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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 rudimentary hymen; 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 practiced coitus 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 distinguish between the post and the propter, 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 perverted before 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.

      This point has not wholly escaped previous observers, though they do not seem to have noted its psychological mechanism. Tissot stated that masturbation causes an aversion to marriage. More recently, Loiman ("Ueber Onanismus beim Weibe," Therapeutische Monatshefte, April, 1890) considered that masturbation in women, leading to a perversion of sexual feeling, including inability to find satisfaction in coitus, affects the associated centres. Smith Baker, again ("The Neuropsychical Element in Conjugal Aversion," Journal of Nervous and Mental Disease, September, 1892), finds that a "source of marital aversion seems to lie in the fact that substitution of mechanical and iniquitous excitations affords more thorough satisfaction than the mutual legitimate ones do," and gives cases in point. Savill, also, who believes that masturbation is more common in women than is usually supposed, regards dyspareunia, or pain in coition, as one of the signs of the habit.

      Masturbation in women thus becomes, as Raymond and Janet point out (Les Obsessions, vol. ii, p. 307) a frequent cause of sexual frigidity in marriage. These authors illustrate the train of evils which may thus be set up, by the case of a lady, 26 years of age, a normal woman, of healthy family, who, at the age of 15, was taught by a servant

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