IMPOTENCE.
Mechanical impediments to the sexual act should be met by appropriate surgical measures.
Functional causes supply the majority of the cases seeking advice, and many of these are in recently married individuals to whom much mischief may be done by the administration of drugs. The situation arises from ignorance and nervousness, and produces sometimes a dan gerous depression of spirits. The majority of cases of this nature right themselves in a short time if left alone, and all that is generally necessary is a little sound advice and no drugging. The stereotyped instruction to rigidly abstain for a time from all attempts at sexual intercourse is a mistake, unless under special circumstances; nature generally soon sets matters right. This is especially true in those cases where emission occurs before penetration has taken place, and then a successful coitus may take place when the act is attempted again a short time after failure. Moral treatment is all that is necessary in most cases where the incapacity is imaginary.
In paralytic cases where impotence arises from previous recent ex cesses, but where the generative organs have not apparently suffered structurally to any obvious extent, total abstinence from all attempts at intercourse must be rigidly advised till evidence is forthcoming that nature means to assert herself. During this period vigorous exercise, with good living and abstinence from alcohol, with the daily use of the cold shower bath or sea-bathing and tonics, are very useful. Of tonics, Iron in full doses of the tincture of the perchloride in combination with Strychnine is the best, and Easton's Syrup of the phosphates is a valuable preparation given three times a day in doses of at least r dr.
Aphrodisiacs as a rule do harm, and should not be prescribed in these cases. The mere production of an erection is a different thing from power to perform the sexual act successfully, and these artificial aids generally fail, and after each failure the position of the patient is decidedly worse. For this reason he should be urged not to attempt the act till he feel that he has reason to believe that the attempt will be more success ful than the last, and the patient's own sensations will be his best guide.
When this treatment fails, other measures remain, and these may at once be resorted to without waiting in those cases occurring after middle life, ur in those who have indulged in sexual excesses or in masturbation to the extent of causing atrophy of the testicles or penis. In such patients there is often weakness of sexual desire, but sometimes it is not dimin ished, and the physician finds that the mental depression associated with the impotence is so serious as to call for active treatment in order to prevent I iypochondriasis or other form of mental disease.
Electricity in the treatment of premature loss of virility comes next in value to abstinence and the general hygienic measures just mentioned. This remedy may be used in various ways. The writer has observed that the best results follow from the employment of a moderately strong continuous current. One large sponge-electrode being placed over the lover end of the spine, the other is applied to the groin, spermatic cord, testicles, penis and perineum in succession. The sitting should last for
20 minutes, and may be repeated twice a day. The interrupted current may be employed occasionally with advantage fur the space of about a week, during which the continuous is suspended. Benefit may some times be obtained from the wearing of a good Pulvermacher chain battery round the pelvis or loins.
1Iassage or gentle kneading of the scrotum and testicles, followed by free sponging of the parts with cold sea-water twice a day, has a decided influence in improving the tone and nutrition of the generative organs, and should always be tried in conjunction with electricity.
If the failure is a purely functional one arising from some deficiency in the apparatus necessary for erection, authorities speak highly of Cantharidin in small doses-3 mins. of the B.P. tincture—or of Phos phorus. The writer has never prescribed these remedies for this purpose, and is doubtful of their utility. Damiana has proved itself to be an aphrodisiac of considerable power without doing harm in most cases of loss of virility due to early sexual excesses or premature weakness of the genito-urinary centres in the curd. It may be advantageously combined with Strychnine as in the following: Ext. Dainiance Liq. (r in t) ntis I ()mica! 5vj. Sanmetto Ft. mist. Capial 5j. ter in die post dims ex aqua.
Yohimbine Hydrochloride is a more powerful though comparatively safe drug obtained from yohimbehe bark. It is procurable in tablets, of which one to three may be given thrice daily or to mins. of per cent. solution may be administered. I fypodermic injections of Spermin (15 nuns. of 2 per s cut. solution) and 5 gr. doses of OF of Did) min by the mouth arc highly recommended.
.\\ hen the impotent c oc( urs as the result of some organic or functiona; di,ease it !nay reasonahl) be expected to pass off \ S hen the affection i! removed, and it is needless to say that appropriate treatment should be directed to the mischief of which it is symptomatic. Thus in diphtheritic paralysis, lead poisoning, renal affections, neurasthenia, diabetes and ataxia, impotence may be the condition which first directs the patient's attention to some departure from health.
In impotence following head or spinal injuries the best hope of success will lie in the judicious administration of small doses of Perchloride of Mercury gr.), or of gr. of the Chloride of Gold and Sodium, or of 5 grs. of the Iodide of Potassium. Phosphorus and Strychnine should be used with the greatest caution in such eases. After a few weeks or months of this treatment the use of a weak continuous current. passed through the cerebrum for a few moments and followed persistently with galvanism of the spine from the head to the sacrum, accomplish all that drugs can be expected to achieve. It has been noted in locomutor ataxia that after suspension treatment in some cases impotence for a time • disappears. The writer has, however, observed the spontaneous disappearance of impotence in one very advanced case this symptom had been marked for many years.