The most frequent cause of psychic impotence is the thought of failure. An accidental single failure through the temporary abuse of alcohol, tobacco, coffee, or tea or through intense desire may occur, some day, which in the healthy man would pass unnoticed. But the nervous man will begin to brood over this failure, and this brooding will prevent the formation of associative paths in the brain at every subsequent attempt of coition. In nervous men, the imagination, having once become impressed with groundless fears, may retain them with extreme tenacity and busy itself with constant brooding in solitude over the fancied ills. Thus a disorder of adjustment is established, and a psychic trauma is created, through the subconscious effects of cryptogrammic nerve-currents. This psychic trauma is translated into fear again. The subconscious cerebral processes lead to the formation of ideas, later recallable in memory. These morbid ideas become the substratum of future anxiety-attacks. A pathological state is thus induced where the natural course of erection fails to follow the sexual excitement. In this way a veritable disease is produced, where there is a strong desire without full power. Every additional failure provokes more intense broodings which are naturally again the cause of failure. Thus a vicious circle is created which may render an occasional innocent failure a permanent impotency. _Atonic impotence._—The most frequent form of impotence of copulation, in fact, the impotence “par excellence,” is the atonic impotence. This is the impotency which is generally caused by venereal excesses, either in copulation, masturbation, mental erethism, frustrate eroticism, or last but not least, conjugal onanism or coitus interruptus. These excesses cause the exhaustion of the centre of erection, irritation of the centre of ejaculation and a debilitation and enervation of the genital nerves. For when the lumbar centre of erection fails to respond, there is a deficiency in activity, excitability, mobility, and tonicity of the entire genital apparatus. In the atonic form of impotence conditions of absolute impotency are quite rare. Absolute impotence is mostly found in the paralytic form which is caused by cerebrospinal and nervous diseases. In the atonic anomaly the vast majority of cases are of partial impotence. The impotence due to weakness is distinguished by premature ejaculation and the subsequent immediate subsidence of erection. Sometimes a vigorous erection ceases suddenly before emission has occurred, and the penis becomes completely flaccid and shrivels to half its normal size before the entrance into the vagina. When ejaculation does later occur it takes place without erection or pleasurable sensations. Not seldom the entrance into the vagina is effected with good erection, but when about to begin the act, the penis suddenly wilts, the wilting either followed by ejaculation or not. The following case illustrates the ordinary symptoms: