often dominates hysterical hallucinations. Gilles de la Tourette seeks to
minimize it by the remark that "it is more mental than real." He means to
say that it is more psychic than physical, but he implies that the
physical element in sex is alone "real," a strange assumption in any case,
as well as destructive of Gilles de la Tourette's own fundamental
assertion that hysteria is a real disease and yet purely psychic.

[275] See, e.g., his substantial volume, _Die Traumdeutung_, 1900, 2d ed.
1909.

[276] _Sammlung_, first series, p. 208.

[277] _Studien über Hysterie_, p. 217.

[278] _Sammlung_, first series, p. 162.

[279] _Sammlung_, second series, p. 102.

[280] Ib. p. 146.

[281] _Sammlung_, first series, p. 229. Freud has developed his conception
of sexual constitution in _Drei Abhandlungen zur Sexualtheorie_, 1905.

[282] As Moll remarks, Freud's conceptions are still somewhat subjective,
and in need of objective demonstration; but whatever may be thought of
their theories, he adds, there can be no doubt that Breuer and Freud have
done a great service by calling attention to the important action of the
sexual life on the nervous system.

[283] Gertrude Stein, "Cultivated Motor Automatism," _Psychological
Review_, May, 1898.

[284] Charcot's most faithful followers refuse to recognize a "hysteric
temperament," and are quite right, if such a conception is used to destroy
the conception of hysteria as a definite disease. We cannot, however, fail
to recognize a diathesis which, while still apparently healthy, is
predisposed to hysteria. So distinguished a disciple of Charcot as Janet
thoroughly recognizes this, and argues (_L'Etat mental_, etc., p. 298)
that "we may find in the habits, the passions, the psychic automatism of
the normal man, the germ of all hysterical phenomena." Féré held a
somewhat similar view.

[285] A.F.A. King, "Hysteria," _American Journal of Obstetrics_, May 18,
1891.

[286] M. Rosenthal, _Diseases of the Nervous System_, vol. ii, p. 44. Féré
notes similar cases (_Twentieth Century Practice of Medicine_, vol. x, p.
551). Long previously, Gall had recorded the case of a young widow of
ardent temperament who had convulsive attacks, apparently of hysterical
nature, which always terminated in sexual orgasm (_Fonctions du Cerveau_,
1825, vol. iii, p. 245).

[287] There seems to be a greater necessity for such explosive
manifestations in women than in men, whatever the reason may be. I have
brought together some of the evidence pointing in this direction in _Man
and Woman_, 4th ed., revised and enlarged, Chapters xii and xiii.

[288] There is no doubt an element of real truth in this ancient belief,
though it mainly holds good of minor cases of hysteria. Many excellent
authorities accept it. "Hysteria is certainly common in the single,"
Herman remarks (_Diseases of Women_, 1898, p. 33), "and is generally cured
by a happy marriage." Löwenfeld (_Sexualleben und Nervenleiden_, p. 153)
says that "it cannot be denied that marriage produces a beneficial change
in the general condition of many hysterical patients," though, he adds, it
will not remove the hysterical temperament. The advantage of marriage for
the hysterical is not necessarily due, solely or at all, to the exercise
of sexual functions. This is pointed out by Mongeri, who observes
(_Allgemeine Zeitschrift für Psychiatrie_, 1901, Heft 5, p. 917): "I have
known and treated several hysterical girls who are now married, and do not
show the least neuropathic indications. Some of these no longer have any
wish for sexual gratification, and even fulfil their marital duties
unwillingly, though loving their husbands and living with them in an
extremely happy way. In my opinion, marriage is a sovereign remedy for
neuropathic women, who need to find a support in another personality, able
to share with them the battle of life."




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 23½ 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
Bedürfniss_,' 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 _curé_ 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 Näcke,[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 (Lüdeln 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 anæsthesia
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, Näcke has also stated ("Kritisches zum Kapitel der
Sexualität," _Archiv für 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. Näcke, 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 anæsthesia (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 _Traité 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 photopsisæ, muscsæ, muscular asthenopia, possibly
blepharospasm, and perhaps conjunctivitis. He goes on, however, to point
out that more serious complaints of the eye are caused by excess in normal
coitus, by sexual abstinence, and especially by disordered menstruation.
Thus we see that even when we are considering a mechanism so delicately
poised and one so easily disturbed by any jar of the system as vision,
masturbation produces no effect except when carried to an extent which
argues a hereditarily imperfect organism, while even in these cases the
effects are usually but slight, moreover, in no respect specific, but are
paralleled and even exceeded by the results of other disturbances of the
sexual system.

Let us turn to the supposed influence of masturbation in causing insanity
and nervous diseases. Here we may chiefly realize the immense influence
exerted on medical science by Tissot and his followers during a hundred
years. Mental weakness is the cause and not the result of excessive
masturbation, Gall declared,[320] but he was a man of genius, in
isolation. Sir William Ellis, an alienist of considerable reputation at
the beginning of the last century, could write with scientific equanimity:
"I have no hesitation in saying that, in a very large number of patients
in all public asylums, the disease may be attributed to that cause." He
does, indeed, admit that it may be only a symptom sometimes, but goes on
to assert that masturbation "has not hitherto been exhibited in the awful
light in which it deserves to be shown," and that "in by far the greater
number of cases" it is the true cause of dementia.[321] Esquirol lent his
name and influence to a similar view of the pernicious influence of
masturbation. Throughout the century, even down to the present day, this
point of view has been traditionally preserved in a modified form. In
apparent ignorance of the enormous prevalence of masturbation, and
without, so far as can be seen, any attempt to distinguish between cause
and effect or to eliminate the hereditary neuropathic element, many
alienists have set down a large proportion of cases of insanity, idiocy,
epilepsy, and disease of the spinal cord to uncomplicated masturbation.
Thus, at the Matteawan State Hospital (New York) for criminal lunatics and
insane prisoners, from 1875 to 1907, masturbation was the sole assigned
cause of insanity in 160 men (out of 2,595); while, according to Dr. Clara
Barrus, among 121 cases of insanity in young women, masturbation is the
cause in ten cases.[322] It is unnecessary to multiply examples, for this
traditional tendency is familiar to all.

It appears to have been largely due to Griesinger, in the middle of the
last century, that we owe the first authoritative appearance of a saner,
more discriminating view regarding the results of masturbation. Although
still to some extent fettered by the traditions prevalent in his day,
Griesinger saw that it was not so much masturbation itself as the feelings
aroused in sensitive minds by the social attitude toward masturbation
which produced evil effects. "That constant struggle," he wrote, "against
a desire which is even overpowering, and to which the individual always in
the end succumbs, that hidden strife between shame, repentance, good
intentions, and the irritation which impels to the act, this, after not a
little acquaintance with onanists, we consider to be far more important
than the primary direct physical effect." He added that there are no
specific signs of masturbation, and concluded that it is oftener a symptom
than a cause. The general progress of educated opinions since that date
has, in the main, confirmed and carried forward the results cautiously
stated by Griesinger. This distinguished alienist thought that, when
practiced in childhood, masturbation might lead to insanity. Berkhan, in
his investigation of the psychoses of childhood, found that in no single
case was masturbation a cause. Vogel, Uffelmann, and Emminghaus, in the
course of similar studies, have all come to almost similar
conclusions.[323] It is only on a congenitally morbid nervous system,
Emminghaus insists, that masturbation can produce any serious results.
"Most of the cases charged to masturbation," writes Kiernan (in a private
letter), basing his opinion on wide clinical experience, "are either
hebephrenia or hysteria in which an effect is taken for the cause."
Christian, during twenty years' experience in hospitals, asylums, and
private practice in town and country, has not found any seriously evil
effects from masturbation.[324] He thinks, indeed, that it may be a more
serious evil in women than in men. But Yellowlees considers that in women
"it is possibly less exhausting and injurious than in the other sex,"
which was also the opinion of Hammond, as well as of Guttceit, though he
found that women pushed the practice much further than men, and Näcke, who
has given special attention to this point, could not find that
masturbation is a definite cause of insanity in women in a single
case.[325] Koch also reaches a similar conclusion, as regards both sexes,
though he admits that masturbation may cause some degree of psychopathic
deterioration. Even in this respect, however, he points out that "when
practiced in moderation it is not injurious in the certain and
exceptionless way in which it is believed to be in many circles. It is the
people whose nervous systems are already injured who masturbate most
easily and practice it more immoderately than others"; the chief source of
its evil is self-reproach and the struggle with the impulse.[326]
Kahlbaum, it is true, under the influence of the older tradition, when he
erected katatonia into a separate disorder (not always accepted in later
times), regarded prolonged and excessive masturbation as a chief cause,
but I am not aware 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] Schüle also recognized a
specific masturbatory insanity, but the general tendency to reject any
such nosological form is becoming marked; Krafft-Ebing long since rejected
it and Näcke decidedly opposes it. Kraepelin states that excessive
masturbation can only occur in a dangerous degree in predisposed
subjects; so, also, Forel and Löwenfeld, as at an earlier period,
Trousseau.[329] It is true that Marro, in his admirable and detailed study
of the normal and abnormal aspects of puberty, accepts a form of
masturbatory insanity; but the only illustrative case he brings forward is
a young man possessing various stigmata of degeneracy and the son of an
alcoholic father; such a case tells us nothing regarding the results of
simple masturbation.[330] Even Spitzka, who maintained several years ago
the traditional views as to the terrible results of masturbation, and
recognized a special "insanity of masturbation," stated his conclusions
with a caution that undermined his position: "Self-abuse," he concluded,
"to become a sole cause of insanity, must be begun early and carried very
far. In persons of sound antecedents it rarely, under these circumstances,
suffices to produce an actual vesania."[331] When we remember that there