In older children, especially those that attend school,
certain exercises in which the legs are frequently rubbed
Disorders of the Sexual Function.
together may be the origin, while warm feather beds and
spanking may often be the starting point. But, in a large
number of cases that develop for the first time among
school-children, the practice has been actually taught them
by older boys; indeed, in some cases, the practice has de-
veloped into a veritable epidemic. During school-life, the
condition is much more common among boys than girls,
although by no means uncommon among the latter.
Pathology. In the vast majority of cases occurring at
this time, no organic changes have as yet taken place, nor
has such a vicious circle been produced as will be presently
described as occurring in the adult male. There is simply
a local irritation of the genitals present, with as yet no per-
manent change in the urethral mucous membrane. In the
majority of cases at this time, if the habit can be abolished
by removing the local irritant which started the trouble,
and adding thereto moral suasion to be presently described,
everything returns to normal without any special treatment.
There are some very precocious cases, however, that de-
velop so rapidly as to cause, even at this stage and at this
early age, the same local and central irritation which is
found in the confirmed adult masturbator. The pathology
of these cases, being the same as in the adult (only having
developed before adolescence), will be described later on
under the caption of Masturbation in the Adult Male.
Symptoms. The local symptoms consist simply of red-
ness, and sometimes a slight swelling of the prepuce in the
male, and of the vulva in the female. Sometimes a slight
vaginitis exists in the latter.
The general symptoms in very young children are some-
Masturbation before Adolescence.
times very hard to recognize. In them masturbation con-
sists mostly of thigh friction or of rubbing the genitals
against some article of furniture. Almost endless varieties
of methods are employed in the habit.
The symptoms in older children who indulge the habit
are quite characteristic. They are generally more bashful,
more retired, more dreamy, more easily embarrassed than
normal children. They complain of headaches, are easily
fatigued, are generally anemic and run down. They do not
play with other children and frequently avoid their society.
Boys are as a general rule more cowardly and timid, and
are frequently praised by their teachers for their quiet and
orderly disposition. Some pediatricians claim to have no-
ticed cases of functional heart disease due to masturbation.
Diagnosis. In some cases the diagnosis is quite easy,
while in others, unless we are on the lookout, the disease
is often not suspected for a long time. As in the case of
so many forms of sexual neuroses, the patients do not come
to us, saying that they are suffering from sexual neuroses,
and have such and such symptoms, but, on the contrary,
complain of the most varied symptoms (vide supra} ; some-
times only headaches, loss of appetite, and general nervous-
ness, etc. Often they do not complain at all, and this is the
regular thing with very young children, until the mother
notices something is wrong with the child. Most of the
symptoms in such cases are often thought to be due to
errors in digestion, overwork at school, etc., without the
real cause being suspected. It is of no use to ask a boy
directly if he masturbates, as in the vast majority of cases
he will positively deny it, and it often requires the greatest
6 Disorders of the Sexual Function.
tact on the part of the physician to get at the truth. The
most important point in the diagnosis of this condition is:
to bear in mind the possibility of such a disease in all cases
of inexplicable nervous or psychic symptoms. Teachers in
school and parents also should be taught to be on their
guard, and should know of the frequent existence of this
neurosis so as to be able to detect it at the earliest possible
moment. The physician should not neglect an examination
of the genitals in any suspicious case, and very often the
local symptoms will tell the tale. In young boys, after an
examination of the genitals by the physician, whether he
finds anything there or not, it is often advisable for the
physician, if he is reasonably sure of his ground from the
general symptoms, to immediately tell the boy, after the
examination, that he masturbates. The boy, being taken off
his guard, if guilty, will imagine that the physician can tell
by the examination, and will often admit the truth at once.
Course and Prognosis. The earlier the habit is discov-
ered and attended to, the easier it is to cure. In very many
cases children themselves notice the evil consequences of
the habit and stop it voluntarily, without any special treat-
ment whatever. But even cases of very long duration can
be cured, if not by the method presently to be described, by
the method of treating adults, which they really are. The
very fact that almost every man or boy has at one time or
another masturbated for varying lengths of time, and that
we can get a history of masturbation in almost every nor-
mal person, even among the great geniuses of the world,
shows that it is not the terrible disease which quacks find it
to their interest to make it out to be. At the same time, it
Masturbation before Adolescence.
is sufficiently serious to command the earnest attention of
every conscientious physician and teacher. While under its
baneful influence, the entire psychical and physical condition
of the child suffers. He can attend to his lessons, but does
so under a greater amount of nervous tension and energy.
And so, while recognizing that it is a curable disease, and
a very common disease, and that, in the vast number of
cases, it leaves no permanent bad results, we should never-
theless not consider it beneath our dignity to treat it, if for
no other reason than to keep the child away from the bane-
ful influences of quack physicians, and because of the ex-
treme importance of early recognition and treatment, so
that the child can develop both physically, mentally, and
psychically with the least expenditure of nerve energy.
Treatment, Prophylactic. Parents should be very care-
ful to remove anything or any cause which might produce
irritation of the genital regions, or which might create a
tendency for the children to handle these parts. A tight
prepuce should either be loosened or circumcision be per-
formed. A long prepuce should be removed either entirely
or partially. Worms and intertriginous processes about the
genitals should be removed and cured. Boys should not be
allowed to associate with much older boys, for fear of being
taught the habit. According to German authorities, boys
in school should always have their hands on the desk or
otherwise exposed to the view of the teacher, so as to give
them as little opportunity as possible to handle their geni-
tals. They also recommend, on this account, that young
boys' trousers should be made without side pockets, as these
pockets are frequently used by boys for purposes of mas-
8 Disorders of the Sexual Function.
turbation. Gymnastic exercises in which friction of the
thighs might frequently occur should be avoided. Parents
should be careful in the employment of nurses, as unscrupu-
lous nurses often employ this method to quiet the children.
Children should not indulge in tea or coffee, and alcoholics
are to be particularly avoided. Older boys should be in-
structed to empty the bladder before retiring, not to sleep
with too many covers on, and to rise early and empty the
bladder at once. For, sometimes even at this early age, a
distended bladder and warm bed-coverings may cause an
early erection.
General Treatment for the Disease. The first thing to
do is to search for and remove the cause which started the
trouble. It is not necessary to repeat the various etiologi-
cal factors, as they have been mentioned in the etiology.
The prophylactic treatment just outlined is even of more
importence when the habit has already been indulged in,
and should be strictly adhered to. In very many cases,
especially if the habit has just been commenced, the mere
removal of the cause of the genital irritation, together with
the prophylactic treatment, is sufficient for a cure. Spank-
ing is especially to be avoided, as in some children the act
of spanking arouses erotic impressions. Older boys should
be spoken to in very plain but tactful language, and their
sense of manhood be appealed to. The object of treatment
is to direct the child's interest into other and more natural
channels. At this time the parent should obtain the child's
confidence and every method be employed to strengthen his
will-power and help him break the habit himself.
It is of very little use to try to treat the patient by em-
Masturbation before Adolescence.
ploying some one to watch him continually; I believe the
method is, in reality, harmful. The methods employed by
the masturbator are so numerous, and the opportunities for
committing the act so easy, that no matter how careful the
watching, it will be of no avail. I have had under treat-
ment a young boy of exceedingly wealthy parentage. Be-
fore he was sent to me the parents had employed two male
nurses who were with him both day and night, who went
with him, even when he had to go to the toilet, and yet the
boy boasted to me that he could masturbate while both
nurses were watching him. The little fellow, when he came
under my care, was already a confirmed masturbator, in
whom the pathological processes had already advanced to
the same degree as that which we find in the adult male,
to be presently described, and he was treated in the same
way as an adult, and was cured and remained cured by the
method to be described later on under that caption. I
believe constant watching not only useless but harmful, be-
cause it constantly keeps the boy's mind reminded of his
genitals. Every time he sees his watcher he thinks of his
sexual apparatus, and that is the very worst thing for him.
Besides this it lessens his will-power, and is almost an in-
citive to see if he can be shrewd enough to deceive his
guardian.
Except in very exceptional cases, I do not believe in
restraining apparatus. In some cases they have done good,
but in the vast majority of cases they not only do no good
but positive harm. In the first place they also concentrate
the child's attention on his genitals, but, and what is even
more important, they stimulate the child's inventive genius
10 Disorders of the Sexual Function.
in many cases, to substitute one form of masturbation for
another. Thus, boys who have been masturbating by
manipulating their genitals with their hands, and who have
their hands tied together, or so tied that they cannot reach
their genitals, very often invent a method of masturbating
in which the hands can be dispensed with, such as thigh
friction, pillow masturbation, etc. Such method of treat-
ment may even be the starting point for psychic masturba-
tion. There have also been reported severe injury not only
to the skin, but even to the genital organs, from either badly
fitted restraining apparatus or from the effort of the patient
to masturbate with the harness on. In short, except for
the very bad cases, the best method of treatment is, first
to remove the cause of the local irritation, and then to ap-
peal to the child's will-power and manhood, with a full and
tactful explanation of the trouble. At the same time, the
child's general health should be improved by tonics and
well-directed outdoor exercises, and an effort should be
made to direct the child's mind into other and more natural
channels by finding objects of special interest. The bad
cases, the young boys who are confirmed masturbators, are
really precocious in this respect, and, as regards their sex-
ual and psychic make-up, are actually adults, having the
same pathology as adults and are to be treated as such.
H. PSEUDO-MASTURBATION IN INFANTS.
Rachford, 97 in his Presidential Address before the
Nineteenth Annual Meeting of the American Pediatric
Society, calls attention to a condition which he calls "pseudo-
masturbation in infants." He says that it has been pre-
Pseudo-Masturbation in Infants. 11
viously described under the titles of "Thigh Friction" and
also "Infantile Masturbation," and describes it as follows :
"It is commonly accomplished with the child lying on
its back; the thighs are flexed, crossed and pressed tightly
together, closely embracing the external genitalia; in this
position the infant makes a wriggling or up-and-down body
movement and rubs its thighs together. In other instances
the genitalia are rubbed with the hands or feet or against
some piece of furniture or other foreign object. These move-
ments are apparently attended by a pleasurable excitement ;
the face is flushed and there is a marked increase in the
general nervous tension. Following this act, which con-
tinues for a few minutes only, there is a general relaxation,
accompanied by mild perspiration, quiet contentment and, in
some instances, sleep."
The etiological factors are exactly the same as in true
masturbation; the treatment is exactly the same; it takes
about two years to cure the child of the habit, and in some
exceptional cases the disease runs into true masturbation.
The author lays stress upon the point that while the
external genitals, as well as the bladder and rectum, are
almost fully developed at birth, the internal genitals, espe-
cially the uterus and ovaries, are almost rudimentary and
do not undergo any development till about the tenth year.
From this he argues that there can be no real masturbation,
except in exceptional cases (which he reports) during the
early years of infancy.
I confess, however, that I cannot at all agree with this
author. Any one reading the above description in connec-
tion with an older child, would unhesitatingly pronounce it
12 Disorders of the Sexual Function.
to be masturbation pure and simple. The fact that a child
may be cured of this habit during infancy, and then later
on, through a repetition of the same or similar causes, or
through bad companions again contract the vice, is by no
means an argument that the first condition was not a true
case of masturbation. The sexual sense is not entirely de-
pendent upon the internal genital organs, and the fact that
these organs lie apparently dormant for about ten years,
is no proof whatever that they may not be exerting through
some internal secretion, perhaps, an influence on the sexual
sense. The modern theories of Freud and his followers
seem to show that the sexual sense is not by any means
absent in young children. Furthermore, I can see no use
in further complicating the nosology of the subject, by in-
venting a special disease, and calling it pseudo-masturba-
tion instead of masturbation, particularly if it has the same
etiology, the same symptoms, the same treatment and the
same prognosis as the condition we all recognize as
masturbation.
CHAPTER II.
MASTURBATION IN THE ADULT MALE.
General considerations. Pathology. Psychic masturbation. Symp-
toms. Exaggerations of many authors. Fallacies in taking histories.
Importance of ruling out other conditions. Masturbation in married
men. Course and prognosis. Illicit intercourse not a cure for mastur-
bation. Treatment. Importance of gentle massage. Conclusions.
Masturbatio interrupta. Masturbatio incomplete Impotentia mastur-
bationis.
IT is a pity that this subject is made so much of by the
medical quacks and their advertising literature, and so little
attention paid to it by the regular physician. "Of what
use," says Vecki, 131 "to a man who suffers from weak-
ening pollutions is a physician, who, following the example
of renowned clinicians, laughs at him and sends him home,
with some insignificant and useless prescription?" The
same may be said of masturbation. It is no wonder that
the patients go to the quacks, when the average physician
does not care to bother with him or always treats the con-
dition as a mere neurosis. I know of one physician who
sends his patients to the mountains for masturbation, treat-
ing it as a neurotic condition. At the other extreme, I have
spoken to the head keeper (not a physician) of one of our
largest public reformatories, who told me that he "treated"
this condition by placing the culprit in a dark cell for a week,
where, besides the total absence of light, he receives only
one meal in the twenty-four hours, consisting of a loaf of
bread and a pitcher of water. "But so bad are the boys,"
(13)
14 Disorders of the Sexual Function.
he added, "that even this treatment does not cure them."
Comment is unnecessary.
There is still another and very important reason why
the subject of masturbation should be thoroughly discussed
and understood. Many a young man enters into illicit con-
nection and becomes infected with venereal disease, because
he believes that coitus is the only relief for masturbation.
There are physicians who advise "careful" coitus to pa-
tients who masturbate, and there are also physicians who
advise patients who, on account of religious or other
scruples, do not wish to violate the Seventh Commandment,
and who have, however, strong sexual feeling, to relieve
themselves by masturbation.
I have elsewhere 54 given my views and discussed the
relationship between masturbation and illicit coitus. In
addition to the many authors cited, I will mention one more
author as an example of some medical advice which is very
common. Vecki 131 says: "In the treatment of Onan-
ism the individual has to be carefully studied; not every
child, nor youth, nor even man, has sufficient will-power to
combat successfully this evil so difficult to conquer. In
many cases the object will be attained by incessant watch-
ing, or ultimately by the application of a suitable preventive
apparatus, which the child must wear day and night.
Mature individuals should be advised to satisfy the sexual
instinct in a natural way, and no notice must be taken of
the cry of horror uttered by pharisaical medical authorities
or by those who, although possessed of great scholarship,
are nevertheless destitute of experience. The notion that
whoever has once enjoyed natural copulation will not feel
Masturbation in the Adult Male. 15
tempted to return to Onanism is an error that is somewhat
prevalent. Only copulation that is practised regularly,
satisfying every strong and real desire, can cure Onanism ;
while copulation enjoyed at long intervals only would rather
incite to more frequent Onanism, because pleasing recollec-
tions are near at hand."
This is certainly a very pleasing way of treating Onan-
ism and ought to be popular ; in addition, it ought to bring
to the adviser not only many cases of Onanism, but also
many cases of gonorrhea and syphilis as well.
With very few exceptions, masturbation is not a nervous
disease. It is not a disease of the imagination. It is a real
disease, and no amount of talking, whipping, or laughing
will cure it Those who say that the patient should be
talked to, and his will-power and self-restraint cultivated,
his general health improved by tonics, outdoor sports, etc.,
have very little experience with this disease. When mas-
turbation has been firmly established you can no more talk
your patient out of masturbating than you can talk a child
suffering from scabies out of scratching. The latter is
caused by an irritation in the skin and the former by an
irritation in the prostatic urethra. On the other hand, so
definite is the disease, so specific is the treatment, and so
positive is the cure, that it is not even necessary to obtain
the patient's confidence or co-operation, from a purely
therapeutical point of view. In the treatment of the disease
no demands are made upon the patient's will-power or self-
restraint, because we recognize that the patient has little
say in the matter; it is not a question of self-control.
Also, the application of restraining apparatus is worse than
16 Disorders of the Sexual Function.
useless, for in the first place it concentrates the patient's
mind on his genitals, and, in the second place, to return to
our comparison with the child suffering from scabies, this
method of treatment would be similar to tying the hands
together of such a child to prevent it from scratching. It
would not scratch, not because it has been cured of its
scabies, but because it is mechanically prevented from so
doing. In treating this disease we should recognize that
we have a definite pathological condition to treat, and not
an imaginary disease, and the treatment should be under-
taken in the same spirit as that of a surgeon when he under-
takes the treatment of a fracture in an otherwise healthy
person; if he gets the fragments in correct apposition and
keeps them so by plaster-of-Paris or other splint for the
necessary time, that bone will knit and the limb become
normal, whether the patient has confidence in the treatment
or not.
Pathology. The pathology of masturbation is quite
simple and directly in harmony with the prognosis and treat-
ment. It shows that there is no new element introduced,
but that it is simply an exaggeration of a perfectly normal
process. As pointed out by Bangs, 9 with every irritation
of the urethra, there is a corresponding irritation of a cer-
tain portion of the brain, which irritation excites the per-
son to increased sexual desire; this increased sexual desire
leads to masturbation and further increases the local hyper-
esthesia in the deep urethra. A vicious circle is thus formed.
We thus see that the entire pathology is essentially and in
the beginning but an exaggeration of what takes place in
normal sexual intercourse. At the beginning, the child
Masturbation in the Adult Male. 17
manipulates his penis ; this act sends an impulse to his brain,
which sends another impulse to his muscles of erection, etc.,
and also causes a congestion of the deep (prostatic) urethra.
So far the condition is like normal coitus. But this act
frequently repeated leads to a hyperesthesia of the prosta-
tic urethra, so that impulses are constantly sent to his brain,
which again in response sends impulses to the prostatic
urethra, still further increasing its hyperesthesia, and thus
the vicious circle is formed. In other words, there is in
time formed such an irritation in the deep urethra that the
patient is compelled to masturbate. The difference between
masturbation and normal coitus is, in the first place, that it
is initiated in the young person at or even before puberty,
when the sexual apparatus is still in an imperfect and de-
velopmental state, when the brain-cells appertaining to this
function are also being developed, are immature and more
irritable and, in short, when the whole body is undergoing
profound chemical, physical, and psychological changes, and
in, the second place that the act is repeated much more fre-
quently than normal coitus could be. It is this combination
that causes the dire results. Even if a normal adult with
fully developed normal sexual organs were to attempt coitus
as often as some of these children masturbate, the result
would also be a final inability to perform the act ; but when
we consider that the act is accomplished with immature and
undeveloped organs, with an overirritable brain, and at a
time when all the energy is needed for body development
not only in this particular field, but in every function of the
body, we can easily understand why the results are so pro-
found. We can also understand how a dose or large amount
18 Disorders of the Sexual Function.
of bromides cannot cure the trouble, as it begins at the
wrong end. It does not cure the hyperesthesia of the pros-
tatic urethra, but simply dulls the brain-cells, so that they
cannot receive impressions from the deep urethra. It is
analogous to dosing a child suffering from scabies so that
it cannot feel the bites of the insect and is thus less liable
to scratch. As long as the insect is not removed, we have
not cured our patient, even if we prevent it from scratching.
We can also see how useless it is to appeal to his self-con-
trol. It must be understood that in this chapter I am only
referring to the adult confirmed masturbator. It is true
that at the beginning, when the child first begins to mastur-