after the discharge these gave way to indifference.

Ordinarily the desire and power wane together in the healthy individual, but they never disappear entirely and permanently during the climacteric. There is usually There is usually a decided alteration in temperament during this time, the man's attitude toward women changes and the natural desire for sexual companionship is lessened.

The psychic stimuli of the libido, the imagination, visual impressions and physical contact such as occurs in the kiss, and the physical stimuli, the irritation occasioned by filled seminal vesicles, and local irritation as in masturbation, do not elicit the same mental response in desire nor the secondary physical response in erection and orgasm. as in earlier life. A much longer time is required before an orgasm can be secured and the exertion often becomes so exhausting that men will rather suppress the desire than undergo the physical effort that the complete gratification of desire entails.

While the individual recognizes the waning sexual desire and power, he usually ascribes it to ageing and as this condition causes no special discomfort he does not complain about it. In some cases the libido remains strong, while the potentia is weakened. This occurs mostly in men of strongly erotic dispositions who have not restrained themselves in earlier life, and the reaction during the climacteric after years of physical excesses remains permanent. In these cases, there is a rapid weakening, which may proceed to complete impotence. (It should be understood that impotence refers to the loss of erectile power and not to spermatic defect causing sterility.) A rapid weakening ending in complete loss of erectile power occurs also in persistent masturbation during the male climacteric.

During the climacteric there is usually an atrophy of the seminal vesicles, the amount of semen is diminished and in celibates there are much longer intervals between the involuntary discharges. In persistent masturbation and the class in whom the libido remains active while the potentia disappears, there may be complete loss of semen, but under strong psychic influence or local irritation there will be a slight prostatic discharge which the individual mistakes for semen. This individual is, however, both impotent and sterile.

In some cases the libido is lost during the climacteric, but the potentia remains. These are mostly cases of naturally frigid men who were indifferent to the usual sexual act and who were satisfied with occasional congress, masturbation or involuntary discharge.

While in the vast majority of men the desire precedes the erection, there is sometimes an erection without conscious desire, or the desire is aroused when the erection occurs. These cases seldom reach the physician, but the man who has erections. without desire frequently resorts to masturbation for relief and many of these cases develop hypertrophied prostate. In almost every case of hypertrophy of the prostate a history of masturbation can be elicited, or evidence of masturbation, i. e.. the elongation and weakening of the cremaster muscles, can be found. So general is this evidence of masturbation in cases of hypertrophied prostate that I am satisfied that the prostatic condition is almost always due to late masturbation. It is the only rational explanation for the abnormal hypertrophy of a gland at a period of life when all other glands atrophy. The only sexual condition which is likely

to reach the physician during the male climacteric is impotence with continued libido. It is not a difficult condition to treat, tho almost impossible to cure.

The erectile power can be temporarily stimulated thru stimulation of the spinal centers by electricity or drugs, notably yohimbe, coca and phosphorus. The cold steel sound will temporarily produce depression followed by stimulation. The most effective measure is diathermia, the highfrequency current applied to the organ itself producing turgesence and erection. I have used this remedy for several years not only during the male climacteric, but much later in life. These therapeutic measures are, however, only of temporary effectiveness, their action disappearing soon after each dose or application. While the action lasts the potentia is increased and the patient is satisfied with the result of the treatment, but within a few hours the erectile power is lost again and the patient is disappointed and dissatisfied. In such cases I generally adopt two lines of treatment, the object of the first being the suppression of the libido, of the other, the temporary stimulation of the potentia.

The bromides and monobromated camphor will generally be effective in suppressing the libido.

The mental and temperamental changes during the male climacteric are similar to, but usually not as marked as the like changes that occur in the female during the menopause.

In some cases very pronounced temperamental changes occur, but these are rarely attributed to the climacterium. Attacks of depression, irritability, impatience, sensitiveness, occasional exaltation and megalomania, a changed attitude toward females and children, toward family and friends,

toward social and economic conditions and problems, occur often and are ascribed to business or family troubles or minor ailments. Such minor ailments are exaggerated and the individual demands excessive sympathy and care. These ailments and other supposed causes for the temperamental changes are often the direct or secondary results of the climacteric, made more pronounced by the greater sensitiveness of the individual, while business and family troubles often arise from the temperamental changes.

The recognition of diminished virility has a very depressing effect upon most men. This depression is accompanied by shyness and a fear that this impairment may be recognized by others, and where there is complete loss of erectile power this may become a dominating obsession. The mental changes, other than emotional and temperamental, include impaired memory and attention, the latter causing weakened impression upon the sight and hearing centers, diminishing the receptivity and retention of ideas based upon such impressions. In old age the mental impairment is of a different character. While the memory and attention are weakened in old age, the memory of early events is restored. old man will talk of events of his childhood and youth, recall trivial incidents which had probably been encrypted for years, while important events of later life will be forgotten. The recollection of early events occurs often spontaneously without effort. or intent and they appear as vividly as tho they had just occurred. This does not happen in the mental impairment during the climacteric. It seems to me that the impairment of memory during the climacteric is not a primary condition, but is due to diminished attention, the individual being more con

The

cerned about his subjective sensations than about objective impressions. Man is in his most perfect condition at the end of the period of development, about the thirtieth year. Soon after this he begins to retrograde. Long before anything definite was known about basal metabolism it was shown that at forty the pulmonary functions were not as active as at thirty, that the average weight of the brain was less at forty than at thirty, and that if there was any change in the heart, it was a compensatory increase in the thickness of the walls and not a general increase in the organ.

In the following decade, between forty and fifty, most men begin to notice the functional diminution due to the progressive degenerative changes. The individual feels that he is not as strong as he was a few years before, he is less active and spry, fatigue sets in more rapidly and a little extra exertion causes palpitation of the heart and shortness of breath.

The man knows that these changes are due to age, but he finds it difficult to resign himself to the inevitable and wilfully deceives himself. He ascribes the suffering of the joints to rheumatism, shortness of breath to asthma, that tired feeling in the afternoon to malaria and evidences of ageing to other diseases. These are the ailments that the man usually complains of during the climacteric.

Some men can view these changes in themselves philosophically, even optimistically, but to most men they indicate the passing from middle age to old age and they become depressed, this depression affecting their reason and judgment as well as their attention.

It is not possible to say how far the normal degenerative changes are influenced by the climacteric or what changes are insti

tuted during this period. It is probable that the only degenerative changes beginning during the male climacteric, and due to it, are in the generative organs, altho diminution in sexual activity generally occurs many years earlier. This, however, can be ascribed to more stable emotions and to the greater control over the emotions after the period of youth has passed. Owing to the usual mental depression during the climacteric, the individual becomes more sensitive and he notices and exaggerates the discomforts caused by the degenerative changes.

Some of these changes now give demonstrable signs as increased blood pressure due to arterial degeneration, diminished body temperature due to diminished metabolism following lessened activity, and the minor signs of anosmia, presbyacusia and presbyopia. These are, however, purely senile changes; they are gradual and progressive and some, like anosmia and presbyacusia, may proceed to complete extinction of function. The changes that can be ascribed to the climacteric may be progressive, but they proceed rapidly during this period and after this period is past they are quiescent or progress very slowly.

A celibate informed me that he had a nocturnal emission about every three weeks until his 46th year. Thereafter the emissions came at irregular but ever-increasing intervals for about two years, when they appeared every two months. Now, at the age of sixty, there is an emission every three months or less-five in 1920. A patient declared that before his 45th year there were few days from the time he was 21, when he did not have sexual intercourse. Soon after he was 45, the tragedy of his life occurred, a long sought opportunity arrived and he found that he was

becoming impotent. In less than six months the impotence was complete. This preyed upon his mind continually until it became a dominating obsession. He neglected his business and his family, blaming his partners for his business reverses and his family for their impatience with him. He was treated for neurasthenia and impotence for about three months without any apparent benefit. Then there occurred a rapid improvement in his mental condition and a slight return of sexual power. This was really the end of the climacteric, but the physician accepted the patient's belief, and probably himself believed, that the improvement was the result of treatment.

A prosperous merchant who left the cares of shop behind him the moment he left his office gradually developed, in the course of years, fixed habits. They could set the clock by the time of his arrival at and departure from his office, home or club. Shortly before his 50th year his associates noticed a change in his behavior. He became pessimistic, irritable, brusque and harsh to his employees and often absent-minded, muttering to himself and shaking his head.

He refused to see his physician, claiming that he did not feel ill, but the physician was appraised of his condition and made a friendly call upon him. His wife told the physician that she could not account for the change in her husband, but stated that while he had never been of a marked erotic disposition, lately he had become entirely impotent and resorted to occasional masturbation. He was induced to take a short vacation, but he suspected that his associates were trying to force him out of business and he came back from his trip worse and more erratic in temper than before. He refused to submit to treatment

or take medicines and the family was considering the advisability of sending him to a sanitarium. His condition, however, improved and he began to realize that he had not been himself for several months. He took another vacation, this time voluntarily, and returned completely restored. His wife says he rarely expresses the desire for sexual congress and has given up the practice of masturbation. These cases illustrate the vagaries of the male climacteric. While degenerative changes occur during this period it is not possible to say which originate during this period, which are due to the climacteric and to what extent the climacteric influences the degenerative processes already at work. In many cases the senile changes begin during this time. Blanching or falling out of the hair, presbyacusia and presbyopia, adiposity or its converse, leanness, often begin during the climacteric. The senile changes are slowly. progressive; the climacteric changes occur rapidly and only during the climacteric, but they may continue slowly thereafter as senile changes. The only changes of this character that have been studied are in the sexual organs. So little study has, however, been given to this subject that its recognition and further research may bring to light other changes which now are. ascribed to other pathologic processes or to ageing.

Finish each day and be done with it. You have done what you could. Some blunders and absurdities no doubt crept in; forget them as soon as you can. Tomorrow is a new day, begin it well and serenely, and with too high a spirit to be cumbered with good and fair. It is too dear, with its your old nonsense. This day is all that is hopes and invitations, to waste a moment on the yesterdays.-Emerson.