so gently, vertigo, syncope and convulsions 
were induced, but no pain was experienced. After the 
first few days the patient lost the faculties of vision and 
hearing on the right, or opposite, side. At the same 
time there were violent pains along the course of the 
spine, and a kind of formication in the testicles, the 
size of which rapidly diminished, so that in less than a 
fortnight they were reduced to the size of small beans. 
The sexual passion became utterly extinguished. 
In the fourth case the patient was struck on the back 150 
SEXUAL INPOTENCE IN THE MALE. 
of the head ; among other consequences the right testi- 
cle became atrophied and the power of erection was 
lost. 
In the fifth case, in consequence of a blow on the 
head with a piece of wood, an abscess of the right lobe 
of the cerebellum was produced, of which, in about 
three months, the patient died. The post-mortem ex- 
amination showed entire disorganization of the right 
lobe and marked atrophy of the testicle of the opposite 
side. 
In the sixth case, disease of the cerebellum was the 
consequence of erysipelas. The patient lived two 
months. Subsequently the post-mortem examination 
revealed the existence of an abscess, which had en- 
tirely taken the place of the left lobe of the cerebellum. 
The scrotum and penis were so much reduced from 
their original size as to be in the second stage of atrophy. 
Three remarkable instances, showing the connection 
between cerebellar lesions and atrophy of the genital 
organs have been reported by Dr. John D. Fisher,* of 
Boston. 
The first was that of a man aged forty-five, who was 
seen soon after his death, which took place from pneu- 
monia. The penis was small; the glans had evidently 
seldom, if ever, been uncovered. When exposed it 
was small, pale and pointed; all the parts of the organ 
resembled those of a boy not yet arrived at the age of 
*“ Contributions Illustrative of the Functions of the Cerebellum.” 
American Journal of the Medical Sciences, Feb., 1839. ABSENCE OF THE POWER OF ERECTION. 
151 
puberty. The scrotum was soft and flabby, and was 
empty. No testicles were anywhere to be found. 
The head was large, measuring 22 inches in circum- 
ference. The brain was healthy and very large, weigh- 
ing 5xi ounces. The relative proportion of the cere- 
bellum to the cerebrum was much reduced, for while 
the latter weighed 47 ounces, the former weighed but 
4i ounces. According to Meckel and others the aver- 
age weight of the cerebrum and cerebellum united is 
48 ounces, and the weight of the cerebellum to that of 
the cerebrum is as 1 to 7 or as 1 to 8. In this case 
the cerebellum measured in its transverse diameter 
2\ inches, and in thickness inches; antero-posteri- 
orly 2\ and perpendicularly 2\ inches. It was there- 
fore one-third less in size and weight than is ordinarily 
the case in an adult male, and was the exact weight of 
that of a female child six years old, whose body was 
examined at the same time. 
The history of the patient is very interesting. The 
deficiency of testicles was discovered by Dr. Warren. 
The voice was like that of a woman ; he had no beard ; 
he never exhibited any amorous propensities, or desire 
for female society; as his mother expressed it, he was 
a virgin in feeling and conduct to the day of his death. 
The second case was that of a man aged forty-one, 
who, while a passenger in a railway train, was injured 
by a collision, so that the back part of his neck was 
struck violently against the window frame of the car. 
The blow was so severe that he remained for some 152 
SEXUAL IMPOTENCE IN THE MALE. 
time in a state of insensibility. At first it was thought 
that his skull was fractured, or his neck dislocated. 
He, however, regained his intelligence and was con- 
veyed to his residence. Various symptoms connected 
with the nervous system supervened, and between the 
fourth and fifth weeks after the accident he made the 
discovery that he had lost the desire for sexual inter- 
course and the power of erection. The ordinary exci- 
tations failed altogether to cause any amorous feeling, 
and this condition, he was of opinion, had existed since 
the accident. The generative function continued dor- 
mant for two years, and six months later was only par- 
tially active. 
The following case is particularly interesting owing 
to the fact that strong venereal desires existed, but 
in consequence of deficient power they could not be 
indulged. It is related by Dr. Whittemore, but is re- 
ported by Dr. Fisher: 
An old man, aged seventy-three, had been married 
forty years, and had had eleven children. Soon after 
marriage he began to complain of dizziness and noises 
in the head, to which he was subject more or less till 
his death. In addition, he had intense vertigo and se- 
vere pain, together with partial deafness in the left 
ear. Then he had several attacks of hemiplegia, and 
after their occurrence was affected with morbid salac- 
ity, which continued with little intermission till about 
three months before his death, when it began to sub- 
side so that the desire became imperious but once or absence OF THE POWER OF ERECTION. 
I5S 
twice during the night. There was, however, no abil- 
ity to gratify it, owing to imperfect erection, and for a 
year there had been no seminal emission. 
On the day after his death his brain was examined. 
The dura mater was adherent to the skull, the arach- 
noid was thickened, there was a large quantity of ser- 
ous fluid in the pia mater, and the arteries were 
undergoing ossification. Otherwise the brain was 
healthy, except as regarded the cerebellum. The 
right lobe of this organ was normal; the left lobe was 
one-fifth smaller, and was found to have lost the greater 
part of its substance, owing to the formation of a cavity 
in its tissue. The sides of the cavity were in contact, 
but it had probably contained serum, which had es- 
caped when it was laid open. 
Budge * found that by irritating the cerebellum 
movements of the testicles were produced. Thus he 
says: 
“ By a lucky coincidence I made the gratifying ob- 
servation that in an old cat, whose testicles lay in the 
abdominal cavity, these organs, immediately after 
death, moved whenever the cerebellum was irritated 
by the scalpel or with caustic potash. The effect was 
such that whenever the right half of the cerebellum 
and the right half of the vermiform process were irri- 
tated, movements of the left testis ensued, and the re- 
verse. Mere superficial irritation sufficed to produce 
this result. The movements of the testicles soon be- 
* “ Untersuchungen uber das Nervensystem.” Heft, ii, p. 82. 154 
SEXUAL IMPOTENCE IN THE MALE. 
came so palpable in this animal that there could be no 
doubt as to its reality. I hastened to open the entire 
skull and the abdominal cavity and found the testicles 
lying perfectly still and without any trace of move- 
ment. On irritating one side of the cerebellum the tes- 
ticle of the opposite side swelled, quitted its position, 
and rose up so as to form a right angle with the sperm- 
atic cord, one side of the angle being directed forward. 
If I desisted from the irritation, the testicle returned to 
its position, and the movement was renewed on renew- 
ing the irritation. The experiment was repeated dur- 
ing half an hour with unvarying results. After the 
first irritation not three seconds elapsed before the 
movement followed. Subsequently the interval be- 
tween the irritation and the effect was prolonged. The 
movement only lasted a short time and was diminished 
more and more. Alternately with the cerebellum I 
irritated the cerebrum, the corpora quadrigemina, the 
thalami optici, the corpora striata, but I have never 
seen the slightest movement result from the irritation 
of those parts.” 
Valentine confirms Budge’s observations, but Volk- 
mann has never been able to do so, and Muller discred- 
its them altogether. 
I have endeavored to satisfy myself in regard to these 
points by repeating Budge’s experiments. In one in- 
stance, in which a cat was used, decided movements of 
the testicles were induced by irritating the cerebellum 
with a scalpel or with the continuous galvanic current ABSENCE OF THE POWER OF ERECTION. 
155 
applied through two needles. The irritation of the left 
lobe produced movements in the right testicle, and 
vice versa. When the current was passed through both 
lobes, both testicles were moved and the penis was also 
brought into a state of erection. I was at first disposed 
to attach considerable importance to these facts, as in- 
dicating a very close relationship existing between the 
cerebellum and the generative organs ; but by further 
observation I found that irritationof the medulla oblon- 
gata and of the cerebrum produced like movements in 
both testicles and in the penis. I also found that irrita- 
tion of the cerebellum in either way I have mentioned 
caused movements of the intestines, of the abdominal 
muscles, and of the muscles of the thigh and back. 
My experiments were performed upon three cats just 
killed. I am hence disposed to attach less importance 
to Budge’s observations than does Romberg,* who 
quotes them with evident approbation. They are nev- 
ertheless interesting as showing that though the con- 
nection between the cerebellum and the sexual organs 
is not exclusive, there is a relation in which, however, 
other parts of the body participate and which likewise 
exists with other parts of the brain.f 
There are various affections of the spinal cord which 
* ‘‘A Manual of the Nervous Diseases of Man.” Sydenham Society’s 
Translation. Vol. ii. p. 33. 
f My experiments were performed in 1856, and are detailed in a mono- 
graph on “The Physiology and Pathology of the Cerebellum,” read be- 
fore the New York County Medical Society, January 4th, 1869, and 
published in the Journal of Psychological Medicine, April, 1869, p. 209. 156 
SEXUAL IMPOTENCE IN THE MALE. 
cause sexual impotence. During the actively inflamma- 
tory stage of these diseases there is often intense and 
long-continued priapism, but as the morbid process ad- 
vances, loss of power is the result. Thus, taking loco- 
motor ataxia as an example, we find that very generally 
during the first period of the disease there is an exalta- 
tation of sexual desire and power, and that nocturnal 
emissions are frequent, but that in the latter stages loss 
of virility, with or without atrophy of the testicles and 
penis, is apt to occur. 
Diseases or injuries of the nerves supplying the gen- 
erative organs may lead to impotence by causing atro- 
phy of the parts concerned. Among these may be 
mentioned severe and long-continued neuralgia of the 
testis or of the cord, degenerative changes in the sper- 
matic nerves, or tumors or other growths compressing 
them. The experiments of Obolensky on rabbits go to 
show that if the spermatic nerve be divided the corre- 
sponding testicle progressively wastes away and in a 
case of fatty degeneration of the nerve occurring in a 
man, the testicle of the same side was atrophied. In 
two cases of neuralgia of the testis in which, for their 
cure, I compressed the spermatic cord there 
was no permanent loss of power. Neither did the 
pressure cause atrophy of the testicle corresponding to 
the side on which the operation was performed.* 
*“ Neuralgia of the Testis.” Read before the New York Neurologi- 
cal Society, May 4th, 1880. Neurological Contributions, No. 3, 1881, 
P- 25. ABSENCE OF THE POWER OF ERECTION. 
157 
The effects of excessive horseback riding in causing 
atrophy of the testicles, and consequent impotence, are 
well known to writers on the subject, but do not ap- 
pear to have attracted the attention of the profession at 
large. In a recently published monograph* I had oc- 
casion to inquire into this subject and will bring for- 
ward some of the results of my investigations. 
From a very early period the idea has existed that 
the male inhabitants of the Caucasus are subject to a 
peculiar disease, the chief characteristics of which are 
the loss of the physiological and moral attributes of 
man, the supervention of impotence, the disappearance 
of the beard, the atrophy of the penis and testicles, and 
eventually the implication of the mind to such an extent 
that the subjects, believing themselves to be women, 
clothe themselves like women and adopt the manners, 
customs, and occupations of the female sex. 
The first mention of the condition in question is that 
by Herodotus,f who states that when the Scythians 
were about leaving Syria and Palestine, which they 
had invaded, their rear guard pillaged the temple of 
Venus at Ascalon. The goddess was so enraged at 
the act of desecration that she caused the perpetrators 
to become like women, and further decreed that their 
posterity should be similarly affected. Herodotus ac- 
cepts this story without question. 
* “ The Disease of the Scythians (Morbus Foeminarum) and other 
Analogous Conditions.” American Journal of Neurology and Psychiatry. 
August, 1882, p. 339. 
f “ History of Herodotus” (Rawlinson’s Translation), vol. i. p. 190. 158 
SEXUAL IMPOTENCE IN THE MALE. 
Hippocrates* is the next to refer to the matter, and 
as showing to what causes the “Father of Medicine’’ 
attributed the remarkable disease I quote his observa- 
tions at length : “ I have to make another allusion,” he 
says, “ and that is to the fact that among the Scythians 
many impotent persons are encountered, who occupy 
themselves with the work of women and who have a 
like pitch or tone of voice. They are called anandrii. 
The natives allege that the phenomena are caused by a 
god, and they venerate and worship those who are 
thus affected, fearing each one that he may himself be- 
come the subject of a like visitation. As for me, I re- 
gard this disease as being no more of divine origin 
than any other, for no disease has any pre-eminence in 
this respect. Each one has a natural cause, and no one 
can arise without the intervention of nature. Let me 
state what appears to me to be the cause of the affec 
tion. 
“ Horseback riding produces with the Scythians en- 
gorgements of the articulations, because the limbs are 
always hanging without support. With those who are 
severely visited the hip is drawn back and they are 
rendered lame. For the cure of this deformity they 
open the two veins which are near the ears. When 
the blood has ceased to flow they are overcome with 
weakness and fall asleep. On awaking some are found 
to be cured, but others are not. I presume that it is 
exactly by this treatment that the seminal fluid is 
* Hepi dspoov, vScctoov, roTtcov. ABSENCE OF THE POWER OF ERECTION. 
159 
changed, for near the ears there are veins which ren- 
der impotent those in whom they are cut. Now, I 
think that they divide these very veins. When after 
this operation they attempt to have sexual intercourse 
and fail, they are at first not disquieted, but if after 
two or three more trials they do not succeed, they im- 
agine that they are being punished by some god whom 
they have offended. They then assume the attire of 
women, declare that they have lost their virility, asso- 
ciate exclusively with women, and follow like occupa- 
tions, 
“This disease attacks the rich and not the lower 
classes. The noble and the powerful are its chief vic- 
tims, because they go much on horseback, while the 
poor do not. . . It is also met with in other people, for 
when equitation is the chief and habitual mode of ex- 
ercise many must suffer from swellings of the joints, 
with sciatica and gout, and be deprived of sexual inter- 
course. These infirmities are widespread among the 
Scythians, who are the most impotent of men, in con- 
sequence of the cause specified and by reason of the 
fact that they constantly wear breeches and pass the 
greater part of the time on horseback. Thus they 
never touch the genital organs with the hands; and 
subdued by cold and restrained by the fatigue attend- 
ant on sexual pleasures, they do not attempt inter- 
course till they have in reality lost their virile power.” 
It will be seen, therefore, that Hippocrates attributes 
the disease under notice indirectly to horseback riding i6o 
SEXUAL IMPOTENCE IN THE MALE. 
in excess, and directly to the division of veins near the 
ears, which he supposes to be in intimate relation with 
the generative organs. 
Sprengel* speaks of the pretended wise men among 
the Scythians who, rendered irritable by the abstinence 
to which they condemned themselves, fell into violent 
convulsions whenever they wished, or whenever the 
superstition of their countrymen required. The unin- 
telligible words which they spoke while in this state 
caused them to be regarded as prophets. The Greeks 
called them enares, anandries, either because their 
prejudices obliged them to avoid intercourse with 
women, or because their excessive sensibility really 
changed their constitutions, and rendered them unfit 
for the generative act. He quotes Reinegg,f who in 
his description of the Caucasus says : 
“ The most remarkable of all the nomadic tribes of 
the Kuban is that called the Nogays or Mongutays. 
The members of this are distinguished from the others 
by the Mongolian features, which characterize their 
entire physical structure. The men are obese, large 
and swollen, the cheek bones very prominent, the eyes 
deep-sunken, and the beard sparse. When they are 
reduced by disease, or when they have attained to an 
advanced age, the skin of the whole body becomes 
wrinkled, the beard disappears altogether, and in this 
* “ Histoire dc la M6decine” (French Translation of A. J. L. Jourdan). 
Paris, 1815, t. 1, p. 207. 
f “ Beschreibung der Kaukasus,” St. Petersburg, 1796, Th. 1, p. 269. ABSENCE OF THE POWER OF ERECTION. 
161 
state they present a great resemblance to women. 
They become incapable of the procreative act, and 
their feelings as well as their actions cease to be like 
those of the sex to which they belong. Obliged to fly 
from the society of men, they seek that of women, 
whose dress they adopt.” 
Jules Klaproth,* the son of the eminent chemist, has 
noticed the like facts in the Nogays of the Caucasus, 
and recognizes the accuracy of the description given 
by Hippocrates, and which I have already cited. 
Chotomskif is authority for the statement that there 
are to this day many among the Tartars of the Cau- 
casus who are affected with impotence as a conse- 
quence of excessive riding on horseback. 
It therefore appears that there is good reason for 
believing that the male Scythians of an early day and 
their descendants, the inhabitants of the Caucasus of 
the present time, are particularly subject to sexual im- 
potence, and that this condition is accompanied with 
such moral and physical changes in the affected indi- 
viduals as to cause them to look like women, and to 
acquire the mental characteristics and instincts of the 
female sex. 
There seems to be little doubt that the male Scyth- 
ians were, and their Tartar descendents of the present 
day are, extremely addicted to the vice of masturba- 
* “ Reise in der Caucasus, und nach Georgien,” Berlin, 1812, Th. 1. p. 
285. 
f Cited by Daremberg, in his translation of Hippocrates, Paris, 1843, 
p. 497. 162 
SEXUAL IMPOTENCE IN THE MALE. 
tion, and that they are also subject to seminal losses 
not directly the result of voluntary acts. And this, 
notwithstanding the circumstance alleged by Hippo- 
crates that the constant wearing of breeches prevents 
them carrying their hands to their genital organs. 
Sprengel * declares that, as a consequence of the local 
excitement due to continual horseback riding, they are 
not only subject to the emissions resulting from the 
friction, but that they practise onanism to an inordinate 
extent. This latter habit is also, doubtless, aggravated 
by the circumstance that their nomadic life deprives 
them to a great degree of the ordinary facilities for 
sexual intercourse, women not accompanying them on 
their forays and other expeditions. 
A similar explanation is given by Lallemand,f who 
reports several cases of impotence due to seminal 
losses as consequences of excessive equitation. Ac- 
cording to him the friction and shocks to the perineum 
resulting from contact with the saddle cause irritation 
of the efferent ducts, thence the morbid process passes 
to the epididymis and the testicles, which are kept in 
an almost constant state of erethism. Emissions result 
spontaneously, and the condition in question prompts 
to the frequent commission of masturbation. Impo- 
tence is the ultimate consequence. 
Another explanation of the abolition of sexual power 
from excessive horseback exercise is that of Darem- 
* “ Apologie der Hippokrates,” Leipzig, 1792, Part ii. p. 610. 
f “ Des pertes seminales,” Paris, 1836, Part i. p. 581. ABSENCE OF THE POWER OF ERECTION. 
163 
berg,* who ascribes it to the pressure exerted upon 
the spermatic vessels and the consequent interruption 
of the due course of their nutrition, and the loss of all 
procreative desire and ability. He does not appear to 
have had his attention drawn to the erethism of the 
sexual organs produced by excessive horseback exer- 
cise. 
Under the heads of “ Eviration” and “ Maladie des 
Scythes,” Nystenf speaks of the impotence resulting 
from inordinate equitation. It produces, he declares, 
complete loss of sexual desire, and an impossibility of 
erection in men who are otherwise vigorous and in 
good health. Foresters and country physicians, who 
pass a good deal of their time on horseback, are men- 
tioned by him as among its subjects. The habitual 
compression of the vesiculas seminales and of the pros- 
tate gland appears to him to interfere with the secret- 
ing process of the semen. 
The object of the monograph to which reference has 
been made was to call attention to the fact that about 
thirty years ago, while stationed in New Mexico as a 
medical officer of the army, I became acquainted with 
the fact that the Pueblo Indians are in the habit of se- 
lecting some one male from among those living in a 
village and rendering him sexually impotent, reserving 
him at the same time for pederastic purposes. This 
person was called a mujerado, a corruption probably of 
* Hippocrates (Translation), i Paris, 1843, Note 58, p. 497. 
f “ Dictionnaire de Medecine,” etc., onzieme Edition, Paris, 1858. 164 
SEXUAL IMPOTENCE IN THE MALE. 
the Spanish word mujeriego, which signifies feminine 
or womanish. There is no such word in Spanish as 
mujerado, but if there were it would, according to the 
construction of the language, mean “ womaned," or, 
“ made like a woman.” 
Two of these creatures came under my observation. 
The first was about thirty-five years old, rather tall and 
slim. There was not a vestige of beard, though I at- 
tached little importance to this fact, as the Indians 
rarely have any marked growth of the kind. His 
countenance was cheerful and his face was free from 
wrinkles, full and rounded, like that of most Indian 
women of his age. He was dressed exactly like a 
woman. On my expression of a desire to examine him 
more closely, he was directed to accompany me into 
an adjoining room, which he at once did, the chief go- 
ing with us. He then at my request removed all his 
clothing. The first thing that attracted my notice was 
the extraordinary development of the mammary glands, 
which were as large as those of a child-bearing woman. 
He told me that he had nursed several infants whose 
mothers had died, and that he had given them 
of milk from his breasts. I expressed my doubts of 
the truth of this assertion, but he persisted with ve- 
hemence that it was true. The chief would neither 
affirm nor deny its correctness, repeating, in answer to 
my inquiries, after the true Mexican fashion, “ Quisas, 
quien sabe/”—(“ Perhaps so, I do not know.”) ABSENCE OF THE POWER OF ERECTION. 
165 
The abdomen was protuberant and the limbs were 
round, full, and soft. 
Of couse the most importants parts to be inspected 
were the genital organs. There was no hair on the 
pubis; the penis was shrunken, but wa§ otherwise nor- 
mal ; the prepuce could be readily retracted and the 
glans presented a healthy appearance, except that it 
was not larger than a thimble, which it very much re- 
sembled in shape. The whole organ was, in its flaccid 
condition, about an inch and a half in length. The scro- 
tum was long and pendulous and contained the remains 
of the testicles, which had almost entirely disappeared. 
Each one was the size of a small filbert, as well as I 
could judge. Pressure upon them gave slight pain. I 
supposed that the glandular structure had become al- 
most entirely atrophied, little besides connective tissue 
remaining. The spermatic cords could be distinctly 
felt up to the external abdominal rings. There was 
slight varicocele. 
In all other respects the organs were normal, there 
being no deformity of any kind. I was surprised at 
this condition, for I had expected to see some form of 
hermaphrodism, or at least cryptorchism. 
He informed me that he had been a mujerado for 
seven years, and that previous to that time he had pos- 
sessed in full all the sexual attributes of a man. First, 
his testicles had begun to get smaller, and with their 
disappearance he had lost all sexual desire, all liking for 166 
SEXUAL IMPOTENCE IN THE MALE. 
the companionship of men and for their ways, and had 
sought the society of the women. His penis had not at 
first diminished in size, but as it gradually lost the 
power of erection it had also become atrophied. Before 
he became a mujerado he had, as he informed me with 
evident pride, possessed a large penis and his testicles 
were “grandes como huevos"—as large as eggs—a state- 
ment which the old chief unhesitatingly confirmed. 
His voice was of high pitch, thin and cracked, es- 
pecially when he became excited, which he did very 
readily ; and he indulged in more gestulations than any 
Indian I had ever seen. 
In the pueblo of Acoma, about twenty miles from 
Laguna, I ascertained that there was another mujerado. 
Accompanied by the old Laguna chief I paid a visit to 
this village in the autumn of 1851, and had the oppor- 
tunity of making a thorough examination of the indi- 
vidual who served in that capacity. 
There was no remarkable development of the mam- 
mary glands; the pubis was devoid of hair ; the penis 
was greatly shrunken, not being over an inch in length 
when flaccid, and of about the circumference of the 
little finger. The testicles apparently consisted of 
nothing but connective tissue, as no pain was experi- 
enced on strong pressure being applied to the soft flat 
masses, about the size of a kidney bean, which lay at 
the bottom of the scrotum. There was no genital de- 
formity of any kind whatever. 
The limbs and the whole body were full and round- ABSENCE OF THE POWER OF ERECTION. 
167 
ed, and there was not a sign of hair anywhere except 
on the scalp. The voice was shrill and weak. As he 
stood naked before me, the whole appearance was more 
that of a woman than of a man. When he put on 
his woman’s dress, it was impossible to discover any 
mark of difference between him and the women among 
whom he lived. He was apparently about thirty-six 
or seven years old, and had been a mujerado for nearly 
ten years. 
These were the only mujerados I saw in New Mexico, 
though I was told that every pueblo had one, or even 
more. Their raison d'etre is evidently to be found in 
the force of tradition, which still exists to a great ex- 
tent with the Pueblo Indians of New Mexico. In re- 
ferring further to that subject, I am actuated by a de- 
sire to shed as much light as possible upon a custom 
and its results, not only important from an anthropo- 
logical but a neurological point of view, and which will 
doubtless disappear ere long before advancing civiliza- 
tion, even if they have not already done so. 
I found it very difficult to ascertain the cause of the 
atrophy of the genital organs, and of the great changes 
which have been produced in other parts of the organ- 
ism, but I finally succeeded in obtaining some informa- 
tion, which was certainly correct as far as it went, for 
it was derived from several authentic sources, includ- 
ing the subjects themselves, and was uniformly to the 
same effect. 
A mujerado is an essential person in the saturnalia or 168 
SEXUAL IMPOTENCE IN THE MALE. 
orgies, in which these Indians, like the ancient Greeks, 
Egyptians and other nations indulge. He is the chief 
passive agent in the pederastic ceremonies, which form 
so important a part in the performances. These take 
place in the spring of every year, and are conducted 
with the utmost secrecy, as regards the non-Indian part 
of the population. For the making of a mujerado, one 
of the most virile men is selected, and the act of mas- 
turbation is performed upon him many times every 
day. At the same time he is made to ride almost con- 
tinuously on horseback. The genital organs are thus 
brought at first into a state of extreme erethism, so that 
the motion of the horse is sufficient to produce a dis- 
charge of seminal fluid, while at the same time the 
pressure of the body on the animal’s back—for the rid- 
ing is done without a saddle—interferes with their 
proper nutrition. It eventually happens that though 
an orgasm may be caused, emissions can no longer be 
effected, even upon the most intense degree of excita- 
tion. Finally the accomplishment of an orgasm be- 
comes impossible. In the meantime the penis and 
testicles begin to shrink, and in time reach their low- 
est plane of degradation. Erections then altogether 
cease. 
But the most decided changes are at the same time 
going on little by little in the instincts and proclivities 
of the subject. He loses his taste for those sports and 
occupations in which he formerly indulged, his courage 
disappears, and he becomes timid to such an extent 169 
ABSENCE OF THE POWER OF ERECTION. 
that if he is a man occupying a prominent place in the 
councils of the pueblo he is at once relieved of all power 
and responsibility, and his influence is at an end. If he 
is married, his wife and children pass from under his 
control, whether, however, through his wish or theirs, 
or by the orders of the council, I could not ascertain. 
They certainly became no more to him than other 
women and children of the pueblo. 
At the same time no disgrace attaches to the condi- 
tion of the mujerado. He is protected and supported 
by the pueblo, is held in some sort of honor, and need 
not work unless he chooses. Men, however, do not as- 
sociate with him, but this is more in accordance with 
his wishes and inclinations than from any desire on 
their part to avoid him. 
Indeed, his endeavor seems to be to assimilate him- 
self as much as possible to the female sex, and to get rid 
as far as may be of all the attributes, mental and physi- 
cal, of manhood. Nevertheless, the condition is one 
which is, I believe, forced upon him by the power of 
tradition, custom and public opinion, and which—recog- 
nizing the impossibility of escape—he assumes probably 
with reluctance in the first instance, but eventually 
with entire complaisance and assent. 
I could not ascertain, with any degree of certainty, 
whether the mujcrados were public property for peder- 
astic purposes at any other times than at the annual 
orgies, but I am inclined to think that the chiefs or some 
of them have the right so to employ them, and that they 170 
SEXUAL IMPOTENCE IN THE MALE. 
do avail themselves of the privilege. They avoided all 
reference to the subject, and professed the most com- 
plete ignorance of the matter when I questioned them 
directly thereon. The old chief, however, who acted 
as my escort, while not disposed to be communicative, 
was not altogether reticent on this point, and admit- 
ted, by unmistakable signs and with perfect equanimity, 
that he himself, in his younger days, had made use of 
the mujerado of his pueblo in the manner referred to. 
The difference between the mujerados and the enares, 
as Herodotus calls them, of the Scythians, consists 
chiefly in the fact that the deprivation of virility is in- 
tentionally produced for a specific purpose in the 
Pueblo cases, while in the Scythians it is the incidental 
result of customs and other factors which exist among 
the people. As a whole, I am quite sure that it is in 
both instances due to causes of similar character. 
The Pueblo Indians appear to recognizethe influence 
of horseback riding as an efficient aid in their process 
for making a mujerado. It is certainly true, as I know 
from my own observations, that the nomadic American 
Indians, who are the representatives of the Scythians 
on the Western Continent, especially the Apaches and 
Navajos, possess small generative organs and limited 
sexual desire and power. From their very infancy 
they are accustomed to the use of the horse for going 
even the shortest distances. They rarely walk unless 
to the places where their horses are hitched, and they 
keep them generally within arm’s reach; I have seen ABSENCE OF THE POWER OF ERECTION. 
171 
them mount a horse to ride twenty-five feet to get the 
saddle ; one of the consequences of this practice is the 
arrest of development in the muscles of the lower ex- 
tremities, their thighs are attenuated and their calves 
are as flat as the hand. They are entirely incapable of 
long foot marches. 
While I have no statistics or very definite informa- 
tion on the subject, I am quite sure that impotence is 
common among them. I have often, when they had 
ascertained that I was a “ medicine man,” had young 
and apparently otherwise vigorous and healthy men 
beg me to give them some “ strong medicine” to restore 
their virile power, and I am aware that the major part 
of the “ pow-wowings” of their own “medicine men” 
is undertaken for the same purpose. An Apache or 
Navajo woman with more than two or three children 
would be a curiosity among them. 
I have already spoken of the probable object had in 
mind in the creation of the miijercidos. It is not at all 
improbable that the subjects of the “ Disease of the 
•Scythians” have from the earliest period been used for 
a like purpose. Bouhier* asserts that they are the pas- 
sive agents in pederasty, and that, therefore, they cor- 
respond to the pathici of the ancients, and, I may add, 
to the mujerados of the Pueblo Indians. A like view is 
held by Rosenbaum,f who regards the disease as also 
being produced by the practice in question, which is at 
* “ Recherches et dissertations sur Herodote,” Dijon, 1746, p. 240. 
f “ Geschichte der Lustseuche,” Halle, 1837, t. 1, p. 141. 172 
SEXUAL IMPOTENCE IN THE MALE 
the same time therefore cause and effect. Interesting 
and important data relative to the mental and physical 
changes in the organism which result from this vice are 
given by Tardieu,* Legrand du Saulle,f Moreau:}: (de 
Tours), Godard,§ and other writers on sexual aberra- 
tion, and the question is also discussed in its relations 
to impotence in the immediately preceding chapters of 
the present work. 
Certain medicines have the power of lessening or de- 
stroying the sexual power of the individual to whom 
they are administered. Among them, and, according 
to some authors, one of the most efficient in this direc- 
tion, is iodine and its compounds. 
Iodine is usually given in the form of the iodide of 
potassium, and very often has to be continued for long 
periods and in extremely large doses. But the pure 
drug is not infrequently administered in the form of 
Lugol’s solution, by inhalation of the vapor or by ab- 
sorption through the skin. 
Roubaudf states that, having given the vapor of 
iodine by inhalation in the treatment of phthisis, he has 
observed four cases of impotence, with more or less 
atrophy of the testicles, supervening during or imme- 
diately after the treatment. In one of these cases, not- 
*“ Etude medico-legale sur les attentats aux moeurs,” 7th edition,. 
Paris, 1878. 
f “Trait6 de medecine legale,” Paris, 1874. 
t “ Des aberrations du sens genesique,” 2d edition, Paris, 1880. 
§ “ Egypt et Palestine,” Paris, 1867. 
| “ Traite de l’impuissance,” etc., Paris, 1876, p. 244. ABSENCE OF THE POWER OF ERECTION. 
173 
withstanding the impossibility of erection, the venereal 
desire remained; and the testicles preserved almost 
their normal volume in the instances of the three others, 
in which there was very decided atrophy of the tes- 
ticles ; the sexual indifference was well marked, they 
had neither desire nor power, and they only sought 
medical advice in order to be able to perform their 
marital duties or to have children. 
The iodide of potassium is not so powerful an agent 
as the uncombined drug in producing impotence and 
atrophy of the testicles ; nevertheless, there is no doubt 
of its power in this respect. Roland* cites two cases 
in which its influence was very distinctly manifested. 
In a debate which took place before the Academy of 
Medicine of Paris, Rilliet asserted that the effect of 
iodine and its compounds, when long continued, was to 
cause atrophy of the mammary glands in females and of 
the testicles in males. This, however, was denied by 
Ricord, Piorry, Velpeau and others. Probably few 
physicians have administered the iodide of potassium 
in larger doses and for longer periods than have I, and 
37et I have never known it to produce either of the ac- 
cidents mentioned. I have, however, often observed a 
diminution of both the sexual desire and the power 
while the medicine was being administered, but these 
effects disappeared soon after the administration of the 
remedy was stopped. 
* “ Bulletin de l’Academie Imp6riale de M6decine,” t. xxv. 185; i860; 
p. 382, et seq. 174 
SEXUAL IMPOTENCE IN THE MALE. 
Nitrate of potash, though not, so far as I know, caus- 
ing atrophy of the genital organs, is certainly a power- 
ful anaphrodisiac, and when given for a long time to 
persons in good sexual health may abolish both the 
desire and the power of the individual. Having em- 
ployed it several years ago in a case of satyriasis, in 
consequence of its use being recommended by MM. 
Grimaud de Caux and Martin Saint-Ange, I was 
not greatly surprised to see the effect in causing 
sexual impotence to two male patients to whom I gave 
it during a continuous period of six months for epilepsy. 
The case cited by the authors named is an instructive 
one, and the description will bear translation into Eng- 
lish. 
“A musician, of athletic build and florid complexion, 
and of an emotional temperament, was so urged by 
amorous desires that the sexual act, although repeated 
several times in the course of a few hours, did not suf- 
fice to cool his ardor. Hateful to himself, he feared 
the chastisement which divine anger inflicts on those 
who devote themselves to a life of voluptuousness, and 
came to ask my help. I bled him, subjected him to a 
course of cooling and calming medicine, and imposed a 
light diet, from all of which he received no benefit. My 
advice then was that he should marry, and he espoused 
a strong, robust daughter of a villager. At first he ap- 
peared to be better, but in a short time his wife suffered 
so greatly from his repeated embraces that he returned 
to his former course of life. Coming to me for further ABSENCE OF THE POWER OF ERECTION. 
175 
relief I advised fasting and prayer, but these proving 
equally unsuccessful, he desired castration. This, how- 
ever, I was unwilling to perform; but he was very 
anxious for the operation, and sought to gain, by pres- 
ents, the consent and approval of those who opposed 
his wishes. He promised a horse that could amble 
beautifully, and whose value was not to be disdained, 
if I would accede to his wishes. 
“ I declare that my servants—not knowing the na- 
ture of his wish, and unacquainted with his satyr-like 
performances—have often made me blush when they 
would request me to do as the poor man wished. Little 
did they suspect that he wanted me to cut out the 
organs that made him a man. 
“ In thinking of the means that might cure this 
musician, I recollected that I had heard the illustrious 
Prevatius say that he had with nitre cured a man who 
suffered with nephritic pains due to the presence of a 
calculus. The patient was cured, but he became in- 
capable of enjoying the pleasure of love. I resolved to 
make use of this remedy, so morning and night I gave 
him nitre dissolved in eau de nymphcea. The use of this 
salt for eight days reduced him to such a state of indif- 
ference, that he hardly sufficed for the wants of his 
wife.” * 
In the instances in my own practice to which I have 
referred, the use of fifteen grains of nitrate of potash 
* Cited by MM. Grimaud de Caux and Martin Saint-Ange, from 
Baldassar Timeus. Cas Med., Lib iii., Salacitas nitro curata. 176 
SEXUAL IMPOTENCE IN THE MALE. 
three times a day produced a gradual loss of sexual 
desire and power in both patients which at the end of 
a month was complete. It was nearly a year after the 
cessation of the administration of the drug before the 
normal condition was regained. 
Alcoholic liquors, if taken very sparingly, perhaps ex- 
ercise a stimulating influence over the genesic function, 
but if very moderate limits be exceeded the result is 
impotence of a more or less permanent and profound 
character, according to the extent of the excess. 
Generally the desires and power both diminish or 
entirely fade away, but in some cases desire remains 
without the ability to accomplish the sexual act in an 
entirely satisfactory manner. Either erections fail alto- 
gether and intromission becomes impossible, or there 
are imperfect erections and premature emissions. In- 
tercourse attempted during a state of intoxication is 
scarcely ever performed in a normal manner, and the 
individual, after a period of alcoholic indulgence, is 
generally incapable of physiological copulation for 
several days thereafter. Repeated and long continued 
acts of dissipation may often lead to absolute and per- 
manent loss of the ability to have intercourse. In many 
of these cases the venereal appetite is not abated; on the 
contrary it may be notably increased, and then the in- 
dividual, not being able to satisfy himself in a legitimate 
way, resorts to masturbation, which he performs with a 
vehemence and frequency almost amounting to fury. 
I have seen a great many habitual drunkards, but never ABSENCE OF THE POWER OF ERECTION. 
177 
one in whose case the investigation was made who was 
not a masturbator and sexually impotent. 
Most physicians whose practice is largely in the 
direction of diseases of the nervous system have noticed 
the decided influence of the bromides in causing a loss 
of virile power. In cases of epilepsy some one of the 
bromide salts is given often for several years without 
interruption, and it is almost invariably the case that 
after a few months the desire and power begin to be- 
come less. Occasionally the effects are permanent, but 
usually when the administration of the drug has ceased 
the normal state returns, especially if proper remedies 
be given. In one case under my charge there was 
atrophy of the penis and testicles. When this con- 
dition ensues a restoration is impossible. 
There are other remedies and some substances used 
as food which are said to have the power of causing 
diminished sexual power, but the reputation rests, I 
think, on insufficient evidence. Among the former, 
however, may be mentioned lead, antimony, arsenic, sul- 
phide of carbon, conium, camphor, and many others. 
Some of these, notably conium and camphor, have the 
effect of moderating the reflex excitability of the repro. 
ductive system, but they in no sense cause impotence. 
Among the substances used as food, lettuce, sorrel, 
cucumbers, and parsley are said by some to have an an- 
aphrodisiac property, but I have never observed any- 
thing in their action to lead me to accept this view of 
their influence. 178 
SEXUAL IMPOTENCE IN THE MALE. 
Castration.—It might reasonably be supposed that 
the operation of castration, by depriving a man of the 
glands which secrete the semen, would invariably ren- 
der him incapable of sexual intercourse, but, as a matter 
of fact, such is by no means the certain effect of the 
procedure. Of course the removal always renders the 
individual sterile, but this is a very different thing, re- 
lating as it does solely to the taking away of the power 
to procreate children. The women of ancient Rome 
were well acquainted with the sexual power sometimes 
possessed by eunuchs, and knowing them to be sterile, 
knew also that they could make use of them to satisfy 
their libidinous desires without much fear of detection. 
Indeed, so well is the fact of their occasional virile power 
known in Egypt and other countries in which eunuchs 
are made, that not infrequently the whole generative 
apparatus is amputated, in order to prevent the pos- 
sibility of sexual intercourse being performed. 
Mental causes.—There are certain mental causes of a 
failure of sexual power which are among the most in- 
fluential of all for,the time being, but which, in general, 
are not difficult to manage, inasmuch as they do not 
depend upon any physical disorder. Among these are 
the following: 
Excessive desire.—This is a not infrequent cause with 
the newly married man who finds himself utterly unable 
to obtain an erection, notwithstanding the fact of the 
strong desire by which he is actuated. In the intervals 
of his attempts his erections are not wanting in vigor, ABSENCE OF THE POWER OF ERECTION. 
179 
but as soon as he endeavors to avail himself of his 
rights the penis becomes flaccid and intromission is an 
impossibility. Frequently a feeling of a,7ixiety or doubt 
arises in the mind relative to the success of the act, and 
this adds greatly to the probability of an unfavorable 
result. John Hunter,* in referring to this influence, 
cites the following case: 
“ A gentleman told me that he had lost his virility. 
After about an hour’s investigation of the case, I made 
out the following facts: That he had at unnecessary 
times strong erections, which showed that he had 
naturally this power; that the erections were accom- 
panied with desire, which are all the natural powers 
wanted; but that there was still a defect somewhere, 
which I supposed to be from the mind. I inquired if all 
women were alike to him. His answer was no. Some 
women he could have connection with as well as ever. 
This brought the defect, whatever it was, into smaller 
compass, and it appeared that there was but one woman 
that produced this inability, and that it arose from a 
desire to perform the act with this woman, and which 
desire produced in the mind a doubt or fear of the want 
of success, which was the cause of the inability of per- 
forming the act. As this arose entirely from the state 
of the mind, produced by a particular circumstance, the 
mind was to be applied to for the cure, and I told him 
that he might be cured if he could perfectly rely upon 
his own power of self-denial. When I explained what 
* “A Treatise on the Venereal Diseases,” Phila., 1859, p. 261. 180 
SEXUAL IMPOTENCE IN THE MALE. 
I meant, he told me that he could depend upon every 
act of his will or resolution. I then told him that if he 
had a perfect confidence in himself in that respect, that 
he was to go to bed to this woman, but first promise 
to himself that he would not have any connection with 
her for six nights, let his inclinations and powers be 
what they would, which he engaged to do, and also to 
let me know the result. About a fortnight after he told 
me that this resolution had produced such an alteration 
in the state of his mind, that the power soon took place ; 
for, instead of going to bed with fear of inability, he 
went with fears that he should be possessed with too 
much desire, too much power, so as to become uneasy 
to him, which really happened; for he would have 
been happy to have shortened the time, and when he 
had once broke the spell the mind and powers went on 
together, and his mind never returned to its former 
state.” 
The device of setting up a different line of thought 
or of emotion from that which fills the mind, will gen- 
erally succeed in cases such as the foregoing. In the 
case of the recently married man, the old prescription 
of bread pills will suffice to restore the supposed loss of 
power as well as anything else in which the patient has 
confidence, or the mere direction to wait patiently, the 
assurance that the trouble is simply transitory, and the 
explanation of its cause, will, with a sensible person, 
prove equally efficacious. Most of the cases cure them- 
selves in a few days at farthest. ABSENCE OF THE POWER OF ERECTION. 
181 
Fear, from whatever cause arising, is a very powerful 
factor in temporarily producing impotence, and one 
which often causes a more or less permanent loss of 
sexual power. The individual engaged in illicit rela- 
tions, with the apprehension of detection constantly 
before him, fails at the moment he attempts intercourse, 
from the absolute inability to maintain an erection ; and, 
indeed, any emotion will, if strongly felt, almost invari- 
ably lead to a like result. A gentleman once, a mem- 
ber of the volunteer fire department, informed me that 
he was for several years practically impotent at night, 
for the reason that he never went to bed without the 
expectation of being called up to go to a fire, and the 
anxiety effectually prevented his having intercourse, al- 
though his desire was strong. 
The effect of superstition in causing impotence is even, 
in our times, occasionally exhibited. In a former 
period this influence was more generally admitted, and 
it was supposed that witches and sorcerers had the 
power of casting a spell upon a man, and by this means 
to deprive him of the ability to accomplish the act of 
sexual intercourse. These individuals were in France 
known as the noueurs d''ciiguillette, “ the tiers of the 
knot.” All that was necessary was that the person 
upon whom they pretended to impose their spell should 
thoroughly believe in it, and the impotence was an ac- 
complished fact. Cases of the kind were a very com- 
mon occurrence, so that after a while every man who 
found his virile powers becoming weaker laid the cause 182 
SEXUAL IMPOTENCE IN THE MALE. 
upon some old man or woman who had the reputation 
of being a sorcerer or witch. Many of these poor 
wretches were burned at the stake or otherwise se- 
verely punished for this supposed crime. 
The extent to which notions of the kind prevail at the 
present day is scarcely known among educated per- 
sons'. Physicians, however, often me’et with cases of 
purely imaginary impotence, which the subject relig- 
iously believes has been produced by an enemy, by a 
look or an incantation of some kind, or by causing him 
to eat some particular substance which has had the 
power conferred upon it of depriving him of his sexual 
functions. The consequence is that, actuated by the 
belief which he entertains, the attempts at intercourse 
result in failure, and hence he ceases to make any fur- 
ther efforts in this direction. 
Only a short time ago a man consulted me for im- 
potence with which he believed his wife had affected 
him so as to keep him continent during a visit he was 
about to make to New York. She had, he said, given 
him a singular glance as he left the house. He felt 
a peculiar thrill pass down his spine to his testicles, 
and after that, erection was impossible. 
In another case a man from Long Island came to see 
me, bringing a lock of the hair of a woman who, he be- 
lieved, had “ laid a spell” on him by which he was ren- 
dered impotent. The woman in question, he explained, 
had wished him to marry her. He, however, had fixed 
his affections on another woman, and had married her, ABSENCE OF THE POWER OF ERECTION. 
183 
whereupon the first, out of revenge, had caused the 
loss of his sexual power. The event had taken place 
on the fifth night after marriage. Up to that time he 
had done his part to his entire satisfaction, but on the 
fifth night, the disappointed woman, concealing her 
jealousy, had invited him and his bride to take tea with 
her, and on their return home he found himself in the 
condition mentioned. He had been told that I could 
cure him by treating a lock of the hair of the witch, 
and with much trouble he had succeeded in procuring 
this, in his opinion, indispensable prerequisite to cure, 
and had brought it to me. 
Such cases, unless the patient can bring to bear a 
little common sense on the subject, are apt to pass on 
into a hypochondriacal condition, in which the whole at- 
tention of the individual is concentrated upon his gen- 
erative organs. He examines them many times a day, 
measures them, and is constantly applying lotions and 
running from one physician to the other with stories 
of their deficient power, the shrinkage of his penis, 
the gradual disappearance of his testicles, etc., etc. 
Convinced that sexual intercourse is altogether beyond 
his powers, he abstains from any attempt, and contin- 
ues to lament his sad condition. In one case of the 
kind that came under my observation, the patient, prob- 
ably from some slight weakness of the organs due to 
previous excess, contracted the belief, soon after mar- 
riage, that his sexual power was gone, and that the re- 
sult was due to atrophy of the testicles. As a matter 184 
SEXUAL IMPOTENCE IN THE MALE. 
of fact, there was no change in the consistence or ap- 
pearance of these organs, but it was impossible to con- 
vince him of this faet. Under the idea that phospho- 
rus was a tonic to the generative system, and would 
cause the nutrition of the testicles to be better effected, 
he kept the scrotum well anointed with an ointment 
containing phosphorus, and drank no other liquid than 
phosphoric acid and water. In this case the conviction 
of absolute impotence was so strong, that it was impos- 
sible for an erection to take place, even under the most 
provoking circumstances. Indeed, he declared that all 
attempts in this direction were a mockery of Provi- 
dence, and therefore in the highest degree sinful. In 
my recently published work on insanity * I have 
treated the subject of hypochondriacal mania at length, 
and have adduced several examples of the length to 
which patients will go in their false beliefs relative to 
the state of their reproductive organs. From that 
book I cite the following instance : f 
“ A patient of my own, after great sexual excesses, 
took the idea that his penis and testicles were diminish- 
ing in size. He spent the greater part of each day in 
measuring them and recording the results in a book 
which he kept for the purpose. Finally he reached 
the conclusion that they had entirely disappeared, and 
although he did not go about lamenting the fact, he 
* “A Treatise on Insanity and its Medical Relations.” New York, 
1883. 
fOp. cit. p. 480. ABSENCE OF THE POWER OF ERECTION. 
185 
was examining the region as often as he could get the 
opportunity, and making a record of the results of his 
examination. As an interesting instance of the line of 
thought of a hypochondriacal maniac, I transcribe here 
a portion of his diary for one day : 
“‘November 4th, 9 a.m. The event that I have been 
fearing has at length occurred; they have vanished ! 
absolutely vanished! and I am ruined. Oh, my God ! 
how I am punished for my sin! 
“‘9:30 A.M. Cold water does no good; hot water is 
no better. Will try blistering. 
“‘9:45 a.m. Not even a vestige of penis or testicles, 
not a vestige. I will consult a physician. No; I can- 
not exhibit my misfortune. Applied blister. 
“ ‘ 10 a.m. Removed blister to see if they really have 
gone. Alas! is is too true. Blistering can be of no 
possible service. Removed it. 
“‘ 10:15 a.m. Reflected that if they were really gone 
there ought to be something left to show where they 
had been. Find ample evidence. A vast cavity at the 
bottom of my belly. Will consult a surgeon, but how 
in heaven can he help me ? Is there any medicine that 
can restore the organs when they have entirely gone as 
have mine? It would be a mockery, a sinful mockery. 
God knows I have sinned enough. 
“ ‘ 10:25 a.m. There is no doubt of it. They have 
gone, and I am a ruined man. I am no man. I am a 
eunuch, an .unsexed man, a mere thing without pur- 
pose on the earth. 186 
SEXUAL IMPOTENCE IN THE MALE. 
“‘ii A.M. I might sing in the choir if they are really 
gone. But oh, God! for me, a man, a strong, lusty, 
vigorous, boastful man, to be reduced to singing in a 
church choir. It is horrible! But what else am I fit 
for? My mind is certain to become weaker. I shall 
grow to be fat and pulpy. I will be an oyster, a big, 
disgusting oyster. 
11:10 A.M. Have just urinated, and had the most 
singular experience. The urine oozed out from the 
place where the penis used to be, but alas! where it no 
longer is.’ ” 
This will suffice; there were hundreds of pages of 
such stuff. He finally came to see me, and brought 
his diary with him for my instruction. He with the 
utmost confidence in the correctness of his perceptions 
and judgment, attempted to demonstrate to me the 
complete absence of his penis and testicles. I could 
detect no deviation from the normal standard in either, 
but no arguments or tests that I could apply sufficed to 
undeceive him. He groaned and wept over his misfor- 
tunes, walked up and down the room cursing himself 
for his wickedness and the science of medicine for 
its inability to help him. 
Such cases are extremely difficult of cure, the de- 
lusions becoming more and more strongly fixed, and 
very often extending in other directions. They con- 
stitute one of the most obstinate forms of insanity with 
which we have to deal. 
There is, however, another form of hypochondria, 187 
ABSENCE OF THE POWER OF ERECTION. 
having its basis in real or supposed derangements of 
the sexual organs, and in which the prognosis is more 
hopeful. Cases of this variety are founded on the emo- 
tion of remorse for sexual misconduct in youth, and are 
further characterized by the display of a vast amount 
of ignorance in regard to the anatomy and physiology 
of the reproductive system. The following extract of 
a letter recently received from a young clergyman ex- 
hibits in a strong light most of the features of this form 
of sexual hypochondriasis: 
“ . . . For oh, sir, I am one of the most unhappy 
and most afflicted of men, and if any one ever needed 
your assistance, I do. 
“ In my youth I was guilty of the fearful sin of mas- 
turbation, and through it I know I have ruined myself 
both in this world and in the world to come. All my 
symptoms are clearly traceable to this cause. . . . 
“ I will be as brief as possible : 
“ First. In the first place, I cannot go into the society 
of ladies, even though they be of the most refined char- 
acter (and of course I know no others), without having 
my semen escape. I do not have erections, but it flows 
from me involuntarily, and I feel weak and depressed 
mentally and physically for hours afterwards. 
“ Second. Then again, when at stool, especially when 
I am constipated, and I am obliged to strain, the semen 
escapes, and again without erection. 
“ Third. I have repeated nocturnal emissions, and 
they are accompanied by the most degradedly lascivious 188 
SEXUAL IMPOTENCE IN THE MALE. 
dreams. When I awake I feel so wretched that I am 
tempted to commit suicide, rather than longer endure 
my suffering and contemplate my degradation. 
“ Fourth. I am engaged to a lovely girl, and yet on 
account of my sexual weakness I am afraid to marry. 
I feel that such a step would be the destruction of her 
and my happiness, and an act of the grossest immor- 
ality. 
“ Fifth. I am sure that my condition is known to 
every one I meet who has any knowledge of such dis- 
orders as mine. I find that physicians scrutinize me 
closely, as if endeavoring to make a diagnosis from my 
appearance, and that many others look at me sharply in 
the face, as if suspecting my trouble. 
“ Sixth. I have pains in my head and back; my di- 
gestion is bad ; I have eructations of gas, and some- 
times of a sour liquid and of food which I have just 
eaten, and I sleep very badly. 
“ Seventh. My penis is shrunken in size; my testicles 
are disappearing, both are softer than they ought to be, 
and one hangs a great deal lower than the other. 
“ Now you will see how desperate my case is. I 
have struggled manfully, I think, against the ills that 
bear so heavily upon me, but without success. I have 
applied to physicians, but they have given me no re- 
lief. One wanted to burn my urethra with nitrate of 
silver, but I defer the operation till I hear from you. I 
am willing to undergo any suffering to be cured of my 
affliction. . . . ABSENCE OF THE POWER OF ERECTION. 
189 
“ As to my virile powers, I scarcely dare to hope that 
they will ever be restored.” 
It will very readily be seen by the physician that 
every circumstance on which this young gentleman re- 
lied to strengthen his conviction that he was impotent, 
was a purely natural phenomenon. Doubtless, as he 
says, he had in his youth committed masturbation. 
The remorse for conduct which he had learned was im- 
proper, and the persistence of nocturnal emissions, are 
the only features deserving of the least consideration as 
causes of his mental and physical state. I required him 
to come to New York. On examination I found the 
generative organs in good condition. By getting his 
thoughts from himself, enlarging his knowledge of the 
anatomy and physiology of his sexual system, insisting 
on a full diet, with plenty of out-door exercise, cold 
baths, and the administration of the mixture, the com- 
position of which is given on page 118, the patient en- 
tirely recovered in a few weeks, and was shortly after 
married. If there had been any real difficulty in con- 
summating the marriage, I think I would have heard 
of it. 
Such an instance is a type of hundreds of others in 
all parts of the country. If the confidence of the pa- 
tient can once be gained, there is never in my experi- 
ence any difficulty in conducting the case to a success- 
ful termination. 
Pathology : The pathology of sexual impotence 
arising from an impossibility of obtaining erections de- 190 
SEXUAL IMPOTENCE IN THE MALE. 
pends upon the cause. Taking up the several factors 
which have any special importance so far as the theory 
of their action is concerned, we come, in the first place, 
to the consideration of the subject when the cause is 
any kind of sexual excess. 
It may be asserted without the possibility of there 
being any error in the declaration, that any attempt at 
the performance of intercourse or any manoeuvre un- 
dertaken before the age of puberty, is destructive more 
or less in accordance with the extent to which the ac- 
tions in question are carried, of the genesic power of 
the individual. Such actions very generally tend to 
cause early puberty, so far at least as the secretion of 
semen is concerned, and early puberty of itself means 
an early loss of procreative power. This is only in ac- 
cordance with the general law of the organism in regard 
not only to the generative function, but of all others of 
the system. 
Moreover, if a function is exercised before the organs 
with which it is connected are prepared for use, by hav- 
ing attained to their development, demands are made 
upon them to which they are not prepared to respond. 
They are consequently overtaxed, and precocious ex- 
haustion must be the inevitable result. The same re- 
sult attends the too early use of any organ of the body. 
Take, for instance, the muscular system, which in a 
child is weak and delicate. If severe physical tasks be 
imposed upon the muscles, they not only break down, 
but the whole organism of the child becomes disor- ABSENCE OF THE POWER OF ERECTION. 
191 
dered. Again, as regards the brain, which in early 
childhood is scarcely fit for any further use, so far as 
the mind is concerned, than that of receiving impres- 
sions of surrounding objects, if it be spurred on to 
the making of what to it are strong efforts towards 
acquiring knowledge, it is not long before the evidences 
of serious derangement make their appearance, and an 
era of suffering begins, which becomes more and more 
strongly marked with every act of mental exertion 
which the child may make. 
But with the sexual apparatus the matter is worse, 
for while the muscles, the brain, and the organs are 
adapted to some use from the very earliest period 
of existence, those intended for the purposes of pro- 
ducing the species are absolutely incapable of fulfilling 
their office till the age of puberty be reached. The 
effects of their use, or rather abuse, for all use prior to 
that time is abuse, are therefore clearly to be seen from 
the very instant that they are subjected to the maltreat- 
ment in question. 
The manner in which early excess acts, therefore, is 
by producing premature extinction of the virile power. 
A function which ought to be very little below its high- 
est point at fifty years of age has come and gone at 
puberty or soon, after. The nervous centres in connec- 
tion with the organs are exhausted, the testicles have 
run through an imperfect process of development and 
are atrophied, the blood-vessels of the penis are shrunken, 
the erectile tissue of the organ is withered and inelastic. 192 
SEXUAL IMPOTENCE IN THE MALE. 
If all these changes have not advanced to the high- 
est point, and if the patient be still young, it is possi- 
ble, under very favorable circumstances, for a second 
development to take place. In general this is readily 
effected. The individual stops short of actual ruin. 
He ascertains that the practices in which he is indulg- 
ing are vicious, both from a mental and physical point 
of view, and merely through the restorative power of 
nature, after he has given it an opportunity to act, or 
through that factor in conjunction with proper medical 
treatment, his sexual organs recover their tone, and ad- 
vance to something like the normal standard of health. 
It may, however, be asserted with absolute truth, that 
the boy who has before puberty indulged even moder- 
ately in masturbation, will never be as strong sexually 
as he would have been had he entirely refrained from 
the practice. 
But in not a few cases the habits of the individual 
have become so firmly established, and his mental power 
over them is so greatly impaired, that he can make no 
successful effort to abandon his destructive practice. 
The processes of degradation which have been initiated 
go on to such further points under the continued forced 
excitation, and drain to which they are subjected, that 
recuperation is out of the question, and a permanent 
state of impotence is the result. 
In the adult the morbid processes which are set up in 
consequence of excessive sexual indulgences are by no 
means so pronounced as those which have just been ABSENCE OF THE POWER OF ERECTION. 
193 
described ; neither are they so readily induced. The 
sexual organs will stand an immense amount of im- 
proper usage in the cases of some men ; in others, how- 
ever, their power of resistance is much less; and in all 
if the excess be continued there is danger that a condi- 
tion of permanent impotence will be reached. This 
and all less pronounced states of sexual weakness may 
be due to nervous exhaustion, to paralysis of the erec- 
tor muscles of the penis, to vaso motor disturbance 
causing a diminished flow of blood into the vessels of 
the organs, especially the penis, to consecutive atrophy 
of the testicles, or to two or more of these circumstances 
acting together, and these are the chief physical states 
which are induced in all cases of impotence coming un- 
der the present division of the subject. They will be 
more definitely considered in the remarks that will be 
made when the therapeutics proper to be employed are 
brought to the notice of the physician. 
Treatment.—The treatment of impotence resulting 
from an inability to have an erection of the penis, and 
hence to effect an entrance into the vagina, or of that 
less severe form in which an imperfect erection is ob- 
tained, may be appropriately considered under the 
heads of hygienic and medical. And though some of the 
agents employed may very appropriately be embraced 
under either of these categories, it is a matter of no 
consequence, so long as it is borne in mind that the 
arrangement is one made only for purposes of conven- 
ience, and not with a view to scientific accuracy. 194 
SEXUAL IMPOTENCE IN THE MALE. 
Hygienic measures.—The first and most important fac- 
tor in restoring an exhausted generative apparatus is 
rest, and by rest is meant not simply a more moderate 
degree of indulgence, but absolute cessation from all 
sexual excitement. Without this it is scarcely worth 
while for the physician or the patient to expect a cure. 
The period during which rest must be enjoined depends 
very much on the degree of exhaustion which has been 
reached. I have generally found that in those cases in 
which an erection sufficient for intromission does not 
take place, sexual repose for about a year is necessary. 
Again, the age of the patient and the length of time 
during which the condition has existed are factors to 
be considered in determining the question. In persons 
over forty, and in whom the condition has lasted six 
months, no attempt should be made for even a longer 
period than a year. With every unsuccessful effort, 
even though no emission occurs, the nervous excitabil- 
ity is still further lessened, and the morale materially 
lowered. Generally in these extreme cases there is no 
difficulty in securing the requisite quiescence. The 
patient is fully aware of his inability, and is in no mood 
to undertake what he knows will result in failure. It 
sometimes happens, however, that masturbation, with 
the erection almost nil and the orgasm imperfect, is 
practised, when the individual finds that intercourse is 
impossible. It is in this respect that the requirement 
of rest must be strictly enjoined. 
But in those cases in which the emission takes place ABSENCE OF THE POWER OF ERECTION. 
195 
too soon, and in which the erection, though feeble, is 
yet sufficient for intromission, more difficulty is expe- 
rienced in enforcing the prescription of absolute rest. 
The patient may be profuse in his promises but nig- 
gardly in keeping them, unless the full consequences 
of his dereliction are placed before him. The physician 
will therefore in such instances be obliged to speak 
very plainly, and perhaps to present the alternative of 
perfect obedience or a change of medical adviser. There 
is nothing to be gained either by the physician or patient, 
unless the condition in question is complied with. I 
am thus emphatic on this point, because I have often 
found great difficulty in causing patients to obey the 
directions given in regard to it. 
In connection with this subject rest of mind from all 
lascivious thoughts is of almost equal importance. A 
man cannot very readily, by simple act of the will, pre- 
vent such thoughts obtruding themselves upon him, 
but there is usually no great difficulty about the mat- 
ter, if he can be made to keep his mind busy with some- 
thing else. Those patients whose lives are spent in 
idleness are always more rebellious in this respect than 
those who have some occupation, especially if it be one 
in which mental concentration is required. If the cir- 
cumstances of the patient admit of it, a course of study 
is often a very efficacious means of directing the mind 
from sexual matters, and the beneficial effects of travel 
in unfamiliar countries where there is much to engage 
the attention are not only of importance, in this respect, 196 
SEXUAL IMPOTENCE IN THE MALE. 
but in many others are so obviously of advantage as not 
to require further consideration. 
Baths.—If the strength of the patient is such as to 
insure a proper degree of reaction, cold baths are of de- 
cided benefit. In such cases they may be taken daily 
in the morning, and may be either plunge or shower, as 
may be preferred. Sea baths are especially tonic to 
most persons. Warm baths are sometimes useful, but 
in general they are better applied to the generative 
organs either alone or alternating with cold water. In 
such cases the water should be poured on the parts 
from a height of several feet, either in the form of a 
shower or stream, first the hot, and then the cold, a 
coarse towel being then used for drying and rubbing 
till a decided sense of heat is produced. There are 
few more powerful tonics than this mode of using 
water. 
Douches, either of hot or cold water or of both, ap- 
plied to the skin and the perineum, are of decided ad- 
vantage. As in the former method, the hot and cold 
water may be used alternately, two minutes for each 
being an average period of application. 
Turkish and Russian baths are also of service taken 
about twice a week, and not of long duration at any one 
time. 
The diet should be full and nutritious, animal food 
forming a large proportion of it, and fat in some form 
being a prominent constituent. This latter may be 
taken in the form of cream or of cod-lWer or other oil. ABSENCE OF THE POWER OF ERECTION. 
197 
Glycerine may sometimes be substituted in the cases of 
those persons to whom oil is disagreeable. 
Of drinks, tea and coffee are quite admissible, as is 
also a glass of Bordeaux, Burgundy or other good wine 
at dinner. The excessive use of alcoholic liquors is, 
however, prejudicial to the object in view. 
Active bodily exercise is always of use, but should not 
be carried beyond the point of fatigue. If this precau- 
tion is neglected, more harm than good will be done. 
Horseback riding is in general not to be advised, unless 
in very great moderation. 
In this connection it is necessary to remind the patient 
that he must not sleep on his back, and this especially if 
there are seminal emissions at night. In that posture 
an unnatural degree of erethism is produced in the sex- 
ual organs by the congestion which it permits in the 
spinal cord and cerebellum, and which occurring dur- 
ing sleep, when the influence of the higher parts of the 
brain are removed, leads to an automatic activity most 
injurious to the health of the organs. Many persons 
find it difficult to avoid this posture. Usually after a 
time, however, the individual going to bed with the 
idea strong in his mind that he is not to sleep on his 
back, avoids the position probably through unconscious 
cerebration. In other cases it is necessary to resort to 
some device in order to correct the habit. A towel tied 
around the waist with a hard knot in contact with the 
centre of the back will generally cause the patient to 
awaken when he gets on his back, and the knot presses 198 
SEXUAL IMPOTENCE IN THE MALE. 
strongly against his skin. In other instances some more 
powerful agent is required. Belts have been made of 
leather with sharp tacks driven so that the points pro- 
jected on the inside, though covered loosely with a thin 
cushion. When the individual rolls over on his back, 
after having put the belt around his waist, with the 
armed portion pressing lightly against the body, the 
sharp points of the tacks penetrate the skin, and 
awakening him cause him to turn over on his side. It 
is, however, rarely the case that these contrivances are 
necessary for any considerable period, as the habit is 
soon acquired of not sleeping on the back. 
The bed occupied by a patient suffering from noc- 
turnal emissions should always be a hard hair mattress. 
I have repeatedly known emissions during sleep kept 
up in spite of all measures employed against them, solely 
by the fact that the bed used was made of feathers and 
almost overwhelmed the individual when he got into 
it. Such beds are too heating: they do not allow the 
body to radiate its natural heat, and they prevent the 
even transpiration from the skin. In the country such 
beds are still used, though they are now rarely seen in 
cities. 
The question of marriage is one which a man who is 
threatened with impotence, or who already suffers 
from it in consequence of his excesses in youth or 
adult life, often submits to his medical adviser. It 
appears to me to be one which under these circum- 
stances, both for the sake of the patient as well as that ABSENCE OF THE POWER OF ERECTION. 
199 
of an innocent woman, should always be answered in 
the negative. In the first place, from a sanitary point 
of view marriage cannot lead to any beneficial result. 
It probably would conduce to increased excesses or at 
least to attempts in this direction which could not fail 
to be of deleterious effect upon the condition of the 
patient. Moreover, by advising a man sexually im- 
potent to contract an obligation which the physician 
knows he cannot fulfil, an offence against good morals 
is committed, and a crime against society perpetrated, 
for which there is no excuse and which it is difficult to 
characterize in mild terms. But I have known physi- 
cians who make a great affectation of decency and 
religion to deliberately advise a broken down rout 
whom they knew to be sexually impotent to wed a 
young, vigorous and pure girl for the purpose of 
having his genital system stimulated to a higher point 
than had yet been reached. 
Nevertheless one of these men thought it in the 
highest degree immoral that a young man of good 
health who had never abused his sexual system, who 
was troubled with frequent nocturnal emissions, and 
who had abstained from sexual intercourse though 
twenty-five years of age, should have been told by 
another physician that the emissions were an outburst 
of nature, and that sexual intercourse was indicated. 
It is said that the first duty of a physician is to his 
patient, and this is true so long as he performs it with 
a decent regard for his obligations to humanity, but it 200 
SEXUAL IMPOTENCE IN THE MALE. 
appears to me that it would be just as proper for him 
to advise an impecunious patient to replenish his purse 
by picking some one’s pocket as to advise his sexually 
impotent patient to contract a marriage he can never 
consummate. Fortunately, however, the question of 
morality can rarely if ever arise. It is injurious to an 
impotent patient to contract a marriage, for such a 
procedure prevents the rest to the debilitated organs 
which their condition so imperatively requires. Noth- 
ing in fact can do more harm. 
Medical means.—There are no aphrodisiacs or special 
restorers of virility known to medical science, notwith- 
standing all that has been said in regard to certain 
remedies. But while this is true, there are agents 
which certainly have an indirect, in some cases a 
powerful influence in giving tone to the generative 
organs and in obviating some of the conditions to 
which the resultant impotence is due. These may be 
considered in two categories—those which are applied 
externally and those which are taken into the system 
as medicines. 
External remedies.—First among these, and ranking 
high in the list of remedies, is electricity. 
This agent is employed under three forms—Galvan- 
ism, Faradism, and Franklinism. In using galvanism 
the only rule in regard to the strength of the current 
is to bring into action as many cells as will pro- 
duce a decided sense of discomfort to the patient. The 
electrodes should ordinarily consist of wet sponges, and ABSENCE OF THE POWER OF ERECTION. 
201 
the application should be made to the spine, the perin- 
eum, the testicles through the scrotum, and the penis. 
In applying the current to the spine, the whole of the 
vertebral column may be embraced within the circuit, 
though greater attention should be given to the lower 
dorsal, the lumbar and the sacral regions. I usually 
first apply one electrode—it makes no difference which— 
to the nape of the neck, and then stroke the back over 
the spinous processes with the other for three or four 
minutes, using a current strong enough to cause a 
considerable sensation of warmth and to produce red- 
ness of the skin. Then the upper electrode is placed 
over the middle of the dorsal region, and the other 
moved slowly down over the parts below a dozen 
times. The effect of the application is rather unpleasant, 
than otherwise, and the back continues to feel a sensa- 
tion of warmth for an hour or more afterwards. 
Then one electrode is placed over the sacrum and 
the other on the perineum, and both are kept in their 
position for about a minute. A current of somewhat 
less strength will be advisable for this application, as 
the patient will not generally endure one so strong as 
that used for the spine. 
In making the application to the penis externally, one 
electrode may be placed on the perineum, and the other 
on the glans, the latter being removed every five or ten 
seconds, or the current broken by the arrangement for 
that purpose on one of the electrodes. Two or three 
minutes are sufficient for this purpose. 202 
SEXUAL IMPOTENCE IN THE MALE. 
It is sometimes the case that the impotence depends 
in a great measure on an anaesthetic condition not only 
of the glans but of the whole penis. In such a case 
the electrode should be passed over the whole organ, 
and the strength of the current should be such as to 
cause considerable discomfort if not actual pain. 
In those cases in which nocturnal emissions are fre- 
quent and the erethism is so great that emissions take 
place without erection or on slight provocation, it is 
sometimes necessary to apply the electricity to the in- 
terior of the organ. A special electrode is necessary 
for the purpose. It is made of some non-conducting 
material, except at the very extremity, which is metallic 
and is in connection with a wire running through the 
instrument and attached to one of the conductors lead 
ing from the battery. This electrode is introduced 
into the urethra, and the metallic point brought into 
contact with the orifices of the seminal ducts or to the 
prostatic portion of the urethra, as the case may seem 
to require. As a remedy for nocturnal emissions or 
analogous conditions it is far superior to the cauteriza- 
tion recommended by Lallemand, and far less painful. 
The application of galvanism in this manner is also 
extremely useful in cases of nervous exhaustion, or in 
paralysis of the erector muscles of the penis, the ac- 
celerator urinae, etc. In this internal use, the other 
pole—the sponge electrode—should be applied to the 
perineum, the sacrum or the pubis, or alternately to 
each of these regions, so as to send a current through ABSENCE OF THE POWER OF ERECTION. 
203 
the penis in all directions. The strength of the current 
need rarely exceed that from four or six Leclanch6 
cells, and it requires to be frequently interrupted to 
avoid too great a degree of irritation. 
In applying galvanism to the testicles, care must be 
taken to provide that the current be not too strong, 
that from four or six cells being generally amply suffi- 
cient. Very intense currents cause a good deal of pain 
and may induce syncope, an accident which has oc- 
curred in my own experience. But the beneficial 
effects of this use of the agent are often very decided, 
even after the organs have begun to become soft and to 
enter upon a state of atrophy. The nutrition is im- 
proved and a condition of greater firmness induced. 
With these changes a return to sexual health is often 
initiated. 
Faradism is also of great value in the form of im- 
potence under consideration. Its mode of use is not 
essentially different from that of galvanism, except in 
certain respects to be noted. 
In applying the current to the spine, one of the 
electrodes should consist of the wire brush; the other, a 
wet sponge is placed high up on the neck, and the 
wire brush is carried down the spine slowly, the action 
being repeated a dozen or more times. The operation is 
a painful one, but the reflex stimulating action is very 
decided. The nutrition of the cord is improved, its 
normal degree of activity restored and the cure of the 
impotence materially faciliated. 204 
SEXUAL IMPOTENCE IN THE MALE. 
For the relief of the anaesthetic condition of the 
glans, which sometimes is a cause of the non-excitability 
of the penis, one pole, the wet sponge, is placed over the 
lumbar or sacral region, while the other, the wire brush, 
is placed on the glans. A mild current is used at first, 
and this is gradually increased as the patient becomes 
more used to it, till one of considerable intensity and 
causing decided pain is reached. The object is to make 
a marked impression on the terminal extremities of the 
nerves of the part, and this cannot be done without ex- 
citing more or less pain. Two or three minutes are 
enough for this application, which, however, ought to 
be repeated, sometimes daily, and at others every 
alternate day. 
For application to the interior of the urethra the 
faradaic current is useful, though in general not as de- 
sirable a means of employing electricity as the galvanic 
current. An electrode of the same kind as that 
previously mentioned is introduced, and being attached 
to the induction machine a current is passed as in the 
other instance. 
Faradaic currents employed in the ways referred to 
should be frequently interrupted. Slowly interrupted 
currents are of little service, and cause fully as much 
pain as those in which the interruptions are rapid. 
Franklinic or Statical Electricity, though not of such 
varied uses as the forms mentioned, is still capable of 
being employed with great advantage, and is, in some re- 
spects the preferable kind to administer. The manner ABSENCE OF THE POWER OF ERECTION. 
205 
in which I generally employ it when I have decided 
that it is the variety of electricity most suitable to the 
case is as follows: * 
The patient being seated on the insulated platform, 
the clothing being unremoved, sparks are drawn by 
means of a large brass ball from along the whole 
length of the spine. The effect of this is to produce a 
counter-irritant action and a degree of reflex excitation 
which no other form of electricity so safely and effectu- 
ally affords. Each spark leaves a slight elevation of the 
skin, and the whole surface is reddened. The penis 
frequently enlarges under the influence, and if the 
sparks be drawn from the sacral region, erections will 
often be produced, even in cases in which they have 
not taken place for several months under the influence 
of venereal excitement. By means of a brass electrode 
enclosed within a glass cylinder perforated at one end, 
devised by Dr. W. J. Morton, the action can be directed 
with great exactness. 
This electrode is also admirably adapted for applica- 
tion to the perineum. Indeed it would be difficult to 
conduct sparks from this region without some such ap- 
pliance. 
For the relief of anaesthesia of the glans the statical 
electricity is fully as effectual as galvanism, perhaps 
even more so. For this purpose I use an electrode, 
* The machine which I use is of four revolving plates of thirty inches 
each, and three stationary plates, made for me by Messrs. J. & H. Berge, 
of this city. 206 
SEXUAL IMPOTENCE IN THE MALE. 
also invented by Dr. Morton, so arranged that, while 
the sponge extremity is on the body, the spark can be 
made to pass between two balls capable of being 
brought close together or separated as may be neces- 
sary. In applying it to the glans penis the dry sponge 
disk is brought into close contact with the organ, and 
the brass balls being separated a half inch or more, a 
powerful effect is produced. In several cases I have 
succeeded, by means of this apparatus and statical elec- 
tricity, on restoring sensibility to the glans and adjacent 
tissues when galvanism and faradism had failed. 
On the whole I am quite satisfied that in the several 
forms of electricity which I have mentioned, the physi- 
cian has the most important of all means for the treat- 
ment of enfeebled conditions of the generative system. 
There are other useful adjuncts to be presently men- 
tioned, but they can none of them, or all of them com- 
bined, take the place of electricity. 
A word more in regard to what not to use. All belts, 
disks, and other contrivances to be permanently worn 
are worse than useless. Many of these affairs furnish 
no electricity at all, being faultily constructed, while 
others only pass a current around the body, no portion 
of which enters at any point, and others, again, though 
making the body a part of the circuit, generate so feeble 
and irregular a current that it cannot be of the slightest 
service. 
Among other agents of external application may be 
mentioned massage, percussion, urtication, and flagellation. ABSENCE OF THE POWER OF ERECTION. 
207 
I have no personal experience with any one of them. 
The two latter were in use before electricity was 
brought into notice as a remedy, and though probably 
of some service then, are scarcely worthy of notice 
now. Flagellation, at one time, was resorted to as a 
temporary stimulus to an exhausted generative system, 
but I do not know that it is employed now. It was ap- 
plied to the buttocks, and there is evidence to show 
that it was occasionally officacious in causing erection 
and even of reducing the orgasm, but its influence was 
never anything more than of the most transient charac- 
ter. Rousseau * speaks of its effects upon him in his 
childhood. Meibomiusf wrote a treatise directed in 
great part to an account of its virtues in this direction, 
and the Abbe adduces many examples of its 
efficacy. Urtication was flagellation performed with 
nettles, and exerted a similar though perhaps for the 
time being a stronger influence than when ordinary 
lashes were used. 
Mondat§ devised an exhausting apparatus into 
which the penis is put, and then the rim being 
pressed strongly against the pubes the air is sucked 
out by a pump and an approach to a vacuum thus 
* “Confessions,” civ. i. 
f “ De flagiorum usu in re medica et venerea et lumborum renumque.” 
London, 1765. 
\ “The History of the Flagellants, otherwise of Religious Flagellations 
among different Nations, and especially among Christians,” etc. Lon- 
don, 1783. 
§ Op. cit. p. 155. 208 
SEXUAL IMPOTENCE IN THE MALE. 
created. As a consequence the penis at once becomes 
filled with blood and a mechanical erection is the re- 
sult. I have tried this arrangement in several cases, 
but have never known it to do any good, not even for 
the purpose of obtaining a single act of intercourse. As 
soon as the air is readmitted and the instrument is re- 
moved the blood leaves the penis, and flaccidity is the 
immediate result. Upon one patient who employed it 
every application was attended with an emission and 
orgasm, but without the least feeling of pleasure. In 
careless hands it is very evident that it might cause 
rupture of the vessels or even of the tissue of the penis. 
Sinapisms have been recommended by Roubaud* as 
being of decided efficacy in some cases. He makes a 
cataplasm composed of linseed meal and ground mus- 
tard, used in varying proportions according to the 
effect desired, and in which the penis is then enveloped. 
It is kept in this situation for from ten minutes to a 
quarter of an hour. Relative to its action he says: 
“ The application to the penis of a sinapism, even 
when the effect is lessened by linseed, is not always un- 
attended with pain, and copulation practised under the 
excitation it causes is rather a punishment than a pleas- 
ure. To calm the pain,'which sometimes is slight and 
transitory, I prescribe lotions of cold water to the penis, 
and this simple means permits of intercourse without 
suffering. 
“ The sinapism is an energetic means of treatment, 
* Op. cit. p. 155. ABSENCE OF THE POWER OF ERECTION. 
209 
and requires prudence and circumspection in its use. 
If it be applied blindly, the penis will be exposed to in- 
flammation and perhaps even gangrene may result. In 
general it is necessary to remove the cataplasm as soon 
as the patient begins to feel the burning. Almost al- 
ways a sufficient effect will then have been produced. 
A new application ought not to be made before the 
next day, or perhaps several days afterward. The total 
number of these applications cannot be predetermined. 
It depends upon the effect obtained and the state of 
irritation produced in the penis.” 
Internal remedies.— It would be very easy to extend 
this division of the subject to a great limit by calling 
attention to all the medicines for impotence which have 
been recommended by writers on the subject. There 
is scarcely a remedy of the materia medica which has 
not at some time or other enjoyed a reputation for the 
cure of the affection in question. This is due to the 
fact that, as we have seen, some forms of loss of sexual 
power are entirely mental, and are cured by whatever 
obtains the confidence of the patient. It is not astonish- 
ing, therefore, to find that substances with the most 
opposite therapeutical properties have been found 
equally beneficial in giving the'ability for sexual inter- 
course. Bread pills are fully as efficacious in these 
varieties of impotence as the most powerful agent, pro- 
vided the patient receives them with confidence in their 
influence. 
But while, as I have said, there are no special aphro- 210 
SEXUAL IMPOTENCE IN THE MALE. 
disiacs, there are certainly medicines which improve 
the tone of the generative organs by their influence 
upon the nervous system as a whole. Among these, 
phosphorus is entitled to a good deal of consideration. 
Probably the most advantageous manner of giving 
phosphorus is in the form of the phosphide of zinc, a 
tenth of a grain of which may be administered three 
times a day in pill form, or it may be given in solution, 
in oil, or in a pure form, as pills in doses of the sixtieth 
of a grain three times a day. It requires to be given 
for several weeks in order to the production of any 
permanent effect, though in a few cases I have known 
great benefit to be derived from its use after two or 
three days. 
Ointments containing phosphorus have been applied 
to the penis and scrotum, but they are of no more value 
than such as may be due to the absorption into the 
system of a minute portion of phosphorus. They would 
be just as efficacious if applied to the head. 
The dilute hypophosphorus acid is also an eligible form 
in which to administer phosphorus. It undergoes very 
speedy decomposition in the stomach, and the odor is 
perceived in the eructations from the stomach. The 
dose is from ten to thirty drops, in a sufficiency of 
water, three times a day, preferably at meal-times. The 
taste is pleasant, and on that account it is preferred by 
patients to any other form of phosphorus. 
The dilute phosphoric acid, though probably not so 
powerful a remedy as those just mentioned, is never- ABSENCE OF THE POWER OF ERECTION. 
211 
theless a useful medicine in the treatment of impotence. 
It is doubtful, however, if its effect is exactly that of 
phosphorus, which is certainly a tonic and stimulant to 
the whole nervous system. Phosphoric acid is probably 
no more influential in curing the affection under consid- 
eration than would be nitric, hydrochloric, or any 
other mineral acid. It is a general tonic and nothing 
more. The doses, from ten to fifty drops properly 
diluted with water, are taken preferably at meal-time 
so as to mix with the food. It makes a pleasant 
drink. 
Nux vomica and one of its active principles, strychnia, 
are also medicines of great value in the treatment of 
impotence coming from excess. The former may be 
given in doses of the third of a grain of the extract in 
pills, or preferably combined with the phosphide of 
zinc. A pill which I use largely in the affection in 
question is thus composed : 
]$ Zinci phosphidi gr. x. 
Nucis vomicae ext gr. xxxiii. 
M. ft. in pill No. C. 
Dose, one three times a day after meals. 
There are few, if any, internal remedies so generally 
efficacious in the alleviation or cure of impotence aris- 
ing from sexual excesses as this combination. 
Strychnia may be given in pill or in solution, in water, 
in doses varying from the sixty-fourth to the twenty- 
fourth of a grain, or more, of the sulphate, three times 
a day. It is preferably given in gradually increasing 212 
SEXUAL IMPOTENCE IN THE MALE. 
doses, starting with the quantity first named and carry 
ing them slowly up to the last designated amount. 
Instead of using water as a solvent it is much better 
to employ either the dilute hypophosphorus acid or 
the dilute phosphoric acid. The combination of the 
former which I am in the habit of prescribing is as 
follows: 
5 Strychnise sulphatis gr. iii. 
Acidi hypohosphori diluti . .oz. iv. 
M. ft. sol. Dose, ten drops in water three times a day, the doses to be 
increased a drop every day up to twenty-five drops. 
In this way a regular increase of the dose is effected 
until, at the end of fifteen days, the patient is taking 
twenty-five drops, a little more than the twenty-fifth of 
a grain three times daily. The dose may then be kept 
at this point for ten days, jand then again increased up 
to forty or even fifty drops. If the patient is then 
markedly better, the further administration should be 
stopped for a fortnight, and then the medicine may be 
resumed in doses of ten drops three times a day, as 
before, with a slight increase. So long as benefit is de- 
rived this course may be continued. I have persevered 
in this way with it for over a year with the most happy 
results. 
If after carrying the doses up to fifty drops there is no 
alleviation whatever, it is scarcely worth while to repeat 
the procedure. 
The phosphoric acid may be given in like manner, 
and in those cases which are occasionally met with in ABSENCE OF THE POWER OF ERECTION. 
213 
which the hypophosphorus acid is not well borne by 
the stomach it is to be preferred. In the use of both 
medicines the quantity of water used as a diluent should 
be increased as the dose is augmented, until, when 
forty or fifty drops are given, the amount should be a 
tumblerful. In some cases in which the system is 
greatly reduced iron is of benefit, and it may be added 
to the mixture first given in the form of phosphate, or 
it may be given separately in any other combination of 
a tonic character, or singly. 
Cod-liver oil is, I think, a very valuable adjunct, and I 
rarely treat a case of impotence of the kind under notice 
without giving it in some form or other: an emulsion 
with the hypophosphites is a very eligible preparation. 
With the exception of one agent of reputed aphro- 
disiac properties there are no others of any special 
value in the treatment of impotence. Derangements of 
other organs, however, require to be met, such as dys- 
pepsia, when pepsin may be given; diarrhoea, which is 
to be treated as in ordinary cases, and so on with other 
non-essential conditions. The substance to which ref- 
erence is made is cantharides, and a few words in regard 
to it are necessary, if only to point out the dangers at- 
tendant on its administration. 
Cantharides act on the generative system as a violent 
irritant, but this effect is altogether secondary to its in- 
fluence in causing inflammation of the bladder. In large 
doses they produce this effect very speedily, and, with 
it, often cause a state of satyriasis characterized by in- 214 
SEXUAL IMPOTENCE IN THE MALE. 
tense, long-continued priapism with irresistible impulses 
to sexual intercourse or masturbation, which frequent 
repetition does not mitigate. Many instances of their 
poisonous effects are cited by authors, and not a few 
deaths have been the consequence of their improper 
administration. 
But occasionally in some cases of impotence of recent 
occurrence benefit may be derived from the cautious 
administration of cantharides. The only admissible 
form is the tincture, and this I usually give in doses of 
fifteen drops three times a day, increasing the doses a 
drop for those of each day till slight strangury is pro- 
duced. If there is going to be any beneficial effect it 
will be experienced at or about this time; if not, it is 
scarcely worth while to persevere with the remedy in 
this manner. 
For the impotence which results from disease exist- 
ing in the brain or spinal cord no special treatment is 
necessary or proper, as the therapeutical measures 
should be directed against the affection of which the 
impotence is only a secondary condition. To do other- 
wise would often be extremely prejudicial to the pa- 
tient affected with organic disease. For instance, loss 
of sexual power is often a state present in locomotor 
ataxia. Phosphorus and strychnia are contraindicated 
in locomotor ataxia, and if administered will quite cer- 
tainly increase the spinal trouble and at the same time 
render the impotence more profound. 
And in general in all cases of symptomatic impotence ABSENCE OF THE POWER OF ERECTION. 
215 
of the form under notice the treatment is to be directed 
against the original disease which is the cause. When 
that is remedied the sexual weakness will probably also 
disappear, but if not, then the remedial measures men- 
tioned can be brought to bear against it. 
I have said nothing of cauterization of the urethra 
after the manner recommended by Lallemand and fol- 
lowed by very many surgeons of the present time, for 
the reason that I think it is a most pernicious practice, 
and one that can scarcely ever fail to do harm with- 
out doing any good commensurate with the pain and 
danger attendant on its employment. There is nothing 
that can be done by cauterization that cannot be better 
and more safely effected by electricity in any of the 
ways mentioned. I have cauterized many patients in 
my time, before 1 knew better, and I have caused a 
great deal of suffering thereby and conferred a very 
small modicum of good, and I therefore cauterize no 
longer. I have seen violent inflammation of the ure- 
thra, stricture, orchitis, epididymitis, and cystitis pro- 
duced by it. Some of these accidents have occurred in 
my own practice, and others in the experience of other 
surgeons. To be sure, in the great majority of cases the 
operation does nothing more than cause a great deal of 
pain and a more or less severe inflammation of the 
urethra, but these events are quite unnecessary, as they 
never follow the proper use of electricity, and the latter 
is far more beneficial than is cauterization in giving tone 
to the parts and arresting involuntary seminal discharges. 216 
SEXUAL IMPOTENCE IN THE MALE. 
CHAPTER III. 
ABSENCE OF THE POWER OF EJACULATING THE 
SEMINAL FLUID INTO THE VAGINA. 
Impotence, from the cause to be considered in the 
present chapter, may be due to malformation, disease, 
or some other anomaly of the penis, to like conditions 
of the testicles or their annexae, or to some condition 
existing in the body as a whole, preventing the emis- 
sion of the seminal fluid into the vagina. 
The Penis.—Absence of the penis. The penis may be 
absent from birth. Cases of the kind have been cited by 
authors, and among them is one referred to by Fodere.* 
The case was that of a young soldier, full of courage 
and strength, who had well-formed testicles, but where 
the penis ought to have been, had only a button like 
the nipple of the mammary gland, in which the urethra 
terminated. He declared that he was born so, and 
that sometimes, in presence of young persons of the 
other sex, the button swelled, and that by friction, a 
thin white liquid was expelled. 
Nelaton reports the case of an infant brought to him 
for examination by a midwife. The child was two days 
old, and was perfectly well formed and healthy, except 
* “Trait6 de m6decine 16gal et d’hygiene publique.” Paris, 1813, t. i 
p. 364- NON-EJACULATION OF THE SEMINAL FLUID. 
217 
that there was an entire absence of the penis. There 
were no traces of that organ, no cicatrix, nothing. The 
scrotum was well formed, and the testicles were in the 
proper places. The urine escaped by the rectum. 
There was, in fact, a kind of cloaca, such as is met with 
in birds and some other animals. 
In such cases impotence is the inherent condition of 
the organism. In the other cases it may be acquired, 
though just as absolute, from the amputation or destruction 
of the penis, but in such cases the organ must have been 
removed to a very considerable part of its extent. How 
much this must necessarily be in order to prevent en- 
trance and ejaculation into the vagina, it is difficult to 
determine a priori. I know of a case in which the 
organ was wounded by the accidental discharge of a 
pistol carried in the trousers pocket, and in which a 
surgical operation removed all of it but about one inch ; 
but th.e man in whom this occurred assured me that he 
was able to discharge semen into the vagina; at any 
rate, he got married after his mutilation, and within a 
year thereafter his wife had a child. There was never 
any complaint from either party in regard to the man- 
ner in which the conjugal duties were performed. 
Less than an inch, I think, would not be sufficient to 
effect entrance and emission into the vagina, though it 
might be enough to give the sexual orgasm and pleas- 
urable sensations. 
During the recent war, and since its close, several 
cases of partial destruction of the penis from gunshot 218 
SEXUAL IMPOTENCE IN THE MALE. 
injury have come under my notice, but in all these 
enough of the organ remained to serve the purposes of 
sexual intercourse. 
In surgical operations requiring the amputation of 
the penis as much of the organ should be left as pos- 
sible. I have only removed it twice, and in both these 
instances not more than half an inch could be spared 
to the patient. I never heard of the result so far as 
intercourse or the orgasm was concerned. 
Smallness of the penis as a cause of impotence cannot 
be very effective. Foder<§ * is scarcely inclined to 
admit it as a factor. Occasionally, however, it exists, 
and Roubaud f gives the following case as in point: 
“ A student of medicine, nineteen or twenty years of 
age, and a Brazilian by birth, came to consult me. He 
was thin, his voice feminine, the muscular system 
scarcely developed. His face and chest were devoid 
of hair, and there was very little on the pubes. Be- 
fore showing me his organ the patient informed me 
that he not only had desire, but also frequent erections, 
and that when he masturbated, the emission took place 
with all the ordinary voluptuous sensation, but that 
when he had intercourse, no matter how great an effort 
he might make, ejaculation never occurred. The case 
was singular, and before losing myself with hypotheses 
relative to a nervous sur-excitation which might have 
placed an obstacle to the free circulation of the semen, 
* Op. cit. p. 366. 
f Op. cit. p. 93. NON-EJACULATION OF THE SEMINAL FLUID. 
219 
I asked to see the organs of generation. What was my 
astonishment to find a penis almost imperceptible, of 
which it was difficult to discover the glans. The scro- 
tum, the testicles, the vasa deferentia, all the apparatus 
were equally liliputian. The penis when in a state of 
erection was of about the circumference of the quill of 
a porcupine, and about two inches in length. The 
testicles were hardly of the size of a filbert, and were 
difficult to find when the scrotum, becoming relaxed, 
left them without its support.” 
A case in which the penis was no longer than that 
described was some years since under my observation. 
It was of about the circumference of an ordinary lead 
pencil, and about two inches in length. It was well 
formed in other respects and copulation was performed 
not very satisfactorily, I was led to believe, but yet not 
altogether without pleasure. 
Great size of the penis. This can hardly be a cause of 
impotence except in regard to some women. As 
Fodere* says, the extreme dimensions of the penis may 
cause the sexual act to be painful to both parties, and 
may give raise to contusions and abrasions. Zacchias 
cites the case of a Roman courtezan who always had 
an attack of syncope when she had sexual relations with 
one of her lovers who possessed a very large penis. 
Neither extreme smallness of the penis, nor its great 
size, are capable of being alleviated by remedial mea- 
* Op. cit. p. 365. 220 
SEXUAL IMPOTENCE IN THE MALE. 
sures. The apparatus of Mondat previously mentioned 
has been recommended for the former condition, but it 
is quite useless for such a purpose, or indeed for any 
other. 
Bifurcation of the penis, either of itself or with its 
ordinary accompaniment, extrophy of the bladder, may 
be a cause of relative impotence, but scarcely of the 
absolute loss of the power of ejaculating the semen into 
the vagina. Gore (de Boulogne) communicated in 
1844 to the Academy of Sciences the case of a double 
penis, of which the two corpora cavernosa were per- 
fectly separated and provided each with a urethral 
canal, and Isidore Geoffroy Saint Hilaire reported 
the case of an adult in whom the two organs were 
separate and placed one above the other. In this 
instance the urine and semen flowed through both 
penises. 
Suture of the penis. By this term is understood a con- 
dition in which the under surface of the penis does not 
exist; being merged in the scrotum, a single cutaneous 
envelop therefore encloses both the penis and testicles 
so that the organ is incapable of erection. 
In a case of the kind which came under the care of 
J. L. Petit, an operation was performed by which the 
penis was separated from its attachment, but it still con- 
tinued to preserve its abnormal curve. Bouisson oper- 
ated in a similar case, and with better success, for the 
* Comptes rendus de l’Academie des Sciences. June i, 1844. 
f Ibid., 1844. NON-EJACULATION OF THE SEMINAL FLUID. 
221 
individual was able to eject the urine to some distance 
and even to have emissions with erections. 
Anomalies of the urethra may lead to impotence of 
the kind under consideration. Hypospadias, in which 
the orifice of the urethra is on the under surface of the 
penis, is one of these, provided the opening is so far back 
as to cause the semen to be ejaculated externally to the 
vagina. In some of these cases a surgical operation 
may be effective in closing the original opening, and 
making one far enongh in front to allow of emission 
into the vagina during sexual intercourse. 
In epispadias the opening is also farther towards the 
proximal extremity of the penis than is normal, but it 
is on the superior surface. Here, again, if the opening 
is sufficiently far back the emission during intercourse 
will take place outside of the vagina. In other cases 
in which it is nearer the distal extremity emission into 
the vagina is possible. 
Besides these vices of conformation the penis is sub- 
ject to certain diseases which interfere more or less 
effectually with the ejaculation of semen into the 
vagina. Strictures of the urethra are among the chief 
of these. 
In stricture of the urethra the calibre of the canal 
may be so greatly reduced as to prevent the passage of 
the semen from the penis. It is obstructed by the nar- 
rowed portion of the urethra and flows backward into 
the bladder. Besides this there is no doubt that stric- 
tures of the urethra can, when not so great as to pre- 222 
SEXUAL IMPOTENCE IN THE MALE. 
vent the passage of the semen, interfere very materially 
with the capacity for erection, and hence they become 
another cause of impotence. Civiale pointed out this 
fact when he said : 
“ Among the other local effects of strictures of the 
urethra which are worthy of the attention of the practi- 
tioner, since they furnish valuable indications for the es- 
tablishment of a diagnosis and for appreciating the prog- 
ress of the disease, are those which relate to the function 
of generation. Erections do not take place as they do or- 
dinarily in healthy men, either because the penis cannot, 
owing to the rigidity of the canal, assume the proper 
position, or because the blood does not come in suffi- 
cient quantity to the corpora spongiosa and corpora 
cavernosa.” * 
Several cases, partly confirmatory of these remarks of 
the great French surgeon, have come under my obser- 
vation, in which not only the power but the desire was 
also extinguished ; but I am inclined to think that these 
results were to be attributed altogether to the moral 
associations of the condition. A patient, for instance, 
has a stricture, and, as is often the case, in diseases of the 
kind, allows his mind to dwell on the subject, till a state 
of hypochondriasis is induced. No phase of mental 
derangement is more calculated to abolish sexual de- 
sire than this, for not only is there a condition of aber- 
*“Trait6 pratique sur les maladies des organes genito-urinaires,” 
Paris, p. 148. NON-EJACULATION OF THE SEMINAL FLUID. 
223 
ration, but the mind is constantly preoccupied with a 
single engrossing subject to the exclusion of all other 
topics and even of so absorbing a one as the sexual feel- 
ing. Besides, there are some men, and it would be well 
if there were more of them, who think it dishonest while 
suffering from any disease of the generative organs to 
have intercourse, and if under peculiar circumstances 
they are carried away for the moment by the height 
of their passion the power is apt to fail at the very mo- 
ment when it is required. The principle to which al- 
lusion has already been made is also influential. The 
individual with a stricture is often doubtful in regard 
to his ability to accomplish the sexual act in a satisfac- 
tory manner. To doubt is to fail. 
But I have been consulted in cases in which there was 
no such mental trouble and in which the only function 
lacking to the act of intercourse was the non-ejaculation 
of the seminal fluid into the vagina. It may be said 
that such cases come under the head of sterility, an asser- 
tion which would be very true so far as the practical 
results are concerned, but as the act of sexual inter- 
course consists in the essential features, intromission, a 
pleasurable orgasm and ejaculation of semen into the 
vagina, it follows that one of the elements of the per- 
fectibility is wanting. Besides, the non-ejaculation of 
semen interferes, there is reason to believe, with the 
voluptuous sensations experienced by both parties. 
Impotence depending on this cause is to be treated 
by the surgical means proper in the management of ure- 224 
SEXUAL IMPOTENCE IN THE MALE. 
thral stricture, by dilatation, electrolysis, or incision, 
as the case may appear to require. With the relief of 
the condition, the sexual act can of course be performed 
in its entirety. 
Spasmodic Stricture.—Although there probably is no 
such thing as a permanent spasmodic stricture of the 
urethra I am quite sure that there is such an affection, 
lasting from a few minutes to an hour or more, and 
which, while it lasts, effectually prevents the emission of 
semen or the passage of the urine. In speaking of this 
subject MM. Grimaud de Caux and Martin Saint-Ange 
say: 
“ Finally we must admit the existence of another form 
of stricture of the urethra: it is that which is caused by 
a nervous state of the canal which becomes so much 
contracted as to entirely obliterate its calibre, the sides 
being brought in contact with each other. Such an ob- 
stacle to the passage of the urine is never more than 
temporary, lasting at most only an hour or two, although 
by its frequent repetition causing much suffering to 
those who are its subjects. It was an affection of the 
kind in question which rendered J. J. Rousseau so un- 
happy, and so unsupportable to himself and others. 
He was supposed to suffer from stone in the bladder. 
Morand, however, could never detect such a body 
by sounding, so Rousseau had recourse to ‘ Fr£re 
Come,’ who, having penetrated, though with difficulty, 
to the bladder, found it to be free from a calculus. This 
examination rendered him for the time a little more quiet, NON-EJACULATION OF THE SEMINAL FLUID. 
225 
but the spasms of the urethra having reappeared, hypo- 
chondria supervened to darken the mental horizon of 
the philosopher and to disgust him, as every one knows, 
with all the objects of his love and friendship. If the 
author of “ Emile ” had lived in our day, under the in- 
fluence of the progress of science in the treatment of 
diseases of the urinary passages, it is more than probable 
that the greater part of his life, especially its end, would 
have felt the full power of his character and genius, 
which being of late development would have illuminated 
his existence in his old age.” 
I have seen several cases in the course of my experi- 
ence in which the condition of the author of the “ Con- 
fessions” was almost exactly repeated, leading to great 
unhappiness, both as regarded its effect upon the mar- 
riage relation and the mind generally. The description 
of one or two of these instances will tend more dis- 
tinctly to the elucidation of the main points of the affec- 
tion than any merely didactic account. 
A gentleman who had never been addicted to women 
before marriage but who since that event had been ex- 
cessive in marital indulgence had suffered for many 
years with a degree of nervous irritability which put 
him out of humour with himself and all the rest of 
humanity with which he had anything to do. He was 
apt to be attacked periodically with neuralgia of the 
fifth pair of nerves, sometimes on one side and again on 
the other, and at these periods he was particularly liable 
to the occurrence of morbid feelings, which affected 226 
SEXUAL IMPOTENCE IN THE MALE. 
him acutely and which plunged him into the lowest 
depths of despair. Frequently at such times he had 
thought seriously of suicide, and upon one occasion had 
made elaborate preparations for its perpetration. For- 
tunately the paroxysm disappeared as suddenly as it had 
supervened, and his thoughts underwent an immediate 
change. At these periods there was often an incongru- 
ous desire for sexual intercourse and of the most irresis- 
tible character, and, strange to say, he never had desire 
at other times. But though he made frequent attempts 
at sexual intercourse, and though there were strong 
erection and orgasm attended with a certain amount of 
pleasure, there was no emission; but the convulsive 
movements of the muscles concerned were almost im- 
mediately followed by a sharp pain deep in the urethra, 
and which extended apparently to the rectum, though in 
this situation being a dull dragging sensation, as though 
the organ were greatly distended. This did not hap- 
pen once only, but every time that he had connection 
the like series of phenomena took place, and as he could 
not explain the circumstance it caused him a great deal 
of additional distress. He would have abstained from 
intercourse, but his sexual appetite at these times was 
very active, and although he controlled it to a great ex- 
tent, he could not altogether obtain the mastery of his 
desire. He was rapidly getting to be hypochondriacal 
on the subject, as the belief was being entertained that he 
was becoming sterile owing to a non-secretion of semen. 
He was very much averse to attempting sexual inter NON-EJACULATION OF THE SEMINAL FLUID. 
227 
course at other times than when his paroxysms of 
mental depression and neuralgia attacked him, as he had 
no desire during these intervals; in fact, the idea was 
extremely repugnant to him. But at my earnest sug- 
gestion he consented to make an effort in that direction, 
and the result was his entire satisfaction, that he was in 
every respect capable of the physiological performance 
of the act of sexual intercourse. 
Repeated examinations with sounds had previously 
convinced me that there was no organic obstruction of 
the urethra, and the fact that there had never been any 
difficulty in voiding urine was of itself sufficient evidence 
on this point; but to make it absolutely certain that 
there was an ejaculation of semen, which, however, 
failed to reach the meatus, I desired him to bring me 
the urine which he passed immediately after the act of 
intercourse while under the influence of one of his 
attacks. This he did, and on examining the sediment 
with the microscope it was found to consist almost en- 
tirely of semen, with the normal proportion of sperma- 
tozoa, dead, however, from the influence of the urine. 
It was very certain therefore that my patient was suf- 
fering from a spasmodic contraction, of the urethra 
which closed the canal and caused the seminal fluid to 
be thrown back into the bladder. 
I treated this patient by galvanism. A urethral elec- 
trode was passed down to the veru montanum every 
day while he was exposed to the affection, and a current 
from ten of Hill’s gravity cells was passed through it to 228 
SEXUAL IMPOTENCE IN THE MALE. 
another electrode introduced into the rectum. This was 
done for about five minutes at each seance. At the same 
time and during the intervals of health the bromide of 
sodium was administered in doses of fifteen grains a day. 
I began this treatment at the very beginning of one 
of his paroxysms, and continued the galvanism for the 
ten days that it lasted. During this period there was 
no improvement, but during the whole of the next 
paroxysm, intercourse was performed in a perfectly 
satisfactory, manner, and moreover there was a notable 
diminution in his desire, which had become more like 
that of a man in a normal condition. 
In the other case the patient, a young man twenty- 
five years of age, had been guilty of gross excesses, 
though thus far there had been no notable diminution 
of sexual power. One night, however, while in the act 
of sexual intercourse, he was surprised by an intense 
pain in the rectum, and by the non-emission of semen. 
The pain was of such an agonizing character that he al- 
most fainted. It lasted, however, only for a few seconds, 
but it was more than an hour before he had entirely re- 
covered from the nervous shock of the occurrence. 
For several days thereafter he was afraid to make a fur- 
ther attempt at sexual intercourse, but finally his de- 
sires overcame his discretion, and again there was the 
intense pain in the rectum and the non-emission of 
semen, with all the subsequent phenomena which char- 
acterized the former attack. The following morning he 
came under my notice. NON-EJACULATION OF THE SEMINAL FLUID. 
22p 
In answer to my inquiries he informed me that he had 
passed a full stream of urine ever since the first attack and 
that he had never suffered from gonorrhoea or any other 
venereal disease. On examination with sounds I found 
that there was no evidence of a stricture; I therefore came 
to the conclusion that his case, like the other, was one of 
spasmodic contraction of the urethra and of the muscles 
of the perineum. I treated him with electricity as in the 
foregoinginstance, giving him the current from ten cells 
daily for about five minutes. This was continued for 
two weeks. At the end of that period he made another 
attempt at sexual intercourse, but owing to the condi- 
tion of his mind and his apprehension that the pain 
would return he was unable to obtain an erection. The 
next day, however, he met with better success, and 
this time without pain, and with a free ejaculation of se- 
men. 
This condition appears to present some analogy with 
the spasm of the urethra sometimes observed in nervous 
individuals and which prevents them passing urine 
while they are particularly desirous of so doing. They 
will stand sometimes for an hour with the bladder 
nearly full, making every effort to evacuate it and yet 
unable to cause a single drop to flow. 
Again, it presents some features similar to the state 
called by Sir James Paget* “Stammering with the 
urinary organs,” but the cases that he adduces and the 
* Surgical Lectures and Essays. New York, 1875, page 77. 230 
SEXUAL IMPOTENCE IN THE MALE. 
remarks he makes upon them are intended to refer en- 
tirely to the bladder, as the following remarks show : 
“ Stammering urinary organs are not rare, and they 
may be known by observing sometimes in the same per- 
son the exact parrallelism between the difficulty of ex- 
pelling urine and that of expelling the air in ordinary 
speech-stammering. The patient can often pass his 
urine without any trouble, especially at customary 
times and places, and when he does so the stream is full 
and strong. But at other times he suffers all the distress 
that he might have with a very bad urethral stricture. 
He cannot pass a drop of urine; or after a few drops 
there comes a painful check, and the more he strains 
the less he passes, and then complete retention may 
ensue, and overfilling of the bladder. In their charac- 
ters the cases may closely resemble one of the ordinary 
instances of so-called congestive stricture, in which rapid 
swelling of some part of the mucous membrane narrows 
or closes the part of the canal which is least capable of 
distention. But the circumstances with which the diffi- 
culty arises are in the two patients very different. The 
stammering with the bladder occurs with just the same 
condition as the stammering speech. There are few 
stammerers in speech so bad but that they can talk or 
read fluently when they are alone or with those with 
whom they are most familiar, or when they are entirely 
thoughtless as to their manner of speaking. Their worst 
times are when with strangers or with persons or in 
places that are associated in their minds with stam- NON-EJACULATION OF THE SEMINAL FLUID. 
231 
mering. It is just so with the bladder and urethra. 
One patient told me that although he could usually 
pass urine well, yet there was one person with whom 
nothing could induce him to walk, because once when 
he was with her he wanted to pass urine, retired and 
failed. His experience of the effects of association of 
thoughts made him sure that if he were again in the 
same circumstances the same distress would come on 
him more intensely. Another, a clergyman, always 
passed a catheter before going into his pulpit. He had 
often had nervous trouble with his bladder; and once 
or more having felt a horrid need of passing urine while 
he was preaching, he found himself at the end of his 
sermon unable to pass any. He said he felt sure that 
if he were to go to his pulpit without the assurance 
of an empty bladder, which his catheter (a No. 12; 
passed easily) gave him, he should be possessed with a 
desire to pass urine and then should have retention. 
As a speech-stammerer might be unable to utter a word, 
so would he be unable to pass a drop of urine again. 
Another patient has described himself as driven to all 
kinds of devices to bring about an association of ideas 
or of actions with which to best succeed in emptying 
his bladder. He must walk up and down his room and 
stand or sit in some customary singular position, and 
then be very careful not to direct his mind either too 
much or too little to what he has to do, and then to let 
the urine run as inconsiderately as he can.” 
Sir James is, I think, mistaken in locating this trouble 232 
SEXUAL IMPOTENCE IN THE MALE. 
in the bladder. It is undoubtedly due to a spasm of the 
organic muscular fibres of the urethra and of the com- 
pressor urethrae muscle. It is exactly similar to the 
condition sometimes excited in nervous individuals by 
attempts to pass a bougie. The canal closes tightly 
against the point of the instrument, but a steady gentle 
pressure continued for a few minutes usually overcomes 
the obstruction. The remarkable fact, one which all 
physicians and surgeons have observed, is that the con- 
dition should be excited by mental influences and certain 
associations of ideas. I have known men who could not 
urinate when asked to do so, unless the water above the 
urinal were allowed to run at the same time, so that 
the idea of a flowing stream should be excited in their 
minds. The fact is common enough, and it is one well 
known to people generally. I recollect when a college 
boy being witness to a wager between two men that 
one of them could not urinate in the other’s hat. A ring 
of curious spectators was formed around the individual 
desirous of exhibiting his powers of urination; he had a 
full bladder, he said ; he prepared himself, held the hat 
of his adversary in his hand, but not a drop would come 
and the more the lookers-on laughed and cheered, and 
the more he strained the less real ability he seemed to 
exhibit. At last the referee announced that the time, a 
half an hour, was up, and he lost his bet without having 
passed a single drop. Five minutes afterward, in the 
solitude of a woody lane, he evacuated over a pint. 
Such conditions remind us forcibly of those states of NON-EJACULATION OF THE SEMINAL FLUID. 
233 
impotence considered in the preceding chapter in which 
certain associations of ideas are necessary to the physio- 
logical performance of the sexual act. 
Relative to the non-ejaculation of the semen, to which 
the foregoing remarks apply, the state has been con- 
founded with another, aspermatism, to which attention 
will presently be directed, but which is quite a different 
condition. 
The emission of the semen may fail to occur in con- 
sequence of paralysis of the compressor urethrce muscles, 
by which condition, though it is deposited in the urethra, 
it is not ejaculated from the meatus, but after some 
time slowly oozes out. Acton regards this state as due 
a lack of consentaneous action on the part of the several 
factors which go to make up the orgasm ; but it is very 
evident, I think, that the explanation I have given is 
the correct one. That the semen enters the urethra 
at the time of the orgasm I have ascertained in several 
cases, of which the following is an example: 
A gentleman who had long been engaged in literary 
pursuits, and whose habits were sedentary, became the 
subject of spinal irritation. He consulted me a few 
days before his marriage, and I found tenderness over 
the spinous processes of the lower dorsal and lumber 
vertebras, with great muscular weakness of the lower 
extremities. He had occasionally suffered from noc- 
turnal emissions, had never had sexual intercourse, and 
denied masturbation very energetically. As he was 
about being married he preferred to delay any active 234 
SEXUAL IMPOTENCE IN THE MALE. 
treatment until after that event had taken place. I there- 
fore did nothing for him beyond prescribing a chaly- 
beate tonic. A month afterward he returned for treat- 
ment, and then he informed me that though he had had 
erections, and that though so far as he knew the sexual 
orgasm was complete, yet that there had never been a 
seminal emission during the act of intercourse. But 
immediately after withdrawal the semen began to flow, 
and it continued to pass out slowly for several hours. 
He had ascertained that by pressing the fingers along 
the course of the urethra on the under surface of the 
penis, he could cause the flow to take place more rapidly. 
Upon introducing a sound I found that the urethra was 
in a healthy condition as regarded size and sensibility, 
and I could find no cause for the trouble beyond a pos- 
sible paralysis of the ejaculatory muscles. I treated him 
with galvanism and faradism internally applied, together 
with counter-irritation to the spine, and the internal ad- 
ministration of iron, quinine and strychnia, and after 
about two months he began to improve, but it was a 
year before the ejaculation took place with any force. 
I have had quite a number of cases similar to the fore- 
going, but not of so severe a character, in men of ad- 
vanced years, in whom, though there were emissions of 
semen, yet they were not complete, a portion, often more 
than two thirds remaining in the urethra and gradually 
oozing out during an hour or so. These cases are 
generally improved by electricity, though occasionally 
they resist all treatment. NON-EJACULATION OF THE SEMINAL FLUID. 
235 
Acton* gives the following case as occurring in his 
practice: “ The patient was an American. Erection 
was perfect, but emission did not follow. When erec- 
tion ceased there was occasionally a slight oozing from 
the urethra. Strange to say, this patient had emissions 
at night once or twice a week. The testicles were small. 
A short time since he had been operated upon for 
varicocele without any good effect. He had also 
been cauterized. Slight stricture existed, as was ascer- 
tained by the bulbous instrument, but a conical bougie 
passed easily. In this instance there was apparently 
nothing but a want of consentaneous actions between 
emission and erection, both being perfect at different 
times.” 
A very slight examination of this case, as detailed, 
suffices to show that Mr. Acton’s f explanation of it is 
not correct. If the emission had been perfect the patient 
would have had the semen discharged as in the normal 
manner instead of its oozing out gradually in the way 
stated. The condition was nevertheless one in which, 
as in the case I have given, the discharge took place 
without there being sufficient strength in the muscles 
to force it to the orifice of the urethra. 
MM. Grimaud de Caux and Martin Saint-Ange £ have 
a clear idea of such instances, as is seen in the following 
quotation which I make from their work: 
* “ The Functions and Disorders of the Reproductive Organs,” etc. 
Fourth American edition, Philadelphia, 1875, page 223. 
f Op. cit. page 340. 
t Op. cit. p. 340. 236 
SEXUAL IMPOTENCE IN THE MALE. 
“ As we have seen,” they say, “there exist in relation 
with the penis certain muscles, of which some, as the 
two ischio-cavernosa, are concerned with the phenomena 
of the erection, and serve to direct the organ in the 
act of copulation, and others, as the bulbo-cavernosa and 
the constrictor, compress the canal of the urethra, and 
by this means accelarate the flow of the seminal fluid 
in the phenomena of ejaculation. It often happens 
that these muscles are paralyzed or that their irrita- 
bility is extinguished. From each of these conditions 
it results either that the erections are incomplete and 
sexual in tercourse is thereby rendered impossible, 
or more frequently that the erection having taken 
place the seminal fluid not being submitted to the 
action is note jaculated in a duly physiological man- 
ner.” 
It is bad enough to have this state as a disease, but 
it is still worse to induce it artificially, as I have known 
to be the case in several instances. 
The authors just cited state that it is no uncommon 
circumstance for women whose object it is to prevent 
impregnation, to press during the act of sexual inter- 
course upon the urethra of the male just in front of the 
veru montanum in such a manner as to prevent the 
passage of the semen through the canal, and cause it 
to be directed backward into the bladder. Eventually, 
as they do not fail to point out, the urethra acquires the 
habitude thus imposed upon it, and the semen always 
and under all circumstances passes into the bladder, the NON-EJACULATION OF THE SEMINAL FLUID. 
237 
individual becoming in consequence not only incapable 
of physiological intercourse, but sterile. 
I am very sure that this practice is followed to no 
inconsiderable extent at the present day and in this 
country, but there is another which is sometimes prac- 
tised which is probably still worse in its ultimate conse- 
quences, and that is the wearing during sexual inter- 
course of an india-rubber ring around the penis so as 
to compress the urethra and thus prevent the emission 
of semen. I have known of three instances in which 
such a contrivance was worn, and in each the conse- 
quence was that the individual was rendered sterile by 
the invariable passage of the semen into the bladder, 
even after the ring was no longer worn. In one of 
these cases the patient, a married man, had worn the 
ring at every connection he had had with his first wife, 
who did not desire children. After having been mar- 
ried over ten years she died, and in two or three years 
afterwards the man married again. This time both he 
and his wife desired children, but impregnation was im- 
possible, for no emission of semen took place from the 
meatus, the whole of it apparently passing back into 
the bladder. That there was semen was shown by mi- 
croscopical examination. 
Both the other cases occurred in young men who had 
adopted this means of carrying on with safety certain 
illicit relations which they had formed, but in both the 
resultant condition, as was also the case with the in- 
stance first mentioned, became permanent. The exact 238 
SEXUAL IMPOTENCE IN THE MALE. 
anatomical alteration which is produced in such cases 
is not definitely known. I am inclined to think, how- 
ever, that the pressure exerted changes the direction of 
the seminal ducts so that the mouths are made to open 
backward toward the bladder instead of forward in 
the direction of the meatus. 
A similar condition might be produced by enlarge- 
ment of the prostate, but none such have ever occurred 
in my experience. 
The emission of semen may, strange as it may appear, 
be entirely prevented by extreme erection. One such 
instance only has come under my observation, and one 
other only of similar character has been published. 
The latter, as quoted by Roubaud * from Cockburn, is 
as follows: 
A noble Venetian married a young lady with whom 
his sexual relations were entirely satisfactory except in 
one respect, and this the most essential of all, for there 
was not the emission of a single drop of semen. Dur- 
ing the sleep that occurred after his failures he had las- 
civious dreams with seminal emissions, but during inter- 
course there was no such accompaniment. All kinds 
of remedies were used without effect, till finally the am- 
bassadors of the republic of Venice at the several Euro- 
pean courts were requested to consult the most famous 
physicians in regard to the case. Among others the 
matter was laid before Cockburn, who attributed the 
difficulty to a too vigorous erection, by which the walls 
*0p. cit. p. 188. NON-EJACULATION OF THE SEMINAL FLUID. 
239 
of the urethra were brought together. During the las- 
civious dreams which took place, the erection, not being 
so strong, emission was effected. 
In the case which was under my observation, the 
patient, a gentleman of about forty years of age, single, 
and not excessive in sexual matters previous to the 
occurrence in question, formed relations with a very 
attractive young woman, who drew largely on his 
virile power. After the first connection, he never had 
another, without the erection being remarkably vigor- 
ous, and lasting sometimes an hour after the act had 
come to an end. During these connections not a drop 
of semen escaped from the urethra, nor, so far as I 
could determine, was there at such times any passage 
of the seminal fluid into the bladder. It appeared to 
be an instance of what Roubaud has called aspermatism, 
a condition in which there is no semen, or at least none 
that enters the urethra. 
The patient did not suffer from priapism, for there 
was an excess of desire and an apparent excess of 
power; nor was he troubled with erections at other 
times than when with his mistress. Things had gone 
on in this way for several weeks when, fearing that dis- 
ease of some kind might be the consequence, he placed 
himself under my care. I did nothing for him but give 
him large doses of the bromide of sodium, thirty 
grains three times a day for a week, and the trouble 
gradually disappeared within that period. 
Priapism may lead to a like result as in the case cited 240 
SEXUAL IMPOTENCE IN THE MALE. 
by Lallemand* of a soldier who, falling on the sacrum 
from a height, had permanent erections without desire, 
which no acts of masturbation or of intercourse sufficed 
to dissipate, and the orgasms of which were unaccom- 
panied by the ejaculation of a drop of semen. 
Relative to the condition which he has happily called 
“ aspermatism,” and of which the foregoing are ex- 
amples, due to excessive erection, Roubaud cites the 
following, which occurred within his own experience: 
“ A young man twenty years of age, of sound health 
and of a sanguine temperament, consulted me under 
the following circumstances: ‘ I have,’ said the patient, 
‘ no difficulty in obtaining erections: my sexual desires 
are sufficiently strong, but I have never experienced 
the pleasures of love. The intromission of the penis 
into the vagina of a woman is effected without difficulty 
and without pain, but this being accomplished, I can- 
not, no matter how strong efforts I may make, experi- 
ence the voluptuous sensations of which my friends 
speak. After a longer or shorter period of ineffectual ex- 
ertion, during which I call to my mind all the resources 
of my imagination and of my amorous energy, I be- 
come fatigued, and my penis, participating in the gen- 
eral state in which I am, becomes flaccid without its 
being possible to obtain an ejaculation.’ 
“ In the examination which I made of this young 
man I ascertained that ejaculations have never taken 
place while he was awake, either by masturbation or 
“ Des pertes seminales involontaires.” Montpelier, 1836-42, t. ii. p. 64. MON-EJACULATION OF THE SEMINAL FLUID. 
241 
by copulation, but that sometimes during sleep either 
under the influence of lascivious dreams, or without 
them, there had been an emission. About this, how- 
ever, there was the curious circumstance that, if from 
any cause whatever the patient awoke during the 
ejaculation, an immediate arrest of the process took 
place, so that he had never obtained an idea of sexual 
pleasure.” 
Roubaud very properly, I think, attributes these and 
similar instances to the spasmodic state of the ejacula- 
tory ducts by which their orifices are closed and the 
semen prevented passing into the urethra. There is 
therefore no accumulation of this fluid in the urethra, 
or passage of it backward into the bladder. For its 
treatment, depending, as he concedes that the condition 
does, on excessive venereal ardor, he recommends anti- 
spasmodics. Nothing better than some one of the 
bromides in full doses could be desired, together with 
the use of galvanism internally, applied in the manner 
already mentioned. 
In other cases the seminal ducts may be obliterated 
through inflammation, the. latter sometimes doubtless 
produced by cauterization after Lallemand’s method, of 
which MM. Grimaud de Caux and Martin Saint-Ange* 
say that “ European cauterization makes more eunuchs, 
than does oriental polygamy.” 
Anomalies of the Prepuce. Phimosis may be so in- 
tense in character as to prevent the emission of semen,. 
* Op. cit. p. 339. 242 
SEXUAL IMPOTENCE IN THE MALE. 
besides interfering very essentially with the develop- 
ment of the full degree of pleasure attendant on the 
act of intercourse. In such a case the enlargement of 
the penis during erection, meeting with the resistance 
of the narrow prepuce, causes a closure of the urethra, 
and the seminal fluid is not emitted till a state of flac- 
cidity ensues. Three such cases only have occurred 
within the range of my experience, but I suppose it is 
a state not very uncommon. In one of the instances 
under my charge the patient, a prominent gentleman of 
a neighboring state, had acquired the affection grad- 
ually during the two or three years before I saw him, 
though he had never had gonorrhoea, balanitis, or any 
kind of preputial inflammation. In the condition of 
flaccid ity there was no obstruction to the free passage 
of the urine, but when erection existed this was not the 
case, and during the sexual orgasm, though there was 
no pain, the ordinary feeling of pleasure was much les- 
sened, and there was no emission of semen till the erec- 
tion passed off. I operated on him by circumcision 
with entire success. 
In the other case the patient was a young gentleman 
who was about to marry, and who had had a contracted 
prepuce from childhood. He had never masturbated 
nor had nocturnal emissions so far as he knew, but 
before coming to see me he had visited a woman in 
order to ascertain whether or not he was capable of 
performing the sexual act, having some doubt upon 
the subject in consequence of what one of his medical NON-EJACULATION OF THE SEMINAL FLUID. 
243 
friends had told him. A few days subsequently he 
came to me with the information that something would 
have to be done to him as in his present condition there 
was no emission during intercourse. 
Upon examination I found that it was impossible to 
retract the prepuce, and that the glans was very con- 
siderably smaller than it ought to have been. I advised 
an operation, to which he at once consented, and I 
heard of no further trouble. 
The condition in question, though treated of at length 
by writers on the subject, in all its other relations, does 
not appear to have attracted attention as a cause of im- 
potence. Its effect in lessening or entirely abolishing 
the normal feeling of pleasure experienced in sexual in- 
tercourse will be more appropriately considered in the 
following chapter. 
The glans may be the seat of ancesthesia of such a 
character as to interfere very materially with the pro- 
duction of the orgasm, and the consequent emission of 
semen. This condition has been mentioned as a cause 
of deficient erection; but there is another kind, differ- 
ent perhaps only in degree, in which the erection is 
sufficiently strong, in which the act of intercourse is 
begun, but in which, notwithstanding all efforts that 
may be made, there is no orgasm. This state is due to 
anaesthesia, probably both to tactile and heat impres- 
sions. Such at least has been the condition in the cases 
that have come under my observation. 
As the result of many determinations, I have ascer- 244 
SEXUAL IMPOTENCE IN THE MALE. 
tained that in the normal condition of flaccidity the 
glans is about one fourth as sensitive to touch as the 
end of the index finger. On the latter, the two points 
of the aesthesiometer can be distinguished at the dis- 
tance of of an inch. On the glans, they cannot be 
discriminated at a less distance than T of an inch. 
During erection the sensibility is exalted to such a de- 
gree that the two points can be distinguished readily at 
the distance of of an inch. I presume that during 
the orgasm the sensibility is still further increased. 
Now, in the cases under consideration, in which fric- 
tion of the glans against the walls of the vagina does 
not suffice to induce the orgasm, I have found that the 
points of the aesthesiometer require to be separated to 
the extent of of an inch before they can be distin- 
guished as two distinct impressions in the flaccid state 
of the penis, and that during erection there is not a 
greater advance towards increased sensibility than 
such as is shown by the points being distinguished, 
though in some cases not very clearly, at A of an inch 
apart. 
Moreover, in the healthy condition of the flaccid 
penis, it is very easy for differences of temperature of 
five or six degrees to be distinguished, and in the state 
of erection half this difference can be readily determined. 
In the anaesthetic condition, however, of the flaccid 
penis, a glass cylinder of water at 98° could not, when 
brought in contact with the glans, be distinguished 
from one containing water at 108°. During erection NON-EJACULATION OF THE SEMINAL FLUID. 
245 
one of 98° could not be recognized as different in tem- 
perature from one of 105°. At 106° a difference could 
be detected. 
The condition in question is, therefore, I think, cer- 
tainly one of anaesthesia. 
Electricity in any one of its forms generally suffices 
for the cure of this derangement of the normal state. 
Franklinic electricity is to be preferred ; but, if it is not 
available, either of the other varieties may be employed, 
and in thh manner recommended in the previous chapter. 
Hypercesthesia of the glans may be so intense as to 
cause the emission and orgasm to take place before en- 
trance is effected. In such cases it is, of course, a true 
cause of impotence. Usually this state is induced by 
excesses either of masturbation or of intercourse, and 
the glans is thrown into such a condition of irritability 
that the reflex actions necessary to the orgasm take place 
on the slightest provocation. This derangement, as 
well as that of anaesthesia, has already been considered 
under another head in the previous chapter. It only re- 
quires notice here, not as a cause of lack of power, as 
it is in those instances in which friction against the 
clothing, even without sexual excitement, is sufficient 
to produce an emission with scarcely any other sign of 
an orgasm, but as a cause of impotence when attempts 
are made at sexual intercourse and the emission takes 
place externally to the vagina. Of course, pathologi- 
cally, the two conditions are nearly identical, that now 
under notice being only an early stage of the other. 246 
SEXUAL IMPOTENCE IN THE MALE. 
For its treatment I have found that the bromides 
taken internally, and lotions of a solution of tannic acid 
in water, in the proportion of ten grains to the ounce, 
constituted the best method of treatment, abstinence 
from sexual intercourse for several months being a 
necessary adjunct. The effect of the tannic acid is to 
decrease the sensibility of the terminal extremities of 
the nerves in the glans, and thus to render them less 
apt to be excited by slight impressions. Sometimes the 
affection is difficult of cure, and if not taken in time is 
exceedingly prone to pass into that more advanced 
stage in which frictions without venereal excitement 
are sufficient to cause an emission. 
In addition to the vices of conformation, and diseases 
to which attention has already been directed, the penis 
may be the seat of various affections which prevent intro- 
mission, and hence are causes of impotence. Such 
cases are, however, rare, and for the reason that before 
that point is reached the patient generally consults a 
surgeon, who performs whatever operation may be 
necessary. 
The Testicles.—Diseases of the testicles are more apt 
to lead to sterility than to impotence. Often, however, 
both conditions exist. In so far as they produce im- 
potence with or without sterility, they require notice 
in this connection. 
Absence of the Testicles.—Complete absence of the 
testicles as a congenital condition probably does not 
exist, though numerous cases of the kind were re- NON-EJACULATION OF THE SEMINAL FLUID. 
247 
ported by the older authors. Thus Cabrol * describes 
the case of a young man hanged for robbery at Mon- 
pellier, and whose autopsy he conducted. “ Among 
other things,” he says, “ the most curious was, that no- 
where were there any testicles, either externally or in- 
ternally, although we found his vesiculae seminales as 
full of semen as those of any man I had ever anatom- 
ized. The fact astonished all who assisted in the exam- 
ination.” 
It is now the generally received opinion that when 
the testicles are not found in the scrotum they are 
retained either in the inguinal canals or somewhere 
within the abdominal cavity. In such instances it is 
usually the case that they are atrophied and that the 
sexual power of the individual is very materially less- 
ened. In those cases in which only one testicle has 
failed to descend into the scrotum the ability to have 
intercourse is not usually markedly diminished, but 
when both have been retained it is almost invariably 
the case that the individual has neither desire nor 
power, neither orgasm nor emission of the semen. In 
fact, he assumes in many respects the mental and phys- 
ical attributes of the female sex. These phenomena 
are due, not to the original absence of the organs, but 
to the fact that owing to the abnormal position they 
occupy, they have not undergone the development 
which occurs at puberty, and that consequently they 
fail to secrete semen. Besides this, the organs suffer 
* Quoted by Roubaud. Op. cit. p. 543. 248 
SEXUAL IMPOTENCE IN THE MALE. 
a positive atrophy, as indeed does every organ, the de- 
velopment of which may be from any cause arrested. 
But if the individual should, after puberty, or even 
shortly before that period, be deprived of his testicles, 
though of course sterility is the consequence, it is not 
always the result that absolute impotence supervenes. 
As we have seen in the immediately foregoing chapter, 
desire may exist. It is equally a fact that in certain rare 
cases erections and the ability of intromission, with the 
emission of a fluid—composed of the prostatic secretion 
that from Cowper’s glands, urethral mucus, etc.—may 
take place in individuals who have been deprived of 
their testicles. In some instances there is a mild kind of 
orgasm, accompanied by a certain degree of voluptuous 
feeling. Thus, Sir Astley Cooper* removed both tes- 
ticles from a man, and the patient four days after had 
an emission of a fluid from the meatus resembling the 
seminal liquid. 
“ For nearly the first twelve months he stated that 
he had emissions in coitu, or that he had the sensations 
of emission. That then he had erections and coitus at 
distant intervals but without the sensation of emission. 
After two years he had erections very rarely and very 
imperfectly, and they generally ceased immediately 
upon the attempt at coitus. Ten years after the opera- 
tion he said he had during the past year been only once 
connected. 
“ Twenty-eight years after the operation he stated 
* “ Diseases of the Testes,” London. NON-EJACULATION OF THE SEMINAL FLUID. 
249 
that for years he had seldom any erection and then that 
it was imperfect, that he had no emissions from the 
first year of the operation; that he had for many years 
only a few times attempted coitus, but unsuccessfully ; 
that he had once or twice dreams of desire and a sensa- 
tion of emission, but without the slightest appearance 
of it. The penis was shrivelled and wasted. He was 
in the habit of shaving once a week and sometimes 
twice. His voice, naturally very feeble, remained as at 
the time of the operation.” 
Such cases are, however, only exceptional, and 
though in the East, chief eunuchs may have harems 
and may experience the shadow of desire, it is not at all 
probable that they are actuated by any much stronger 
feeling than the wish to make a display of their wealth. 
Arrest of the Development of the Testicles.—After their 
entrance into the scrotum the testicles may at any 
period of infantile life—that is, before puberty—cease 
to grow, or at least they do not grow in size or in the 
tendency to assume their proper function as rapidly as 
should be the case. As a rule such a state, if profound, 
passes to complete impotence, but there are cases in 
which, notwithstanding the non-development of the 
organs, sexual intercourse has been begun, and under 
its influence the organs have grown until they have al- 
most reached the normal size. Thus Wilson * relates 
the case of a gentleman twenty-six years of age who 
applied to him for advice relative to the advisability 
* Lectures on the Urinary and Genital Organs, London, p. 424. 250 
SEXUAL IMPOTENCE IN THE MALE. 
of his getting1 married. On examination it was discov- 
ered that his penis and testicles were not larger than 
those of a boy of eight years old. He had never ex- 
perienced sexual desires till he became acquainted with 
the lady whom he desired to marry. Then he had had 
erections and nocturnal emissions. He married and 
had several children, and two years afterward it was 
found that his testicles were nearly as large as those of 
an adult man. 
Such cases are, however, quite exceptional. I have 
never seen one of the kind. On the other hand, I have 
frequently been consulted by men who were suffering 
from an arrest of development of the testicles, but not 
to an extreme degree, supervening, in fact, at about 
the age of puberty, in whom there was some sexual 
power and which was capable of being still further de- 
veloped by proper therapeutical measures. Doubtless 
such cases, if left to themselves, especially with the 
habits of masturbation or other sexual excess into 
which the individuals have fallen, would terminate in 
active atrophy and complete loss of power. 
But, by improving the habits, administering cod liver 
oil and the hypophosphites or phosphorus, together 
with a full and nutritious diet, and, above all, by the 
,-use of electricity, in the form of galvanism to the 
testicles, after the manner described, the relief of the 
patient is not a matter of much difficulty. But it is 
essential to this result that there should still be some 
desire or some power. If both be utterly exting- NON-EJACULATION OF THE SEMINAL FLUID. 
251 
uished, there is nothing to be gained by subjecting the 
patient to treatment, as the case is certainly hopeless. 
Atrophy of the testicles is, when established, a cause of 
impotence, for which there is no successful treatment 
known. In the beginning, if the cause can be ascer- 
tained and removed, there is some hope of arresting 
the degenerative process. 
The average weight of the adult human testicles is 
about five drachms, but it is difficult, if not impossible, 
to determine the weight, during life, to even an ap- 
proximation. A testicle, however, weighing less than 
three drachms, would certainly be in a state of atro- 
phy ; more is to be determined by the size and the con- 
sistency. 
The most common cause of atrophy of the testicle is 
orchitis, and especially, according to my experience, 
the disease supervening on parotitis. The inflam- 
mation of the testicle accompanying gonorrhoea is not 
usually situated in the body of the gland, and hence is 
not so apt to be followed by atrophy. Blows and in- 
juries of various kinds are, however, comparatively 
prolific causes of atrophy from the inflammation which 
they produce. 
Injuries or diseases of the brain or spinal cord are 
sometimes followed by atrophy of the testicles. Many 
cases in support of these facts are given by authors and 
several have come under my own observation. In one 
instance a man was struck on the back of the head with 
a cart-rung and although the blow inflicted no very 252 
SEXUAL IMPOTENCE IN THE MALE. 
severe injury on the part, atrophy of the testicles super- 
vened. In this case the degeneration went on so 
rapidly that at the end of two months there was noth- 
ing in the scrotum but two masses of soft amorphous 
substance. 
In another case a man fell from a perpendicular bank 
over fifteen feet high, and struck his head violently 
against the earth below. He was taken up senseless 
but soon recovered from the immediate effects of the 
injury. Six months afterward he came under my ob- 
servation and I found that both testicles had almost 
entirely disappeared. 
In the previous chapter, I have adduced several in- 
stances of injury of the cerebellum causing atrophy of 
the testicles and impotence. In certain injuries of the 
spinal cord atrophy of the testicles is liable' to super- 
vene. Cases have been reported in which blows 
on the nape of the neck and on the lumbar region of 
the spine have led to this result. Two cases of the 
kind came under my notice several years ago, in one of 
which a dragoon fell from a stable loft and struck the 
lower part of the spine against a stall-partition. Para- 
plegia was the immediate result, and in a few days the 
testicles began to atrophy. In the course of less than 
three weeks there were no vestiges of them to be per- 
ceived. 
In the other case, a man was shot in a street fight, the 
ball grazing the spinous process of the fourth lumbar ver- 
tebra, but not inflicting any damage to the bone beyond NON-EJACULATION OF THE SEMINAL FLUID. 
253 
taking off about half an inch of its end. No other in- 
jury resulted except atrophy of the, testicles which be- 
gan soon afterward, and in four or five months had 
become complete. 
Diseases of the spinal cord are sometimes followed or 
accompanied by atrophy of the testicles, but as the 
subject has already been referred to in the preceding 
chapter, it is not necessary to go over the matter again, 
further than to say that in some cases of organic dis- 
eases of the spinal cord, those in which there is great 
reflex excitability, as in antero-lateral sclerosis, and in 
some instances of congestion, I have seen patients suf- 
fering from atrophy of the testicles in a marked degree 
and yet exhibiting very decided sexual desire and pow- 
er of intromission. In one case of the kind—lateral 
sclerosis—the testicles were not to be distinguished, but 
the patient was subject to the most ungovernable de- 
sires, with erections, which repeated acts of mastur- 
bation and of intercourse failed to relieve. The condi- 
tion was quieted by the administration of several doses 
of the bromide of sodium of one hundred grains each. 
The other diseases of the testes do not require 
special consideration. If they are of the nature of 
malignant disease they require the removal of the 
affected organ, and even if they are not, the treatment 
comes under the head of general surgery. The like is 
true of the annexae of the testicles. 
Bodily Deformity or Peculiarity. The body may be so 
deformed as to render intercourse in the ordinary man- 254 
SEXUAL IMPOTENCE IN THE MALE. 
ner impracticable, owing to the impossibility of bring- 
ing the penis into close relations with the vagina. Cer- 
tain diseases of the spinal cord may cause such extensive 
contractions of the lower extremities as to produce this 
result. Thus, in a case of spinal meningitis of a chronic 
character under my charge, the right leg was flexed to 
its utmost extent on the thigh, and the thigh on the 
pelvis in such a manner as to cross the lower part of 
the abdomen, while the left leg and left thigh were 
similarly contracted, though not to as great a degree. 
The consequence was that it was impossible to ap- 
proach the female according to the natural method, or 
indeed after any position so far as I could determine. 
The patient was troubled with intense sexual desire 
and he had frequent emissions, but intercourse was im- 
possible. 
In another case the patient, a young man, married 
about two years, became the subject of lateral spinal 
sclerosis, and among the symptoms exhibited were 
violent tonic contractions of the lower extremities. 
These contractions would last sometimes for two weeks 
at a time and during their existence sexual intercourse 
was impossible. They were not accompanied with 
pain, and as his desires were strong and he was at- 
tached to his wife, he bitterly lamented his condition. 
While in the condition referred to, the lower extremi- 
ties were drawn up strongly against the abdomen, and 
at the same time adducted to the utmost extent. Many 
attempts were made at intercourse, but the situation NON-EJACULATION OF THE SEMINAL FLUID. 
255 
was such that it was quite impossible for the penis to 
enter the vagina. At first there were frequent inter- 
missions during which the parts were straightened out, 
but eventually they become permanently contracted 
and pressed forcibly against the abdomen, rendering 
sexual intercourse a physical impossibility. 
Tumors of the neighboring parts might act in a simi- 
lar manner, as would also extensive elephantiasis of the 
scrotum. 
Excessive corpulency, as it affects desire and power, 
has already been considered, but it still remains for me 
to notice it so far as it presents a physical impediment 
to sexual intercourse. It is obvious that with men of 
very enormous abdomens intercourse is impossible. 
In speaking of this subject Roubaud * says: “The 
sense of propriety and of morality seems to revolt 
against medical prescriptions on the subject, and in 
justification I must support myself by the authority of 
Lisfranc. ‘ We can,’ he says, ‘ to make things easy for 
married people, permit the positions which are most 
agreeable. Religion does not interpose when the ob- 
ject in view is the multiplication of the species. It is 
more contrary to the spirit of the dogmas of religion 
to enjoy sterile pleasures than to seek to render them 
fruitful by means which nature and the instinct of all 
animals indicates. I am not to be understood as re- 
commending to married people those postures invented 
* Op. cit. 205. 256 
SEXUAL IMPOTENCE IN THE MALE. 
by the most ungovernable debauchery and libertinage, 
which, so far from curing sterility, cause this con- 
dition. Let those deceitful attitudes which seem to 
offer the image of pleasure to corrupt and withered 
hearts, remain in the places where love has never 
entered without horror ; in those places, where pleas- 
ure is a monster to which sacrifices are made, with the 
transports of madness. Hymen, more anxious to give 
energy to pleasure than to multiply the sacrifices 
which are demanded, banishes from his mysteries 
everything that can give umbrage to modesty and 
decency—for they are one, whatever the cynic may say. 
Every position that tends to take away from pleas- 
ure the fruits that belong to it is contrary to natural 
laws, and every one which diminishes the obstacles to 
conception ought to be advised in those cases that 
require them.* 
This appears to me to be sound coctrine and at the 
same time in accordance not only with the laws of 
nature but with those of common sense and propriety. 
Physicians are sometimes consulted in regard to this 
matter, and it is well that they should be prepared to 
give advice which is in accordance with physiology 
and decency. Undoubtedly all positions other than 
that which appears to be instinctive in man, are inimi- 
cal to fertility, but if that posture be impossible by 
means of physical impediments it is strictly in accord- 
* “ De 1 Homme et de la Femme Consid6r6s Physiquement dans l’Etat 
de Mariage.” 1784, t. i. p. 3S9. NON-EJACULATION OF THE SEMINAL FLUID. 
257 
ance with science to assume that which is least re- 
moved from the one which propriety and nature indi- 
cate when they are free to choose. 
At the same time, it appears proper to point out that 
some of the attitudes assumed during the act of inter- 
course are in the highest degree injurious as liable to 
induce diseases of great severity. In regard to this 
point the citation of a few authorities will perhaps give 
additional weight to this statement. 
MM. Grimaud de Caux and Martin Saint-Ange,* in 
regard to the subject, say : 
“ The generative act absorbs all the physical and 
moral faculties ; it is that in which nature expends the 
greatest possible amount of vitality and innervation ; it 
is a transitory convulsion, a short accession of epilepsy, 
which for the moment overpowers all the muscular 
forces. Consequently it is dangerous to indulge, with- 
out taking into account all individual conditions of 
time, circumstance, and even of place and position. 
“ Let us see what the treatises on physiology tell us 
in regard to the muscular power put in action in order 
to keep an individual in the erect posture. First, 
there is the head, which by its weight tends to fall for- 
ward. It is necessary to restrain it by attaching mus- 
cles to its posterior part. Then there is the vertebral 
column, which, besides carrying the head, supports 
also the chest and abdomen. These organs, like the 
head, tend to fall forward, and so are held in position 
*“ Histoire de la Generation de l’Homme,” etc. Paris, 1847, p. 257. 258 
SEXUAL IMPOTENCE IN THE MALE. 
by the vertebral column. Muscles, the most powerful 
in the whole range of animal mechanics, occupy the 
posterior and inferior part of the trunk to oppose this 
tendency, and there is, besides, the pelvis, which, in 
dition to the weight of its own organs, carries also that 
of the vertebral column and the head, and which, with 
all its burden, has no other points of support than the two 
round heads of the femurs inserted into corresponding 
round cavities. The situation is manifestly precarious, 
for the relations of these cavities with the heads of 
the bones are such as to render every movement easy 
of execution. We perceive, then, that the trunk is only 
maintained in the erect attitude by the observance of a 
perfect equilibrium, and this equilibrium is the result of 
the combination of a great number of muscular actions. 
If the power which acts on the anterior part were to 
yield, the vertebral column would at once fall back- 
ward, and a like movement would be made to the front 
if the posterior actions were to to fail. It is not neces- 
sary to pursue further the exposition of the system of 
animal mechanics: what we have said is sufficient for 
our object. It will be readily seen that to maintain 
the erect position the co-ordinate action of a great 
number of muscles is necessary, and that the failure of 
any one of them would inevitably lead to a fall. It is 
therefore a matter of great imprudence to exercise, 
while in this positions a function which so materially 
depresses the muscular strength as does the act of sex- 
ual intercourse. NON-EJACULATION OF THE SEMINAL FLUID. 
259 
“The sitting posture presents inconveniences less 
numerous but quite as real and as serious. In the hor- 
izontal position, on the contrary, there is no muscular 
effort, the body rests in its entire weight on the plain 
which supports it, and it is this attitude which should 
be preferred in sexual intercourse. To resume : the 
act of generation is one in which all the forces tend 
towards a single aim, and the recumbent posture is the 
most favorable, by reason of the fact that it diverts no 
muscular strength and imposes no muscular fatigue.” 
Sanctorius,* who, notwithstanding the fact of his 
holding many absurd notions, enunciated many sound 
ideas, says: 
“The use of coition after meat, and standing is 
doubtful. After meat it diverts the offices of the en- 
trails; standing it diverts the muscles and diminishes 
their beneficial perspiration.” 
Tissotf makes the following observations in regard 
to this subject: 
“ An able surgeon spoke to me one day of a man 
who indulged in a singular taste, and who worshipped 
those daughters of Venus who belong to the lowest 
strata of life, only when he could approach them in the 
street corners and then in a standing posture. The 
patient became greatly debilitated, had severe pains in 
*“Medicina Statica; or, Rules of Health,” etc. Englished by J. D., 
London, 1676. Aphorism, xl. p. 154. 
f “ L’onanisme: Dissertation sur les Maladies produites par la mastur- 
bation.” Paris, 1805, p. 88. 260 
SEXUAL IMPOTENCE IN.THE MALE. 
the regions of the kidneys, and atrophy, or wasting of 
the thighs and legs, and paralysis of these parts. 
These phenomena appeared to be due to the attitude 
assumed in his acts of sexual intercourse. He died 
after having been confined to bed for six months, and 
in a condition equally calculated to inspire pity and 
fright. . . . 
“ When an individual loses his forces by two chan- 
nels at the same time the weakness is very much in- 
creased. A person who is standing or sitting has need 
in order to maintain himself in these positions, espe- 
cially the first, to make use of a great many muscles, 
and this lessens the animal spirits. Weak persons, who 
cannot stand erect for an instant without experiencing 
fatigue, sick persons who cannot even sit without ex- 
periencing the same result, prove this beyond a doubt. 
In lying, no expenditure of strength is necessary. It is 
very certain that the act of sexual intercourse per- 
formed in either of the first-named postures will cause 
much more exhaustion than when the attitude is that 
of lying at full length.” 
Relative to the special effects produced by the stand- 
ing position in sexual intercourse, Morgagni,* Gaul- 
thier de Claubry,f Leudet4 and Ollivier (d’Angers) § 
* Opera. Ep. 62. 
f Journal de la SocidtJ M/dicale de Paris. 
% “ Recherches cliniques sur la congestion de la moele 6pini&re & la 
suite d’efforts violentes.” Archives gtlndrales de Medicine, Mars, 1863. 
§ “ Trait6 des maladies de la moele 6pini6re,” etc. Troisidme edition, 
Paris, 1837, t. ii. obs. lxxiii. p. 44. NON-EJACULATION OF THE SEMINAL FLUID. 
261 
have expressed themselves with decision, and the latter 
gives the case of a man who was excessive in the matter 
of sexual indulgence, during which he always assumed 
the erect posture. Since two months, observing that 
he was injuring himself, he became more moderate, but 
still continued the same fatiguing posture. As a con- 
sequence, he was affected with congestion of the spinal 
cord, with its ordinary concomitants of paralysis of the 
lower extremities, lumbar pains, etc. 
Carre * assigns the factor in question as one of the 
causes of locomotor ataxia, when he says: 
“ Excess in venereal indulgence, especially in the ver- 
tical position, acts in the same manner [causing conges- 
tion of the cord, as the first step towards locomotor 
ataxia]. In the horizontal position, on the contrary, the 
flow of blood is more easy, and the effect less marked.” 
In my own experience I have known, several times, 
serious results to follow the constant use of the position 
in question during sexual intercourse. In one of these 
instances the patient, an elderly gentleman, who had 
long been addicted to the employment of the erect 
posture in his amatory indulgences, was, on one ocr 
casion (and, I may add, the last), seized with a violent 
tremor in both lower extremities at the occurrence of 
the orgasm, and this continued, without intermission, 
for forty-eight hours. At the end of that time he ascer- 
tained that his lower extremities were semi-paralyzed, 
* “ Nouvelles recherches sur l’ataxie locomotrice,” etc. Paris, 1865. 
p. 257. 262 
SEXUAL IMPOTENCE IN THE MALE. 
and that he had lost all sexual power. Under the use 
of strychnia he recovered to a great extent the use of 
his limbs, but he has never been able to have intercourse 
since. 
In another case the patient, who had never before 
adopted that posture, was induced to do so by a rather 
lascivious woman with whom he was cohabiting. The 
effect was a sudden loss of power in both lower extrem- 
ities, syncope, lasting several minutes, and on recovery 
from this, a partial paralysis of both lower extremities 
with incontinence of urine, owing to insufficiency of the 
sphincter of the bladder. In the course of a few weeks 
recovery took place under the use of electricity and 
strychnia, except as regarded the bladder, the sphincter 
of which still, after five years, remains weak. 
From these remarks it will be seen that though we 
are justified in recommending or sanctioning any pos- 
ture in sexual intercourse which bodily peculiarities 
may render necessary for the accomplishment of the 
act of procreating the species, yet, that all changes from 
the position that physiology teaches is most suitable for 
the purpose are made with risk, and that all such devia. 
tions are otherwise not to be countenanced. INABILITY TO EXPERIENCE PLEASURE. 
263 
CHAPTER IV. 
ABSENCE OF THE ABILITY TO EXPERIENCE PLEASURE 
DURING THE ACT OF COPULATION AND DURING THE 
EMISSION OF THE SEMEN. 
The essential parts of an act of sexual intercourse are 
the emission of semen and the experiencing of a sensa- 
tion of physical pleasure for a short period before the 
ejaculation takes place, during its continuance, and for 
a short time after its cessation. This sensation, origin- 
ating in the glans penis, is not confined to that part of 
the body, but extends to the neighboring regions, and 
in some persons is felt as a voluptuous thrill through 
the spine and upper and lower extremities. But for 
the experience of these voluptuous sensations, which 
the average adult man acquires, it is quite certain that 
he would abstain, to a great extent, if not altogether, 
from sexual intercourse. But it sometimes happens 
that, while the desires are in general strong and the 
sexual power all that can be desired, there is a deficiency 
of pleasurable feeling attendant on the ejaculation of 
the semen, and that at times there is a complete absence 
of such feeling. This may be either relative or absolute ; 
that is, it may exist only as regards some particular 
woman or women, or it may be a permanent condition 
present at all times of sexual intercourse and with all 
women. 264 
SEXUAL IMPOTENCE IN THE MALE. 
It is undoubtedly true that with most men the vol- 
uptuous feelings experienced during sexual intercourse 
vary greatly in accordance with the degree of eager- 
ness with which any particular act may be approached. 
If the individual is impelled by the emotion of love the 
pleasure is infinitely greater than when he is actuated 
by a mere animal feeling, such as he might experience 
for a prostitute, or when doing the duties of the mar- 
riage-bed from a sense of obligation from which he 
would gladly be relieved. In the one case there is 
desire stimulated by love, and, as a consequence, all the 
physiological phenomena of the procreative act are of 
the most exalted kind ; in the other there is sexual in- 
difference, and the legitimate result is not only a mini- 
mum of pleasure, but also a diminution of the other ac- 
companiments of copulation. 
For this condition there is, of course, no remedy 
which the physician can apply. In fact it is not in any 
respect pathological, and though patients often consult 
us in cases of this kind, ignorant of the physiology of 
the subject, the functions of the medical adviser are 
fulfilled when he gives them a little instruction in regard 
to the laws of their being and some advice relative to 
the influence that might be exerted through the emotion 
of love. The matter, in fact, is one which is entirely 
within the control of the patient, unless, indeed, there 
be some other manifestation than deficiency of pleasure. 
But in the other kind, that in which there is deficient 
pleasure under all circumstances of love or variety, the INABILITY TO EXPERIENCE PLEASURE. 
265 
state is abnormal, and is a proper instance for medical 
intervention. In cases of the kind the patient is actu- 
ated by affection as well as by animal passion, the desire 
is powerful, the erections are vigorous, and yet the 
orgasm, perfect in all other respects, causes little or no 
pleasure. The condition is analogous to loss or impair- 
ment of the sense of taste. In such instances the tactile 
sensibility of the tongue is unaffected, but the gustatory 
faculty is lessened or abolished. In the other category 
of cases the sensibility of the glans to friction is un- 
diminished, but, either the nerves, which are concerned 
in the transmission of the pleasurable sensations, have 
had their impressionability obtunded or there is some 
derangement of the nerve centre in relation with these 
nerves. In other words, the trouble is either in the 
penis or it is in the brain. 
Now, as regards the ordinary sensibility of the glans, 
and its capacity for being excited by friction, there is, 
as I have said, in these cases, no derangement. It is 
probable that the centre for this action resides in the 
spinal cord, and that the centres for erection and 
excitability by ideation, as well as that for pleasure, 
reside in the cerebral cortex. For the due physiological 
functionation of this centre, two anatomical points must 
be in a normal condition: the nerves in which the sen- 
sation originates, and by which it is transmitted to the 
brain, and the cortical centre by which it is received 
and appreciated. If either of these be diseased or tem- 266 
SEXUAL IMPOTENCE IN THE MALE. 
porarily deranged, the function will be correspondingly 
impaired. 
The actions of certain drugs afford us valuable in- 
formation in regard to the subject. Thus, cantharides 
may produce priapism and strong desire, sometimes 
reaching to the extent of veritable insanity, and yet the 
pleasure derived from the sexual act, or that of mastur- 
bation, is very slight, and often is not experienced at 
all. In other cases, it excites priapism, without either 
desire for the act of intercourse, or pleasure during its 
performance. Thus, Stille * quotes Dieu to the effect 
that, while in twenty-five cases in which the drug was 
administered, priapism was a constant occurrence, and 
sexual desire was very rare, in a case of poisoning by 
this drug, in a man, which came to my knowledge, 
though the patient was not under my charge, it was 
stated, that while the individual had intercourse with 
his wife thirty-one times in a single night, besides 
masturbating frequently, there was intense desire and 
permanent priapism, though there was entire absence 
of pleasure. 
Again, in priapism due to central disease, there is 
often a tendency to sexual intercourse, toward which 
the individual feels impelled, but from which he derives 
no pleasure. In a previous chapter, I have cited a case 
from Lallemand to this effect, and there are many 
others that could be adduced. 
* Therapeutics and Materia Medica. Philadelphia, 1864, vol. i. p. 355. INABILITY TO EXPERIENCE PLEASURE. 
267 
It is seen, therefore, that the centres for erection are 
different from those for pleasure, and that there is, 
probably, a special set of nerve-fibres in the glans, and 
other parts of the penis, whose function it is to be ex- 
cited to the point of causing them to transmit pleasura- 
ble sensations to the brain. 
When proceeding from a centric cause, the loss of 
pleasure during sexual intercourse is unaccompanied by 
other abnormal phenomena, and when there is no feel- 
ing of satiety, indifference or disgust, it is almost always 
attended by certain symptoms of disordered brain- 
action. Cases of the kind usually occur in men who 
have severely overtaxed their brains, and who, in con- 
sequence, are less impressionable than when in a 
normal state. The same persons, frequently, do not 
appreciate the flavor of different articles of food ; they 
complain that “ things do not taste to them as they 
did they may even lose the appreciation of things of 
beauty which once would have infallibly delighted them, 
and music no longer gives them pleasure. These are 
the indications of an exhausted brain, and there are 
others of a more local character, such as pain in the 
head, vertigo, and an inability to concentrate the mind, 
which are generally present. 
Such cases require moderate sexual indulgence, a 
cessation of the excessive mental work, in which the 
patient is engaged, and a mode of life calculated to give 
the brain a change from the labor to which it has be- 
come habituated. At the same time, medical treatment 268 
SEXUAL IMPOTENCE IN THE MALE. 
will generally be of very decided service, and this 
should consist mainly of cod-liver oil, strychnia, iron 
and quinine. The strychnia may be advantageously 
given according to either of the formulae already 
specified, and in gradually increasing doses, up to the 
twenty-fourth or twentieth of a grain. The other 
remedies have nothing special about their administra- 
tion. 
The diet ought to be full and nutritious, animal food 
forming a considerable proportion of it, and a glass or 
two of Bordeaux or Burgundy at dinner will generally 
prove of service. Moderate physical exercise cannot 
be dispensed with. It is very certain that sedentary 
pursuits interfere materially with the development of 
pleasurable sensations during sexual intercourse, main- 
ly, probably, for the reason that such work is chiefly of 
a mental character. On the other hand, excessive bodi- 
ly exertion is still more prejudicial to the production of 
the full physiological feeling. I have had gentlemen 
addicted to severe athletic exercises tell me, that one of 
the results was the decided diminution of the voluptu- 
ous sensations of copulation. The element of fatigue, 
mental or physical, is antagonistic to sexual enjoy- 
ment. 
Again, there are cases in which mental pre-occupa- 
tion is fully as efficacious in destroying pleasure, as we 
have already seen that it is, in abolishing desire and 
power. If there are engrossing subjects engaging the 
attention, other than that which ought to be promin INABILITY TO EXPERIENCE PLEASURE. 
269 
ently in the mind of the individual, it is very certain that 
the pleasure of the act will be at its minimum. 
In the other form of the affection, the seat appears to 
be in the penis. The desire is strong, the power suffi- 
cient, the mind is in concurrence, the emission and the 
orgasm occur, and yet there is scarcely the vestige of a 
voluptuous sensation. Instances of the kind are quite 
common and they are most apt to be met with in those 
who have been excessive in sexual indulgenge. That 
this is a cause can be readily ascertained by question- 
ing those persons who have had repeated connections 
in the course of a single night, or other short period of 
time. The information is invariably given, that, though 
the pleasurable feeling was great during the first act, 
it gradually became less, till, after half a dozen or more, 
there was no longer the slightest degree of enjoyment 
.accompanying the performance. 
Again, it is a normal circumstance, that, as the indi- 
vidual advances in life, after he passes about the forty- 
fifth or fiftieth year, the sensibility of the nerves of the 
glans becomes blunted, and the pleasure of the act of 
sexual intercourse is, accordingly, correspondingly 
lessened. Physicians are constantly consulted in re- 
gard to these cases, by men who cannot be satisfied 
with the condition, though it is as natural as gray hair 
or a wrinkled face. Nothing, so far as I know, can be 
done to restore the sensibility of youth. 
And there are persons in whom the voluptuous sen- 
sations ordinarily experienced, are inherently deficient. 270 
SEXUAL IMPOTENCE IN THE MALE. 
They are, for the most part, individuals who have not 
only been chaste in act, but also in thought. For such, 
time and opportunity will be all that are necessary to 
develop the feeling to its normal standard. But for 
those who cannot allege chastity as the cause, the pros- 
pect of relief is not so promising. These subjects 
appear to be analogous to those who are blind to cer- 
tain colors, deaf to certain sounds, or whose gustatory 
nerves cannot appreciate certain flavors, or whose 
olfactory nerves cannot distinguish certain odors. I 
have only met with one such case, and, I presume, they 
are exceedingly rare. 
The instance in question was that of a gentleman 
about thirty years of age, a manufacturer of silver- 
ware, and in excellent health. In his youth he had 
never masturbated, though he had had repeated emis- 
sions during sleep. At the age of twenty-five, he mar- 
ried a healthy and vigorous lady five years his junior, 
to whom he was much attached. On his wedding- 
night, he had intercourse which was characterized 
by an emission, attended with the ordinary convulsive 
movements, but without the least sensation of pleasure. 
In the morning, feeling a strong desire, and having a 
vigorous erection, he again had connection, but again 
there was no pleasure. There was, he said, a cer- 
tain degree of mental satisfaction almost amounting 
to positive enjoyment on both occasions, but not the 
slightest feeling in the glans or in any other part of the 
body. INABILITY TO EXPERIENCE PLEASURE. 
271 
Previous to his marriage he had never had sexual 
intercourse, although he was frequently visited by 
strong desires and erections. A high sense of morality 
restrained him from any illicit indulgence. About 
once in ten days he had had an emission at night, but 
though he always awoke at the time, he had never been 
conscious of any pleasurable feeling attendant on the 
orgasm. 
He had frequently heard the sexual act spoken of as 
one attended with very intense pleasure, and hence 
upon his marriage he had to admit a certain degree of 
disappointment. So far as his wife was concerned 
everything was satisfactory. The trouble, he was con- 
vinced, resided entirely with himself. 
It was about six months after his marriage that he 
consulted me. His wife was then far advanced in 
pregnancy, so that there could be no question in regard 
to his sexual ability. On examination I could detect 
no sign of disease or derangement in any part of the 
sexual apparatus. The glans appeared to be endowed 
with the normal degree of tactile sensibility and sensi- 
bility to heat and pain. It was only the sensibility to 
venereal excitement that was absent. 
I advised electricity—galvanism—applied daily to the 
glans by means of a wet sponge, and also faradism 
through the medium of water. But after six months’ 
use of these agents there was no improvement, and he 
discontinued them. Several years have now elapsed. 
He has three children, but he tells me that never once 272 
SEXUAL IMPOTENCE IN THE MALE. 
has sexual intercourse given him any more pleasure 
than the feeling of bien aise, of which he formerly 
spoke. 
I am inclined to think that the operation of circum- 
cision, when performed in early life, generally lessens 
the voluptuous sensations of sexual intercourse, and 
that even when done in later years the same result 
sometimes follows. In regard to the former point it is 
almost impossible to arrive at positive conclusions, ow- 
ing to the want of a fixed standard. It is something 
like the question which some two or three hundred 
years ago agitated medical philosophers; that is, 
whether the man or the woman had the more pleasure in 
the act of sexual intercourse ? After wasting elaborate 
arguments on one side and the other, the problem re- 
mained as undetermined as ever, and it always must be 
unsolvable, unless we can be men and women alternate- 
ly. 
But the information afforded us by some who have 
been circumcised soon after puberty, and who have 
subsequently indulged in sexual intercourse, is to the 
effect that when there had been a possibility of uncover- 
ing the glans during intercourse, the operation had very 
decidedly diminished the voluptuous feelings afterward 
experienced. In the cases where there had been no 
possibility of retracting the prepuce, the operation has 
not only increased the pleasure, but has in some cases 
developed it from nothing. 
I believe that nature intended the glans to be habitually INABILITY TO EXPERIENCE PLEASURE. 
273 
nearly covered by the prepuce when the penis is in a 
non-erect state, and that this is necessary for the preser- 
vation of the full degree of sensibility of the glans, and 
that circumcision, by allowing the glans to be con- 
stantly exposed to the atmosphere and to friction 
from the clothing, has the effect of toughening the 
delicate membrane covering it and of diminishing its 
sensibility. It acts just as exposure to all kinds of 
weather and hard manual labor do on hands that have 
hitherto been kept gloved, and which have done no 
work. The skin is rendered thick and rough and the 
tactile sensibility of the fingers is greatly lessened. 
The ends of the fingers of a man who has never done 
any hard work will distinguish the two points of an 
assthesiometer at less than of an inch apart, while 
those of a bricklayer, for instance, can not feel the two 
points at double that distance. 
Extreme narrowness of the prepuce, by which there 
exists an impossibility of uncovering the glans, is an 
effectual bar to the pleasure of sexual intercourse. 
For this condition, an operation, either of circumcision 
or of slitting up the prepuce, removes the difficulty, 
and in a short time the sensibility of the glans, if not 
always existing, is developed to its normal extent. 
I have seen one case of insensibility of the glans 
which was apparently the result of frequent and long- 
continued immersion in the sea. The patient was a 
Jewish gentleman, and one summer, while residing at 
the sea shore, it was his habit, to take three baths in the 274 
SEXUAL IMPOTENCE IN THE MALE. 
ocean each day, remaining in the water about an hour 
each time. Whether this was the cause of his partial 
impotence from insensibility of the glans, which came 
on gradually before the summer was over, may admit 
of some question, but the relation of cause and effect 
seems probable. By keeping the glans enclosed in the 
end of a condom, having previously lubricated it well 
with vaseline, the sensibility was restored in the course 
of a couple of months.