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 attributed to 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 his Traite 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 his Dictionnaire 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 of Onania, 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 of Onania, 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 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 photopsisae, muscsae, 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 Naecke, 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 (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] Schuele 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 Naecke decidedly opposes it. Kraepelin states that excessive masturbation can only occur in a dangerous degree in predisposed subjects; so, also, Forel and Loewenfeld, 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." Naecke, again, has declared ("Kritisches zum Kapitel der Sexualitaet," Archiv fuer 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 Fuerbringer, 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 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 anaemia 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 diarrhoea. 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 nymphae, 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, Fuerbringer, 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 to masturbate. At the age of 18 she married. She loved her husband, but she had no sexual feelings in coitus, and she continued to masturbate, sometimes several times a day, without evil consequences. At 24 she had to go into a hospital for floating kidney, and was so obliged to stop masturbating. She here accidentally learnt of the evil results attributed to the habit. She resolved not to do it again, and she kept her resolution. But while still in hospital she fell wildly in love with a man. To escape from the constant thought of this man, she sought relations with her husband, and at times masturbated, but now it no longer gave her pleasure. She wished to give up sexual things altogether. But that was easier said than done. She became subject to nervous crises, often brought on by the sight of a man, and accompanied by sexual excitement. They disappeared under treatment, and she thereupon became entirely frigid sexually. But, far from being happy, she has lost all energy and interest in life, and it is her sole desire to attain the sexual feelings she has lost. Adler considers that even when masturbation in women becomes an overmastering passion, so far as organic effects are concerned it is usually harmless, its effects being primarily psychic, and he attaches especial significance to it as a cause of sexual anaesthesia in normal coitus, being, perhaps, the most frequent cause of such anaesthesia. He devotes an important chapter to this matter, and brings forward numerous cases in illustration (Adler, Die Mangelhafte Geschlechtsempfindung des Weibes, pp. 93-119, also 21-23). Adler considers that the frequency of masturbation in women is largely due to the fact that women experience greater difficulties than men in obtaining sexual satisfaction, and so are impelled by unsatisfying coitus to continue masturbation after marriage. He adds that partly from natural shyness, partly from shame of acknowledging what is commonly accounted a sin, and partly from the fear of seeming disgusting or unworthy of sympathy in the doctor's eyes, women are usually silent on this matter, and very great tact and patience may be necessary before a confession is obtained.

On the psychic side, no doubt, the most frequent and the most characteristic result of persistent and excessive masturbation is a morbid heightening of self-consciousness without any co-ordinated heightening of self-esteem.[340] The man or woman who is kissed by a desirable and desired person of the opposite sex feels a satisfying sense of pride and elation, which must always be absent from the manifestations of auto-erotic activity.[341] This must be so, even apart from the masturbator's consciousness of the general social attitude toward his practices and his dread of detection, for that may also exist as regards normal coitus without any corresponding psychic effects. The masturbator, if his practice is habitual, is thus compelled to cultivate an artificial consciousness of self-esteem, and may show a tendency to mental arrogance. Self-righteousness and religiosity constitute, as it were, a protection against the tendency to remorse. A morbid mental soil is, of course, required for the full development of these characteristics. The habitual male masturbator, it must be remembered, is often a shy and solitary person; individuals of this temperament are especially predisposed to excesses in all the manifestations of auto-erotism, while the yielding to such tendencies increases the reserve and the horror of society, at the same time producing a certain suspicion of others. In some extreme cases there is, no doubt, as Kraepelin believes, some decrease of psychic capacity, an inability to grasp and co-ordinate external impressions, weakness of memory, deadening of emotions, or else the general phenomena of increased irritability, leading on to neurasthenia.

I find good reason to believe that in many cases the psychic influence of masturbation on women is different from its effect on men. As Spitzka observed, although it may sometimes render women self-reproachful and hesitant, it often seems to make them bold. Boys, as we have seen, early assimilate the tradition that self-abuse is "unmanly" and injurious, but girls have seldom any corresponding tradition that it is "unwomanly," and thus, whether or not they are reticent on the matter, before the forum of their own conscience they are often less ashamed of it than men are and less troubled by remorse.

Eulenburg considers that the comparative absence of bad effects from masturbation in girls is largely due to the fact that, unlike boys, they are not terrorized by exaggerated warnings and quack literature concerning the awful results of the practice. Forel, who has also remarked that women are often comparatively little troubled by qualms of conscience after masturbation, denies that this is due to a lower moral tone than men possess (Forel, Die Sexuelle Frage, p. 247). In this connection, I may refer to History IV, recorded in the Appendix to the fifth volume of these Studies, in which it is stated that of 55 prostitutes of various nationalities, with whom the subject had had relations, 18 spontaneously told him that they were habitual masturbators, while of 26 normal women, 13 made the same confession, unasked. Guttceit, in Russia, after stating that women of good constitution had told him that they masturbated as much as six or ten times a day or night (until they fell asleep, tired), without bad results, adds that, according to his observations, "masturbation, when not excessive, is, on the whole, a quite innocent matter, which exerts little or no permanent effect," and adds that it never, in any case, leads to hypochondria onanica in women, because they have not been taught to expect bad results (Dreissig Jahre Praxis, p. 306). There is, I think, some truth—though the exceptions are doubtless many—in the distinction drawn by W.C. Krauss ("Masturbational Neuroses," Medical News, July 13, 1901): "From my experience it [masturbation] seems to have an opposite effect upon the two sexes, dulling the mental and making clumsy the physical exertions of the male, while in the female it quickens and excites the physical and psychical movements. The man is rendered hypoesthetic, the woman hyperesthetic."

In either sex auto-erotic excesses during adolescence in young men and women of intelligence—whatever absence of gross injury there may be—still often produce a certain degree of psychic perversion, and tend to foster false and high-strung ideals of life. Kraepelin refers to the frequency of exalted enthusiasms in masturbators, and I have already quoted Anstie's remarks on the connection between masturbation and premature false work in literature and art. It may be added that excess in masturbation has often occurred in men and women whose work in literature and art cannot be described as premature and false. K.P. Moritz, in early adult life, gave himself up to excess in masturbation, and up to the age of thirty had no relations with women. Lenau is said—though the statement is sometimes denied—to have been a masturbator from early life, the habit profoundly effecting his life and work. Rousseau, in his Confessions, admirably describes how his own solitary, timid, and imaginative life found its chief sexual satisfaction in masturbation.[342] Gogol, the great Russian novelist, masturbated to excess, and it has been suggested that the dreamy melancholy thus induced was a factor in his success as a novelist. Goethe, it has been asserted, at one time masturbated to excess; I am not certain on what authority the statement is made, probably on a passage in the seventh book of Dichtung und Wahrheit, in which, describing his student-life at Leipzig, and his loss of Aennchen owing to his neglect of her, he tells how he revenged that neglect on his own physical nature by foolish practices from which he thinks he suffered for a considerable period.[343] The great Scandinavian philosopher, Soeren Kierkegaard, suffered severely, according to Rasmussen, from excessive masturbation. That, at the present day, eminence in art, literature, and other fields may be combined with the excessive practice of masturbation is a fact of which I have unquestionable evidence.

I have the detailed history of a man of 30, of high ability in a scientific direction, who, except during periods of mental strain, has practiced masturbation nightly (though seldom more than once a night) from early childhood, without any traceable evil results, so far as his general health and energy are concerned. In another case, a schoolteacher, age 30, a hard worker and accomplished musician, has masturbated every night, sometimes more than once a night, ever since he was at school, without, so far as he knows, any bad results; he has never had connection with a woman, and seldom touches wine or tobacco. Curschmann knew a young and able author who, from the age of 11 had masturbated excessively, but who retained physical and mental freshness. It would be very easy to refer to other examples, and I may remark that, as regards the histories recorded in various volumes of these Studies, a notable proportion of those in which excessive masturbation is admitted, are of persons of eminent and recognized ability.

It is often possible to trace the precise mechanism of the relationship between auto-erotic excitement and intellectual activity. Brown-Sequard, in old age, considered that to induce a certain amount of sexual excitement, not proceeding to emission, was an aid to mental work. Raymond and Janet knew a man considering himself a poet, who, in order to attain the excitation necessary to compose his ideal verses, would write with one hand while with the other he caressed his penis, though not to the extent of producing ejaculation.[344] We must not believe, however, that this is by any means the method of workers who deserve to be accepted seriously; it would be felt, to say the least, as unworthy. It is indeed a method that would only appeal to a person of feeble or failing mental power. What more usually happens is that the auto-erotic excitement develops, pari passu and spontaneously, with the mental activity and at the climax of the latter the auto-erotic excitement also culminates, almost or even quite spontaneously, in an explosion of detumescence which relieves the mental tension. I am acquainted with such cases in both young men and women of intellectual ability, and they probably occur much more frequently than we usually suspect.

In illustration of the foregoing observations, I may quote the following narrative, written by a man of letters: "From puberty to the age of 30 (when I married), I lived in virgin continence, in accord with my principle. During these years I worked exceedingly hard—chiefly at art (music and poetry). My days being spent earning my livelihood, these art studies fell into my evening time. I noticed that productive power came in periods—periods of irregular length, and which certainly, to a partial extent, could be controlled by the will. Such a period of vital power began usually with a sensation of melancholy, and it quickened my normal revolt against the narrowness of conventional life into a red-hot detestation of the paltriness and pettiness with which so many mortals seem to content themselves. As the mood grew in intensity, this scorn of the lower things mixed with and gave place to a vivid insight into higher truths. The oppression began to give place to a realization of the eternity of the heroic things; the fatuities were seen as mere fashions; love was seen as the true lord of life; the eternal romance was evident in its glory; the naked strength and beauty of men were known despite their clothes. In such mood my work was produced; bitter protest and keen-sighted passion mingled in its building. The arising vitality had certainly deep relation to the periodicity of the sex-force of manhood. At the height of the power of the art-creative mood would come those natural emissions with which Nature calmly disposes of the unused force of the male. Such emissions were natural and healthy, and not exhaustive or hysterical. The process is undoubtedly sane and protective, unless the subject be unhealthy. The period of creative art power extended a little beyond the end of the period of natural seed emission—the art work of this last stage being less vibrant, and of a gentler force. Then followed a time of calm natural rest, which gradually led up to the next sequence of melancholy and power. The periods certainly varied in length of time, controlled somewhat by the force of the mind and the mental will to create; that is to say, I could somewhat delay the natural emission, by which I gained an extension of the period of power."

How far masturbation in moderately healthy persons living without normal sexual relationships may be considered normal is a difficult question only to be decided with reference to individual cases. As a general rule, when only practiced at rare intervals, and faute de mieux, in order to obtain relief for physical oppression and mental obsession, it may be regarded as the often inevitable result of the unnatural circumstances of our civilized social life. When, as often happens in mental degeneracy,—and as in shy and imaginative persons, perhaps of neurotic temperament, may also sometimes become the case,—it is practiced in preference to sexual relationships, it at once becomes abnormal and may possibly lead to a variety of harmful results, mental and physical.[345]

It must always be remembered, however, that, while the practice of masturbation may be harmful in its consequences, it is also, in the absence of normal sexual relationships, frequently not without good results. In the medical literature of the last hundred years a number of cases have been incidentally recorded in which the patients found masturbation beneficial, and such cases might certainly have been enormously increased if there had been any open-eyed desire to discover them. My own observations agree with those of Sudduth, who asserts that "masturbation is, in the main, practiced for its sedative effect on the nervous system. The relaxation that follows the act constitutes its real attraction.... Both masturbation and sexual intercourse should be classed as typical sedatives."[346]

Gall (Fonctions du Cerveau, 1825, vol. iii, p. 235) mentioned a woman who was tormented by strong sexual desire, which she satisfied by masturbation ten or twelve times a day; this caused no bad results, and led to the immediate disappearance of a severe pain in the back of the neck, from which she often suffered. Clouston (Mental Diseases, 1887, p. 496) quotes as follows from a letter written by a youth of 22: "I am sure I cannot explain myself, nor give account of such conduct. Sometimes I felt so uneasy at my work that I would go to the water-closet to do it, and it seemed to give me ease, and then I would work like a hatter for a whole week, till the sensation overpowered me again. I have been the most filthy scoundrel in existence," etc. Garnier presents the case of a monk, aged 33, living a chaste life, who wrote the following account of his experiences: "For the past three years, at least, I have felt, every two or three weeks, a kind of fatigue in the penis, or, rather, slight shooting pains, increasing during several days, and then I feel a strong desire to expel the semen. When no nocturnal pollution follows, the retention of the semen causes general disturbance, headache, and sleeplessness. I must confess that, occasionally, to free myself from the general and local oppression, I lie on my stomach and obtain ejaculation. I am at once relieved; a weight seems to be lifted from my chest, and sleep returns." This patient consulted Gamier as to whether this artificial relief was not more dangerous than the sufferings it relieved. Gamier advised that if the ordinary regime of a well-ordered monastry, together with anaphrodisiac sedatives, proved inefficacious, the manoeuvre might be continued when necessary (P. Garnier, Celibat et Celibataires, 1887, p. 320). H.C. Coe (American Journal of Obstetrics, p. 766, July, 1889) gives the case of a married lady who was deeply sensitive of the wrong nature of masturbation, but found in it the only means of relieving the severe ovarian pain, associated with intense sexual excitement, which attended menstruation. During the intermenstrual period the temptation was absent. Turnbull knew a youth who found that masturbation gave great relief to feelings of heaviness and confusion which came on him periodically; and Wigglesworth has frequently seen masturbation after epileptic fits in patients who never masturbated at other times. Moll (Libido Sexualis, Bd. I, p. 13) refers to a woman of 28, an artist of nervous and excitable temperament, who could not find sexual satisfaction with her lover, but only when masturbating, which she did once or twice a day, or oftener; without masturbation, she said, she would be in a much more nervous state. A friend tells me of a married lady of 40, separated from her husband on account of incompatibility, who suffered from irregular menstruation; she tried masturbation, and, in her own words, "became normal again;" she had never masturbated previously. I have also been informed of the case of a young unmarried woman, intellectual, athletic, and well developed, who, from the age of seven or eight, has masturbated nearly every night before going to sleep, and would be restless and unable to sleep if she did not.

Judging from my own observations among both sexes, I should say that in normal persons, well past the age of puberty, and otherwise leading a chaste life, masturbation would be little practiced except for the physical and mental relief it brings. Many vigorous and healthy unmarried women or married women apart from their husbands, living a life of sexual abstinence, have asserted emphatically that only by sexually exciting themselves, at intervals, could they escape from a condition of nervous oppression and sexual obsession which they felt to be a state of hysteria. In most cases this happens about the menstrual period, and, whether accomplished as a purely physical act—in the same way as they would soothe a baby to sleep by rocking it or patting it—or by the co-operation of voluptuous mental imagery, the practice is not cultivated for its own sake during the rest of the month.

In illustration of the foregoing statements I will here record a few typical observations of experiences with regard to masturbation. The cases selected are all women, and are all in a fairly normal, and, for the most part, excellent, state of health; some of them, however, belong to somewhat neurotic families, and these are persons of unusual mental ability and intelligence.

OBSERVATION I.—Unmarried, aged 38. She is very vigorous and healthy, of a strongly passionate nature, but never masturbated until a few years ago, when she was made love to by a man who used to kiss her, etc. Although she did not respond to these advances, she was thrown into a state of restless sexual excitement; on one occasion, when in bed in this restless state, she accidentally found, on passing her hand over her body, that, by playing with "a round thing" [clitoris] a pleasurable feeling was produced. She found herself greatly relieved and quieted by these manipulations, though there remained a feeling of tiredness afterward. She has sometimes masturbated six times in a night, especially before and after the menstrual period, until she was unable to produce the orgasm or any feeling of pleasure.

OBSERVATION II.—Unmarried, aged 45, of rather nervous temperament. She has for many years been accustomed, usually about a week before the appearance of the menses, to obtain sexual relief by kicking out her legs when lying down. In this way, she says, she obtains complete satisfaction. She never touches herself. On the following day she frequently has pains over the lower part of the abdomen, such pains being apparently muscular and due to the exertion.

OBSERVATION III.—Aged 29, recently married, belonging to a neurotic and morbid family, herself healthy, and living usually in the country; vivacious, passionate, enthusiastic, intellectual, and taking a prominent part in philanthropic schemes and municipal affairs; at the same time, fond of society, and very attractive to men. For many years she had been accustomed to excite herself, though she felt it was not good for her. The habit was merely practiced faute de mieux. "I used to sit on the edge of the bed sometimes," she said, "and it came over me so strongly that I simply couldn't resist it. I felt that I should go mad, and I thought it was better to touch myself than be insane.... I used to press my clitoris in.... It made me very tired afterward—not like being with my husband." The confession was made from a conviction of the importance of the subject, and with the hope that some way might be found out of the difficulties which so often beset women.

OBSERVATION IV.—Unmarried, aged 27; possesses much force of character and high intelligence; is actively engaged in a professional career. As a child of seven or eight she began to experience what she describes as lightning-like sensations, "mere, vague, uneasy feelings or momentary twitches, which took place alike in the vulva or the vagina or the uterus, not amounting to an orgasm and nothing like it." These sensations, it should be added, have continued into adult life. "I always experience them just before menstruation, and afterward for a few days, and, occasionally, though it seems to me not so often, during the period itself. I may have the sensation four or five times during the day; it is not dependent at all upon external impressions, or my own thoughts, and is sometimes absent for days together. It is just one flash, as if you would snap your fingers, and it is over."

As a child, she was, of course, quite unconscious that there was anything sexual in these sensations. They were then usually associated with various imaginary scenes. The one usually indulged in was that a black bear was waiting for her up in a tree, and that she was slowly raised up toward the bear by means of ropes and then lowered again, and raised, feeling afraid of being caught by the bear, and yet having a morbid desire to be caught. In after years she realized that there was a physical sexual cause underlying these imaginations, and that what she liked was a feeling of resistance to the bear giving rise to the physical sensation.

At a somewhat later age, though while still a child, she cherished an ideal passion for a person very much older than herself, this passion absorbing her thoughts for a period of two years, during which, however, there was no progress made in physical sensation. It was when she was nearly thirteen years of age, soon after the appearance of menstruation, and under the influence of this ideal passion, that she first learned to experience conscious orgasm, which was not associated with the thought of any person. "I did not associate it with anything high or beautiful, owing to the fact that I had imbibed our current ideas in regard to sexual feelings, and viewed them in a very poor light indeed." She considers that her sexual feelings were stronger at this period than at any other time in her life. She could, however, often deny herself physical satisfaction for weeks at a time, in order that she might not feel unworthy of the object of her ideal passion. "As for the sexual satisfaction," she writes, "it was experimental. I had heard older girls speak of the pleasure of such feelings, but I was not taught anything by example, or otherwise. I merely rubbed myself with the wash-rag while bathing, waiting for a result, and having the same peculiar feeling I had so often experienced. I am not aware of any ill effects having resulted, but I felt degraded, and tried hard to overcome the habit. No one had spoken to me of the habit, but from the secrecy of grown people, and passages I had heard from the Bible, I conceived the idea that it was a reprehensible practice. And, while this did not curb my desire, it taught me self-control, and I vowed that each time should be the last. I was often able to keep the resolution for two or three weeks." Some four years later she gradually succeeded in breaking herself of the practice in so far as it had become a habit; she has, however, acquired a fuller knowledge of sexual matters, and, though she has still a great dread of masturbation as a vice, she does not hesitate to relieve her physical feelings when it seems best to her to do so. "I am usually able to direct my thoughts from these sensations," she writes, "but if they seem to make me irritable or wakeful, I relieve myself. It is a physical act, unassociated with deep feeling of any kind. I have always felt that it was a rather unpleasant compromise with my physical nature, but certainly necessary in my case. Yet, I have abstained from gratification for very long periods. If the feeling is not strong at the menstrual period, I go on very well without either the sensation or the gratification until the next period. And, strange as it may seem, the best antidote I have found and the best preventive is to think about spiritual things or someone whom I love. It is simply a matter of training, I suppose,—a sort of mental gymnastics,—which draws the attention away from the physical feelings." This lady has never had any sexual relationships, and, since she is ambitious, and believes that the sexual emotions may be transformed so as to become a source of motive power throughout the whole of life, she wishes to avoid such relationships.

OBSERVATION V.—Unmarried, aged 31, in good health, with, however, a somewhat hysterical excess of energy. "When I was about 26 years of age," she writes, "a friend came to me with the confession that for several years she had masturbated, and had become such a slave to the habit that she severely suffered from its ill effects. At that time I had never heard of self-abuse by women. I listened to her story with much sympathy and interest, but some skepticism, and determined to try experiments upon myself, with the idea of getting to understand the matter in order to assist my friend. After some manipulation, I succeeded in awakening what had before been unconscious and unknown. I purposely allowed the habit to grow upon me, and one night—for I always operated upon myself before going to sleep, never in the morning—I obtained considerable pleasurable satisfaction, but the following day my conscience awoke; I also felt pain located at the back of my head and down the spinal column. I ceased my operations for a time, and then began again somewhat regularly, once a month, a few days after menstruation. During those months in which I exercised moderation, I think I obtained much local relief with comparatively little injury, but, later on, finding myself in robust health, I increased my experiments, the habit grew upon me, and it was only with an almost superhuman effort that I broke myself free. Needless to say that I gave no assistance to my suffering friend, nor did I ever refer to the subject after her confession to me.

"Some two years later I heard of sexual practices between women as a frequent habit in certain quarters. I again interested myself in masturbation, for I had been told something that led me to believe that there was much more for me to discover. Not knowing the most elementary physiology, I questioned some of my friends, and then commenced again. I restricted myself to relief from local congestion and irritation by calling forth the emission of mucus, rather than by seeking pleasure. At the same time, I sought to discover what manipulation of the clitoris would lead to. The habit grew upon me with startling rapidity, and I became more or less its slave, but I suffered from no very great ill effects until I started in search of more discoveries. I found that I was a complete ignoramus as to the formation of a woman's body, and by experiments upon myself sought to discover the vagina. I continued my operations until I obtained an entrance. I think the rough handling of myself during this final stage disturbed my nervous system, and caused me considerable pain and exhaustion at the back of my head, the spinal column, the back of my eyes, and a general feeling of languor, etc.

"I could not bear to be the slave of a habit, and after much suffering and efforts, which only led to falls to lower depths of conscious failure, my better self rebelled, until, by a great effort and much prayer, I kept myself pure for a whole week. This partial recovery gave me hope, but then I again fell a victim to the habit, much to my chagrin, and became hopeless of ever retracing my steps toward my ideal of virtue. For some days I lost energy, spirit, and hope; my nervous system appeared to be ruined, but I did not really despair of victory in the end. I thought of all the drunkards chained by their intemperate habits, of inveterate smokers who could not exist without tobacco, and of all the various methods by which men were slaves, and the longing to be freed of what had, in my case, proved to be a painful and unnecessary habit, increased daily until, after one night when I struggled with myself for hours, I believed I had finally succeeded.

"At times, when I reached a high degree of sexual excitement, I felt that I was at least one step removed from those of morbid and repressed sex, who had not the slightest suspicion of the latent joys of womanhood within them. For a little while the habit took the shape of an exalted passion, but I rapidly tired it out by rough, thoughtless, and too impatient handling. Revulsion set in with the pain of an exhausted and badly used nervous system, and finding myself the slave of a passion, I determined to endeavor to be its master.

"In conclusion, I should say that masturbation has proved itself to be to me one of the blind turnings of my life's history, from which I have gained much valuable experience."

The practice was, however, by no means thus dismissed. Some time later the subject writes: "I have again restarted masturbation for the relief of localized feelings. One morning I was engaged in reading a very heavy volume which, for convenience sake, I held in my lap, leaning back on my chair. I had become deep in my study for an hour or so when I became aware of certain feelings roused by the weight of the book. Being tempted to see what would happen by such conduct, I shifted so that the edge of the volume came in closer contact. The pleasurable feelings increased, so I gave myself up to my emotions for some thirty minutes.

"Notwithstanding the intense pleasure I enjoyed for so long a period, I maintain that it is wiser to refrain, and, although I admit in the same breath that, by gentle treatment, such pleasure may be harmless to the general health, it does lead to a desire for solitude, which is not conducive to a happy frame of mind. There is an accompanying reticence of speech concerning the pleasure, which, therefore, appears to be unnatural, like the eating of stolen fruit. After such an event, one seems to require to fly to the woods, and to listen to the song of the birds, so as to shake off after-effects."

In a letter dated some months later, she writes: "I think I have risen above the masturbation habit." In the same letter the writer remarks: "If I had consciously abnormal or unsatisfied appetites I would satisfy them in the easiest and least harmful way."

Again, eighteen months later, she writes: "It is curious to note that for months this habit is forgotten, but awakens sometimes to self-assertion. If a feeling of pressure is felt in the head, and a slight irritation elsewhere, and experience shows that the time has come for pacification, exquisite pleasure can be enjoyed, never more than twice a month, and sometimes less often."

OBSERVATION VI.—Unmarried, actively engaged in the practice of her profession. Well-developed, feminine in contour, but boyish in manner and movements; strong, though muscles small, and healthy, with sound nervous system; never had anaemia. Thick brown hair; pubic hair thick, and hair on toes and legs up to umbilicus; it began to appear at the age of 10 (before pubic hair) and continued until 18. A few stray hairs round nipples, and much dark down on upper lip, as well as light down on arms and hands. Hips, normal; nates, small; labia minora, large; and clitoris, deeply hooded. Hymen thick, vagina, probably small. Considerable pigmentation of parts. Menstruation began at 15, but not regular till 17; is painless and scanty; the better the state of health, the less it is. No change of sexual or other feelings connected with it; it lasts one to three days.

"I believe," she writes, "my first experience of physical sex sensations was when I was about 16, and in sleep. But I did not then recognize it, and seldom, indeed, gave the subject of sex a thought. I was a child far beyond the age of childhood. The accompanying dreams were disagreeable, but I cannot remember what they were about. It was not until I was nearly 19 that I knew the sexual orgasm in my waking state. It surprised me completely, but I knew that I had known it before in my sleep.

"The knowledge came one summer when I was leading a rather isolated life, and my mind was far from sex subjects, being deep in books, Carlyle, Ruskin, Huxley, Darwin, Scott, etc. I noticed that when I got up in the morning I felt very hot and uncomfortable. The clitoris and the parts around were swollen and erect, and often tender and painful. I had no idea what it was, but found I was unable to pass my water for an hour or two. One day, when I was straining a little to pass water, the full orgasm occurred. The next time it happened, I tried to check it by holding myself firmly, of course, with the opposite result. I do not know that I found it highly pleasurable, but it was a very great relief. I allowed myself a good many experiments, to come to a conclusion in the matter, and I thought about it. I was much too shy to speak to any one, and thought it was probably a sin. I tried not to do it, and not to think about it, saying to myself that surely I was lord of my body. But I found that the matter was not entirely under my control. However unwilling or passive I might be, there were times when the involuntary discomfort was not in my keeping. My touching myself or not did not save me from it. Because it sometimes gave me pleasure, I thought it might be a form of self-indulgence, and did not do it until it could scarcely be helped. Soon the orgasm began to occur fairly frequently in my sleep, perhaps once or twice a week. I had no erotic dreams, then or at any other time, but I had nights of restless sleep, and woke as it occurred, dreaming that it was happening, as, in fact, it was. At times I hardly awoke, but went to sleep again in a moment. I continued for two or three years to be sorely tried by day at frequent intervals. I acquired a remarkable degree of control, so that, though one touch or steadily directed thought would have caused the orgasm, I could keep it off, and go to sleep without 'wrong doing.' Of course, when I fell asleep, my control ended. All this gave me a good deal of physical worry, and kept my attention unwillingly fixed upon the matter. I do not think my body was readily irritable, but I had unquestionably very strong sexual impulses.

"After a year or two, when I was working hard, I could not afford the attention the control cost me, or the prolonged mitigated sexual excitement it caused. I took drugs for a time, but they lost effect, produced lassitude, and agreed with me badly. I therefore put away my scruples and determined to try the effect of giving myself an instant and business-like relief. Instead of allowing my feelings to gather strength, I satisfied them out of hand. Instead of five hours of heat and discomfort, I did not allow myself five minutes, if I could help it.

"The effect was marvelous. I practically had no more trouble. The thing rarely came to me at all by day, and though it continued at times by night, it became less frequent and less strong; often it did not wake me. The erotic images and speculations that had begun to come to me died down. I left off being afraid of my feelings, or, indeed, thinking about them. I may say that I had decided that I should be obliged to lead a single life, and that the less I thought about matters of sex, the more easy I should find life. Later on I had religious ideas which helped me considerably in my ideals of a decent, orderly, self-contained life. I do not lay stress on these; they were not at all emotional, and my physical and psychical development do not appear to have run much on parallel lines. I had a strong moral sense before I had a religious one, and a 'common-sense' which I perhaps trusted more than either.

"When I was about 28 I thought I might perhaps leave off the habit of regular relief I had got into. (It was not regular as regards time, being anything from one day to six weeks.) The change was probably made easier by a severe illness I had had. I gave this abstinence a fair trial for several years (until I was about 34), but my nocturnal manifestations certainly gathered strength, especially when I got much better in health, and, finally, as at puberty, began to worry my waking life. I reasoned that by my attempt at abstinence I had only exchanged control for uncontrol, and reverted to my old habits of relief, with the same good results as before. The whole trouble subsided and I got better at once. (The orgasm during sleep continued, and occurs about once a fortnight; it is increased by change of air, especially at the seaside, when it may occur on two or three nights running.) I decided that, for the proper control of my single life, relief was normal and right. It would be very difficult for anyone to demonstrate the contrary to me. My aim has always been to keep myself in the best condition of physical and mental balance that a single person is capable of."

There is some interest in briefly reviewing the remarkable transformations in the attitude toward masturbation from Greek times down to our own day. The Greeks treated masturbation with little opprobrium. At the worst they regarded it as unmanly, and Aristophanes, in various passages, connects the practice with women, children, slaves, and feeble old men. AEschines seems to have publicly brought it as a charge against Demosthenes that he had practiced masturbation, though, on the other hand, Plutarch tells us that Diogenes—described by Zeller, the historian of Greek philosophy, as "the most typical figure of ancient Greece"—was praised by Chrysippus, the famous philosopher, for masturbating in the market-place. The more strenuous Romans, at all events as exemplified by Juvenal and Martial, condemned masturbation more vigorously.[347] Aretaeus, without alluding to masturbation, dwells on the tonic effects of retaining the semen; but, on the other hand, Galen regarded the retention of semen as injurious, and advocated its frequent expulsion, a point of view which tended to justify masturbation. In classical days, doubtless, masturbation and all other forms of the auto-erotic impulse were comparatively rare. So much scope was allowed in early adult age for homosexual and later for heterosexual relationships that any excessive or morbid development of solitary self-indulgence could seldom occur. The case was altered when Christian ideals became prominent. Christian morality strongly proscribed sexual relationships except under certain specified conditions. It is true that Christianity discouraged all sexual manifestations, and that therefore its ban fell equally on masturbation, but, obviously, masturbation lay at the weakest line of defence against the assaults of the flesh; it was there that resistance would most readily yield. Christianity thus probably led to a considerable increase of masturbation. The attention which the theologians devoted to its manifestations clearly bears witness to their magnitude. It is noteworthy that Mohammedan theologians regarded masturbation as a Christian vice. In Islam both doctrine and practice tended to encourage sexual relationships, and not much attention was paid to masturbation, nor even any severe reprobation directed against it. Omer Haleby remarks that certain theologians of Islam are inclined to consider the practice of masturbation in vogue among Christians as allowable to devout Mussulmans when alone on a journey; he himself regards this as a practice good neither for soul nor body (seminal emissions during sleep providing all necessary relief); should, however, a Mussulman fall into this error, God is merciful![348]

In Theodore's Penitential of the seventh century, forty days' penance is prescribed for masturbation. Aquinas condemned masturbation as worse than fornication, though less heinous than other sexual offences against Nature; in opposition, also, to those who believed that distillatio usually takes place without pleasure, he observed that it was often caused by sexual emotion, and should, therefore, always be mentioned to the confessor. Liguori also regarded masturbation as a graver sin than fornication, and even said that distillatio, if voluntary and with notable physical commotion, is without doubt a mortal sin, for in such a case it is the beginning of a pollution. On the other hand, some theologians have thought that distillatio may be permitted, even if there is some commotion, so long as it has not been voluntarily procured, and Caramuel, who has been described as a theological enfant terrible, declared that "natural law does not forbid masturbation," but that proposition was condemned by Innocent XI. The most enlightened modern Catholic view is probably represented by Debreyne, who, after remarking that he has known pious and intelligent persons who had an irresistible impulse to masturbate, continues: "Must we excuse, or condemn, these people? Neither the one nor the other. If you condemn and repulse absolutely these persons as altogether guilty, against their own convictions, you will perhaps throw them into despair; if, on the contrary, you completely excuse them, you maintain them in a disorder from which they may, perhaps, never emerge. Adopt a wise middle course, and, perhaps, with God's aid, you may often cure them."

Under certain circumstances some Catholic theologians have permitted a married woman to masturbate. Thus, the Jesuit theologian, Gury, asserts that the wife does not sin "quae se ipsam tactibus excitat ad seminationem statim post copulam in qua vir solus seminavit." This teaching seems to have been misunderstood, since ethical and even medical writers have expended a certain amount of moral indignation on the Church whose theologians committed themselves to this statement. As a matter of fact, this qualified permission to masturbate merely rests on a false theory of procreation, which is clearly expressed in the word seminatio. It was believed that ejaculation in the woman is as necessary to fecundation as ejaculation in the man. Galen, Avicenna, and Aquinas recognized, indeed, that such feminine semination was not necessary; Sanchez, however, was doubtful, while Suarez and Zacchia, following Hippocrates, regarded it as necessary. As sexual intercourse without fecundation is not approved by the Catholic Church, it thus became logically necessary to permit women to masturbate whenever the ejaculation of mucus had not occurred at or before coitus.

The belief that the emission of vaginal mucus, under the influence of sexual excitement in women, corresponded to spermatic emission, has led to the practice of masturbation on hygienic grounds. Garnier (Celibat, p. 255) mentions that Mesue, in the eighteenth century, invented a special pessary to take the place of the penis, and, as he stated, effect the due expulsion of the feminine sperm.

Protestantism, no doubt, in the main accepted the general Catholic, tradition, but the tendency of Protestantism, in reaction against the minute inquisition of the earlier theologians, has always been to exercise a certain degree of what it regarded as wholesome indifference toward the less obvious manifestations of the flesh. Thus in Protestant countries masturbation seems to have been almost ignored until Tissot, combining with his reputation as a physician the fanaticism of a devout believer, raised masturbation to the position of a colossal bogy which during a hundred years has not only had an unfortunate influence on medical opinion in these matters, but has been productive of incalculable harm to ignorant youth and tender consciences. During the past forty years the efforts of many distinguished physicians—a few of whose opinions I have already quoted—have gradually dragged the bogy down from its pedestal, and now, as I have ventured to suggest, there is a tendency for the reaction to be excessive. There is even a tendency to-day to regard masturbation, with various qualifications, as normal. Remy de Gourmont, for instance, considers that masturbation is natural because it is the method by which fishes procreate: "All things considered, it must be accepted that masturbation is part of the doings of Nature. A different conclusion might be agreeable, but in every ocean and under the reeds of every river, myriads of beings would protest."[349] Tillier remarks that since masturbation appears to be universal among the higher animals we are not entitled to regard it as a vice; it has only been so considered because studied exclusively by physicians under abnormal conditions.[350] Hirth, while asserting that masturbation must be strongly repressed in the young, regards it as a desirable method of relief for adults, and especially, under some circumstances, for women.[351] Venturi, a well-known Italian alienist, on the other hand, regards masturbation as strictly physiological in youth; it is the normal and natural passage toward the generous and healthy passion of early manhood; it only becomes abnormal and vicious, he holds, when continued into adult life.

The appearance of masturbation at puberty, Venturi considers, "is a moment in the course of the development of the function of that organ which is the necessary instrument of sexuality." It finds its motive in the satisfaction of an organic need having much analogy with that which arises from the tickling of a very sensitive cutaneous surface. In this masturbation of early adolescence lies, according to Venturi, the germ of what will later be love: a pleasure of the body and of the spirit, following the relief of a satisfied need. "As the youth develops, onanism becomes a sexual act comparable to coitus as a dream is comparable to reality, imagery forming in correspondence with the desires. In its fully developed form in adolescence," Venturi continues, "masturbation has an almost hallucinatory character; onanism at this period psychically approximates to the true sexual act, and passes insensibly into it. If, however, continued on into adult age, it becomes morbid, passing into erotic fetichism; what in the inexperienced youth is the natural auxiliary and stimulus to imagination, in the degenerate onanist of adult age is a sign of arrested development. Thus, onanism," the author concludes, "is not always a vice such as is fiercely combated by educators and moralists. It is the natural transition by which we reach the warm and generous love of youth, and, in natural succession to this, the tranquil, positive, matrimonial love of the mature man." (Silvio Venturi, Le Degenerazioni Psico-sessuale, 1892, pp. 6-9.)

It may be questioned whether this view is acceptable even for the warm climate of the south of Europe, where the impulses of sexuality are undoubtedly precocious. It is certainly not in harmony with general experience and opinion in the north; this is well expressed in the following passage by Edward Carpenter (International Journal of Ethics, July, 1899): "After all, purity (in the sense of continence) is of the first importance to boyhood. To prolong the period of continence in a boy's life is to prolong the period of growth. This is a simple physiological law, and a very obvious one; and, whatever other things may be said in favor of purity, it remains, perhaps, the most weighty. To introduce sensual and sexual habits—and one of the worst of them is self-abuse—at an early age, is to arrest growth, both physical and mental. And what is even more, it means to arrest the capacity for affection. All experience shows that the early outlet toward sex cheapens and weakens affectional capacity."

I do not consider that we can decide the precise degree in which masturbation may fairly be called normal so long as we take masturbation by itself. We are thus, in conclusion, brought back to the point which I sought to emphasize at the outset: masturbation belongs to a group of auto-erotic phenomena. From one point of view it may be said that all auto-erotic phenomena are unnatural, since the natural aim of the sexual impulse is sexual conjunction, and all exercise of that impulse outside such conjunction is away from the end of Nature. But we do not live in a state of Nature which answers to such demands; all our life is "unnatural." And as soon as we begin to restrain the free play of sexual impulse toward sexual ends, at once auto-erotic phenomena inevitably spring up on every side. There is no end to them; it is impossible to say what finest elements in art, in morals, in civilization generally, may not really be rooted in an auto-erotic impulse. "Without a certain overheating of the sexual system," said Nietzsche, "we could not have a Raphael." Auto-erotic phenomena are inevitable. It is our wisest course to recognize this inevitableness of sexual and transmuted sexual manifestations under the perpetual restraints of civilized life, and, while avoiding any attitude of excessive indulgence or indifference,[352] to avoid also any attitude of excessive horror, for our horror not only leads to the facts being effectually veiled from our sight, but itself serves to manufacture artificially a greater evil than that which we seek to combat.

The sexual impulse is not, as some have imagined, the sole root of the most massive human emotions, the most brilliant human aptitudes,—of sympathy, of art, of religion. In the complex human organism, where all the parts are so many-fibred and so closely interwoven, no great manifestation can be reduced to one single source. But it largely enters into and molds all of these emotions and aptitudes, and that by virtue of its two most peculiar characteristics: it is, in the first place, the deepest and most volcanic of human impulses, and, in the second place,—unlike the only other human impulse with which it can be compared, the nutritive impulse,—it can, to a large extent, be transmuted into a new force capable of the strangest and most various uses. So that in the presence of all these manifestations we may assert that in a real sense, though subtly mingled with very diverse elements, auto-erotism everywhere plays its part. In the phenomena of auto-erotism, when we take a broad view of those phenomena, we are concerned, not with a form of insanity, not necessarily with a form of depravity, but with the inevitable by-products of that mighty process on which the animal creation rests.

FOOTNOTES:

[289] For a bibliography of masturbation, see Rohleder, Die Masturbation, pp. 11-18; also, Arthur MacDonald, Le Criminel Type, pp. 227 et seq.; cf. G. Stanley Hall, Adolescence, vol. i, pp. 432 et seq.

[290] Oskar Berger, Archiv fuer Psychiatrie, Bd. 6, 1876.

[291] Die Masturbation, p. 41.

[292] Dukes, Preservation of Health, 1884, p. 150.

[293] G. Stanley Hall, Adolescence, vol. i, p. 434.

[294] F.S. Brockman, "A Study of the Moral and Religious Life of Students in the United States," Pedagogical Seminary, September, 1902. Many pitiful narratives are reproduced.

[295] Moraglia, "Die Onanie beim normalen Weibe und bei den Prostituten," Zeitschrift fuer Criminal-Anthropologie, 1897, p. 489. It should be added that Moraglia is not a very critical investigator. It is probable, however, that on this point his results are an approximation to the truth.

[296] Ernst, "Anthropological Researches on the Population of Venezuela," Memoirs of the Anthropological Society, vol. iii, 1870, p. 277.

[297] Niceforo, Il Gergo nei Normali, etc., 1897, cap. V.

[298] Debreyne, Moechialogie, p. 64. Yet theologians and casuists, Debreyne remarks, frequently never refer to masturbation in women.

[299] Stanley Hall, op. cit., vol. i, p. 34. Hall mentions, also, that masturbation is specially common among the blind.

[300] Moraglia, Archivio di Psichiatria, vol. xvi, fasc. 4 and 5, p. 313.

[301] See his careful study, "Die Sexuellen Perversitaeten in der Irrenanstalt," Psychiatrische Bladen, No. 2. 1899.

[302] Venturi, Degenerazioni Psico-sessuali, pp. 105, 133, 148, 152.

[303] J.P. West, Transactions of the Ohio Pediatric Society, 1895. Abstract in Medical Standard, November, 1895; cases are also recorded by J.T. Winter, "Self-abuse in Infancy and Childhood," American Journal Obstetrics, June, 1902.

[304] Freud, Abhandlungen zur Sexualtheorie, pp. 36 et seq.

[305] G.E. Shuttleworth, British Medical Journal, October 3, 1903.

[306] See for a detailed study of sexuality in childhood, Moll's valuable book, Das Sexualleben des Kindes; cf. vol. vi of these Studies, Ch. II.

[307] This is, no doubt, the most common opinion, and it is frequently repeated in text-books. It is scarcely necessary, however, to point out that only the opinions of those who have given special attention to the matter can carry any weight. R.W. Shufeldt ("On a Case of Female Impotency," pp. 5-7) quotes the opinions of various cautious observers as to the difficulty of detecting masturbation in women.

[308] This latter opinion is confirmed by Naecke so far as the insane are concerned. In a careful study of sexual perversity in a large asylum, Naecke found that, while moderate masturbation could be more easily traced among men than among women, excessive masturbation was more common among women. And, while among the men masturbation was most frequent in the lowest grades of mental development (idiocy and imbecility), and least frequent in the highest grades (general paralysis), in the women it was the reverse. (P. Naecke, "Die Sexuellen Perversitaeten in der Irrenanstalt," Psychiatrische en Neurologische Bladen, No. 2, 1899.)