I am indebted to a correspondent for the following notes:—"From my observation during five years at a boarding-school, itseemsthat eight out of ten boys were more or less addicted to the practice. But I would not statepositivelythat such was the proportion of masturbators among an average of thirty pupils, though the habit was very common. I know that in one bedroom, sleeping seven boys, the whole number masturbated frequently. The act was performed in bed, in the closets, and sometimes in the classrooms during lessons. Inquiry among my friends as to onanism in the boarding-schools to which they were sent, elicited somewhat contradictory answers concerning the frequency of the habit. Dr. ——, who went to a French school, told me thatallthe older boys had younger accomplices in mutual masturbation. He also spoke with experience of the prevalence of the practice in a well-known public school in the west of England. B. saidallthe boys at his school masturbated; G. stated thatmostof his schoolmates were onanists; L. said 'more than half' was the proportion."At my school, manual masturbation was both solitary and mutual; and sometimes younger boys, who had not acquired the habit, were induced to manipulate bigger boys. One very precocious boy of fifteen always chose a companion of ten 'because his hand was like a woman's.' Sometimes boys entered their friend's bed for mutual excitement. In after-life they showed no signs of inversion. Another boy, aged about fourteen, who had been seduced by a servant-girl, embraced the bolster; the pleasurable sensations, according to his statement, were heightened by imagining that the bolster was a woman. He said that the enjoymentof the act was greatly increased during the holidays, when he was able to spread a pair of his sister's drawers upon the pillow, and so intensify the illusion."Before puberty the boys appeared to be more continent than afterward. A few of the older and more intelligent masturbators regulated the habit, as some married men regulate intercourse. The big boy referred to, who chose always the same manipulator, professed to indulge only once in twenty days, his reason being that more frequent repetition of the act would injure his health. About twice a week for boys who had reached puberty, and once a week for younger boys, was, I think, about the average indulgence. I have never met with a parallel of one of those cases of excessive masturbation recorded by many doctors. There may have been such cases at this school; but, if so, the boys concealed the frequency of their gratifications."My experience proved that many of the lads regarded masturbation as reprehensible; but their plea was 'everyone does it.' Some, often those who indulged inordinately and more secretly than their companions, gravely condemned the practice as sinful. A few seemed to think there was 'no harm in it,' but that the habit might stunt the growth and weaken the body if practiced very frequently. The greater number made no attempt to conceal the habit, they enlarged upon the pleasure of it; it was 'ever so much nicer than eating tarts,' etc."The chief cause I believe to be initiation by an older schoolmate. But I have known accidental causes, such as the discovery that swarming up a pole pleasurably excited the organ, rubbing to allay irritation, and simple, curious handling of the erect penis in the early morning before rising from bed."I quote the foregoing communication as perhaps a fairly typical experience in a British school, though I am myself inclined to think that the prevalence of masturbation in schools is often much overrated, for, while in some schools the practice is doubtless rampant, in others it is practically unknown, or, at all events, only practiced by a few individuals in secret. My own early recollections of (private) school-life fail to yield any reminiscences of any kind connected with either masturbation or homosexuality; and, while such happy ignorance may be the exception rather than the rule, I am certainly inclined to believe that—owing to race and climate, and healthier conditions of life—the sexual impulse is less precocious and less prominently developed during the school-age in England than in some Continental countries. It is probably to this delayed development that we should attribute the contrast that Ferrero finds (L'Europa Giovane, pp. 151-56), and certainly states too absolutely, between the sexual reserve of young Englishmen and the sexual immodesty of his own countrymen.In Germany, Näcke has also stated ("Kritisches zum Kapitel derSexualität,"Archiv für Psychiatrie, pp. 354-56, 1899) that he heard nothing at school either of masturbation or homosexuality, and he records the experience of medical friends who stated that such phenomena were only rare exceptions, and regarded by the majority of the boys as exhibitions of "Schweinerei." At other German schools, as Hoche has shown, sexual practices are very prevalent. It is evident that at different schools, and even at the same school at different times, these manifestations vary in frequency within wide limits.Such variations, it seems to me, are due to two causes. In the first place, they largely depend upon the character of the more influential elder boys. In the second place, they depend upon the attitude of the head-master. With reference to this point I may quote from a letter written by an experienced master in one of the most famous English public schools: "When I first came to ——, a quarter of a century ago, Dr. —— was making a crusade against this failing; boys were sent away wholesale; the school was summoned and lectured solemnly; and the more the severities, the more rampant the disease. I thought to myself that the remedy was creating the malady, and I heard afterward, from an old boy, that in those days they used to talk things over by the fireside, and think there must be something very choice in a sin that braved so much. Dr. —— went, and, under ——, we never spoke of such things. Curiosity died down, and the thing itself, I believe, was lessened. We were told to warn new boys of the dangers to health and morals of such offences, lest the innocent should be caught in ignorance. I have only spoken to a few; I think the great thing is not to put it in boys' heads. I have noticed solitary faults most commonly, and then I tell the boy how he is physically weakening himself. If you notice, it is puppies that seem to go against Nature, but grown dogs, never. So, if two small boys acted thus, I should think it merely an instinctive feeling after Nature, which would amend itself. Many here would consider it a heinous sin, but those who think such things sins make them sins. I have seen, in the old days, most delightful little children sent away, branded with infamy, and scarce knowing why—you might as well expel a boy for scratching his head when it itched. I am sure the soundest way is to treat it as a doctor would, and explain to the boy the physical effects of over-indulgence of any sort. When it is combated from the monkish standpoint, the evil becomes an epidemic." I am, however, far from anxious to indorse the policy of ignoring the sexual phenomena of youth. It is not the speaking about such things that should be called in question, but the wisdom and good sense of the speaker. We ought to expect a head-master to possess both an adequate acquaintance with the nature of the phenomena of auto-erotism and homosexuality, and a reasonable amount of tact in dealing with boys; he may then fairly be trusted to exercise his own judgment.It may be doubted whether boys should be made too alive to the existence of sexual phenomena; there can be no doubt about their teachers. The same is, of course, true as regards girls, among whom the same phenomena, though less obtrusive, are not less liable to occur.
I am indebted to a correspondent for the following notes:—
"From my observation during five years at a boarding-school, itseemsthat eight out of ten boys were more or less addicted to the practice. But I would not statepositivelythat such was the proportion of masturbators among an average of thirty pupils, though the habit was very common. I know that in one bedroom, sleeping seven boys, the whole number masturbated frequently. The act was performed in bed, in the closets, and sometimes in the classrooms during lessons. Inquiry among my friends as to onanism in the boarding-schools to which they were sent, elicited somewhat contradictory answers concerning the frequency of the habit. Dr. ——, who went to a French school, told me thatallthe older boys had younger accomplices in mutual masturbation. He also spoke with experience of the prevalence of the practice in a well-known public school in the west of England. B. saidallthe boys at his school masturbated; G. stated thatmostof his schoolmates were onanists; L. said 'more than half' was the proportion.
"At my school, manual masturbation was both solitary and mutual; and sometimes younger boys, who had not acquired the habit, were induced to manipulate bigger boys. One very precocious boy of fifteen always chose a companion of ten 'because his hand was like a woman's.' Sometimes boys entered their friend's bed for mutual excitement. In after-life they showed no signs of inversion. Another boy, aged about fourteen, who had been seduced by a servant-girl, embraced the bolster; the pleasurable sensations, according to his statement, were heightened by imagining that the bolster was a woman. He said that the enjoymentof the act was greatly increased during the holidays, when he was able to spread a pair of his sister's drawers upon the pillow, and so intensify the illusion.
"Before puberty the boys appeared to be more continent than afterward. A few of the older and more intelligent masturbators regulated the habit, as some married men regulate intercourse. The big boy referred to, who chose always the same manipulator, professed to indulge only once in twenty days, his reason being that more frequent repetition of the act would injure his health. About twice a week for boys who had reached puberty, and once a week for younger boys, was, I think, about the average indulgence. I have never met with a parallel of one of those cases of excessive masturbation recorded by many doctors. There may have been such cases at this school; but, if so, the boys concealed the frequency of their gratifications.
"My experience proved that many of the lads regarded masturbation as reprehensible; but their plea was 'everyone does it.' Some, often those who indulged inordinately and more secretly than their companions, gravely condemned the practice as sinful. A few seemed to think there was 'no harm in it,' but that the habit might stunt the growth and weaken the body if practiced very frequently. The greater number made no attempt to conceal the habit, they enlarged upon the pleasure of it; it was 'ever so much nicer than eating tarts,' etc.
"The chief cause I believe to be initiation by an older schoolmate. But I have known accidental causes, such as the discovery that swarming up a pole pleasurably excited the organ, rubbing to allay irritation, and simple, curious handling of the erect penis in the early morning before rising from bed."
I quote the foregoing communication as perhaps a fairly typical experience in a British school, though I am myself inclined to think that the prevalence of masturbation in schools is often much overrated, for, while in some schools the practice is doubtless rampant, in others it is practically unknown, or, at all events, only practiced by a few individuals in secret. My own early recollections of (private) school-life fail to yield any reminiscences of any kind connected with either masturbation or homosexuality; and, while such happy ignorance may be the exception rather than the rule, I am certainly inclined to believe that—owing to race and climate, and healthier conditions of life—the sexual impulse is less precocious and less prominently developed during the school-age in England than in some Continental countries. It is probably to this delayed development that we should attribute the contrast that Ferrero finds (L'Europa Giovane, pp. 151-56), and certainly states too absolutely, between the sexual reserve of young Englishmen and the sexual immodesty of his own countrymen.
In Germany, Näcke has also stated ("Kritisches zum Kapitel derSexualität,"Archiv für Psychiatrie, pp. 354-56, 1899) that he heard nothing at school either of masturbation or homosexuality, and he records the experience of medical friends who stated that such phenomena were only rare exceptions, and regarded by the majority of the boys as exhibitions of "Schweinerei." At other German schools, as Hoche has shown, sexual practices are very prevalent. It is evident that at different schools, and even at the same school at different times, these manifestations vary in frequency within wide limits.
Such variations, it seems to me, are due to two causes. In the first place, they largely depend upon the character of the more influential elder boys. In the second place, they depend upon the attitude of the head-master. With reference to this point I may quote from a letter written by an experienced master in one of the most famous English public schools: "When I first came to ——, a quarter of a century ago, Dr. —— was making a crusade against this failing; boys were sent away wholesale; the school was summoned and lectured solemnly; and the more the severities, the more rampant the disease. I thought to myself that the remedy was creating the malady, and I heard afterward, from an old boy, that in those days they used to talk things over by the fireside, and think there must be something very choice in a sin that braved so much. Dr. —— went, and, under ——, we never spoke of such things. Curiosity died down, and the thing itself, I believe, was lessened. We were told to warn new boys of the dangers to health and morals of such offences, lest the innocent should be caught in ignorance. I have only spoken to a few; I think the great thing is not to put it in boys' heads. I have noticed solitary faults most commonly, and then I tell the boy how he is physically weakening himself. If you notice, it is puppies that seem to go against Nature, but grown dogs, never. So, if two small boys acted thus, I should think it merely an instinctive feeling after Nature, which would amend itself. Many here would consider it a heinous sin, but those who think such things sins make them sins. I have seen, in the old days, most delightful little children sent away, branded with infamy, and scarce knowing why—you might as well expel a boy for scratching his head when it itched. I am sure the soundest way is to treat it as a doctor would, and explain to the boy the physical effects of over-indulgence of any sort. When it is combated from the monkish standpoint, the evil becomes an epidemic." I am, however, far from anxious to indorse the policy of ignoring the sexual phenomena of youth. It is not the speaking about such things that should be called in question, but the wisdom and good sense of the speaker. We ought to expect a head-master to possess both an adequate acquaintance with the nature of the phenomena of auto-erotism and homosexuality, and a reasonable amount of tact in dealing with boys; he may then fairly be trusted to exercise his own judgment.It may be doubted whether boys should be made too alive to the existence of sexual phenomena; there can be no doubt about their teachers. The same is, of course, true as regards girls, among whom the same phenomena, though less obtrusive, are not less liable to occur.
As to whether masturbation is more common in one sex than the other, there have been considerable differences of opinion. Tissot considered it more prevalent among women; Christian believed it commoner among men; Deslandes and Iwan Bloch hold that there are no sexual differences, and Garnier was doubtful. Lawson Tait, in hisDiseases of Women, stated his opinion that in England, while very common among boys, it is relatively rare among women, and then usually taught. Spitzka, in America, also found it relatively rare among women, and Dana considers it commoner in boys than in girls or adults.[307]Moll is inclined to think that masturbation is less common in women and girls than in the male sex. Rohleder believes that after puberty, when it is equally common in both sexes, it is more frequently found in men, but that women masturbate with more passion and imaginative fervor.[308]Kellogg, in America, says it is equally prevalent in both sexes, but that women are more secretive. Morris, also in America, considers, on the other hand, that persistent masturbation is commoner in women, and accounts for this by the healthier life and traditions of boys. Pouillet, who studied the matter with considerable thoroughness in France, came to the conclusion that masturbation is commoner amongwomen, among whom he found it to be equally prevalent in rich and poor, and especially so in the great centres of civilization. In Russia, Guttceit states in hisDreissig Jahre Praxis, that from the ages of 10 to 16 boys masturbate more than girls, who know less about the practice which has not for them the charm of the forbidden, but after 16 he finds the practice more frequent in girls and women than in youths and men. Näcke, in Germany, believes that there is much evidence pointing in the same direction, and Adler considers masturbation very common in women. Moraglia is decidedly of the opinion, on the ground of his own observations already alluded to, that masturbation is more frequent among women; he refers to the fact—a very significant fact, as I shall elsewhere have to point out—that, while in man there is only one sexual centre, the penis, in woman there are several centres,—the clitoris, the vagina, the uterus, the breasts,[309]—and he mentions that he knew a prostitute, a well-developed brunette of somewhat nervous temperament, who boasted that she knew fourteen ways of masturbating herself.
My own opinion is that the question of the sexual distribution of masturbation has been somewhat obscured by that harmful tendency, to which I have already alluded, to concentrate attention on a particular set of auto-erotic phenomena. We must group and divide our facts rationally if we wish to command them. If we confine our attention to very young children, the available evidence shows that the practice is much more common in females,[310]and such a result is in harmony with the fact that precocious puberty is most often found in female children.[311]Atpuberty and adolescence occasional or frequent masturbation is common in both boys and girls, though, I believe, less common than is sometimes supposed; it is difficult to say whether it is more prevalent among boys or girls; one is inclined to conclude that it prevails more widely among boys. The sexual impulse, and consequently the tendency to masturbation, tend to be aroused later, and less easily in girls than in youths, though it must also be remembered that boys' traditions and their more active life keep the tendency in abeyance, while in girls there is much less frequently any restraining influence of corresponding character.[312]In my study of inversion I have found that ignorance and the same absence of tradition are probably factors in the prevalence of homosexual tendencies among women.[313]After adolescence I think there can be no doubt that masturbation is more common in women than in men. Men have, by this time, mostly adopted some method of sexual gratification with the opposite sex; women are to a much larger extent shut out from such gratification; moreover, while in rare cases women are sexually precocious, it more often happens that their sexual impulses only gain strength and self-consciousness after adolescence has passed. I have been much impressed by the frequency with which masturbation is occasionally (especially about the period of menstruation) practiced by active, intelligent, andhealthy women who otherwise lead a chaste life. This experience is confirmed by others who are in a position to ascertain the facts among normal people; thus a lady, who has received the confidence of many women, told me that she believes that all women who remain unmarried masturbate, as she found so much evidence pointing in this direction.[314]This statement certainly needs some qualification, though I believe it is not far from the truth as regards young and healthy women who, after having normal sexual relationships, have been compelled for some reason or other to break them off and lead a lonely life.[315]But we have to remember that there are some women, evidently with a considerable degree of congenital sexual anæsthesia (no doubt, in some respect or another below the standard of normal health), in whom the sexual instinct has never been aroused, and who not only do not masturbate, but do not show any desire for normal gratification; while in a large proportion of other cases the impulse is gratified passively in ways I have already referred to. The auto-erotic phenomena which take place in this way, spontaneously, by yielding to revery, with little or no active interference, certainly occur much more frequently in women than in men. On the other hand, contrary to what one might be led to expect, the closely-related auto-erotic phenomena during sleep seem to take place more frequently in men, although in women, as we have found ground for concluding, they reverberate much more widely and impressively on the waking psychical life.
We owe to Restif de la Bretonne what is perhaps the earliest precise description of a woman masturbating. In 1755 he knew a dark young woman, plain but well-made, and of warm temperament, educated in a convent. She was observed one day, when gazing from her window at a young man in whom she was tenderly interested, to become much excited. "Her movements became agitated; I approached her, and really believe that she was uttering affectionate expressions; she had become red. Then she sighed deeply, and became motionless,stretching out her legs, which she stiffened, as if she felt pain." It is further hinted that her hands took part in this manœuvre (Monsieur Nicolas, vol. vi, p. 143).Pictorial representations of a woman masturbating also occur in eighteenth century engravings. Thus, in France, Baudouin's "Le Midi" (reproduced in Fuchs'sDas Erotische Element in der Karikatur, Fig. 92), represents an elegant young lady in a rococo garden-bower; she has been reading a book she has now just dropped, together with her sunshade; she leans languorously back, and her hand begins to find its way through her placket-hole.Adler, who has studied masturbation in women with more care than any previous writer, has recorded in detail the auto-erotic manifestations involved in the case of an intelligent and unprejudiced woman, aged 30, who had begun masturbating when twenty, and practiced it at intervals of a few weeks. She experienced the desire for sexual gratification under the following circumstances: (1) spontaneously, directly before or after menstruation; (2) as a method to cure sleeplessness; (3) after washing the parts with warm (but not cold) water; (4) after erotic dreams; (5) quite suddenly, without definite cause. The phenomena of the masturbatory process fell into two stages: (1) incomplete excitement, (2) the highest pleasurable gratification. It only took place in the evening, or at night, and a special position was necessary, with the right knee bent, and the right foot against the knee of the extended left leg. The bent index and middle fingers of the right hand were then applied firmly to the lower third of the left labium minus, which was rubbed against the underlying parts. At this stage, the manifestations sometimes stopped, either from an effort of self-control or from fatigue of the arm. There was no emission of mucus, or general perspiration, but some degree of satisfaction and of fatigue, followed by sleep. If, however, the manipulation was continued, the second stage was reached, and the middle finger sank into the vagina, while the index finger remained on the labium, the rest of the hand holding and compressing the whole of the vulva, from pubes to anus, against the symphysis, with a backwards and forwards movement, the left hand also being frequently used to support and assist the right. The parts now gave a mushroom-like feeling to the touch, and in a few seconds, or after a longer interval, the complete feeling of pleasurable satisfaction was attained. At the same moment there was (but only after she had had experience of coitus) an involuntary elevation of the pelvis, together with emission of mucus, making the hand wet, this mucus having an odor, and being quite distinct from the ordinary odorless mucus of the vagina; at the same time, the finger in the vagina felt slight contractions of the whole vaginal wall. The climax of sexual pleasure lasted a few seconds, with its concomitantvaginal contractions, then slowly subsided with a feeling of general well-being, the finger at the same time slipping out of the vagina, and she was left in a state of general perspiration, and sleep would immediately follow; when this was not the case, she was frequently conscious of some degree of sensibility in the sacrum, lasting for several hours, and especially felt when sitting. When masturbation was the result of an erotic dream (which occurred but seldom), the first stage was already reached in sleep, and the second was more quickly obtained. During the act it was only occasionally that any thoughts of men or of coitus were present, the attention being fixed on the coming climax. The psychic state afterwards was usually one of self-reproach. (O. Adler,Die Mangelhafte Geschlechtsempfindung des Weibes, 1904, pp. 26-29.) The phenomena in this case may be regarded as fairly typical, but there are many individual variations; mucus emissions and vaginal contractions frequently occur before actual orgasm, and there is not usually any insertion of the finger into the vagina in women who have never experienced coitus, or, indeed, even in those who have.
We owe to Restif de la Bretonne what is perhaps the earliest precise description of a woman masturbating. In 1755 he knew a dark young woman, plain but well-made, and of warm temperament, educated in a convent. She was observed one day, when gazing from her window at a young man in whom she was tenderly interested, to become much excited. "Her movements became agitated; I approached her, and really believe that she was uttering affectionate expressions; she had become red. Then she sighed deeply, and became motionless,stretching out her legs, which she stiffened, as if she felt pain." It is further hinted that her hands took part in this manœuvre (Monsieur Nicolas, vol. vi, p. 143).
Pictorial representations of a woman masturbating also occur in eighteenth century engravings. Thus, in France, Baudouin's "Le Midi" (reproduced in Fuchs'sDas Erotische Element in der Karikatur, Fig. 92), represents an elegant young lady in a rococo garden-bower; she has been reading a book she has now just dropped, together with her sunshade; she leans languorously back, and her hand begins to find its way through her placket-hole.
Adler, who has studied masturbation in women with more care than any previous writer, has recorded in detail the auto-erotic manifestations involved in the case of an intelligent and unprejudiced woman, aged 30, who had begun masturbating when twenty, and practiced it at intervals of a few weeks. She experienced the desire for sexual gratification under the following circumstances: (1) spontaneously, directly before or after menstruation; (2) as a method to cure sleeplessness; (3) after washing the parts with warm (but not cold) water; (4) after erotic dreams; (5) quite suddenly, without definite cause. The phenomena of the masturbatory process fell into two stages: (1) incomplete excitement, (2) the highest pleasurable gratification. It only took place in the evening, or at night, and a special position was necessary, with the right knee bent, and the right foot against the knee of the extended left leg. The bent index and middle fingers of the right hand were then applied firmly to the lower third of the left labium minus, which was rubbed against the underlying parts. At this stage, the manifestations sometimes stopped, either from an effort of self-control or from fatigue of the arm. There was no emission of mucus, or general perspiration, but some degree of satisfaction and of fatigue, followed by sleep. If, however, the manipulation was continued, the second stage was reached, and the middle finger sank into the vagina, while the index finger remained on the labium, the rest of the hand holding and compressing the whole of the vulva, from pubes to anus, against the symphysis, with a backwards and forwards movement, the left hand also being frequently used to support and assist the right. The parts now gave a mushroom-like feeling to the touch, and in a few seconds, or after a longer interval, the complete feeling of pleasurable satisfaction was attained. At the same moment there was (but only after she had had experience of coitus) an involuntary elevation of the pelvis, together with emission of mucus, making the hand wet, this mucus having an odor, and being quite distinct from the ordinary odorless mucus of the vagina; at the same time, the finger in the vagina felt slight contractions of the whole vaginal wall. The climax of sexual pleasure lasted a few seconds, with its concomitantvaginal contractions, then slowly subsided with a feeling of general well-being, the finger at the same time slipping out of the vagina, and she was left in a state of general perspiration, and sleep would immediately follow; when this was not the case, she was frequently conscious of some degree of sensibility in the sacrum, lasting for several hours, and especially felt when sitting. When masturbation was the result of an erotic dream (which occurred but seldom), the first stage was already reached in sleep, and the second was more quickly obtained. During the act it was only occasionally that any thoughts of men or of coitus were present, the attention being fixed on the coming climax. The psychic state afterwards was usually one of self-reproach. (O. Adler,Die Mangelhafte Geschlechtsempfindung des Weibes, 1904, pp. 26-29.) The phenomena in this case may be regarded as fairly typical, but there are many individual variations; mucus emissions and vaginal contractions frequently occur before actual orgasm, and there is not usually any insertion of the finger into the vagina in women who have never experienced coitus, or, indeed, even in those who have.
We must now turn to that aspect of our subject which in the past has always seemed the only aspect of auto-erotic phenomena meriting attention: the symptoms and results of chronic masturbation. It appears to have been an Englishman who, at the beginning of the eighteenth century, first called popular attention to the supposed evils of masturbation. His book was published in London, and entitled:Onania, or the Heinous Sin of Self-pollution, and all its Frightful Consequences in both Sexes, Considered, with Spiritual and Physical Advice, etc. It is not a serious medical treatise, but an early and certainly superior example of a kind of literature which we have since become familiar with through the daily newspapers. A large part of the book, which is cleverly written, is devoted in the later editions to the letters of nervous and hypochondriacal young men and women, who are too shy to visit the author, but request him to send a bottle of his "Strengthening Tincture," and mention that they are inclosing half a guinea, a guinea, or still larger sum. Concerning the composition of the "Strengthening Tincture" we are not informed.[316]This work, which was subsequently attributedto a writer named Bekkers, is said to have passed through no less than eighty editions, and it was translated into German. Tissot, a physician of Lausanne, followed with hisTraité de l'Onanisme: Dissertation sur les Maladies produites par la Masturbation, first published in Latin (1760), then in French (1764), and afterward in nearly all European languages. He regarded masturbation as a crime, and as "an act of suicide." His book is a production of amusing exaggeration and rhetoric, zealously setting forth the prodigious evils of masturbation in a style which combines, as Christian remarks, the strains of Rousseau with a vein of religious piety. Tissot included only manual self-abuse under the term "onanism;" shortly afterward, Voltaire, in hisDictionnaire Philosophique, took up the subject, giving it a wider meaning and still further popularizing it. Finally Lallemand, at a somewhat later period (1836), wrote a book which was, indeed, more scientific in character, but which still sought to represent masturbation as the source of all evils. These four writers—the author ofOnania, Tissot, Voltaire, Lallemand—are certainly responsible for much. The mistaken notions of many medical authorities, carried on by tradition, even down to our own time; the powerful lever which has been put into the hand of unscrupulous quacks; the suffering, dread, and remorse experienced in silence by many thousands of ignorant and often innocent young people may all be traced in large measure back to these four well-meaning, but (on this question) misguided, authors.
There is really no end to the list of real or supposed symptoms and results of masturbation, as given by various medical writers during the last century. Insanity, epilepsy, numerous forms of eye disease, supra-orbital headache, occipital headache (Spitzka), strange sensations at the top of the head (Savage), various forms of neuralgia (Anstie, J. Chapman), tenderness of the skin in the lower dorsal region (Chapman), mammary tenderness in young girls (Lacassagne), mammary hypertrophy (Ossendovsky), asthma (Peyer), cardiac murmurs (Seerley), the appearance of vesicles on wounds (Baraduc), acne and other forms of cutaneous eruptions (the author ofOnania, Clipson),dilated pupils (Skene, Lewis, Moraglia), eyes directed upward and sideways (Pouillet), dark rings around the eyes, intermittent functional deafness (Bonnier), painful menstruation (J. Chapman), catarrh of uterus and vagina (Winckel, Pouillet), ovarian disease (Jessett), pale and discolored skin (Lewis, Moraglia), redness of nose (Gruner), epistaxis (Joal, J. N. Mackenzie), morbid changes in nose (Fliess), convulsive cough of puberty (Gowers), acidity of vagina (R. W. Shufeldt), incontinence of urine in young women (Girandeau), warts on the hands in women (Durr, Kreichmar, von Oye), hallucinations of smell and hearing, (Griesinger, Lewis), intermittent functional deafness (Bonnier), indican in the urine (Herter), an indescribable odor of the skin in women (Skene), these are but a few of the signs and consequences of masturbation given by various prominent authorities.[317]
That many of these manifestations do occur in connection with masturbation is unquestionable; there is also good reason to believe that some of them may be the results of masturbation acting on an imperfectly healthy organism. But in all such cases we must speak with great caution, for there appears to be little reliable evidence to show that simple masturbation, in a well-born and healthy individual, can produce any evil results beyond slight functional disturbances, and these only when it is practiced in excess. To illustrate the real pathological relationships of masturbation, a few typical and important disorders may be briefly considered.
The delicate mechanism of the eye is one of the first portions of the nervous apparatus to be disturbed by any undue strain on the system; it is not surprising that masturbation should be widely incriminated as a cause of eye troubles. If, however, we inquire into the results obtained by the most cautious and experienced ophthalmological observers, it grows evident that masturbation, as a cause of disease of the eye, becomes merged into wider causes. In Germany, Hermann Cohn, the distinguished ophthalmic surgeon of Breslau, has dealt fully with thequestion.[318]Cohn, who believes that all young men and women masturbate to some extent, finds that masturbation must be excessive for eye trouble to become apparent. In most of his cases there was masturbation several times daily during from five to seven years, in many during ten years, and in one during twenty-three years. In such cases we are obviously dealing with abnormal persons, and no one will dispute the possibility of harmful results; in some of the cases, when masturbation was stopped, the eye trouble improved. Even in these cases, however, the troubles were but slight, the chief being, apparently, photopsia (a subjective sensation of light) with otherwise normal conditions of pupil, vision, color-sense, and retina. In some cases there was photophobia, and he has also found paralysis of accommodation and conjunctivitis. At a later date Salmo Cohn, in his comprehensive monograph on the relationship between the eye and the sexual organs in women, brought together numerous cases of eye troubles in young women associated with masturbation, but in most of these cases masturbation had been practiced with great frequency for a long period and the ocular affections were usually not serious.[319]In England, Power has investigated the relations of the sexual system to eye disease. He is inclined to think that the effects of masturbation have been exaggerated, but he believes that it may produce such for the most part trivial complaints as photopsisæ, muscsæ, muscular asthenopia, possibly blepharospasm, and perhaps conjunctivitis. He goes on, however, to point out that more serious complaints of the eye are caused by excess in normal coitus, by sexual abstinence, and especially by disordered menstruation. Thus we see that even when we are considering a mechanism so delicately poised and one so easily disturbed by any jar of the system as vision, masturbation produces no effect except when carried to an extent which argues a hereditarily imperfect organism, while even in these cases the effects are usually but slight, moreover, in no respect specific, butare paralleled and even exceeded by the results of other disturbances of the sexual system.
Let us turn to the supposed influence of masturbation in causing insanity and nervous diseases. Here we may chiefly realize the immense influence exerted on medical science by Tissot and his followers during a hundred years. Mental weakness is the cause and not the result of excessive masturbation, Gall declared,[320]but he was a man of genius, in isolation. Sir William Ellis, an alienist of considerable reputation at the beginning of the last century, could write with scientific equanimity: "I have no hesitation in saying that, in a very large number of patients in all public asylums, the disease may be attributed to that cause." He does, indeed, admit that it may be only a symptom sometimes, but goes on to assert that masturbation "has not hitherto been exhibited in the awful light in which it deserves to be shown," and that "in by far the greater number of cases" it is the true cause of dementia.[321]Esquirol lent his name and influence to a similar view of the pernicious influence of masturbation. Throughout the century, even down to the present day, this point of view has been traditionally preserved in a modified form. In apparent ignorance of the enormous prevalence of masturbation, and without, so far as can be seen, any attempt to distinguish between cause and effect or to eliminate the hereditary neuropathic element, many alienists have set down a large proportion of cases of insanity, idiocy, epilepsy, and disease of the spinal cord to uncomplicated masturbation. Thus, at the Matteawan State Hospital (New York) for criminal lunatics and insane prisoners, from 1875 to 1907, masturbation was the sole assigned cause of insanity in 160 men (out of 2,595); while, according to Dr. Clara Barrus, among 121 cases of insanity in young women, masturbation is the cause in ten cases.[322]It is unnecessary to multiply examples, for this traditional tendency is familiar to all.
It appears to have been largely due to Griesinger, in the middle of the last century, that we owe the first authoritative appearance of a saner, more discriminating view regarding the results of masturbation. Although still to some extent fettered by the traditions prevalent in his day, Griesinger saw that it was not so much masturbation itself as the feelings aroused in sensitive minds by the social attitude toward masturbation which produced evil effects. "That constant struggle," he wrote, "against a desire which is even overpowering, and to which the individual always in the end succumbs, that hidden strife between shame, repentance, good intentions, and the irritation which impels to the act, this, after not a little acquaintance with onanists, we consider to be far more important than the primary direct physical effect." He added that there are no specific signs of masturbation, and concluded that it is oftener a symptom than a cause. The general progress of educated opinions since that date has, in the main, confirmed and carried forward the results cautiously stated by Griesinger. This distinguished alienist thought that, when practiced in childhood, masturbation might lead to insanity. Berkhan, in his investigation of the psychoses of childhood, found that in no single case was masturbation a cause. Vogel, Uffelmann, and Emminghaus, in the course of similar studies, have all come to almost similar conclusions.[323]It is only on a congenitally morbid nervous system, Emminghaus insists, that masturbation can produce any serious results. "Most of the cases charged to masturbation," writes Kiernan (in a private letter), basing his opinion on wide clinical experience, "are either hebephrenia or hysteria in which an effect is taken for the cause." Christian, during twenty years' experience in hospitals, asylums, and private practice in town and country, has not found any seriously evil effects from masturbation.[324]He thinks, indeed, that it may be a more serious evil in women than in men. But Yellowlees considers that in women"it is possibly less exhausting and injurious than in the other sex," which was also the opinion of Hammond, as well as of Guttceit, though he found that women pushed the practice much further than men, and Näcke, who has given special attention to this point, could not find that masturbation is a definite cause of insanity in women in a single case.[325]Koch also reaches a similar conclusion, as regards both sexes, though he admits that masturbation may cause some degree of psychopathic deterioration. Even in this respect, however, he points out that "when practiced in moderation it is not injurious in the certain and exceptionless way in which it is believed to be in many circles. It is the people whose nervous systems are already injured who masturbate most easily and practice it more immoderately than others"; the chief source of its evil is self-reproach and the struggle with the impulse.[326]Kahlbaum, it is true, under the influence of the older tradition, when he erected katatonia into a separate disorder (not always accepted in later times), regarded prolonged and excessive masturbation as a chief cause, but I am not aware that he ever asserted that it was a sole and sufficient cause in a healthy organism. Kiernan, one of the earliest writers on katatonia, was careful to point out that masturbation was probably as much effect as cause of the morbid nervous condition.[327]Maudsley (inBody and Mind) recognized masturbation as a special exciting cause of a characteristic form of insanity; but he cautiously added: "Nevertheless, I think that self-abuse seldom, if ever, produces it without the co-operation of the insane neurosis."[328]Schüle also recognized a specific masturbatory insanity, but the general tendency to reject any such nosological form is becoming marked; Krafft-Ebing long since rejected it and Näcke decidedly opposes it. Kraepelin states that excessive masturbation can only occur in a dangerous degree in predisposedsubjects; so, also, Forel and Löwenfeld, as at an earlier period, Trousseau.[329]It is true that Marro, in his admirable and detailed study of the normal and abnormal aspects of puberty, accepts a form of masturbatory insanity; but the only illustrative case he brings forward is a young man possessing various stigmata of degeneracy and the son of an alcoholic father; such a case tells us nothing regarding the results of simple masturbation.[330]Even Spitzka, who maintained several years ago the traditional views as to the terrible results of masturbation, and recognized a special "insanity of masturbation," stated his conclusions with a caution that undermined his position: "Self-abuse," he concluded, "to become a sole cause of insanity, must be begun early and carried very far. In persons of sound antecedents it rarely, under these circumstances, suffices to produce an actual vesania."[331]When we remember that there is no convincing evidence to show that masturbation is "begun early and carried very far" by "persons of sound antecedents," the significance of Spitzka's "typical psychosis of masturbation" is somewhat annulled. It is evident that these distinguished investigators, Marro and Spitzka, have been induced by tradition to take up a position which their own scientific consciences have compelled them practically to evacuate.
Recent authorities are almost unanimous in rejecting masturbation as a cause of insanity. Thus, Rohleder, in his comprehensive monograph (Die Masturbation, 1899, pp. 185-92), although taking a very serious view of the evil results of masturbation, points out the unanimity which is now tending to prevail on this point, and lays it down that "masturbation is never the direct cause of insanity." Sexual excesses of any kind, he adds (following Curschmann), can, at the most, merely give an impetus to a latent form of insanity. On the whole, he concludes, the best authorities are unanimous in agreeing that masturbation may certainly injure mental capacity, by weakening memory and depressing intellectual energy; that, further, in hereditarily neurotic subjects, it may produce slight psychoses likefolie du doute,hypochondria, hysteria; that, finally, under no circumstances can it produce severe psychoses like paranoia or general paralysis. "If it caused insanity, as often as some claim," as Kellogg remarks, "the whole race would long since have passed into masturbatic degeneracy of mind.... It is especially injurious in the very young, and in all who have weak nervous systems," but "the physical traits attributed to the habit are common to thousands of neurasthenic and neurotic individuals." (Kellogg,A Text-book of Mental Diseases, 1897, pp. 94-95.) Again, at the outset of the article on "Masturbation," in Tuke'sDictionary of Psychological Medicine, Yellowlees states that, on account of the mischief formerly done by reckless statements, it is necessary to state plainly that "unless the practice has been long and greatly indulged, no permanent evil effects may be observed to follow." Näcke, again, has declared ("Kritisches zum Kapitel der Sexualität,"Archiv für Psychiatrie, 1899): "There are neither somatic nor psychic symptoms peculiar on onanism. Nor is there any specific onanistic psychosis. I am prepared to deny that onanism ever produces any psychoses in those who are not already predisposed." That such a view is now becoming widely prevalent is illustrated by the cautious and temperate discussion of masturbation in a recent work by a non-medical writer, Geoffrey Mortimer (Chapters on Human Love, pp. 199-205).
Recent authorities are almost unanimous in rejecting masturbation as a cause of insanity. Thus, Rohleder, in his comprehensive monograph (Die Masturbation, 1899, pp. 185-92), although taking a very serious view of the evil results of masturbation, points out the unanimity which is now tending to prevail on this point, and lays it down that "masturbation is never the direct cause of insanity." Sexual excesses of any kind, he adds (following Curschmann), can, at the most, merely give an impetus to a latent form of insanity. On the whole, he concludes, the best authorities are unanimous in agreeing that masturbation may certainly injure mental capacity, by weakening memory and depressing intellectual energy; that, further, in hereditarily neurotic subjects, it may produce slight psychoses likefolie du doute,hypochondria, hysteria; that, finally, under no circumstances can it produce severe psychoses like paranoia or general paralysis. "If it caused insanity, as often as some claim," as Kellogg remarks, "the whole race would long since have passed into masturbatic degeneracy of mind.... It is especially injurious in the very young, and in all who have weak nervous systems," but "the physical traits attributed to the habit are common to thousands of neurasthenic and neurotic individuals." (Kellogg,A Text-book of Mental Diseases, 1897, pp. 94-95.) Again, at the outset of the article on "Masturbation," in Tuke'sDictionary of Psychological Medicine, Yellowlees states that, on account of the mischief formerly done by reckless statements, it is necessary to state plainly that "unless the practice has been long and greatly indulged, no permanent evil effects may be observed to follow." Näcke, again, has declared ("Kritisches zum Kapitel der Sexualität,"Archiv für Psychiatrie, 1899): "There are neither somatic nor psychic symptoms peculiar on onanism. Nor is there any specific onanistic psychosis. I am prepared to deny that onanism ever produces any psychoses in those who are not already predisposed." That such a view is now becoming widely prevalent is illustrated by the cautious and temperate discussion of masturbation in a recent work by a non-medical writer, Geoffrey Mortimer (Chapters on Human Love, pp. 199-205).
The testimony of expert witnesses with regard to the influence of masturbation in producing other forms of psychoses and neuroses is becoming equally decisive; and here, also, the traditions of Tissot are being slowly effaced. "I have not, in the whole of my practice," wrote West, forty years ago, "out of a large experience among children and women, seen convulsions, epilepsy, or idiocyinducedby masturbation in any child of either sex. Neither have I seen any instance in which hysteria, epilepsy, or insanity in women after puberty wasdueto masturbation, as its efficient cause."[332]Gowers speaks somewhat less positively, but regards masturbation as not so much a cause of true epilepsy as of atypical attacks, sometimes of a character intermediate between the hysteroid and the epileptoid form; this relationship he has frequently seen in boys.[333]Leyden, among the causes of diseases of the spinal cord, does not include any formof sexual excess. "In moderation," Erb remarks, "masturbation is not more dangerous to the spinal cord than natural coitus, and has no bad effects";[334]it makes no difference, Erb considers, whether the orgasm is effected normally or in solitude. This is also the opinion of Toulouse, of Fürbringer, and of Curschmann, as at an earlier period it was of Roubaud.
While these authorities are doubtless justified in refusing to ascribe to masturbation any part in the production of psychic or nervous diseases, it seems to me that they are going somewhat beyond their province when they assert that masturbation has no more injurious effect than coitus. If sexual coitus were a purely physiological phenomenon, this position would be sound. But the sexual orgasm is normally bound up with a mass of powerful emotions aroused by a person of the opposite sex. It is in the joy caused by the play of these emotions, as well as in the discharge of the sexual orgasm, that the satisfaction of coitus resides. In the absence of the desired partner the orgasm, whatever relief it may give, must be followed by a sense of dissatisfaction, perhaps of depression, even of exhaustion, often of shame and remorse. The same remark has since been made by Stanley Hall.[335]Practically, also, as John Hunter pointed out, there is more probability of excess in masturbation than in coitus. Whether, as some have asserted, masturbation involves a greater nervous effort than coitus is more doubtful.[336]It thus seems somewhat misleading to assert that masturbation has no more injurious effect than coitus.[337]
Reviewing the general question of the supposed grave symptomsand signs of masturbation, and its pernicious results, we may reach the conclusion that in the case of moderate masturbation in healthy, well-born individuals, no seriously pernicious results necessarily follow.[338]With regard to the general signs, we may accept, as concerns both sexes, what the Obstetrical and Gynecological Society of Berlin decided in 1861, in a discussion of it in women, that there are none which can be regarded as reliable.[339]
We may conclude finally, with Clouston, that the opposing views on the subject may be simply explained by the fact that the writers on both sides have ignored or insufficiently recognized the influence of heredity and temperament. They have done precisely what so many unscientific writers on inebriety have continued to do unto the present day, when describing the terrible results of alcohol without pointing out that the chief factor in such cases has not been the alcohol, but the organization on which the alcohol acted. Excess may act, according to the familiar old-fashioned adage, like the lighted match. But we must always remember the obvious truth, that it makes a considerabledifference whether you threw your lighted match into a powder magazine or into the sea.
While we may thus dismiss the extravagant views widely held during the past century, concerning the awful results of masturbation, as due to ignorance and false tradition, it must be pointed out that, even in healthy or moderately healthy individuals, any excess in solitary self-excitement may still produce results which, though slight, are yet harmful. The skin, digestion, and circulation may all be disordered; headache and neuralgia may occur; and, as in normal sexual excess or in undue frequency of sexual excitement during sleep, there is a certain general lowering of nervous tone. Probably the most important of the comparatively frequent results—though this also arises usually on a somewhat morbid soil—is neurasthenia with its manifold symptoms. There can be little doubt that the ancient belief, dating from the time of Hippocrates, that sexual excesses produce spinal disease, as well as the belief that masturbation causes insanity, are largely due to the failure to diagnose neurasthenia.
The following case of neurasthenia, recorded by Eulenburg, may be given as a classical picture of the nervous disturbances which may be associated with masturbation, and are frequently regarded as solely caused by habits of masturbation: Miss H. H., 28 years of age, a robust brunette, with fully developed figure, without any trace of anæmia or chlorosis, but with an apathetic expression, bluish rings around the eyes, with hypochondriacal and melancholy feelings. She complains of pressure on the head ("as if head would burst"), giddiness, ringing in the ears, photopsia, hemicrania, pains in the back and at sacrum, and symptoms of spinal adynamia, with a sense of fatigue on the least exertion in walking or standing; she sways when standing with closed eyes, tendon-reflexes exaggerated; there is a sense of oppression, intercostal neuralgia, and all the signs of neurasthenic dyspepsia; and cardialgia, nausea, flatulence, meteorism, and alternate constipation and diarrhœa. She chiefly complains of a feeling of weight and pain in the abdomen, caused by the slightest movement, and of a form of pollution (with clitoridian spasms), especially near menstruation, with copious flow of mucus, characteristic pains, and hyperexcitability. Menstruation was irregular and profuse. Examination showed tumid and elongated nymphæ, with brown pigmentation; rather large vagina, with rudimentaryhymen; and retroflexion of uterus. After much persuasion the patient confessed that, when a girl of 12, and as the result of repeated attempts at coitus by a boy of 16, she had been impelled to frequent masturbation. This had caused great shame and remorse, which, however, had not sufficed to restrain the habit. Her mother having died, she lived alone with her invalid father, and had no one in whom to confide. Regarding herself as no longer a virgin, she had refused several offers of marriage, and thus still further aggravated her mental condition. (Eulenburg,Sexuale Neuropathie, p. 31.)Since Beard first described neurasthenia, many diverse opinions have been expressed concerning the relationships of sexual irregularities to neurasthenia. Gilles de la Tourette, in his little monograph on neurasthenia, following the traditions of Charcot's school, dismisses the question of any sexual causation without discussion. Binswanger (Die Pathologie und Therapie der Neurasthenie), while admitting that nearly all neurasthenic persons acknowledge masturbation at some period, considers it is not an important cause of neurasthenia, only differing from coitus by the fact that the opportunities for it are more frequent, and that the sexual disturbances of neurasthenia are, in the majority of cases, secondary. Rohleder, on the other hand, who takes a very grave view of the importance of masturbation, considers that its most serious results are a question of neurasthenia. Krafft-Ebing has declared his opinion that masturbation is a cause of neurasthenia. Christian, Leyden, Erb, Rosenthal, Beard, Hummel, Hammond, Hermann Cohn, Curschmann, Savill, Herman, Fürbringer, all attach chief importance to neurasthenia as a result of masturbation. Collins and Phillip (Medical Record, March 25, 1899), in an analysis of 333 cases of neurasthenia, found that 123 cases were apparently due to overwork or masturbation. Freud concludes that neurasthenia proper can nearly always be traced to excessive masturbation, or to spontaneous pollutions. (E.g.,Sammlung Kleiner Schriften zur Neurosenlehre, first series, p. 187.) This view is confirmed by Gattel's careful study (Ueber die Sexuellen Ursachen der Neurasthenie und Angstneurose, 1898). Gattel investigated 100 consecutive cases of severe functional nervous disorder in Krafft-Ebing's clinic at Vienna, and found that in every case of neurasthenia in a male (28 in all) there was masturbation, while of the 15 women with neurasthenia, only one is recorded as not masturbating, and she practicedcoitus reservatus. Irrespective of the particular form of the nervous disorder, Gattel found that 18 women out of 42, and 36 men out of 58, acknowledged masturbation. (This shows a slightly larger proportion among the men, but the men were mostly young, while the women were mostly of more mature age.) It must, however, always be remembered that we have no equally careful statistics of masturbation in perfectly healthy persons. We must also remember that we have to distinguishbetween thepostand thepropter, and that it is quite possible that neurasthenic persons are specially predisposed to masturbation. Bloch is of this opinion, and remarks that a vicious circle may thus be formed.On the whole, there can be little doubt that neurasthenia is liable to be associated with masturbation carried to an excessive extent. But, while neurasthenia is probably the severest affection that is liable to result from, or accompany, masturbation, we are scarcely yet entitled to accept the conclusion of Gattel that in such cases there is no hereditary neurotic predisposition. We must steer clearly between the opposite errors of those, on the one hand, who assert that heredity is the sole cause of functional nervous disorders, and those, on the other hand, who consider that the incident that may call out the disorder is itself a sole sufficient cause.
The following case of neurasthenia, recorded by Eulenburg, may be given as a classical picture of the nervous disturbances which may be associated with masturbation, and are frequently regarded as solely caused by habits of masturbation: Miss H. H., 28 years of age, a robust brunette, with fully developed figure, without any trace of anæmia or chlorosis, but with an apathetic expression, bluish rings around the eyes, with hypochondriacal and melancholy feelings. She complains of pressure on the head ("as if head would burst"), giddiness, ringing in the ears, photopsia, hemicrania, pains in the back and at sacrum, and symptoms of spinal adynamia, with a sense of fatigue on the least exertion in walking or standing; she sways when standing with closed eyes, tendon-reflexes exaggerated; there is a sense of oppression, intercostal neuralgia, and all the signs of neurasthenic dyspepsia; and cardialgia, nausea, flatulence, meteorism, and alternate constipation and diarrhœa. She chiefly complains of a feeling of weight and pain in the abdomen, caused by the slightest movement, and of a form of pollution (with clitoridian spasms), especially near menstruation, with copious flow of mucus, characteristic pains, and hyperexcitability. Menstruation was irregular and profuse. Examination showed tumid and elongated nymphæ, with brown pigmentation; rather large vagina, with rudimentaryhymen; and retroflexion of uterus. After much persuasion the patient confessed that, when a girl of 12, and as the result of repeated attempts at coitus by a boy of 16, she had been impelled to frequent masturbation. This had caused great shame and remorse, which, however, had not sufficed to restrain the habit. Her mother having died, she lived alone with her invalid father, and had no one in whom to confide. Regarding herself as no longer a virgin, she had refused several offers of marriage, and thus still further aggravated her mental condition. (Eulenburg,Sexuale Neuropathie, p. 31.)
Since Beard first described neurasthenia, many diverse opinions have been expressed concerning the relationships of sexual irregularities to neurasthenia. Gilles de la Tourette, in his little monograph on neurasthenia, following the traditions of Charcot's school, dismisses the question of any sexual causation without discussion. Binswanger (Die Pathologie und Therapie der Neurasthenie), while admitting that nearly all neurasthenic persons acknowledge masturbation at some period, considers it is not an important cause of neurasthenia, only differing from coitus by the fact that the opportunities for it are more frequent, and that the sexual disturbances of neurasthenia are, in the majority of cases, secondary. Rohleder, on the other hand, who takes a very grave view of the importance of masturbation, considers that its most serious results are a question of neurasthenia. Krafft-Ebing has declared his opinion that masturbation is a cause of neurasthenia. Christian, Leyden, Erb, Rosenthal, Beard, Hummel, Hammond, Hermann Cohn, Curschmann, Savill, Herman, Fürbringer, all attach chief importance to neurasthenia as a result of masturbation. Collins and Phillip (Medical Record, March 25, 1899), in an analysis of 333 cases of neurasthenia, found that 123 cases were apparently due to overwork or masturbation. Freud concludes that neurasthenia proper can nearly always be traced to excessive masturbation, or to spontaneous pollutions. (E.g.,Sammlung Kleiner Schriften zur Neurosenlehre, first series, p. 187.) This view is confirmed by Gattel's careful study (Ueber die Sexuellen Ursachen der Neurasthenie und Angstneurose, 1898). Gattel investigated 100 consecutive cases of severe functional nervous disorder in Krafft-Ebing's clinic at Vienna, and found that in every case of neurasthenia in a male (28 in all) there was masturbation, while of the 15 women with neurasthenia, only one is recorded as not masturbating, and she practicedcoitus reservatus. Irrespective of the particular form of the nervous disorder, Gattel found that 18 women out of 42, and 36 men out of 58, acknowledged masturbation. (This shows a slightly larger proportion among the men, but the men were mostly young, while the women were mostly of more mature age.) It must, however, always be remembered that we have no equally careful statistics of masturbation in perfectly healthy persons. We must also remember that we have to distinguishbetween thepostand thepropter, and that it is quite possible that neurasthenic persons are specially predisposed to masturbation. Bloch is of this opinion, and remarks that a vicious circle may thus be formed.
On the whole, there can be little doubt that neurasthenia is liable to be associated with masturbation carried to an excessive extent. But, while neurasthenia is probably the severest affection that is liable to result from, or accompany, masturbation, we are scarcely yet entitled to accept the conclusion of Gattel that in such cases there is no hereditary neurotic predisposition. We must steer clearly between the opposite errors of those, on the one hand, who assert that heredity is the sole cause of functional nervous disorders, and those, on the other hand, who consider that the incident that may call out the disorder is itself a sole sufficient cause.
In many cases it has seemed to me that masturbation, when practiced in excess, especially if begun before the age of puberty, leads to inaptitude for coitus, as well as to indifference to it, and sometimes to undue sexual irritability, involving premature emission and practical impotence. This is, however, the exception, especially if the practice has not been begun until after puberty. In women I attach considerable importance, as a result of masturbation, to an aversion for normal coitus in later life. In such cases some peripheral irritation or abnormal mental stimulus trains the physical sexual orgasm to respond to an appeal which has nothing whatever to do with the fascination normally exerted by the opposite sex. At puberty, however, the claim of passion and the real charm of sex begin to make themselves felt, but, owing to the physical sexual feelings having been trained into a foreign channel, these new and more normal sex associations remain of a purely ideal and emotional character, without the strong sensual impulses with which under healthy conditions they tend to be more and more associated as puberty passes on into adolescence or mature adult life. I am fairly certain that in many women, often highly intellectual women, the precocious excess in masturbation has been a main cause, not necessarily the sole efficient cause, in producing a divorce in later life between the physical sensuous impulses and the ideal emotions. The sensuous impulse having been evolved and pervertedbefore the manifestation of the higher emotion, the two groups of feelings have become divorced for the whole of life. This is a common source of much personal misery and family unhappiness, though at the same time the clash of contending impulses may lead to a high development of moral character. When early masturbation is a factor in producing sexual inversion it usually operates in the manner I have here indicated, the repulsion for normal coitus helping to furnish a soil on which the inverted impulse may develop unimpeded.