Following this group of causes of sterility that depend upon organic defects of the sexual organs, or other diseases and disturbances of the organism, there is a category of cases that are perhaps still more impor tant in practice, viz., those who have become impotent through sexual excesties.
In the highest development of this condition, a complete paralysis of sexual activity exists. Even the strongest irritations exerted upon the centre of sexual activity are not capable of bringing about an erection of the penis. Along with this disturbance in the nerve tract, which pro ceeds from the centre to the genitals, there is also an alteration of the centre itself, which no longer reacts to irritation conveyed by the organs of sense or by the mind itself; sexual desire itself is entirely abolished. But if this is not the consequence, if sexual desire remains, the patient be ing unable to satisfy it by regular cbhabitation, seeks to do so in another, a so-called unnatural way; then arise those strange, repulsive vices and excesses, which in many cases are to be considered as the result of a dis turbed actiyity of the mind. This total inability of producing erections in spite of the existence of sexual desire—furthermore, the complete want of sexual impulse, and also the stated perversions of the latter—may, though rarely, occur as congenital defects; they may also be symptoms of certain psychical disturbances, but in the great majority of cases they arise from long-continued intense abuse of the genitals. Here masturba tion plays the principal rdle. It exerts the most weakening influence, because it is practised very early, at a time when the genitals have not yet reached their proper development, also because it is very easy to in dulge in it, and because it requires great strength of will to shake off the habit. The satisfaction of the sexual instinct in a natural way, however, may also have the same consequences when it is sought excessively at a. very youthful age.
Very often, however, other excesses are combined with too frequent coition, and assist in bringing about impotence. Not infrequently indi viduals who have already been so weakened by excess in venery that erections no longer take place to a sufficient degree, give themselves up to masturbation, since by it the voluptuous feeling can still be excited even when the penis remains relaxed. In this highest degree of sexual weakness the impotence is lasting, and there is no possibility of a return to normal function.
Next to this highest degree of impotentia paralytics of writers, there are many intermediate steps down to a weakened but still sufficient potency for fertility in marriage. Thus after long and intense irrita tion, there may be a slight erection of short duration; others may have an insufficient erection and no ejaculation; with still others there is an outflow of semen, but before the weakly erect member has been intro duced into the female genitals. All these lesser degrees belong to impo tence from so-called irritable weakness.
Next to this group of causes of sterility, which mainly depend upon great abuse of the sexual organs, we have another form of impotence called psychical impotence. The characteristic of this form consists in the fart that it is brought about mainly in a psychical way. It proves, after exclusion of severe bodily lesions, to be chiefly a functional disturb ance of the organs of generation, in consequence of which there is either no erection at all, or one of so short duration and so incomplete as to be insuffecient for the regular performance of coition.
This form of impotence not infrequently developes upon a soil weak • ened by semi' excesses, that alone would not be sufficient to depress potency down to paralysis, if psychical influences were not superadded. Explanations of the true nature of excesses, especially of masturbation and its consequences, earnest remonstrances and lectures concerning the sexual excesses, the reading of popular literature, that portray the dis grace and harmfulness of the vices in question in too vivid colors, may exert so powerful an impression upon the mind that weakness already present may turn into a complete paralysis of the function of generation. With other patients again they are the first symptoms of the conditions of weakness caused by excesses (insufficient erection, headache, disturb ances of digestion, etc.), which conditions produce a psychical depression, perhaps of a hypochondriacal nature, and it is only by these depressions that complete impotence is brought about. That in the etiology of these forms the mind is the important factor is evident, for when these condi tions of the mind are partly or wholly removed, an improvement or entire cure may take place.