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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 the question.^[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, but are 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

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