ft I Rlb6s 2.865 Scientific'and Medical Books, and Minerals. A. E. FOOTE, M. D., Philadelphia, Pa. SURGEON GENERAL'S OFFICE | A1UEZ ■ > ^ ^ T | Section/,: V .-■ \?JJ±$/l ^ SEMINALIA; OR, AN ENQUIRY INTO I"he Symptoms, Consequences, Causes, Signs, Natvre and Treatment of SEMINAL DISEASES, Whether Arising from Abuse, Excess or Irregularity IN EITHER SEX ; INCLUDING SPERMATORRHEA, STRICTURE, IMPOTENCE, SEMINAL GLEET; AND INTENDED TO BE A FAITHFUL AND PRACTICAL GUIDE TO ALL WHO IN ANY WAY MAY BE INTERESTED. — V BY JOSEPH E. PALPH, M,,g--e "^ . ;/^ Eleve de VEcole Royale de Medicine, de Pat 'V',A OJi*^ 1 Nthi fork: EVERARDUS WARNER, 1 VESEY STREET. 1865. V K/64s '/lH -y '/? j JH>*, z~ Entered according to Act of Congress, in the year one thousand eight hun- dred and sixty-five, by Joseph E. Ralph, M. I'. BAPTIST & TAYLOR, PRINTERS, SUN BUILDING, N. T. CONTENTS. CHAPTER I. The Character of this Work—Abuse or Masturbation defined—Vast importance of the subject, and its alarming prevalence—The duty of parents and others to understand this subject—Existence of the vice often not suspected until too late—The symptoms of abuse- Symptoms described and explained in their natural groups—The symptoms in the Female described in the same way—May be con- founded with Green-sickness—Symptoms of Chlorosis. CHAPTER II. The Consequences of Abuse and Excess__Powerful influence in causing disease explained—Why masturbation is more hurtful than the natural act—Why more hurtful the younger it is commenced—Why more injurious to one than to another—The derangements and dis- eases it induces described, explained, and illustrated with cases- Irritation of the bladder—Irritation of the urinary canal—Morbid erections—Diseases of the testicle—Spermatorrhoea, or seminal emissions—Diminution of pleasure in the seminal act—Transitory, or incomplete erections—Stricture—Impotence—Disordered mind— Insanity—Disordered nervous system—Dyspepsia—Disease of the brain—Sleeplessness—The Eyes—Piles—Disease of the heart—Rheu- matism and neuralgia—Consumption—Epilepsy — Hypochondria— Disease of the spine—Especial curability of most of these, when caused by abuse—Consequences in the Female, peculiar to her sex- Irritation—Voluptuous dreams—Leucorrhcea—Deranged menstru- ation—Hysteria—Diseases of the womb—Barrenness—Loss of pleas- ure in, or aversion to, the sexual act—Its occurrence explained—Pe- culiar encouragement for female cases. iv CHAPTER III. The Causes of Masturbation and Abuse.—The variety of causes, acting directly and indirectly, from without and from within the in- dividual, not generally even suspected—Causes which have come to the knowledge of the author and of other observers—Cause; acting in childhood, in youth, and in the adult, of either sex * from Nurses and Servants ; from Precocity ; from a variety of accidental causes ; from irritation about the genitals ; from incontinence of urine, " wetting the bed ;" from injudicious punishments; from the child's habits in bed ; from diet; from schools ; from sitting too long; from moral influences ; from Solitude ; from Celibacy; from Phymosis— Remarks on circumcision—Important suggestion. CHAPTER IV. The Signs of Masturbation, or Abuse.—Possible at any period—Why every child ought to be the subject of a watchful care—Necessity of intelligent watchfulness—When suspicion ought to be excited, in connection with, the Health ; the Physical development; the Habits and Manners; the traits of Character ; with Fits—Every parent, guardian, or teacher, ought to understand all this—The Presump- tive Signs, connected with Bed ; with certain Habits ; with the Eyes; with certain Complaints—The Positive Signs, connected with Bed ; with the Hands ; with Stains on the linen ; with peculiar develop- ment of the genitals. CHAPTER V. The Nature of the Special Disease.—Is a disease sui generis—Its con- stant presence—Reasons for its great importance ; because it claims the first attention in the treatment ; because it is not understood by physicians ; because, as is explained, life may be lost for want of such knowledge—Description of this disease in the Male—Its pro- gress and particular symptoms—How it marks the three distinct stages—Formula of each stage with its distinctive symptoms—De- scription of the special disease in the Female—Its peculiar progress and symptoms in her case—The corresponding three stages—For- mula of each stage in the female with the distinctive symptoms— Possibility of false suspicion—Important remarks. CHAPTER VI. Strictures, Seminal Gleet, Impotence.—Peculiar tendency to stricture in every case—The true nature of Stricture—It may continue and keep V up the symptoms, after the seminal disease is cured, with serious con- sequences—The symptoms of Stricture—How easily confounded with those of abuse—Seminal Gleet explained—May supersede nocturnal emissions, deceiving the patient into false security—When it may be suspected—Danger from its obscure and insidious (Character—Local symptoms of seminal gleet—Is easily mistaken or overlooked, or not even suspected at all—Physicians generally ignore it—Internal seminal emissions, still more obscure and serious—Appearance of in the urine—Its special symptoms—Such patients said to be troubled with ennui, or called " Malades imagi/iaires"—Curability, in appa- rently hopeless cases, if recognized—Impotence. CHAPTER VII. The Treatment.—Introductory Remarks—Prevailing false ideas—Pos- sibility of spontaneous cure during period of first stage, in either sex, and always, in children—Reason why so many seem not to have suffered from abuse—Spontaneous cure impossible after the first stage is past—Difficulty in obtaining certainty, or a confession, in young subjects ; is rather experienced by parents than the physi- cian who is used to them—Preventive Treatment—Direct preventive means that have been resorted to—A new remedy, preventive and curative, proposed—Indirect preventive means, described—Inutility of mere precept—Better not to obtrude the subject on the innocent— Hygienic Treatment—Diet, adaptation to the different stages, two important rules—Directions relating to, Exercise. Occupation. Bed. Bathing. Sponging. Marriage—False notions regarding; injudicious advice, even from physicians; when remedial, when hurtful— When marriage is the true remedy; when it should be pro- hibited—When proper in the Female case—Medical Treatment—Vi- tally important cautions—Devices and snares of heartless charla- tanry exposed and dangers pointed out—Complicated character of the disease—False ideas of patients—When nocturnal seminal emis- sions constitute disease, and when they do not ; the only rule— Their natural and proper remedy. CHAPTER VIII. Sexual Excesses and Irregularities.—(ffcpable of the same effects, in kind, as abuse—What constitutes excess 1—Causes disease in the same way as abuse does, explanation—Circumstances un- der which excesses are most hurtful; in connection with Age, Cli- mate, Habits, Surroundings—State of Health, &c.—Vanity—Sexual wants of the system ; may be deceptive from general or local mor- VI bid causes—Need of a proper rule of judgment—Difficulty in laying down any general rule—Imperfection of those heretofore given—The only true rules to judge of moderation or excess—Sexual Irregulari- ties—How they are injurious and resemble abuses—Variety. After meals. Toyifig. Drunkenness. Imperfect erentions. Prolonging the act. The Condom. Withdrawing. Lewd Thoughts and Conversa- tion ; Moral Onanism—Facts deeply interesting to all, yet generally unknown—Concluding remarks. PREFACE. In the following pages the great- object has been to demon- strate two weighty, but generally ill-understood, facts *, viz., the immense importance of the subject of sexual abuses and ex- cesses, in all its bearings ; and, the peculiar dangers of charla- tanry in this class of diseases—the further consideration of the causes, consequences, signs, special disease, and treatment, but adding further proof of the truth of these two propositions*. Addressed to those concerned, it is written in the plainest possible language, perfectly free from anatomical or technical terms of any kind, except, in one or two instances where no english word exists or where such would have been inadmis- sible. It is also thus rendered suitable to the perusal of parents or guardians who would fulfil their duty in understanding this important subject; or, for putting into the hands of those, of either sex, who unfortunately need the information and warn- ing it conveys. No- 80 Amity Street, September, 1865. r> Joseph E. Ralph, M. D., No. 80 Amity Street. P. 0. LOJ -\752, 21 T. City. CHAPTER I. The character of this work—Abuse defined.—The importance of this subject and its alarming prevalence.—Duty of understanding it__ The Symptoms—Symptoms described and explained in their natural groups.—Symptoms in the female, described in the same way__ May be confounded with Green-sickness.—Symptoms of Chlorosis. Opposed to the way in which this subject is usually treated in works intended for unprofessional reading, I shall not infringe upon the province of the moralist, but shall rather, in my proper character as physician, consider it simply as a disease, the causes, symptoms, nature and consequences of which are to be discovered and the remedy pointed out. I therefore propose to give the plain and simple truth, leaving all the rest to the good sense of the reader; and especially to such as are, unfortunately, most interested ; and this I believe will be both most acceptable and most useful. Masturbation, then, may be defined to be the stimu- lation or excitement of the genital organs by friction with the hand or other unnatural means and with or without a seminal discharge; in the male applied to 2 10 the external organ and usually carried to the point of a seminal ejaculation; in the female, to a certain part of the external organs and carried to the point of voluptuous sensations or nervous exhaustion. It is variously known by the terms, masturbation, self-abuse, self-pollution, manustupration, onanism, luxuria manuensis, solitary or secret vice, voluntary pollution; or by its proximate consequences, as seminal weakness, spermatorrhea, nervous debility, nocturnal or seminal emissions, wet dreams, sexual debility, involuntary pollutions; and popularly, or amongst nostrum-venders and the various empirics, whence the public get most of their medical knowledge and nomenclature, any of these terms are used indis- criminately, The importance of this subject cannot be over-esti- mated, or, I may say, is utterly beyond computation, for this vice constitutes a source of disease more pro- lific than any other; and is by all authorities acknow- ledged to be, to an alarming extent, a cause of deterioration of the human race. ' In my opinion,' says one, ' neither the plague, nor war, fior small-pox, nor similar diseases, have produced results so dis- astrous to humanity as the pernicious habit of onanism; it is the destroying element of civilized societies, which is constantly in action, and gradually under- 11 mines the health of a nation.' There is no disease or infirmity which masturbation may not, in one way or other, directly or indirectly, and in either sex, be the cause of. Many serious and,fatal disorders are the direct consequence of it, while others to which the constitution was liable from hereditary disposition or weakness of some particular organ, are developed under its influence when otherwise the powers of na- ture would have overcome or outgrown them. The celebrated commentator, Dr. Adam Clarke, speaking from his own observation, says, ' The sin of self-pollution, which is generally considered to be that of Onan, is one of the most destructive evils ever practiced by fallen man. In many respects it is several degrees worse than common whoredom, and has in its train more awful consequences, though practised by numbers who would shudder at the thought of criminal connection with a prostitute.' ' Worse woes than my pen can relate, I have witnessed in those addicted to this fascinating, unnatural and most destructive of crimes.' The profound and learned physician and writer, Dr. James Copland, says on the subject, 'So numerous are the ills, both of body and mind, which this dis- order (seminal weakness) induces—and so certainly are those ills entailed upon the subsequent life of the 12 person who is its subject, and upon his offspring to the third and fourth generation, if, indeed, he possess the power of propagating his species, even in the most imbecile forms, that it becomes the duty of the medical instructor to point out its forms, relations and consequences. The subject has been improperly neg- lected by both instructed writers and scientific phy- sicians, because it is one frequently involving delicate ideas, and requiring unpleasant revelations—as the due consideration of it unveils the innate and con- cealed depravity of our nature. But the vice, the moral depravity, of which the disorder at first consists, soon creates for itself, in actual and often incurable physical disease, a necessity for disclosure—a necessity which is not confined to the person concerned, but ex- tended to his family and his offspring. This being the case with disorders and their usual consequences, which involve so extensive and important considerations, should they be relinquished by the only persons who are able to investigate them aright, and to restore the • mental and the physical imperfections upon which they depend, and be handed over to ignorant harpies, who . prey upon the wretched sufferers, who take the utmost advantage of the fears which torment them, of the moral and physical debility which sinks them, and of the circumstances in which they are involved, to de- ceive, to plunder, and to swindle them, and who have 13 neither the knowledge, nor the ability, nor even the in- tention, to render them any aid ?" In an able article published in the Boston Medical and Surgical Journal, the writer says 'The per- nicious and debasing practice of masturbation is a more common and extensive evil with youth of both sexes, than is usually supposed. The influence of this habit upon both body and mind, severe as it has been considered, and greatly as it has been deprecated, is altogether more prejudicial than the public, and, as it is believed, even the medical profession are aware. ' A great number of the evils which come upon the young at and after the age of puberty, arise from mas- turbation, persisted in, so as to waste the vital energies and enervate the physical and mental powers of man. Not less does it sap the foundation of moral principles, and blast the first budding of manly and honorable feelings which were exhibiting themselves in the opening character of the young.' ' Many of the weaknesses commonly attributed to growth and the changes in the habit by the important transformation from adolescence to manhood, are justly referable to this practice. This change requires all the energy of the system, greatly increased as it is at this period of life, which if undisturbed will bring 14 about a vigorous and healthy condition of both the mental and physical powers. If masturbation be com- menced at this period it cannot fail to interrupt es- sentially this important process; and if continued, will inevitably impress imbecility on the constitution, not less apparent in the body than in the mind, preventing, as it will not fail to do, the full developement of the powers of both.' Mr. Phillips, at the conclusion of a paper on this subject, in the Medical Gazette, says ' Since the pub- lication of the first part of this paper, I have been painfully impressed with the conviction, that the evil is more widely spread than I had before conceived; and that it will not be largely alleviated by the means I have adopted.' ' The pages of a strictly medical jour- nal do not meet the eyes of the great mass of suf- ferers.' Dr. Choate, in his report for the year 1859, remarks, ' Next to intemperance and physical derangement, with the latter of which causes it undoubtedly has much to do, ranks the indulgence in solitary sexual excesses. The baneful effects of this habit in both sexes have been often dwelt upon, and, I believe, have not been overrated. As a cause, I fear it is a growing one, increasing with increasing luxury, and with the 15 diffusion of precocious knowledge which marks the pre- sent day.' Invading, then, as this vice does, almost every family, more or less seriously, and principally the youth of both sexes, it behoves every one to be aware of it, if not for their own sakes for the sake of their children, their younger friends, those over whom they may have care or authority; to become acquainted with the kind of symptoms it produces, the signs by which the unfortunate practice may be suspected, and the means of discovering, in spite of most artful dis- simulation, the existence of the habit. In the course of this little volume, each of these points will be en- larged upon and may be easily turned to. It is, doubtless, in every point of view a delicate and unwelcome duty; but "the delicacy would be false indeed that would stand in the way of such a duty. ' However revolting' as Sir W. C. Ellis writes, ' to the feelings it may be to enter upon such a subject, it can- not be passed over in silence without a great violation of duty. Unhappily it has"hot been hitherto exhibited in the awful light in which it deserves to be shown. The worst of it is that it is seldom suspected. There are many pale faces and languid and nervous feelings attributed to other causes, when all the mischief lies here; and when it is suspected, it.is so delicate and 16 painful a subject, that it can be scarcely hinted at with- out a blush. It should not, however, be forgotten, that a great deal of misery in life, and insanity and prema- ture death are often the consequences; and it, there- fore, demands some sacrifice of feeling, especially from those having charge of youth; they ought to be warned, indirectly at least, of the consequences.' Dr. Woodward, extensively acquainted with the sub- ject, says, ' Much experience has taught me that this is an important and necessary subject of education; that information should be diffused upon it; that the young should be admonished, and the whole community enlightened, so that no one himself shall suffer, or wit- ness the ravages of the vice upon those around him, without being able to detect it, and avoid it before it is too late. A hint from a parent who understands the case, may be sufficient. A tract extensively circulated, may do much good as a preventive, and a cure before serious injury is done to the health or intellect.' THE SYMPTOMS OF ABUSE. Having made these preliminary remarks I now pro- ceed to give the general symptoms in the order in which they commonly appear, and increasing in variety and severity as the practice is persisted in. I shall then describe them more particularly in their natural n groups, which will afford the opportunity to add some explanatory remarks. The symptoms may be divided into three grades, answering to the stages of the actual disease. Thus, there is generally, at first, increased appetite, lassitude, paleness, disinclination to arise in the morning; then, absent mindedness, decreasing liveliness and lightness, and an unwillingness to be alone, hot hands, flushing of the skin, quickened pulse, biting of the nails. As the evil begins to tell upon the system nocturnal semi- nal emissions commence, sleep is unrefreshing and there is increasing fondness for bed. Indigestion is complained of, with a sense of dragging at the pit of the stomach; costiveness; headache, more particularly in the back of the head; noise in the ears. Emaciation becomes evident, the skin grows sallow and the mus- cles soft, and the testicles hang too low. Nervousness or shyness, a noticeable seeking for solitude, and grow- ing timidity; indisposition to study, drowsiness during fhe day or at studies, want of memory. Darkness ap- pears under the eyes, or pimples come on the face; the urine is passed oftener than is natural; the character becomes changed, irritable, quarrelsome, impatient or resentful. Female society is avoided, yet they are secretly and curiously watched; exciting or loose read- ing is eagerly devoured. Erections are easily produced, 18 and if connection is sought are transient, and the act prevented or quickly terminated by a precipitate dis- charge. If the unfortunate practice is still persisted in the symptoms now rapidly increase in gravity; dys- pepsia is established, with obstinate constipation; natu- ral or inherited weakness or disease are developed; there is great depression of spirits, cowardice, dislike for society and positive aversion to the company of females; incapacity for mental or bodily employments; is melancholjc, irritable without cause; always com- plaining of ill-health and dreading the worst diseases; ready to fancy insults, suspicious, inordinately exalted or depressed by slight causes. Nocturnal seminal emissions take place unconsciously; the external or- gans are relaxed, and there is great emaciation and debility. In some cases the hair thins, and if the vice was begun before puberty the beard is checked or hardly appears; seminal gleet, in one form or other, sets in, impotence, imbecility, marasmus, lingering death. Of course, as in all diseases, every symptom is not found in each case, but some always are and any may be. The above is a superficial view of all the symptoms that masturbation may produce. But it must be remembered that this habit is far from affecting every one alike. Though it is probable, nay, certain, that almost every one, especially of the male 19 sex, has practiced it more or less at some period of their youth, yet in a great proportion it has happily been early abandoned under some influence or other; in a smaller, but still large number, it has been longer continued, but, under a sense of its unmanliness or dan- gers, has been struggled against more or less success- fully; whilst in the smaller number it has gained ascendency over and more or less injured or destroyed its victim. Now, in the first group no. positive injury has been done to the constitution, or, nature in the exuberant vitality of youth, has overcome and outgrown it, and the individual forgetting or thinking lightly of the matter supposes all he afterwards hears to be exag- geration—so many a one has expressed himself to me. In the second group, the person has grown up to a puny or delicate manhood ; or, though seemingly ro- bust, yields unaccountably to sickness or is unexpect- edly carried off by consumption or some other com- plaint; or his mind gives way under troubles; or if he marries he either has no offspring, or it dies young or is punv,; and such persons never confess to their attending physician, who generally—and -partly for this very reason, knows little or nothing about it if he did. A professional friend lately told me that not one of 20 those schoolfellows that he knows to have practiced masturbation, though some have grown up strong and hearty, have attained more than a bare mediocrity. The practical writer in the ' Boston Journal' before quot- ed, remarks that ' even those who have indulged so cau- tiously as not to break down the health or the mind, cannot know how much their physical energy, mental vigor, or moral purity, have been affected by the indul- gence.' The condition of those composing the third group will be found in a perusal of the later conse- quences of this vice. I will now proceed to the description and explana- tion of some of these symptoms in their natural groups. The increased appetite is perhaps the very first effect produced; it is probably an instinctive effort of nature to meet the premature or unaccustomed drain, and may, for a while, be actually mistaken for a healthy and gratifying indication. Yet, upon closer observation it will be found that, contrary to all expectation, the child or youth grows thinner instead of stouter, and paler, especially in the face, that his flesh is softer and he shows signs of lassitude not usual at his age. All this is sometimes ascribed to growing too fast; but the sooner such delusion is dissipated the better, for that is not a cause of disease except in a limited and recog- nizable way. And he does not arise in the morning 21 with the freshness and vivacity that sleep ought to have given him. A fondness for being alone is never a right or natural feeling in young people, and it can have almost no other cause than this ; and if to this are added a list- lessness or inattention that used not to be, and less of the gay, thoughtless or buoyant state of mind and desire for amusement, that belong to the young, the case should be closely watched. Heat of the hands may be merely dependant on a cold, or indigestion, want of rest or over-excitement ; but if noticed frequently and without any such causes, and especially if the skin of the body flushes over and the pulse is quicker than natural, it is a suspicious symptom. Biting the nails has been noticed as a frequent habit in young masturbators. Nocturnal Seminal Emissions. Irritation of the seminal organs generally early induces these. They generally continue for some time to awaken the sub- ject, and if he has attempted sexual connection are likely to be accompanied by lascivious dreams. These involuntary discharges are now maintained by local morbid action ; the vice is no longer only a habit the mere abandonment of which is called for, as was the case in the earliest period ; the morbid 22 action now persists and develops its effects. Sleep becomes unrefreshing, and, after an emission the person wakes up with difficulty, feels heavy or stupid, and the effect lasts partly or through the day; fondness for bed, or rather aversion to getting up, increases. Indigestion is the first sign that the stomach is im- plicated. It will be remembered that at first the appe- tite was increased ; still in the middle stage the de- rangement is rather functional, but it already begins to bring its own train of symptoms, though real dis- ease, dyspepsia, has not yet set in. The appetite is uncertain, in some fastidious, in others rather vora- cious ; but it generally gradually diminishes ; appetite for breakfast is poor, nothing is relished, or it sud- denly ceases in a feeling of faintness or nausea ; the bowels grow costive and the breath bad. It is derangement of this most vital process of healthy nutrition that, as much or perhaps more than any- thing else, exaggerates any latent debility or morbid predisposition, or lays the system open to attacks of disease from external causes ; and, in connexion with the nervous exhaustion hinders the full develop- ment of the body both as to size and perfection. It also becomes the principal cause of headaches and other pains; and as the digestive derange- 23 ment increases the innate sense of shame, and self-accusation, more and more assume the character of dejection and melancholy. Palpitations are also frequent, often accompanied with trembling or faint- ness, or a stuffed feeling in the chest, or short breath. The voice is injured in its quality. The peculiar bluish or dark color about the eyes and fulness of the lower lid increase and the lids grow irritable ; pimples come on the face, and such persons pick them more than others would. The urine is pale and passed often, and begins to be followed by the lingering of a few drops afterward, characteristic of threatening stricture. Emaciation, to some degree, is general; and in those who are constitutionally weak, is an early and marked symptom. Connected with it are sallowuess of com- i plexion or unnatural paleness and want of color in I the lips ; there is evident want of exercise, fresh air | and sunshine, plenty of which go far to prevent this ' unfortunate habit from being contracted at all. The flesh loses its firmness, the muscles become soft or flabby, the bag of the testicles too loose, the per- sonal habits lazy or indolent. There is a want of firm- ness in the step and a growing distaste for sport, exercise or continued ©ccupation ; stooping and round- shouldered. In some exceptional instances, however, 24 there is no emaciation, but, with the other signs of debility a plump, apparently muscular and healthy appearance continues. Nervousness. With this relaxation of the muscular the nervous system necessarily sympathizes ; the per- son is easily agitated or startled, or sighs, and is annoyed by blushing when unexpectedly addressed, especially by females, or on slight occasions ; is wanting in self-confidence, timid, bashful or nervous to an unnatural degree, irritable and bad-tempered ; or it sometimes takes the form of positive dejection and craves solitude. This-depressed condition of the nervous system involves the intellect, the powers of which are relaxed ; the person grows inattentive, slow or apparently careless to perceive or answer ; memory is impaired, and study becomes difficult or irksome. Erections. The special disease established in the parts soon begins to cause a morbid excitability on which another set of symptoms both local and general depends. Thus erections are too easily excited; by mere pressure of the clothes, an accidental touch, or any trifling thing; or, by means of reflected sympathy a mere thought, a picture, a loose joke or allusion, a woman's ankle, will excite erections quite contrary to the will, and happening in the streets or anywhere, 25 become a source of so much annoyance that the individual is afraid to be about without such a coat as will conceal its occurrence. If sexual connection is attempted, or marriage, as is so often ignorantly recommended as a cure-all for these troubles, is tried, the sexual act cannot be half performed, the seminal ejaculation either taking place before or at the moment of entrance, or very quickly after, without satisfaction or pleasure, and to the mortification or disgust of both parties. Dyspepsia. The derangement of the stomach which had existed as indigestion more or less severe, at length becomes confirmed sympathetic dyspepsia ; generally with obstinate costiveness, sometimes with diarrhsea, or changing from one to the other -, and con- stipation with hardened stool remaining in the lower gut increases the local irritation and emissions. When there is inherent organic weakness of any kind and it has remained inactive so long it is now likely to break forth, sometimes violently and uncontrollably- first in the popular mind is consumption, but it may be other as serious disorder. _ All the symptoms grow- ing out of indigestion increase ; the eyes become sunken, the face pinched, the urine worse, the breath offensive, the skin dry, harsh or unhealthy, the per- spiration disagreeable ; languor ; vacancy or unmean- 3 26 ing expression in the face ; the voice loses its rich- ness and becomes thin and unmanly. Depression of Spirits. Intimately connected as the brain is with the stomach and the sexual organs, it must necessarily sympathise with their derangements ; and when to this is added the uncompensated loss of ' that precious liquid which is the cause of beauty, youth and love/ the train of nervous symptoms is by no means astonishing, and cannot but become grad- ually impressed on the countenance. And the further depressing influence of shame and self-condemnation also profoundly depresses the nervous centre, even to weakening the love of life itself—as has been said, ' The wasting of that which gives life excites disgust of life in the highest degree.' Still it depends somewhat upon the nature of the individual, for, just as in stricture of the urinary canal from other causes, while one who is of a lively turn of mind, full of gaiety, is but little affected in his spirits, one of a contrary turn of mind, naturally retiring or thoughtful, will be sadly affected. The mind becomes weak, filled with vague apprehensions ; the person grows suspicious, fancies he is watched, or that, through all his art and dissimulation people suspect his case ; every thing seems to urge him to moroseness and solitude. Memory grows weak*—very much as in stricture 27 especially numbers, dates and names are forgotten ; the train of thought is easily broken so that he forgets the-rest of what he was saying, or stops for want of some word or expression he was about to use. He grows peevish, irritable, easily taking offence yet failing to resent it; unable to look another in the eye, or to bear his gaze, or threat ; and this loss of con- fidence in self gradually becomes actual cowardice; and it is a curious fact that just in proportion as a man is conscious of inability with women his courage in the face of men vanishes. Often, whilst haunted by a continual fear of death there is a strong pro- pensity to commit suicide. Seminal Emissions, happening involuntarily, or as the result of disease, are of several kinds. The simplest, or those occurring at night, generally with a dream and awakening the subject, have been already men- tioned. There are still remaining to be considered, Nocturnal emissions without any dream or conscious- ness— Internal emissions — Diurnal emissions ; the gravity of the case increasing with each. Nocturnal Emissions occurring unconsciously never commence till actual local disease has been for some time established, and has extended to the orifices of the seminal tubes; and whether it is attended with any of the other symptoms in severe form or not the 28 case ought to be looked upon very seriously, for if allowed to proceed it will terminate in the worst way in one direction or other. As the more serious char- acter of emissions becomes established or continues in force all the other symptoms increase in severity; emaciation in some cases becomes extreme, the legs and knees weak and the gait unsteady; soreness of the lower part of the back-bone, not only shown by weakness or pain in the back, as formerly, but by tenderness or soreness on external pressure; the back is bent or stooping, the shoulders round and drawn together, and the chest contracted. Internal Emissions exist when instead of being thrown forward and out in the natural manner the semen makes- its way backward into the bladder. Now, this constitutes a subject of the greatest import- ance, for several reasons; for instance, if a patient has had nocturnal seminal emissions and been cured of them, or nearly so, and yet he makes little or no further progress toward recovery, but, on the contrary, the case either stands still or the symptoms of general depression increase, internal emissions may be the cause; generally brought on by some empirical treatment, especially by the use of one of the several mechanical contrivances advertised to cure 'seminal losses,' or whatever it may happen to be termed, 29 'without medicine or operations.' Or, masturbation may have brought about internal emissions—they may have soon spontaneously superseded the noctiiral discharges. This always puts even the sufferer him- self off his guard, and he lingers, and dies of con- sumption, marasmus, or other disease, without a single effort being directed to the true source of all the trouble. Or, lastly, it may set in after long-con- tinued regular sexual excesses have been given up either from sickness or reformation, and then they may never once be suspected. How many persons have perished in this way who might have been saved can never be computed, but the number must be consider- able. The subject of emissions will be more partic- ularly explained in chapter VI. Diurnal Emissions, or Seminal Gleet, is of several kinds. It may be observed in the form of discharge of a slimy substance coming from the penis when costive, the semen being forced out of its receptacles into the urinary canal by the stool pressing against them in its passage, or by the straining effort connected with it. Another occurs when the local irritability and relax- ation has reached such a degree that a kind of half- erection is produced by slight exciting causes, with feeble ejaculation and but little sensation, and the semen is not thrown out but dribbles away. Or, it 30 may be found in the form of a slimy substance mixed with or following the last drops of the urine. It is a symptom of serious import, and, with stricture, forms the subject of chapter VI. With seminal gleet aversion to females is confirmed; life itself becomes irksome and distasteful; the organs are flaccid, the testicles soft or wasted, or become a mass of varicocele, and the bag in some instances is greatly attenuated and pendulous. Impotence has of course long been established; and dorsal consumption gradually terminates the poor victim's sufferings if some other disease has not already shortened his existence. It would seem impossible that such a practice should be carried so far, and in the very face of such fearful effects; but Dr. Copland observes, ' There can be no doubt that the individual who has once devoted himself to this Moloch of the species becomes but too frequently its slave to an almost incredible degree. A patient who was sent to London for* my advice confessed that he had practiced this vice seven or eight times daily from the age of thirteen until twenty-four; and he was then reduced to the lowest state of mental weakness, associated with various bodily infirmities; indeed, both mental power and physical existence were nearly extinguished.' 31 THE SYMPTOMS OF THE FEMALE. Most of the symptoms are of course the same, and all have the same general character, in either sex; still there are peculiarities growing partly out of different habits and education, and partly out of difference of structure and nervous organization. The vice is cer- tainly not as universally prevalent among girls as among boys and young men; but one peculiarity in the former is that it is apt to be begun earlier, which may go far to account for the greater frequency of serious results in proportion to the number of cases; and, to a great extent, for the ill-developed and unin- viting female forms often met with. The earlier symptoms or effects are much the same in either sex; the paleness of the face however is more remarkable, is of a more pallid, sickly hue—she looks worse than the boy generally does; the lips lose their bright, attractive redness, and the tongue and gums are pale; the dark tint about the eyes is more marked; there is the same inclination to be alone, somewhat dejected manner, listlessness, disrelish of fun and withdrawing from company, and especially from that of her own sex—not that natural timidity which is an ornament to a girl, but rather a confused or embarrassed timidity, or wish to avoid attention, and which is not overcome by games, dancing or any 32 of the amusements of her companions; slight emacia- tion with good or ravenous appetite; cramps in the stomach; weak sight and irritable eyelids; inclination to go to bed early and lie long after awaking; pimples; lassitude, weariness, and dislike of any occupation or study. With the continuance of the habit the symptoms assume a more definite character, and are more dis- tinctly influenced by the sex ; thus, corresponding with the appearance of seminal emissions or spermatorrhoea in the male, chronic disease of the internal sexual organs is established, and may be considered as mark- ing a second stage, with new symptoms and aggrava- tion of those already existing. Leucorrhcea begins to show itself, though in but a slight and premonitory way—but it is to be found, more or less, in every case of masturbation; pains are felt in the loins and back; sleep is unrefreshing and fitful, and may be attended by profuse perspiration ; she awakes wearier than when she retired. Indigestion gives rise to more distress; heart-burn, pains in the pit of the stomach and between the shoul- ders, nausea and faintness ; the bowels are constipated, the breath faint; the voice loses its sweetness, the eyes their winning expression, and the skin its charm- ing softness ; it grows dry and harsh, the perspiration 33 becomes unhealthy and the odoriferous secretions are altered—the indescribable but ever-grateful exhalation from the body is destroyed; the hands are cold and clammy, or burning, or look clear and the veins are imperceptible. Nervousness is more apparent; there is a tendency * to swimming of the head, ringing in the ears, involun- tary and deep-drawn sighing; frequent headaches, especially from reading or giving attention to any- thing ; strange feelings and apprehensions ; irregular and unaccountable pains ; she is dejected and sad—old pleasures loose their attraction and new ones are not sought or equally fail; she is fond of solitude, but the aversion to society refers only to female company, for this vice in the girl necessarily, excites a longing after the other sex in which company she generally delights; all employment or exercise is distasteful, except novel- reading, for which the appetite is insatiable. After each act of self-abuse the nervous feelings are espe- cially aggravated, and there is great lassitude and aching weariness. Emaciation is more relentless in the female ; the face soon becomes sharp and pinched, gets an old, care-worn look, or is frightfully pale and expressive of languor and indifference; the swelling lines of the bust and hips shrink away ; the arms and legs lose their soft, elastic roundness and become wasted, flabby, angular 4 34 and ugly; the chest grows flat and contracted and the strength of the back is lost; she is troubled with pal- pitations ; the breath is short, a little walk is exhaust- ing instead of refreshing, and she is obliged to stop and rest; the feet and ankles swell; the character be- comes apathetic, there seems to be a languishing of the powers of life; she is always looking ill—feels that she is not what she was, and ages prematurely. Menstruation is deranged, growing painful and scanty, and as this continues or increases the dyspeptic symp- toms increase, and the nervousness also—she is terri- fied by everything; a hysterical tendency becomes apparent, and which may lead to actual hysterics ; pain is sometimes complained of in the nose ; the breath grows offensive ; the urine cannot, be held easily, and is passed too often or with slight pain. And now, as in the male, any natural weakness or hereditary ten- dency to disease and especially pulmonary consump- tion, becomes developed and active. But, if no such thing occur and the practice is per- severed in, or if the injury already done progresses, serious disorder of the internal sexual organs is estab- lished, with still more alarming manifestations. Leu- corrhoea is confirmed and bad ; the neck of the womb becomes permanently engorged, excoriated or ulcer- ated ; the urine is muddy ; the voice is altered or harsh, the breath offensive, the enamel of the teeth cracks or 35 breaks. The temper and disposition is changed; the dejection of spirits grows into confirmed melancholy, or religious monomania ; strange delusions, unfounded fears—mental misery in some form or other; or fits. She is sterile ; emaciation is extreme ; and the victim, her life having long been a burden, gradually sinks ; and often, it can not be said that she died of any defi- nite disease. Now, all this is but a very moderate picture of what may, and does, result from the miserable infatuation of self-abuse, in either sex. I have seen such cases—and deaths that I am convinced had no other cause ; though many are recorded in medical writings, but a mere frac- tion ever come to light; and the numbers that die of consumption and other diseases the direct consequence of masturbation—the true cause being neither con- fessed nor suspected, cannot be known. It may be objected that, in the female, many of these symptoms, at any rate those of the earliest stage, merely indicate chlorosis or the green-sickness, com- mon in girls just reaching the age of puberty; and many of them are the same; but this always occurs be- tween different disorders that implicate or are situated in the same parts, and generally constitutes the great difficulty in arriving at correct opinions. I will add, simplified and shortened, Dr. R. Dunglison's description of the green-sickness. ' At the beginning of an attack 36 of chlorosis the patient feels unusual languor and de- pression of spirits, frequently crying without obvious motive ; constriction of the chest, yawning, palpita- tions; the countenance becomes pale; the eyelids puffy, and, especially in the morning, surrounded by a black- ish circle ; the white of the eyes extremely white. The skin is usually dry and lurid ; the pulse very rapid, but weak. Nutrition falls off, the flesh is soft and flabby, and dropsical collections form under the skin. The appetite becomes greatly diminished or annihilated, or undergoes wonderful mutations, such substances as chalk, earth or ashes being greedily desired; at other times a marked desire for acids. The author had a pa- tient who preferred eating slate pencils to any other article. Digestion is generally impaired; often with ^ome fever and alternations of constipation and diarr- hoea; the urine is watery. Occasionally hemorrhages take place. There is almost always leucorrhoea, with suppression of, or very light colored menses; hysterical or nervous symptoms, headache, ringing in the ears. In unfavorable cases the patient becomes gradually emaciated and dies of dropsy, or worn down by a hectic' Unless the chlorosis be a consequence of self-abuse, which indeed it may be, attention to the case will soon detect the difference between the two affections. CHAPTER II. THE CONSEQUENCES. The Consequences of Abuse and Excess.—Its powerful influence in causing disease explained—Why Masturbation is more hurtful than the natural act—Why more hurtful the younger it is commenced— Why more injurious to one than to another—The derangements and diseases it induces described and explained, with cases—The conse- quences in the female peculiar to her sex—Why more easily cured in her. Growing out of the intimate and universal nature of the sympathies that exist, in a state of health, between the generative organs and the rest of the body ; and owing also to the wonderful influence they exert over the mature development and subsequent condition of the whole organization ; the morbid influence emanat- ing from these organs when abused not only imparts activity to any tendency to disease from whatever cause arising, but is capable of originating diseased action ; and it also superadds to other diseases its own characteristics, thereby adding both to their complica- tion and to their danger. 38 Hence masturbation is with justice accused of be- ing, directly or indirectly, the cause of almost every other disease by those who have made this subject their study. Dr. L. Deslandes observes, ' This vice then compromises both the present and future health of the body ; the present by the diseases with which it is accompanied, and the future by those for which it prepares. Hence if the young man escapes with life, he is as it were loaded with a tribute of ills which he must pay before long and perhaps always. Thus the indirect influence of onanism in producing human suffering is enormous. I consider it even as greater in proportion than that of the most immediate conse- quences of this fatal habit.' In view of the serious importance of this subject, therefore, and to give the reader every possible ground for full and perfect confidence in the simple and un- colored truth of the statements here made, I shall quote from writers of great special experience, and also il- lustrate the principal consequences with cases taken partly from their writings and partly from my own practice. Some of the disorders already placed among the symptoms will be found again among the consequences, because, what was at first merely afunctional derange- ment or disorder, or symptom, by frequent repetition 39 and increasing duration at last becomes an established or actual disease. Dr. Copland says ' Although this vice is most pre- valent among young persons, its ill effects generally becoming apparent to them with riper years, yet it is not infrequently indulged in, by persons of both sexes, during advancing years ; and is generally the cause of most of the complaints observed in unmarried persons after the age of twenty-five years, as well as sometimes before that period. It i^ certainly the chief cause of the lives of this class of persons being of much less mean duration than those of the married.' Hufeland, in his ' Art of Prolonging Life,' observes of this vice, ' Of all the means of hastening death, with which I am acquainted, there are none so highly destructive, and in which every baneful property is so much united, as in these. None comprehend so per- fectly all the four requisites for that purpose, which I have already laid down ; and indeed these melan- choly excesses may be considered as the most highly concentrated process for shortening vital duration.' ' The first means of shortening life was, lessening the vital power itself. But what can more lessen the sum of the vital power within us than wasting those juices which contain it in the most concentrated form, 40 as well as the first vital spark for a new being, and the most powerful balsam for our own blood ?' ' The second manner of shortening life consists in lessening the necessary solidity and elasticity of the vessels and organs. But it is well known that nothing tends so much to relax, to soften, and to corrupt, as this dissipation.' ' The third manner, or more rapid consumption, can be promoted by nothing so much as by a circumstance, which, as appears from the example of all nature, is the highest degree of vital activity ; and which, as be- fore shown, is in many beings the conclusion of their whole life.' ' Lastly, proper restoration is thereby prevented in an uncommon degree, because that rest and that equi- librium necessary for repairing what has been lost are impeded, and the organs deprived of the power requi- site for the same purpose ; but, in particular, because these debaucheries have a peculiar weakening effect on the stomach and the lungs, and thereby specifically desiccate the grand source of our restoration.' And, in reference to the mind, he says ' It appears that between both these organs, that of the soul (the brain), and those of generation, as well as between 41 the two functions, that of thinking and that of gener- ating, the one spiritual, and the other physical crea- tion, there is a very intimate connection ; and that they both require the noblest and most refined part of the vital power. We find, therefore, that they both act alternately on each other, and have a mutual and contrary effect. The more we strain the mental facul- ties, the less vigorous will be our power of generation ; the more we stimulate the generative power and waste its juices, the more does the soul lose its faculty of thought, its energy, its acuteness, and its memory. Nothing in the world can so much and so irretrievably ruin the brightest mental talents as excess of this kind.' The question is sometimes asked, why masturbation is, in itself, more hurtful than the sexual act ; I will answer this and the several following points by quota- tions. Dr. M. Lallemand replies thus : 'Whilst the or- gans are healthy, and intercourse is proportioned to the wants of the system, its effect is simply tonic and stim- ulant. The semen is more abundantly secre'ted and more energetically retained in the seminal vesicles, and so far the influence is useful, being within proper bounds. Coitus therefore is, under favorable circum- stances, the natural excitement of the genital organs. This is not the case with regard to masturbation, and 0 42 the other abuses of which I have spoken, and hence such ha"bits are so pernicious. Disturbance, disorder, and irritation alone result from unnatural abuses ; a tonic effect is never produced.' Dr. Deslandes, on this point, says, ' One reason why masturbation is more pernicious than coition arises from the state of mind during the two acts. The onanist, and here we allude only to those who have some ideas of sexual intercourse and love, having no material object which is the beginning and the end of its pleasures, the imagination must supply and invent it. This mental labor renders the sensations stronger and the body more disposed to feel them. Added to these, the onanist is desirous of prolonging his feeling, and having under his control certain circumstances which in sexual intercourse hasten the denouement, he retards it. Thus with fatal skill he gives to this destructive vice all the power it can possess, and ex- periences all the evil which this vice can cause.' The younger the habit is commenced the more hurt- ful it is. Dr. Deslandes says, ' Other things being equal, the period of life when the act of venery is at- tended with the least dangers is that which begins when the organization is completed, is perfected ; and as the reverse of this statement we may say, that, ve- nereal enjoyments anterior to this period are more de- 43 trimental the less perfect the system is. The perfect state then is the point at which the system must ar- rive, before the act of venery is permitted, and before marriage is allowable. There is then no longer any fear of disturbing the formative process.' And Dr. Copland's remarks are still plainer ; he says that ' it should be recollected that self-pollution is of- ten commenced at an earlier or more immature age than that at which the intercourse of the sexes can take place in the usual states of civilized society ; and that hence it is the more injurious, because it impairs or interrupts the due development of both mind and body, at a period when such development receives, in the healthy frame, its chief impetus and full consum- mation from the genital organs and secretions.' The very celebrated J. J. Rousseau, whose opinion on this subject is peculiarly valuable, writes, ' until the age of twenty the body grows and has need of all its substance : continence is natural, and if not observed it is at the expense of the constitution.' Masturbation is well known to be more injurious to one person than to another ; or, the active develop- ment of its effects may depend upon some inapprecia- ble condition of the individual. The reason cannot al- ways be given, or the particular condition recognized 44 or foreseen ; Dr. Deslandes thus states the facts ; ' Two individuals indulge in onanism : one becomes ill in a few weeks ; but the other resists the pernicious habit longer. These two individuals were certainly indif- ferent states, as the event proves. This fact however was indicated previously by no circumstance : their age, constitution and manner of living before this were similar ; in fact the reason why they were affected so differently cannot be told. The difference here pre- sented by two individuals may be observed in the same person, when considered at different epochs and periods of life. He will resist the excess of masturba- tion and coition to a greater degree at some times than at others, although the circumstances on which these differences depend are not known. There are then unknown circumstances which have an effect on the consequences arising from onanism. These re- marks are highly important and ought to be well under- stood ; and it is clear that there is no possible secu- rity for the onanist : in vain does he look for encour- agement by comparing himself to others, or by re- marking of a comrade " if he had been as healthy as I am, his health would still be good, he would not have died :" or by saying " why should I fear what I have indulged in so long with impunity." This mode of rea- soning is out of the question when the truth of the pre- ceding remark is admitted, and it is then impossible for' 45 a person to deceive himself ; and the reason that so many abuse themselves is because they think them- selves stronger than others.' With these introductory remarks and quotations I will now proceed to a brief view of the actual conse- quences ; not, of course, mentioning all, for that would be tedious and unnecessary, but the most constant and important of the diseases induced by masturbation. Irritation of the Bladder. Perhaps the very first lo- cal announcement of disease is an unnaturally frequent desire to make water, and more or less inability to hold it back ; it is unattended with pain, and may even not be noticed ; but it is really a premonitory symptom of further mischief, and is present in almost every case. I will transcribe an instance or two from my Case-book. Mr.----(5989). Never contracted any disease, but practiced masturbation ; find he has slight incipient stricture ; his most prominent complaint is frequent urinating, which began eighteen months ago ; it calls him suddenly in the day time, and obliges him to get up two or three times at night; otherwise his health seems to be good. Mr.----of Albany (5991). Has had no disease but practised masturbation somewhat when a boy. His principal trouble now is in having to get up three or four times every night to urinate— 46 the water is rather too light, and clear ; has some weakness and pain in the back. I might add an in- definite number of instances. This slight irritability may suddenly assume the form of actual spasm, then either incontinence or retention of urine ensues : as an instance of the latter—a young man called at my office one morning in great distress, pale and covered with a cold sweat, bent forward and holding the lower part of his belly, and said he had not passed a drop of water' for nearly thirty hours ; he had gone to bed hoping relief would come, but had passed a sleepless night, and by this time was in perfect agony. I found he had never had any venereal disease, nor, indeed, ever run the risk, but had been in the habit of self-abuse. A catheter passed with perfect freedom into the blad- der and his water was drawn off ; he had laid it all to taking cold. Irritation of the Urinary Canal is also an early and constant effect, generally for a long time so slight as not to attract attention, though its ultimate conse- quences are very important—being the first link in the chain of disorders that end in impotence. It re- mains for a long time as it were latent; the urine may not even feel a little warm as it passes through; but the irritation sooner or later passes, either through sympathy or continuity of tissue, or both, to the 41 testicles, exciting increased secretion of semen and often some degree of varicocele; to the prostrate gland, causing irritability and increased secretion there; and to the seminal vesicles behind the bladder, affecting them in the same way. It is also the cause of Stricture when present; of ulceration of the seminal ducts, and of spermatorrhoea—all of them constituting important diseases which have to be described. Also, through the bladder and internal urinary ducts, or by sympathy, affecting the kidneys, even fatally. The proper examination of the urinary canal detects this state of irritation in the form of tenderness in its whole length, or later, concentrated at the inner end in the form of circumscribed engorgement or incipient stricture. This is a most important part of the subject, and will be more fully treated of in chapter V., on the Nature of the Disease, and in chapter VI., on Stricture and Seminal Gleet. Morbid Erections of the penis; an irritable state of the part, through which erections are excited on the slightest occasions and to the great annoyance and mortification of the person, are the result partly of the irritability of the seminal organs before mentioned, and partly of the state of the brain presently to be described. They are soon attended or immediately followed by the discharge in undue quantity, of a 48 transparent mucus which again soon exerts a debilitating effect upon the erection, lessening its duration and diminishing its firmness, and terminat- ing, if it goes on, in true seminal gleet. Mr.----, case 5998. Never had any venereal disease. Has, for the last eight years, been troubled with erections too easily produced, ' all the time while asleep,' too sensitive to the touch; and the erections, even without emission, followed by increased nervousness, etc.; his eyes are affected, pain in back of head, some weakness in the small of the back, occasionally very frequent urinating, . the urine generally light, and having alight-colored sediment; bowels regular. Disease of the Testicle. Those who abuse themselves seldom escape without some injury to the testicles. The first effect is a slight irritation with too rapid secretion of semen and a little increase in size and sensitiveness to the touch. This, as the cause con- tinues, gradually passes on to subacute inflammation, and still later to depraved secretion of semen, and - actual disease of the tissue of the gland. In other in- stances the testicles are attacked by pains of a rheu- matic kind which run along the chord into the groin; or they begin to hang low and grow flabby, and finally waste away, and this is always attended with vari- cocele; or some of the other diseases of the testicle are developed. 49 'A young man entered St. George's Hospital (London) affected with pains in the left testicle; it was soft, flabby, and one third smaller than the other one. The patient had never received a blow on it nor had gonorrhoea; but he admitted that for five years he had been addicted to onanism, and that a day "Seldom passed without his indulgence. Before wasting away, the testicle had been the seat of a swelling, which had been preceded by severe pains. These pains had continued to be felt, and the disease was attended with such a degree of moral depression that the countenance of the patient assumed a sombre and melancholy character.' Mr.----(6285). Practised masturbation at the age of nineteen and continued it three years; is now 21 years of age; never had any venereal disease. For the last five or six years the testicles have hung very low, and felt painful and heavy; urine sometimes comes freely, sometimes with a straining; weakness in his back; considerable low- ness of spirits and loss of memory, especially of names; has a moderate stricture. Dropsy of the testicle, or hydrocele, is sometimes the form assumed. Quite recently I drew off the water in a case of this kind—nearly six ounces; the patient, a young man, had practised masturbation for some years, very badly for a length of time, but had over- 5 50 come it. The disease appeared in the left testicle very suddenly and without any other cause whatever. Spermatorrhea or Seminal Emissions have already been mentioned among the symptoms, and will be further explained in chapters V. and VI. It should be understood that they do not, under all circum- stances, necessarily imply disease—the means of de- termining this important point will be found in the chapter on the ' Treatment.' And when morbid their effect is not altogether dependant upon the frequency of the emissions, as the following abstract of cases shows. Mr.----(6165). Never had any venereal disease ; practised masturbation from the age of twelve to sixteen, then abandoned it; has a nocturnal seminal emission about once a month; complains of weakness in the loins; is nervous, very excitable and irritable, so much troubled with depression of spirits as fre- quently to long for death; urine pale and throws down a white sediment; has slight dyspepsia but good ap- petite. Mr. ---- (6052). Never cohabited; has abandoned the habit of masturbation; has nocturnal emissions two or three times a week, but sometimes two weeks apart; urinates too often, and it dribbles away at the last; penis shrunk; is troubled with nervousness; memory constantly fails him; has a sore- 51 ness in the throat; bowels regular, appetite good, and sleeps well. c. Mr.----(5841). Practised self-abuse while young, but has never committed sexual excess since, nor con- tracted any disease. Married 12 years ago and has a healthy family. Still, seminal emissions occur quite frequently, very irregularly as to times, and always accompanied by dreams; sometimes even in the day. Complains of weakness in the back; considerable effect on his mind and memory; weakness of the eyes; dribbling after passing water, with occasional pain and smarting; dwindling of penis; hanging of the testicles; some dyspeptic complaints and costiveness. Light complexion, full habit, general health pretty good. The special symptoms and manner of detecting the more obscure and dangerous forms of emission, viz., Seminal Gleet or Diurnal emissions, will be found in chapter VI. Diminution of pleasure in the sexual act. This is a point of more importance than would at first appear. I speak of it here in relation to abuse; in chapter VIII. it is further mentioned in relation to excess. It comes on insidiously and for a long time is not noticed, or is accounted for in various ways, its significance of 52 actual disease not being suspected. It, however, in- dicates the commencement of two serious condition's— deterioration of the semen, and relaxation of the seminal ducts, and marks the advance toward another stage. Many patients have complained to me of this symptom, as also married women. Capt. ---- (6264). Has practised masturbation, never contracted any gonorrhoea. Is dyspeptic, but bowels are regular; there is some dribbling after micturition ; erections and sexual desires are unaf- fected ; has a seminal nocturnal emission about every two weeks. But the greatest complaint is a too pre- cipitate discharge in the sexual act and absence, more or less, of the natural enjoyment. Transitory or incomplete erections. In the early period the erection is perfect, but if connection with a female is essayed an emission takes place before the act ought to be half completed, or at the very commencement ; or, as the disease continues, the erection is firm but soon subsides again before the act, probably with a copious discharge of the pecu- liar mucus before mentioned ; or, finally, mere in- crease in size without firmness, is all that it reaches. This depends upon the same condition as the fore- going, and in one degree or other I find it complained of by a great many patients. 53 Stricture, first in the preliminary state of simple engorgement, then of distinct incipient stricture, is found to exist in almost every case. It sometimes, however, becomes permanent or organic stricture, and some of the worst and most obstinate cases of this disease I have ever met with have had this origin, the patients never having contracted any venereal disease nor had sexual intercourse at all. Mr ----(5814). Contracted the habit of masturba- tion at 13 years old and continued it till lately; has never had any'involuntary seminal emission ; his nerves, as he expresses it, are gone, there is no energy about him ; his mind is depressed and memory much weakened ; has a gleety discharge ; the lips of the urinary passage are glued together in the morning ; has been very constipated for the last several years. I find he has a stricture at b\ inches which has reduced the canal to about half its original capacity at that point, with much tenderness between it and the neck of the bladder. Mr.---- (6001). Practised masturbation a good deal from the age of 16 till a year ago.; nocturnal emissions are rare, but since the last eight months he has suffered from general debility, is costive and has the piles. I find a moderate dilatable stricture- at 5 and another at 6 inches. I have had very many such 54 cases having different degrees of stricture. This subject is of the greatest importance from the fact that it may become the prominent, and, in some instances, actually the only remaining symptom or consequence—all the other effects of the vice having passed away ; and in either case the cure of the patient will hinge upon this knowledge. Stricture therefore, with seminal gleet, being of such paramount importance, are made the subjects of a separate chapter. Impotence is the natural, and, ultimately more or less constant and necessary result of any one, or varying combinations, of the disorders hitherto de- scribed. I have met with many cases of partial, and some of absolute impotence, in the course of #my practice ; the following is a curious one. Mr.----, had been- for several years in a regiment stationed at an extreme frontier fort, and had never touched a woman, but had practised masturbation during the whole time. He afterwards came to this city and married, when he found himself to be impotent, and a few weeks afterward consulted me. I found he had a very bad stricture, in which the whole disease seemed to concentrate itself, for he had otherwise but slight symptoms ; the absence of erections he had attributed solely to his reformation and good 55 resolutions. The cure of the stricture was tedious, and not, as was to be expected, followed by the return of virility—perfectly well in every other respect he still remained absolutely without erections. The only thing I could discover was that, contrary to my directions, he had not even moderated his tobacco- chewing, which I now insisted upon being given up altogether ; in a few days afterward he enjoyed the full return of his powers. Disordered Mind. As the relation of instances oc- curring in my own practice—and I have met with some of a most distressing kind, but which have perfectly recovered—might give pain, I will illustrate this with a case or two from others. The temper, inclinations and whole character is sometimes much changed. 1----, aged 21, called for advice in the summer of 1834, having had ill health for some eighteen months or two years. He complained of confusion of the head and pain in the eyes, indigestion, pal- pitation of the heart, and difficulty of respiration. His sleep was 'disturbed, his temper irritable, and he felt dissatisfied with himself, and greatly inclined to gloom and melancholy. He complained of listlessness and indisposition to any bodily efforts, and of inability to fix his mind upon any subject, or give his attention 56 to any business. His hands were cold, countenance pale and dejected, pulse frequent, and his whole system in a state of great irritation. It was ascer- tained that for two or three years he had been in the daily habit of masturbation.' ' Mr.----of high intellectual powers and general talents, and of a lively disposition, studying medicine, became suddenly changed ; he shunned society, espe- cially that of females, was morose, taciturn, and frequently shed tears ; he often sat for hours in a kind of abstraction, and on being aroused could give no explanation of his thoughts or feelings ; he constantly expressed a conviction that he should never succeed in his profession—that he was ruined here and here- after. A year before he had contracted a gonorrhoea which left his bladder irritable ; digestion was much disordered ; the best medical advice proved unavail- ing. After six months he spent some time by the sea-side with a friend who discovering the true cause of his troubles kept with and otherwise closely watched him. By his return home he had almost recovered his health and spirits ; but, by a twelve- month, he had relapsed and was worse than before'; he would often remain in bed nearly all day, no threats nor entreaties could induce him to get up ; his intellectual faculties were prostrated, and a vacant 51 stare took the place of his naturally lively expression.' Dr. Ray, an eminent authority, says, ' It is a fact well established in this country at least, that masturbation or self-pollution is a prolific cause of mental derange- ment in young subjects. It deserves our special atten- tion for the reason, that although the intellect finally suffers deeply and rapidly, yet, in its initiating stage, the moral and affective powers may be seriously per- verted, while the conduct and conversation of the indi- vidual may be outwardly marked by his usual pro- priety. Long before any intellectual aberration is observed and while the patient is merely moody and reserved, his mind may be tortured by fears and suspi- cions that mar his peace and sometimes lead him to acts of violence.' And instances of this very kind have come under my own observation, in some of which the acts, had they occurred amongst strangers or persons severely inclined, might have been treated as actual offences or crimes ; and it was for this reason that I declined relating them, as likely, if read and recog- nized by the parties, uselessly to wound their feelings. Different authors record cases in which various crimes, even to homicide, have been committed under the influence of hallucinations growing out of this dis- ordered state of mind. And these cases are not so rare as may be supposed ; but a month since, a gentlemen 6 58 with whom I had been professionally acquainted some years ago, called on me ; he told me he had determined on destroying himself, and felt sure that I would give him some friendly advice in the matter; also that he felt it a duty to kill his two sons, whom he dearly loved, because they wore doomed to grow up like him (really a case of severe hypochondria from unrecog- nised seminal gleet). I succeeded in persuading him, against his firm conviction of its uselessness, to allow me to prescribe for him, he assenting with a mixture of childlike confidence and contemptuous indifference. He is already a different man; and, I believe, has no further thoughts of violence. And, doubtless, children are often chastised—senselessly flogged or otherwise maltreated for acts which, but for ignorance or stupid- ity on the part of their elders and superiors, would rather excite commiseration, and appeals to the phy- sician for a remedy. Under the continued action of the causes that have led to such state of mind, actual Insanity is produced. This, though a sadly frequent and terrible consequence of abuse, is not so much met with in private practice as by those who have charge of public institutions. Many authors might be cited, I will however only quote from the work of Sir W. C. Ellis. He says, ' But there is a vice, the secret and unsuspected indulgence of 59 which seems in addition to its weakening the general powers, to have a specific and direct tendency, in many conditions at least, to operate on the brain and nervous system. Would that I could take its melancholy vic- tims with me in my daily rounds, and could point out to them the awful consequences, which they do but little suspect to be the result of its indulgence. I could show them those, gifted by nature with high talents, and fitted to be an ornament and a benefit to society, sunk into such a state of moral and physical degradation as wrings the heart to witness.' And, in another place, he explains the mental symptoms and ultimate insanity as due to positive debility of the brain,' the direct result of deficient supply of blood; which, as I have before briefly explained, is also pro- foundly deteriorated by masturbation. Disordered Nervous System. The symptoms growing out of this condition are endless ; a case will explain it better than any description. A young man, twenty- two years of age, gives the following account of his own experience. ' At sixteen years of age I learned to masturbate; this habit I continued for several years with a kind of fury. My health soon became affected, my strength failed and also my digestion. I soon perceived a heat and constant pain in my stomach ; my throat was in- 60 flamed and my feelings were extremely bad. The advice which I received and the alteration in my health, caused me to renounce this habit. My situation soon improved and I gained daily, but at the same time my desires returned and I shortly relapsed into my former errors. The same cause produced the same effects and I again abandoned onanism, promising never to indulge again. For two years I kept my word: un- happily this time however my health was not restored as at first, and I continually experienced all the suffer- ings which I have described. Besides, I have become so sensitive that everything incommodes me ; the least change in the weather and particularly a storm causes me a great deal of suffering. Farther I cannot say what temperature is best for me, for I do not experi- ence much difference whether it be cold or warm. I have but little desire for females, and although indulg- ing at times after long intervals, yet I have always suffered for several days afterward, in the same man- ner as after masturbation. I feel constant pains of a lacerating character in the limbs; sometimes also, but more rarely pains in the back ; often also, I have pains in the stomach and colic. My digestion although better than before, is far from being good ; I can take but a few articles of food, and the smallest portion of wine, spirit, or coffee produces great distress.' ' This was the young man's statement: he was deeply affected 61 by the slightest cause ; his appearance was sad, he was tired of himself and was constantly tormented by thoughts of his former excesses.' Dyspepsia is present, more or less, in every case; but for a long time it continues in the form of sympathetic dyspepsia; hence its rapid disappearance under the successful treatment of its cause. Disease of the brain. The very earliest effects of self-abuse are shown here; at first a slight functional disturbance or irritation, but which, through the most intimate of all sympathies, immediately reacts upon the sexual organs. The first sign of this evil effect upon the brain is the frequent recurrence of lascivious thoughts, slight giddiness, tendency to headache, list- lessness ; it is seated in the lower and back part of the head—in that portion of the brain that has direct con- trol over the sexual functions, and indirectly over the rest of the organ. Now here, just as in other organs, slight functional disturbance, if continued, passes by degrees into actual irritation, with such increasing activity that the intellect gradually loses its proper controling power. And this is the reason why it is so exceedingly difficult at first, and sometimes ultimately impossible for the unfortunate victim, by the power of his own volition, to break off the habit. Happily, however, it is now in the power of art so to modify 62 or control these conditions as to render it compara- tively, and often positively, easy. This condition is the starting-point of the more formidable affections of the brain that masturbation is the cause of. A symptom entirely referrible to this morbid state of the brain, is sleeplessness—slight during the.early period of the habit, but eventually becoming complete in some instances. Sound, refreshing sleep results only from perfect health and sufficient exercise; but, if the brain be the seat of irritation, however slight, it is necessarily the opposite of sound and refreshing —it is disturbed by dreams, often of a disagreeable or horrifying kind; is restless, broken or feverish. Such persons therefore awake unrefreshed, unsatisfied with their sleep, disinclined to arise; ready to retire again early both from want of sleep and because it is the more natural and convenient time for yielding to their depraved inclinations. The Eyes always suffer in some degree from self- abuse. During or immediately after the act they are red, swollen or watery; this of course passes off again, but it soon begins to leave a permanent effect; they lose their natural brilliancy; the direct gaze of another becomes disagreeable and is avoided by look- ing away or toward the ground. A slight ophthalmia sets in, which gives rise to redness of the edges of the 63 lids, the collection of matter in the morning, and some bloodshot appearance, or watery look; and the darker ring round them appears, or shows more plainly. They are easily fatigued and grow irritable or sore from reading or other use in the evening, and which is often followed by headache. The sight becomes gradually weaker, and irritable twitching or tremors of the lids is not uncommon, and sometimes confirmed squinting. „ In some cases a bright light of any kind is intolerable. In some a peculiar dizziness with dimness of sight, or even temporary blindness, follows each act of abuse; and such symptoms, or increasing weakness of vision, must, in accordance with the opinion of every autho- rity, be considered as threatening blindness, either sudden or gradual. Even amaurosis, however, gene- rally admits of cure along with the cure of masturba- tion or seminal emissions. As it has been truly observed, ' There exists in all these patients something peculiar in the expression of the eyes, in the,position, in the voice, and in the general appearance; something of timidity and bash- fulness which I am unable to express, but which is in- stantly recognised by the experienced, although per- haps it is incapable of explanation.' 64 Piles is a frequent consequence of this vice, and is produced through the medium of the same morbid influence as causes varicocele of the testicle. Disease of the Heart is directly induced by sexual abuse and excesses; the circulating system is always deeply agitated by these acts, and when palpitations and short breathing are too often repeated, and especially when excited in an unnatural way, per- manent derangement and ultimate disease cannot be wondered at. Though apparently severe it is still often for a long time only functional, and then, if the true cause be concealed by the patient and it be treated as actual disease, its aggravation is the mildest consequence; it however yields rapidly to abandonment of the vice and the cure of the true disease. Mr.----(5984), aged 22; never had any venereal disease but practised masturbation; has nocturnal seminal emissions, sometimes several in a week; suffers from depression of spirits, is melancholy, and cannot attend to his business; has pains* in the chest and between the shoulders; shortness of breath, and is much alarmed about palpitations, which are especially severe in going up stairs; expectorates; is costive; is apprehensive of consumption. 65 Mr.----(6180). Began masturbation at the age of thirteen, nine years ago; • has never had any venereal disease. The principal symptom he com- plains of is palpitation of the heart, from which he has suffered for the last four years without relief; has also pain in his back, considerable depression of spirits and forbodings of death; is very nervous; has seminal nocturnal emissions, formerly twice a week but latterly only every two or three weeks; bowels costive, appetite good. ' Mr.----Contracted the practice of masturbation at school, but shortly afterward took a fever and was removed ; this was followed by pain in the chest, sense of suffocation and palpitations. At the age of 19 he broke himself of his habits and involuntary seminal emissions set in. The following winter the palpitations and difficulty of breathing increased and he was treated for heart-disease, and by the summer was a little better. The following winter they grew worse again and he was treated in the same way with aggravation of the breathing, palpitations and pollu- tions, and additional .emaciation and dropsy in his legs. At the age of 23 he came to Montpellier (France). A minute examination assured me there was no organic disease, and treatment was directed to the effects of masturbation with the most satisfactory results.' 66 Rheumatism and Neuralgia are sometimes most evidently caused by abuse and excesses. Quite lately a patient told me that his rheumatism set in soon after he had contracted the habit of self-abuse, and when relieved returned again and again, and he was ' quite sure that caused it.' ' Individuals who have braved the usual causes of rheumatism with impunity,' says Deslandes, ' not unfrequently become vulnerable to these causes after venereal excesses. M. Villeneuve relates the case of a stone-cutter, who had long been exposed to changes of weather without inconvenience, and who was violently attacked with rheumatism after unusual venereal excesses. He also mentions the case of a groom, who had long slept in a damp and narrow stable without suffering, but who was attacked with rheumatism the winter after his marriage. Sancerotte has seen a similar case ; it was that of a man who had constantly braved the changes of weather, and who was affected with rheumatism after indulging in women and wine. The same author has estab- lished, in the memoir where this fact was reported, that muscular rheumatism is only a variety of neuralgia. Among the proofs that he gives of it, he states that many authors have placed venereal excesses among the causes of neuralgias and those of rheumatism. Consumption. This is perhaps the most frequent 61 of all the diseases developed under the depressing influence of sexual abuse, and it is the oftenest fatal. When family or other predisposition exists this vice rarely fails to bring it into activity. The number of persons who thus fall a prey to consumption cannot be told ; their friends, their physician, and often even themselves .not suspecting its true cause ; and who might or would have outgrown the tendency to this disease but for the blight of masturbation at the very period in which the constitution was in need of all its vigor and resources. Disease in the lungs, just as others that have been described, begins in mere functional disturbance ;\ shortness of breath, or panting and flushing in the face only, at first attends each act of abuse ; after a while the same symptoms are noticed in going up stairs or up hill ; very slight exercise is enough to put the person out of breath ; or the chest feels oppressed, and which he relieves by a sigh. Dr. Lallemand describes the cause of this so well that I cannot do better than give his words. ' The muscles which perform the function of respiration, participating in the general debility of the system, contract less energetically and less frequently than natural ; the respirations, therefore, become shorter and less frequent: hence the necessary changes in 68 the blood are not properly performed, and there is defective equilibrium between the respiration and circulation, with habitual sense of uneasiness and oppression in the chest. Hence arises the necessity for deep voluntary inspirations or sighs, to re-estab- lish this equilibrium occasionally, and to fill the extreme pulmonary vesicles with air. The patients are apt to call these sighs involuntary, because they are forced to make them without knowing why. On the other hand, again, being deeply afflicted at their condition, and incessantly occupied in seeking its cause, the patients sometimes suspend the motions of the thorax, and this habit increases their habitual oppression. Lastly, it is necessary to take into ac- count the influence of the pulmonic nervous system. It is not probable that the pulmonary nerves should escape the generally debilitating influence of invol- untary discharges. Dr. Deslandes indeed thinks that the nervous asthma may be produced by masturbation and venereal excesses, inasmuch as these attacks only seem to him to be aggravations of their ordinary symp- toms. This opinion is strongly supported by what I have seen in many patients.' Wichman, in his" dissertation on pollutions, says, ' Experience has taught me that in many patients who have been considered as affected with true 69 phthisis the disease must be referred to this cause alone. The symptoms of diurnal pollution are not very dissimilar to those of the first period of pulmo- nary consumption, at this purely spasmodic period, which I should be tempted to term insidious, if I considered merely the difficulty and uncertainty of the diagnosis at this period. The cough which then at- tends some patients, also, leads physicians to dread phthisis ; or, rather, consumption, arising from diurnal pollution, assumes so much the characters and form of this disease, that one is disposed to treat it by the ordinary method, to the great disparagement of the patient, whose state requires opposite remedies. Farther ; it is clear, that the disease of which we speak must infallibly terminate in phthisis, if it be not soon arrested.' And in my own practice I have seen the same re- marks also applicable to cases closely simulating con- sumption, but which depended on Stricture of the urin- ary canal, and to such a degree that the patients have been given up; yet have perfectly recovered with the cure of the stricture. Epilepsy is a form of disease often assumed when the irritation of the brain passes into actual or con- firmed disease; it is difficult or impossible to arrive at the exact truth, but the probability is that the great 10 majority of cases have masturbation for the exciting, and often for the predisposing cause as well. There is sometimes so much congestion about the face as to look something like apoplexy ; but if blood is taken the result may be fatal, and the case would certainly be aggravated, for it is a disease of exhaustion, and the weaker the patient becomes the more frequent are the fits. The pulse alone is sufficient to decide the case ; in apoplexy it is full, hard, resisting ; but in epilepsy though quick it is irregular, and often so feeble that compression stops it altogether, and to feel it the fin- ger must be held very lightly over it. Hypochondria, often connected with some kind of hal- lucination, or monomania, is seldom absent in confirmed habits of masturbation or long-continued seminal emis- sions, and most especially diurnal or internal emis- sions. Whenever such symptoms occur in early life self-abuse should be suspected as the chief or only cause. A case or two will best describe it. ' Mr.----. Aged 25, contracted the habit of mastur- bation at school, at 12 years of age; but it. was not till the age of 19, whilst studying law at Paris, that a change in his character became apparent. He then began to feel a disgust for everything and a constant sense of ennui ; to see only the dark side of everything. Thoughts of suicide then haunted him during a year ; 11 but afterwards gave place to other ideas. He fancied himself to be a subject of ridicule ; that the expression of his countenance, or his manners, excited an insult- ing gaiety in others ; and, at length, that every one wished to insult him. Sometimes he would feel en- raged, but more frequently depressed in spirits, and would break into involuntary tears. If any one spat, or blew their nose, coughed, laughed, or put their hands or handkerchief before their face in his presence, he ex- perienced the most painful sensations. He could look at no one nor fix his eyes on any object, but, wrapt in his own thoughts, became indifferent to all about him. He experienced heaviness and oppression in the head ; though fatigued by slight exertion was constantly in motion ; dyspeptic ; constipated ; all erections and venereal desires had vanished ; his urine was muddy, passed too frequently, and soon putrefied ; the testi- cles and urinary canal were very sensitive.' • Mr.----. 21 years of age; well made, robust, his face and appearance bespeaking health, had complained of headache for several years, and often showed derange- ment of his ideas. He had been treated for chronic dis- ease of the brain by distinguished practitioners, both in England and Germany. His feeble and husky voice, and timid and embarrassed manners led me to suspect masturbation ; but, examining a rupture that had come 12 without apparent cause I discovered evident marks of semen upon his shirt, when he told me that he often had discharges of glairy matter at night ; further ex- amination assured me that he passed semen at stool and with his urine. I was convinced that the sup- posed brain disease depended upon spermatorrhoea— which the result confirmed. This is the previous history of the case ; the cause of these discharges was obscure. At the age of 16 nocturnal pollutions occasionally appeared without dreams ; he was ignorant of sexual intercourse or mas- turbation ; was passionately fond of study ; at 11 had frequent headaches, disordered vision, pbtuseness in his ideas, loss of memory, and fatigue in studying ; and, several times, long fits of unconsciousness with- out apparent cause. At 18 he was placed in a school at Paris, and suffered from violent headaches. Soon afterward he was placed in a commercial house in Lon- don, but after two months the headaches, giddiness, noise in the ears and disordered vision increased ; a residence in the country produced some improvement which was lost on returning to his occupation, and he experienced such giddiness and weakness in his legs that he dared not go out alone. At length his intellect became so deranged that he doubted everything he heard, or saw, or did, and even his own existence ; and 13 by degrees his digestion became deranged. His phy- sician sent him to travel in Belgium and Germany. During this long journey he became more and more disordered ; everything seemed illusory and fantas- tic ; he fancied himself in a painful dream. He im- agined too that every one was ridiculing him, and con- spiring against him ; and especially three Englishmen who followed the same route, and who he thought were plotting against him ; and one of the gentlemen espe- cially he was a hundred times tempted to throw into the Rhine as he passed him on board the steamboat. These hallucinations remained on the patient's memory after his recovery, like a kind of nightmare. Disease of the Spine, or rather, of the spinal marrow, which is really a continuation of the brain itself and at least as important in the animal economy, is among the consequences of self-abuse. In its incipient stage this shows itself early in every case in weakness and pain in the back and loins, and stiffness ; and in some cases by a pain felt by pressure on the lower part of the spine. As it progresses the step becomes un- steady or trembling, pains are felt in the loins or wan- dering like rheumatism, the legs become more emaci- ated and feebler in proportion than the rest of the body, and it naturally leads to'or ends in Palsy, Contractions of the limbs, or Dorsal Consumption. I saw a distress- ing case of this kind last year. 7 14 ^In concluding this formidable list of possible and probable consequences of sexual abuse there is one point of great encouragement that must not be forgotten —which is, that though most of them are known to be of a fatal or more or less incurable nature, yet, when they are caused by masturbation they are exceedingly curable if the truth is confessed to the physician and the case is radically treated. I ought also to add that every case I have quoted here was perfectly cured. I might have illustrated the subjects with ' letters/ but that it has always been my rule to destroy all my patients' communications. THE CONSEQUENCES IN THE FEMALB. Many of the consequences, or actual diseases, are the same in both sexes ; some, however, are modified in the female by her nervous system, and some are quite peculiar on account of her special organization. Irritation. The first appearance of disease is local, and consists in an irritation established in the internal parts by the unnatural and frequent excitement ap- plied, always probably at first, by means of the fingers; and which soon assumes the form of subacute inflam- mation.- Upon examination these parts will be found • 15 a brighter red and somewhat swollen or more devel- oped than is proper ; sometimes distinctly inflamed ; and the part especially chosen for titillation is often en- larged ; in some instances it has been found enor- mously so. The irritation and heat thus produced in the external parts keeps the thoughts directed there and acts as a continual provocative of abuse ; it also leads to the same effect upon the brain as has been de- scribed in the case of the male with similar results. This external inflammation is the simplest form of disease and belongs to the earliest stage; but sooner or later it passes inward by means of the lining skin, ex- tends to all the internal sexual organs, and becomes a subject of great importance ; and when the vice has been contracted much before puberty it has been known to arrest the development of some of them almost al- together. This progress inwards really marks the ad- vent of a second stage, with more numerous and marked symptoms, and corresponds with the subacute inflammation of the seminal organs in the male, being, like that, the first link in an important and ulti- mately most formidable chain of diseases. In the same way it reaches the female urinary canal, giving rise to the frequent desire to pass water, and in some cases to actual disease of the bladder ; or, through the urinary ducts, to disease of the kidney ; but its more frequent 16 direction, and where it is productive of the worst con- sequences, is toward the internal generative organs, causing the diseases of those parts presently to be mentioned. Voluptuous Dreams. Growing partly out of the local irritation and partly out of the functional dis- turbance of the brain thereby induced, as before de- scribed in the case of the male, are lascivious thoughts which haunt the mind during the day, and volup- tuous dreams at night ; and though the female can- not exactly have seminal emissions, they are at- tended with such a flow of mucus as takes place in an actual embrace. And this discharge morbidly produced has, in kind though not in degree, the same debilita- ting and sad effects as has the nocturnal seminal dis- charge in the male. Leucorrhcea, called also fluor albus, female weak- ness, the whites, is an early and frequent symp- tom of local irritation ; indeed it is believed by some writers that whenever the whites exists anteriorly to the age of puberty it has been brought on by self- abuse, except where other definite and tangible cause exists. This complaint is unfortunately too familiar to every one ; it is a certain consequence of masturba- bation, and, if uncured, is almost sure to lead to bar- renness. 11 Deranged Menstruation. When the habit has been contracted before puberty the monthly discharges are delayed, or they are scanty, pate, are accomplished with distress and difficulty, and are attended with nerv- ous complaints. And that full development of the fe- male form which is just as intimately connected with and dependant upon the healthy influence of the womb and its internal appendages in the female as the corresponding change in the male is dependant upon the integrity of the seminal organs, is more or less completely arrested ; the bosom is often but a meagre apology for the exquisitely developed beauty that nature would have brought forth ; the hips do not attain their swelling proportions and admirable out- line ; and so of the voice, the eye, the manners, the whole being—the charms and graces that so illu- mine youth are dimmed or destroyed. If the habit has been commenced after this period is passed and its changes established its destructive in- fluence will be longer resisted, but will still inevitably follow ; the menstrual discharges will be deranged, suppressed, accompanied with pains, or brought on too often or immoderately according to the constitution or mode of life ; and if the vice be continued, or the dis- ease marking the third stage has been initiated, body and soul will be robbed again of all their charms. 18 Hysteria. In the great majority of cases, this affec- tion is the direct consequence of functional disturb- ance of the womb and derangement of the courses; and this, though it may have various causes, is much more frequently the result of masturbation than seems generally to be supposed. Diseases of the Womb. The irritation described as commencing externally and extending inwardly, is the cause of all the subsequent diseases of the womb and its appendages,"and of the more serious character of the symptoms belonging to the brain and nervous system by reflex sympathy. The first sign of this irritation passing inwardly is the frequent desire to urinate, as before mentioned. Then, as it gradually invades the whole length of the female passage leu- corrhoea in its simplest form appears; then the neck of the womb is attacked; then the appendages of the womb, with more or less affection of the organ itself. Disease of the neck of the womb is the most important of all, both on account of its greater fre- quency, the symptoms it gives rise to, and its prone- ness to degenerate into some form of cancerous dis- ease ; and it is, fortunately, the most curable of all, since the means of making a satisfactory examination of and proper application to it, have been perfected. It also indicates the stage of the disease of masturba- 19 tion. The first disease resulting from irritation or subacute inflammation of this part, is engorgement, which progressively reaches the condition of excoriation, then of ulceration; and the Whites become of a very bad kind, constant, and more weakening. These will be more particularly described in connexion with the Nature of the disease in the female, in chapter V. In unfavorable constitutions, or when continually irritated by venery or by abuse, there is the greatest danger of their assuming the character of cancer. This subacute inflammation may remain stationary at the neck of the womb for a long time, or it may pass on to the body of the organ, generally in the form of chronic inflammation of the womb. However, it more frequently but slightly affects or passes by the womb on its way to its more important appendages, where its effects are the same as in the testicles and seminal vesicles of the male—it first produces super-excite- ment with slight enlargement and tenderness, and increased secretion; and which, through the same intimate sympathy, adds to the excitement of its par- ticular part of the brain with consequent increase of lascivious thoughts and voluptuous dreams; and also directly excites the rest of the sexual organs. But after a longer or shorter period, according to the na- tural powers of the constitution and the sexual organ- 80 isation of the individual, it is succeeded by relaxation and ultimate wasting away, or by permanent disease, sometimes of a malignant character. Falling of the womb is a frequent consequence of chronic inflamma- tion seated there; and masturbation brings its own debilitating influences to add to its frequency. Barrenness. After what has been stated it will be evident that long continued or excessive abuse must destroy fecundity; and this is in accordance with the views of all writers on this subject. But, nearly in connexion with this, there is sometimes another most distressing effect—it robs the sexual embrace of its pleasure, or, actually produces aversion to the act; and I am occasionally consulted, especially by letter, upon this very point. Now, this may be due to one or more of several things—it may be owing to great relaxation of the passage and its entrance, to which, in most cases, the depressing and deadening effect of long-standing leucorrhoea is added; or to relaxation and threatened wasting of the internal appendages of the womb, whereby their secretion is imperfectly formed, or de- praved, and then the natural local desire and vitality is lost, as with relaxation and depraved seminal secre- tion in the male; or again, it may be owing to deaden- ing of the peculiar sensibility of those external parts 81 in which pleasure is supposed to reside, from the rude, unnatural and too frequent excitement to which they have long been subjected, so that they cannot respond to the delicate and exquisite natural stimulus; or, the/ female may have nurtured false and immoderate ex- pectations of enjoyment founded upon what her solitary efforts had produced, but which through the morbid incapacity of her own parts meets with utter disappointment, and is sometimes followed by un- governable disgust. Some women are indifferent unless excited by the opposite sex, and may be so to a great degree; but where there is no other actual disease to account for it I do not think that total absence of enjoyment, or actual disgust of or aversion to the sexual embrace, ever exists but as a consequence of self-abuse. And in these cases, where the bodily and mental conditions remain sufficiently attractive to lead, on both sides, to marriage—which fact evinces an ignorance of such an unhappy state of things and the existence of natural affections and desires, I think that restoration to hap- piness will always prove possible. And further, for the encouragement of those who may be personally interested, I ought to add here that a rapid and perfect recovery from the evil effects of self-abuse is more easy and certain than in the male. 8 82 To my own statement of this truth I will subjoin the words of that most celebrated and practical of modern authorities, Dr. Lallemand. He says, ' Whenever we succeed in entirely putting a stop to the habits of abuse in children, we may make sure of obtaining their return to health, and that very quickly. This I have remarked in all the cases of children that have come under my care. I do not mean to infer that the disorder done to nutrition dur- ing the progress of developement is easily repaired, but that the acute symptoms rapidly disappear, and that all the functions are quickly re-established. If the effects produced are active and serious they cease very rapidly, as soon as the cause is removed, and re- turn to health becomes certain.' ' What I have just said respecting children, applies equally to females.' ' Why in these two classes of cases (children and females), is the cure certain and the return to health rapid, as soon as the vice has been mastered ? It is that the cause of the weakness immediately ceases to act on the economy. Why is it that so many men continue to waste away after they have entirely left off their habits of abuse ? It is because diurnal emis- sions have commenced, which are even more debilitat- ing than the abuses which gave rise to them'—and these do not occur in women and children. CHAPER III. THE CAUSES. The Causes of Masturbation and Abuse.*-The variety of causes, direct and indirect, not generally even suspected—Causes which have come to the knowledge of the author, and of other observers—Causes acting in childhood, in youth, in the adult, of either sex—Remarks upon circumcision—Important suggestion. The number of influences that are brought to bear, some upon one and some upon another individual, and that are capable of becoming, directly or indirectly, the cause of a habit which constitutes ' a disease that degrades man, poisons the happiness of his best days, and ravages society,' is not as much as suspected by people generally ; yet it is a subject the importance of which cannot be exaggerated—and above all to parents—and would, if once seen in its true light, excite the most intense interest. In the course of my experience, which has been extensive, I have become acquainted with many; it has happened to other observers to see different ones ; I therefore propose, in this chapter, principally 84 to bring together the observations and experience of several of the most eminent, as the more perfect and satisfactory way of treating the subject. And the consideration of its causes will prove also to be, at the same time, that of its prevention. ' Of such an occurrence it is especially of importance to prevent the evil, inasmuch as, when once established, it is occasionally without remedy, and generally leaves its traces during the rest of the patient's life. There is, perhaps, no single 'question of more importance to the happiness of families, and to the welfare of society. The influences bearing upon the individual before puberty are the most numerous and dangerous, and of which it is the duty of every parent, or guardian of children, to be aware. With regard to Nurses and Servants the following remarks of Dr. Lallemand are full of interest and suggestion. ' The most anxious parents believe that there is no occasion to watch over the actions of their children with regard to their genital organs, pre- viously to the epoch of puberty ; and few, even of our own profession, are led to suspect bad habits before that period. This is a fatal error, against which it is necessary to be on our guard : numerous causes may give rise to abuses, at a much earlier 85 period—infancy being hardly exempt from them. I saw one unfortunate child, which, while still at the breast, nearly fell a victim to the stupidity of its nurse. She had' remarked, that handling the genital organs appeased its cries, and induced sleep more easily than any other means, and she repeated these manoeuvres, without noticing that the sleep was pre- ceded by spasmodic movements. These increased, and took on a convulsive character, and the child was losing flesh rapidly, and becoming daily more irritable, when I was consulted. At first I attributed the disorder to worms, teething, &c, but my attention being attracted by certain signs, I examined the genital organs, and found the penis erect. I was soon told all, for the nurse had no idea she was doing wrong. It was necessary to dismiss her, for her presence alone sufficed to recall to the child's memory . sensations which had already become a habit. Time and strict watching were required before these early impressions were entirely effaced. Dr. Deslandes re- lates two similar cases, and Professor Halle, in his lectures on hygiene, used to mention many such ; Chaussier, too, has told me of several that came under his notice ; and both these observers believed such cases to be less rare than they are usually considered. These manoeuvres quiet the children very readily, and nurses always endeavor to obtain quiet at any sacri- 86 fice ; they have no idea of the consequences of their conduct. At a later period, children are exposed to the same dangers, on the part of the servants having charge of them; and in these cases, it is not of ignorance that the attendants are to be accused. Many patients have consulted me, who owed their disorders to this cause.' Dr. Copland says, ' Several writers whose works I have perused have stated that they have known instances when this vice had commenced in females as early as three or four years of age ; and cases of it have come before me when this age was hardly passed. At this early age, the practice has generally been acquired from the girls to whom the care of children has been Committed. In a case of nymphoma- nia, in a patient to whom I was called in consultation, and who was sixteen years of age, the intelligent mother, the wife of an eminent physician in India, stated that the disease originated in manustupration acquired from a native Indian nurse, when the child was only four years old.' And Dr. Deslandes also says, ' Most frequently, however, the habit of onanism arises from direct pro- vocation, from instruction. Sometimes this provocation can be attributed only to imprudence. Thus nurses sometimes titillate the genital organs in children to 81 stop their cries. We have already stated, from Biett, the instance of a young girl who had thus contracted this bad habit, and who was cured by amputation of the part. Sometimes, however, servants teach their master's children from wilfulness. One should be particularly careful of female servants, as it is to them that young children are generally entrusted. And in another part of his work, speaking of the frequency of fluor albus in servant girls, ' We have seen several, who were so weakened by the whites, and the irritation of the sexual parts, that they have been obliged to quit their situations, being unable to do their duty. We will even say, that the most sincere of these girls have given us such information as to their habits, that we suspect most of this class of onanism. Precocity in Children increases the dangers to be feared from any untoward influence. Dr. Lallemand has seen much of this, and remarks that ' In some chil- dren there is a kind of precocity of sexual instinct, which leads to very serious results. In these, it often happens that the sexual instinct arises long before pu- berty ; such children manifest an instinctive attraction toward the female sex, which they show by constantly spying after their nurses, chambermaids, etc. These freaks of children are usually laughed at; but if they 88 were regarded with more attention, it would become evident that the sexual impulse has been already awak- ened. Rousseau, in his Confessions, has well described the influence which early sexual impulse exercised on his whole life, and I have received numerous confi- dences of the same nature, which, however, it would be of no service to relate here. One case, however, is so remarkable, that an abstract of it may be instruc- tive. ----, the son of a distinguished physician, be- tween five and six years of age, was one day in sum- mer in the room of a dressmaker who lived in his family ; this girl, thinking that she might safely put herself at her ease before such a child, threw herself on her bed, almost without clothing. The little---- had followed all her motions, and regarded her figure with a greedy eye. He approached her on the bed, as if to sleep, but he soon became so bold in his behaviour, that after having laughed at him for some time, the girl was obliged to put him out of the room. This girl's simple imprudence produced such an impression on the child, that when he consulted me, forty years afterwards, he had not forgotten a single circumstance connected with it.' ' The continual occupation of his mind by lascivious ideas did not produce any immediate effect, but about the age of eight, the most insignificant occurrence 89 served to turn his recollections to his destruction. Having mounted one day on one of the movable frames which are used for brushing coats, he slid down the stem which supports the transverse bar, and the fric- tion occasioned caused him to experience an agreeable sensation in his genital organs. He hastened to re- mount, and to slide down in the same manner, until the repetition of these frictions produced effects which he had been far from anticipating. This discovery, added to the ideas constantly before him, gave rise to the most extraordinary abuses, and, after a time, to exces- sive masturbation.' ' One patient informed me, that about the period of puberty, while hanging one day by his arm, he experi- enced an energetic erection accompanied with plea- sure, and that by his efforts to raise his body, he caused an abundant seminal emission. This was the first. The next day he repeated the same motions, and no- ticed the same phenomena, and from that time he knew no other pleasure. From the principles which had been instilled into him, he would have thought himself degraded by connection with a female, or by the least mutual contact with his genital organs ; but his con- science was quiet with regard to these practices, be- cause they had not been forbidden him. He continued, therefore, to hang by the hands, from the furniture, 90 doors, etc., without being suspected by any one, and fell, by degrees, into a state of debility and wasting equal to those caused by the most unbridled masturba- tion. After a time, from weakness, the patient lost the power of hanging, and his voluntary emissions ceased; but they were soon replaced by nocturnal emissions, which were very difficult of cure.' ' The following are a few passages from a letter I have recently received. " Being of an ardent tempera- ment, I abused myself, from the age of eight years, by practising masturbation, or rather, by still more hurtful manoeuvres. By compressing the penis between my legs, or against the seat on which I was sitting, I pro- duced excitement, which was commonly followed by the discharge of a few drops of a viscid and transparent fluid. This practice I repeated several times a day, up to the age of sixteen, when I ceased entirely, having been frightened by the discharge of nearly pure blood, which occurred several times. From this time I only sought natural enjoyments, but I found it impossible to obtain a complete erection. This state was attribu- ted to weakness,' and was combatted by tonics, stimu- lants, and even irritants of all kinds, which have done me much injury. I used, also, cold bathing and cold lotions." ' I have seen an officer of high rank who had fallen 91 into the same condition, from the practice of similar manoeuvres. He experienced his first sensation against the leg of a table, at the early age of ten years, and continued for several years to employ the same means.' ' From these facts an important scientific conclusion may be deduced, viz., that in many children the genital instinct shows itself with much energy many years be- fore the age of puberty.' ' A no less important practical precaution presents itself, viz., that the age of puberty should not be waited for, in order to surround children with prudent circum- spection, and to prevent their curiosity from being gratified.' Dr. Deslandes also makes some valuable remarks and suggestions upon this subject. ' Sometimes, too, a knowledge of this vice comes by accident. Hence children at an early age should be taught habits of modesty; all handling of the genital organs should be prohibited. Children should not be allowed to keep their hands in their pockets. Neither should they be left long alone; the necessity of observing, which is so vivid at their age, is exercised on themselves, when they find nothing else to interest them, and they some- times make dangerous observations. It is in bed par- ticularly that this evil is most liable to happen ; hence 92 they should be taken from their beds as soon as they awake, and the hour of rest should not long precede that of sleep.' ' Unfortunately, the smallness of dwelling houses in cities, and other necessities, particularly that of watch- ing their offspring, oblige parents to keep their child- ren near them, and their curiosity being always on the alert, often leads them to unfortunate discoveries.' ' If accidental observations in the most moral fami- lies may be attended with the results just mentioned, what must be the consequence of constant depraved manners ; their empire is so great at this age when the mind is inexperienced, and is always ready to adopt the impressions of the moment.' And it is from such sources that most of our servant girls generally come. How much beauty and truth there is in the words of the celebrated J. J. Rousseau ; he says, on this very subject, ' i" do not see but one mode of preserving in children their innocence ; which is, that all those around should respect and love it.' Irritation and eruptions about the genitals may exert a powerfully exciting influence, more especially in the female. The natural secretions of the parts if allowed to remain sometimes gives rise to superficial inflamma- tion or excoriation, or eruptions, and which in its turn 93 is capable of exciting internal irritation ; and this is much more likely to happen in hot weather. The ir- ritation that at one time leads to frequent urinating at another may excite the sexual propensities, sometimes to the extent of ungovernable local desire or actual ve- nereal furor, called, in the male satyriasis and in the female nymphomania. Dr. Deslandes says ' It is not uncommon to see symp- toms of inflammation appear at the same time or suc- cessively in different mucous membranes. The mem- brane lining the genital organs is not more exempt from this, than others. The heat which patients feel in the genital parts, the redness and swelling which are there developed, are generally the only symptoms which then become known to the physician. But there is another, the excitement of the venereal sense, which often escapes him ; either because the patients are too young to explain it, or because a natural feel- ing prompts them to coneal it. Hence this symptom is frequently unnoticed, except in rare cases, where it ex- ists to a great degree, and presents characters analo- gous to those of satyriasis and nymphomania.' And again ' This irritation may also act in another manner. The itching it occasions may cause the hands to be carried to the genital organs ; unknown sensations are produced, and masturbation is accidentally discov- ered.' 94 Now all this is easily avoided or remedied by simple washing or bathing; children should be washed daily by their mother, or a near relative, in plenty of cold water, till they are old enough to do it themselves; and then it should be continued, under a slight supervision, till they take full charge of themselves. This is in many ways a powerful safeguard against all causes originating in the individual. There are several other causes, gener- ally but little suspected, that are capable of giving rise to this vice through local excitement. Incontinence of urine1 wetting the bed' is closely allied to sexual irritability ; as Dr. Lallemand observes ' The spermatic apparatus does not attain its full de- ' velopment until the age of puberty, but the urinary organs perform their functions from the period of birth. The connection that exists between the two systems is so intimate, that the observations drawn from the one first in action foreshadow the affections to which the other may become liable.' And in another place he says, 'Accumulation of urine in the bladder during the night, is a powerful cause of excitement of the genital organs—another proof of the intimate connection be- tween the genital and urinary systems. This influence is well known to all who suffer from nocturnal emis- sions ; nearly all such, warned by their own observa- tions, take care to empty the bladder before going to 95 bed, and every time they wake. Some even get into the habit of waking at stated periods for this purpose, and abstain from taking fluids in the evening. These things should always be attended to and children carefully got into the habit of not drinking much late in the day, and always making their water the last thing before getting into bed. The fear of pun- ishment seriously aggravates the case, for the efforts to resist, and retain the urine, more and more provoke and maintain erections, and also bring the hands to the part. Dr. Deslandes writes, ' Many children have been led to onanism by their efforts to resist the wish to urinate. The pressure exercised on the penis by pressing the thighs firmly against each other, has ex- cited sensations which they have attempted to repro- duce. We mention this cause of onanism as being much more common than is generally supposed.' Whipping of children, though undoubtedly necessary and salutary under certain circumstances, "which in a well managed family are really rare, may be fraught with danger, and has called forth remonstrances from thoughtful and learned men. Dr. Deslandes says on this subject, ' Irritation of the skin, particularly in the neighborhood of the sexual parts, may act on them as we have seen, and produce venereal desires.' ' Casti- gation, and also the denuding of the body, which is ne- 96 • cessary, often have an effect on children, indicated by the erection of the penis. Young persons sometimes desire this punishment. The sensations caused by it have been so strong, as to be followed by an imme- diate emission. How many children have become addicted to onanism, in consequence of this imprudent punishment ! how often has the fatal habit of onanism been encouraged by it 1 These consequences have been pointed out by many authors.' ' Pic de la Mirandole, Rhodoginus, &c, have re- lated instances of it.. The following is from Serrurier. " One of my school-fellows," says he, " found an inde- scribable pleasure in being whipped : he took every occasion to provoke the master, who never pardoned an offender, but had him scourged, by individuals to whom this duty was committed. This same school- fellow declared that he was sorry when the punish- ment was ended, because then the pollution was not complete. What has been the consequence of this hor- rid discovery. The unhappy person became addicted to onanism. Reduced to the lowest stage of consump- tion, in consequence of the habitual loss of semen, his death presents us a picture of depravity, and an in- stance of the danger to which one is exposed by this fatal passion." ' 'Castigation is much more to be dreaded when 91 practised by one of an opposite sex from that of the patient. Rousseau, describing the effect produced p on him by being punished by Mademoiselle Lam- bercier, says—he was then eight years old, " For a long time she confined herself to threats, and the threat of punishment seemed very dreadful to me ; but after it was performed, I found it less terrible than I expected; so much so, that it required all my natural sweetness to prevent me from seeking a return of the punishment ; for I found in the pain, and even in the shame, a mixture of sensuality which had left rather a desire, than a fear to be punished by the same hand. The same punishment from the hand of her brother would doubtless have been less agree- able." Rousseau having exposed himself a second time to punishment, it was seen by a certain sign, that this chastisement did not produce the desired effect: he therefore escaped afterward. Thanks to his tempera- ment, Rousseau did not contract, at that dangerous period, a habit which would have extinguished, at their source, those admirable faculties which were afterwards developed.' ' The rod, too, should be excluded from families, and physicians should explain to families the double danger of a loss of modesty, and of exciting the senses.' 9 98 ' Certain articles of clothing may excite the skin, cause an itching, and thus produce effects similar to those of flagellation. It is wise to avoid the use of flannels next the skin, particularly in young patients, and around the hips.' The child's habits in .bed should be watched. The custom some have of going to kiss their children after they have got into bed, or of looking at them before they retire themselves, is a most excellent one—for not only is such loving watchfulness fully appreciated by the child, but it gives the opportunity, without seeming to do so, of observing its habits in bed ; of seeing that he or she lies on one side or the other, and not always on the same side of the body and especially not upon the belly; that the head is not covered up ; that the hands and arms are out of bed, or at least not about the genitals. Dr. Lallemand observes, ' I have already spoken of the danger of allowing children to sleep on the abdomen ; I should add, that many of my patients thus contracted habits which ruined their health. Independantly of the inconveniences to respiration, digestion, &c, which arise in this position, erections are favored. The least friction awakens new sensa- tions, and once on the track, progress is soon made. Sometimes recollections have caused the choice of 99 this position ; of this I have related a remarkable example ; at other times, scruples early instilled by a sage foresight, but which the violence of the impulse has at length succeeded in eluding, have induced it. Thus, I have been told respecting one of my patients, that he would suffer death rather than defile himself by touching the genital organs, yet, for five or six years, he seldom passed a night without working his own destruction while lying on his abdomen. It is not necessary for me to enter into a description of the other means by which patients have sought to satisfy their genital impulses, without trans- gressing the religious and moral principles which have been taught them in infancy. Suffice it to say, that if they have succeeded in satisfying their consciences, they have not succeeded in preserving their health.' Lying on the back is also bad because the spine and base of the head become heated, and, through the sympathy before mentioned this is conveyed to the genital organs. A soft bed, especially of feathers or wool, adds to this bad effect ; the bed should be hard and cool; a straw or horse hair mattrass is best; and the covering should be no thicker or heavier than really is necessary; from the bolster, or pillow, feathers should also be rigidly excluded. 100 •Lying in bed after being awake,' Dr. Copland observes, ' is another occasion of no small importance —of much greater than is generally attached to it. Although this and several others of the foregoing causes may not have first occasioned this vice, still they remarkably favor a frequent recurrence to it, and often render the morbid influence to it too strong for the self-control of the person who has fallen into the habit.' It is a* custom to send children to bed early—too early ; when they cannot at once go to sleep for neither of the two requisites, fatigue or sleepiness, is present ; it is an unreasonable custom, and of dan- gerous tendencies. And still more so is the unthink- ing custom, so much in vogue with some, of sending children to bed early for punishment, or shutting them up alone, or in their bedroom, for a length of time ; and ten times worse when preceded or accompanied by a whipping ; and these things are often done. I knew, when a boy, in London, an otherwise well- educated and intelligent gentleman, who used to lock his boys up in a room in solitary confinement from a day to a week at a time—his regular mode of pun- ishment. The Diet of children, of the greatest importance in this, as well as in other points of view, seems to be 101 entirely disregarded by very many, even parents ; it should be more of milk and farinaceous food and less of meat than it commonly is, the least candy and cake possible, or things highly flavored with aroma- tics, as pepperment and the like, which are all direct stimulants, and very much so in a special way as is well known to confectioners themselves. Tea and coffee, if allowed at all, should be very weak and cool; of course spirituous beverages of any kind are wrong ; also the use of much spices ; indeed, con- diments are not needed at all, and when a child cannot eat his meals without them the indication really is— a dose of physic, and it ought to be given. Schools. In my own practice I have found that mas- turbation has generally been taught in one way or other; many patients tell me they have learnt it from other boys and generally at school, but sometimes from older people or servants, especially female ser- vants, and in some instances from persons who would be least suspected of such infamy, and, occasionally, that they discovered it themselves. Dr. Deslandes seems to have observed the same; and Dr. Lallemand writes, ' If I may judge from my own observations, out of ten persons whose health has been deranged im- mediately or remotely from the effects of masturbation, nine first contracted the habit at school. All that I 102 have read on the subject has led me to conclude that this proportion is not exaggerated. A child brought up in the bosom of his family is, it is true, surrounded by many causes sufficient to arouse his curiosity and excite his imagination; but such causes act acci- dentally, and in an isolated manner; they only pro- duce a serious effect on a few ardent imaginations; a thousand circumstances may remove the attention from them. At school it is admitted that such causes do not exist, but there are others, less numerous and less varied, but which operate in a much more active and continuous manner; the effects of these are direct and almost inevitable. The child finds, on his first arrival, a focus of contagion, which soon spreads itself around him; the vice is established endemically, and is transmitted from the old pupils to those newly arriving. If a few privileged individuals escape being initiated, they are only such as do not experience any gratification. But their time will come at a later period; when the passions make themselves felt, the same circumstances will be presented to the mind, under a less disgusting aspect. I shall not enter into details on this subject; but from all that has come to my knowledge, from various and direct sources of in- formation, I do not hesitate to affirm, that nowhere are obscene books circulated more freely and boldly, than in educational establishments; that the origin of the 103 vice is not solely in the scholars, but also in the ushers and servants; that the abuses are not always confined to masturbation; and that they are not always propagated by example or persuasion, but are some- times enforced by threats or violence.' And Dr. H. J. McDougal says, ' I regret to say that his statements apply with nearly the whole of their force to the schools of England.' Dr. Copland says, ' Boarding-schools and other semi- naries or institutions, where a number of children or young persons are brought together, and especially where several sleep in the same apartment, or more than one in the same bed, are the places where this vice is most frequently acquired, by both sexes; but it is not infrequently practised by those who have never entered these places, it being either suggested by the local irritation and physical excitement often present during early puberty, or soon after this epoch, or ac- quired from tutors and governesses.' There are also other causes, still of course of the same general nature, but taking a different form, that act more at the period of, or after puberty. Sitting too long is condemned by all who have written on such subjects. Dr. Deslandes says, ' The sitting posture, when long continued, excites the 104 genital organs. Simon thinks so because this attitude, by the pain and obstruction which it causes to the circulation, brings the blood to the lower parts of the trunk, and keeps it there; hence it exposes the young man to excitement of the genital organs, and to en- gorgements of the spermatic chord; even piles appear in those who ride and sit much. This authou'concludes by condemning the custom, in schools, of keeping the students sitting the greater part of the day. He thinks that the number of hours spent in school should be less, and that the students should study as many of their lessons as possible in the erect posture. He re- commends, also, that the seats should be so con- structed as not to generate much heat.' And Dr. Lallemand remarks that ' A too sedentary life is injurious at all ages, especially in childhood, when there exists such constant desire for exercise and change. Gymnastics, therefore, should on this ac- count alone occupy an important position in the sys- tem of education; but they must be viewed under a much more serious aspect. Nothing can prevent the genital organs, at the time of their development, from re-acting on the economy and giving rise to new sen- sations and ideas. It is impossible to prevent the at- tention from being attracted by the impressions caused by these organs; impossible to restrain the imagina- 105 tion and to prevent it from frequently dwelling on such impressions. The slightest circumstance may, in such a case, lead to a fatal discovery, even if the informa- tion be not transmitted directly, and enforced by ex- ample. How are such discoveries to be prevented; or rather, how are their results to be guarded against? Study gives us no aid here; indeed the continually sitting necessarily heats the organs already too ex- cited. The eyes may be fixed on the book, the ears may appear to listen to the master, but who can guard against the wandering of the imagination ? At night it is still worse; no surveillance can prevent this. There exists only one means capable of counteracting it, and that is muscular exercise carried so far as to in- duce fatigue. This alone is able to deaden the suscep- tibility of the newly acting organs which excite the economy; exercise alone, by requiring matter for the repair of the muscular waste it causes, withdraws a stimulus from the genital organs, and induces sound and refreshing sleep.' Moral influence—bad books. ' Notions of love may,' writes Dr. Deslandes, ' when acquired too soon, excite in the soul a sensation which is first vague, then more precise, and which only requires an opportunity to be- come a fatal passion. Thus the reading of romances, and books which always interest the soul in love 10 106 scenes which are painted in bright colors, ought to be strictly forbidden to young people. The venereal sense becomes excited sooner than it ought to be, and desires demand to be satisfied before the body has at- tained its strength, and consequently before legiti- mate pleasures are practicable or allowable.' And Dr. Lallemand says ' I have seen a multitude of cases of this nature. From these I conclude, that in certain very excitable individuals, reading such works, the sight of voluptuous images, lascivious conversa- tion, in a word, all things that can excite or keep up irritation in the spermatic organs are capable of pro- ducing the same effects as actual abuse, even when the will is sufficiently powerful to prevent the thoughts from leading to the acts. On the other hand, an abun- dant secretion of semen with importunate erections, irritation of the urinary canal and prostate gland, always results under such circumstances ; and these favor the occurrence of nocturnal and diurnal emissions as serious, and perhaps more dificult of cure than those produced by masturbation, because it is impossible to act directly on the memory or the imagination.' ' It is not sufficient then to prevent all material ac- tion on the genital organs ; it is necessary also to pre- vent all erotic excitement of the senses and all concen- tration Qf the ideas on lascivious objects. Fortune's 101 favors are so distributed that numbers live in absolute indolence without Joeing blamed by the world, because they demand nothing-of any one. This inaction pro- duces results, the only remedy for which that I am aware of, is daily fatigue of the body by various kinds of exercise.' Solitude should be discouraged in young people under any and all circumstances as most dangerous in its tendencies. The custom some have of shutting children up for punishment, sometimes by the day or two together—and I have known it carried to the length of a week—and still worse if preceded by a whipping, is most reprehensible. The ignorance that exists on this subject is almost universal; the very best-meaning and affectionate parents often do that in the training of their children, the bare idea of which, if understood in all its bearings, would appal them. Again, boys and girls who are very studious and naturally seek retirement, should not have a too separate or distinct chamber assigned to them, and most especially those who have artistic tastes—who delight in drawing or painting, are always more impressionable, of a volup- tuous or imaginative mould, and their ' studio' though suitable and quiet, should, as much as possible, be occupied by some one else, or at least occasionally en- tered or passed through for some reason or other. 108 ' Celibacy, in adults,' Dr. Deslandes says ' is with some few exceptions the only caus%of onanism. This practice, and others still more revolting, are common among monastic orders, as the consequence and pun- ishment of vows made contrary to the laws of nature. Polygamy, the quasi celibacy to which the females of many countries submit, also causes great derange- ments in the system. A kind of consumption has been described to which the Turkish women are subject, and which can be traced to no other cause.' Phymosis predisposes to self-abuse by the local irri- tation of which it is always more or less the cause. I have operated upon numerous cases of natural phymo- sis (inability to draw the foreskin backward from Over the head) where no venereal disorder had ever been contracted; but where the irritation and other incon- veniences occasioned by it alone impelled the persons to seek a remedy. Most authors recommend complete circumcision, but I have found a mode of operating quite efficaciously by which so much incision is avoided and the foreskin spared^ with but very little alteration in its natural appearance—so little that, in more than one instance where the patient has applied to me long afterward on account of disease there, I have asked whether it had not been performed. Yet, doubtless, complete circumcision is always proper if preferred, and, in some instances, more desirable; it is an opera- 109 tion very quickly performed and unattended with any danger. I shall speak of it more fully in chapter VII. on the treatment. The following remarks made by Dr. Copland upon this same point I would endorse to the very letter; I think'we have been far from wise in ignoring, because no longer enforced as religious observances, many of the rules and obligations of the great Hebrew Law- giver; certainly we have gained no good, but much evil, thereby; and I would say, that, while it would be highly proper in all cases, every parent who is con- scious that their male offspring may inherit a tendency to this fearful vice ought to have this rite performed during infancy. ' It should not be overlooked that physical conditions and local irritations are often the causes of many of our most uncontrollable desires and passions; and that professional inquiries ought to be directed to the state of those organs which not only are influenced by these desires, but which instinctively excite the desires them- selves, independently of reason and volition. There can be no doubt, as I have above stated, that the oc- currence of this vice is remarkably favored by the phy- sical condition of the male genitals, especially as re- gards the neglect of circumcision. I am convinced that the abrogation of this rite among Christians has been injurious to them, in religious, in moral, in physi. 110 cal, and in sanitary and constitutional points of view; that circumcision is a most salutary rite, as respects not only the individual, but also the female whom he marries, and his offspring.' Phymosis is that state of the foreskin in which its free edge is so narrow or tight that it cannot be drawn backward so as to uncover the head—hence acrid accumulations, irritation, and at last disease. There is another malformation exactly the contrary of this, exuberant foreskin, which, from its unnatural bulk and length, is productive of similar consequences; this variety requires circumcision, or its entire removal, which is followed by the best results. There is yet another natural malformation which tends, though in a rather different way, to the same ultimate evils, but which I have never found mentioned by any author; it consists in a preternatural smallness of the external orifice of the urinary canal; the urine, coming along the passage, suddenly meets this constricted opening against which the column of water butts or strikes every time, giving rise to irritation which is soon reflected to the-inner extremity of the canal, and then to the internal organs. I have, in many instances, had to remedy this little deformity, which requires a very slight operation. The simple statement of the causes, is at the same time that of the prevention, of masturbation. CHAPTER IV. THE SIg!nS. The Signs of Masturbation or Abuse.—When suspicion ought to be excited— The presumptive signs—The positive signs. It has been said that until after the age of puberty every boy and girl ought to be suspected of self-abuse, because it is actually practiced by many and may be by all, and because, though possible at any age it es- pecially belongs to the period of youth. Certainly, a constant vigilance engendered of this possibility, if not probability, ought to watch over all who have not ar- rived at the age of maturity. And it will not do to imagine that one's own child is too good, or innocent, or sensible—none is exempt from danger, coming as it does from within and from without, in such endless forms and varieties ; and, very often, the lovelier or the more noble the subject the greater the danger from these very qualities. Only in that watchfulnessHhat grows out of a just appreciation of the danger lies safe- ty—whilst ignorance or neglect is fraught with danger and may lead to bitter and unavailing regrets. 112 It is not meant that every child will fall into this vice if not actually prevented ; nor that one exhibiting every healthy attribute, both of body and mind, is a subject for suspicion ; but only, that one of a thousand bad influences may occur to lead any one to it ; and that therefore every one ought to be the subject of a watchful care. The practical part of the matter is; first—When ought suspicion to be excited ?—and then, What are the pre- sumptive—What the positive signs, of this habit ? There are various circumstances which may proper- ly give rise to suspicion, several of the more prominent of which might be mentioned. Thus, when a child or youth falls into a state of debility or growing emacia- tion ; is evidently ill, perhaps seriously, yet no one can give his complaint a name ; or has more or less cough and seems to be hastening to consumption ; when a thorough investigation of his system can detect no cause in any internal organ, nor in worms, the teeth, a too fast growth of the body ; and when the case is not benefited by anything that is done for it at home, nor even by medical treatment, nor by change of air ; or when the physical or nervous exhaustion is not the re- sult of improper or insufficient food, grief, over work ; under any of these or like circumstances the patient ought be suspected of self-abuse; for, if this be the true 113 cause—and it probably is, his very life hangs upon that one thing. Again, defect in the proper mature development that ought to set in about the period of puberty, especially when this is connected with a weakness or delicacy of constitution not to be accounted for by hereditary transmission, previous or present severe disease, insuf- ficient food, over-work mental or physical, or other deleterious influence—in the male showing itself prin- cipally by backwardness or defect in the voice or growth of beard, boldness and manliness of character; in the female by retardation or irregularity of the monthly discharges, and want of the engaging and lovely attributes of budding womanhood—constitutes a legitimate ground for suspicion. When all this comes as it were like a blight, and unaccountably, it is from no other cause. Or, when a child or young person does not sleep ; gets a shuffling, unsteady or trembling gait ; stoops and grows round-shouldered; is languid ; loses the gaiety and sprightliness of youth, and brilliancy of eyes and expression ; the natural relish for amusement, or readiness for exercise regardless of fatigue ; and no reason or cause is evident or can be discovered, it is right to suspect masturbation. 114 If the natural traits of character unaccountably change, or the affections become distorted or unnatu- ral ; the boy becomes irritable or peevish, or morose and taciturn ; or the girl unhappy, nervous, irritable, dissatisfied, and will not confide her troubles to mother or sister as formerly, and no reason can be assigned for such change ; or the intellect fails, lessons are not learnt as they formerly were, or are forgotten, the mind seeming to have lost its normal power, such is not a case for blind and ignorant punishment—no other suffi- cient cause existing, as sickness, overstrained mind and want of sufficient air and exercise, and so on, sus- picion of this fearful vice ought to be excited. Epilepsy or falling fits in children or youths, and hysterics in girls, ought to give rise to such suspicion, and to the most careful investigation, till proved whe- ther this be the cause or not. Now, under any such circumstances it becomes of great interest to know what may be held to indicate the existence of this vice—what constitutes the signs that self-abuse is being practised. The Presumptive signs, those that tend rather to strengthen suspicion, are the most numerous ; and gen- erally rather lead to the positive, to actual detection in the act, or to an avowal on the part of the individual. 115 But the discovery may not be easily made, for the in- genuity displayed in hiding the habit or any evidence of it is often astonishing ; even very young devotees know intuitively, if not that it is wrong at least that it is to be concealed. But if ingeniously and persist- ently watched none can long elude detection. Of course it is expedient not to let the suspicion be known at first. Watchfulness exercised over children is by all con- sidered as a powerful preventive means, for solitude is essential to the continuance or the very existence of the practice ; as has been well said ' the opportuni- ties for onanism are all embraced under one term, iso- laiionl And it may be remembered that solitude is not natural to youth of any age or either sex ; the love of solitude can only exist as a morbid sentiment. There- - fore we should be watchful of all such ; of those who remain long in the privy or water-closet ; who are fond of solitary walks—I have known of secluded spots in the country being found and resorted to for the very purpose of self-abuse, also of the garret being fre- quented for the same reason. ' Watch where the child goes. Have an eye to him who seeks solitude—who remains a long time alone, and who cannot give a good account of himself.' In connection with bed—it is a bad sign to find a 116 child or young person closely covered up, with the hands always under the bed clothes and often about the genitals, and still more so if the penis is generally found to be in a state of erection ; though this latter will frequently be found the case in the morning in an innocent and healthy child if he be uncovered or the clothes be thrown off; but such a boy will be more likely to be found with his head and arms and chest uncov- ered, even in cold weather, the anxiety of the mother be- ing to keep him covered up. Biting the nails—keeping them bitten close, has been found to be an indication ; and in girls the existence of warts on the two first fingers, or soreness or slight ulceration about the roots of the nails. Want of color in the lips and gums ; loss of the bril- liancy of the eyes, with a very peculiar expression, and turning them to the ground instead of meeting the look of another, are very significant in either sex. Palpitations of the heart without disease there or general debility, easily produced and often excessive ; delay or irregularity of the monthly discharges, with fits of nervousness or of hysterics ; green-sickness, which may be the cause of any of these symptoms in girls, is often, probably in the majority of cases, itself produced by masturbation. Ill Of course, any one or two of these appearances alone, and unsupported by any other signs or symptoms, would possess little or no significance—except perhaps to ren- der the child an object of more care in this respect than it otherwise would have been; but, where the habit real- ly exists, they must lead to the discovery of something more ; and this leads to the discovery of what may be considered The Positive signs. These, of course, are not numer- ous ; and though, alone, perhaps, not always positive, become really or practically so when considered' in connection with the signs or symptoms which lead to their discovery. The hands frequently found to be about or upon the genitals during sleep, when the bed clothes are gently removed, is a very bad sign. ' Have an eye to those young persons, whose hands, when in bed, or during sleep, are in the position described ; they are onanists, or will become so.' If the penis also be found in a state of erection or promptly becomes so on any slight touch, appearances are still worse. And the same is gener- ally true of those boys who always have their hands in * their pockets—this should never be allowed from the first, and when there is a marked tendency to keep them there the boy's trowsers should be made without any pockets at all. 118 If, the boy being apparently asleep, the bed clothes are suddenly throWn off on any pretext, and he be found in a perspiration, his face flushed, the penis in a state of erection and the hands on or near it, no room for doubt can be left. If the breathing is quick or hur- ried, the pulse too fast, the body heated and bathed in perspiration which the weather and bed clothes would not occasion, and he is agitated and confused, or probably still feigns sleep, he is under full venereal excitement, and most likely a more or less confirmed offender. When it is observed that a child readily gets • into bed, covers itself up closely and is at once—appa- rently, asleep, it would be well to come into the room quietly, at times, and listen—the manner of breathing alone will reveal all. In girls, under the same circum- stances, instead of erections there will be turgescence of the corresponding organ and increased redness and moisture of the surrounding parts. If stains are frequently found upon the night-shirt or sheet they must be considered as seminal, for children are not subject to any disease that can account for it. It is barely possible that it should come from the piles, a rare complaint in children and which easily ad- mits of verification ; and surely the stains of urine could not be misunderstood. When for any reason it is impracticable to make the discovery in the manner 119 above described these stains can always be critically 'ooked for and examined ; ' there is reason to regard stains of semen as positive proofs of onanism, when the patients have not attained the age of puberty ; and as more probable signs of this habit, when older, if these stains be frequent.' An unnatural appearance and development of the genital organs in quite young subjects of either sex, is sometimes very apparent. ' The preternatural size which masturbation gives to the penis in children,' and equally to the corresponding organ in the female child, 'is so remarkable that this alone is often sufficient to reveal this habit.' But this is lost again as the child grows up, when the parts are found to be rather thin, meagre or flabby. CHAPTER V. NATURE OF THE DISEASE. The Nature of the disease of Masturbation—An affection sui generis— Its constant existence—Reasons of its great importance—Descrip- tion of, in the male—Its progress and particular symptoms—Its three distinct stages—Formula of each stage, with distinctive symp- toms—Description of, in the female—Its three corresponding stages —Formula of each stage in the female, with distinctive symptoms. Abuse of the sexual organs, as well as excesses and irregularities, give rise to a distinct affection— a disease sui generis ; one which is the result of this class of causes only ; which, whatever other diseases may accompany or attend it, is always present and, according to its degree, marks the stage of the case ; and, with some modifications the same holds with regard to the female, as I shall presently proceed to show. Of the long array of diseases that have been described as symptoms or consequences or effects of self-abuse, any one may or may not be found in a given case ; some of them are quite frequently met 121 with, others very rarely, while some are pretty con- stantly present. But this affection, in one degree or other from its incipient to its confirmed and terrible form, is never absent in any case whatever. In former editions of my Practical Treatise on the dis- eases of the genital organs, where the subject of this volume, in a short and rudimentary form constituted two or three chapters, I called this the ' special dis- ease of masturbation;' and though since then I have had immense opportunity, in my private practice, of further investigating the subject, I have found my definition to have been substantially correct and to require only further development, toward which I am indebted to late writers. Now, this special affection—the real disease of masturbation, is of more importance than any or all its consequences, and for several reasons. Thus, all the symptoms or consequences, local or general, are either directly or indirectly caused by this ; or, originating otherwise, are maintained by it and cannot be cured or much alleviated until, or in proportion as, this is modified or cured. Again, because for this reason, the first and most important part of the treatment must be directed to this for any chance of success ; and must continue of paramount interest if a radical cure is aimed at. 11 122 Also because it is either but little understood by practitioners generally or its true nature is totally misconceived, the whole complaint with its special symptoms or consequences being referred to 'debility'" general or local. Almost every patient I treat is a proof of this. Or, consumption, a general wasting away, hypo- chondria, heart-disease, hysterical or nervous diseases, leucorrhoea, monomaniacal hallucinations called in- sanity, or some other serious or formidable set of symp- toms, may so closely simulate the corresponding actual disease that this true cause is overlooked—either not sought for at all, or ignored—its mere symptoms engrossing all the attention ; and the unfortunate sufferer draws out a lingering existence, or dies— his health or life really hanging on that one unknown or unrecognised point. IN THE MALE. This disease in the male commences in the form of irritation in the urinary canal, and which, sooner or later according to circumstances of constitution or temperament, or the degree of energy with which it is excited or maintained, passes into the form of sub- acute or chronic inflammation—that which has been mentioned among the consequences as ' irritation of the urinary canal' and referred to several times after- 123 ward. Its seat is in the skin that lines the urinary canal ; and through this medium, or as it is called, by continuity of tissue, may reach every part of the genito-urinary apparatus ; for this skin without break or interruption lines them all. From the urinary canal it passes along the small tubes or ducts into the seminal vesicles situated close behind the bladder ; through other tubes down into the testicles ; it also lines the excretory ducts of the prostate gland which is situated at the neck of the bladder ; lines the bladder itself; the urinary tubes leading to the kid- neys, and lastly the interior of the kidney. But, though serious disease and even death. may result from its extension to and settlement in the urinary organs of this group, it is from its localization in the seminal organs that it derives its great importance and from which all the sad effects result, and toward them it surely though insidiously advan- ces ; these are the testicles, the seminal vesicles, the prostate gland. While in its primary or incipient form of simple irritation it first attacks the testicles, to which it imparts greater activity ; they increase a little in size, are more tender to the touch and secrete their portion of the semen more abundantly. The seminal vesicles perhaps at the same time, but probably later 124 are acted upon in the same way ; the prostate gland either remains uninfluenced for a longer time or is much more slightly affected. Thus the two former, and perhaps all three secrete their respective com- ponents of the semen too fast—there is at first simple super-secretion occurring under irritable excitement. This, both by its local reaction on the genital organs and its sympathetic effect upon the brain, increases venereal excitement and erections ; and, the super- abundant secretion of semen producing more than can be retained, spermatorrhoea or nocturnal seminal emissions is the consequence ; it is the first stage of the disease of masturbation. This irritation itself is not of a permanent char- acter, and would soon subside again if not kept up by the continuation of the cause that gave rise to it, as however it usually is when that cause is masturbation, and therefore, soon develops actual disease—subacute or chronic inflammation, which is of a permanent char- acter. And thus it may remain in a slight form for months or years without making much advance in degree. The symptoms at once begin to change for the worse, but here we have to do only with the strictly local ones. The different seminal organs are seldom equally affected, the inflammation usually con- centrating itself more in one or two of them—in the 125 testicles or seminal vesicles, or both ; to determine this point, on which successful treatment often turns, requires much experience and accurate investigation. The nocturnal seminal emissions may continue much the same for a time, but as the disease becomes more and more established its deleterious effects increase ; rapidly if the cause is continued as a confirmed vice, more slowly and insidiously, but none the less surely, even if it is abandoned; and, as with any other secreting organ suffering under chronic inflammation, the secretion itself becomes affected ; so, at length, it may be after several years, the semen is altered in quality, depraved. If sexual connection is essayed the emission is precipitate, perhaps at the very com- mencement of the act; erections are more and more transient, they are less firm, and the pleasure of the act is more or less impaired. In the early period of this stage at the moment of ejaculation a burning or smart- ing pain is experienced in the fundament or region of the neck of the bladder. In the former stage the seminal organs were only functionally disordered— they are now organically diseased; and the second stage of the real disease of masturbation is estab- lished. With a good constitution, abstinence from the evil practice, temperate and regular habits of life, and 126 occasional imperfect attempts at cure chiefly founded on the idea of ' debility,' this condition may go on for years without material change, as an independent disease. But it is always tending to its natural ter- mination, hastened or delayed by attending circum- stances. The first thing, generally, is increasing deterioration of all the seminal secretions, more especially of one or two of them, with relaxation or loss of tone of the organs themselves, and par- ticularly of the ducts leading from the seminal vesicles into the urinary canal. Seminal gleet, in one or other of its forms of diurnal emissions, or internal seminal emissions, the most serious and important symptoms of all, both from their terrible results and their in- sidiousness and obscurity, may now occur, according to the particular circumstances in each case, with great increase of the general debility. Or, the orifices of these ducts in the urinary canal may become ulcerated. If the force of the disease be spent upon the testicle its secretion is steadily deteriorated and becomes thin, watery, useless; or the organs waste away. The prostate gland may also be ulcerated or otherwise diseased ; but ere this the part of the semen secreted by this gland and the seminal vesicles is also injured more or less profoundly, and may be mingled with blood, or with matter, or both. The termination is in some variety of consumption if death has not occurred 121 from other causes. Such is the commencement and end of the third stage of the disease of masturbation, in the male, drawn as simply and lightly as possible. Before proceeding to a description of the disease in the female I will give a condensed formula of each of these stages, with the symptoms most commonly belonging to it, that a patient may judge very nearly his own condition, and thus be saved from the fear, which I find haunts so many, of having reached an incurable state or stage. It will also assist in de- scribing the case, if necessary. 128 FIRST STAGE. Irritation of the seminal organs, icith functional disorder—The semen still healthy—Nocturnal seminal emissions. Increased appetite, without increase of flesh. Lassitude, weariness without cause. Disinclination to exercise, either for pleasure or business, idleness. Irritability and nervousness, palpitations. Heat of hands, flushing of face, bashfulness. Dark color under the eyes. Unrefreshing sleep, disinclination to arise in the morning. Paleness of face and lips. Diminished br lliancy of the eye and brightness of expression. Distrust of self, easily put out of countenance. Erections too easily excited. Lascivious thoughts obtrusive, and followed by copious limpid discharge. Inclination to be alone. Shame-faced, troubled in society. Temper less amiable, irritable, unnatural. Longing after females but strangely shy in their company. The desire to urinate too frequent. Nocturnal seminal emissions with awaking, and with dreams if the individual has had sexual connection. The sexual act too hurried if attempted. 12 129 SECOND STAGE. Subacute inflammation of the seminal organs, actual disease being established—semen not healthy—sexual powers injured. Indigestion, appetite irregular or unnatural. Distress after a meal, especially after breakfast, or followed by slight nausea. , Costiveness, flatulence, colic, bad breath. Inaptitude for study or business. Loss of interest in amusements or games. Headache, often in the back of the head. Timidity, tendency to tremble, amounting to unaccountable cowardice. Powers of mind weakened, difficulty in thinking, unprepared with answers. Shortness of breath, sighing, palpitation. Unmanly sentimentality, liability to watering of the eyes or weeping. A sad or melancholy expression, eyes dull, heavy, weak. Erections troublesome, but less firm and lasting. Lascivious thoughts frequent, the mind haunted with unclean or distorted imaginations. Seeking for solitude, aversion to company, shunning old friends, and especially females. Sediments in the urine. External organs thin and flabby. Nocturnal seminal emissions often without any dream or awaking, and followed by depression of spirits, languor, and general aggravation of symptoms. Sexual act too quick and without proper pleasure, the discharge sometimes occurring before entrance, and, in many cases, accompanied by a smarting or burning sensation. Seminal gleet or diurnal emissions, or internal emissions. Semen thinner and less odorous. 12 130 THIRD STAGE. Relaxation, ulceration, or destruction of some of the seminal organs—Diurnal or internal emissions—Impotence. Confirmed dyspepsia, great constipation and occasional loose- ness. * Depraved appetite, or none at all. General emaciation, debility. Prostration of mind and memory. Strange fears and apprehensions, dread of being watched. Insult, offense, or slight imagined in every thing. Hypochondria, hallucinations, monomania. Sleep irregular, or actual sleeplessness. Face pale, complexion sallow or muddy. Countenance shrunken, pinched, expression anxious, melan- cholic or despondent, a besotted or stupid look. Eyes sunken and dull. Disease of some kind established and unaccountably obstinate or irremediable. All society shunned, positive aversion to females. Love of life weakened. Genitals relaxed, flabby and small, wasting of testicles. Erections imperfect or wanting. Seminal discharge on the slightest provocation. Semen thin, watery, with but little odor, or mixed with blood or matter. Seminal Gleet—semen passed at stool or with the last drops of urine, diurnal emissions ; or flowing backward into the blad- der, internal emissions. Constant drainage of semen. Impotence, imbecility, marasmus. 131 But, it may be said, many of these complaints arise from simple and innocent causes, or are symptomatic of other and quite different disorders—and this is very true; but so it equally is of the symptoms of any dis- ease; many belong to several diseases in common, others may occur from temporary and accidental causes, as headache, costiveness, dark circle about the eyes, palpitation, and so on indefinitely. But when several symptoms known to occur in such cases, are met with, reason for suspicion arises; and if they can- not be accounted for in the ordinary way, or when such treatment as is generally successful fails, such suspicion is much strengthened; and besides, there is always a something peculiar in symptoms con- nected with masturbation, and other suggestive signs and circumstances are discovered, which one experienced in the complaint will detect. Further, it may safely be said, that, whenever anomalous symptoms are observed in any one, and most es- pecially in youth of either sex, the possibility of mas- turbation should never be lost sight of; and also, whenever an apparently common disorder does not yield at all, or as it ought to do, to proper treatment. And again, it is not to be supposed that in any given case the symptoms of either stage will agree exactly with these tables, though in some cases they 132 will do so very remarkably; for peculiarities of tem- perament, education and modes of life, predisposition to certain diseases, age, natural strength or weakness of the sexual organisation, produce infinite varieties; indeed, connected with no other disease is such inter- minable diversity of cases to be met with. IN THE FEMALE. This disease, in the female, commences as irritation of the external parts, and has been partially described^ among the consequences under the head of ' irritation/ As in the male subject, it extends, through the medium of the lining skin, to the urinary canal and bladder, exciting frequent desire to. make water ; and it may pass into the bladder itself and along the urinary tubes to the kidneys and produce disease there. But its nat- ural and constant tendency is toward the internal gen- erative organs^ which it is sure to reach sooner or later, and whence all its serious and distressing con- sequences flow : these organs are the neck of the womb, the womb itself, and the appendages attached to it. The effect of this state of incipient disease, or irrita- tion, in these parts, is to increase their vital activity and natural secretions, the local reaction being to stimulate desire, and the sympathetic effect on the brain provoking unchaste thoughts whilst awake and voluptuous dreams 133 when asleep. Like irritation of any other organ it is transient in its nature, and passes off again if the cause is removed without leaving a trace of its former pres- ence. Such is the first stage of the disease of mastur- bation in the female. But if the unfortunate practice is continued irritation passes into the form of real disease—subacute inflam- mation, which is of a permanent nature. Still it may remain very slight for a long time, dependant however on the non-continuance of the cause, or the extent to which it had been carried, the kind of constitution, the comparative strength or weakness of the sexual organ- ization. But, sooner or later, it will progress in ac- cordance with its nature and will tell fearfully upon the victim ; our attention, here, is confined to the local manifestations. This chronic inflammation, then, becomes established in the passage, the neck of the womb, the womb itself, its appendages ; but these are never all equally af- fected. During the earlier period there will probably be swelling and superficial disease of the neck of the womb, and inflammation of the passage especially to- ward its inner extremity, with moderate leuchorrhoea; in the appendages of the womb increased activity and supersecretion—a state similar to that in the testicles of the male, keeping up the disease and longing for 134 gratification experienced in the parts ; the womb itself may be unaffected or suffer only a fullness of blood, but this, with the increased flow through the other parts, gives it an undue weight and predisposes to falling. Derangement of the monthly periods is also confirmed. A peculiar effect is also exerted upon the sebaceous and odoriferous follicles of the parts, the natural and healthy secretions of which, declared by King Henry the fourth of France to be a more potent provocative of desire than any perfume, is lost or so altered as to become the very reverse. This is the second stage of the disease of masturbation. Actual disease thus established in the internal genera- tive system, it continues though the habit be abandoned, for one characteristic of chronic inflammation is perma- nency ; and if it be not abandoned its progress may be rapid and fearful. The appendages of the womb may become otherwise and dangerously diseased, but the injury they are most likely to suffer is a wasting away, with apathy, or with positive aversion to the sexual embrace. The favorite seat of the disease, how- ever—where it is most constantly found and oftenest concentrates itself, is the neck of the womb, when it passes from simple swelling or engorgement to excori- ation and ulceration, with predisposition to degenerate into some form of cancer. And in remarkable connec- 135 tion with disease of this part are affections of the nervous system, the mind and the temper. Continued chronic inflammation in the passage is at- tended with increasing discharge or whites ; loss of contractility of the entrance of the passage ; relax- ation and diminished sensibility of its entire extent and of the external parts, sometimes to such a degree that the sexual embrace affords little pleasure, even rather disappointment, or disgust. And in connection with disease of the neck the leucorrhceal discharge is exaggerated, offensive, mattery, or tinged with blood. The monthly periods are more and more deranged, ex- cessive or suppressed ; and falling of the womb is in many cases established. With a good constitution and other favorable circum- stances the disease may, and often does, remain in a moderate form for many years, merely keeping up an endless train of unaccountable and recurring ailments —robbing the unhappy victim of her charms and life of all its pleasure. But it is very likely to cause death, indirectly, through other disease ; or, to end in one of the several forms of consumption. Such is the progress and termination, if left to itself, of the third stage of the special disease of masturbation, in the female. I will now give a formula of each of these stages in the 136 female also, with the symptoms most generally belonging to them, subject to the same remarks as precede those for the male. FIRST STAGE. Irritation of the external and internal sexual apparatus, with functional disorder—secretions augmented. Increased appetite with decrease of flesh. Lassitude, weariness, disinclination to move about, or walk out. Skin losing its healthy freshness, the lips their fulness and color. Bluish or dark color forming about the eyes. Heat in palms of hands, and feet, irregular flushing of face and skin. Readiness to retire to bed and dislike to arise in the morning. Character growing apathetic, appearance weak and languid. Eyes losing their brightness. A fondness for being alone, growing habit of novel-reading in the bedroom or in secluded places. Disregard of playmates and amusements. Company of her own sex dull and uninteresting. A confused or awkward bashfulness in presence of the oppo- site sex. Unchaste thoughts becoming frequent. Premature swelling and tenderness of the breasts and appear- ance of the monthly discharges. External parts fuller and more developed than natural, more heat and redness than proper, increase of the natural moisture and secretions. Slight leuchorrhoea or whites. Too frequent desire to pass the water. 131 SECOND STAGE. Subacute inflammation of the internal organs, actual disease established—secretions unhealthy. Indigestion *, irregular, capricious appetite. Discomfort after eating, heart-burn. No appetite for breakfast and nausea after it. Costiveness, flatulence, bad breath. Incapacity for study or application. Headache, swimming in the head, hysteric or nervous fits. Foolishly timid, terrified by trifles, unnerved. Growing emaciation, sallow and unhealthy complexion, eyes dimmed and weak. Intolerance of fatigue, or of changes of weather. Shortness of breath or palpitations disproportionate to the sur- prise or excitement. Expression of indifference, appearance of dissatisfaction, gen- eral languor, dispelled only by the society of the other sex. Sleep unsound, awaking un refreshed or wearier than on re- tiring. The healthy fragrance of the body and blooming tints of skin fading. The mind haunted by immodest and voluptuous ideas, and &% night by lascivious dreams. Irritable venereal sensations and urgent desire for gratification. Mock-modesty, affectation of virtuousness, sensitiveness to words capable of double meaning, inability to use or hear the word leg, stone, etc. Menstrual discharge deranged, pains in the back. Desire to urinate too frequent, or painful. Leucorrhcea established. External parts pale, the natural odor lost or altered. Actual disease of the neck of the womb. 138 THIRD STAGE. Wasting, or ulceration, of the internal organs—Relaxation and loss of sensibility—Distorted or destroyed sexual appetite. Confirmed dyspepsia, appetite depraved or wanting. Obstinate constipation, occasional looseness, breath offensive. Sleep irregular and troubled, or sleeplessness. Debility, incapability of exercise, swelling of legs and feet. Hysterics, headache, strange aches pains and ailments. Anomalous affections refractory to treatment. Mind and memory weak, the temper soured, peevish, uncertain. The face thin and sharp, expression of melancholy or suffer- ing, the eyes dull and hollow, the sight weak, lips bloodless, the limbs wasted, the breasts shrunk and loose, voice thin or whining. Skin harsh, perspiration unhealthy or offensive. Strange hallucinations, religious monomania, or confirmed melancholy. Immoderate longing for, or utter aversion to, men. Leucorrhcea or whites bad, dragging pains in the back. More or less falling of the womb. Urine disordered, turbid, or too copious and watery. Admixture of blood, or of matter, with the leucorrhoeal dis- charge. External parts pale, flabby, shrunken, dry. Ulceration of neck of womb, or still more serious state of dis- ease. 139 Now, the remarks made after these formulae in the male are equally applicable here; a person is not to be accused of, or set down as, guilty of this vice from any symptom, however decided it may appear; no one or two symptoms, alone, can be conclusive, though some are very indicative and justify solicitude and watchful- ness on the part of parents or friends. In the party concerned, even if before unaware of the connection, conscience will prove faithful. At the advent of puberty the womanly attributes are in process of development, and during this intermediate period mental and physical irregularities, otherwise unaccountable and sometimes remarkable, may be pre- sented; or, in weak and delicate subjects, chlorosis may occur; these have their own peculiar characteris- tics, and should not deceive us; so of symptoms of debility or nervousness from disease or other tangible cause. But, when we see a girl losing the graces, the charms, the sprightliness of youth; when the pow- ers of life are languishing; when the exquisitely devel- oped beauties of form are shrinking away—the illumi- nation of loveliness fading; when a young woman ' ages' prematurely—is always looking ill, and neither her friends nor her physician can detect a reason for it,* shall a false delicacy resign her to death ? and where, unless pulmonary consumption is actually established, she can almost certainly be restored. CHAPTER VI. STRICTURE, SEMINAL GLEET, IMPOTEKCE. Stricture, Seminal Gleet, Impotence—Peculiar tendency to stricture in every case—The true nature of stricture—It may continue after the seminal dis- ease is cured—Symptoms of stricture—Seminal Gleet—May succeed to noc- turnal emissions—When it may be suspected—Great danger from its ob- scure and insidious nature—Local symptoms of seminal gleet—Is easily mis- taken or overlooked—Internal seminal emissions, still more obscure—Ap- pearances of, in the urine—Special symptoms—Danger—Impotence. The serious nature of these two diseases, whether as consequences of abuse, excess, or disease, has de- termined me te devote a chapter to them alone, in order to consider them more fully than could ap- propriately be. done amongst the symptoms or conse- quences. STRICTURE OF THE URINARY PASSAGE. This is, at any time, an important and serious com- plaint. It is peculiarly so as one of the consequences of masturbation or of excesses; first, because, in the male, there is a natural tendency to it in every case. The essential nature of stricture, as is so fully ex- plained in my ' Practical Treatise,' is chronic inflam- 141 mation, and this may originate in simple irritation. ^ Now, in the preceding chapter it is shown how this irritation, commencing in the urinary canal, becomes the cause of actual disease in the sexual organs; strict- ure is merely mentioned as one of its results, the others claiming more attention there; but here we are dealing only with the urinary canal. Now it may and generally does happen that the irri- tation, though it passes on to the further organs, still leaves a permanent irritation in a certain part of the canal; just, in fact, as happens in a badly treated case of gonorrhoea; and like that, when once established it never spontaneously disappears; and both alike are characterised by slowness. It sooner or later settles into chronic inflammation, gradually contracts in ex- tent, and assumes the form of a circumscribed engorge- ment of the lining skin of the canal—this is incipient stricture. In the course of time, it may even be several years, this soft engorgement grows denser and more contracted, but still yields to the advance of a gum- elastic instrument—this is dilatable stricture. At length, sometimes after a number of years, it becomes so nar- row, hard and unyielding that it resists the passage of the instrument altogether or only allows a very small one to go through—this is permanent or callous stricture. Secondly, because all the other consequences of 142 abuse or excess may have passed off or been cured, and the stricture alone remaining may perpetuate many of the old symptoms; for some of the symptoms of both are alike, as will presently be seen. In such a case the patient never seems to get well; and it is especially likely to occur when he has been treated by medicine or.by hygienic or dietetic means, only; or, when he has also contracted disease. The truth is that neither the special disease, nor stricture, can ever be cured by general treatment of any kind without ap- propriate local treatment also—all that may ever be heard or read to the contrary notwithstanding; and to be faithful this must be insisted on. When masturba- tion or the effects of excess are correctly and radically cured no such thing will ever remain afterward. The symptoms of stricture. These, taken all together, are very numerous; I will mention the most constant; and those that may cause mistake will be easily recog- nised. There is always a little dripping after making water, a few drops remain and are apt to wet the shirt; a little hesitation before the stream starts; in some cases a desire to urinate too often, or to get up at night for the purpose; a shrinking or dwindling of the penis; pain or weakness in the small of the back; less perfect erections and diminished sexual inclinations; more and more narrowness of the stream as the strict- 143 ure grows worse, even becoming very small, or the water running away drop by drop, or complete stop- page; loss of memory, especially of names and places; dulness, sleepiness, disinclination to arouse the mind or to attend to business, dislike of company, some- times amounting to hypochondria; pains in the testi- cles, round the hips, or down the legs, sometimes to the soles of the feet; a variable, or only occasional gleety discharge, especially after the sexual act, and then at times looking like new disease, or after drink- ing or taking cold; decreasing erectile powers, with or without loss of inclination, in some cases actual im- potence. It is plain, therefore, that a remaining stricture may simulate the original disease; there is one thing however, in its favor—its perfect curability. In every point of view, or from whatever cause, the importance of stricture is not easily exaggerated. SEMINAL GLEET. Especial importance attaches to this complaint both from its obscure and insidious character, and from the grave nature of its consequences. Seminal gleet comprises the several forms of Diurnal emissions. Nocturnal seminal emissions are bad enough, but their occurrence is obvious and unmistake- able; everybody is more or less aware of their weak- ening and dangerous consequences, and knows when 144 he is suffering from their effects. But it is not at all generally so much with seminal gleet; and what is worse is that, often, it succeeds to or takes the place of the nocturnal emissions either spontaneously or after treatment, thus deceiving the patient into a false security, whilst, by its more diseased nature and more constant draining away of the precious fluid it is really still more surely and rapidly undermining his constitution. Whenever, therefore, a person haS nearly or quite recovered from his nocturnal emissions by medical treatment or otherwise, and yet does not recover his health and strength; or, some other co-existing dis- ease proves intractable under proper means of cure, and without any discoverable reason; or he steadily declines, some other form of seminal loss ought to be suspected. The obscure and insidious character of this disease is remarkable; patients frequently come to me about complaints or weakness, some connected with the sexual organs and some not, who have a seminal gleet which is evident enough to them when once discovered and pointed out; yet they never had the least idea of it, or if they had observed the particular symptom were ignorant of its meaning. The Local Symptoms of Seminal Gleet show themselves 145 in several different ways. One form, and which is most likely to be noticed, occurs chiefly when the per- son has to strain at stool, which is most generally from costiveness; it will then be found that a jelly-like or glairy substance escapes from the urinary canal; some- times almost a teaspoon-full comes away, having more or less exactly the look of semen. It usually appears during or'immediately after the straining, but may be a minute or so afterward. This discharge is generally known of, because it gives a peculiar sensation as it passes along the passage. It may also be occasioned by other causes than abuses, by gonorrhoea, gleet, stricture, sexual excesses, sudden absolute continence, but will always, sooner or later, entail its terrible de- pressing effects both on mind and body. And, by long continuance, such discharges grow so facile that, at last, they take place without any costiveness or strain- ing at all, even when the bowels are ever so loose. After great and unusual straining efforts, a drop or two of clear transparent mucus may be forced out by the pressure and remain at the orifice, but this will never be known unless looked for, and it is very differ- ent from the discharges referred to. And this leads me to remark, that, if some one or other of the dis- charges here described or very nearly simulating them, happens to a person in sound and good health, and he 13 146 continues so, doubtless they are of no moment and may be disregarded; but, if happening, and the person is out of health, always ailing or complaining yet nothing the matter with him, pale and flabby, an invalid, and no sufficient reason can be found for his being so—he had better look to such symptoms. There is another, not so common, which is generally brought on through abuse of the organs either by natural or unnatural excesses. A soft, imperfect or semi-erection occurs often from the very slightest ex- citement, and attended or succeeded by the stealing away of a slimy substance, sometimes in quantity, sometimes only slowly and gradually; this also is likely to be known, though it may not be understood. But there is one form so easily overlooked that the patient hardly ever discovers it himself, or thinks any- thing of it if he does; but which is not the less serious in its consequences. It may be known by a slimy or slippery feel that the last drops of urine will have, if taken between the thumb and finger just as they pass away and rubbed; in the absence of this the last drops, tried in the same way, will feel even rougher than a drop or two of plain water would. If closely observed the last drops of the urine will be seen to come away as if a little thick or gummy instead of sharply and promptly like water. Now, this does not indicate ac- 141 tual internal emissions, for in the latter the semen is more mingled with the urine, while in the former it is rather pressed out by the last spasmodic contractions of the bladder; still, in either case, it is principally found in the last of the urine, and they may easily be confounded. Sometimes, just as the semen is passing out of the ducts there will be some turgescence or slight effort at erection and a peculiar sensation; or sometimes it will take place just after the stream of urine is finished instead of with the last drops of it. There is also, generally, a too frequent desire to urinate. Unfortunately, this seminal gleet, prolific source as it is of misery and death, is not at all understood by the profession. If the patient apply to his family phy- sician the first variety will be merely called a chronic disease of the prostate gland, or prostatic discharge— and so it may be; but it is usually more. The second will be treated as a seminal weakness—and so it is; but the tonic medicines and cold bathing will not cure it. The third will simply be pooh-pooh'd; yet the pa- tient's life may, in reality, be dependent, ultimately, upon its present recognition and cure. INTERNAL SEMINAL EMISSIONS. These exist where, under circumstances which some- times occur, and especially the injudicious or empirical 148 interference with nocturnal emissions, the passage of the semen is reversed, and it flows backward into the bladder instead of forward and outward through the urinary canal. And this has been the cause of hypo- chondria, insanity, pulmonary and dorsal consumption, death, in many a person in whom its existence has never been suspected. It is even more insidious and obscure than the former, for it gives no outward sign at all; and its appearance in the urine, in the gen- erality of cases, can only be detected by an experienced eye; and is often verified with difficulty even with the assistance of artificial means. Sometimes, however, the patient may be able to judge by the appearance of his water; if the last ounce or so is caught in a wineglass and allowed to stand a few hours, the urine being clear, half-trans- parent irregular-shaped but rather round little bodies may be discovered settled down to the bottom of the glass, but mingling again if shook up. If the superna- tant fluid be carefully poured off they will be found to feel soft and slippery between the fingers. Sometimes this deposit is of a rather clouded kind with little bright points or spots sprinkled through it. These appearances will not be always discoverable in the urine; there may be days without any; they will be found in it more especially, and with greater distinct- 149 ness, after a lascivious dream, loose conversation or exciting reading, indecent pictures or sights, or vene- real thoughts; any thing that has tended to excite erec- tions. Still, it may be there and elude all unpracticed scrutiny. The symptoms that more particularly attend seminal gleet, or internal emissions, are, diminution of pleasure in the sexual act; erections growing less and less fre- quent and of shorter duration, or the seminal ejacula- tion arriving too quickly; the sexual act fatiguing, or even followed by symptoms like those of nocturnal emissions, and which may last a great part of the day; a pain or weakness in the small of the back; a too fre- quent desire to urinate. Often, the patient's external appearance is no index to the true state of his case, but, as professor Lallemand well observes, ' The good health of such patients is only apparent ; the least circumstances disorder it, and what they suffer is unsuspected ; their parents, their most intimate friends, are ignorant of the cause of the various disorders they complain of ; the medical man who possesses their confidence is not better in- formed, because the patients themselves do not suspect it ; thus their indispositions are set down to ennui, tendency to melancholy, hypochondria. When their diseases become more serious, their constitutions are 150 said to be delicate, impressionable, or unhealthy, or they are considered malades imaginaires. They are told that they pay too much attention to themselves, or that they have fondness for medicines. Medical men in large practice get tired of hearing their long series of inexplicable complaints, and get rid of them by ad- vising travelling, or change of air. Charlatans rob them ; officious friends advise marriage, or occupation to fill the void in their existence ; every one blames, because no one understands them. Incapable of all^se- rious occupation or deep affection, they grow discon- tented with themselves and still more so with others j absorbed by one sole thought, they return unceasing- ly to themselves to^seek the cause of their condition, and soon become misanthropical.' I have thus endeavored to point out, clearly and in- telligibly, the nature of these important and dangerous affections, with the means of detecting their existence ; and, I feel confident, it will lead to the restoration of health and the saving of life even, in many instances. They are all difficult, sometimes obstinate cases, requir- ing skill united to great experience on the part of the surgeon ; confidence and patience on the part of the patient ; but all will in due time be repaid—even in apparently hopeless cases if the patient's health be not already mortally involved through other or induced dis- 151 ease—by restoration to natural tone and action, and general health. IMPOTENCE. The history of Stricture and of the different forms of Seminal loss is the history of impotence. When it de- pends upon such causes it is generally curable ; when from other causes it may or it may not be. i CHAPTER VII. THE TREATMENT. The Treatment.—Introductory remarks—Possibility bf spontaneous cure during the period of the first stage, in either sex, and always, in children—Spontane- ous cure impossible afterward—Advantages of a written statement of the case previous to consultation—Preventive treatment—Direct preventive means—In- direct preventive means—A new remedy, preventive and curative, proposed— Hygienic treatment, Diet, Exercise, Occupation, Bed, Bathing—Marriage, when remedial, when hurtful—When proper in the female case—Medical treatment—Vitally important information and warnings—When seminal noc- turnal emissions constitute disease and when they do not. In the treatment of abuses or excesses, or the dis- eases resulting therefrom the first and all-important step, as it would seem almost unnecessary to say, is the positive abandonment of the cause, and this is the more necessary to insist upon when that cause is mas- turbation, because that cause is the most difficult to abandon. Yet it is a sine qua non, as no one who has read the foregoing will for a moment doubt ; happy were it as easily done as said. But it is far from be- ing so ; the whole moral power of the individual must be summoned, with the aid of whatever other helps can be availed of or brought to bear in the case. 153 • And it presents especial difficulties when it occurs in quite young subjects, ' at a time' as the very practical Dr. Wilson says, ' when the moral power is insufficient to oppose, the contagion of bad example, or the force of violent and precocious animal passions. Indul- gence of this habit under these circumstances ought not, in my opinion, to be classed in the list of moral crimes, as too frequently happens, but rather in that of disease. The principal difficulty in the management and cure of this fatal propensity is the incapability of making the patient, at an early age, fully under- stand the injurious influence upon the constitution or its after effects. It is not an easy matter to convince him that he is pursuing a course that demands the very strictest attention and counteraction to save him from the most evil consequences to his health. To him the necessity for a strict resistance is quite incomprehensi- ble ; he is practising, as he believes, a simple sensual gratification merely, and if at any time it occurs to his mind, that he is doing something which is wrong, the impression unfortunately is so slight as scarcely to oc- casion him a moment's uneasiness. He relies, perhaps, on his capability of giving up the habit at a later age, before it becomes injurious to his health. In this idea, however, he will find himself sadly mistaken. 'Vhen the mind has become morbidly directed to this subject, it is continually and irresistibly seeking the means of 14 154 reproducing its pleasurable sensations. There is no de- parture from the idea, every moment unoccupied in bodily exertion is devoted to erotic fancies, and even sleep is not exempt from the mental fascination. As the disease increases in intensity, the mind wearies of any direction but the one, and however much it may be distracted for a short time, wanders back unconsci- ously to its morbid train of thought.' And again he remarks, ' It is a prevailing idea that the disease will prove of easy self-correction when the mind begins to comprehend the degradation of the habit; and that as the child becomes older, he will leave off the practice of his own accord. Nothing can be more fallacious than this supposition, and the reverse is more generally the case ; the demand for the peculiar excitement becomes more urgent, and the moral disgrace lessens in his own eyes in proportion as the practice acquires an ascendancy over the mind. The endeavor to stay its progress cannot, therefore, be too prompt or too energetic' It has been recommended by some writers to aban- don the vice gradually ; and patients, in one way or other awakened to a sense of the enormity of their folly, often propose this plan to themselves ; but it is a fallacy, and ends in utter failure. Action must be decisive, in intention at least, for compromise and 155 failure are synonymous. A resolute determination may be overcome, again and again overcome, but triumphs at last; for the human will once truly fixed is, in every thing, invincible—all but ominpotent. No case, therefore, is hopeless, that has the energy to resolve at all. When the habit is broken off within the period of the first stage, i. e. before the irritation has passed into the form of actual disease or chronic inflammation, although nocturnal emissions may have already oc- curred, and do generally become more frequent for a time from the sudden cessation of the unnatural act and accompanying discharges, yet spontaneous re- covery is the rule ; hastened however, by the atten- tion to hygienic measures which is generally observed; but, at any rate, absolute removal of the cause is then followed by a natural cure. And, in the case of chil- dren, or females, which is much the same thing, recovery, even from apparently most serious conse- quences is astonishingly rapid ; the former do not, and the latter can not, have seminal emissions. And here we find the reason why although so many, perhaps almost all of the male and a great many of the female sex, have practised this vice more or less, yet so comparatively few suffer from it, at least—so far as they are aware of. Why those who, neither knowing 156 or looking beyond their own personal experience, say there is no harm in it. And why even some eminent medical authorities have under-rated or doubted its fearful powers of mischief. But if the second stage, the period of subacute inflammation or permanent diseased action, has ar- rived, the possibility of spontaneous cure is passed, no matter how strictly moral control, dieting, bathing and the rest may be observed. It may then be held more or less in check but it will never be cured by them, because morbid seminal emissions in one of their forms, obviously or obscurely, from part or from all of the seminal organs, still go on ; fortunate, in- deed, if they continue in the more obvious form of nocturnal emissions, for then the sufferer himself, at any rate, is not thrown off his guard. According to the frequency of the seminal losses, the degree of morbid character belonging to them, and the comparative strength of the sexual organisation of the individual will be the increase of the local disorder and the aggravation of the general symp- toms ; but always an inevitable increase at one rate or other. The great danger during this period is the apparition of other disease, especially if any heredi- tary or accidental predisposition exist, with anoma- lous and unmanageable characters and permanent or fatal result. 151 The treatment of masturbation or excesses is natu- rally divided into three kinds of means. When the subject of this vice has discovered its real nature or effects he or she will find, by a study of the hygienic treatment here described, the means which should at once be put in practice, and which are within the reach of every one ; while parents, guar- dians, or others will see, in the preventive treatment, the means that have been employed and reported as more or less successful; but which are, in a great measure, to be determined by the peculiarities and circumstances of each individual case. Before the commencement of any kind of treatment whatever, when masturbation is suspected, certainty as to the existence of the vice, is essential ; and when the absolute commission of the act cannot be detected, yet a knowledge of the signs and a vigilant watch- fulness will lead so near that the individual can be charged with it and a confession obtained, the which, in view of whatever remedial or preventive measures are to be taken, is indispensable, as the following judicious and practical remarks so well express, ' First, it removes all d oubt; then it renders the action of the physician more frank, and consequently more efficacious. He is no longer fearful of wounding the feelings—of compromising his character, by show- 158 ing a wrongly founded suspicion ; of awaking the attention of the young patient to a subject of which he was ignorant, or of teaching it to him. Advice, remonstrance, punishments, and all the moral re- medies, are now easily applicable ; and if therapeutic or coercive measures are called for, the patient can no longer deny their utility, and reject their use. Finally, an avowal places the physician, parents, instructors— in short, all who have authority over the patient—in a position to proceed directly to their aim, and thereby attain it.' ' An avowal never takes place spontaneously; to ob- tain it is difficult. With males, one need not be so particular; but we must be careful with females. On this topic no positive advice can be given; much must be left to the tact of the practitioner. We will only add, that we have more than once simply given advice; and we could see, from the manner in which it was received, that our conjectures were right. The physi- cian, however, should always attempt to acquire the confidence of the onanist, to place him at his ease. They have no frankness where a person is stern, or when a moral lecture is expected. The physician should confine himself to his profession. In his eye, onanism should be regarded as a cause of disease—as a cause similiar to an excess of labor, bad regimen— 159 in fact, like any influence which might prove injurious to the health.' I have observed that the difficulty of obtaining such avowal is rather experienced by parents or others than by the physician, who, if he have much experience of the subject hardly asks anything at all. And this is natural, and proper; so painful and mortifying a con- fession will not be made to one looked upon perhaps as an inquisitor as it will to one coming as a friend and deliverer. I have found that patients, sometimes, before con- sulting me personally on this or any other matter which they consider very delicate or which would be especially mortifying or repugnant to their feelings to relate, first open the subject in writing, either hand- ing the letter to me or sending it through the post a day or two before their visit; and it is a very excellent plan, for it not only does away with a certain distress or sense of shame that many experience in a first in- terview, as well as the worry and nervousness caused to such by its anticipation; but it allows the patient quietly and at his leisure to collect his thoughts and make a complete statement of his case, its causes, peculiar circumstances, etc., etc.; instead of forgetting or holding back half he meant to say—in fact, it puts both parties at their ease amazingly, and robs such 160 interview of its anticipated pain. In the female case especially it is a suitable plan. We will now pro- ceed to the consideration of the treatment. The Preventive Treatment. This is of course only adapted to very young subjects, or to those who be- come imbecile, or who have so succumbed to the in- fluence of the vice as to be unable to control their own actions. It may consist of direct or of indirect means of prevention. Various direct means have been devised and put into practice and recorded. In some cases the hands have been tied so that they could not easily, or as sometimes happens, half unconsciously, seek the genitals; the straight-waistcoat has also been em- ployed, so as to keep the arms on the chest. A night shirt, made too long and tied at the bottom, has been used to prevent easy access to the parts; or drawers made to open behind. When the habit is not too con- firmed or the patient is willing to attempt reformation, such means have been found of great assistance; they can also be put into practice when it is wished to place impediments in the way without explaining the purpose to the young patient. A cold poultice ap- plied over the parts has been reported of favorably. But more positive measures are at times found neces- 161 sary. A young man for a length of time kept a servant sitting in his room all night and a dim light burning, to awake him if he made any movement to- ward gratifying his morbid propensity. Different bandages and apparatus have been invented to be used at night, or day and night, to prevent any access to the parts; I have often seen them exhibited in the shop windows in Paris, ticketed ' appareil contre l'on- anisme.' A mother who discovered the vice in a daughter of seven years, without accusing her of it, ingeniously and effectually bandaged her, saying this was customary for girls of her age, and which proved successful. Using some means to render the organs sore and painful to the touch, either internally or externally has been found very' successful, in boys especially; blistering the penis, or with the parts immediately surrounding, has been one means which, by the subse- quent soreness that remains for some time, hinders the act in bed or while asleep. I do not remember to have seen it proposed as a direct preventive, but should strongly recommend cir- cumcision in boys, or even young men, when other means have failed, as a most promising measure; or even in children as a prompt and final measure; and by all means to be performed without the use of 162 chloroform. It must prove powerfully preventive, first, by the little shock caused by the pain, just bad enough to make a good impression on the mind; next, by the consequent soreness extending • over two or three weeks, just enough to make a long and distinct break in the habit; and lastly, and for all the future, by the perfect removal of that super-excitability which the foreskin maintains, and' which led Dr. Copland to say that ' the neglect of circumcision in Christian countries is certainly no mean physical cause of the prevalence of this vice, and of many of the conse- quences which follow. The institution of this rite for the descendants of Abraham, and the faithful observ- ance of it to the present day not only by them, but also by the followers of Mohammad, have tended, amid numerous countervailing influences and persecu- tions, to perpetuate an enduring and healthy race; the beneficial results of circumcision being experienced not only by the individual himself, but also by his offspring, and even indirectly by the female sex, as may be inferred from various physiological considerations.' And Dr. Lallemand writes, 'Indeed, after having long and seriously reflected on the numerous cases that have come under my notice, I have arrived at the opin- ion, that the discontinuance of the practice of circum- cising children is to be regretted; the operation is, 163 without doubt, unnecessary in many cases, but it can never be injurious, and in a great proportion it would be exceedingly useful.' The operation is quickly done and is perfectly free from danger; I have operated on the foreskin in many cases for other reasons, and never found the least diffi- culty arise from it. A nearly corresponding little op- eration in the female, of removing the offending part, which is small and taken away very quickly and with trifling pain, has repeatedly proved effectual, though recourse has been had to it only in extreme cases, being followed by perfect recovery both of body and mind. Men are very apt to propose the removal of their tes- ticles, either as an heroic remedy for the habit or for the debilitating seminal emissions. They seem to ima- gine that the whole difficulty is concentrated there, and surgeons have been importuned to castrate their patients, and in some instances have yielded to urgent and continued importunity; but it is a great mistake; such mutilation has been profoundly and injuriously felt throughout the whole nature, yet with but a par- tial cure, or total failure. It has been proposed to me by many patients, sometimes in earnest, sometimes suggesting it as perhaps a last resort—so general is the idea of its efficacy. 164 The indirect preventive means are in many cases sufficient. The principal, perhaps, of these consists in the thwarting of solitude. It should be so managed that the young person be very little alone, or for a very little while at a time; and that he or she never be sure of privacy or retirement at any time; and this may be done without the subject being aware of the reason or that it is really done with any special object. The habit of sleeping with the hands and arms out of bed and the face and neck uncovered should be formed from infancy, or afterward insisted on. Care should also be taken that little or no liquid is drunk near bed- time, or indeed after supper unless' in the hottest weather; also that the water is passed before getting into bed and the first thing on getting up. Keeping the young person by one device or other, during play, work or studies, constantly about or in the company of elder people is an important means, and greatly tends to keep the mind interested and diverted from self. It has sometimes been found neces- sary for the child to sleep with one of the parents, or a relative; instances are recorded of mothers sharing their bed with a daughter with the happiest result. Too much heat, either of clothing, dwelling apart- ments or bed, should be avoided, for a luxurious or delicate bringing up predisposes to sexual precocity. 165 Also, flannel should not be worn next the skin, and woollen pantaloons ought always to be lined because of the exciting or stimulating effect of such fabrics. Also, a child should be either sleepy or tired before going to bed; and partly to this end and partly to avoid temptation or risk early in the morning when erections are liable to occur naturally and healthily, he should always arise early. Exercise—muscular exer- cise to the extent of moderate fatigue, and out of doors as much as possible, affords perhaps the most powerful indirect means of prevention that can be employed. ' This alone is able to deaden the susceptibility of the newly acting organs which excite the economy; exer- cise alone, by requiring matter for the repair of the muscular waste it causes, withdraws a stimulus from the genital organs, and induces sound and refreshing sleep.' Prevention by precept is of little or no value. In quite young children it is, of course, utterly useless. In youths of either sex, growing up, or who are una- voidably exposed to or have a knowledge of the exist- ence of such a vice, a judicious word or two in the way of precaution and opportunely given, perhaps pointing to its effects in some one, or explaining its .inevitable and direful effects, especially as to loss of the much coveted attributes of manhood in the one sex, or of the 166 graces and charms of womanhood in the other—so managed as to look to and work upon the animal and intellectual pride, but in no way seeming to suspect the individual of such foolish practices, might, and probably would, be all-effective. But, if the habit is established and has told upon the system before it was suspected or discovered its influence over the mind and will is such that reproof, persuasion, eloquence, or anything else would be so many waste words—then, proof must be obtained, or as nearly as possible, the sufferer charged directly with it, the better by a physi- cian, and, according to the age of the subject the proper treatment, preventive, hygienic, or medical, or a combination of all, put in force. It has been recommended to make all acquainted with this subject; by some, under the reformer's cant plea of ' know thyself;' by others, without any know- ledge or thought at all. But if a child has been prop- erly brought up—has happily had parents or guaMians who were acquainted with these dangers and exercised a right watchfulness, its mind will remain innocent of such abominations; and if it sees or is told of such things by others its nature will recoil instinctively with a healthy animal pride. Still, if it is determined upon, or necessary, to expose a child or youth to the fearful risks of an ordinary boarding-school, then he 161 or she should either be judiciously informed of what will inevitably be met with, or be supplied with a proper book on the subject. The Hygienic Treatment may properly include every- thing that relates to the mode of life. But the rules usually laid down, though excellent in themselves, are given in so general a manner as often to do harm in- stead of good, for they are indiscriminately applied to all the stages alike. Diet is of the first importance in all cases. It should always be unirritating, easy of digestion, in moderate quantity ; and the supper or last meal of the day very light, and never taken so late that digestion must go on in bed. As a rule—all liquor, wine, beer or cider should be strictly abstained from ; and of all of them strong beer or ale is the worst. Coffee also is condemned by all observers, for it is not only a diuretic or excitant of the urinary organs, but ' augments the venereal de- sires, favors erections and accelerates ejaculations.' Tea is liable to the same objections but in a less de- gree ; coffee should therefore be rejected altogether, and tea, if taken at all, be only at breakfast, and then weak and cool, or cold ; no drinks of any kind should be taken hot. Smoked or salt meats, game, the dark 168 meats, and all shellfish, dried fish, rich soups, hashes or stews or highly seasoned meat dishes ; all condi- ments, are improper. Except when severe exercise or work require it, meat should only be eaten once a a day, either at breakfast or dinner as may seem to di- gest or agree best, and the white or young meats chosen when possible. Roasting or broiling is the best. There is no objection to fats or butter if they are di- gested. Tobacco must not be used at all, and above all not chewed. On the other hand ; all the refreshing and cool- ing drinks are proper—as soda-water, lemonade, root beer, toast-water, weak flaxseed tea or barley water agreeably flavored, liquorice water, ' eau sucr£'—which is two or three lumps of sugar dissolved in a tumbler of cold water and flavored with orange-flower water, currant jelly dissolved in water, and the like. Choco- late and cscoa are free from objection if they agree with the stomach.. Milk is, of all things, the most excellent, and in some cases it is for a time advisable to be confined to a strictly milk diet ; i. e. milk or its different pre- parations with rice, meal, bread, farina, arrowroot, &c, and they may be taken iced or merely warm. Milk alone will sometimes disagree, but it may be boiled and then taken cold or cool; sugar, salt, a 169 little black pepper, fruit jam or jelly, vary it agree- ably and make it set well. If it turn acid in the stomach a little calcined magnesia stirred into it, or lime water, will correct this. A raw egg stirred into any of the milk preparations while boiling hot so as to cook it at the same time, is very digestible when more nutriment is required. Sugar, all ripe fruits, especially strawberries and the juicy fruits ; bread, not hot or new ; all the fari- naceous articles of food ; boiled vegetables, the vege- tables usually eaten raw if they digest; salad pre- pared with oil, a little vinegar and salt and very little other condiment, are all proper. Simple soups or broths, not hot, and eaten with bread or potato, for they seldom agree without some solid matter ; an egg boiled soft and eaten with plenty of bread ; fish boiled ; beef or mutton, lamb, veal or poultry, either boiled, roast or broiled ; all these things give rise to the least possible heat or excitement in their digestion. But there are two rules that should never be lost sight of, especially by invalids, viz. to thoroughly chew and mix every mouthful with saliva ; and, to drink as little as possible with a meal ; sometime after- ward thirst will come properly ; and, for the sake of 15 110 the stomach and digestion the spittle ought always, when not poisoned with tobacco, to be swallowed at all times. Children should be allowed no tea or coffee nor any condiment but salt, even in health. Children, or pa- tients in the first stage should, for a greater or less time, be confined to farinaceous, vegetable and fruit diet, or perhaps even to a milk diet ; but scrofulous subjects must always be allowed a much more nutritive, and even stimulant diet, than others. In the second stage the diet should generally be pretty strict, but where much muscular exercise is per- formed meat at breakfast or dinner, or even at both, may be proper ; or where the patient is of a delicate constitution, or is much reduced. In the third stage a strengthening, or perhaps more stimulant diet, may be called for ; the judicious use of condiments, good wine, or liquor ; governed very muclj by the capabilities of the stomach and requirements of the system ; though, generally, tonic medicine will have a great advantage over stimulant drinks of any kind. Exercise, as a rule, should be carried to the extent of moderate fatigue—producing a desire to go to bed for actual rest, and consequent sound sleep ; muscular Ill exercise, whether work, play or otherwise, should be in the open air as much as possible. But in weak or delicate individuals, or those in the third, or far ad- vanced in the second stage, real fatigue would often prove injurious, just as a severe or low diet would. Such should also rest for a time after a meal. They must use exercise with a prudent care ; if it become necessary to take rest during the day sleep is to be strictly guarded against ; it must be saved for bed- time. Riding on horseback or in a vehicle is never good ; when, on account of debility the latter is necessary, the seat should be of cane, or as little heating as possible. Gymnastic exercises are commonly recommended, but are not half as good as natural and wholesome out-door sports, walking, work, or other occupation. Hunting— not on horseback—is of all the most salutary in this disease, for, as J. J. Rousseau has well said, ' Diana is the enemy of love.' And so true is this that persons exceedingly fond of sporting have been known to lose their venereal desires, in some instances to such a degree as, for the time, to amount to impotence. The rule as to exercise is to take as much as is borne without over-fatigue, and to increase it in proportion to returning strength. In the first stage it may always be pushed to actual fatigue ; in the 112 second, if there is much debility, or nervous symptoms are prominent, or there is excitability of the system, or of the bladder and seminal organs, any real fatigue will react injuriously, and exercise must be used with some moderation; the complications attending the third stage require its nice adaptation to the circum- stances of each individual case. Occupation of the Mind, in some agreeable or pro- fitable way, either by reading, conversation, or light occupation or responsibility that engages the mind or attention, is also of great service, subject to the same rules as muscular exercise as regards carrying it to the extent of fatigue. The judicious combination of these two kinds of exercise is especially productive of sound and refreshing sleep. But all such advice is most applicable to the two first stages. When the system is actually debi- litated, or the nerves 'gone,' the mind weak or hypochondriac; ' when,' as Dr. Lallemand says, ' a man is fatigued by the least exercise, how can we expect that he shall occupy himself.with walking or gar- dening ? How can we desire him to go into society, when the simple presence of a woman intimidates him and recalls all his former misfortunes ? How can we expect him to enjoy conversation, when he loses its thread every moment? When his memory leaves 113 him, and when he feels his nullity? We persuade him to seek amusements and pleasures, but are they such to him ? Is not the happiness of others his greatest punishment?. Because he is unable to follow our advice we accuse him of unwillingness, and we wish to compel him. Let us first remove the cause of our patient's disease, and we shall soon see that his character and conduct will change, and that he will return to his natural tastes and habits.' The Bed should be cool and hard ; a hair mattrass is the best of all, with a bolster of the same and just high enough to keep the head on the same plane with the body ; pillows should be dispensed with, and particularly feather pillows, which heat the head so much, are very objectionable in these cases. And the hab|t of lying with the neck bent to an angle with the body and the free circulation of the blood to and from the head impeded ; or sleeping in a half-sitting posture, are bad. Seven hours sleep is, probably, the proper average ; some constitutions however doing better with an hour less and some with an hour more. It is better, if possible, not to go to bed till tired or sleepy; and the rule should be strictly obeyed, to get up immediately on awaking. And the same holds with regard to garments; flannel should not be worn next the skin; the panta- 114 loons ought to be loose, not too thick, and always lined. The head should be kept cool, the hair being cut short, and the *hat a light one and kept off as much as practicable; also, whatever is worn round the neck ought to be loose, and light. Staying long in heated air is also to be avoided. Cold Bathing is a means of great value if judiciously employed; but it has, perhaps more than any other thing, been universally and indiscriminately recom- mended, and hence been productive of as much harm as good. It is really subject to about the same rules as are applicable to exercise, and which therefore need not be repeated; but tepid, or warm baths, will always be substituted with benefit when cold disagrees. It is a practice excellent beyond exaggeration to use children to the daily cold bath from infancy till they are old enough to take charge of it themselves ; and then, if necessary—which it rarely will be, to insist on its continuance. If a child is very delicate the chill may just be taken off, and be done in a wartn room in very cold weather ; otherwise no such pre- cautions will be needed. My own children have been treated so from the age of a month or two ; not merely washed, but bathed in a tub, to their incal- culable benefit and great delight, the dislike only being at leaving the water, no matter how cold. 115 This, with a preponderating farinaceous diet, plenty of sunshine and out of door exercise, and being taught a little at home only till seven or eight years old, is infallible against masturbation during childhood or early youth ; and, with an intelligent vigilance against outside influence, a child so favored will grow up to the fullest development of his powers physical or mental, whatever that may be. Washing or sponging all over, every night, before getting into bed, is a most excellent thing for adults, is always applicable during the first and generally during the second stage, and is a good substitute when a bath cannot be had. It is very conducive to sound healthy sleep and is, I think, much more useful at night than in the morning as is sometimes recommended. In delicate subjects or where it is particularly desirable to insure reaction on the surface, a little salt may be added, to the water; for which purpose the unpurified, or rock salt, is the best. Either bathing, or washing in this way, is indispen- sable; it also insures cleanliness of the parts, which, in the female, is doubly important; and in her case local ablutions should be practised in the morning also, but for this, generally, without the salt. When change of air or scene is proposed a colder climate or locality should always be chosen. 116 Marriage is, in this connexion, a question of grave importance, for it may lead to serious aggravation of the disease and sometimes to a fatal termination, insanity, or suicide; toward the deceived girl it is, at the best, an injustifiable cruelty. Yet it is the commonest thing to prescribe marriage, indiscrimi- nately, as a remedy for this disease. The advice, momentous as it is, seems to be given without a thought—to take a little tincture of iron, and get married. Physicians in general practice know literally nothing of the disease of masturbation; and they are not to be blamed for it: in medical schools it is ignored; patients rarely mention it to their doctor under any circum- stances, and would, as if by instinct, flatly and persis- tently deny it if hinted at by him. And again, if he has any practice at all he is seldom without cases of such importance, if not of life and death depending upon him, that he has neither time nor thought to spare for any speciality; nor would he generally have cases enough to yield him the necessary experience were he inclined to do so. The blame is therefore not so much in the want of knowledge as in not sending the case to, or calling in the assistance of those who have—and then, he cannot turn to an empiric. I have had many cases of seminal disease in married Ill persons; some have told me that the internal excitation has urged them to the act of self-abuse even whilst lying beside their wife; in others nocturnal seminal emissions have steadily persisted, or returned when- ever the sexual act was hindered for a time; in many the natural act itself has been attended with a pain, or sense of heat or smarting at the moment of ejaculation, or continuing afterward, or has been followed by symp- toms or effects such as follow unnatural or morbid emissions. Many complain of great disappointment, absence, more or less complete, of the anticipated plea- sure of the act; or, diurnal emissions have set in, with their sad consequences physical and mental. In some the individual had been married for years, and had children. Dr. Copland, after mentioning some very similar cases occurring in his own experience, says, ' This, and similar cases, have shown that marriage, which will prove a cure of the complaint in many instances, will not always prevent its occurrence, or remove it when it depends upon chronic irritation of the mouths of the seminal ducts, and upon congestion and enlargement of the prostate gland;' and in the next paragraph re- marks that under sufficiently favorable circumstances ' marriage will generally bring about the healthy state of the sexual organs, if they be very moderately and 16 118 regularly exercised at the promptings of sincere affec- tion in connection with sexual desire.' 'But it is always preferable that the complaint should be re. moved before the married life is commenced'.' Dr. Lallemand observes, very truly, ' It is not long, in such cases, before we are embarrassed by questions about the propriety of marriage, being put to us: this is a matter which is serious in all its aspects, and on which the least scrupulous should not pronounce, with- out having had sufficient assurance of their patient's return to health. The question of our patient's health is not now the only one, nor is even his future happi- ness alone implicated; the fate of the innocent being who is about to be associated with him, is the matter of chief importance, and justice to her demands that we do not counsel matrimony, until sufficiently long proof has been given that our patient's re-establish- ment is permanent.' These are, perhaps, the highest modern authorities that can be cited, yet they throw no light upon the question when marriage may properly be recommended as a remedy for masturbation or its effects; and I can remember none that do; whilst the opinion of some is very vague and quite useless as a guide. Yet, undoubtedly, marriage is sometimes the true 119 remedy and the only one that is required—whilst, sometimes, it is perfectly noxious. When, then, should marriage be recommended; and, when should it be pro- hibited ? As the result of my experience, which has been long and extensive, it may be considered as a rule that marriage will prove remedial, for the male, at any time within the duration of the first stage—perhaps with a little preliminary cooling hygienic treatment; of course, provided the subject be of a proper age, and that he indulge ' very moderately and regularly, at the promptings of sincere affection, in connection with sexual desire;'—and these three points have a signifi- cance and importance of which few are aware. But, at any period after the accession of the second stage marriage will prove injurious, if not disastrous. It must not be thought of till the special disease has been cured and the general health re-established. I have brought many cases to this so desirable termination, and in a manner satisfactory to all concerned, as time has abundantly proved; and such truths ought to be stated, for I find they greatly confirm hope and encour- age confidence, which, in all these patients, need every help. In girls it will, as a rule, always prove the remedy; also in women where there is no disease of the neck of the womb, or where it has been cured; of course taking into account the general health. 180 THE MEDICAL TREATMENT. This part of the subject is one of peculiar interest to the patient because of the dangers by which he is as- sailed in his search for the competent and faithful assistance it needs; to the true physician because of its complicated nature. First, then, in order to guard my readers against these dangers, I will make some cursory remarks des- criptive of the former; and then some few explanatory of the latter. The subject being one of such peculiar privacy and delicacy that it is not generally mentioned even to the nearest friend, it cannot be talked about; and herein lies the opportunity of the heartless charlatan. Re- course must be had to the newspapers, and there he can lay his snares with what art or ingenuity he is master of. Accordingly, in one column will be found self-styled doctors who promise cures in almtfst no time at all, and by means so simple and pleasant that it would seem almost a piece of good fortune to need their ser- vices; or medicines called 'cordials,' 'essences,' 'reju- venators,' etc., etc., of such amazing efficacy as to fall little short of miraculous—and persons are found who are as easily gulled as this. In another column a 181 more dangerous snare is encountered; a pamphlet, letter, or little book is advertised to be forwarded to any one on receipt of a postage stamp or two. Now this will prove to be some very specious, and per- haps well-worded but utterly empirical production, sometimes so suggestive or immoral as to be ap- parently intended to excite to the very vices it pre- tends to censure, or merely teaching how to avoid the consequences of vice, and, at best, proving to be a mere advertising circular. Or perhaps a respectable looking book is purchased, which may turn out no better, being the same thing on a larger scale, with many quotations some acknowledged and some not, much superficially learned language and specious argument dressed in technical phraseology, all apparently conclu- sive to the reader who necessarily knows nothing of the subject; the whole being intended to prove that the author (?) who compiled the mass of quotations, com- monplaces and false statements, or who, as in two or three of them, employed other brains to get it up for him, is the only person in the country, if not in the world, who can cure the complaint: all this is literally true of several, and more or less of almost all. Passing over the extravagant promises of the ad- vertising ' doctors' and the various all-potent cordials and essences as unworthy of the notice of persons of 182 any intelligence; also the promises to cure without any kind of local treatment at all but by the use of medi- cines alone, as but loss of time at the very best; and the various emanations from self-constituted colleges and institutions as the most bare-faced imposture, in- asmuch as no real medical college in the world ever put forth anything of the kind; I would mention as dangerous beyond all, the different external appliances or instruments professing to cure seminal weaknesses or emissions at once, without any trouble or disagreable whatever. These things sometimes pretend to be the invention of some notable european professor, to have superseded everything else in their own country, to be, in fact, infallible, and to have been sent here from the purest motives of humanity: I suppose they pre- sume upon the weakening influence that self-abuse and seminal disorders have upon the intellect. Now, these things cannot cure, as any one who has read the description I have given of the nature of the disease—and which no real medical man will contra- dict, must at once see. But this is not the worst; their inevitable tendency is to aggravate the disease by inducing, in place of the obvious nocturnal emis- sions, the obscure and insidious internal emissions. There is a natural tendency, sooner or later after the establishment of the second stage, for the emis- 183 sions to begin to lose their spasmodic character, to occur with less and less erection and sensation, in a word, to degenerate into unconscious diurnal emis- sions, i.e., seminal gleet, or, under certain circum- stances, into internal emissions, the most serious and dangerous of all the forms of seminal disease. And it is into this latter especially that all these con- trivances are so apt to bring the case. Numbers of instances are recorded in which persons, thinking to prevent the seminal discharges when abus- ing themselves, or to arrest the nocturnal emissions when awakened by it in time, and thus stop the loss of semen and save their strength, have resorted to the device of firmly squeezing or compressing the penis, close to the body; and after a time they have suc- ceeded—no more emissions have been seen; yet their health and strength have deteriorated even more rapidly than before. The natural process has been reversed; the semen has of course been none the less discharged, but it has gone backward into the bladder. And this is the very effect produced by the various in- struments or appliances referred to; the most obscure and obstinate, and in view of the probable conse- quences the most serious possible form of the disease being initiated. And the cruelly deluded patient thinking he is cured, when the almost inevitable hypo- 184 chondria, insanity, consumption or marasmus super- venes and proves utterly intractable, wastes away or rapidly dies, really of unrecognised internal seminal emissions. Of course it is not always thus; often, perhaps gene- rally, the instrument fortunately fails—has no effect, and is soon thrown by as useless. Although the cure of masturbation, or of the effects of excess, is possible in almost all cases—sometimes when all hope would seem to have fled; and certain, under a proper course of treatment, in the great ma- jority of cases, yet expectation of a quick cure must be dismissed as unreasonable. It is a disease, or associa- tion of diseases, that has been gradually brought about, has in many cases become as it were constitu- tional; its production has always been a matter of time, and its treatment must be more or less slow and gradual—time must also constitute one of the remedies; in ever so slight or early a case it will only be comparatively rapid, the cure will also be a matter of time. As Dr. Deslandes says, ' The physician who would attempt to hasten it by the employment of ac- tive remedies, would soon exhaust the system.' Pa- tience is necessary; when final success—a perfect cure, may be looked forward to with all confidence after it 185 had seemed doubtful or been utterly despaired of, surely the necessary patience can be commanded. Then, it is a complicated disorder ; even in the first stage the symptoms show how profoundly, though not yet permanently, the whole individual is affected in the physical powers, the digestion, the nervous system—is altered in the sexual feelings, the disposition, the tem- per. In the second stage some of these become actual diseased conditions ; and then also, certain parts of the seminal organs are more or principally affected, the manner and degree of which materially influences the treatment. The complications with other organs must also be understood, for they react upon the special dis- ease. And in the third stage other diseases are always established and must also be successfully combatted and removed. Then, again, Stricture may complicate the case by becoming really a prominent part of it, or be the only remaining and permanent consequence and give rise to a continuation of all the other symptoms, as explained in Chapter VI. ; or one of the forms of seminal gleet, or still worse internal emissions, may remain unsus- pected, as is there also explained. Now, if all this is true can anything but disappoint- ment, loss of invaluable time and of money result from 186 trusting to empirics, cordials, curious contrivances, et hoc genus omne. Is it not, on the contrary, plain that no plan of treatment can be prescribed for one case that is at all sure to be proper, or that may not be ac- tually improper, for the next case. To attempt to lay down a plan of treatment would be censurable. There is one point on which a patient should be put right—it relates to the nocturnal seminal emissions. He very naturally supposes that when he is thorough- ly cured the emissions will cease altogether ; he is also led to suppose so by the professions of charlatans and nostrum-makers ; it will not be so, and must not be looked for as a proof of cure. Emissions do not always and necessarily imply disease, and that is one reason why they cannot be totally put a stop to. All the sem- inal organs, the testicles, prostate gland, and seminal vesicles are each, after the age of puberty, constantly engaged in the elaboration of their part of the secre- tion which, all together, constitutes the semen. Yet generally, if not always, in a person perfectly healthy both in body and mind and who has never provoked a discharge either by natural or unnatural means, this is so nicely proportioned as not to exceed the capability of re-absorption into the blood. But, when, by right or wrong means, the semen has been discharged, not only is the entire secretion at once and permanently aug- 181 mented both by the new stimulus from the mind and the need of increased quantity, but a habit or fa- cility of discharge is established—all which, of course, may be legitimate and healthy; but the quan- tity continues, in some degree, to exceed the power of re-absorption ; and, the habit of throwing off any su- perabundance has, as may be said, been learnt. Such being the truth of the case, so long as it continues healthy and its natural and proper remedy cannot be availed of, an occasional nocturnal emission should really be considered favorable, for it proves a safeguard against diurnal emissions or seminal gleet—affections most to be dreaded. The question then comes to be—How is a healthy and laudable emission to be distinguished from a dis- eased and culpable one ? and, How often may it oc- cur compatibly with health ? When a nocturnal seminal emission is really the nat- ural relief of over accumulation it is energetic, ' accom- panied with a dream, complete erection and lively sensations' more or less well marked ; and, most es- pecially, is not succeeded by dullness or languor but rather by a sense of relief—the person even feels the better for it. With regard to frequency, governed by mode of liv- ing and associations, but most particularly by sexual 188 temperament, it may occur once in three to six weeks; seldom regularly ; the intervals may sometimes be very long, and then two are apt to happen quite near together. The natural and proper remedy above referred to for this state of things, is marriage. As Dr. Lallemand so well says, ' natural moderate exercise can alone give to the organs (internal) sufficient energy, and suffi- ciently regular habits to arrest nocturnal pollutions, and to prevent the occurrence of diurnal ones. No one would think of depriving a delicate child of exer- cise simply because he shows less disposition for it than his companions. Every one, on the contrary, would understand that it is the only means by which his weak constitution can be strengthened, if not ren- dered hardy. The same reasoning holds good in re- spect to the cases under consideration.' CHAPTER VIII. SEXUAL EXCESSES AND IRREGULARITIES. Sexual Excesses and Irregularities.—Capable of the same effects as abuse—What is excess—Causes disease in the same way that abuse does—Circumstances under which excesses are most hurtful —The more important described—Special causes of excesses- Sexual wants of the system—Difficulty of laying down a general rule—Imperfection of those heretofore given—Necessity of some rule to decide between moderation and excess—The only true rules—Sexual irregularities—How they are injurious—The more important and dangerous described—Facts deeply interesting to all, yet generaUy unknown. The subject of seminal diseases should not be con- cluded without taking into consideration the part that the various excesses and irregularities in the natural act itself plays in their production; for, although masturbation or abuse is by far the most frequent as well as effective cause, yet others do prevail exten- sively and are productive of much mischief. As the symptoms and consequences are pretty much the same, and the nature of the disease is identical, when once produced, let the cause have been what it may, it would be superfluous to repeat 190 them here. The difference exists only in the nature or character of the cause; the one, abuse or masturba- tion, is unnatural and vicious, cannot be right under any circumstances, and whatever effect it has is for mischief only; whilst the sexual act, under proper circumstances, is natural and virtuous and actually beneficial, and is only wrong and hurtful when in- dulged excessively or irregularly; and irregularity itself is hurtful just in proportion as it departs from what is natural and approaches in character to abuse or onanism. It would seem better to consider the subjects of excess and of irregularity separately. The first question that naturally arises is, What is excess ? Dr. Lallemand says, ' I consider venereal excesses to consist of all sexual intercourse carried beyond the actual wants of the system.' What the exact wants of the system are it is generally difficult to tell in any given case, and for many reasons. To lay down a general rule, then, is impossible, owing not only to the great diversity that exists in this respect amongst different persons, and even in the same per- son at different times, but also to possible morbid reasons; and all of which is again affected by the kind of occupation, mode of living, and so on. This want can, however, always be determined by the individual for the time being, by a very safe and reliable rule which will be given hereafter. 191 Excesses give rise to disease in the same way that abuse does, viz. : by exciting local irritation, which soon reaches the neck of the bladder, irritating the prostate gland and causing too frequent desire to make water, a symptom always, and first of all, to be noticed; from this it extends to the other seminal organs. And thus a morbid desire is established; erections are more frequent, the desire more impor-' tunate, and the individual may actually imagine that his organs and powers are growing stronger by exercise ! If, for any reason, he should now very much moderate or abstain from indulgence, nocturnal seminal emis- sions take place and add to the deception by ap- parently proving an actual need of intercourse. Yet it is but evidence of irritation—of commencing disease, and which may lead to the worst results. Still, in natural and legitimate indulgence there is much and wonderful compensation ; in abuse there is none whatever—the one is necessarily and inva- riably hurtful, the other rather possibly and occa- sionally. SEXUAL EXCESSES are most liable to occur, or to prove hurtful, under certain conditions or circumstances; and here again I will rather illustrate by quotations from eminent authorities, than by my own statements. 192 ' The age,' Dr. Deslandes says, ' at which the vene- real power enters into full action, and when its exercise is attended with the least detriment has been generally determined on two distinct grounds; first, the physical aptitude for sexual intercourse; second, the general state of the organisation. The marriageable age has been fixed at an earlier or later period according as legislators have assumed one or the other of these bases. The first served as founda- tions for the matrimonial' laws of the Romans; and probably the second served as a guide to Lycurgus, who prohibited men from marrying before the age of thirty-seven, and to Plato who recommended that every child born of a female younger than twenty years old or begotten by a man less than thirty years, should be branded with infamy. J. J. Rousseau too reasons in the same manner: 'until the age of twenty,' he says, 'the body grows and has need of all its ' substance : continence is natural, and if not observed it is at the expense of the constitution.' Although the physical aptitude for coition comes at the age of puberty, this fact proves nothing except that the genital organs can then be used. It does not follow that the genital power is fully developed or that the body is in the state most favorable for its use ? Particular circumstances in which the sexual act 193 becomes an excess. Dr. Deslandes again says, ' When an individual suddenly changes his mode of living, and the influences to which he has been exposed, and becomes subject to new influences, his health generally suffers to a certain extent. This is seen in the young man who comes directly from the pure air of the country into the confined atmosphere of the city, and in those who remove from the temperate to the torrid zone. The action of powerful causes of disease, of excessive heat, of deleterious exhala- tions, often adds to the simple change of habit. Thus all authors who have written on the diseases of warm countries, consider the act of venery as one of the most active occasional causes of yellow fever, of malignant fevers, of cholera morbus, and generally of the severe diseases contracted by Europeans. A similar disposition may be seen in young men who pass many hours in the infected atmosphere of hos- pitals, and particularly in dissecting-rooms, if they indulge with females or in onanism ; typhus fevers have been caused by it.' ' The individual who lives in a filthy neighborhood, who experiences privations, who indulges to excess in wine or spirituous liquors, who labors hard either cor- poreally or mentally, who is deprived of sleep, who is affected with sadness, etc., bears the act of venery badly; it adds to the enervation already felt, and gen- ii 194 erally robs the individuals of health. Venereal plea- sures should be abstained from during the prevalence of epidemics: every person is then disposed to the pre- vailing disease, and a single act of coition may pro- duce it.' ' The influence of the act of venery is much more in- jurious, when the causes which we have mentioned, and generally all those which impair the constitution, have affected it to a greater or * less degree. Diseases of long duration, if badly treated, excesses, and the causes mentioned above, may bring the system to such a state that enjoyments, even if seldom indulged in, may produce great suffering and disease. Venereal excesses may also create predispositions and change them as well as those which have a different origin, into other morbid affections.' 'Vanity, Dr. Lallemand observes, 'is perhaps the most common cause of venereal excesses. Man covets the esteem of his race; and especially that of woman, of whom he is the natural protector. It is when in the presence of woman that he is proud of his intellectual and physical superiority, and of his social position; but it is his virile power of which he is^ especially proud, and which he endeavors to prove—those who are the least strong in this respect, fear the most to allow their weakness to appear. Hence excesses 195 arise, which are not caused by the real necessities, and which do not spring from a violent passion. Young men who have given themselves up to the ardor of their passions soon after their marriage, endeavor to sustain the excesses with which they commenced. They dread causing a suspicion of coolness, or of infi- delity, though they very soon repent of their first im- prudence—their irritated organs being no longer in the physiological condition which at first permitted them to support excesses. If I may judge from the facts I have learned from patients, their venereal excesses have been caused more frequently by an unfortunate vanity than by an ardent attachment. I admit all that an exclusive and blind passion concentrated on one object is capable of; but this does not prevent the im- pulses of which I have just spoken from acting at the same time; it must even lend them more energy.' 'Excitement caused by an ardent attachment un- doubtedly exposes to great excesses, and it is not less evident that these excesses may become hurtful; but they are not so much so as if, were it possible, the same individual had committed them with perfect in- difference. This is easily explained by referring to the excitement which the whole economy receives from feelings of joy and pride.' With regard to the wants of the system in a sexual 196 point of view, these, as before remarked, may be very deceptive, and quite out of the power of the individual to form any just estimate of. The only wise and safe course to pursue'when a person has inordinate, very frequent, or importunate venereal feelings, which he is conscious are tending, or amount, to excess, is to dis- cover wherein lies the cause, and to have it remedied. 'The genital wants,' Dr. Lallemand says 'may be ficti- tious; a violent attachment may, in this respect, give rise to great illusions; the direct irritation brought on by external eruptions, by the presence of thread-worms in the fundament, may excite morbid erections which have no connection with the real wants of the system. Irritation in the lower and back part of the brain, the spinal cord, or the nerves supplying the genital organs, may produce the same effects, so that the frequency and duration of the erections will not always show the amount of the true powers. In many persons the de- sires are greater than the powers of fulfillment; the imagination of such is constantly occupied by erotic ideas whilst their physical powers are very little. The impulse in these persons is purely derived from the brain, and their immoderate desires cannot, therefore, furnish a measure of their real wants.' Many other states might be named; as, cracks or sores on the edge of the fundament; frequent accumu- lation of hardened stool in the lower gut, or the con- 191 tinual presence of hardened portions; irritability of some part of the seminal organs in the male, or appen- dages of the womb in the female, induced by past ex- cess or abuse, or by some disease; holding the water too long—this is very noticeable in the morning when erections that had been unyielding and urgent disap- pear at once on making water. In the female a variety of irritations and eruptions affecting the external parts or their proximity; collections of acrid secretion; un- due development of certain parts, may excite such feel- ings to a distressing degree. After what has been said some rule will naturally be asked for, by which any one who is desirous of acting prudently in a matter of such profound importance— in truth, of increasing and prolonging his capacity of enjoyment, and, in all human probability, of prolonging his life—may be guided. All kinds of rules have been laid down, especially by reformatory and other empirical philosophers, but generally with the radical fault of looking to the fre- quency of the act—a superficial view quite in keeping with the erudition of these gentry. Now, individuals differ so widely that the best rule of that kind, though of course it would be suitable to many, would over- tax some, and not satisfy others. I was intimate- ly acquainted with a medical student in Paris who told 198 me he only indulged about twice a year, and that if he married he thought once a month ought to satisfy his wife. Another, a resident of this city, and whom I had known some years, told nTe that he had never omitted a single night since his marriage unless his wife's health actually prohibited him ; he had then been mar- ried many years and was having a large family ; and both of these persons were, I have every reason to be- lieve, in the enjoyment of perfect health. The only general rule that can be laid down, is, that it shall not exceed the real wants of the system—which wants can only be known by experience in each indi- vidual case. As Dr. Lallemand says, ' The following signs cannot be misunderstood, and are applicable in all cases ;' and I cannot improve upon his own words. The following may therefore be taken as the rules whereby to determine moderation or excess. ' When coitus is followed by a sense of happiness, of general comfort, and of increased strength ; when the intellect is more acute, and the body more active; when an inclination to take exercise, or to engage in intellectual excitement is observed, together with in- creased activity of the genital organs, it is evident that an imperious want has been satisfied within the limits necessary to health. The happy influence all the or- 199 gans experience from the act is similar to that which follows the accomplishment of every other function necessary to the economy.' ' On the contrary— When coitus is followed by a feeling of sadness, of uneasiness, fatigue, or satiety; when heaviness of the head and a disposition to sleep occur, with confusion in the ideas and disinclination for exercise, it may be pre- sumed that the act has teen too often repeated, or performed under unfavorable circumstances ; and erec- tions, however energetic, which occur soon afterwards, should be considered as excited by the commencement of irritation, and not by the return of the want.' These two rules are simple, intelligible, easy to re- member. He then goes on to say, that, ' It is only when coitus is followed by all these marks of debility, that it is in- jurious ; indeed, sadness, ill-temper, and regret are never shown, unless the act be too often or unseason- ably repeated. Such conditions, therefore, should be sufficient to show that there has been either excess or unfitness—which produce the same effects.' ' These two classes of phenomena, however, are rarely of so striking a nature as I have just supposed, because, on the one hand, the want is seldom very im- 200 perious, and on the other, the excess is seldom very great ; but at the same time there are few who have not experienced something analagous to the one case or the other. Cases intermediate between these extremes, constitute the ordinary course of life ; then coitus is followed by no remarkable phenomena, and hence we must conclude that in the majority of cases it isfar from exciting the hurtful influence on the econ- omy that has been attributed to it.' SEXUAL IRREGULARITIES Are injurious exactly in proportion as they deviate from the natural act. The faults we have just been considering are to a certain extent natural, and are comparatively excusable ; but these are in no way natural, but highly censurable. They are, in kind, if not in degree, the same as masturbation or onanism, with the latter of which some of them are, properly speaking, identical. Variety. ' Gregarious amours' partake both of the nature of irregularity and excess ; of irregularity in- asmuch as it is without doubt unnatural and most in- jurious in an intellectual and moral point of view—of excess as it leads to indulgence which is not really re- quired ; and even when fatigue, or an internal morbid condition, indicates abstinence ; and then proves di- - rectly injurious. 201 After meals it is always better to abstain, for though, •in many persons, a marked desire occurs at such times it must be classed amongst the deceptive or merely apparent wants of the system. Dr. Deslandes observes, ' We cannot say that they are then always injurious, as this would be contradicted by facts ; but that they frequently are is supported by the opinions of all authors who have written on the subject. The act of venery during digestion may' injure in two ways. First, by deranging the digestive system, and by ex- posing it to the affections which are the usual conse- quences of such derangement. Secondly, by causing a general state of excitement, which adds to that caused by the digestive process. All the organs, as the heart, lungs, brain, &c, are, during digestion, in a state of excitement or congestion ; they are crowded with blood, as is indicated by a great number of symptoms. It can easily be imagined that venereal excitement under such circumstances may become the cause of inflammations and organic affections, or may, at least, contribute to their development; by increas- ing also a congestion caused by an abundant repast, it may immediately excite severe and fatal symptoms. Instances of individuals who have died during the act of coition, after leaving the dinner table, are by no means rare.' Toying, without intention or possibility of gratifying 18 202 the naturally excited organs, is a direct cause of dis- ease when often repeated and long continued. It first affects the testicle, which grows heavy and painful, exceedingly tender to the touch, its veins varicose and a pain running through the groin to the lower part of the belly—all this sometimes remaining hours before it subsides. Serious, cases of seminal disease are recorded from this cause alone. I have been consulted in cases having no other origin. Drunkenness. ' During complete intoxication,' Dr. Lallemand says, '.coitus is impossible, because the functions of the cerebro-spinal system are suspended. But when fermented liquors have produced effects short of stupefaction, when excitement is followed by a com- mencing weakness, with a disposition to somnolency, venereal excitement is frequently manifested, on the nature of which it is very easy to be deceived, because in this state nothing is feared. Indifferent erections occur. These may suffice to permit the commence- ment of coitus, but the sensibility of the genital organs is blunted, for the same reason that all other sensa- tions are vague and dull. The pleasurable feeling may be sufficient to keep up the erection, but does not suf-" fice to produce that high state of excitement which is necessary for the accomplishment of the act. This dim- inution of sensibility then, renders coitus incomplete, 203 or retards its consummation, sometimes even render- ing it impossible. It becomes evident, therefore, that such ineffectual efforts must favor the development of irritation in parts which are at the same time in a state of more or less active congestion.' ' Again, on the other hand, it is well known that fer- mented liquors irritate the genito-urinary organs, and that those who take them in excess frequently lose their virility. It is well known too, that drunkards are subject to chronic catarrh of the bladder, to engorge- ment of the prostate gland, pain in urinating, retention of urine and chronic gleet ; and I have before shown that wine is hurtful to patients laboring under seminal emissions.' ' Fermented drinks, then, taken in excess, produce an excitement in the genito-urinary organs, which is very likely to run into a state of permanent irritation, at the same time that they disturb the intellect, blunt all sensations, and prolong the efforts of coitus by post- poning the convulsive action which concludes the act. Hence it occurs that those tissues, already irritated by the direct action of the fermented liquors, are still more disturbed by the violent and prolonged action of such unsuitable efforts. It is not wonderful, then, that coitus under such unfavorable circumstances should often produce hurtful results.' 204 Imperfect erections; attempts at connection under such circumstances is a most direct infraction of the fundamental rule. In a well-balanced condition erec- tions are seldom urgent except in presence of the nat- ural stimulus, and at all other times are controllable ; but, if it happen in the lecherous and morbid condition of the brain so often induced, immoderate desire is felt to which the organ does not respond, or but imper- fectly. Various means are then devised by one or both parties to excite the desired state. It is doubt- less done in ignorance; but it is an ignorance almost universal. This ' weakness' is always a sign of the establishment of a diseased state which all such at- tempts inevitably increase. For remedying this stim- ulating food and drinks are consumed, and the various stimulating nostrums bought and swallowed, all which, exactly in proportion to the effect they have are so much ruination to the faculty they are taken to restore. Instruments are also indirectly advertised in the pa- pers, or secretly in little pamphlets &c, ultimately ruinous in their tendency, and founded on the gross- est ignorance, or knavery, or both ; a new one that was shown to me lately is of a character so utterly de- structive that I could not have imagined a man infam- ous enough to originate, or sordid enough to sell it ; yet both, I suppose, pass for respectable. persons in this city. 205 Prolonging the act is very prone, by the too confin- ed engorgement which it causes, to produce irritation and subsequent chronic inflammation, whereby actual disease is established. The use of the condom for whatever reason ; also withdrawing before the completion of the act, are noth- ing more nor less than literal and unmitigated onanism. Their effect is, upon the mind, demoralising and de- basing, and on the female mind most fearfully so—yet there are men (?) who do not hesitate to subject even their own wife to such influence ; upon the body the effect is, slowly though surely, that of masturbation, in kind if not in degree. Lewd thoughts and conversation—the habit of allowing the mind to dwell on venereal subjects. There are per- sons who, quite above the commission of so foolish a crime against nature as masturbation, yet indulge, and even revel in the bawdiest imaginings. This is a form of abuse that must not be overlooked here, for it is chargeable with the most serious and even fatal effects. And it becomes the more important because no one seems to be aware of its true nature and consequences. This form of vice is well described by Prof. Hufeland under the apt name of Moral Onanism ; and, just as he says ; ' it is possible without bodily pollution ; but it 206 exhausts in a dreadful manner also. I here allude to heating and filling the imagination with obscene and lascivious ideas, and a vicious and habitual propensity to indulge in such thoughts. This evil may, at length, become a real disease of the mind ; the imagination is then totally corrupted, and governs the whole soul : nothing is interesting to men subject to it, but what relates to lewdness ; the slightest impression of that kind excites in them a general fervor and irritation ; their whole existence is a continual fever, which weak- ens the more, as it always stimulates without gratifi- cation. This state may be found, above all, among vo- luptuaries who have abandoned sensual enjoyment, but who endeavor, by such mental indulgence, to make themselves amends, without reflecting that in its con- sequences it is almost equally destructive ; also in re- ligious celibacy, where mental onanism can assume the mark of fervid devotion, and conceal itself under the appearance of divine rapture and ecstacy ; and, lastly, among idle persons of the other sex, who, by novels and the like means, have corrupted their imagin- ations, and excited in them a propensity which is not unfrequently honored with the modish name of sen- sibility ; and who, under a stiff and severe outside, in- dulge often in the lewdest and most dissolute ideas.' I have known persons who, in all probability and 201 as evidently as symptoms could proclaim it, have died from this cause ; and I know others who will almost certainly meet the same fate—who even themselves profess to believe so. An instance of the former occurred in a gentleman a little beyond middle age, married, of most pleasing manners and a general favorite. Standing at his store door down Broadway, no female at all attractive could pass without eliciting exclamations about her ankle, bust, and so on ad extremum. Treating him for a slight stricture at one time, every thing was always distorted into some such connexion. At the store he was daily visited by a knot of gray headed lechers who enjoyed his conver- sation. He thought he had some excuse in his wife, who, he said, was cold and unyielding. Of the latter, in a gentleman hardly middle aged, of good education and superior intelligence, married, and withput any such excuse in his wife—though he seems to have inherited the vice from his father ; who is so haunted by obscenities that, as he has repeatedly declared to me, he could not resist it though he feared it would be the death of him. This gentleman, one of a con- genial group, has related to me monstrous and filthy scenes got up in brothels, on which occasions each of the party has paid ten dollars. Such are two of many I could mention; they all differ only in details. It is a species of drunkenness, and holds its victim 208 as relentlessly; my duty is only to point out these diseases; if the symptoms and consequences are not moral enough, words would be wasted. The following quotations will fitly conclude this sub- ject: Prof. Hufeland says, 'It may, perhaps, be here asked, what is meant by excess in physical love ? My answer is, when either sex indulges that passion too early, before the body is completely formed—females before the age of eighteen, and males before that of twenty; when this enjoyment is too often and too violently repeated, which may be known by the following con" sequences : lassitude, dejection, and loss of appetite ; when one, by a frequent change of object and cir- cumstances, or by the artificial stimulus of condi- ments, heating liquors, and the like, excites new desires and the relaxed powers, or makes that ex- ertion during the time of digestion; and, to include the whole in a few words, when one enjoys physical love without marriage ; for it is only under the matrimonial tie, which excludes the stimulus of variety, and directs the physical propensity to a higher moral object, that this passion can be physically refined, that is to say, be rendered salutary and useful.' The following excellent and valuable observations 209 are quoted by Dr. Carpenter in his 'Human Physi- ology,' from a little work published in London, en- titled 'Be not Deceived.' 'When the appetite is naturally indulged, that is, in marriage, the necessary energy is supplied by the nervous stimulus of its j natural accompaniment of love before referred to, which prevents the injury which would otherwise arise from the increased expenditure of animal power ; and in like manner also, the function being in itself grate- ful, this personal attachment performs the further necessary office of preventing immoderate indulgence, by dividing the attention through the other sources of sympathy and enjoyment which it simultaneously opens to the mind. But when the appetite is irregu- larly indulged, that is in fornication, for want of the healthful vigor of true love, its energies become ex- hausted, and from the want of the numerous other sympathetic sources of enjoyment in true love, in similar thoughts, common pursuits, and above all, in common holy hopes, the mere gross animal gratifi- cation of lust is resorted to with unnatural frequency, and thus its powers become still further exhausted, and therefore still more unsatisfactory; while, at the same time, a habit is thus created, and these jointly cause an increased craving ; and the still greater deficiency, in the satisfaction experienced in its indul- gence, further, continually, ever in a circle increases , 210 —the habit demands indulgence, consequent exhaus- tion, diminished satisfaction, and again demand,—-till the body and mind alike become disorganized.' THE FOLLOWING REMARKS On the Nature, Symptoms and Consequences of a frequent, but generally ill- understood Malady, will prove deeply interesting to many:—to those con- cerned they may prove invaluable. With regard to the reasons for writing on this subject and in this manner, they are several, and, in my opinion, weighty. The first is, that the complaint which is the subject of the following remarks frequently exists in those who are not in the lea.si aware of it- It is a disease which, in its earliest stage, is seldom attended with pain or inconvenience; and those circumstances which do attend this stage, are generally referred to other causes. Among other symptoms, that want of mental energy in busi- ness, which so remarkably connects itself with this disease, is attributed to any cause but the true one. But, while under this delusion, the disease is gainit?g ground, and is quietly forming the foundation of the most serious and distressing maladies. I do not know (and I speak with a careful regard to truth) in the whole range of human mala- dies, one more pregnant with consequences which embitter life, as well by its effects upon the mind as on the body, than Stricture of the urinary passage. .My second reason is, that this, unlike almost every other malady, never terminates in cure spontaneously; nor can it be possibly cured by any kind of medicine alone. This should be ever kept in mind, not only because it will warn you against the trash of trading advertisers, but will lead you to seize the period when a cure can so easily be obtained. Do me no discredit when I assert the perfect inefficiency of medicine for the cure of Stricture. It is enough to make you doubt it to read of the boasting nos- trums in the newspapers; but I repeat,—and indeed, call every real physician in the world to attest its truth, that no medicine whatever, alone, can cure a Stricture. Un- suspecting persons are daily duped by these nostrum venders: { have had patients who have assured me they had taken scores of bottles of such things as Colored Drops or Mixtures, or Sarsaparilla, and used " newly invented instruments," &c, &c. To refer again to the advantage of detecting and attending to Stricture in its early stage, I assure my reader, that although there is no example of Stricture—Jiot even the most severe and complicated—which does not admit of cure; yet, the ease and quickness with which a recent case is cured, compared with an old and complicated one, makes its early detection a point of great importance. :A last reason I will mention arises from the repugnance which every one of proper feelings has, to publish of himself, in a common newspaper, that degree of learning and ability, as well as integrity of character, which is so peculiarly desirable in the physician selected for consultation on diseases of this nature. Now, to form an opin- ion from the statements and promises made by that description of persons who recom- mend themselves by public advertising, you would conclude that the diseases of the urinary and procreative organs were too simple and unimportant to claim the notice ot a man of rank in his profession. But nothing in the world is more untrue. On the contrary it is a fact-and one which every physician will accede to—that, among the wonderfully complicated structures of the body, there is none more intimately eon- nected with the mind and distant parts, so that it* diseases become more influenced and modified by various causes; or which, from iheir delicacy of.structure and function, demand a deeper measure of anatomical and physiological knowledge, thiin the sexual organs, both male and female. On this account, I think it appropriate here to state, as the ground on which I claim the confidence of society, the opportunities I have enjoyed of making myself thoroughly acquainted with this important subject, viz: .Besides a long and very extensive'practice principally in this class of diseases, and being author of a practical work upon them (Dr. Ralph's Practical Treatise), I resided in Paris nearly two years for the purpose of studying the siibject in the most complete manner possible—at the Hospitals, the University Lectures, and private classes of the Profes- Bors; and have, Hesides others not bearing exclusively on this speciality, " Certiticate d'Btude " from Dr. Ph. Ricord, Chirurgien de l'Hopital des Veneriens. Professenr de Clinique et de Pathologie Speciales. Dr. P. Guersant, Chirurgien de l'Hopital Bicdtre. Professeur particulier de Chi- rurgie, &c, &c. Dr. Cazhnave, Medicin de l'Hopital Saint-Louis. Professeur des Maladies V6ne- riennes de la peau, ou Syphilides, &c. Dr. Robert, l'Hopital Beaujou. Medicine Operatoire des organes genitaux et urinaires. Dr. Auo. Merciek, Professeur d'Anatomie et de Chirnrgie Speciales: Chirurgien k !'Hotel-Dieu, &c, &c. Dr. Segalas, Membre de l'Acadamie Royale. Cours sur les Maladies genito- arinaires. These may be seen in my office by any one. I should not have dwelt so long on my reasons for this letter, but there are many facts and observations interspersed among them, which should be known and thought of. I will now proceed with— The Nature, &c, of Stricture.—A Stricture consists in a thickening of one part or other of the membrane which lines the urinary passage. The immediate cause of this thickening is slow or chronic inflammation, and this chronic inflammation is that state which a Gonorrhoea or Clap is apt to settle into when it is not early and properly treated, and is called a Gleet. Now, there is no pain in this early stage of Stricture; neither does the stream of urine become sensibly altered—not enough, for instance, to strike the attention. There is, however, now and then, a little discharge, which is very puz- rling to those wlio do not understand "it, for, though it may be stopped a hundred times, it will again and again return. The fact is, this discharge is now no longer that of Gonor- rhoea, but arises from a different cause—a Stricture—or a condition very near akin to it. When the Stricture is free from irritation, whether under the use of medicine or not !t ceases, but when any thing happens to irritate or excite the Stricture, it reapnears. But, while there is but little to complain of in this early stage of Stricture, arising Immediately from the seat of the disease, it is very apt to ftffect the mind and depress the spirits. The reason why it should thus affect the spirits, will be easily scon by reflecting on the intimate connections which subsist between the mind and sexual organs. Who does not know the effect of a single thought of a certain nature upon these organs? Now, it happens throughout the body, that whenever, through the nervous system, one part has a remarkable power to affect another, the latter also has the same power to affect the former. For instance, if a sexual thought, through a certain medium, has the power of influencing the genital organs, so, in like manner a Maeased condition of those parts, through the same medium, has the power of disturb- ing the mind * and it is on this striking reciprocity of action, that Stricture in the urin- ary passage is so wont to depress the spirits—a circumstance I am inclined to lay a greater stress upon than many authors, for by this I have been enabled to detect a Stricture when there was hardly any other indication of it. The Symptoms of Stricture in its early state.—The very first of these, I think I may safely state, is that of a drop or two of urine which is observed to pass away after a person has finished making water, so as to wet his shirt a little. It has been observed there is at first but little alteration in the stream of urine ; nor is there always a discharge, although, in general, there is a little to be seen. Now, a Stricture is almost always the consequence of a badly-managed Gonorrhoea, (though it may arise from long continued irritation of the urinary passage in whatever way produced, and sometimes apparently from no cause at all.) If the treatment of Gonorrhoea, for instance, has not been followed up by injections in the manner I have particularly directed in my Private Treatise, so as to bring its cure within, at farthest, a few weeks, it/will slide into a Gleet, which is indeed itself a Chronic Inflammation of a specific kind, and Chronic Inflammation, as has been remarked, naturally produces a thicken- ing—which thickening of the lining membrane of the passage is Stricture. Now, if any one, having had a Gonorrhoea which has continued, say from six to eight weeks (or if long ago he had a Gonorrhoea which was tedious, or, has had it several times, though apparently each had been cured), and still has a discharge, at least occasion- ally, and he perceives a drop or two of urine to escape, as I have described, and espe- cially if he can detect any difference in force or in manner of urinating; and, more especially still, if in addition to this he feels a depression of spirits and an inaptitude or incapacity for business which is not natural to him, then I say, that man has sufficient reason to suspect his malady is either Stricture or is assuming that form, and that it is his duty to consult some competent surgeon on the subject. "These being the symptoms which attend the very early stage of Stricture, of course they become more definite and striking as the disease proceeds, but wi£h regard to the rapidity of their forming, this differs greatly in different individuals: in some, they creep on very slowly, and it may be months and sometimes years before any difference in the-manner of jnaking, water is observed. All this time, however, if the patient were aware of it, and were to pay attention to his stream of urine, he would find it was not so large and bold as formerly; and especially would he observe, that after finishing and buttoning up, a drop or two would always steal away and wet his shirt. This latter is the most constant of all the symptoms of Stricture: not that it never happens from any other cause, for it may occur from weakness of the parts, and other causes; but though this drop may happen without a Stricture, a Stricture cannot exist without this drop. I would conclude these remarks by saying that although I have given great atten- tion to the subject of Stricture in every stage, and have certainly treated more cases ,Tn any practitioner in America-very manyof which would have been considered £cWeP°T subjected to the now justly o^e h^^era^ of ^tUng my office Smmon^dva^ I have enjoyed, and subsequent extensive common diivd. » insure the utmost poss b e success of treatment. experience, 1 can sately insuie uimo D*()(,T0R RALpH> jYo. 80 Amity SireeL 'At home for consultation as much as possible every morning and evening. ( onsu™tations by LETTER.-Almost all cases that do not require actual surgical oneration cotbe treated successfully in ihis way, as has been proved during many ^^s'Tmy practice; though city patients of ~ secure the adpnu- espe- cially as to time, of persoualtieatineut. r. v. lua 0,10*, u. i. huy. V \