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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 (in Body 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 predisposed subjects; 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 like folie 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's Dictionary 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 idiocy induced by masturbation in any child of either sex. Neither have I seen any instance in which hysteria, epilepsy, or insanity in women after puberty was due to 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 form of 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 symptoms and 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 considerable difference whether you threw your lighted match into a powder magazine or into the sea.

      While we may thus dismiss the

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