A much more frequent cause of permanent aspermatism is found in the diseases of the prostate gland. All the affections of the prostate have this in common, that they e,ause a high degree of stenosis or atresia of the two ejaculatory ducts, and thereby may prevent the entrance of the sperma into the urethra. The various tumors of the prostate do not so much come into consideration here, for these only make their appearance in advanced age, running a rather rapid course. Moreover, the matter of sterility scarcely is considered at all on account of the presence of other troubles. The same facts are true of hypertrophy of the prostate. But on the other hand cases of congenital hyperplasis; of the organ have been recognized a,s causes of sterility of the male. The most frequent causes probably are the inflammations of the prostata and of its ducts. These may, either directly or by an abscess formation, bring about an atrophy of the prostate gland with consequent occlusion or stenosis of the ejacula tory ducts. Calcifications within the substance of the organ, as a rule, also a consequence of inflammation, may bring about a similar result. Furthermore traumatism, operative interferences (lithotomy) etc., may cause changes in the tissue of the prostate, and in this way the termina tions of the seminal ducts may become impassable. Then there are the inflammations of the seminal ducts themselves, which still more frequently than prostatitis are of gonorrhceal origin. If the two ejaculatory ducts are especially affected in this way, there may be produced stenoses or occlusions with retention of seminal fluid as a consequence. Inflamma tions of the seminal vesicles alone are not sufficient to cause aspermatism. For this reason Roubaud is not justified in considering a failure of proper conservation of the sperma in these structures, to be a particular kind of sterility. But inasmuch as with an inflammatory affection of them, the ejaculatory duct is as a rule also involved, there may be a lack of seminal fluid when they are diseased.
If the obstruction haa its seat further back toward the testicles, viz., over the confluence of the seminal vesicles, there may result an ejacula tion of fluid during cohabitation. It may even be rather copious, but it is only the secretion of the accessory glands (seminal vesicles and pros tate), which is entirely devoid of the active piineiple of the semen, namely the spermatozoa. This condition forms the transition, or perhaps be longs properly to the following anomaly, the so-called azoospermia.
This name implies that functional disturbance of the male genitals, with which sexual excitement, erection, and cohabitation regularly takes place, and even, contrary to'aspermatism, a semen-like fluid is ejaculated into the vagina, but this fluid lacks the most important thing, the sper matozoa. The secretion that is discharged is much more fluid than nor mal semen; but it retains the characteristic odor and also the peculiar crystals, for these two properties depend not upon the secretion of the testicles, but upon that of the prostate. A microscopie,a1 examination will show masses of detritus and those well-known sperms crystals, but no trace of spermatozoa.
This anomaly in the majority of cases is of a permanent character, and seems much more rarely to exist as a temporary suffering. This
permanent, absolute azoospermia may be produced by mechanical ob structions which render the discharge of spermatozoa into the urethra impossible, though these may have been properly formed in the testicles, but which do not prevent the evacuation of the secretion of the seminal vesicles and prostate. This will occur when the occlusion of the seminal canal is beyond the prostate, between it and the testicles. It is further more necessary that this defect should exist on both sides. Now this ob struction may. consist in an imperfect development or a complete absence of the seminal duct and epididymis, a failure in development which, how ever, is very rarely observed. A very frequent condition, on the other hand, is an acquired stenosis of high degree or a complete atresia of the seminal ducts; both of these conditions again may frequently be the result of gonorrhceal infection. A still more frequent cause of the interruption of the seminal canal is a bi-lateral epididymitis, produced by extension of a gonorrhcea, followed by a shrinking of the epididymis. In like manner an inflammation of the spermatic cord of similar origin may render the seminal ducts impassable.
Various processes taking place in the testicles, which finally lead to an atrophy of these organs, such a8 certain general diseases, severe injuries of the brain and spinal cord, troubles of the central nervous system affect ing the centres presiding over the function of the testicles, chronic iodine poisoning, may lead to azoospermia as well as to aspermatism, but before they do this, impotence has generally occurred. The cases, therefore, in which these two disturbances concur are, by reason of chronological priority, better classified with impotence.
It may well be doubted that the lack of spermatozoa in the case of men otherwise potent should depend simply upon an occlusion of the seminal organs. The anatomical researches of Gosslin, the experiments on a.nimals by A. Cooper, Curling, and lately by Kehrer, show especially that the occlusion of the vas deferens causes a collection of the sperms, and thereby a dilatation of the seminal canal and of its branches far back into the testicle, leading finally, just like occlusion of the ducts of other glands, to atrophy of the testicle. Ligations of the spermatic c,ord also bring about degeneration of the testicle, though in a somewhat different man.ner. That Brissaud's assertion of the opposite is untenable is shown hy the way in which castration of certain domestic animals is performed, for all these methods lead to an atrophy of the testicle by a compression or cutting of the spermatic cord. Though the atrophy proceeds slowly, yet it seems finally to result without exception. But with such a change in the testicles, a continuance of regular cohabitation cannot take place; it would, therefore, be impossible that men who suffer from azoospermia could continue to have coition for years, and even tens of years; for the atrophy of the testicle dependent upon the occlusion of the seminal ducts would have produced impotence in a much shorter time.