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III. The Prevalence of Masturbation--Its Occurrence in Infancy and Childhood--Is it More Frequent in Males or Females?--After Adolescence Apparently more Frequent in Women--Reasons for the Sexual Distribution of Masturbation--The Alleged Evils of Masturbation--Historical Sketch of the Views Held on This Point--The Symptoms and Results of Masturbation--Its Alleged Influence in Causing Eye Disorders--Its Relation to Insanity and Nervous Disorders--The Evil Effects of Masturbation Usually Occur on the Basis of a Congenitally Morbid Nervous System--Neurasthenia Probably the Commonest Accompaniment of Excessive Masturbation--Precocious Masturbation Tends to Produce Aversion to Coitus--Psychic Results of Habitual Masturbation--Masturbation in Men of Genius--Masturbation as a Nervous Sedative--Typical Cases--The Greek Attitude toward Masturbation--Attitude of the Catholic Theologians--The Mohammedan Attitude--The Modern Scientific Attitude--In What Sense is Masturbation Normal?--The Immense Part in Life Played by Transmuted Auto-erotic Phenomena. The foregoing sketch will serve to show how vast is the field of life--of normal and not merely abnormal life--more or less infused by auto-erotic phenomena. If, however, we proceed to investigate precisely the exact extent, degree, and significance of such phenomena, we are met by many difficulties. We find, indeed, that no attempts have been made to study auto-erotic phenomena, except as regards the group--a somewhat artificial group, as I have already tried to show--collected under the term "masturbation" while even here such attempts have only been made among abnormal classes of people, or have been conducted in a manner scarcely likely to yield reliable results.[289] Still there is a certain significance in the more careful investigations which have been made to ascertain the precise frequency of masturbation. Berger, an experienced specialist in nervous diseases, concluded, in his _Vorlesungen_, that 99 per cent. of young men and women masturbate occasionally, while the hundredth conceals the truth;[290] and Hermann Cohn appears to accept this statement as generally true in Germany. So high an estimate has, of course, been called in question, and, since it appears to rest on no basis of careful investigation, we need not seriously consider it. It is useless to argue on suppositions; we must cling to our definite evidence, even though it yields figures which are probably below the mark. Rohleder considers that during adolescence at least 95 per cent. of both sexes masturbate, but his figures are not founded on precise investigation.[291] Julian Marcuse, on the basis of his own statistics, concludes that 92 per cent. male individuals have to some extent masturbated in youth. Perhaps, also, weight attaches to the opinion of Dukes, physician to Rugby School, who states that from 90 to 95 per cent. of all boys at boarding school masturbate.[292] Seerley, of Springfield, Mass., found that of 125 academic students only 8 assured him they had never masturbated; while of 347, who answered his questions, 71 denied that they practiced masturbation, which seems to imply that 79 per cent. admitted that they practiced it.[293] Brockman, also in America, among 232 theological students, of the average age of 231/2 years and coming from various parts of the United States, found that 132 spontaneously admitted that masturbation was their most serious temptation and all but one of these admitted that he yielded, 69 of them to a considerable extent. This is a proportion of at least 56 per cent., the real proportion being doubtless larger, since no question had been asked as to sexual offenses; 75 practiced masturbation after conversion, and 24 after they had decided to become ministers; only 66 mentioned sexual intercourse as their chief temptation; but altogether sexual temptations outnumbered all others together.[294] Moraglia, who made inquiry of 200 women of the lower class in Italy, found that 120 acknowledged either that they still masturbate or that they had done so during a long period.[295] Gualino found that 23 per cent. men of the professional classes in North Italy masturbate about puberty; no account was taken of those who began later. "Here in Switzerland," a correspondent writes, "I have had occasion to learn from adult men, whom I can trust, that they have reached the age of twenty-five, or over, without sexual congress. '_Wir haben nicht dieses Beduerfniss_,' is what they say. But I believe that, in the case of the Swiss mountaineers, moderate onanism is practiced, as a rule." In hot countries the same habits are found at a more precocious age. In Venezuela, for instance, among the Spanish creoles, Ernst found that in all classes boys and girls are infested with the vice of onanism. They learn it early, in the very beginning of life, from their wet-nurses, generally low Mulatto women, and many reasons help to foster the habit; the young men are often dissipated and the young women often remain single.[296] Niceforo, who shows a special knowledge of the working-girl class at Rome, states that in many milliners' and dressmakers' workrooms, where young girls are employed, it frequently happens that during the hottest hours of the day, between twelve and two, when the mistress or forewoman is asleep, all the girls without exception give themselves up to masturbation.[297] In France a country _cure_ assured Debreyne that among the little girls who come up for their first communion, 11 out of 12 were given to masturbation.[298] The medical officer of a Prussian reformatory told Rohleder that nearly all the inmates over the age of puberty masturbated. Stanley Hall knew a reform school in America where masturbation was practiced without exception, and he who could practice it oftenest was regarded with hero-worship.[299] Ferriani, who has made an elaborate study of youthful criminality in Italy, states that even if all boys and girls among the general population do not masturbate, it is certainly so among those who have a tendency to crime. Among 458 adult male criminals, Marro (as he states in his _Caratteri dei Delinquenti_) found that only 72 denied masturbation, while 386 had practiced it from an early age, 140 of them before the age of thirteen. Among 30 criminal women Moraglia found that 24 acknowledged the practice, at all events in early youth (8 of them before the age of 10, a precocity accompanied by average precocity in menstruation), while he suspected that most of the remainder were not unfamiliar with the practice. Among prostitutes of whatever class or position Moraglia found masturbation (though it must be pointed out that he does not appear to distinguish masturbation very clearly from homosexual practices) to be universal; in one group of 50 prostitutes everyone had practiced masturbation at some period; 28 began between the ages of 6 and 11; 19, between 12 and 14, the most usual period--a precocious one--of commencing puberty; the remaining 3 at 15 and 16; the average age of commencing masturbation, it may be added, was 11, while that of the first sexual intercourse was 15.[300] In a larger group of 180 prostitutes, belonging to Genoa, Turin, Venice, etc., and among 23 "elegant cocottes," of Italian and foreign origin, Moraglia obtained the same results; everyone admitted masturbation, and not less than 113 preferred masturbation, either solitary or mutual, to normal coitus. Among the insane, as among idiots, masturbation is somewhat more common among males, according to Blandford, in England, as also it is in Germany, according to Naecke,[301] while Venturi, in Italy, has found it more common among females.[302] There appears to be no limit to the age at which spontaneous masturbation may begin to appear. I have already referred to the practice of thigh-rubbing in infants under one year of age. J.P. West has reported in detail 3 cases of masturbation in very early childhood--2 in girls, 1 in a boy--in which the practice had been acquired spontaneously, and could only be traced to some source of irritation in pressure from clothing, etc.[303] Probably there is often in such cases some hereditary lack of nervous stability. Block has recorded the case of a girl--very bright for her age, though excessively shy and taciturn--who began masturbating spontaneously at the age of two; in this case the mother had masturbated all her life, even continuing the practice after marriage, and, though she succeeded in refraining during pregnancy, her thoughts still dwelt upon it, while the maternal grandmother had died in an asylum from "masturbatory insanity." Freud considers that auto-erotic manifestations are common in infancy, and that the rhythmic function of any sensitive spot, primarily the lips, may easily pass into masturbation. He regards the infantile manifestations of which thumb-sucking is the most familiar example (Luedeln or Lutschen in German) as auto-erotic, the germ arising in sucking the breasts since the lips are an erogenous zone which may easily be excited by the warm stream of milk. But this only occurs, he points out, in subjects in whom the sensitivity of the lip zone is heightened and especially in those who at a later age are liable to become hysterical.[304] Shuttleworth also points out that the mere fidgetiness of a neurotic infant, even when only a few months old, sometimes leads to the spontaneous and accidental discovery of pleasurable sexual sensations, which for a time appease the restlessness of nervous instability, though a vicious circle is thus established. He has found that, especially among quite young girls of neurotic heredity, self-induced excitement, often in the form of thigh-friction, is more common than is usually supposed.[305] Normally there appears to be a varying aptitude to experience the sexual organism, or any voluptuous sensations before puberty. I find, on eliciting the recollections of normal persons, that in some cases there have been voluptuous sensations from casual contact with the sexual organs at a very early age; in other cases there has been occasional slight excitement from early years; in yet other cases complete sexual anaesthesia until the age of puberty. That the latter condition is not due to mere absence of peripheral irritation is shown by a case I am acquainted with, in which a boy of 7, incited by a companion, innocently attempted, at intervals during several weeks, to produce erection by friction of the penis; no result of any kind followed, although erections occurred spontaneously at puberty, with normal sexual feelings.[306] I am indebted to a correspondent for the following notes:-- "From my observation during five years at a boarding-school, it _seems_ that eight out of ten boys were more or less addicted to the practice. But I would not state _positively_ that such was the proportion of masturbators among an average of thirty pupils, though the habit was very common. I know that in one bedroom, sleeping seven boys, the whole number masturbated frequently. The act was performed in bed, in the closets, and sometimes in the classrooms during lessons. Inquiry among my friends as to onanism in the boarding-schools to which they were sent, elicited somewhat contradictory answers concerning the frequency of the habit. Dr. ----, who went to a French school, told me that _all_ the older boys had younger accomplices in mutual masturbation. He also spoke with experience of the prevalence of the practice in a well-known public school in the west of England. B. said _all_ the boys at his school masturbated; G. stated that _most_ of his schoolmates were onanists; L. said 'more than half' was the proportion. "At my school, manual masturbation was both solitary and mutual; and sometimes younger boys, who had not acquired the habit, were induced to manipulate bigger boys. One very precocious boy of fifteen always chose a companion of ten 'because his hand was like a woman's.' Sometimes boys entered their friend's bed for mutual excitement. In after-life they showed no signs of inversion. Another boy, aged about fourteen, who had been seduced by a servant-girl, embraced the bolster; the pleasurable sensations, according to his statement, were heightened by imagining that the bolster was a woman. He said that the enjoyment of the act was greatly increased during the holidays, when he was able to spread a pair of his sister's drawers upon the pillow, and so intensify the illusion. "Before puberty the boys appeared to be more continent than afterward. A few of the older and more intelligent masturbators regulated the habit, as some married men regulate intercourse. The big boy referred to, who chose always the same manipulator, professed to indulge only once in twenty days, his reason being that more frequent repetition of the act would injure his health. About twice a week for boys who had reached puberty, and once a week for younger boys, was, I think, about the average indulgence. I have never met with a parallel of one of those cases of excessive masturbation recorded by many doctors. There may have been such cases at this school; but, if so, the boys concealed the frequency of their gratifications. "My experience proved that many of the lads regarded masturbation as reprehensible; but their plea was 'everyone does it.' Some, often those who indulged inordinately and more secretly than their companions, gravely condemned the practice as sinful. A few seemed to think there was 'no harm in it,' but that the habit might stunt the growth and weaken the body if practiced very frequently. The greater number made no attempt to conceal the habit, they enlarged upon the pleasure of it; it was 'ever so much nicer than eating tarts,' etc. "The chief cause I believe to be initiation by an older schoolmate. But I have known accidental causes, such as the discovery that swarming up a pole pleasurably excited the organ, rubbing to allay irritation, and simple, curious handling of the erect penis in the early morning before rising from bed." I quote the foregoing communication as perhaps a fairly typical experience in a British school, though I am myself inclined to think that the prevalence of masturbation in schools is often much overrated, for, while in some schools the practice is doubtless rampant, in others it is practically unknown, or, at all events, only practiced by a few individuals in secret. My own early recollections of (private) school-life fail to yield any reminiscences of any kind connected with either masturbation or homosexuality; and, while such happy ignorance may be the exception rather than the rule, I am certainly inclined to believe that--owing to race and climate, and healthier conditions of life--the sexual impulse is less precocious and less prominently developed during the school-age in England than in some Continental countries. It is probably to this delayed development that we should attribute the contrast that Ferrero finds (_L'Europa Giovane_, pp. 151-56), and certainly states too absolutely, between the sexual reserve of young Englishmen and the sexual immodesty of his own countrymen. In Germany, Naecke has also stated ("Kritisches zum Kapitel der Sexualitaet," _Archiv fuer Psychiatrie_, pp. 354-56, 1899) that he heard nothing at school either of masturbation or homosexuality, and he records the experience of medical friends who stated that such phenomena were only rare exceptions, and regarded by the majority of the boys as exhibitions of "_Schweinerei_." At other German schools, as Hoche has shown, sexual practices are very prevalent. It is evident that at different schools, and even at the same school at different times, these manifestations vary in frequency within wide limits. Such variations, it seems to me, are due to two causes. In the first place, they largely depend upon the character of the more influential elder boys. In the second place, they depend upon the attitude of the head-master. With reference to this point I may quote from a letter written by an experienced master in one of the most famous English public schools: "When I first came to ----, a quarter of a century ago, Dr. ---- was making a crusade against this failing; boys were sent away wholesale; the school was summoned and lectured solemnly; and the more the severities, the more rampant the disease. I thought to myself that the remedy was creating the malady, and I heard afterward, from an old boy, that in those days they used to talk things over by the fireside, and think there must be something very choice in a sin that braved so much. Dr. ---- went, and, under ----, we never spoke of such things. Curiosity died down, and the thing itself, I believe, was lessened. We were told to warn new boys of the dangers to health and morals of such offences, lest the innocent should be caught in ignorance. I have only spoken to a few; I think the great thing is not to put it in boys' heads. I have noticed solitary faults most commonly, and then I tell the boy how he is physically weakening himself. If you notice, it is puppies that seem to go against Nature, but grown dogs, never. So, if two small boys acted thus, I should think it merely an instinctive feeling after Nature, which would amend itself. Many here would consider it a heinous sin, but those who think such things sins make them sins. I have seen, in the old days, most delightful little children sent away, branded with infamy, and scarce knowing why--you might as well expel a boy for scratching his head when it itched. I am sure the soundest way is to treat it as a doctor would, and explain to the boy the physical effects of over-indulgence of any sort. When it is combated from the monkish standpoint, the evil becomes an epidemic." I am, however, far from anxious to indorse the policy of ignoring the sexual phenomena of youth. It is not the speaking about such things that should be called in question, but the wisdom and good sense of the speaker. We ought to expect a head-master to possess both an adequate acquaintance with the nature of the phenomena of auto-erotism and homosexuality, and a reasonable amount of tact in dealing with boys; he may then fairly be trusted to exercise his own judgment. It may be doubted whether boys should be made too alive to the existence of sexual phenomena; there can be no doubt about their teachers. The same is, of course, true as regards girls, among whom the same phenomena, though less obtrusive, are not less liable to occur. As to whether masturbation is more common in one sex than the other, there have been considerable differences of opinion. Tissot considered it more prevalent among women; Christian believed it commoner among men; Deslandes and Iwan Bloch hold that there are no sexual differences, and Garnier was doubtful. Lawson Tait, in his _Diseases of Women_, stated his opinion that in England, while very common among boys, it is relatively rare among women, and then usually taught. Spitzka, in America, also found it relatively rare among women, and Dana considers it commoner in boys than in girls or adults.[307] Moll is inclined to think that masturbation is less common in women and girls than in the male sex. Rohleder believes that after puberty, when it is equally common in both sexes, it is more frequently found in men, but that women masturbate with more passion and imaginative fervor.[308] Kellogg, in America, says it is equally prevalent in both sexes, but that women are more secretive. Morris, also in America, considers, on the other hand, that persistent masturbation is commoner in women, and accounts for this by the healthier life and traditions of boys. Pouillet, who studied the matter with considerable thoroughness in France, came to the conclusion that masturbation is commoner among women, among whom he found it to be equally prevalent in rich and poor, and especially so in the great centres of civilization. In Russia, Guttceit states in his _Dreissig Jahre Praxis_, that from the ages of 10 to 16 boys masturbate more than girls, who know less about the practice which has not for them the charm of the forbidden, but after 16 he finds the practice more frequent in girls and women than in youths and men. Naecke, in Germany, believes that there is much evidence pointing in the same direction, and Adler considers masturbation very common in women. Moraglia is decidedly of the opinion, on the ground of his own observations already alluded to, that masturbation is more frequent among women; he refers to the fact--a very significant fact, as I shall elsewhere have to point out--that, while in man there is only one sexual centre, the penis, in woman there are several centres,--the clitoris, the vagina, the uterus, the breasts,[309]--and he mentions that he knew a prostitute, a well-developed brunette of somewhat nervous temperament, who boasted that she knew fourteen ways of masturbating herself. My own opinion is that the question of the sexual distribution of masturbation has been somewhat obscured by that harmful tendency, to which I have already alluded, to concentrate attention on a particular set of auto-erotic phenomena. We must group and divide our facts rationally if we wish to command them. If we confine our attention to very young children, the available evidence shows that the practice is much more common in females,[310] and such a result is in harmony with the fact that precocious puberty is most often found in female children.[311] At puberty and adolescence occasional or frequent masturbation is common in both boys and girls, though, I believe, less common than is sometimes supposed; it is difficult to say whether it is more prevalent among boys or girls; one is inclined to conclude that it prevails more widely among boys. The sexual impulse, and consequently the tendency to masturbation, tend to be aroused later, and less easily in girls than in youths, though it must also be remembered that boys' traditions and their more active life keep the tendency in abeyance, while in girls there is much less frequently any restraining influence of corresponding character.[312] In my study of inversion I have found that ignorance and the same absence of tradition are probably factors in the prevalence of homosexual tendencies among women.[313] After adolescence I think there can be no doubt that masturbation is more common in women than in men. Men have, by this time, mostly adopted some method of sexual gratification with the opposite sex; women are to a much larger extent shut out from such gratification; moreover, while in rare cases women are sexually precocious, it more often happens that their sexual impulses only gain strength and self-consciousness after adolescence has passed. I have been much impressed by the frequency with which masturbation is occasionally (especially about the period of menstruation) practiced by active, intelligent, and healthy women who otherwise lead a chaste life. This experience is confirmed by others who are in a position to ascertain the facts among normal people; thus a lady, who has received the confidence of many women, told me that she believes that all women who remain unmarried masturbate, as she found so much evidence pointing in this direction.[314] This statement certainly needs some qualification, though I believe it is not far from the truth as regards young and healthy women who, after having normal sexual relationships, have been compelled for some reason or other to break them off and lead a lonely life.[315] But we have to remember that there are some women, evidently with a considerable degree of congenital sexual anaesthesia (no doubt, in some respect or another below the standard of normal health), in whom the sexual instinct has never been aroused, and who not only do not masturbate, but do not show any desire for normal gratification; while in a large proportion of other cases the impulse is gratified passively in ways I have already referred to. The auto-erotic phenomena which take place in this way, spontaneously, by yielding to revery, with little or no active interference, certainly occur much more frequently in women than in men. On the other hand, contrary to what one might be led to expect, the closely-related auto-erotic phenomena during sleep seem to take place more frequently in men, although in women, as we have found ground for concluding, they reverberate much more widely and impressively on the waking psychical life. We owe to Restif de la Bretonne what is perhaps the earliest precise description of a woman masturbating. In 1755 he knew a dark young woman, plain but well-made, and of warm temperament, educated in a convent. She was observed one day, when gazing from her window at a young man in whom she was tenderly interested, to become much excited. "Her movements became agitated; I approached her, and really believe that she was uttering affectionate expressions; she had become red. Then she sighed deeply, and became motionless, stretching out her legs, which she stiffened, as if she felt pain." It is further hinted that her hands took part in this manoeuvre (_Monsieur Nicolas_, vol. vi, p. 143). Pictorial representations of a woman masturbating also occur in eighteenth century engravings. Thus, in France, Baudouin's "Le Midi" (reproduced in Fuchs's _Das Erotische Element in der Karikatur_, Fig. 92), represents an elegant young lady in a rococo garden-bower; she has been reading a book she has now just dropped, together with her sunshade; she leans languorously back, and her hand begins to find its way through her placket-hole. Adler, who has studied masturbation in women with more care than any previous writer, has recorded in detail the auto-erotic manifestations involved in the case of an intelligent and unprejudiced woman, aged 30, who had begun masturbating when twenty, and practiced it at intervals of a few weeks. She experienced the desire for sexual gratification under the following circumstances: (1) spontaneously, directly before or after menstruation; (2) as a method to cure sleeplessness; (3) after washing the parts with warm (but not cold) water; (4) after erotic dreams; (5) quite suddenly, without definite cause. The phenomena of the masturbatory process fell into two stages: (1) incomplete excitement, (2) the highest pleasurable gratification. It only took place in the evening, or at night, and a special position was necessary, with the right knee bent, and the right foot against the knee of the extended left leg. The bent index and middle fingers of the right hand were then applied firmly to the lower third of the left labium minus, which was rubbed against the underlying parts. At this stage, the manifestations sometimes stopped, either from an effort of self-control or from fatigue of the arm. There was no emission of mucus, or general perspiration, but some degree of satisfaction and of fatigue, followed by sleep. If, however, the manipulation was continued, the second stage was reached, and the middle finger sank into the vagina, while the index finger remained on the labium, the rest of the hand holding and compressing the whole of the vulva, from pubes to anus, against the symphysis, with a backwards and forwards movement, the left hand also being frequently used to support and assist the right. The parts now gave a mushroom-like feeling to the touch, and in a few seconds, or after a longer interval, the complete feeling of pleasurable satisfaction was attained. At the same moment there was (but only after she had had experience of coitus) an involuntary elevation of the pelvis, together with emission of mucus, making the hand wet, this mucus having an odor, and being quite distinct from the ordinary odorless mucus of the vagina; at the same time, the finger in the vagina felt slight contractions of the whole vaginal wall. The climax of sexual pleasure lasted a few seconds, with its concomitant vaginal contractions, then slowly subsided with a feeling of general well-being, the finger at the same time slipping out of the vagina, and she was left in a state of general perspiration, and sleep would immediately follow; when this was not the case, she was frequently conscious of some degree of sensibility in the sacrum, lasting for several hours, and especially felt when sitting. When masturbation was the result of an erotic dream (which occurred but seldom), the first stage was already reached in sleep, and the second was more quickly obtained. During the act it was only occasionally that any thoughts of men or of coitus were present, the attention being fixed on the coming climax. The psychic state afterwards was usually one of self-reproach. (O. Adler, _Die Mangelhafte Geschlechtsempfindung des Weibes_, 1904, pp. 26-29.) The phenomena in this case may be regarded as fairly typical, but there are many individual variations; mucus emissions and vaginal contractions frequently occur before actual orgasm, and there is not usually any insertion of the finger into the vagina in women who have never experienced coitus, or, indeed, even in those who have. 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