present attitude towards sexual intercourse outside the conditions of
coercive marriage, the removal of the stamp of infamy from such
intercourse, would limit prostitution, and therewith also limit venereal
diseases.[394] This is as clear as daylight. But, unfortunately, those
very persons who declare the existing conditions in respect of
prostitution to be absolutely intolerable will not admit its truth.

The misery of the life of these unhappy creatures must be relieved, but
=we= must do it =ourselves=, and soon; for they are not in a position to
do so. The last, the highest goal of the campaign against venereal
disease is the humanization of the prostitute.[395]

  SUPPLEMENTARY NOTE.--In the essay on “The Woman’s Question” in the
  sociological section of his work, “The Ethic of Free-Thought,” Karl
  Pearson discusses the question of Prostitution in relation to the
  Woman’s Question at large. His remarks have especial interest in view
  of what is said above about “the ennoblement of prostitution” and “the
  humanization of the prostitute,” and it seems expedient to quote the
  passage at length (_op. cit._, 1888, pp. 379-382).--TRANSLATOR.

  “The emancipation of woman, while placing her in a position of social
  responsibility, will make it her duty to investigate many matters of
  which she is at present frequently assumed to be ignorant. It may be
  doubted whether the identification of purity and ignorance has had
  wholly good effects in the past; indeed, it has frequently been the
  false cry with which men have sought to hide their own anti-social
  conduct. It is certain, however, that it cannot last in the future,
  and man will have to face the fact that woman’s views and social
  action with regard to many sex-problems may widely differ from his
  own. It is of the utmost importance that woman, not only on account of
  the part she already plays in the education of the young, but also
  because of the social responsibilities her emancipation must bring,
  should have a full knowledge of the laws of sex. Every attempt
  hitherto to grapple with prostitution has been a failure. What will
  women do when they thoroughly grasp the problem, and have a voice in
  the attitude the state should assume in regard to it? At present
  hundreds do not know of its existence; thousands only know of it to
  despise those who earn their living by it; one in ten thousand has
  examined the causes which lead to it, has felt that degradation, if
  there be any, lies not in the prostitute, but in the society where it
  exists; not in the women of the streets, but in the thousands of women
  in society, who are ignorant of the problem, ignore it, or fear to
  face it. What will be the result of woman’s action in the matter? Can
  it possibly be effectual, or will it merely tend to embitter the
  relations of men and women? Possibly an expression of woman’s opinion
  on this point in society and the press would do much, but then it must
  be an educated opinion, one which recognizes facts and knows the
  difficulties of the problem. An appeal to chivalry, to a Christian
  dogma, to a Biblical text, will hardly avail. The description we have
  of Calvin’s Geneva shows that puritanic suppression is wholly idle.
  What form will be taken by the reasoned action of women, cognizant of
  historical and sexualogical fact?

  “Perhaps it may be that women, when they fully grasp the problem, will
  despair, as many men do, of its solution. They may remark that
  prostitution has existed in nearly all historic times, and among
  nearly all races of men. It has existed as an institution as long as
  monogamic marriage has existed; it may be itself the outcome of that
  marriage. I do not know whether any trace of a like promiscuity has
  been found in the animals nearest allied to man--I believe not. The
  periodic instinct has probably preserved them from it. How mankind
  came to lose the periodic instinct, and how that loss may possibly be
  related to the solely human institution of marriage, are problems not
  without interest. On the one hand, it has been asserted that
  prostitution is a logical outcome of our _present_ social relations,
  while, on the other hand, it is held to be a survival of matriarchal
  licence, and not a _sine qua non_ of all forms of human society. There
  is very considerable evidence to show that a large percentage of women
  are driven to prostitution by absolute want, or by the extremities to
  which a seduced woman is forced by the society which casts her out.
  This point is important. It may, perhaps, be that our social system,
  quite as much as man’s supposed needs, keeps prostitution alive. The
  frequency with which prostitutes, for the sake of their own living,
  seduce comparative boys, may be as much a cause of the evil as male
  passion itself. The socialists hold the sale of a woman’s person to be
  directly associated with the monopoly of surplus labour. Is the
  emancipated woman likely to adopt this view? and if so shall we not
  have a wide-reaching social reconstruction forced upon us? That
  emancipated woman would strive for a vast economic reorganization, as
  the only means of preserving the self-respect and independence of her
  sex, is a possibility with the gravest and most wide-reaching
  consequences. We cannot emancipate woman without placing her in a
  position of political and social influence equal to man’s. It may well
  be that she will regard economic and sexual problems from a very
  different standpoint, and the result will infallibly lead to the
  formation of a woman’s party, and to a more or less conscious struggle
  between the sexes. Would this end in an increased social stability or
  another subjection of sex?

  “Woman may, however, conclude that the alternative is true--that
  prostitution is not the outcome of our present social organisation,
  but a feature of all forms of human society. She must, then, treat it
  as a necessary evil or as a necessary good. In the former case she
  will at least insist on an equal social stigma attaching to both sexes
  if she does not demand, as in the instance of any other form of
  anti-social conduct, so far as practicable its legal repression. In
  the latter case--that is, if its existence really tends in some way to
  the welfare or stability of society--women will have to admit that
  prostitution is an honourable profession; they cannot shirk that
  conclusion, bitter as it may appear to some. The ‘social outcast’
  would then have to be recognized as filling a social function, and the
  problem would reduce to the amelioration of her life, and to her
  elevation in the social scale. Either there is a means of abolishing
  prostitution, or all participators must be treated alike as
  anti-social, or the prostitute is an honourable woman--no other
  possibility suggests itself. Society has hitherto failed to find a
  remedy, perhaps because only man has sought for one; woman, when she
  for the time fully grasps the problem, must be prepared for one, or
  must recognize the alternatives. There cannot be a doubt, however,
  that in a matter so closely concerning her personal dignity she will
  take action, and that, if only in this one matter, her freedom will
  raise questions, which many would prefer to ignore, and which, when
  raised, will undoubtedly touch principles apparently fundamental to
  our existing social organization.”

  [330] See note to p. 390.

  [331] Parent-Duchatelet, “The Moral Corruption of the Female Sex in
  Paris,” vol. ii., p. 234 (Leipzig, 1837). Similarly, Julius Donarth
  remarks (“The Beginnings of the Human Spirit,” p. 19; Stuttgart,
  1898): “=Syphilis and alcoholism= can by social arrangement and
  carefully adapted measures =be suppressed just as much as plague and
  cholera=.”

  [332] The literature of this subject is very extensive. In addition to
  a comprehensive work dealing with the older literature, by J. K.
  Proksch, “The Prevention of Venereal Diseases” (Vienna, 1872), I must
  mention the following: E. Lang, “The Prevention of Venereal Diseases”
  (Vienna, 1894); M. Joseph, “Prophylaxis of Cutaneous and Venereal
  Diseases” (Munich, 1900); Neuberger, “The Prophylaxis of Venereal
  Diseases,” pp. 35-37 (Munich and Berlin, 1904); Felix Block, “How
  shall We protect Ourselves against Venereal Diseases and their Evil
  Consequences?” second edition (Leipzig, 1905); E. Boureau, “Conseils
  Pratiques à la Jeunesse pour Éviter les Avaries” (Paris, 1905); Suarez
  de Mendoza, “Conseils de Prophylaxie Sanitaire et Morale” (Paris,
  1906); same author, “ABC à l’Usage des Mères de Famille pour la
  Défense de Leurs Foyers contre les Grands Fléaux du XXe Siècle:
  Tuberculose, Avariose [= Syphilis], Neissérose [= Gonorrhœa],
  Alcoolisme, Mortalité Infantile” (Paris, 1905); same author, “Avariose
  des Innocents” (Paris, 1905).

  [333] _Cf_. also the valuable remarks of Robert Hessen, “Cleanliness
  or Morality?” published in _Die Zukunft_, June 9, 1906, pp. 367-377
  (also separately printed in Munich, 1906).

  [334] Otto Neustätter, “The Public Recommendation of Protective
  Measures,” published in _The Journal for the Suppression of Venereal
  Diseases_, vol. v., No. 3, pp. 225-227 (Leipzig, 1905).

  [335] H. Ferdy, “The History of the Cæcal Condom,” published in _The
  Journal for the Suppression of Venereal Diseases_, 1905, vol. iii.,
  No. 4, pp. 144-147.

  [336] _Cf._ in this connexion the admirable essay, distinguished by a
  critical spirit, of R. de Campagnolle, “The Value of the Modern
  Prophylaxis of Gonorrhœa by Means of Instillations,” published in _The
  Journal for the Suppression of Venereal Diseases_, 1904, vol. iii.,
  Nos. 1-4, pp. 1-31, 51-115, 148 (with a complete bibliography).

  [337] In place of these solutions, Cronquist (“Contributions to the
  Personal Prophylaxis against Gonorrhœa,” published in _Medizinische
  Klinik_, No. 10, 1906) recommends the use of little rods or bougies
  containing 2 per cent. of =albargin=, which melt from the body-heat
  when introduced into the urethra (these are sold under the trade name
  of “antigon-rods”); they are used, like the solutions, immediately
  after coitus. The advantage they possess is their greater durability.

  [338] The same idea had already been advanced in Germany by Eduard
  Richter and S. Behrmann.

  [339] E. Metchnikoff, “The Prophylaxis of Syphilis,” published in
  _Medizinische Klinik_, 1906, No. 15, pp. 372, 373. _Cf._ also Paul
  Maisonneuve, “Experimentation sur la Prophylaxie de la Syphilis”
  (Paris, 1906); and A. Neisser. “Experimental Research regarding
  Syphilis,” pp. 81-83 (Berlin, 1906).

  [340] O. Neustätter, “The Public Recommendation of Protective
  Measures,” published in _The Journal for the Suppression of Venereal
  Diseases_, 1905, vol. iv., pp. 203-252.

  [341] G. Bernhard, “The Criminal Law and Protective Measures against
  Venereal Diseases,” _ibid._, pp. 253-273.

  [342] F. von Liszt, “Legal Protection against Dangers to Health from
  Venereal Diseases,” published in _The Journal for the Suppression of
  Venereal Diseases_, 1903, vol. i., pp. 1-25.

  [343] Von Bar, “The Need for a Special Law against Blameworthy
  Venereal Infection,” _ibid._, pp. 64-72.

  [344] R. Schmölder, “Criminal and Civil Juridicial Significance of
  Venereal Diseases,” _ibid._, pp. 73-106.

  [345] Albert Reibmayr, “The Immunization of Families by Inheritable
  Diseases (Tuberculosis, Lues, Mental Disorders),” p. 17 (Leipzig and
  Vienna, 1899).

  [346] This conception of “partial syphilization” of our race appears
  somewhat vague. If we take care to think clearly, and in terms of
  exact biological knowledge, we shall see that--apart from a
  spontaneous loss of intensity on the part of the syphilitic virus (of
  which we have no precise knowledge whatever)--the only known way of
  accounting for syphilis having become milder is by natural selection,
  by the death of those who suffered most severely from the disease.
  Now, in 400 years, ten or twelve human generations, there has hardly
  been time for the development of immunity to a disease to which at
  most a small fraction only of the population has ever been exposed. It
  appears to me, however, that we may reasonably doubt the alleged
  decline in the severity of syphilis. It must be remembered that the
  entire absence of mercurial treatment at first, and the misuse of that
  specific for many years after its value had been proved, will account
  for much in respect of the apparent greater virulence of medieval as
  compared with modern syphilis. (See also p. 356, and footnote to that
  page referring to the writings of Archdall Reid).--TRANSLATOR.

  [347] Alfred Fournier, “The Treatment and Prophylaxis of Syphilis.”
  One vol. Rebman, London.

  [348] _Cf._ Iwan Bloch, “Personal Reminiscences of my Lecturing
  Journey this Year,” published in _Medizinische Klinik_, 1906, No. 10.

  [349] Hermann is a fanatical _medical_ opponent of mercury. There are,
  in fact, such oddities. They are very rare birds in the medical world.

  [350] Recently R. Kaufmann has collected in a small readable essay the
  scientific views of the present day, “The Therapeutic Use of Mercury”
  (Leipzig, 1906). I warmly recommend this book to all who are
  interested in the question.

  [351] _Cf._ Iwan Bloch, “The After-Treatment of Syphilis,” published
  in _Medizinische Klinik_, 1905, No. 4, pp. 88-91.

  [352] _Cf._ Iwan Bloch, “Nutritive Therapeutics in Cases of Syphilis,”
  published in _Medizinische Klinik_, 1905, No. 18, pp. 442-446.

  [353] Alfred Fournier, “En Guérit-on?” pp. 95, 96 (Paris, 1906).

  [354] “=Krankenkassen.=”--I have to employ the German term, since in
  England we do not possess the institution, nor even the name. In
  Germany there is a general system of insurance against illness, to
  which workmen have to contribute a proportion of their wages, the fund
  being supplemented by contributions from the employers of labour. When
  ill the workman applies to the _Krankenkasse_ for the necessary
  medical advice and treatment.--TRANSLATOR.

  [355] A. Blaschko, “The Treatment of Venereal Diseases in
  Krankenkassen” (Berlin, 1890).

  [356] A. Neisser, “Krankenkassen and the Campaign against Venereal
  Diseases,” published in _The Journal for the Suppression of Venereal
  Diseases_, 1904, vol. ii., pp. 161-169, 181-194, 221-247.

  [357] R. Ledermann, “Do the Provisions of the Law for Insurance
  against Sickness Provide for the Cure of Venereal Disease?” _ibid._,
  1905, vol. iii., pp. 449-463.

  [358] Albert Kohn, “Should Krankenkassen send Delegates to Hygienic
  Congresses?” _ibid._, 1906, vol. v., pp. 121-130.

  [359] Rudolf Lennhoff, in an address on February 8, 1907, to the local
  group of Berlin of the German Society for the Suppression of Venereal
  Diseases on “Venereal Diseases and Social Legislation,” drew especial
  attention to the necessity of enrolling in the scheme of insurance
  against illness wider circles of the impecunious population,
  especially the class of domestic servants. Servants suffering from
  venereal disease, since at the present day they usually preserve
  secrecy as to their trouble, in order that they may not lose their
  place, constitute a dangerous source of infection for their employers
  and the latters’ children. Therefore, a particularly thorough and
  speedy treatment of servants suffering from venereal diseases is
  necessary. It is further necessary to insist that all the employees of
  the Krankenkassen should observe the duty of professional secrecy.
  Recently the Landesversicherungsanstalt (an insurance institution) of
  Berlin started a dispensary of its own in Lichtenberg for patients
  suffering from venereal disease, in which every year more than 400
  patients undergo treatment.

  [360] A. Blaschko, “The Diffusion of Venereal Diseases,” published in
  _The Hygiene of Prostitution and of Venereal Diseases_, pp. 19-36
  (Jena, 1900).

  [361] “Diffusion of Venereal Diseases in Prussia, as well as the
  Measures Necessary in the Campaign against these Diseases,” edited by
  A. Guttstadt; Berlin, 1901 (_Journal of the Royal Prussian Statistical
  Bureau_).

  [362] M. Kirchner, “The Social Importance of Venereal Diseases.”

  [363] _Cf._ Chotzen and Simonson, “The Duty of Notification and the
  Obligation of Professional Secrecy on the Part of Physicians in the
  Case of Venereal Diseases,” published in _The Journal for the
  Suppression of Venereal Diseases_, 1904, vol. ii., pp. 433-474; A.
  Neisser, “Amendment of § 300 of the Criminal Code, and the Medical
  Duty of Notification, in Relation to the Suppression of Venereal
  Diseases,” _op. cit._, 1905, vol. iv., pp. 1-28; Bernstein, “Medical
  Professional Secrecy and Venereal Diseases,” _ibid._, pp. 29-31; M.
  Flesch, “Medical Professional Secrecy and the Suppression of Venereal
  Diseases,” _ibid._, pp. 32-51; Magnus Möller, “The Duty of
  Professional Secrecy on the Part of Physicians, the Notification of
  Diseases, and the Ascertainment of the Sources of Infection in the
  Case of Venereal Diseases,” _ibid._, 1906, vol. vi., pp. 241-258,
  283-301; Ludwig Bendix, “Professional Secrecy on the Part of
  Physicians,” _ibid._, 1906, pp. 372-376.

  [364] H. Loeb, “Statistics Relating to Venereal Diseases in Mannheim,”
  published in _The Journal for the Suppression of Venereal Diseases_,
  vol. ii., pp. 97, 98 (1904).

  [365] H. Berger, “Prostitution in Hanover,” pp. 37, 38 (Berlin, 1902).

  [366] Schmölder, “The State and Prostitution,” p. 1 (Berlin, 1900).

  [367] _Cf._ J. Fabry, “The Question of Inscription under Police
  Surveillance, with especial Regard to the Conditions in Dortmund,”
  published in _The Journal for the Suppression of Venereal Diseases_,
  1906, vol. v., pp. 325-342.

  [368] A. Neisser, “In what Direction can the Regulation of
  Prostitution be Reformed?” published in _The Journal for the
  Suppression of Venereal Diseases_, 1903, vol. i., pp. 163-356.

  [369] Anna Pappritz, “Is the Present Method of the Regulation of
  Prostitution Capable of Reform, and in What Manner?” published in _The
  Journal for the Suppression of Venereal Diseases_, 1903, vol. i., pp.
  367-372.

  [370] Clausmann, “Prostitution, Police, and Justice,” _op. cit._,
  1906, vol. v., pp. 219-225.

  [371] Friedrich Hammer, “The Regulation of Prostitution,” published in
  _The Journal for the Suppression of Venereal Diseases_, 1904, 1905,
  vol. iii., pp. 373-385, 426-435.

  [372] S. Bettmann, “The Medical Treatment of Prostitutes” (Jena,
  1905)--a thorough study of all the available material.

  [373] Schmölder, “Professional Fornication and Compulsory Inscription
  on the List of Prostitutes” (Berlin, 1894).

  [374] “The Social Evil, with Especial Reference to Conditions existing
  in the City of New York. A Report prepared under the Direction of the
  ‘Committee of Fifteen,’” pp. 91, 92 (New York and London, 1902).

  [375] A severe criticism of regulation and its consequences is to be
  found in the excellent dissertation of Paul Emile Morhardt, “Les
  Maladies Vénériennes et la Réglementation de la Prostitution au Point
  de Vue de l’Hygiène Sociale” (Paris, 1906).

  [376] _Cf._ the admirable description of soutenage given by Hans
  Ostwald, “Soutenage in Berlin” (Berlin and Leipzig, 1905).

  [377] “The human being awakens in the prostitute. That is the whole
  secret and the cause of soutenage.”--H. OSTWALD.

  [378] The dislike to the brothels of Paris is confirmed by Lassar
  (“Prostitution in Paris,” _Berliner klinische Wochenschrift_, 1892,
  No. 5).

  [379] J. Rutgers (“Sketches from Holland,” published in _The Journal
  for the Suppression of Venereal Diseases_, 1906, vol. v., p. 345) has
  admirably expressed this fact in the following words: “=The danger of
  infection is directly proportionable to centralization.=”

  [380] Anna Pappritz, “What Protection can Brothel Streets Offer?”
  published in _The Journal for the Suppression of Venereal Diseases_,
  1904, 1905, vol. iii., pp. 417-424.

  [381] Stachow, “The Controlled Streets of Bremen,” _ibid._, 1905, vol.
  iv., pp. 77-87.

  [382] Fabry, “Brothels and Brothel Streets,” _ibid._, 1905, pp.
  167-169 (in favour of “Kasernierung”); Wolff, “The Question of
  Kasernierung,” _ibid._, 1905, vol. iv., pp. 73-76 (in favour of
  “Kasernierung”); F. Block, “The Kasernierung of Prostitution in
  Hanover” (Hanover, 1907).

  [383] F. Zinsser, “The Conditions of Prostitution in the Town of
  Cologne,” _ibid._, 1906, vol. v., pp. 201-218.

  [384] E. von Düring, “The Brothel Question,” _ibid._, 1905, pp.
  111-128.

  [385] H. Fürth, “The Suppression of Venereal Diseases and the Brothel
  Question,” _ibid._, pp. 129-156.

  [386] K. Nötzel, “Brothels in Russia,” _ibid._, 1906, pp. 41-66,
  81-106.

  [387] M. Bruck, “Good Morals and the Brothel Trade,” _ibid._, pp.
  57-62.

  [388] O. Lassar, “Prostitution and Venereal Diseases,” published in
  _Hygienische Rundschau_, 1891, No. 23.

  [389] See note at end of chapter.

  [390] B. Marcuse, “Treatment of Prostitutes,” published in _The
  Journal for the Suppression of Venereal Diseases_, 1906, pp. 1-8.

  [391] F. Schiller, “Rescue-Work and the Suppression of Prostitution,”
  _ibid._, 1903, 1904, vol. ii., pp. 294-313, 341-349.

  [392] _Ibid._, 1906, vol. iii., pp. 336-350.

  [393] P. Kampffmeyer, “Educational Work in Connexion with
  Prostitutes,” _ibid._, pp. 351, 352.

  [394] E. Kromayer, “The Physician and the Protection of Motherhood,”
  published in _Mutterschutz_, 1905, vol. iii., pp. 351-352.

  [395] Quite recently--October, 1906--the =first= step in this
  direction has been taken. The Chief Commissioner of the Berlin Police
  addressed to the medical specialists in venereal diseases an inquiry
  whether they were prepared to treat gratuitously impecunious
  prostitutes who were not under police control. The girls would then be
  given a register of these doctors. If they presented themselves for
  treatment, no particulars about them would be demanded from the
  physician. The presentation by the patients to the police of a
  certificate from a medical man =would suffice to exempt them from
  police control, and from compulsory examination and treatment at the
  police department of the section of the town to which they belonged=.
  Further details will be arranged later in co-operation with the
  Committee of the Society for the Suppression of Venereal Diseases.

  In his valuable study, “The Future of Prostitution,” published in the
  monthly magazine _Mutterschutz_, July, 1907, pp. 274-288, Havelook
  Ellis also takes an extremely optimistic view regarding the gradual
  and inevitable diminution of prostitution by indirect means--that is
  to say, in this way we are elevating ourselves socially and
  economically to a higher stage of humanity.

CHAPTER XVI

STATES OF SEXUAL IRRITABILITY AND SEXUAL WEAKNESS

(Auto-erotism, Masturbation, Sexual Hyperæsthesia and Sexual Anæsthesia,
Seminal Emissions, Impotence, and Sexual Neurasthenia).

  “_The conditions of modern civilization render auto-erotism a
  phenomenon of increasing social importance._”--HAVELOCK ELLIS.

CONTENTS OF CHAPTER XVI

  Wide diffusion of auto-erotic phenomena -- Their significance in
  relation to civilization -- Physiological and pathological relations
  -- Their diffusion among animals and among primitive peoples -- The
  auto-erotic instrumentarium -- Causes of auto-erotism and of
  masturbation -- New views regarding the masturbation of sucklings --
  The sexual tension of puberty -- Sexual toxins -- Mechanical stimuli
  in sexual tension -- Sedative and anodyne effects of masturbation --
  Seduction as the cause of masturbation -- Group-masturbation in
  schools, etc. -- Diseases as causes of masturbation -- Inheritance of
  the tendency to masturbation -- Masturbation in the female sex -- Its
  frequency -- Psychical onanism -- Sexual day-dreams -- Erotic
  correspondence -- Consequences of masturbation -- Exaggerated views of
  former times -- Analysis of the harmfulness of masturbation -- Changes
  of the psyche and of the will -- Explanation of certain phenomena of
  our time as due to masturbation -- Physical consequences of
  masturbation -- Local changes in the genital organs -- Abnormalities
  in the libido sexualis -- Treatment and cure of masturbation --
  Clothing -- Trousers and masturbation -- Doctor Bernhard Faust’s book
  -- Various medical methods employed in the treatment of masturbation.

  Sexual neurasthenia -- Its connexion with masturbation -- Relative
  independence of its symptoms -- Abnormal increase of the sexual
  impulse (sexual hyperæsthesia) -- Causes -- Peculiar form of nocturnal
  increase of the sexual impulse -- Satyriasis and priapism --
  Nymphomania -- Causes of Nymphomania -- Examples -- Treatment of
  sexual hyperæsthesia -- Abnormal diminution of the sexual impulse
  (sexual anæsthesia) -- Causes -- Frequency of sexual frigidity in
  women -- Causes -- Vaginismus -- Treatment of frigidity in women --
  Frigidity and prostitution -- Frigidity and marriage -- Erotomania --
  Seminal emissions -- Lallemand’s distinction between normal and
  abnormal pollutions -- Morbid pollutions -- Diurnal pollutions --
  Abnormalities of the genital organs and of the sensation during
  pollutions -- Spermatorrhœa and prostatorrhœa -- Pollutions in women
  -- Older and more recent observations -- Medical treatment of
  pollutions.

  Impotence -- Its principal forms -- Malformations of the genital
  organs -- Castration -- Gonorrhœal diseases -- Azoospermia --
  Smallness and injuries of the penis -- Incomplete erections -- Central
  and peripheral causes of erection -- Functional impotence -- General
  disorders -- Deleterious influence of alcohol and tobacco -- Nervous
  impotence -- The psychical impotence of the wedding night -- Examples
  -- Mental work and potency -- The effect of sudden mental impressions
  -- Reflective impotence -- Rousseau’s Venetian adventure --
  Neurasthenic impotence -- Its forms and symptoms -- Impotence due to
  abstinence -- Senile impotence -- Treatment of impotence.

  Other phenomena of sexual neurasthenia (gastric disorders, etc.) --
  Sexual hypochondria -- The treatment of sexual neurasthenia.

CHAPTER XVI

Almost as widely diffused as venereal diseases are the abnormal sexual
manifestations to be considered in this chapter under the general title
of “States of Sexual Irritability and Sexual Weakness.” They arise in
part out of the =very nature of mankind=; in part they are the external
manifestations of a =natural impulse=, of an instinctive excitement, in
which form we see them also in other animals; in part they are connected
with man’s =spiritual= nature, with =civilization=. We may, indeed, say
that the duplex nature of man, his bodily-spiritual dualism, is most
clearly reflected in this phenomenon of his sexuality. In this respect
he is wholly human.

It is a great service performed by Havelock Ellis[396] that he was the
first to direct attention to the “involuntary” manifestations of the
sexual impulse peculiar to mankind, occurring =without= relation to the
other sex. He gives them the distinctive name of “=auto-erotism=,” by
which he means “the phenomenon of spontaneous sexual excitement
manifesting itself =without any stimulus, direct or indirect, supplied
by any other person=.” For the most part, therefore, the normal
manifestations of art and poetry belong also to the province of
auto-erotism, in so far as they are the result of erotic perception; and
the same is true of all those manifestations which I have termed
“=sexual equivalents=,” all transformations of sexual energy, such as
religio-sexual phenomena, the transformation of individual love into the
general love of mankind, the stimuli of fashion, and =every powerful
activity= by means of which sexual tension finds a mode of discharge,
even though this sexual relationship is usually of an unconscious
nature, as in the dance, in society games, and other enjoyments.

In my essay on “The Perverse,” pp. 14, 15 (Berlin, 1905), I have shown
that there is no doubt that these sexual equivalents, taken in their
entirety, have played an extremely important part in the course of the
evolution of mankind; that they represent =the natural outlets= for
feelings of tension and excessive forces of sexual origin; and that they
should not be unnecessarily suppressed, unless we wish to evoke =much
worse and far more dangerous= variations of their activity--as, for
example, in the political sphere.

Appositely, I find in Friedrich Nietzsche’s “Posthumous Works” (vol.
xii. of the “Collected Works,” p. 149; Leipzig, 1901) an interesting
remark bearing on the question:

  “Many of our impulses find an outlet in a mechanically powerful
  activity, which =can= be directed by intelligent purpose; unless this
  is done, these manifestations are destructive and harmful. Hate,
  anger, =the sexual impulse=, etc., can be =set to the machine= and
  taught to do useful work--for example, to chop wood, to carry letters,
  or to drive the plough. =Our impulses must be worked out.= The life of
  the learned man more especially demands something of the kind.”

What a wise and apt remark! Our whole civilization is permeated with
sexual equivalents of this kind; the pleasure of life and the joy of
existence are based thereon, however much our puritans and asexual
“morality-fanatics” may strive against this fact. And it is well that
the sexual impulse has been “civilized,” that there are now so many
spontaneous modes of its discharge, that the sphere of auto-erotism
increases _pari passu_ with the growth of civilization. Many new, finer,
and nobler incitations and stimuli stream therefrom into love and life,
upon which they exercise a rejuvenating and strengthening influence.
Still, this light throws a shadow, inasmuch as fantastic and unnatural
aberrations of the sexual life are also apt to ensue.

Auto-erotism (including its grosser form, masturbation) is therefore, to
a certain extent, a =physiological= manifestation; it becomes morbid
only in certain conditions--that is to say, in individuals who are
previously =morbid=. This is, indeed, an old medical doctrine, that
there exists a physiological masturbation _faute de mieux_, and a morbid
masturbation in cases of neurasthenia, mental disorder, and other
troubles. The same is true of auto-erotism in its entire extent. When
Fürbringer describes masturbation as “an =unnatural= gratification of
the sexual impulse,”[397] this is only partly true. There exists a
=natural, physiological masturbation=, a =normal= auto-erotism.
Metchnikoff shares this view.[398] He says: “=It is man’s constitution
itself= that permits the premature development of sexual sensibility,
before the reproductive elements are mature.” The ultimate cause of such
auto-erotic manifestations as belong neither to the category of “vice”
nor to that of “crime” is to be found, he thinks, in a =disharmony= in
the nature of man in respect of the premature development of sexual
sensibility. For this reason we meet with these manifestations just as
much among the lowest races of mankind as we do among civilized
peoples; even among =animals= auto-erotism is a widely diffused
phenomenon. This can be observed, not only among the monkeys (perhaps
already a little civilized) of our Zoological Gardens, which masturbate
freely _coram publico_, but it may be seen also in horses, which shake
the penis to and fro until seminal emission occurs; also in mares, which
rub themselves against any available firm object. We see the same thing
in wild deer. Even elephants masturbate. Among primitive races
masturbation is, perhaps, even more general than among civilized races.
Among South African tribes, Gustav Fritsch reports, masturbation is
actually a popular custom.

Havelock Ellis has described the entire auto-erotic instrumentarium, and
it appears from his account that savage races manufacture onanistic
stimulatory apparatus for women quite as elaborate as those which are
produced by the most highly developed lewd industry of civilized
peoples. Most frequently articles in everyday use are employed for
auto-erotic gratification--as in Hawaii, bananas; in our own part of the
world, cucumbers, carrots, and beetroots. Further, in the vagina and
bladder have been found pencils, sticks of sealing-wax, empty reels,
bodkins, knitting-needles, needle-cases, compasses, glass stoppers,
candles, corks, tumblers, forks, toothpicks, pomade-boxes,
cockchafers,[399] hens’ eggs, and, with especial frequency, =hairpins=.

I may allude here, in passing, to the fact that C. Posner refers the
discovery of various bodies in the male urethra to other causes than
masturbation in some cases. He states that often they have been
introduced by other persons than the one in whom they are found, and is
of opinion that the introducer is a man with sadistic tendencies, and
usually homosexual (see C. Posner, “The Introduction of Foreign Bodies
into the Male Urethra, with Remarks on the Psychology of such Cases,”
published in _Therapie der Gegenwart_, September, 1902). In the year
1862 masturbation with the aid of hairpins was so widely practised in
Germany that a surgeon invented a special instrument for the removal of
hairpins from the female bladder! At the present day this hairpin
masturbation is extremely common.[400] Still more elaborate are
artificial imitations of the male penis, the so-called _godemichés_
(_gaude mihi_, _dildoes_, _consolateurs_, “_bijoux indiscrets_,”
etc.),[401] of which we find representations in ancient Babylonian
sculpture, in Egypt, and in the “Mimiamben” of Herondas[402] (third
century before Christ); and since very ancient times they have been in
use in Eastern Asia, where the Spaniards found them in the Philippines.
Particularly well known are the wax phalli of the Balinesian women. In
Europe, as early as the twelfth century, Bishop Burchard of Worms
condemned the use of artificial penes. Their use was especially common
at the time of the Italian renascence; the technique of their employment
became continually more elaborate. The culmination was reached in the
eighteenth century France. No less a man than Mirabeau, the celebrated
French politician, in his erotic romance, “Le Rideau Levé, ou
l’Education de Laure,” describes such an artificial phallus, and I
append his description in order to enable the reader to represent to
himself the extremely elaborate technique that was used in the
application of such auto-erotic instruments:

  “The instrument resembled in every respect the natural penis. The only
  difference consisted in this, that from the apex to the root it was
  shaped in transverse waves, in order to render the rubbing action more
  powerful. Made entirely of silver, it was covered with a kind of
  smooth and very hard varnish, giving it the natural colours. For the
  rest, it was very light and thin, being hollow. Through the middle of
  the hollow interior there passed a round tube, made also of silver,
  and about twice the diameter of a goose-quill, and within this tube
  was a piston; the tube was firmly closed at the other end by means of
  a screw. This screw was perforated, and firmly soldered to the base of
  the head. Consequently there was an empty space between the central
  tube and the outer wall of the instrument. This outer cavity of the
  godemiché was filled with water warmed to blood-heat, and then closed
  with a well-fitting cork. The small central tube was filled with a
  thin, whitish solution of isinglass (!), which was previously
  prepared. The warmth of the water was immediately communicated to the
  isinglass solution; and the latter then represented, as far as was
  possible, the human semen.”

This description dates from the year 1786! But even to-day apparatus of
this kind are advertised in the catalogues of certain traders, under
the title of “Parisian Rubber Articles.” Whether they really exist I do
not know, for I have never actually seen anything of the kind. Havelock
Ellis assumes that they are still used to-day. In brothels, prostitutes
use at the present time very primitive leathern phalli, such as were
described by Herondas and Aristophanes, for erotic practices and
demonstration.

In addition to these, there are numerous other methods of purely
peripheral-mechanical masturbation. Thus, the rubbing and movement of
the genital organs in bicycle-riding, horse-riding, very frequently in
working the treadle of a sewing-machine, and in travelling on the
railway, may give rise to masturbatory stimulation. Very commonly in
women merely rubbing the thighs against one another is sufficient to
induce a sexual orgasm; whereas men almost always need to have
recourse to more powerful manipulation, such as manual friction
(_manustupratio_).

What are the general physiological =factors= of auto-erotic phenomena,
more especially of masturbation? In this connexion it is interesting to
note that =auto-erotism is almost always a precursor of completely
developed sexuality=, and manifests itself a long time =before= puberty;
and may even appear soon after birth, for the older and more recent
medical literature of the subject contains numerous observations of
masturbation in =sucklings=, not to speak of masturbation in older
children. The auto-erotism of sucklings is =purely peripheral= in its
nature, and depends upon the mechanical stimulation of certain parts of
the body, the first “erogenic” zones of man. Freud enumerates among the
regions of the body by the stimulation of which sexual pleasure is most
readily obtained, the lips of the infant, which, in sucking the mother’s
breast or its substitute, receive an instinctive perception of pleasure,
in which the stimulation produced by the warm flow of milk also plays a
part. This “ecstatic sucking” of infants is auto-erotic in character.
Not infrequently, while sucking in this voluptuous manner, the infant
simultaneously rubs certain sensitive parts of the body, such as the
breast and the external genital organs. A kind of orgasm occurs,
followed by sleep. Freud aptly compares this phenomenon with the fact
that in later life sexual gratification is often the best means of
inducing sleep. Freud also regards the masturbation of sucklings as
being within certain limits a physiological phenomenon, as exhibiting on
the part of Nature an intention “to establish the future primacy of
these erogenic zones for sexual activity.”[403]

With the onset of puberty the auto-erotic instincts are newly
stimulated; new sources of auto-erotism become active, principally owing
to the development of the genital organs and to the evacuation of the
reproductive products. Various theories have been propounded to explain
by what means the =sexual tension= occurring at puberty is induced, this
sexual tension being regarded as the ultimate cause of the masturbation
of sexually mature human beings. The most plausible hypothesis is the
=chemical= theory of sexual tension and sexual excitement, which was
explained in more detail above (p. 47). It may be that, as Freud
assumes, a substance generally diffused throughout the organism is
destroyed by the stimulation of the erogenic zones, and that the
products of decomposition of this substance give rise to a discharge of
sexual energy; it may be that the reproductive organs themselves produce
such chemical substances, =sexual toxins=. This assumption is supported
by the experimental observation that when in animals the ovaries and all
the nerves connected with these organs have been removed, and
consequently the ordinary periodic recurrence of sexual activity is no
longer seen, if now ovarian extract is injected into the body of such
animals, rutting once more occurs. Starling introduced the term
“=hormone=” to denote these chemical sexual substances. They appear also
to play a part in connexion with certain abnormalities and perversions
of the sexual impulse--a matter to which we shall return later. R.
Kossmann also speaks of a “=neuro-chemical=” injury--a kind of
intoxication of the nervous system induced by “retained secretions or
excretions of the reproductive organs.”[404]

The same author also advances the =neuro-mechanical= theory of sexual
tension. He understands by this that the purely mechanical =distension=
of the organs belonging to the reproductive apparatus exercises a
=mechanical stimulus= on the genital nerves, and thus has a reflex
action upon the centres of the brain and spinal cord, which reflex
stimulation is allayed by orgasm and ejaculation. Haig explains the
feeling of relief after masturbation, and the consequent discharge of
sexual tension, as rather dependent upon the mechanism of the
blood-pressure. He remarks:

  “Since the sexual act gives rise to a low and falling blood-pressure,
  it must necessarily alleviate conditions which are due to high and
  increasing blood-pressure--for example, mental depression and
  ill-humour--and if my observations are correct, we have here an
  explanation of the relation between conditions of high blood-pressure
  with mental and physical depression, on the one hand, and masturbatory
  practices on the other, for such practices alleviate this condition,
  and are readily indulged in for this purpose” (quoted by Havelock
  Ellis).

The statement made to Dr. Garnier by a monk, thirty-three years of age,
bears out this view:

  “If no nocturnal seminal emissions occur, the tension of the semen
  gives rise to general depression, headache, and sleeplessness. I admit
  that sometimes, in order to obtain relief, I lie upon the abdomen, and
  so produce a seminal discharge. I immediately feel =freed=, as if a
  =burden= had been lifted from me, and sleep returns” (_ibid._, p.
  273).

Similar motives for masturbation are alleged by many otherwise healthy
onanists. They apply, moreover, in an equal degree to the normal, not
excessive, sexual intercourse of ordinary human beings. Persons
belonging to the most diverse classes of society--men of letters,
shopmen, labourers, etc.--of whom I have inquired regarding the effect
of seminal emissions, whether produced by masturbation or by coitus,
have unanimously agreed in describing to me this sense of “freeing” from
a burden, from pressure, from harmful substances accumulated in the
body--a sense of mental energy and creative power after such discharges
of sexual tension not exceeding normal limits. The frequency of these
discharges varies in different individuals; in one the intervals were
short, in another they were long. This point has a very important
bearing upon the “question of sexual abstinence,” and we shall return to
it in the discussion of that topic.

Masturbation is often the means for inducing sleep and repose; it dulls
nervous sensibility, and connected with this is the fact that _pain_ is
often allayed by masturbation. Here I may refer once more to the
previously quoted (p. 44) view of a talented young alienist, Edmund
Forster, that, in association with sexual tension, there occurs an
increased stimulation of the =pain-perceiving nerves= of the genital
organs. It is conceivable that sexual tension, especially if it depends
upon chemical causes, also increases pains arising from other areas of
the body, and that the discharge of sexual tension would thus alleviate
or completely allay these pains. Coe reports (_American Journal of
Obstetrics_, 1889, p. 766) the case of a woman who was accustomed by
masturbation to obtain immediate relief of intense menstrual ovarian
pains. It is very remarkable that =these pains were accompanied by a
powerful sexual impulse=, which ceased when the pain ceased, and did
not return during the intermenstrual period. Here we have a striking
testimony of the accuracy of Forster’s view. The phrenologist Gall was
aware of the manner in which masturbation relieves pain.

In addition to these more natural causes of masturbation, which in
themselves suffice to explain the wide diffusion of the practice, we
have also to consider masturbation dependent upon =seduction= and upon
=morbid states=.

To seduction must be referred all the phenomena of =group-masturbation=
(masturbation on the large scale) in =schools=,[405] training-ships,
barracks, factories (especially in this case as regards female
employees!), prisons, etc. One leads another astray, and masturbation is
diffused like an epidemic disease; the individuals are subjected to the
influence of the =suggestion of the crowd=, which they are unable to
resist. Thomalla describes boarding-schools in which masturbation was
practised for a wager, and that boy won the prize in whom seminal
emission first occurred! He further speaks of a school club in which
obscene readings were held, and in which by means of forbidden pictures
the boys were sexually excited until erection occurred, then followed
general masturbation, also accompanied by wagers.

This group-masturbation is the best proof of the fact that those who
masturbate are not simply individuals with an inherited morbid
predisposition; for nothing is easier to suggest than masturbation.
Havelock Ellis[406] reports the following case of an unmarried healthy
young woman, thirty-one years of age, which throws a strong light on
this suggested manifestation:

  “When I was about twenty-six years of age, a female friend informed me
  that she had masturbated already for several years, and was so much
  enslaved by the habit that she suffered seriously from its
  ill-effects. I listened to her account with sympathy and interest, but
  felt rather sceptical, =and I resolved to make the attempt on myself=,
  with the intention of understanding the matter better, so that I might
  be able to help my friend. With a little trouble I =succeeded in
  awakening what had hitherto slumbered in me unknown=. I intentionally
  allowed the habit to become stronger, and one night--for I usually did
  it just before going to sleep, never in the morning--I really
  experienced an extremely agreeable sensation. But the next morning my
  conscience was aroused, and I felt pains also in the back of the head
  and along the spine. For a time I discontinued the habit, but later
  began it again, masturbating with considerable regularity once a
  month, a few days after each menstruation.... The habit overcame me
  with alarming rapidity, and I soon became more or less its slave....
  In conclusion, I must say that masturbation has proved to me one of
  the blind chances in my life’s history, out of which I have derived
  many valuable experiences.”

Frequently local morbid changes in or near the genital organs lead to
the practice of masturbation, such as skin troubles, intestinal worms,
phimosis, inflammatory states of the penis or near the entrance of the
vagina, prurigo and other itching affections of the penis,
constipation, urinary anomalies, etc. Further, mental disorders,
epilepsy, and degenerative nerve troubles, are frequent causes of
masturbation. Masturbation has been observed after epileptic paroxysms
in patients who at other times never masturbate. There is no doubt that
neurasthenia powerfully predisposes to masturbation. =Excessive=
masturbation is almost always the consequence, not the cause, of
associated neurasthenia; it is “the manifestation of a disease in
course of development or of a permanently existing degenerative
predisposition.”[407] To these cases of invincible, habitual, excessive
masturbation Oppenheim’s view applies--that the disposition to onanism
is often =inherited=. A characteristic instance of this is offered by an
observation of Block’s (Havelock Ellis, _op. cit._, p. 240) in the case
of a little girl, who began to masturbate at the early age of two years,
and had probably inherited this tendency from her mother and
grandmother, for they had both masturbated throughout life, whilst the
grandmother had actually died in an asylum of “masturbatory insanity.”
In the majority of cases in which =masturbation makes its first
appearance in sucklings= we have to do with such an inheritance. In many
cases the peculiar oscillatory movements of sucklings may merely be the
expression of the sense of general comfort, as Fürbringer believes, and
may have nothing to do with actual masturbation; but, on the other hand,
it cannot be denied that veritable masturbation may be observed in the
first and second years of life. Havelock Ellis, J. P. West, and Louis
Mayer have reported such cases. In children somewhat older than
this--from three years upwards--seduction and suggestion certainly play
a great part. The author of “Splitter” was told by a professor that,
when visiting an institution for small children in St. G[allen], he saw
a girl about three years of age who was making suspicious movements. The
matron, whose attention was called to the matter, said that almost all
babies were already infected when they first came to the institution
(“Splitter,” p. 375).

Another disputed question relates to the =diffusion of masturbation in
the female sex=. Is the practice commoner or less common among women
than among men? Metchnikoff[408] is of opinion that in girls it is much
less common than in boys, because sexual excitability generally develops
much later in the female sex. Female monkeys masturbate only in
exceptional cases, whereas in male monkeys masturbation is very common.
The circumstance which Metchnikoff adduces in further support of his
view of the rarity of masturbation in women--that, namely, most girls
are enlightened regarding sexual sensibility only after marriage--proves
very little, because the sensations aroused in woman by masturbation are
of a very different nature from those produced by coitus, and coitus
often first makes them acquainted with entirely new sensations. Tissot
regards masturbation as commoner in women than in men; Deslandes
believed that there was no difference between the sexes. Lawson Tait,
Spitzka, and Dana, inclined rather to Metchnikoff’s view as to the
greater rarity of the practice among women. Albert Eulenburg considers
masturbation “not quite so common among young women as among young men,”
but still “far more common than parents, teachers, and the laity of both
sexes as a rule imagine.”[409] Havelock Ellis considers that =after=
puberty masturbation is commoner in women because men can then much more
readily obtain gratification in a normal manner by means of intercourse
with the other sex. Otto Adler estimates the frequency of masturbation
to be very great, because he regards it as the principal cause of
deficient sexual sensibility in women, which latter condition he also
believes to be extremely common, although he does not go so far as to
accept Rohleder’s enormous proportion of 95 masturbators in every 100
women (!).[410] L. Löwenfeld, who characterizes Rohleder’s and Berger’s
(99 %) estimates as exaggerations, considers that the frequency of
masturbation in women is not so great as in men.[411] In reality,
masturbation, given similar circumstances and causes, is probably
diffused to an approximately equal extent among both sexes.

But this relates only to peripheral-mechanical masturbation; from this
“=psychical onanism=” has rightly been separated--that form of
masturbation in which, simply by ideas, without the assistance of manual
stimulation of the genital organs, sexual excitement is caused and the
orgasm is induced. Psychical onanism, of which Eduard Reich[412]
remarked that our own time nourishes it to the fullest possible extent,
develops in the majority of cases out of masturbation proper. In this
form the =imagination= is tasked with representing all the factors of
normal sexual gratification. The simple physical act suffices only in
the first beginnings of this vice. Every practised onanist understands
that he must soon call his imagination to his aid in order to produce
sexual gratification, and that ultimately ideas alone dominate the
entire libido, and the orgasm often enough terminates an act which in
every respect has throughout remained purely ideal.

  “So great is the power of imagination,” remarks the experienced
  Rouband, “that quite alone, without the assistance of physical
  stimulation, it can produce the venereal orgasm, with ejaculation of
  the semen, as happened to one of my fellow-students every time he
  thought of his beloved.”[413]

Hammond even knew an actual sect of such “onanists by means of simple
ideal unchastity,” who formed a sort of club or society, and who were
known to one another by certain signs.[414] A patient related to him
that in his thoughts of women whom he met, or those who were sitting
opposite to him in the railway-carriage, he was accustomed to undress
them in imagination; he then would represent to himself very plainly
their genital organs, and during this representation he experienced very
active voluptuous sensations, culminating in ejaculation. Löwenfeld has
also observed several such cases. Eulenburg speaks of an “ideal
cohabitation.” The ideas are usually of a lascivious nature, but this is
not always the case. Von Schrenck-Notzing reports the case of a lady
twenty years of age in whom the simple idea of men, but also agreeable
sensory perceptions, such as theatrical scenes, or musical impressions,
or beautiful pictures, gave rise to the sexual orgasm.[415]

Allied with psychical onanism is the brooding over sexual ideas--the
_delectatio morosa_ of the theologians--and erotic excitement associated
with dream-imaginations, or “sexual day-dreams” (Havelock Ellis). This
is the spinning out of a continuous erotic history with any hero or any
heroine, which is carried on from day to day. Most commonly this occurs
in bed before going to sleep. Sexual activities form the material of
these histories. We often find carefully worked out and more or less
erotic day-dreams in young men, and especially in young women,
frequently containing perverse elements. This dreaming, according to
Havelock Ellis, does not necessarily lead to masturbation, although it
often induces seminal discharges. It occurs both in healthy and in
abnormal persons, especially in imaginative individuals. Rousseau
experienced such erotic day-dreams. The American author Garland, in his
novel, “Rose of Dutcher’s Coolly,” has admirably described the part
played by a circus-rider in the erotic day-dreams of a =normal healthy
girl= during the =period of puberty=.[416]

In close relationship with these psychical-onanistic day-dreams there
stands another phenomenon, to which, as far as I know, I was the first
to refer, which I have denoted by the term =erotographomania=.[417]
There are numerous men and women who induce their lovers--male or
female, as the case may be--prostitutes, masseuses, etc., to write to
them =letters= with a sexually stimulating content; or also, as very
frequently occurs, they themselves write such letters, containing
numerous obscenities. Such correspondence, filled with ardent erotism,
seems recently to have made its appearance as a peculiar refinement of
sexuality; this also has the effect of a kind of psychical onanism. The
interchange of obscene letters of this character recently played a part
in the trial of two homosexual individuals in East Prussia. There
exists, also, a comparatively blameless, more or less physiological,
erotographomania of the time of puberty, in which most passionate
letters are written to imaginary lovers, and the still obscure sexual
impulse finds a satisfaction in these erotic imaginations.

After this brief account of the various forms and varieties of
masturbation, we now turn to consider the =consequences= of the
practice. In the course of time there has been a remarkable change of
views in respect of this matter. The true founder of the scientific
literature of masturbation, Tissot, in his celebrated monograph
(“Masturbation; or, the Treatment of the Diseases that result from
Self-Abuse”; St. Petersburg, 1774), regarded masturbation as the evil of
all evils, and deduced from it all possible severe troubles. His book
bears as motto the verse by Von Canitz:

   “Wenn schnöde Wollust dich erfüllt,
    So werde durch ein Schreckensbild
    Verdorrter Totenknochen
    Der Kitzel unterbrochen.”

  [“When base lust fills thy thoughts,
    Let a horrible picture rise before thy mind
    Of withered dead men’s bones,
    So let the sensual stimulation be driven away.”]

It is dominated by a thoroughgoing pessimism. In this view he is
followed by Voltaire, in his “Dictionnaire Philosophique,” and by the
authors of the first seventy years of the nineteenth century. Such
gloomy views are expressed, above all, by Lallemand, in his celebrated
book upon involuntary losses of semen; but they are shared by German
physicians also, as, for example, B. Hermann Leitner, in his treatise,
“_De Masturbatione_” (Buda-Pesth, 1844), and in the preface to his book
we read: “The writers who speak of the terrible results of self-abuse do
not exaggerate; on the contrary, their picture is not sufficiently
gloomy.”[418] Modern medical science has, however, reduced these
exaggerations to a reasonable measure. For this we have, above all, to
thank W. Erb and Fürbringer. The old belief in the enormous dangers and
the eminent injuriousness of masturbation, still remains as a bugbear in
certain popular writings, some of which have been published in hundreds
of editions. Who has not heard of the “Selbstbewahrung” (“Self-Abuse”)
of Retaus,[419] the prototype of this dangerous literature, which must
be regarded as the principal source of sexual hypochondria; frequently,
also, it induces direct sexual stimulation, because it does indeed
describe the devil, but describes also voluptuousness!

At the present day all experienced physicians who have been occupied in
the study of masturbation and its consequences hold the view that
=moderate= masturbation in healthy persons, without morbid inheritance,
has no bad results at all. It is only excess that does harm; but even
excess in healthy persons does less harm than in those with inherited
morbid predisposition. I may express the matter in this way: it is not
masturbation (Ger. _Onanie_) that is harmful, but “=onanism=” (Ger.
_Onanismus_)--that is to say, the habitual and excessive practice of
masturbation, continued for a number of years, =which certainly has an
injurious influence on health=. The boundary line at which the harmless
masturbation (_Onanie_) ceases and the injurious onanism (_Onanismus_)
begins cannot generally be defined. The difference between individuals
makes their reactions in this respect very different. For example,
Curschmann reports the case of a talented and brilliant author who,
notwithstanding the fact that he had masturbated to excess for eleven
years, remained physically and mentally vigorous, and pursued his
literary labours with notable success. Fürbringer reports a similar case
in a University lecturer. The following case, which came under my own
observation, shows that even excessive masturbation need not impair
health and working powers. A man of letters, forty years of age,
probably misled by a nursemaid in the first instance, had masturbated
without intermission since the age of five, and since puberty had done
so =several times a day= (three to ten times), without any interference
with his powers for work. He is a big, powerful, healthy man, of a
really imposing appearance. No one would suspect him to be a habitual
masturbator. That from the masturbation (Ger. _Onanie_) of childhood and
youth there developed a condition of formal onanism (Ger. _Onanismus_)
in the adult is in this case principally to be ascribed to the continued
abuse of alcohol. The patient drinks daily twelve to fourteen glasses of
Munich beer. He is also a heavy smoker. No evidence of inherited
predisposition to masturbation can be obtained. For the patient the
female sex exists only in the imagination; he has very rarely had sexual
intercourse, and avoids ladies’ society, although he has good fortune
with women. It is the same with masturbation as it is with sexual
intercourse: the effects vary according to the individual. Recently
masturbation and coitus have been compared in this respect. Sir James
Paget in his lecture on “Sexual Hypochondriasis” says: “Masturbation
does neither more nor less harm than sexual intercourse practised with
the same frequency in the same conditions of general health and age and
circumstance.” Erb and Curschmann go even further; for they consider
that masturbation has less influence on the nervous system than coitus.
=In reality=, however, masturbation is almost always more harmful than
coitus. The reasons for this are obvious. In the first place,
masturbation is begun much earlier, generally at an age when the body
has not yet developed any marked capacity for resistance. Masturbation
in childhood is, therefore, especially harmful.[420] Löwenfeld (_op.
cit._, p. 127) is of opinion that self-abuse begun before virility is
attained more readily gives rise to weakness of the nervous system than
masturbation begun later in life. In neuropathic children he saw several
times, as a consequence of masturbation, well-marked general
nervousness, paroxysms of anxiety, sleeplessness, and arrest of mental
development. In the second place, masturbation is more dangerous than
coitus in this way--that it can be carried out =much more frequently=,
on account of the more frequent opportunities, so that masturbation
four, five, or even more, times in a =single= day is by no means rare.
In the third place, the =spiritual influence= of masturbation is much
more harmful than that of normal coitus. The “solitary” vice influences
the psyche and the character in the mere child. The youthful masturbator
seeks solitude, becomes shy of human beings, reserved, morose, unhappy,
hypochondriacal. In the adult the sense of the debasing character and of
the sinfulness of masturbation is much more lively; self-confidence
departs; the masturbator regards himself as absolutely “=enslaved=” by
his vice, the eternal =struggle= against the ever-recurring impulse
gives rise more to mental depression than to actual physical harm. From
this there results a whole series of diseases of the will, for by
masturbation much less harm is done to the intellect than to the vital
energy, the capacity for spiritual and physical activity. The cold,
blasé manner of many young men, who seem never to have known the natural
youthful joy of life, the whole “demi-virginity” of modern young
girls--all these are without doubt dependent upon masturbation and upon
psychical onanism. The egoism of the onanist in the sexual relationship
increases his egoism in other respects, gives rise to cold-heartedness,
and blunts the more delicate ethical perceptions. The campaign against
masturbation as a group manifestation is eminently a _social_ campaign
for altruism; it insists that young people should take their share in
all questions relating to the common good. Peculiar extravagances and
unnatural characteristics in art and literature may also be partly
attributed to masturbation. Many works clearly bear its imprints. Thus
Havelock Ellis rightly refers in this connexion to the peculiar
melancholy in Gogol’s stories, for Gogol masturbated to great excess. It
would be possible to mention also certain writings of our own time which
inevitably give rise to such a suspicion.

The reader will do well to consult the interesting discussion of
masturbation from the philosophical standpoint by Schopenhauer (“Neue
Paralipomena,” ed. Grisebach, pp. 226, 227).

The =physical= consequences of immoderate and habitual masturbation may
also be really serious. The =eye= especially suffers manifold injuries,
as has been proved by the investigations of Hermann Cohn. Irritable
states of the conjunctiva, spasms of the eyelids, weakness of
accommodation, subjective sensations of light, and photophobia, may
result from masturbation. The =heart= also is sympathetically affected.
Krehl even speaks of “=masturbator’s heart=” as a consequence of the
long-lasting nervous hyperexcitability, which injures the heart and the
vessels, and is manifested by irregularity of the pulse and by
sensations of pressure and pain in the cardiac region, by palpitation,
etc. Discontinuance of the habit leads to an immediate disappearance of
all these alarming symptoms. Very important is also the causal connexion
between masturbation and =nervous= or =mental disorders=. Here, however,
as Aschaffenburg has recently insisted, we must distinguish clearly
between masturbation =resulting= from previously existing
nervo-psychical troubles, in which a vicious circle develops--for here
the masturbation is partly the consequence of the original trouble,
partly the cause of an aggravation of this trouble--and the effects of
onanism on the =healthy= central nervous system. Here Aschaffenburg is
in agreement with the views of those who consider these effects are less
serious than earlier writers were accustomed to assume. Aschaffenburg
also recognizes that the most harmful effect is to be found in the
=psychical= influence of masturbation, in the continuous, but ever-vain,
contest against the habit. This is the source of the majority of the
hypochondriacal and other troubles. He often succeeded, by the discovery
of this psychical mode of origin, in putting an end to a number of
morbid manifestations. As soon as the patient =becomes aware= that these
have a purely mental cause, he at once feels himself freed from them.
That masturbation is =never= a direct cause of mental disorder is now
generally recognized by alienists.[421] At the most, masturbation is no
more than a favouring element in the production of such disorder.
“=Masturbatory insanity=” occurs only in those with marked hereditary
predisposition, and who already have been extremely neurasthenic.[422]

But masturbation can unquestionably give rise to =purely local changes=
in the genital organs, such as =inflammatory states of the prostate
gland=, =spermatorrhœa=, and =prostatorrhœa=; in women =fluor albus=,
=excessively painful menstruation=, and =other disturbances of the
menstrual function=, and in connexion with these phenomena there may
appear the morbid picture of “=sexual neurasthenia=,” which we have soon
to describe.

A very serious result of onanism (not of _Onanie_) is the
=disinclination to normal sexual intercourse= to which the habit gives
rise, and the =production of sexual perversions=. The former is more
marked in the female sex, the latter more in the male sex. Masturbation
is the principal cause of sexual frigidity in women and of a
disinclination to normal intercourse. Undoubtedly psychical influences
here play the principal part; but also a certain blunting of the
sensations of the genital organs by means of excessive masturbatory
stimulation. They are no longer susceptible to the normal stimulatory
influence of coitus. Moreover, masturbation is often effected by
stimulation applied to =some definite portion= of the female
reproductive organs, most frequently to the clitoris or the labia; and
these parts in such cases are not sufficiently stimulated by coitus. In
the male the especially sensitive portions of the penis are stimulated
alike by masturbation and in coitus, for which reason man,
notwithstanding the practice of masturbation, is much more readily able
to obtain sexual gratification in the course of ordinary sexual
intercourse. Notwithstanding this, there are also certain peculiar
methods of masturbation in the male, the effect of which is not attained
by coitus. In such cases men also may fail to induce the sexual orgasm
by ordinary intercourse.

The close relationship of masturbation to sexual perversions is obvious.
The more frequently the onanistic act is repeated, the more the normal
sensibility is blunted, the stronger and more peculiar are the stimuli,
which must be of a nature diverging from the ordinary, demanded in order
to induce a sexual orgasm. The content of the lascivious ideas must be
varied more and more frequently, and soon passes entirely into the
sphere of the perverse. Gradually these perverse sexual ideas become
more firmly rooted, and ultimately develop into complete sexual
=perversions=. A classical example of this is the case reported by
Tardieu[423] of a man who was in the habit of =masturbating seven or
eight times every day=, and ultimately inflamed his imagination to the
point of representing the act of intercourse with female corpses. At
length he passed to the =practical carrying out= of this horrible idea,
which had now assumed definite sadistic characters. He arranged to
obtain a view of opened female bodies, killed dogs, dug up human
corpses--all in order thereby to provide satisfaction for his
imagination, which had been disordered in consequence of masturbation,
and thus to obtain sexual gratification. In the etiology of
pseudo-homosexuality masturbation unquestionably plays a part--a fact to
which Havelock Ellis has drawn attention.[424] The Mexican “mujerados”
are trained for pæderasty by means of masturbation repeated several
times daily. Ideas of bestial intercourse may even be aroused by
masturbation. Von Schrenck-Notzing[425] reports the case of a woman who
had masturbated for thirty years, and ultimately came to represent to
herself in imagination that she was having intercourse with a stallion.

The prospects of the satisfactory =treatment= and =cure= of masturbation
are unquestionably greater in the case of children. To attain perfect
success, parents, teachers, and physicians must co-operate. Above all,
it is necessary to relieve any local and general morbid conditions
favouring the practice of masturbation. The diet should be light and
unstimulating, the clothing and bedding light and cool. In the year 1791
the body physician of the Schaumburg-Lippe family, Dr. Bernhard
Christian Faust, published a remarkable work under the title “How to
Regulate the Human Sexual Impulse,” with a preface by the celebrated
pedagogue J. H. Campe (Brunswick, 1791). In this book he maintained the
thesis that the principal cause of masturbation in boys was the wearing
of =breeches=. According to him, the =wrapping up= of children in
swaddling clothes causes premature stimulation of the sexual organs.
Later, in consequence of wearing breeches, there is produced “a great
and damp warmth, which is especially marked in the region of the sexual
organs, where the shirt falls into folds” (p. 46). Also, the boy, “when
he wishes to pass water, must take his little penis out of his breeches.
At first, and for a long time after he begins to wear them, the little
boy cannot manage this himself; other children, maids, and menservants,
help him, and pull and play with his sexual parts. By this handling,
pulling, and playing, which he himself does, or which others do for him,
with his sexual organs, the boy is led (also the girl, who very often
assists, and whom the blameless boy, out of gratitude, wishes to help in
return) into constant acquaintanceship with parts which he would
otherwise have regarded as sacred, unclean, and shameful. The child
becomes accustomed to play with his sexual organs, and =occasional
masturbation= develops into habitual self-abuse, =all brought about by
wearing breeches=” (p. 45). To prevent all this, he suggested that boys
from nine to fourteen years of age should wear clothing resembling
rather that of girls. Then these children would be “according to Nature,
children, and would ripen late; and the human sexual impulse would come
under control, and mankind would be better and happier” (p. 217).

Although the far-reaching and systematic development of this thesis
appears ludicrous, still, there is an element of truth in it, and
unsuitably tight and warm clothing certainly favours the tendency to
masturbation.

According to the suggestion of Ultzmann, in the case of nursing infants
and of small children, the hands may be confined in little bags or tied
to the side of the bed. The methods of the older physicians, who
appeared before the child armed with great knives and scissors, and
threatened a painful operation, or even to cut off the genital organs,
may often be found useful, and may effect a radical cure. The =actual=
carrying out of small operations is also sometimes helpful. Fürbringer
cured a young fellow in whom no instruction and no punishment had proved
effective, by simply cutting off the anterior part of his foreskin with
jagged scissors. In the case of a young lady who often in company
indulged her passionate impulse towards masturbation, he brought about a
cure by repeated cauterization of the vulva. Other physicians perforate
the foreskin and introduce a ring. Cages have even been provided for the
genital organs to prevent masturbation, the key being kept by the father
(!). Enveloping the penis in bandages without any opening has also been
tried. Corporal punishment sometimes has a good effect. Of the greatest
value is =continuous care, to safeguard the children against seduction=.
“Parents, protect your children from servants,” exclaimed Rétif de la
Bretonne. Valuable also are =earnest warnings and explanations=,
=increase of energy and force of will= (by sports and games, and by work
in the garden, and by the setting of tasks which stimulate ambition).
=Climatic cures= and =hydro-therapeutic methods= are also valuable
means in the treatment of masturbation. The same measures may be
employed in the treatment of masturbation in =adults=. In their case,
however, =psycho-therapeutics= plays the principal part. In many cases
here also local cauterization of the urethra and massage of the prostate
may bring about a cure. =Utterly perverse= would it be to introduce
youthful onanists to actual sexual intercourse, after the manner of the
Parisian “soup-merchants,” as the common speech names them, who, in
order to cure their youthful scholars of masturbation, take them into
brothels.[426]

Masturbation is intimately connected with =irritable nervous weakness=,
or “=neurasthenia=,” this typical disease of civilization, and more
especially with the genital form of the disease, “=sexual
neurasthenia=.” In an analysis of 333 cases of neurasthenia Collins and
Philipp found that 123 cases--that is, more than one-third--resulted
from overwork or from masturbation.[427] Freud, von Krafft-Ebing,
Savill, Gattel, and Rohleder see in masturbation the true cause of
neurasthenia. Fürbringer, Löwenfeld, and Eulenburg are of opinion that
other injuries must also come into play in order to produce the typical
picture of sexual neurasthenia. It is certain that very frequently the
order of causation is reversed, =neurasthenia= being the =primary= and
masturbation the secondary disorder. Masturbation is then only a
=symptom= of sexual neurasthenia. The same duplex mode of consideration
may also be applied to the other morbid phenomena of which the clinical
picture of sexual neurasthenia is composed. Every one of these symptoms
of irritable weakness, the excessive sexual excitability, the deficient
sexual sensibility, the seminal discharges, and the impotence, can, like
masturbation, exhibit a certain =independence=, can be induced by
various causes, and may lead to sexual neurasthenia; it may be, on the
other hand, that they first developed in the soil of sexual
neurasthenia. It is often impossible to determine the true =beginning=
of the vicious circle. It therefore appears to be more practical to
describe the morbid picture of sexual neurasthenia (which we owe to
Beard)[428] according to its individual symptoms, as is done also by A.
Eulenburg[429] in an admirable essay, and by L. Löwenfeld in his
well-known work on “The Sexual Life and Nervous Disorders.”

The =abnormal increase in the sexual impulse= (=sexual hyperæsthesia=,
=satyriasis=, =nymphomania=) begins at the point at which the normal
sexual impulse is exceeded; and that point is subject to wide individual
variations, according to the age, race, habits, and external influences.
The normal sexual impulse can also be temporarily increased by special
circumstances--as, for example, by prolonged sexual abstinence, and by
various kinds of erotic stimulation, without our being justified in
speaking of “hyperæsthesia.” This is always an abnormal condition, which
may be referred to various causes. It is more frequent in men
(“satyriasis”) than in women (“nymphomania”); it may be permanent or
periodic; it almost always arises from lascivious =ideas=, and,
according to its cause, is accompanied by a greater or less diminution
of responsibility, or even by complete lack of responsibility. The
readiness with which sexual ideas give rise to an abnormally increased
desire and to reaction on the part of the genital apparatus is
characteristic of sexual hyperæsthesia; and this may attain such a
degree that the man (or woman) may really be “sexually insane,” and,
like the wild animals, rush at the first creature he meets of the
opposite sex in order to gratify his lust; or he may be overpowered by
some abnormal variety of the sexual impulse, so that he seizes in sexual
embrace any other living or lifeless object, and in this state may
perform acts of pæderasty, bestiality, violation of children, etc. In
these most severe cases we can always demonstrate the existence of
mental disorder, general paralysis, mania, or periodical insanity, and
very often of =epilepsy= (Lombroso), as a cause. In a more chronic and
milder form, sexual hyperæsthesia is observed after excessive
masturbation, often also in association with a congenitally neuropathic
constitution. Löwenfeld describes a peculiar form of =nocturnal= sexual
hyperæsthesia occurring in married men, especially men in the forties or
fifties, who for various reasons are compelled to abstain from conjugal
intercourse, and who live continently. =In the daytime= these patients
were free from their trouble; it appeared only at =night=. Soon, or some
hours after going to sleep, a =violent, painful, enduring erection of
the penis= (=priapism=) set in, which disturbed their sleep, and left
them in the morning with a feeling of enervation. In such a case
obviously there is a hyperexcitability of the genital erection centre.
The erection results as a reflex effect of stimuli proceeding from the
genital organs, but manifests itself only when, during sleep, the
inhibitions proceeding from the brain are in abeyance. This nocturnal
priapism may, according to Löwenfeld’s observations, last for
years.[430]

Sexual hyperæsthesia in women, or “=nymphomania=,” is, in its slighter
forms, also in most cases a consequence of excessive masturbation. Such
women do not so much exhibit a more powerful inclination towards sexual
intercourse, which, on the contrary, is incompetent to satisfy their
abnormal and perverse sexual excitability. We rather see in them an
impulsion to obtain new sensations in their sexual organs in any
possible way. These are the women who, for example, consult the
gynæcologist as often as possible, because examination with the speculum
or other manipulations induce in them sexual excitement. During the
climacteric--the time when menstruation ceases--such states are also met
with. Nymphomania proper always develops upon the foundation of severe
neurasthenia and hysteria, or of direct brain and mental disorder. Then
is produced the type of the “=man-mad=” woman, as described by Juvenal
in the person of the Empress Messalina, who in the brothel gave herself
to all comers, without obtaining complete satisfaction of her sexual
desire. Such types exist also at the present day. Thus, the brothers de
Goncourt in their Diary reported the case of an old housekeeper who for
several decades indulged in the most lascivious love orgies, had
innumerable lovers, and a “secret life full of nocturnal orgies in
strange beds, full of nymphomaniac lusts.”[431] There recently lived in
Charlottenburg the wife of a workman, well known on account of her
incredible sexual ardour and man-mania. Her husband, a professional
stabber, was imprisoned for life. His wife often gave herself in a
single day to four or five different men; every male creature that
approached her she asked to perform the sexual act with her.--The
following almost incredible case of this nature is reported by Trélat:

  Madame V., of a strong constitution, agreeable exterior, good-natured
  manner, but very reserved, came under the care of Trélat on January 1,
  1854. Notwithstanding the fact that she was sixty years of age, she
  still worked very diligently, and hardly spared herself time for
  meals. Nothing in her outward appearance or in her actions indicated
  during her stay in the asylum that she was in any way affected with
  mental disorder. During the four years not a single obscene word, not
  a gesture, not the slightest passionate movement, indicated anger or
  impatience.

  Since her earliest years she has pursued handsome men and given
  herself to them. When a young girl, by this degrading conduct she
  reduced her parents to despair. Of an amiable character, she blushed
  when anyone spoke a word to her. She cast her eyes down when in the
  presence of several persons; but as soon as she was alone with a young
  or old man, or even with a child, she was immediately transformed; she
  lifted her petticoats, and attacked with a raging energy him who was
  the object of her insane love. In such moments she was a Messalina,
  whereas a few instants before one would have regarded her as a virgin.
  A few times she met with resistance, and received severe moral
  lectures, but far more often there was no obstacle to her desires.
  Although various distressing adventures occurred, her parents arranged
  for her marriage, in the hope thereby to put an end to the moral
  disturbance. But her marriage was only a new scandal. She loved her
  husband passionately; and she loved with the like passion every man
  with whom she happened to be alone; and she exhibited so much cunning
  and cleverness that she made a mock of any attempts at watching her,
  and often attained her end. Now it was a manual worker busy at his
  trade, now some one walking past her in the street, to whom she spoke,
  and whom she brought home with her on any possible excuse--a young
  man, a servant, a child returning from school! In her exterior she
  appeared so blameless, and she spoke so gently, that every one
  followed her without mistrust. More than once she was beaten or
  robbed; but this did not prevent her continuing the same way of life.
  Even when she had become a grandmother there was no change.

  One day she enticed a boy, twelve years of age, into her house, having
  told him that his mother was coming to see her. She gave him sweets,
  embraced and kissed him, and as she then began to take off his clothes
  and approached him with obscene gestures, the boy strove to resist
  her. He struck her, and he related everything to his brother,
  twenty-four years of age. The brother entered the house pointed out by
  the boy, and abused the corrupt woman to the uttermost, saying: “In
  such circumstances one helps oneself, without having recourse to law,
  in order not to bring one’s name into disrepute by public proceedings.
  I hope this disturbance will teach you not to behave in this way
  again.” While this scene was going on, the woman’s son-in-law chanced
  to come in, realized the situation before there was time to tell him
  anything, and at once took sides with the incensed young man.

  She was shut up in a convent, where she behaved in so good, sweet,
  amiable, and modest a manner, that no one would have believed that she
  had ever committed the slightest fault, and representations were made
  to the effect that she ought to be allowed to return to her home. All
  the inmates of the convent had been charmed by the zeal with which she
  took part in the religious exercises. When she was free again, the
  scandalous doings were immediately resumed, and so it went on all
  through her life.

  After she had reduced her husband and children to despair, they
  finally hoped that age would extinguish the fire with which she was
  consumed. They were mistaken. The more excesses she committed, the
  more she wanted to commit, the more vigorous she appeared. It is
  hardly credible that such debased ideas and habits should leave
  intact such a sweet expression of countenance, a voice so youthful, a
  behaviour so full of calm repose, and a glance of such clear
  assurance. She became a widow. Her children, on account of her
  horrible mode of life, could not any longer keep her at home, and they
  sent her to a distant place, where they provided her with an
  allowance. Since she was now old, she was at length compelled to offer
  payment for the shameful services which she demanded; and as the small
  allowance she received did not suffice for this purpose, she worked
  with untiring zeal in order to be able to pay the great number of her
  lovers.

  To see the old, alert woman sitting at her work, as I myself saw her,
  when aged seventy or upwards, without spectacles, always cleanly and
  carefully, but not strikingly, dressed, with a simple and honourable
  appearance, and an open countenance--to suspect her shameful mode of
  life would never occur to anyone. Several of the wretched men who were
  paid by her related how diligent she was. She assured Trélat of her
  morality, in the hope that he would discharge her, and so enable her
  to resume her mode of life. Trélat could not agree to this, and he
  succeeded in obtaining from one of these men an accurate account of
  her shameless loves.

  This corrupt woman preserved her repose of manner, her excellent
  appearance, and her honourable demeanour until her death. She died at
  the age of seventy-four years from a cerebral hæmorrhage. There was no
  remarkable change in the brain (_Journ. de Méd. de Paris_, 1889, No.
  16).

With regard to the treatment of abnormal sexual hyperexcitability, the
severer forms--satyriasis and nymphomania--urgently need =asylum
treatment=. In the slighter forms favourable results will be obtained by
means of psycho-therapeutics, the internal use of sedatives (such as
monobromide of camphor and bromide of potassium), regulation of the
diet, suitable clothing and bedding.[432]

The converse of sexual hyperæsthesia is =sexual anæsthesia=, or the
=abnormal diminution of the sexual impulse=. It occurs in both sexes as
a =congenital= condition, owing in such cases to atrophy or absence of
the genital organs, after exhausting diseases, or in consequence of
arrest of development of the reproductive organs from unknown causes.
This latter condition is denoted by A. Eulenburg by the name of
“=psycho-sexual infantilism=.” The same author also terms sexual
anæsthesia “sexual loss of appetite.” It is commoner in women than in
men. It is often merely =apparent=--a pseudo-anæsthesia--because the
man does not understand how to awaken the still slumbering sexual
perceptions (_vide supra_, p. 86). Recently Otto Adler has written a
comprehensive and interesting monograph on this “Deficient Sexual
Sensibility in Women” (Berlin, 1904). According to him, the statement of
Guttzeit, =that of ten women, four have no sensation at all “in coitu,”
and submit to it without any agreeable sensation at all during the
friction, and without any intimation of the intense pleasure of
ejaculation=--that is, that 40 % of women suffer from coldness and lack
of sensibility, from “=frigidity=”--is indeed somewhat exaggerated in
respect of the percentage; but still it is a correct expression of the
fact that deficient sexual sensibility is much commoner in women than it
is in men, in whom Effertz,[433] for example, estimates the frequency of
frigidity at only 1 %.[434] In women various circumstances explain the
frequency of deficient sexual sensibility. First of all, =masturbation=
lowers sexual excitability in women much more than it does in man, and,
above all, it blunts sensibility for normal sexual intercourse, both by
means of psychical influences and by the insensibility of the external
genital organs, owing to deficient stimulation of the clitoris during
normal intercourse, whereas this organ is most powerfully stimulated
during masturbation. Sexual frigidity also occurs in women in
consequence of maladroitness and brutality of the man _in coitu_, giving
rise rather to pain than to voluptuous sensations, and very frequently
being the cause of the first onset of the so-called =vaginal spasm=, or
“=vaginismus=.”[435] It is also due in some cases to impotence on the
part of the man.

In an interesting and valuable work, Carl Laker, in the year 1889,
described, as “A Peculiar Form of Perversion of the Sexual Impulse in
the Female” (German _Archives of Gynæcology_, 1889, vol. xxxiv., No. 3,
pp. 293 _et seq._), cases of sexual frigidity in woman _in coitu_, which
are not to be regarded as cases of “anæsthesia sexualis,” since the
=sexual impulse= was normal--indeed, frequently was increased--and it
was sexual gratification in normal intercourse which was completely
wanting. In these cases gratification was obtainable only by simple or
mutual onanism. There existed a normal inclination towards the other
sex, associated with mental and physical health. The author assumes
that, in consequence of some anatomical abnormality, stimulation of the
sensory nerves by which the voluptuous sensation is perceived,
especially those of the clitoris, failed to occur; but perhaps by a
change of posture _in coitu_ this stimulation can still be effected. The
case previously reported by me on page 86 belongs to this category of
=relative= or =temporary= sexual anæsthesia; whereas in cases of genuine
=absolute= sexual anæsthesia the sexual =impulse= also is in abeyance at
the outset, or disappears in consequence of excesses and in female
libertines and in prostitutes.

The =treatment= of deficient sexual sensibility in women must, above
all, take into consideration psychical influences, and depends,
therefore, more on the husband or lover than it does on the physician;
the conditions of intercourse must be adapted to the particular
circumstances of the case (as by change of posture in coitus,
preparatory tenderness, etc.). Painful sensibility in vaginismus can
sometimes be cured by mechanical treatment, by the removal of painful
remnants of the hymen, by the cure of small lesions, and also by
extension by means of the speculum. It also appears, as is evidenced by
an observation of Courty, that at the time of impregnation there occurs
a stronger stimulation and voluptuous sensation _in coitu_ in women who
are at other times frigid.

Sexually frigid women of the lower classes are apt, as Effertz points
out, to become prostitutes. During the practice of their profession they
always keep a cool head, because they are at first and always sexually
insensitive, and can devote their whole energy and regulate all their
actions towards the plunder of the man. The following case reported by
Effertz (_op. cit._, p. 51) illustrates this connexion very clearly:

  “I was once consulted by a very highly placed hetaira on account of
  supposed articular rheumatism. When I informed her of my diagnosis of
  lues, she was greatly moved, and said to me that I should not
  therefore think the worse of her. She was better than her occupation;
  she had never followed it on account of evil passions; she was quite
  insensitive; she had done it only in order to provide for her parents
  freedom from care in the evening of their life, and to secure the
  future of her small child. She also told me on this occasion that she
  owed her success to her coldness, =for which condition she was
  extremely thankful=. She never gave herself for less than 1,000 marks
  (£50). At the same time, she made a mock of her colleagues--those
  stupid and wicked girls who frequently, when their heads were fired by
  champagne, would give themselves for nothing, and would even run after
  men.”

Otto Adler describes Madame de Warens, in Rousseau’s “Confessions,” as a
type of such a _femme de glace_. Frigid women marry with comparatively
greater frequency than women who are sexually very excitable, because
their natural reserve endows them with greater value in the eyes of men,
and also offers a certain security for their faithfulness. Such
marriages are naturally in almost all cases unhappy, for the man soon
grasps the true nature of the case, and since most will say with Ovid,
_odi concubitus qui non utrimque resolvunt_, he seeks outside the house
some =response= for his love.[436] In some cases, indeed, frigid women
make a pretence of experiencing libido and the sexual orgasm, so that
the man is deceived. In some cases, also, notwithstanding a manifest
frigidity on the part of the wife, the marriage is none the less happy
when the husband is partially or wholly impotent, and voluntarily
renounces coitus. Such a case I myself recently observed.

  “The case was that of a merchant, physically and bodily in excellent
  health, aged a little under forty years, who, since the eleventh year
  of his age down to the present time, has continued to masturbate
  (between the eleventh and eighteenth years of his life, twice daily).
  He has often had ejaculation =without= erection. When twenty years of
  age, he frequently attempted coitus, but could not obtain an erection.
  Generally speaking, he never had an erection when his attention was
  directed to the matter, but only without his co-operation, on other
  occasions than those of attempted sexual intercourse. Thus, until his
  engagement, in the thirtieth year of his age, he had never completed
  normal coitus, but had only obtained sexual gratification by means of
  masturbation, and therefore married with considerable hesitation,
  although during the eleven months of his engagement he had masturbated
  much less frequently. On the wedding-night, however, and later, it
  =appeared= that his wife had a =natural disinclination to coitus=, was
  =extremely frigid=, and only had traces of sexual sensation when, by
  means of onanistic stimulation on the part of her husband, her libido
  was slightly stimulated. Spontaneously she never felt any desire for
  sexual gratification, not even in consequence of masturbation. The two
  have lived for seven years in =most happy= married life, and love one
  another tenderly, =without= ever having completed coitus. This
  deficient sensibility in the wife, and her failure to respond, have
  naturally not relieved the impotence of the husband, and he gratifies
  himself now, as before, by solitary masturbation.”

This case proves that the capacity for love is to a certain extent
independent of the strength of the libido; frigid men and women can be
thoroughly “erotic”; that is to say, they can experience the need for
tenderness, just as “erotomania”--that is to say, the excessive longing
for love--is completely different in its nature from satyriasis and
nymphomania (= excessive sexual desire).[437]

Julius Pagel and other authors have recently drawn attention to the fact
that the condition of “erotomania”--excessive amativeness--was fully
described by the ancient and medieval physicians, who regarded it as a
morbid state. He published (in the _Deutsche Medizinal-Zeitung_, 1892,
p. 841) under the title, “A Historical Contribution to the Chapter of
‘Cures by Disgust,’” the translation of a passage from the _Lilium
Medicinæ_ of Bernhard von Gordon in Montpelier, a well-known and
favourite compendium of the beginning of the fourteenth century, in
which, following the example of Avicenna, the _amor (h)ereos_ was
numbered among the _melancholicæ passiones_, and was considered to
constitute a particular section of the group of diseases of the brain
(see the edition of the _Lilium Medicinæ_, p. 210 (Lyons, 1550)). It is,
unfortunately, impossible here to deal at any length with the
exceedingly instructive and remarkable contents. One of the methods of
treatment was to find an old hag as hideous and repulsive as possible,
who was to hold under the nose of the erotomaniac a chemise stained with
menstrual blood, saying at the same time, _talis est amica tua_. We may
remark, in passing, that this genuine medieval “cure by disgust”
diverges, much to its disadvantage, from the manner in which in
antiquity (three centuries before Christ) Erasistratos, the pupil of
Aristotle, a celebrated physician of the Alexandrian school, cured the
son of King Antiochus, who had fallen in love with his stepmother
Stratonica. An account of the ancient therapeutic art is also to be
found in another work by J. Pagel, “Introduction to the History of
Medicine” (Berlin, 1898). In a comprehensive work, “The History of Love
Considered as a Disease,” this topic has recently been considered by
Hjalmar Crohns. Here we have a theme the literature of which is very
extensive, and which might be suitably dealt with in a special treatise.

In the male, sexual frigidity in the majority of cases is associated
with sexual weakness or with impotence--that is to say, with the
impossibility of copulating or of procreation. The former variety of
sexual incapacity (_impotentia cœundi_) is, properly speaking, peculiar
to the male. The second form--true “sterility” (_impotentia
generandi_)--occurs in women as well as in men.

In the case of male impotence, various symptoms, preliminary
disturbances, and associated phenomena, make their appearance, and these
we shall have to describe separately, since they often occur as
independent disorders.

This is, above all, true of the =outflow of sexual secretions from the
urethra=, =seminal losses= (=pollutions=[438] and =spermatorrhœa=), and
the evacuation of the =secretion of the prostate gland=, the so-called
“=prostatorrhœa=.” The literature of these conditions, which are partly
physiological (as a proportion of pollutions) and partly morbid, is
enormous. Of fundamental importance, notwithstanding the serious
exaggerations of the author, is the celebrated work of Dr. M. Lallemand,
“Involuntary Losses of Semen.” In recent times this important province
of sexual pathology has been more especially advanced by the researches
of leading German physicians, above all by those of Curschmann and
Fürbringer.

The most important question with regard to seminal losses or pollutions
in any case is this: have we to do with physiological processes, lying
within the range of health, or have we to do with morbid processes?

As normal, not morbid, seminal losses Lallemand regarded pollutions in
=healthy, sexually mature, continent= individuals, occurring
=spontaneously during sleep=, associated with =erection= of the penis
and voluptuous sensations. He rightly regarded these as physiologically
necessary, indicated their purpose to be the discharge of sexual
tension, the prevention of an excessive accumulation of the reproductive
products, and compared their effect with that of hæmorrhages from the
nose, which are so common in youth, and in most cases are distinctly
beneficial. But he drew attention to the =indeterminate, fluctuating
boundary-line= between normal and morbid pollutions. This latter point
of view is dealt with also by Eulenburg (“Sexual Neurasthenia,” p. 171),
in opposition to other authors who regarded all pollutions, even the
physiological, as abnormal. In practice, however, it is generally not
difficult to distinguish between physiological and morbid seminal
losses. The former are characterized, not only by the distinctive signs
already mentioned, but also by their occurrence =at longer intervals=,
and by the =absence= of any disadvantageous effect upon the general
state of health. As soon as pollutions have such a deleterious influence
they are morbid; and they are generally morbid when they occur
abnormally =early=, before puberty, with abnormal =frequency=, at
abnormal =times of the day=, and in association with abnormal
=conditions of the genital organs=. According to Fürbringer, the normal
intervals between pollutions in the case of continent youths vary
between ten and thirty days. Löwenfeld considers pollutions occurring
once a week, and even the transient occurrence of pollutions on several
successive nights, as a result of sexual excitement, as being still
within normal bounds. But if these repeated pollutions within a single
week, or even within a single day, continue =for a long time=, we are
always concerned with morbid pollutions. These sometimes occur not only
at night, but also--a fact to which the German physician Wichmann, in
his dissertation _De Pollutione Diurna_ (Göttingen, 1782), drew
attention--they occur =by day= (“diurnal pollutions”), in the waking
state, without masturbation or coitus, upon slight mechanical or
physical stimulation. In such cases erection of the penis is often
completely =wanting=; ejaculation of the semen takes place with the
organ flaccid, and even without any voluptuous sensation. In many cases,
indeed, these pollutions are accompanied by actual =painful= sensations
in the genital organs, and instead of voluptuous dreams or thoughts, the
nocturnal ejaculation is accompanied by anxious dreams, the daylight
pollution by an extremely disagreeable sensation. Commonly in these
pollutions ordinary semen is at first evacuated--a mixture of the
secretions of the testicles, the prostate, the vesiculæ seminales, and
Cowper’s glands--containing numerous =spermatozoa=. After the trouble
has lasted a long time the semen becomes thinner (owing to its
containing a smaller proportion of the thick testicular secretion) and
more transparent; the spermatozoa are less numerous and mostly
undeveloped, and ultimately they may be completely absent. Löwenfeld
observed a peculiar form of pollution in which the semen was ejaculated
only in drops, or might be =completely wanting=--that is to say, there
might be a pollution =without= ejaculation, purely a voluptuous
orgasm.[439]

In such cases Löwenfeld was able to prove that it is not the loss of
semen which weakens, as Lallemand assumed, but that it is the =nervous
disturbance= of the lumbar spinal cord which plays the principal part.
This irritable weakness of the lumbar spinal cord may have existed
for a long time before, or may have developed only as the result of
repeated pollutions or of excessive sexual excitement; it may give
rise, not only to proper seminal emissions, but, in addition,
to “=spermatorrhœa=”--that is to say, to the =outflow of semen
accompanying urination or defecation=; and it may also cause the rarer
“=prostatorrhœa=”--the outflow of the secretion of the prostate gland. A
long duration of all these morbid discharges has a serious effect on the
health, and induces the typical picture of sexual neurasthenia. As a
=cause= of seminal losses we must mention masturbation, excessive sexual
intercourse, chronic inflammation of the urethra (especially after
=gonorrhœa=), stricture of the urethra, rectal affections, alcoholism,
diabetes, and tabes dorsalis.

In =women=, also, =processes analogous to pollution= may be observed,
although much more rarely than in men, and generally as a consequence of
masturbation practised for several years. According to Adler (_op.
cit._, p. 130), pollutions--that is to say, evacuations of the secretion
of the vaginal glands and of the uterine mucous membrane, as well as of
the secretion of Bartholin’s glands near the vaginal inlet--never occur
in chaste and intact virgins, but only in women who have already learned
the enjoyment of sexual intercourse, and who are subsequently compelled
to lead a continent life. For this reason pollutions are a “trouble of
young widows,” and occur in young girls only when they have learned to
know the nature of sexual pleasure by means of masturbation. Eulenburg
remarks (“Sexual Neurasthenia,” p. 174):

  “In connexion with lascivious dreams there occur spontaneous, more or
  less abundant, discharges of the clear muco-gelatinous secretion of
  the glands. These form a striking manifestation of sexual
  neurasthenia in women, and can be compared with the morbid pollutions
  occurring in similar circumstances in male neurasthenics. We hear less
  about them, however, and they are insufficiently known, even by
  medical men. For this reason especially, when they occur in
  association with physical virginity and a normal genital condition in
  other respects, they do not usually receive sufficient attention.”

The older physicians, especially those of the eighteenth century,[440]
described these pollutions in women very well and thoroughly; in erotic
and pornographic literature they have always played a great part. An
interesting observation on peculiar processes analogous to pollutions is
reported by Paul Bernhardt.[441] A hysterical sempstress, twenty-five
years of age, as the result of any kind of =annoyance=, experienced
sexual excitement completely resembling the sensation of sexual
intercourse, and ending with a discharge of mucus. This was, however,
never accompanied by any trace of voluptuous sensation; on the contrary,
it gave rise to lumbar pains. Also, when she dreamed of anything
=disagreeable= or had =nightmare=, this condition recurred. Erotically
the patient is very indifferent, and denies the practice of
masturbation.

To the category suggested by P. Bernhardt of sexual excitement induced
by anxiety and trouble belongs the case reported to me by Dr. Emil Bock
of a boy of fifteen years of age, who, when very anxious about his
inability to complete a school task, experienced an ejaculation for the
first time. To the literature of impotence belongs the work by Nicolo
Barrucco, “Sexual Neurasthenia, and its Relations to the Diseases of the
Genital Organs.” Regarding physiological pollutions, and the trifling
difference between them and normal seminal discharge during coitus,
Schopenhauer makes some apt observations in his “Neue Paralipomena,” pp.
230, 231.

In the =treatment= of pollutions, which always demands the most careful
medical observation and examination of the individual case, the most
important measures are =dietetic and hygienic treatment=, =change of
scene= from town to =country=, and especially to =mountain air=,
methodical =hydrotherapeutic measures=, =warm baths=, =massage=,
=electricity=, =hyperalimentation=, the use of =bromides=, =local
treatment of the urethra=, etc., etc.

The last and most important of the phenomena connected with sexual
neurasthenia is =sexual weakness= or =impotence= in its various
forms.[442]

We distinguish in the male =two principal forms= of impotence: (1)
“=Impotentia coeundi=”--that is, incapacity for erection of the penis
and the completion of coitus; (2) “=impotentia generandi=”--that is, the
impossibility of fertilization (owing to want of semen or to the lack of
fertilizing quality in this fluid).

Congenital malformations of the genital organs giving rise to impotence
are extremely rare. Gyurkovechky, amongst 6,000 men fit for military
service, found three such men only. More frequently are =acquired=
defects met with as causes of impotence, such as complete or partial
loss of the penis and testicles, as in eunuchs and castrated persons. It
is well known that, notwithstanding the removal of the external genital
organs, sexual desire may persist; and when the penis is retained,
though the testicles have been removed, erection and copulation are
possible, providing the castration was effected after puberty. But it is
obvious that in most cases potency is very markedly interfered with, and
ultimately it may entirely disappear. More light is thrown on the
question by the occurrence of impotence after =unilateral= castration. A
tragical case of this latter kind is reported by von Gyurkovechky (_op.
cit._, p. 71):

  “A former colleague of mine at the University of Vienna had to have
  one of his testicles removed in consequence of obstinate inflammation
  resulting from gonorrhœa; thereafter the second testicle underwent
  complete atrophy. The much-to-be-pitied, handsome, elegant, and
  amiable young man remained for some years capable of performing
  coitus, was greatly pleased with himself for this reason, and paid
  ostentatious court to ladies. Still, he was seldom in a position to
  perform coitus, and after three years he completely withdrew himself
  from the society of ladies, and became gradually morose and reserved,
  until one day he disappeared from Vienna, discontinued his studies,
  and never let any of us hear from him again. This case has remained
  very vividly in my memory, and it illustrates most clearly the
  influence of virile potency upon the entire being of the individual.”

If the second testicle remains intact, the capacity for sexual
intercourse is not interfered with; and reproductive capacity also
persists, although it may be diminished in degree.

An important source of sterility in the male, in which the capacity for
sexual intercourse remains unimpaired, is =bilateral epididymitis=,
consequent upon =gonorrhœa=. This represents more than 50 % of all the
cases of incapacity for procreation in the male. Finger found in 85 % of
cases of epididymitis that the =spermatozoa were absent from the semen=
(the so-called “=azoospermia=”); and Fürbringer is led by his own
experience to believe that 80 % of men who have had double epididymitis
are incapable of procreation. Thus we may really speak of “=gonorrhœal
sterility in the male=.” In many sterile marriages the fault lies with
the husband, as was first clearly proved by F. Kehrer’s fundamental
investigations. And the no less momentous gonorrhœal sterility in women
is also, in the majority of cases, ultimately dependent upon the
husband, who has presented his wife with “gonorrhœal infection as a
wedding gift.”[443]

An extremely =small size= of the penis, also a =relatively small size=
of this organ in cases of obesity and tumours, =malformations= of the
penis, also the by no means rare mechanical hindrances to erections due
to injuries and indurations in the corpora cavernosa (especially as a
result of gonorrhœal inflammation)--all these may make coitus
impossible. Fürbringer and Finger have also seen peculiar chronic
shrinking processes of the corpora cavernosa occur independently of
gonorrhœa and tumours. All these conditions give rise to =incomplete=
erection, in which the penis is bent at an angle at some point or other,
or is curved, so that it cannot be introduced into the vagina (chordee).

All the hitherto described forms of impotentia coeundi are less frequent
than those =in which the external genital organs are completely intact=,
and in which we have to do simply with =imperfection= or =complete
failure of erection= in consequence of various =general disorders=.

Erection of the penis is induced both =centrally= from the brain (by
voluptuous ideas), and from the spinal cord (by direct stimulation),
and also =peripherally= from the genital organs (by friction of the
glans penis), by stimuli proceeding from the urethra, bladder, prostate,
seminal vesicles, rectum, and the neighbourhood of the genital organs
(as, for example, the buttocks), and may be either of a morbid or of a
physiological character. When there are inflammatory conditions of the
genital organs, especially gonorrhœa of the anterior and posterior
urethra, erections occur very readily. From the full bladder there also
proceed stimuli giving rise to erection, thus inducing the well-known
“=morning erection=,” utilized by many who would otherwise be completely
impotent. Blows on the buttocks also give rise to erections--a subject
to which we shall return when we come to discuss flagellation.

The =nature= of erection can be very briefly described as consisting in
a stiffening of the penis by the profuse =streaming of blood= into the
=reticular spaces= of the =corpora cavernosa=, enlarged by =stimulation=
of the =erection nerves=. The consequent erection of the penis is
dependent upon the action of a particular muscle--the ischio-cavernosus
muscle.

Impotence when the external organs are intact is in most cases due to
central causes, and ultimately to psychical causes, even though severe
bodily affections or local morbid states play a predisposing part (the
so-called “=functional impotence=”).

This impotence is sometimes one of the =earliest= symptoms of =diabetes
mellitus= and of =chronic Bright’s disease with contracted kidney=, also
of =severe conditions of exhaustion=--to which consumption offers a
significant exception, signalized already by the old saying, _phthisicus
salax_--of =obesity=, and of =tabes dorsalis=, in which the sexual
potency gradually disappears, but libido outlasts the capacity for
erection. Certain =poisons= also particularly damage potency. This is
especially the case with =alcohol=, the deleterious influence of which
on potency has already been described (pp. 293, 294). Georg Hirth goes
so far as to recognize a special “=impotentia alcoholica=.”

  “Above all, no alcohol,” says he, “especially not as a means for
  producing erection. In youth a man needs no such stimulus, and in age
  he will be apt to find, with the porter in Shakespeare’s ‘Macbeth’
  (Act ii., Scene 3), that ‘drink may be said to be an equivocator with
  lechery,’ for, as he says, ‘it provokes the desire, but it takes away
  the performance; it makes lechery, and it mars him; it sets him on and
  takes him off; it persuades him and disheartens him; makes him stand
  to and not stand to: in conclusion, equivocates him into sleep, and,
  giving him the lie, leaves him.’”[444]

Fürbringer’s view, that alcohol, taken up to the degree of slight
intoxication, rather increases potency, in connexion with which he
refers to sexual invalids who are only able to perform sexual
intercourse in a state of moderate intoxication, cannot be regarded as
generally true. It is possible that in these admitted sexual invalids
alcoholic intoxication overcomes =stronger psychical inhibitions=, which
in the state of sobriety had hindered erection. For the normal
individual alcohol is not a means for the increase of sexual potency,
but the reverse.

=The free use of tobacco= certainly also impairs sexual potency.[445]
Nicotine and love are as little compatible as alcohol and love.
Fürbringer, Hirth, and Eulenburg, ascribe to the excessive use of
tobacco a diminution in sexual potency. The following interesting
passage is from the Diary of the De Goncourts (_op. cit._, p. 89):

  “=There is an antagonism between tobacco and women. The taste for one
  diminishes the taste for the other=. So true is this, that passionate
  Lotharios usually give up smoking, =because they feel or believe that
  tobacco diminishes their sexual appetite and their powers of love=.”

=Coffee= and =tea=, taken in excess, and, above all, =morphine=, are
also antagonistic to potency. Dupuy has observed the frequent occurrence
of impotence in men who were in the habit of drinking large quantities
of strong coffee (five or six breakfast-cups every day). Sexual potency
returned as soon as the use of coffee was discontinued; whilst when the
use of the beverage was resumed the impotence again appeared (_Comptes
Rendus de la Société de Biologie_, 1886, No. 27).

The majority of cases of functional disturbances of potency depend upon
nervous impotence. It is the form which at the present day the physician
most frequently encounters. It is intimately connected with the state of
“irritable nervous weakness,” or sexual neurasthenia, the most important
symptom of which is represented by “psychical” impotence. There exist,
also--and this justifies the independent consideration of psychical
impotence--numerous cases of impotence =without= neurasthenia
(Fürbringer). This remarkable form occurs especially in perfectly
=healthy= young =husbands=, who often before were completely potent, and
had previously effected coitus in a perfectly normal manner, or had
lived a quiet, continent life, without having injured themselves in any
way by masturbation. Such individuals, in consequence of the excitement,
shame, and embarrassment of the wedding-night, often suffer from
psychical impotence. Réti[446] speaks of “=impotence due to
compassion=,” arising from “the sympathy felt with the pains suffered by
the still virgin wife” when the attempt at coitus is made.

  “The young married pair kiss one another and vie with one another in
  tenderness, but when the matter becomes serious--when the husband
  wants to enjoy his rights as a husband--the wife experiences
  incredible anxiety; she trembles in all her limbs, writhes, screams,
  and weeps. The man becomes exhausted, and at length, when the wife is
  resigned, and willing to surrender herself to her fate, he has become
  unfitted for his share in intercourse.”

It is clear that these forms of psychical impotence, which appear in
very various shades, are mostly transient phenomena, and exhibit a good
prospect of complete cure.

Much more difficult is the matter when we have to do with cases,
becoming commoner every day, of psychical impotence in consequence of
=sexual perversions=. Sadistic, masochistic, fetichistic, and homosexual
inclinations may, in certain individuals, predominate to such an extent
that either copulation cannot be effected without the =preliminary=
gratification of these perverse instincts, or else the latter =entirely
usurp the place= of normal coitus, which has become, generally speaking,
quite impossible (relative and absolute psychical impotence in
consequence of sexual perversions). To the former category belong, for
example, those cases, which are by no means rarely seen, in which
homosexual persons are only able to have intercourse with their wives
after preliminary caresses by their male friends; or masochists must be
subjected to a preparatory flagellation in order to become potent. In
the second category copulation has become quite impossible; the orgasm
takes place only in connexion with the activity of the perverse impulse,
and there often exists an actual repugnance to normal coitus.

Well known also is that rare relative psychical impotence in which the
man can perform coitus only with =prostitutes=, whereas he is impotent
as regards decent women. This, however, may often be associated with the
existence of sexual perversions, which are gratified only during
intercourse with prostitutes.

Another form of relative psychical impotence is =temporary= impotence,
in which the potency is entirely subject to =custom=, and a change in
the custom induces impotence. Thus, Frenzel reports the case of a man
who had always had intercourse with his wife immediately on going to
bed, and proved completely impotent when this habit was interrupted, and
he now wished to perform the act early in the morning. Only gradually
did he recover his lost potency and become able to adapt himself to the
changed conditions.[447]

Another form of impotence by no means rare, and occurring in otherwise
healthy men, is that produced by powerful =mental= activity or
=artistic= production, the impotence of literary men and of artists. It
is usually of a transient nature,[448] manifesting itself only during
the periods of intellectual activity, and it is explicable in accordance
with the law of sexual equivalents, according to which the sexual
potency appears in the latent form of spiritual productive activity. A
remarkable case of this impotence of literary men is reported by the
just quoted Frenzel.[449] Allied with this variety of impotence is the
form due to transient =mental distraction=, to =instantaneous ideas=,
which suddenly act as psychical inhibitions. These sudden ideas can be
of a very varied content--joyful, sad, anxious, annoying; in every case
they are capable of annulling the =already existing potency=, and of
making the further erection of the penis impossible. Such conditions
occur alike in healthy persons and in those who are readily excitable
and neurasthenic. A classical instance of this nature is J. J.
Rousseau’s adventure with the Venetian courtesan Giulietta, which he
describes very vividly in his “Confession.” He went to see her full of
passionate desire for sexual enjoyment, but Nature “had put into his
head a poison against this unspeakable happiness” for which his heart
yearned. Hardly had he glanced at the beautiful girl than an idea came
to him which moved him to tears, and completely diverted him from his
purpose. He became more deeply absorbed in this idea, the sexual desires
completely disappeared, and he was no longer in a position to prove his
manhood. To this tragi-comic episode we owe the exclamation of the
disappointed girl, which has passed into a proverb: “Lascia le donne e
studia la matematica” (“Leave women alone, and go and study
mathematics”). In the =reflective love= of Kierkegaard, Grillparzer,
Alfred de Musset, and other men of remarkable genius, there is also
recognizable an element of impotence.

The majority of all cases of impotence belong to the class of true
=nervous, neurasthenic= impotence, and these are diffused especially
among the circles who supply the greatest contingent to the ranks of
neurasthenics in general--that is, among officers, merchants,
physicians, and other classes of the cultured part of our population
whose professional duties are arduous. Among the causes of neurasthenic
impotence, excessive masturbation and chronic gonorrhœa, with its
consequences, play the principal part. Neurasthenic impotence manifests
itself, above all, by abnormal conditions of erection and ejaculation,
either of which may by itself be diminished or completely prevented; or,
again, both may exhibit abnormalities, whilst in some cases even
erection may be =very frequent=, =unusually powerful=, and
=long-lasting= (the so-called “=priapism=”), whilst ejaculation and
voluptuous sensation are completely wanting, and these erections are in
most cases accompanied by very =painful= sensations. An extremely
characteristic symptom of nervous impotence is a =premature discharge of
the semen=, not merely _ante portas_, but often even at the first signs
of activity of the libido sexualis, at which time erection may be very
well developed. In other cases, again, erection occurs, but no
ejaculation of the semen. Finally, both may be completely wanting (the
so-called “=paralytic impotence=”).

The following cases, which came under my own observation, show some of
the above-mentioned types of impotence:

  1. A man, twenty-nine years of age, married for ten months, complains,
  after obviously excessively frequent enjoyment of his conjugal rights,
  of a sense of weakness and weariness after intercourse, such as he has
  never previously experienced, as well as of a continually earlier
  ejaculation, latterly even on simple contact of his penis with the
  vulva. Erection is always present and is powerful. On further inquiry
  he admitted that in his four-weeks’ honeymoon he had connexion once
  daily, and thenceforward two or three times a week.

  2. A man, twenty-one years of age, states that a year and a half ago
  for the first time he endeavoured to have sexual intercourse; he has
  never yet succeeded in completing coitus. Since the age of fourteen
  years he has suffered from frequent pollutions and from marked sexual
  excitability. He has often tried to effect coitus, but there has
  always resulted precipitate ejaculation, with his penis in a flaccid
  condition. He has, properly speaking, only morning erections,
  dependent upon a full bladder. It is possible that a marked varicocele
  on the left side has something to do with the genesis of this
  impotence.

  3. A man, forty-eight years of age, has noticed for some years a
  distinct decline in sexual potency. Ejaculation always occurs shortly
  before _immissio membri_, when the penis is flaccid or only
  semi-erect. If erection is complete, on the other hand, then
  ejaculation fails to occur.

Very peculiar, and offering a kind of analogy to vaginismus in women, is
impotence consequent upon =excessively painful sensibility of the glans
penis=, as a result of sexual neurasthenia or of local inflammatory
processes (balanitis, etc.). The pains during coitus in these cases are
often so severe that those thus affected completely abandon any attempt
at intercourse.

The question =whether impotence can result from sexual abstinence= is
still disputed. Fürbringer does not know of any certain cases. According
to Virey,[450] by “complete and continuous abstinence from intercourse”
in the male the organs by which the semen is prepared--the testicles,
the seminal vesicles, and the vasa deferentia--and also the penis,
become smaller, “unsightly, wrinkled, and inactive.” Galen reports the
same of the athletes of the Roman Empire, men who had to live a life of
strict continence. Virey alludes to an “extremely chaste saint, in whom
after death no trace of genital organs could be discovered” (!). That
absolute abstinence must ultimately limit potency, if only by psychical
means, is _a priori_ probable.

Recent observations confirm the view that long-continued absolute sexual
abstinence exercises a harmful influence upon potency, and especially
upon potentia coeundi. As a proof of this, I may more especially mention
two cases of University professors, not yet thirty years of age, both of
whom until a little while ago had had no experience of sexual
intercourse, one having remained continent during two years of married
life! Quite recently both of them repeatedly attempted normal coitus,
but with complete failure _quoad erectionem_. Von Schrenck-Notzing[451]
also reported a case of this character not long ago, in which,
notwithstanding the strong desire for normal sexual intercourse, in the
case of a literary man thirty-five years of age, who prior to marriage
had lived a life of =complete abstinence=, and had never practised
masturbation, every attempt at coitus proved a failure.

Finally, we have to consider the more or less physiological =presenile
and senile impotence= which accompanies the commencement of old age, but
naturally occurs at very different times in different individuals, for
some men are already old at the age of forty years, and others are not
yet old at the age of seventy years. Von Gyurkovechky dates the first
decline in the sexual powers from the fortieth year of life, and
considers that normally these powers are completely extinguished at
about sixty-five years. But there are numerous exceptions. Complete
potency in respect of libido, erection, and ejaculation has been
observed in men of seventy and eighty years; and isolated cases have
even been recorded in which men of ninety and one hundred years have
procreated children.[452] In the sense of Metchnikoff and Hirth, who in
their writings proclaim the prevention of senility as a hygienic ideal,
this physiological _potentia senilis_ is no Utopia, and a future
scientific macrobiotic will defer the onset of old age by from ten to
twenty years.

  “I do not ask,” says Georg Hirth, “that the man in advanced age should
  play with his sexual powers; but that he should possess =the
  consciousness of being able to use them=--that I do demand” (“Ways to
  Love,” p. 462).

The treatment of impotence in the male in its various forms is indeed a
difficult matter in individual cases, more especially in view of the