and spongiosum and in the arteries of these parts, as a result of which there takes place an influx of blood; the rigidity of the penis immediately takes place as soon as this relaxation of the muscular fibres is complete and the venous sinuses are filled. The check to the return of the blood through the veins, which are much larger in calibre than the arteries, and which would otherwise empty themselves much faster than the arteries could possibly supply blood, is maintained by the action of the bulbo-cavernosi, the ischiocavernosi and the adductor prostate, upon the deep and superficial veins of the penis. That such a physiological process takes place and is the most probable explanation of the power of erection, has been satisfactorily confirmed by experiments upon the dog and derived from observations made upon man in disease.
By atonic impotence we mean a failure in satisfactory coitus, whether such failure manifests itself in precipitate emission, delayed emission, incomplete erection or absence of sexual desire. The disturbance with emission and erection are principal types of the disease for which we are most consulted, the last named condition, absence of sexual desire, being usually an advanced or later stage of complete exhaustion of this disease. To enter into a discussion of the pathology and etiology of sexual impotence would take me wide of the particular phase of the subject which I desire to present for your consideration. The underlying cause in all these conditions, be the primary cause what it may, is impaired nervous function and stimulus due to exhaustion of specialized nerve tracts and centers in brain and spinal cord, by which the sexual function is torpid or temporarily suspended. Ligation of the dorsal vein of the penis is not a cure for every case of atonic impotence, and it is only in a few selected cases of the vast number of afflicted patients who present themselves for treatment where you will find such surgical resort necessary or conditions indicating such a procedure. The accepted and well established practice of hunting for and removing all local inflammations and focal lesions in and about the genito-urinary tract, together with the rational use of medical, mechanical, moral and suggestive therapeutics, will still have their prominent place in the treatment of this condition, but after all possible reflex sources of trouble have been removed and these remedies applied and you have failed to restore a normal erection and a satisfactory coitus, which you will often do, it is then that I advocate the ligation of the dorsal vein of the penis, and believe its field of usefulness will be found wide in perfecting a cure. It does it in this way: Some of you are
