The exciting causes are straining during stool, heavy lifting, excessive sexual indulgence or anything that would determine more blood to the testicles. Varicocele is similar to the varicose state of the hemorrhoidal veins and may have like causes. The =diagnosis= is easily made. The feeling of the veins between the fingers like a convolution of earth worms; dull, aching, dragging sensation, and possibly prostration, weakness and dejectedness of spirits, are characteristic symptoms. “The condition is devoid of danger, except that it often begets morbid fears on the part of the patient, usually the result of suggestion.”[49] The =treatment= consists of regulation of the bowels, removal of such predisposing and exciting causes as may be found, treatment of the vessels along the spermatic cord, and treatment to the lower dorsal and lumbar regions. In severe cases a suspensory bandage will give temporary relief. Surgical interference may be necessary in some cases in order to effect a cure. Impotency Results from treatment in these conditions are particularly gratifying and offer a great field of activity in this day of sensational medical advertising. This condition can well be classed under four heads, Exhaustive, Traumatic, Psychic and Organic. =Exhaustive Impotency= is the result of functional abuse, masturbation in early life, excessive venery, coupled with intemperate use of alcohol and improper diet without sufficient sleep. It can be symptomatic in neurasthenia. There is at first irritation of the spinal centers, which causes exaggerated sexual activity, and later this is followed by complete or partial loss of function. The first step is for a radical reform in habits; regulation of the bowels, as they will likely be constipated; direction of the mind into wholesome channels, and then skillfully directed spinal treatment. Where there has been masturbation, look well for sources of irritation to the parts; a long foreskin or adherent prepuce indicates surgical aid, or there may be a lesion at the sacrals involving the nervi erigentes or, of greater importance, the pudic nerve. The innominatum can be at fault in this. The lower dorsal, ribs and upper lumbar are of importance. Kraft-Ebing says: “Conditions of absolute impotency are, however, rare, and are caused =only= by severe vertebral and nervous diseases.” Nerve irritation undoubtedly is the cause of sexual perversion (outside of heredity and malformation) so their relief is as necessary to bring about reform of habits as to effect a cure. Where the general health is affected constitutional treatment should follow. Motschutkovsky uses suspension in treating these cases with good results. The effect is to separate the vertebræ, freeing spinal nerve and blood channels. The prostate will probably be found in an irritated, sensitive condition, as well as the seminal vesicles. Treat as outlined under the prostate gland. Ligation of the dorsal vein of the penis is recommended by some