The matter is still worse in eases like two which I vividly recollect, where the females were young widows who had already tasted of the joys of happy marriages.
Nor are such men always quite impotent at t'ne time that they con tract marriage, but the continuous sexual excitement and the increased demands of a recent marriage are too much for them, and the remnants of potency soon disappear.
The prognosis is much better when there is only slight sexual weak ness, or what is known as excitable weakness, present. Here also, how ever, we cannot hope for a complete restitutio ad integrum; caution and good management will give a sufficiently strong procreative power.
Above all things prolonged continence is necessary; for we find that ex cessive onanists who have mastered their vice some time before marriage, can fulfill their sexual duties satisfactorily,while those whoc ontinue their venereal excesses during their engagement, can only practise cohabitation imperfectly. If circumstances permit, the couple should be separated, and travel, residence in mountain resorts, and sea-baths alone will cure milder cases. Hydropathy and electricity have made great claims in this direction, but I must refer the re,ader to works upon electro-therapy, since I have had no experience myself with them.
If seminal emissions are present, they demand special treatment, es pecially when there is any anatomical change of the genitals.
The medicine of the past had a large number of remedies for impo tence, and some of them very curious ones. Most have been thrown over board, though a number have been retained in spite of the nihilistic ten dency of therapeutics of late years. Among these are cantharides, nux, secale cornutum, and phosphorus. The reports upon them, though differing, are in general depreciatory. We are rightly reminded that some of them cause general disturbances when used for a long time; and others, like cantharides, cause local inflammations. Curschmann not incorrectly claims that any effect which they may have is only transitory, and leaves greater weakness behind. Still, a careful trial of them may be made in hopeless cases. I have myself used strychnine and arsenic, but without effect.
Kehrer has employed successfully a not ineffective method, where the seminal emission occurred too early. A specultun was introduced into the vagina, sexual excitement procured, and the ejaculated semen emptied into the instrument; conception occurred. This seems to be an excellent
method of artificial impregnation, in cases where ejaculation occurs too early, or an erection (=not properly be procured. In eases where the natural vaginal friction is insufficient to cause emission, A. Peyer em ploys a method common with those who have formerly been onanists. Erection and orgasm is caused manually, and the glans introduced int,o the vagina just before ejaculation occurs. Peyer saw conceptiou occur JLS a result.
, Our best cases for treatment, however, are those of psychic impotence, which can be remedied by the same moral means that caused them. The most favorable cases are those in which the husband hiui been virtuous before marria,ge, and from inexperience and want of skill has been unable to attain his object inwt ?alphas, and so has lost courage to renew the at tempt.. Here a little instruction as to the manner of accomplishing coi tus, with!' little encouragement, is all that is necessary. But there may also be slight obstacles on the part of the woman, and these also (see Vaginismus) should be treated. The same is true of moderate onamsts, especially when they have given up the habit some time ago. But some times not even the most solemn assurance upon the part of the physician suffices to banish the idea that some deeper-seated lesion is present. The hypochondriacal and melancholic condition persists, or soon returns after another futile attempt. Here nothing remains but to treat the case in the way detailed for cases of irritable weakness. • It is advisable not to make too favorable a prognosis in these cases, for the excitement of newly married life may have started into activity some mental trouble, the first symptoms of which lie in the sexual sphere.
Cases of so-called relative impotence are difficult to treat; there is usually some cause for distaste, either mental or bodily, in the woman. Ro,senthal reports a case where the man had to think of other women in order to provoke an erection, and it might be useful to teach the patient to do this before and during cohabitation, if possible.
Temporary impotence, on the other hand, is usually of very favorable prognosis. When the cause is removed, the evil disappears. But the proper regimen may not be always possible. And here also we should be cautious; impotence or diminished virile power is sometimes in these cases the first sign of some obscure malady.