Another group comprises those e,ases in which, on account of absence or imperfect development of the penis, there cannot be any efficient sexual congress with the female at all. Complete absence of the penis, with a body normal in other respects, occurs very rarely as a congenital affection; more frequently there occurs a rudimentary formation, the penis being replaced by a body resembling a button, which, even under sexual exci tation, takes on such slight dimensions that cohabitation is not possible. When absence of the penis is acquired by amputation, mutilation, gan grene, etc., much depends upon the size of the stump that remains. When the rudiment is still considerable and the opening is normal, there is still a possibility of the stump entering the female genitals. It must be emphasized that a glans penis is not at all necessary for this purpose, as is proved by many a case of congenital or acquired defect of that part of the penis.
It is known that a considerable number of diseases can diminish or abolish a man's potency. The genitals at the same time are normal, at least in the beginning, and have heretofore performed their functions in a regular manner. These diseases are mostly of a chronic nature, and are combined with more or less prostration. With most of these disturb ances of course potency or impotence does not come into consideration, but it does An a number of others where great weakness in the sexual re lations or even entire impotence occurs early, sometimes even before the other symptoms of the disease are pronounced. IIere the general weak ness produced by the disease cannot be considered the cause of the im potence, but the disease itaelf directly exerts an unfavorable influence upon the centre of generation. In the first instance certain diseases of the central nervous system are to be mentioned. With spinal meningitis as well as with chronic myelitis the sexual activity is as a rule depressed, but this is not constant, and often does not oe,eur until a later stage. Much more constantly impotence occurs with tabes dorsalis, often very early, but in the beginning sometimes alternating with periods of sexual excitement, which soon, however, disappears entirely. Sometimes sex ual power remains very long. Thus a woman in my practice, whom I de livered artificially, because of placenta prrevia, had to be persuaded by the clergy to desist from a suit of divorce from her husband. The complaint was founded upon satyriastical tendencies of the husband, who had long exhibited exquisite symptoms of tabes. These rases, however, are rare
exception& The explanation of this impotence is very easy; either the lower part of the spinal cord in which the centre of the function of gener ation mast be sought is itself affected, or else the upper part of the central nervous system being diseased, exerts the inhibitory influence already mentioned. Impotence is also observed with certain diseases of the diges tive tract—perluips the influence here exerted is rather of a psychical nature. being brought about by consecutive hypochondriacal conditions. Diseabes of the kidneys, especially chronic Bright's disease, have similar consequences. The best known is the influence of diabetes mellitus upon the sexual organs. Almost always impotence is at first the only symptom. Very rarely sexual desire is preserved for a long time, sometimes it is even slightly increased. The physiological explanation of this influence is not easy. A large number of articles of diet aud drugs are said to have an influence upon sexual activity. Of course we now refer to a prolonged use of them, a chronic intoxication. Thus the abuse of alcohol, chronic lead poisoning, prolonged stay in the vapors of antimony and arsenic, prolonged use of preparations of iodine, are said, according to the views of many toxicologists and. the experiences of many prominent physicians, to diminish the potency of the male, but this does not occur with all in dividuals without exception. In the case of other impotent men other causes are often to be found, so that these substances act rather as auxilia ries. Besides these a similar efficacy is ascribed to camphor, bromide of potassium, and lupulin, whether justly so is not yet certain; at present they have the reputation of acting as soothing agents in sexual irritation. Perhaps this is the explanation of their reputation as agents in producing impotence. The same effect is ascribed to the various narccrtics; at pres ent this has only been proved of morphine, for according to the latest ex periences, sexual activity seems to be greatly depressed or entirely abol ished by the opium habit. (Levinstein.) All these agents seem to exert their unfavorable influence directly upon the centre of generation, but a direct influence upon the organs of generation must also be admitted; thus in alcoholic subjects there may occur a degeneration of the testicles, Ihich alone can produce impotence.