1. IMPOTENCE.
Impotence, or the incapacity of sexual intercourse, and Sterility, or the inability of procreation, are subjects which frequently become questions in the Ecclesiastical Courts, as relating to the performance and dissolution of the marriage contract; and as medical evidence is generally required upon such occasions, the subjects necessarily present themselves for discussion in the present work.
Impotence may exist either in the male or female. Sterility is confined to the female, for if the male be proved capable of accomplishing the act of coition, no farther question can arise as to his virility.
Impotence may be Absolute or Relative, that is to say, the parties may be incapable of cohabiting with each other, and yet they may each accomplish the venereal congress, and enjoy a fruitful intercourse with others; it may also be functional or organic, and depend either upon physical or moral causes; and hence in some cases it may be temporary, in others permanent, and upon this point the evidence of the medical practitioner will be always very essential. It is therefore important that we should proceed to investigate the subject in its various relations to those different causes.
1. Organic Causes of Impotence.
IN MALES.
There was a period in the history of physiology, when the testicles were not considered essential to virility. Aristotle was led to such a conclusion from having observed that a bull was capable of impregnating the female after castration; a fact which depended upon the quantity of semen, retained in the vesiculæ seminales, conferring fertility upon a coitus which took place immediately after the operation. The true theory of the functions of the testicles having been thus abandoned, it was necessary to substitute some other explanation of their use, and the Naturalist of Stagira has accordingly asserted, that they merely serve as weights to hinder the spermatic vessels from being folded up; an hypothesis which, absurd as it is, has found advocates in the later schools; and in its support we shall find many experiments and cases related by Marchetti of Padua.[[287]] Sabbatier[[288]] observes, that subjects have been found who have only possessed one testicle, and what is more extraordinary, that there are others who although entirely destitute of these organs, have exhibited the other parts of generation in their natural state; in proof of which Cabrolio mentions the case of a soldier addicted to sexual pleasures, in whose body no testicles were found, although the vesiculæ seminales were distended with semen. Scurigio[[289]] and Lieutaud[[290]] refer to the same case; upon which Portal[[291]] very justly observes, that the soldier was doubtless furnished with testicles, but which, from their unnatural situation, probably escaped the notice of Cabrolio. The extraordinary situations in which the testicles may be found are fully detailed by Rinlaender;[[292]] their absence from the scrotum does not necessarily imply impotence; they are formed in the cavity of the abdomen, and until the sixth month, lie immediately below the kidneys on the fore part of the Psoæ muscles, after which period they gradually descend towards the abdominal ring, through which they generally pass into the scrotum before birth; but it occasionally happens that this descent, in regard to one or both testicles, does not take place until a late period, and in some instances they remain within the cavity of the abdomen during life;[[293]] in such a case, a question has arisen as to the virility or impotence of the individual so situated, and upon which medical opinion would seem to be still unsettled. Foderé states that such persons have even been remarkable for their vigour; for these organs, says he, appear to derive greater power of secretion from the warm bath in which they lie, than when they have descended into their natural situation. Mr. John Hunter has given a very different opinion, and one which appears to be more compatible with the sound doctrines of physiology; he believes that when both testicles remain through life in the belly, they are exceedingly imperfect, and incapable of performing the natural functions of these organs; and that it is such imperfection in structure which prevents the disposition for their descent taking place; an opinion in which Zacchias and Riolan entirely concur. Mr. Wilson[[294]] observes that he is acquainted with one case that confirms, and another that would to a certain degree refute this opinion; and this is probably the true state of the question; each case must rest upon its individual merits, and the practitioner, whose opinion is desired upon such an occasion, must carefully inquire into every moral and physical circumstance that can, collaterally, assist his judgment; such as the general appearance, soprano voice, and effeminate physiognomy, of the individual, “frustra enim ætas advenit, si testes defuerint; manebit enim etiam virili ætate fæminæ similis.”[[295]] But the absence of the testicles in the scrotum may depend upon other and less equivocal circumstances, they may have been removed by excision (Eunuchs), in which case there will be no difficulty in ascertaining the fact by the appearance of the cicatrix: or they may have been actually absorbed by an operation of Nature, after considerable inflammatory action. Mr. John Hunter[[296]] has given an account of three cases in which such a result occurred.
It does not appear that two testicles are essential to virility, although the Parliament of Paris in 1665 decreed that the matrimonial contract should not be deemed valid unless two testicles were evident; it is now generally admitted that persons with only one (Monorchides) are fully capable of procreation.
It has occurred to Dr. Baillie,[[297]] and other anatomists, to observe the testicles exceedingly small, “I have known,” says this distinguished pathologist, “one case in a person of middle age, where each of them was not larger than the extremity of the finger of an adult; this, as appeared from its history, arose from a fault in the original formation, and was attended with a total want of the natural propensities.” Mr. Wilson,[[298]] on the other hand, relates a case that would induce us to pause before we pronounced judgment on such an occasion: “I was,” says he, “some years ago consulted by a gentleman, on the point of marriage, respecting the propriety of his entering that state, as his penis and testicles very little exceeded in size those of a youth of eight years of age. He was then six and twenty, but never had felt the desire for sexual intercourse until he became acquainted with his intended wife; since that period, he had experienced repeated erections, attended with nocturnal emissions; he married, became the father of a family, and these parts which at six and twenty years of age were so much smaller than usual, at twenty-eight had increased nearly to the usual size of those of an adult man.”
The structure of the testicle may be defective; Mr. John Hunter has given a representation,[[299]] in his work on the Animal Œconomy, of a case in which the Epididymis, instead of passing to a Vas deferens, terminated in a cul-de-sac; with such a structure it is evident that the semen cannot be evacuated by the urethra, and that the individual must therefore be incurably impotent.