By this is generally considered the inability to engage in the virile act. It essentially signifies a loss of the virile powers. Impotency may be either partial or complete, and, like sterility, absolute, and relative. The term impotence is frequently used synonomously with sterility, but, as sterility has been considered in another place, we shall discuss the subject in this place only in the sense implying loss of capacity.

The loss of virile power is owing to a variety of causes. The process of loss in idiopathic cases is usually slow, though in some cases invirility ensues quite rapidly. When due to traumatic causes virile power is lost synchronously with the occurrence of the injury. Impotence usually follows injuries received by the spine and base of the brain, but in these cases the loss is not of itself a pathological disorder, but essentially symptomatic of the injury.

The most common cause of impotence is nervous debility, apparent or concealed and unsuspected. It is the usual sequel to that disease, if it is allowed an unchecked career, manifesting itself at first by a slight incapacity, but which gradually progresses until finally the virile power is completely lost. That impotence is the inevitable result to nervous debility is quite natural, the ceaseless waste of such a vital element of the male economy as semen can have no other finality. The general disturbance of the nervous system caused by involuntary spermatic losses is manifested first in the virile organs, as the erectile property of the organ, purely a nervous phenomenon, and consequently any function so directly under the control of nervous power as the erectile quality is the one first to succumb to nervous disorganization. Impotence in such cases is, therefore, due to feebleness or insufficiency of the nervous stimuli necessary to provoke a copulative aspect of the male organ. This condition of invirility is also caused by immoderate indulgence, the pathological disorder produced being in all respects the same as that following seminal incontinence, though as a general thing masculine power is lost less rapidly.

Spinal and cerebral diseases are usually associated with a low condition of the virile power. This manifestation is quite in accordance with the physiological laws governing the virile functions, as it will be remembered that the nervous supply that the organs of generation receive is the pudental nerve, which arises from the sacral plexus. The nerve and branches afford the requisite stimuli necessary to promote congestion of the organ, which phenomenon constitutes an erection. The brain gives the necessary sensory stimulus, without which the nerves are not excited to action. Phrenologists place amativeness in the lower lobe of the cerebellum, but it is quite probable that its locality, though most evidently in the base of the brain, is not in that situation, as analogy will not comport with such a view. Observation teaches that the chanticleer is the most amorous of animals, yet anatomists find no lower lobe of the cerebellum in the brain of the fowl. External violence, however, upon the sacral and occipital regions usually cause virile imbecility, and hence we know that a healthy condition of the base of the brain and sacral plexus is necesssary to the existence of virility. Diseases, excessive study, intemperate use of tobacco, violent and prolonged grief, etc., are therefore causes of impotency, from the fact that the cerebral disorganization which follows produces inertia of the nervous stimuli. Apoplexy is also a cause of temporary impotence, in consequence of the paralysis of the sacral plexus ensuing. It is therefore vitally important that in the consideration of any case of impotence every predisposing cause should receive attention, so that restorative efforts are based upon correct principles. No pathological condition requires such nicety of treatment as impotence, and none that will so readily be remedied if the medication is thoroughly adapted to the case. Although impotence is the usual concomitant to long-continued seminal losses, my experience teaches me that a fair proportion of impotent cases are the results of habits and practices which are perfectly legitimate, and to which no shadow of blame or disgrace can be properly attached. It is a well-established fact that too much mental application, also constant confinement within doors in a vitiated atmosphere, or habitual or sudden exposure to heats and colds, or the destroying influences of extreme grief and care, will produce all the evil effects upon the mental and physical organization that are caused by and attributed to solitary habits. Nervous debility, which is quite a common and comprehensive name for all failures of the intellectual or physical organs or faculties to perform their functions properly, is originated and nurtured, in both sexes, by a variety of causes as countless as the leaves of the forest. Consequently, people should not be backward about making their deficiencies of mind or body known to physicians in such a clear and confidential way as to secure to them the full restoration of their normal health and vigor. Any course of life which is inordinately irksome or, involves heavy tasks, is liable to cause the loss of virile power, or especially in middle age, IMPOTENCY, which is the aggravated form of the same difficulty. Thus we find that clergymen, merchants, bookkeepers, literary workers, men who are overtaxed by care and labor, lawyers, judges, boys confined too closely at school, young men who seldom take out-of-door exercise, clerks, heads of public departments, and all others who are constantly wearing and tearing both mind and body without seeking the neutralizing aid of rest, amusement, and change of scene, are subjected to some of the numerous ills developed in disabilities and incapabilities which impose untold suffering. These ills are the inheritance of everybody physically and mentally over-worked, no matter in what capacity they may labor. It is to be lamented that many of these innocent individuals, from the fear of being charged with guilt, suffer long years in silence when the truly judicious course is to engage medical aid as soon as the fact becomes known. The old-class physicians have used the most powerful minerals within their reach, and with the earnest and honest desire to do good, have accomplished much that has been of temporary benefit. But the reaction from the use of these minerals has been, in all instances, of a non-curative character, the patient purchasing for temporary enjoyment many after-years of incapacity and local weakness.

There is nothing so discomforting to man as the loss of virile power. He may not be a sensual being, yet manhood is a pride to him, the possession of which is always a gratifying knowledge. Impotence implies more than mere virile imbecility, it signifies also a loss of vigor and elasticity of the whole organism, and a gloomy state and impairment of the mental faculties. It has elsewhere been observed that the well-being of the whole economy is greatly dependent upon healthy genitalia; and mental composure, vitality and acuteness of intellect, graceful and easy manners, etc., are no less independent of the virile faculties. Impotency is, therefore, always a deplorable condition, and he who permits himself to be long without the legacy of virility, commits a great injury upon his own personal welfare, and places but a poor value upon the choice powers of manhood. Man without virile power is an anomaly; he has lost his status of sex, and is practically a eunuch as long as the unmanly condition is tolerated. There is a higher motive in posssession of virile power than the ability to gratify amorous passion. If that alone gave chief value to virility, its loss would be but inconsiderate, but as we have seen that vigorous manhood is consonant to vitality of the mental and physical economies, it gains a value not to be despised, but greatly cherished, even by the most continent and virtuous men. Healthy functions of the genital organs are as requisite to the integrity of the whole organism as healthy functional action of the thoracic and abdominal organs, and any derangement of the pelvic organs is capable of precisely as much, if not more, disorganization of the general health as a disordered digestive or circulatory apparatus. I will close the consideration of this subject by inviting all those who are deficient in masculine tone or capacity to call on me in person or consult me by letter. (See page 385.)