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CHAPTER IV.
MASTURBATION AND ONANISM.
STRICTLY speaking, the meaning of the word masturbation is the inciting to and producing of a venereal orgasm by the hand; namely, manual prostitution. By general custom, however, its use has been extended to cover all those cases in which a sexual excitation and orgasm are produced by any mechanical cause, always excepting the physiological one of coitus. The term onanism, first used, I believe, by Tissot as an alternative word for masturbation, I regard as absolutely incorrect. It is supposed to have been derived from Onan, the son of Judah, whose name received this unpleasant and lasting notoriety in consequence of his not completing the sexual act with his sister-in-law in accordance with the commands which were supposed to have been given him to raise up a family to his dead brother. Upon reference to the thirteenth chapter of Genesis and the ninth verse, it will be seen that he went in to his sister-in-law Tamar, and spilled his seed upon the ground. The phraseology in the biblical account is, I admit, vague, but the words, "going in to a woman," in scriptural parlance, mean sexual intercourse with her, and I believe Onan's crime to have been not one of masturbation, but of withdrawal at the critical moment when the orgasm occurred, because the child which might be born would not be his own, but would belong, according to the social customs of the time, to his brother. In this work, therefore, I shall treat of the two as separate matters, and shall confine the use of the word masturbation to the inducement of a sexual orgasm by artificial means—by the hand or otherwise—and onanism to the withdrawal from the vagina before the completion of the sexual act.
By some writers on this subject (Vecki v. Gyurkovechky and others) masturbation has been considered to be an ancient and time-honored custom, coeval perhaps with the origin of the human race, and probably this view is correct ; indeed it would seem unlikely that a habit so easy of accomplishment and so natural of performance should not have been indulged in from time immemorial by all races and branches of the human family. In fact, the pornographic literature of the ancients shows ample proof that this habit was recognized as one of common and daily occurrence, nor did the satirists of olden days hesitate to make accusation of this habit the vehicle for a merry jest or friendly admonition, as witness Martial's epigram In Ponticum (Lib. IX., Ep. XLII.) et passim. Perhaps other sexual pleasures, ex. gr. paederasty and tribadism, may have overshadowed the more homely pleasure of the hand, and it should also be remembered that illicit sexual intercourse was not severely frowned upon by the prudes or purists of that day.
There is no period of life in the male at which this habit is not performed, or at least is not capable of performance, from the baby in the cradle to the graybeard, so long as the sexual power or capacity for erection remains; indeed, the late Dr. Palmer, of Louisville, tersely and truthfully puts it, "of the male human being it may be said that he begins sexual life as a masturbator." In this statement Palmer is more gallant than Schmuckler, for while the former specifies only the male of the species, the latter states that of one hundred youths, boys and girls, ninety-nine masturbate.
In order to study the history and consequences of this habit, I shall divide the subject into the three following heads:
Masturbation in Infancy,
Masturbation in Childhood and Youth,
Masturbation in Adult Life,
inasmuch as the causes, symptoms, and effects vary much,
according to the stage of life in which this habit is indulged.
MASTURBATION IN INFANCY.
Etiology.—The causes of this habit in young children, and particularly in infants at the breast or in the cradle, are probably due to some irritation, either of the sexual organs, the genito-urinary tract, or of the rectum, and the two most fruitful sources of trouble in this class of subjects I believe to be the presence of ascarides and of phimosis, especially if this latter be tight and, as not infrequently is the case, adherent. These two conditions produce reflex irritation, which is shown by frequent erections and constant rubbing of the genitals by the infant, either between his crossed thighs, or by turning over on his belly and exercising friction against the bedding or his nurse's body. This goes on under conditions of intense excitement, the child becomes almost purple in the face, which is bathed in sweat, the respiration becomes short, sharp, and labored, and the performance ends in a chronic spasm with extreme pallor of the face, in opisthotonos with or without a cry, in fixation of the eyes with partial closure of the eyelids and a rolling up of the eyeballs; in fact, all the symptoms of a convulsive attack. This performance may end with a discharge from the urethra of a clear tenacious fluid supposed to be mucus (Taliaferro), or of a limpid mucus (Miller). In Taliaferro's and Miller's cases the infants were less than a year old. The erection subsides and the child from exhaustion falls into a sleep. Some writers (Lallemand, Acton, Howe) have stated that the habit has been induced by nurses who find titillation of the genital organs an easy and ready method of quieting querulous and crying babies. I think this is quite possible, but my own experience in this line has not been sufficient to enable me to state positively that I regard this as a very frequent cause of the habit in infants.
Age.—As stated above, masturbation may be practised by infants at the breast, and the youngest recorded instances that I have been able to find of masturbation in infancy are given by Heckford of a boy three months old, by Van Bambecke of a boy ten months old, and of two girl babies twenty months of age. In White's case (see p. 54) the child was twenty-four months old when it began to masturbate; so that no age may be considered too young for the indulgence of this habit.
MASTURBATION IN CHILDHOOD AND YOUTH.
As the child grows up, between the ages of five and twenty years, the habit is much, more likely to become confirmed and to be practised not only frequently, but oftentimes intemperately. Indeed, if we may believe the older writers, it has been performed in one instance (a child of twelve years) as often as fifteen times in an hour (Lallemand). If this statement be true, the child's whole hour must have been occupied in masturbation, and this I am inclined to doubt, for I do not believe any child's muscular strength or its nervous force would be equal to such a strain. It is much to be regretted that a great deal which is not only wildly improbable, but is absolutely impossible, should apptear in the works of respectable writers when treating of this subject. The consequences of this evil habit are bad enough when it is carried to excess, without resorting to extreme exaggeration.
Masturbation may also be indulged in during sleep, as is instanced by Hirschsprung in the case of two boys, respectively aged two and three years, who masturbated during sleep with ardor (" eifrig") in consequence of a chronic urticaria.
Etiology.—The causes which induce the habit at this period of life are manifold, and I find the two most frequent in my experience to be that of example by playmates and friends, and by the perusal and inspection of indecent books and pictures. In addition to these causes, some children seem to be sexually precocious, and take delight, whenever they can get an opportunity, of seeing naked girls and women. Lallemand gives several instances of this, and one is a case in which a lad, six years of age, was so busily occupied in looking up under her clothes at the naked legs of a washerwoman who was engaged in the pursuit of her vocation, as is common in France, on the border of a river, that approaching too near the brink he tumbled in and would certainly have been drowned but for the timely interference of the woman, the contemplation of whose legs had come so near ending the life of this precocious brat. Such instances I believe not are common, but they do occur, and in this connection it must also be remembered that the nervous system and the sexual proclivities of children have a great deal to do with this question of masturbation. Some youths, especially those who are brought up in a sedentary mode of life, are particularly prone to be troubled with vague sexual desires and sexual longings which find morbid gratification in looking at, and oftentimes in manipulating, their own and their playmates' persons of the opposite sex.
The different methods mentioned by writers upon this subject, whereby masturbation is accomplished other than by the hand, are from friction of the genitals against the clothing, between the thighs and against the body. Vecki states that this may come about accidentally and without any intention of indulging in the habit, and cites the case of a youth, sixteen years of age, who was in the habit, while studying, of lying upon his belly. One day, being stretched upon three chairs busily occupied in reading and unconscious of an erection of the penis, he suddenly found his clothing and body wet, which he at first thought was due to urination. It was, however, an emission, which had occurred without any voluntary effort on the boy's part and due perhaps to some slight movement of his body made unwittingly during the act of reading. The act may also be performed by mutual action between playmates and companions, and some authors state that it not infrequently takes place between man and wife, with the object of producing sexual gratification without the penalty of an increase in family (Vecki, Peyer). In the United States, I believe, this is very exceptional, and I do not remember in my experience to have been told of any such action, although not infrequently married men will practise masturbation, particularly if they are prevented from having sexual intercourse with their wives, from any cause whatsoever.
Titillation and stroking of the perineum, excitation by means of a penholder and gum elastic catheter intra urethram, irritation of the prostatic urethra per amum, the insertion of a foreign body into the rectum, simple contact with women without any sexual relation, as, for instance, in cars and public conveyances, and sometimes merely thinking about sexual connection, have been sufficient causes for producing the sexual orgasm (Peyer, Hammond).
In addition to these methods, two most extraordinary means of inducing this form of sexual pleasure have been reported by Kreps and by Moll. Kreps's case is so singular, and in my experience so unusual, that it is worthy of an extended notice. He was consulted in June, 1895, by a young man, aged twenty-two years, who complained of dull pains in the urethra, the testicles, the back, and the head. He further stated that he had had an early gonorrhoea which had ended in a stricture, for which he had been treated in Moscow by the introduction of bougies and which had done him great good, and he asked Kreps to continue the use of sounds. Kreps suspected nothing, and thinking it was a case of old gonorrhoea with a resulting stricture and neurasthenia, an old story to a genito-urinary surgeon, gave it no further thought and treated the man secundum artem, using the psychrophore and sounds three times a week, although the patient begged for the latter every day. As the patient was getting well he suggested reducing the number of visits to one per week, when to his excessive astonishment the patient begged him to continue as he was then doing, and there was something in the urgency of the plea, as well as the plaintive tone of the voice, that caused Kreps to suspect, but he kept his own counsel, said nothing, and told the patient that he could come as before, with the idea of watching him carefully while the sound was being passed. The instrument was passed slowly, and during its introduction as far as the bulb there seemed to be no response from the patient; he lay quietly on his back with his eyes shut and an expectant look on his face as though he was watching for something. As the passage of the sound progressed, and when Kreps was making the half turn to clear the openings through the triangular ligament, as soon as the distal end of the sound had passed into the pars posterior urethras, the entire appearance of the patient's face changed and there spread over his countenance a look of gratified lust and well-being; in other words, the passage of the sound had undoubtedly caused a sensation of sexual pleasure, and the act was nothing more nor less than that of masturbation. Kreps was naturally very much astonished, and the next time the patient came, instead of passing the sound he told him that it would be necessary to examine his urethra endoscopically with the electric light. The patient was very much disgruntled at learning this and objected strongly, but Kreps was firm, and willy-nilly, the patient was examined with the endoscope with the following result :
No. 25 tube (presumably French, F.R.S.) passed easily, the examination being made without cocaine. The introduction of the instrument through the pars posterior occasioned hardly any pain, and the patient's face wore a totally different appearance from what it was when the sounds were passed, having a rather anxious look and his eyes were open. The first thing to meet the eye on examination was the decidedly enlarged colliculus seminalis; it took up the entire lumen of the instrument and overlapped the borders of the endoscope; it was of a deep red color; it possessed well-marked furrows; the sinus prostaticus was well marked and was surrounded by a ring of a darker color; the ejaculatory ducts and prostatic ducts were also clearly visible, their mouths were open, and they were also surrounded with a dark ring. The pars membranacea was of a dark red color, with markedly hypertrophic folds. The pars anterior was darker than normal, was almost devoid of its shiny look, and was of a dead coloration. The epithelium had lost its brilliancy and its transparency; there was no evidence whatever either of desquamation nor of infiltration. In many points five to eight of the glands of Littre were grouped together with patulous mouths. The lacuna of Morgagni was well marked. The entire mucous membrane had the character of a highly developed irritation, such as is found among people who are either given over to great sexual excess, or who masturbate ardently.
" After the examination was finished I told the patient very plainly that the examination of his canal showed that for many years he had been in the habit of masturbating, and that this agreeable cure by the use of sounds was nothing more than a continuation of his habit and was injurious to him. He at first became highly offended and attempted to deny it, but he gradually calmed down, finally admitted the truth of my statement, and gave me the following history:
" He began the habit at so early an age of life that he could not remember the time at which he did not masturbate. When he went into the gymnasium,* at ten years of age, he gave up the habit for a few months, but began it again very soon afterward. He continued the habit ardently at one time, and that was when he was studying Greek, a study which was exceedingly tedious and disagreeable to him. So intimately are all Grecian matters connected with this habit that it is simply necessary to use the word Greek or Grecian in his presence for his mind to immediately refer to his habit of masturbation, and oftentimes with an almost irresistible impulse to carry his thought into practice. A few years ago he got hold of a popular book which enlightened people as to the way of carrying on this habit by the introduction of foreign bodies into the urethra. At once this struck him as a good idea, and he immediately went to work to put it into execution, and for several months he labored at it, but he
never could find anything that would quite meet all the indications which he required, until one day by accident at a friend's house he saw a metallic sound, and that at once suggested itself to him as the best instrument. He bought one and practised for many weeks assiduously the art of passing it for himself, and finally succeeded in doing so. On the first passage of the instrument there was no sensation, but after a time and by slowly passing it he was enabled to get an orgasm. After this the ordinary method lost all attraction for him, and he practised his bad habit with the sounds, but at the end of three months he came to grief; busily occupied in one of his seances in passing the sound, some one knocked at his door suddenly; he jumped up, and withdrew the instrument quickly from his canal, which created sharp pain and a good deal of bleeding. The pain lasted for a whole week, and so frightened him that he never used the sounds himself again. When his family came to St. Petersburg, he was obliged to live in a large family with sisters, so that at any moment some one was liable to come into his room; at night he was obliged to sleep with his brothers in the same room, and' these circumstances very naturally interfered with his pastime with the sounds. One day he happened to learn that doctors treated strictures and neurasthenia with sounds; that idea was quite sufficient for him, and he turned over in his mind how he could get a physician to pass a sound for him. After several delays he finally went to a physiciarf who passed a soft bougie. That was of no good, so he went to a second physician, who used a metallic instrument, but passed it so quickly that it gave him no pleasure whatever, and he therefore came to me. The rest of the history is known. Let me here state that the patiant is perfectly healthy. ..."
Moll's case is that of a patient of von Krafft-Ebing, who when a lad of thirteen years of age in os proprium penem suscipere potuit, and in that manner was enabled to perform the act and to obtain an ejaculation. This seems almost incredible, unless possibly the boy was a contortionist or an india rubber boy, whereby he could twist his spine in any direction that he chose to; but as it comes from an eminent and trustworthy source, and worthy of all credence, I give it as I have read it myself. I have never seen nor heard of such a case.
Some writers upon this subject believe that certain gymnastic exercises have laid a foundation for the exercise of this habit; thus, Acton writes that climbing in a gymnasium was the beginning of one of his patient's masturbating practices, and Howe cites exercise on a swinging pole, sliding down a boat's mast and banisters as causes assigned by some of his patients for their learning to masturbate. Peyer also expresses the same views. Of course, it is possible that the friction which would be exercised by these movements might cause enough genital irritation to produce a pleasurable sensation, but having had in my younger days a pretty wide experience of gymnasia, I am certain that a habit of -masturbation would be very rarely, if ever, induced in a healthy boy, even by sliding down a pole. My experience has been that youths who are gymnasts or who take regular physical exercise are very little inclined to this practice. Indeed, so far from inducing this habit, I believe physical exercise is one of the best prophylactics against masturbation. Howe's case, where the patient learned to masturbate by- sliding down the banisters, occurred in a girl, and in that sex perhaps such an exercise might induce the habit; a point which I shall leave to my gynaecological brethren to decide, as being better qualified to answer it than I am.
Besides the causes which have been enumerated, balanitis, stone in the bladder, a tight foreskin, intestinal worms, stimulating and unsuitable food and drink, constipation, uncleanliness, too warm a bed, tight and ill-fitting clothing, and sleeping in the same bed with another person have been assigned as causes for the induction of this habit, the first three being not infrequent causes from the sense of relief which the pulling and rubbing of the sexual organs produces, without there having been originally any desire for or intention of masturbating. This habit, if long indulged in, produces reflex conditions which tend to keep up the habit, so that a vicious circle is established, the masturbation keeping up the irritation and the irritation induciMg a continued habit of masturbation. It is in these young subjects that the most pronounced evil effects of the habit are discernible.
Occasionally, but rarely, I believe, in this country, children have been taught the vice by adults, and particularly is this the case in tenement-house districts and. places where men, women, and children herd together and where it would be a great wonder if children did not learn a great deal about things that they ought to know nothing of (Hammond). Sometimes parents have unwittingly been the cause of inducing this habit in children, by calling the child's attention to its genitals while dressing or washing it; by stripping back the foreskin, thus inducing more or less irritation in the genitals, and by such irritation laying the foundation for its relief by masturbation. Vecki states also that scholastic instruction in classical literature of an erotic type is, in his belief, one of the causes of inducing this habit. It is possible that such may be the case, but I myself should be strongly inclined to doubt it.
It has been clarmed that punishment of a child by slapping its buttocks has sometimes induced the habit; but at the present day, such a method of correction is, in this country at least, I think, very infrequent. It will be remembered that Rousseau, in his " Confessions " says pretty plainly that pleasurable desires were produced in him whenever he was thus corrected by his female teacher, Mademoiselle Lambercier; but he very naively admits that when a similar correction was administered by her brother these pleasurable sensations were entirely wanting, and I incline to the belief that young Rousseau's sexual desires were aroused more from contact with the body of his female teacher than by the spanking which he got. Peyer, however, says, that he has seen cases in his experience, where flogging on the nates has laid the foundation for masturbating habits and warns against this method of punishment.
Lazy and indolent habits, lolling in bed after the child is fairly awake, are also exciting causes toward erection and masturbation. It is well that children who are suspected of this habit should be obliged to get out of bed as soon as they are awake. Irritation of the genitals or any skin eruption about them, such as eczema, prurigo, or, as sometimes happens, phthiriasis, may lay the foundation of the habit, and we must also bear well in mind the fact that congenital tendencies, especially in infants and children, are sometimes to blame for the commencement of this habit.
In speaking of children (p. 71) I mentioned the fact that masturbation might take place in a somnambulistic condition, and the same is true of the young adult. Many years ago, during my association with the late Dr. Bumstead, I saw with him a young lawyer who was in the habit of masturbating during sleep, in an entirely unconscious condition, waking up only at the time of the emission. His case I refer to more in extenso upon page so I shall say nothing more about it here.
Cabot, of New York, has recorded three cases, all in grown persons, respectively of the ages of fifteen, twenty-two, and twenty-eight. Of these, two recovered, one was still under treatment. One was finally cured by marriage, the other one by wearing plaster of Paris drawers during sleep. These cases were reported to the neurological section of the Academy of Medicine, and in the discussion which took place Dr. Graeme Hammond instanced one case in his own experience which occurred in a young man, aged twenty-five, to whom the habit was exceedingly repugnant, and who invariably woke up during the night to find himself seated in a chair in the performance of the act. Hammond tried to correct this habit by making him work hard both physically and mentally and exhausting him so that when he went to sleep he would sleep through, but that apparently was not enough, because even then he would find himself in the same position as usual, but Hammond finally cured him by dressing him at night in a pair of thick canvas drawers, or rather trunks, which locked behind and which he could not open himself, thus preventing him from performing the act.
Dr. F. Pedersen narrated the details of one case which was cured by being sent to a private asylum.
These conditions are singular and noteworthy because they exemplify this fact, that masturbation is partly a matter of habit, and having once got into the habit, even though it may be broken off for several years, as was the case in some of these patients, it will yet return while the patient is in an unconscious condition.
Symptoms.— Almost among the first of the symptoms which this habit may produce is a condition of chlorosis, emaciation, physical lassitude, and mental hebetude. The lad who previously was so bright, intelligent, and active, both physically and mentally, becomes precisely the opposite. He has lost his healthy, blooming appearance; he drags his limbs about as if they were too heavy for his muscles ; he shuns physical exercise or association with his playmates; he is irritable, peevish, stupid and unable to apply himself either to his studies or amusements, and is the cause of much solicitude and anxiety to his parents, who wonder what can have come over their boy to have changed him so much. If the habit has been intemperately and continuously indulged in, the nervous symptoms may go on so far as to produce epileptic attacks or, if not carried to such an extent, attacks of vertigo, fainting, and dyspnoea, which induce the belief in some deep-seated organic lesion, either of the heart, lungs, or brain. The sexual organs, at first in a more or less condition of priapism, gradually lose their power of complete erection, becoming exceedingly irritable, so that the slightest friction, even that against the clothing, is sufficient to induce the discharge of a thin watery fluid, not seminal in its strictest sense, but probably a secretion from the irritated and inflamed glands of Cowper or of Littre, leading ultimately to spermatorrhoea as adult life is reached. This condition of irritability increases and is accompanied by inflammation of the deeper part of the urethra, inducing a tendency to frequent micturition, which is sometimes involuntary, especially at night, although occasionally diurnal eneuresis takes place.
Joal, Peyer, Morgan, and Rendu mention epistaxis as a symptom which occurs in masturbators, whether children or young adults arrived at the age of puberty. In my experience I have never seen this symptom, and am strongly inclined to doubt its direct connection with the habit.
Nyctalopia, amaurosis, and deafness have also been ascribed to the indulgence in this habit of masturbation (Johnson). In addition to these conditions of the eye a sensation of weight, of pain in the lids as well as in the globe, spasmodic contraction of the palpebras, photophobia, photopsia, together with a condition of neurasthenic asthenopia, chronic catarrhal conjunctivitis with an impairment of the power of accommodation, together with hyper&ae;sthesia of hearing (Löwenfeld, Landersberg) are considered to be induced by this habit. Deneffe gives an instance where derangement of vision was associated with atrophy of the optic nerve, and visual weakness.
It would seem as though there were no disease which this gruesome practice may not give rise to, for Marjolin expresses his firm belief that masturbation is a fruitful source of Pott's disease of the spine, stating that children affected with this form of disease abandon themselves to masturbation "with a species of fury." But it would seem as though Pott's disease might be the origin of the habit of self-pollution instead of its result, for he furthermore writes that the development of a precocious sexual passion as shown by masturbators is especially noticeable in children who suffer from Pott's disease of the spine.
Phthisis has also been laid at the door of masturbation. In a paper read before the Medico-Chirurgical Society, Dr. Smith stated that out of one thousand phthisical persons, 11.6 had committed sexual, excesses, 18.2 had been addicted to masturbation, and twenty-two per cent. had suffered from nocturnal emissions. This is a fair exemplification of the use to which figures are put to support a theory. Of the eleven per cent. of persons who had suffered from sexual excesses had any masturbated; if so, how many? The same might be asked of the twenty-two per cent. who had suffered from nocturnal emissions. The probability is that some, if not all of them, had masturbated, and if so the percentage of masturbators would be increased, and it would also be pertinent to ask which influence was the greatest in producing the phthisis: the sexual excess or the masturbating? It would be interesting also to know how many, if any, of these phthisical subjects had tubercular disease of the generative organs; of the testes, the vesicul&ae; seminales, the vasa deferentia, or of the prostate ? Is it not possible that disease of these organs may have been the starting point of the vicious habits, instead of vice versa ? There is nothing in Dr. Smith's statistics to disprove this view. The "post hoc ergo propter hoc " mode of reasoning is a dangerous one, and leads to such improbable and wild statements as are to be found in Howe's work, where he boldly proclaims that " I (Howe) have for many years made it a practice to get at the history of the parents of consumptive children, and my examinations so invariably confirm my suspicions that I have now no doubt whatever of the direct relation between masturbation and hereditary phthisis." In this Howe goes a step beyond Smith; the latter only claims that masturbation induces phthisis in the masturbator, but Howe says not only does the masturbator become phthisical, but he transmits phthisis to his children as a consequence of his vicious habit.
Notwithstanding these statements, I do not think any proof exists which shows a direct connection between masturbatfon and phthisis. That, given a person who is * of debilitated constitution and perhaps with an inherited tendency to phthisis, such a one may by intemperate and exhausting masturbation develop tuberculosis of any organ of the body, I can readily conceive, but that is very different from saying that X—— masturbates and has phthisis, ergo X——'s masturbating habits caused the phthisis.
The same is true with regard to cardiac disease in this class of cases. In children and young adolescents one of the principal symptoms is chlorosis, and this is frequently accompanied by a bruit de diable which is purely a functional disturbance. The nervous exhaustion following repeated and furious masturbation is often followed by an irregular and enfeebled heart's action, the beats being sometimes greatly increased, sometimes much diminished, but there is no evidence of heart disease (Bachus).
In addition to the constitutional effects already mentioned, there are local ones which should be taken into consideration. In adolescents who habitually masturbate, there is not infrequently an irritable condition of the bladder and involuntary urination, with oftentimes difficulty in passing water; neuralgia of the neck of the bladder, of the testicles, and of the spermatic cord; a relaxed and pendulous condition of the scrotum, with abnormal perspiration of the genitals, varicocele, and a sense of discomfort in the entire organ. Some authors speak of the shrivelled, dried, and bloodless condition of the glans penis which, in confirmed masturbators, becomes of a bulbous swollen character. This latter symptom, at least in my own experience, is by no means constant nor pathognomonic and is not to be depended upon.
Stricture has also been mentioned by Gross, Otis, Deneffe and others as induced by masturbation, but upon this point I differ from my colleagues, if by stricture we are to understand a contraction of the urethra occurring from the deposit of organized material beneath the mucous membrane. That an irritable condition of the canal may and does occur in cases where masturbation is carried to excess, and which may at times be so marked as to temporarily check the passage of the sound, I will freely admit, but in all such cases my experience has been that the impediment is due to an irritable condition of the canal, producing spasmodic contraction, which yields rapidly to the passage of sounds after the lapse of a short time. If the urethra be examined under these circumstances by the endoscope, the mucous membrane about the colliculus seminalis instead of being of its normal bright hue is seen to be of a purple color, deeply congested, puffy, and bleeds readily upon being touched with a tampon of cotton. The examination is attended with exquisite pain, and the patient often complains of a sensation as though he were going to have an emission. In marked cases this congestion extends along the prostatic urethra and sometimes, but rarely, invades the portion of the canal about the bulbus urethrse and even a little anterior to that point. In these cases also the patient is exceedingly alarmed by what he considers to be spermatozoa in the urine, and upon examination numerous shreds of varying size are found floating about in the secretion from the kidneys. These shreds, viewed under the microscope, are found to be portions of mucous membrane which have been stripped from the urethra, and of coagulated mucus, probably from the glandular portion of the prostate and from Cowper's glands. They are very similar to what is seen in cases of chronic urethritis and which have been called by the German writers "tripperfäden."
The diagnosis is somewhat difficult to make as to whether these shreds are due to masturbation or to an old clap, because many patients have had, at some time or other in their life, an attack of gonorrhoea, but there are a sufficient number of instances in which the patients, having never had sexual intercourse and never having had a venereal disease, yet show these shreds, and there is no reason why they should not, inasmuch as the filaments result from inflammation and congestion of the mucous membrane of the urethra, and these may occur from any irritation, whether of venereal or non-venereal origin.
Besides these shreds there are various little shining bodies, leucocytes and seminal corpuscles, which some writers consider as pathognomonic of the habit of masturbation. These phenomena are not necessarily present in every case of masturbation for which the surgeon is consulted. They usually occur in those cases where the habit has been of long standing and has been persistently practised, and are much more likely to be associated with cases of spermatorrhoea. I shall refer again to this subject when I come to treat of that affection.
It has also been stated that urethritis may result as one of the consequences of this habit (Deneffe), but in this view I cannot agree, if by urethritis is meant a catarrhal discharge due to inflammation of the urethra. Not infrequently the practice of masturbation will produce some irritation of the urethral mucous membrane in the male, and will cause a hypersecretion from the glands of Cowper and from the urethral glands (Littrè's glands). This irritation will often give rise to leaking of a thin sticky mucous discharge, sometimes quite abundant, but which under the microscope very seldom, if ever, shows pus corpuscles or other results of true inflammation. This discharge, to my mind, should not be called a urethritis, as a urethritis implies a catarrhal or muco-purulent discharge, due to inflammation of the urethra. It is rather a urethrorrhoea than a urethritis.
Besides these physical symptoms there are others and more important ones which have been laid to the door of masturbation: I refer to affections of the nervous system as exemplified by epilepsy, tabes dorsalis, insanity, and suicide. The older writers upon this subject have considered masturbation as a fruitful parent of all sorts of nervous and mental derangements, not drawing the line between those instances in which the masturbation was induced by local causes and by example, and those in which the habit was brought about by neurotic tendencies and by a congenital weakness of the nervous system. As regards the question of epilepsy, it may occur in persons of a nervous temperament where the habit has been prolonged and frequent; and indeed the same symptom occurs in some persons after sexual intercourse. The shock has been too great for their nervous powers and an epileptiform seizure has followed. Most men, however, are able to indulge moderately in coitus without such unpleasant results, and the same I believe to be true with regard to masturbation. While admitting the possibility that, in exceptional instances, epilepsy may follow, I am decidedly of the opinion that it is the exception rather than the rule, and where it occurs it shows a previous degeneration of the nervous system. I am quite of Mr. Yellowlee's mind in thinking that "epileptic insanity may be either a cause or a result. Some epileptics are habitual masturbators and some invariably have a fit at or after the sexual orgasm. The religious sentiment, often so strong in epileptics, does not prevent the vice; indeed, masturbators are often religiously disposed persons who would never resort to fornication, but compromise with conscience by indulging in the solitary vice."
As regards tabes dorsalis, I am very skeptical indeed as to its being induced by masturbation, notwithstanding the opinion of many neurologists that it is. I believe that it much more frequently has its cause in a venereal origin, i.e., syphilis, and I incline to the view of Marie that, while tabes may be produced by sexual excess, and while a large number of tabid patients have been somewhat profligate, it depends for its origin much more on the contraction of syphilis than it does upon sexual excesses or masturbation. De Renzi, however, mentions the case of a boy of ten, who before his attack was in good health, but who in consequence of contracting masturbating habits, in which he indulged intemperately for about a year, was attacked with paraplegia, characterized by a loss of motion from the waist down, but not of sensation. The muscles of the lower extremities responded to the stimulus of electricity, while tickling of the soles of the feet caused a bending of the toes, but no raising or flexion of the leg.
Insanity is another one of the nervous diseases which have been laid to the door of masturbation, but in this view I cannot agree with Ritchie, Hamilton, Maudsley and other writers who regard insanity as caused by the vice. Spitzka, I think, comes nearer to the mark in saying that "in reality masturbation, although a frequent accompaniment and perhaps a result of hebephrenia, is not its cause, however much this habit may ultimately modify the character of the psychosis." I by no means intend to say that intemperate masturbation may not be followed by nervous symptoms, nor that insanity and masturbation may not occur in the same person; but I very strongly doubt if, in the majority of instances where lunatics and epileptics are given to this habit, masturbation is the real cause of their nervous disorders. I incline to the opinion that they masturbate because they are lunatics, and the habit exercises such an influence over them as to be practically incurable and leads to the sad results which sometimes occur because the persons are mentally weak, but not because of the habit.
Ribbing has collated the statistics of the English hospitals for the three years 1885, i886, and 1887, and in these three years 41,118 insane patients were admitted into the insane asylums in England. In 526, or about 1.03 per cent. of the inmates, was the insanity considered as due to masturbation.
The same author collated the statistics of the Swedish hospitals for the years 1883, 1884, 1885, i886, and 1887, and out of a total of 3,623 insane patients, in 136, or 3.70 per cent., was the cause ascribed to this habit.
I have myself gathered the statistics published in the report of the New York State Commissioner in Lunacy between October i, 1888, and September 30, 1895, inclusive, a term of seven years. In those seven years the total number of patients admitted to the institutions in New York State were 19,237, and the number in which masturbation either entirely or partially played a part was 502, or about 2.60 per cent. Taking the reports of single hospitals and comparing their statistics with those of the aggregate of the hospitals, I obtained the following results from the statistics of the Manhattan State Hospital and of the St. Lawrence State Hospital. In the Manhattan State Hospital the number of cases admitted between October i, 1888, and 1896 (eight years) was 12,605, and of these the insanity was due to masturbation in 328 cases, or about 2.60 per cent. In the St. Lawrence State Hospital since December 9, 1890, to 1896 (six years) 2,561 cases were admitted. Of these the insanity was due to masturbation in 57 cases, or 2.20 per cent.
Now I am well aware it is generally considered that nothing lies like figures, but in the present state of our imperfect knowledge they are the best means we have of ascertaining facts, and I think that these figures are trustworthy. At any rate, it is a curious coincidence that these statistics, collated as they have been from entirely different and independent sources, should show such a very even percentage, differing from 1.03 to 3.70 per cent., an average of about 2.40 per cent. Certainly that does not show that this habit, bad as it is, should be charged with being a common, or indeed a usual cause of insanity. ^
Melancholia is another symptom which is sometimes seen in masturbators. This melancholia may be associated with ideas of suicide or self-mutilation, but my experience has been that such accidents are exceedingly rare in this class of subjects, as they have neither strength of will nor pluck, and much as they may talk about killing or injuring themselves, they almost invariably fail from want of courage.
Dementia has also been spoken of as one of the results of this practice (Bauer), but in studying Bauer's case I am exceedingly doubtful if the masturbation was the cause of the patient's dementia. The youth, aged twenty-two, was so dull and stupid as to be a semi-idiot, and while it is highly probable that the habit did not conduce toward quickening or brightening his intellect, I cannot see in the report of the case that there is anything to show it had to do with his lack of wits. I am therefore strongly inclined to believe that his vicious habit was result and not cause.
Besides its effect upon the general nervous system, some writers ascribe localized nervous disturbances as due to this practice (Löwenfeld et alii). Writer's cramp has been said to be due to the influence of masturbating habits, but such a statement needs further confirmation.
At one time great stress was laid upon what was called the masturbator's face. This was supposed to be characterized by the sunken eye, the haggard expression, the long, cadaverous countenance, by inability to look persons in the face when addressing them, by a hang-dog look, a sidelong glance of the eyes, and a looking down upon the ground when speaking to people. These symptoms are of no value. I have had patients look me squarely in the face while detailing their vice, and, moreover, the same aversion to looking one fairly in the eye while talking may arise from other causes than masturbation. It is seen in the persons who are self-conscious or who are naturally timid or bashful.
It is pretty generally believed by the laity, and by not a few professional men, that every boy or man who masturbates is on the high road to the devil. I by no means agree with this opinion. There are many instances recorded where the habit has been prolonged and no injury whatever has resulted, a case in point being given by Curschmann, where a young and apparently well-known writer of his acquaintance masturbated steadily and vigorously from his ninth to his twentieth year, without suffering either in his physical or his intellectual health. Fiirbringer gives a similar instance in the person of a " Docent " of his acquaintance, who was of middle age, and who had kept up this practice even since marriage, without detriment either to his physical or mental well-being, and McClanahan gives the record of twelve cases, the life histories of which he had been able to follow up from their youth (many of them up to middle life), where it is curious to note how little influence for good or bad this habit played in their future welfare. Many of the men became well known and to a certain degree locally distinguished in their various walks in life; and as bearing on this question as to how much or little injury is done by this practice, Peyer gives a curious history of a subject who, having been given over body and soul to this habit, broke it off. As frequently happens in these cases, nocturnal emissions followed as a sort of compensation, and Peyer states on the authority of the patient that whereas masturbation produced a sense of comfortable well-being, his nocturnal emissions gave rise to a great deal of mental and physical disturbance, much more than anything he had ever experienced from his habit of masturbation.
Rohleder also furnishes a case personal to himself, of a young army officer, thirty years of age, who indulged in this habit with great enthusiasm for many years of his early life, while in college and as a cadet, masturbating sometimes two and three times daily. In addition to this vicious form of amusement he also indulged in Veneris et Bacchi gaudia. Notwithstanding all these excesses he escaped unharmed, albeit he was not of a particularly strong constitution. And not only did he escape scott free, but he turned out, as Rohleder expresses it, a clever and, corporally speaking, well set up and trustworthy officer (ein geistig and körperlich tüchtiger, flichttreuer offizier).
I believe that the larger proportion of masturbators entirely get over their habit, many of them indulging it but little, in this country at least, and provided the general health, both physical and mental, is decently sound, they need not and do not suffer any irreparable harm.* There is a minority, however, where harm does result, but in this class of cases it will nearly always be found that they begin with a rotten physical and mental constitution, and under such circumstances the strain and loss has been too great, but although the shock is great, it is by no means so severe as stated by Tissot, when he argues that the loss of an ounce of semen is more debilitating than the loss of forty ounces of blood. It is a pity that such misleading and exaggerated statements should be put forward under the guise of scientific authority.
Here comes up an interesting question. Is masturbation a disease per se, or is it not rather a symptom of some underlying morbid condition? It is oftentimes exceedingly difficult to separate the one from the other
particularly where the habit has been contracted, as it sometimes is, from pure thoughtlessness and in consequence of bad example, but I believe that in the larger number of cases both masturbation and spermatorrhoea should be regarded rather as symptoms of a disease having many and various origins than as distinct diseases, and it will of course make a great deal of difference with regard to the treatment, whether these symptoms are based upon physical or psychical causes.
MASTURBATION IN ADULT LIFE.
The last to be considered are those subjects who masturbate after the age of puberty is passed, and when they have arrived at adult life, and who perform the act either while they are married or, as not infrequently happens, as bachelors or as widowers, being restrained from seeking relief by illicit connection from a moral sense of wrongdoing or from fear of contracting a venereal disease.
In these instances the bad results of the habit are much less noteworthy than they are where masturbation is indulged in during youth or early adult life; first, because the physical and mental conditions of the patient are much better calculated to withstand the effects of the habit, and secondly, because these subjects do not perform the habit so intemperately nor so frequently, indulging only so far as it is necessary to relieve the urgent needs of their sexual organs. Such men usually masturbate no mere frequently than they would practise sexual intercourse in ordinary married life. Under such conditions, the results, so far as my experience goes, seem to be but little, if at all, different from what they would be if coitus were indulged in. In this opinion I am aware that I am at variance with many of my colleagues who regard the effects of coitus and masturbation as not being identical. Act for act, I believe my position is correct; the danger in masturbation is the frequency with which the act can be performed in comparison with sexual congress; if a man could cohabit as -frequently as he can masturbate the risk would be as great, because the nervous exhaustion would be as marked and as continuous, and that is the danger point in both cases. Another reason assigned for the difference in effect is the sense of shame attending masturbation which tends to depress the nervous system and injure the patient's morale. To a limited extent this is true; for, after coitus, the man, like "gallus qui cantat," is rather proud of his performance and glories in the sense of sexual power; but all masturbators are not by any means "broken up" by their habit. Some regard it as a choice between two evils, and-while deploring the necessity, they think it a safer alternative than running the chance of contracting venereal disease. In this class of subjects, as well as in others that have been mentioned, much depends upon the natural physical condition of the patient; some men are naturally more vigorous, sexually speaking, than others, and are much better able to stand the reaction and slight exhaustion which follow even the normal performance of the sexual act, and in these cases it may be said that the habit produces very little if any bad results. While by no means apologizing for nor excusing indulgence in this evil habit, it may be said, taking into consideration the risk attendant upon intercourse with public women, and of the chances for contracting disease, that these patients perhaps pursue the wisest course, if it be positively necessary that they should indulge their sexual passions.
This habit of masturbation, when it produces evil results, produces them for three reasons: one, because the physical condition of the patient is not sufficiently strong nor well enough established to resist and to overcome the nervous exhaustion which follows; two, because from the fatal facility with which the act may be performed, the continuous practice produces a continuous exhaustion and the victims have no time to rally between the performance of each individual act; and three, because the feeling of disgust and fright which has been induced in the patient by the lurid pictures drawn by well-meaning but injudicious friends and relatives tends to beget a nervous depression and hypochondria out of all proportion to the real injury done by the habit. This is well exemplified by the paper of McClanahan, and one case he relates is such a good illustration of my point that I shall give it in the doctor's own language:
" D. E——, aged fifty years, about five feet eight inches tall; hair gray; refined in appearance and agreeable in manner. During the whole period of adolescence and early manhood he masturbated habitually, usually several times a week, and often several times in one night. His parents learned of his habit, and, with the kindest intentions, did more harm than good by their efforts to stop it. The consequences of self-abuse were pictured to the boy in the most appalling colors. His soul recoiled in horror from the fate that was said to be in store for him unless he discontinued his habit—nay, he was made to believe that his filthy habit had already rendered him unfit for human companionship. In one moment of despair the light of his life went out. Henceforth his most resolute and continuous efforts were directed to the conquering of his habit, but he would grow weary of the gloomy struggle; from sheer exhaustion his vigilance would relax; and the pruriency of his nature, which had apparently only been husbanded by repression, would break forth with an imperiousness which he was powerless to resist. A wave of passion would sweep over him, which, gathering fury with its progress, would make his blood boil and seethe with sensuality till the complete act of masturbation had given him relief. Then he was plunged into the depths of despair and degradation till the inevitable temptation came again. Feeling its approach he would kneel at his bedside, and, with tears streaming down his face and sobs breaking his voice, would pray to God to help him overcome his hideous habit; and he would then go to bed and masturbate without delay.
" Believing at last that his soul was lost, he left off praying, and believing that his manhood was lost he refused to think of marriage. One night, being partly intoxicated, he stayed till morning with an amorous widow and surprised both himself and the widow with his copulative powers, which had been tried but once before, and that time without success. Perceiving that his opinion of - himself was without foundation, he went into the society of refined women, and many years ago he married a charming woman, with whom he has lived happily ever since, and by whom he has had two healthy children. D. E—— is one of the most brilliant writers connected with journalism."
Before leaving this case the chief points are worth reviewing. Here we find a youth given over to a bad habit, which apparently does him no harm. He is warned and admonished with the kindest of motives, but his friends over-do the business, and frighten him so that a mental disturbance bordering almost upon melancholia is produced. This continues without any cessation of his bad habit, which he seems to be utterly incapable of giving up, and he finally comes to regard himself as a pariah and an outcast, a thing accursed of God and man. Remember this is no fancy picture; it is a statement of facts made by a reputable physician. He makes another false step, but fortunately for him a false step in the right direction. He gets half drunk, and in that condition, oblivious of the past, he exercises his sexual powers, which to his great astonishment he finds to be good; in other words, his second folly teaches him that the consequences of his first folly were grossly exaggerated, and that statements made to him were untrue. This knowledge puts new life into him, and apparently he becomes a sound man. Now suppose he had not encountered this " amorous widow," with the attendant consequences; he would perhaps have gone on from bad to worse, possibly have wound up in a lunatic asylum, and everybody would have at once said, " Oh, yes; another victim of masturbation! " when he really would have been the victim of the folly of his friends.
I know it is exceedingly hard to tell how far admonition shall go, but it certainly never ought to go to the point of thoroughly frightening the patient, for there is nothing that will destroy a man's morale and pluck more than the false and fabulous stories which are told as the consequence of this habit, and it is upon that knowledge that the circulars of the charlatan and the advertising blackguard are cunningly and shrewdly based. As I have already stated, I am no apologist for the habit; but as this book is written for medical men, I think it well that medical men should be told the truth, a truth which I believe most of them are now beginning to recognize, but which in this country at least has never been frankly and formally declared.
My experience does not agree with those writers who state that the act may be committed repeatedly in the course of a day for any great length of time, apart from the insane., It is very exceptional indeed that patients admit to me that they have abused themselves six or seven times in the course of a day, and cases where the act has been repeated twelve, fifteen, or twenty times per diem I candidly admit I have never seen. In those instances where the act has been of frequent occurrence, there has been some brain or spinal lesion, or else some mental disturbance at the time, and we must be careful to distinguish, in these cases of masturbation, between those instances where the habit results from a reflex irritation of the genital organs, and those where it is derived from some lesion of the nervous system, be it of the brain or spinal cord. Alienists and neurologists claim that epilepsy, tabes dorsalis, and insanity result from masturbation, and it is possible that, in a few instances, these diseases do occur. * Epilepsy, I believe, may occasionally result from intemperate masturbation, but with regard to the other two diseases I am .inclined to think that the patients masturbate because they are lunatics or are nervously deranged, and that their nervous derangements have not followed as a consequence of their masturbation. Some patients have an hereditary tendency toward nervous and mental disorders, and it is in these cases I believe that we find the worst results from masturbation. It is the hereditarily weak-minded and neurotic condition of these patients that renders them particularly prone to the evil effects resulting from this habit, but in the ordinarily sound and healthy young adult, I believe the habit is attended, as a rule, with very slight, if any, permanently bad effects, even where it. has been long continued, and when we take into consideration the probable number of masturbators, for I believe that eighty per cent., and perhaps more, of young adults at some time or other in their lives have indulged in this habit, † and when we note how little evil follows, even admitting all the cases of insanity and
epilepsy which are claimed as being due to this cause, I think we are warranted in saying that a great deal of the evil results ascribed to this habit are exaggerated and overdrawn. There is nothing which frightens a man more than belief in a derangement of his sexual organs, particularly if he gets it into his head that he is subject to seminal losses, or if he thinks he is sexually impotent, and the perusal of literature upon this subject, and the gossip and tattle which goes on among men upon this topic, produce a mental disturbance which is of far more consequence than the physical results derived from their bad habit, and a large proportion of patients who consult the surgeon for treatment are really more hypochondriacs than sexual cripples. They dwell continually upon the condition of their sexual organs. Every little irritation, every slight discharge, some of them perfectly normal; every little secretion that passes from them in stool or even in urination, causes them immediate and intense alarm, and by continually dwelling upon the subject, produces a condition of nervous irritation which prevents them from thinking of anything else and precludes them from pursuing their daily occupations with the ordinary zest and vigor with which they have been accustomed to perform their duties.
Undoubtedly in many of these cases there is some underlying reason, either an irritation of the genito-urinary tract, or some other of the many causes which have been enumerated as inducing this habit; but were it not for the mental disturbance which has been produced upon these patients, the physical causes would probably play but a very small part.
From Sturgis, F.R. Sexual Debility in Man. Pub by E.B. Treat & Co., 1900
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