Whether a congenital permanent impotence, such as is seen in idiots, cretins, etc., can also occur with people whose bodies and genitals are otherwise well formed, is not yet quite certiiin, in spite of some accurately described cases. It is still possible that the testicles in such cases, though their form be otherwise intact, may be abnormal as to the structure of their parenchyma. Of the diseases of the epididymis and of the sper. matic cord, scarcely any except the acute and chronic inflammations, which may arise from the same causes as orchitis, need to be considered; these, when the testicle is intact, are less liable to produce impotence than sterility directly, by an absence of the seed elements proper, as has been described.
Of great importance are the diseases of the organs at the junction of the urinary and genital paths, viz., of the prostate, seminal vesicles, and ejaculatory ducts. Chronic inflammations of these parts, some having been produced gradually, others arising from acute processes, are not in frequently found among the impotent. Sometimes the site of the disease is confined to the pars prostatica urethrEe with the colliculus seminalis, that includes the mouths of the ejaculatory ducts. These affections, however, are not merely the consequences of a gonorrhce,a1 urethritis, but are ranch more frequently produced by great over-excitation of the geni tals (onanism, sexual excesses). This ailment, however, is not as a rule followed by impotence directly, but in the first place by involuntary seminal emissions in the form of pollutiones nocturnes et deurnes, which may be later followed by a true spermatorrhcea.. The impotence in this case may indeed be explained by an irritation starting from the diseased part, and exerted upon the centre of sexual function, the spermatorrhoea, however, by the flaccidity of the ejaculatory ducts that ensues, so that the sperma produced, or the secretion of the accessory glands, can empty itself spontaneously into the urethra. With these losses of semen there is almost always combined an inability of erection and consequently steril ity, the fluid that is poured out, at the same time, in the severe CMOS, con taining few or no spermatozoa, so that azoospermia is combined with this affection. The impotence, however, is not to be ascribed to a weakening of the organism in consequence of the loss of semen, but is to be regarded as the expression of an affection of the centres of sexual activity. The centripetal irritation is no longer responded to by the act of erection. But inasmuch as spermatorrhcea and impotence may often occur in consequence of sexual excesses, while an examination fails to show any such inflam matory affection of the prostatic portion of the urethra, and inasmuch as thii latter mode of origin of male sterility occurs much more frequently, the local affection upon which so much stress was formerly laid (LaRe mand and his school) has lost much of its significance as a cause of ste rility; in fact, according to the views of some, it is to be regarded merely as an assisting or even merely as a coexisting factor in the etiology of spermatorrluea and impotence. (Curschnumn.) Whereas the affections of the genitals, thus far considered, manifest themselves mainly by a want of erections, we now come to a number of defects that may prevent regular coitus in spite of engorgement of the corpora cavernosa. These are the various abnormalities of the penis itself. Traumata that affect the penis may bring about a tear in the corpora c,avernosa, with consequent hemorrhages. The indurations that
are formed during the healing process may cause such deformities of the penis that, when it is in the erect condition, it loses the shape and direc tion necessary for introduction into the vagina. In the case of inflamma tions also, if in the same situation, the callosities which arise may bring about the same result. But even an inflammation of the connective-tis sue coat of the corpora cavernosa, if it has reached a certain development, suffices to affect the form and position of the erect penis in a manlier un favorable for colusbitation. Here also must be mentioned those shorten ings of the frmnum which are either congenital or more frequently ac lamed by ulceration; cicatrization also influences the capability of the penis becoming erect, and the meatus urinarius is drawn in a direction unfavorable for the ejaculation of semen. All pathological 'formations that greatly increase the volume of the part may also prevent coitus, and lead to impotence. Among these may be included those cases where the eircurnference of the erect penis is so considerable that it cannot be in troduced on account of the great disproportion. These cases cannot be denied. The inability of introducing the largely developed penis into the vagina certainly occurs often enough, especially when the female genitals themselves are insufficiently developed and very resisting; but by force, and with increased practice and experience, the obstacle can certainly be overcome in time. Of the tumors of the penis, but few come into con sideration; in the case of the malignant ones their character excludes the question of sterility, and the benign tumors do not often increase the volume of the penis considerably. Diseases of the neighboring parts may also interfere with coition. Large cedemas of the scrotum, considerable hydroceles, may encircle the penis or lie close to it in such a manner that an introduction into the vagina becomes impossible. Then there is also tue condition in which the penis is connected with the scrotum, a dupli catare of skin joins the under surface of the penis to the scrotum. and prevents the regular erections. In a similar manner large irreducible scrotal hernim or elephantiasis of the scrotum may make sexual congress impossible. Another group of abnormalities of the penis comprises those cases in which erection takes place in the regular manner, the penis is properly introduced into the vagina, and sperma is ejaculated, but the latter, on account of certain deformities of the penis, is discharged out side of the ostium vaginas. These include those congenital or acquired lip.shaped urethral fistulm. If these are fairly large, and are situated pretty far back toward the scrotum, the sperms is not discharged through the anterior portion of the urethra into the vagina, but outside o! it through the fistula. The same thing takes place in the case of epi- and hypospadias, if the opening is near the root of the penis. In all these cases erection and cohabitation may be normal, but the semen is dis charged outside of the vagina. It is similarly the case in pseudo-herma phroditismus maseulinus externus. Here the penis is rudimentary and resembles a clitoris. By sexual irritation it may undergo an erection, it may even, if somewhat more developed, enter the female genitals, and coitus may be, though imperfectly, performed. But as in all these cases the urethra empties at the root of the penis, there can also, as in hypo spadias, be no discharge of semen into the vagina.