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 great number of existing methods of treatment; but treatment promises good results when it is based upon an exact, critical, individual analysis of the separate causes and symptoms. It is partly local and partly general. In the case of impotence resulting from excessive masturbation, or in the case of the well-known “gonorrhœal” impotence, good results will be obtained from slight cauterization of the urethra and massage of the prostate, local carbonic-acid douches or carbonic-acid baths, warm or cold sitz-baths, or electrical treatment, with which, however, great care must be exercised. In some cases imperfect erection will be benefited by the application of a 10 % ethereal solution of camphor, in the form of friction or a spray, to the entire genital region. Mechanical apparatus have also been employed to favour erection, as, for example, the so-called “schlitten,” consisting of a conducting instrument for an insufficiently erect penis, made up of two thin, suitably shaped laminæ of metal, or the “erector” of Gassen, which works in a similar manner. Apparatus of this nature are useful only to this extent, that they give the penis a certain purchase. We cannot allow that they possess any other effect, any more than Gassen’s other apparatus, the “compressor,” the “cumulator,” and the “ultimo” (Löwenfeld, Fürbringer). Any local changes that can be detected as having some connexion with the occurrence of impotence must receive attention. This is obvious; and no less obvious is the treatment of any general disorders which may give rise to the impotence. As regards the general treatment of impotence, psychical influence must first be considered. In most cases this must take the form of temporary withdrawal of the thoughts from the sexual sphere in general, for which the strict prohibition of sexual activity (masturbation, etc.) forms the foundation; in addition, will and self-confidence must be strengthened. In these matters an intelligent wife can do much to supplement the work of the physician. Sometimes a mere change in the mode of life or in the relations between husband and wife, above all, a change in the mode of performing sexual intercourse (a change in posture, greater responsiveness on the part of the wife, etc.), may have a manifest curative influence. The treatment of the neurasthenia which may have caused the impotence will also have a favourable effect. Alcohol and tobacco are best entirely forbidden. Innumerable drugs have been recommended for the treatment of impotence. The belief in the beneficial effect of cantharides is as much a superstition as the belief in the aphrodisiac action of celery, asparagus, caviare, and truffles. Certainly all these may cause excitement of the genital organs, but this is merely due to an increased flow of blood to these organs, which is of a very fugitive nature, and when the effect is often repeated (especially when cantharides is used for this purpose), it may have serious consequences. The influence of these substances may be compared with the purely stimulating effect of flagellation. More confidence may be placed in phosphorus, strychnine, and, above all, in yohimbin, a drug prepared from the bark of a West African tree,[453] which is warmly recommended in cases of neurasthenic impotence by Mendel and Eulenburg. Having myself seen good results from the use of Yohimbin Riedel in two cases of pre-senile gonorrhœal impotence, I can confirm the favourable judgment of Eulenburg. In the case of pre-senile impotence in a man nearly sixty years of age yohimbin was the only means which, after several years’ intermission, enabled him once more to have erections, and repeatedly to perform coitus. Eulenburg reports the case of a man, which is probably unique, in whom, after a few days’ use, yohimbin restored sexual potency after he had been impotent for twelve years! This interesting drug is certainly a valuable enrichment of our aphrodisiac armamentarium, and the first drug of this nature to which the name of a specific against impotence can justly be given.
Quite recently Eulenburg, Posner, Nevinny, and others, have warmly recommended as a true specific in cases of functional impotence a combination of lecithin with the active principle of the Brazilian plant Muira Puama. This new drug is by Eulenburg termed “muiracithin.”
From the above-described individual troubles (masturbation, sexual hyperæsthesia, sexual anæsthesia, pollutions, and impotence) is composed the clinical picture of sexual neurasthenia, which, however, is manifested also by other symptoms, among which we must mention certain perceptions of anxiety and certain coercive ideas, such as the condition, known also to the laity, of agoraphobia, which is very frequently met with in sexual neurasthenia; also the fear of travelling alone by railway, or sudden anxiety in the theatre or concert-hall, in the form of the fear of fire, with the accompanying irresistible impulse to rush out into the open; further, lumbar pains and neuralgia of the genital organs, and anomalies and pains connected with the evacuation of urine; an inclination to sexual perversions; gastric affections,[454] such as nervous retching and vomiting, painful cramps of the stomach, loss of appetite, also excessive hunger, nervous dyspepsia, etc.; migraine and heart troubles of manifold kinds. It is not to be wondered at that when sexual neurasthenia is markedly developed, and when several of the above-described manifestations occur, the disease may pass on into a condition of complete mental exhaustion, associated with morbid irritability and hypochondriacal and melancholy ideas. We then ultimately see the development of typical sexual hypochondria.
The treatment of sexual neurasthenia—which in the last-described general symptom-complex occurs also in women, associated in their case with amenorrhœa, dysmenorrhœa, or menorrhagia[455]—consists for the most part in the already described treatment of the individual symptoms. In addition, we have to make use of hyperalimentation, hydro-therapeutic methods, gymnastic treatment, general massage, and climatic cures.
[396] Havelock Ellis, “The Sexual Impulse and the Sense of Shame.”
[397] Fürbringer’s article, “Masturbation,” in Eulenburg’s Real-Enzykldopädie der gesamten Heilkunde, vol. xvii., p. 523, third edition (Vienna and Leipzig, 1898).
[398] Metchnikoff, “The Nature of Man,” pp. 95-99.
[399] A French erotic work describes how an impotent man, in the hope of obtaining an erection, allowed a cockchafer to crawl about his penis.
[400] Probably the following case of an onanist, sixty-four years of age, is unique. It is reported by A. Wild (“A Contribution to the Refinements of Masturbation,” published in the Münchener Medizinische Wochenschrift, No. 11, 1906). He introduced a twig of a pine-tree into the urethra, and in such a way that when the attempt was made to draw it out, the pine-needles acted as barbs; consequently the twig broke off short, and it was necessary for the medical man to remove it with the aid of dressing forceps!
[401] Cf. the complete historical and literary account of godemichés, given in my “Sexual Life in England,” vol. ii., pp. 284-292 (Berlin, 1903).
[402] Cf. the explanation of this passage by Iwan Bloch, “Were the Ancients aware of the Contagious Character of Venereal Diseases?” published in the Deutsche Medizinische Wochenschrift, No. 5, 1899.
[403] S. Freud, “Three Papers on the Sexual Theory,” pp. 37, 42 (Leipzig and Vienna, 1905).
[404] R. Kossmann, “Is the Medical Man Justified in Recommending Extra-Conjugal Sexual Intercourse?” published in the Journal for the Suppression of Venereal Diseases, 1905, vol. iii., p. 126.
[405] Cf. R. Thomalla, “Masturbation in the School: its Consequences and its Suppression,” published in the Journal for the Suppression of Venereal Diseases, 1906, vol. v., pp. 63-68.
[406] H. Ellis, “The Sexual Impulse and the Sense of Shame.”
[407] Gustav Aschaffenburg, “The Relations of the Sexual Life to the Origin of Nervous and Mental Disorders,” published in the Münchener Medizinische Wochenschrift, 1906, No. 37, p. 1794.
[408] Metchnikoff, “The Nature of Man” (English edition), p. 96.
[409] A. Eulenburg, “Sexual Neuropathy,” p. 80 (Leipzig, 1895).
[410] Otto Adler, “Deficient Sexual Sensibility in Woman,” p. 112 (Berlin, 1904). Mendel observed excessive masturbation in hypochondriacal women (Deutsche Medizinal-Zeitung, 1889, No. 15, p. 180).
[411] L. Löwenfeld, “The Sexual Life and Nervous Disorders,” fourth edition, p. 114 (Wiesbaden, 1906).
[412] Eduard Reich, “Immorality and Immoderation,” p. 122 (Neuwied and Leipzig, 1866).
[413] Felix Roubaud, “Treatise on Impotence and Sterility in Man and Woman,” third edition, p. 7 (Paris, 1876).
[414] W. A. Hammond, “Sexual Impotence in the Male and Female Sexes.”
[415] A. von Schrenck-Notzing, “Therapeutic Suggestion in Cases of Morbid Manifestations of the Sexual Sensibility,” pp. 66, 67 (Stuttgart, 1892).
[416] Cf. Havelock Ellis, “The Sexual Impulse and the Sense of Shame,” pp. 184-186.
[417] Iwan Bloch, “Contributions to the Etiology of Psychopathia Sexualis,” vol. ii., pp. 107, 108 (Dresden, 1903).
[418] On p. 18 of his treatise he goes so far as to say: “There is no disease of the body or the mind which cannot be referred to masturbation.”
[419] Eulenburg refers also to “Persönliche Schutz,” by Laurentius; the “Jugendspiegel,” by Bernhard; the “Johannistrieb,” by B. Mohrmann; the “Krankheit der Welt,” by A. Damm.
[420] According to A. Jacobi (“The History of Pædiatry, and its Relation to Other Arts and Sciences,” p. 66 (Berlin, 1905)), this is not true of quite young children, at ages of from one to ten years, in whom masturbation does less harm than in half-grown or adult individuals.
[421] Cf. H. Rohleder, “Die Masturbation,” pp. 185-192 (Berlin, 1899).
[422] Cf. L. Löwenfeld, op. cit., p. 137.
[423] A. Tardieu, “Étude Médico-Légale sur les Attentats aux Moeurs,” p. 114 (Paris, 1878).
[424] Cf. my “Contributions to the Etiology of Psychopathia Sexualis,” vol. i., p. 135.
[425] Von Schrenk-Notzing, op. cit., p. 9.
[426] Cf. A. Weill, “The Laws and Mysteries of Love,” p. 101 (Berlin, 1895).
[427] Havelock Ellis, op. cit., p. 266.
[428] G. M. Beard, “Sexual Neurasthenia,” second edition (Leipzig and Vienna, 1890).
[429] A. Eulenburg, “Sexual Neurasthenia,” published in Deutsche Klinik, 1902, vol. vi., pp. 163-206.
[430] L. Löwenfeld, op. cit., pp. 273, 274.
[431] Edmond and Jules de Goncourt, “Leaves from a Diary.”
[432] “During my life I have had under observation many a lecherous man and many a wanton woman, and I have always found that, without exception, voluptuous persons clothe themselves very warmly, and sleep under very warm bed-clothes. In earlier years I have reported several cases observed by me of warm clothing of the genital organs on the part of women who distinguished themselves by lasciviousness, and I could increase the number of examples of this kind by several dozen” (E. Reich, “Immorality and Intemperance,” pp. 43, 44).
[433] O. Effertz, “Neurasthenia Sexualis,” p. 46 (New York, 1894).
[434] Effertz estimates the frequency of frigidity in women at about 10 per cent. The truth probably lies midway between the views of Effertz and those of Guttzeit.
[435] By vaginismus we understand involuntary convulsive contraction of the vaginal muscles, associated with abnormal sensibility of the vaginal inlet, dependent on masturbation, or induced by the above-mentioned painful sensations and injuries which occur in maladroit and brutal coitus (this is by far the commonest cause of vaginismus), especially when the penis is very large and the vaginal inlet very small, or when the female genital organs are further forward than usual. Vaginismus generally arises from small injuries and lacerations, produced in this manner; with the physical sense of pain is associated also psychical anxiety with regard to renewed attempts at intercourse; and in this way the reflex spasm is produced. Sometimes the vaginal spasm does not begin until after the penis has been introduced, so that this organ is retained (penis captivus). A few years ago a remarkable case of this kind occurred in Bremen. One of the dock labourers was having sexual intercourse in an out-of-the-way corner of the docks, when the woman became affected with this involuntary spasm, and the man was unable to free himself from his imprisonment. A great crowd assembled, from the midst of which the unfortunate couple were removed in a closed carriage, and taken to the hospital, and not until chloroform had been administered to the girl did the spasm pass off and free the man!
[436] A very clever study of the conditions here described will be found in a recent English novel, “Mr. and Mrs. Villiers,” by Hubert Wales (Heinemann, London, 1907).—Translator.
[437] Rozier describes two typical examples of feminine erotomania (“The Secret Aberrations of the Female Sex,” pp. 123-128; Leipzig, 1831).
[438] Pollutions.—This term has not perhaps as yet acquired a right of residence in the English tongue, but I use it because it is needed. There is no other word which can be employed as a general term (1) to include all involuntary emissions of semen, whether nocturnal or diurnal; and (2) to include involuntary sexual orgasm in the female as well as in the male. In the female the term “seminal emission” is inapplicable; but the term “pollution” can be applied in English (as it is in German) to either sex. By American writers the term “pollution” is now generally used (see, for instance, Allen, “Disorders of the Male Sexual Organs,” Twentieth Century Practice, vol. vii., p. 612 et seq.).—Translator.
[439] L. Löwenfeld, op. cit., pp. 206, 207.
[440] Swediaur relates: “I have, although much more rarely, seen the aforesaid diseases also in the other sex” (he speaks of diurnal pollutions). “At the present time I have under treatment a woman, twenty-eight years of age, who for a year and a half, since the time when she had a miscarriage, suffers from very frequent involuntary nocturnal pollutions, which are induced by very voluptuous dreams, and are accompanied by all the symptoms of wasting of the spinal cord, which Hippocrates describes as a disease peculiar to the male sex.” Quoted by L. Deslandes, “Masturbation and other Aberrations of Sexual Intercourse,” p. 204 (Leipzig, 1835).
[441] Paul Bernhardt, “Processes Resembling Pollutions Occurring in Women, without Sexual Ideas or Lustful Feelings,” published in Die ärztliche Praxis, 1903, No. 17, pp. 193-197.
[442] The best recent work on impotence is Fürbringer’s “The Disturbances of the Sexual Function in Man,” second edition (Vienna, 1901). See also Frenzel, “On Incapacity for Procreation” (Wittenberg, 1800); F. Roubaud, “Traité de l’Impuissance et de la Stérilité chez l’Homme et chez la Femme” (Paris, 1878); V. von Gyurkovechky, “Pathology and Therapeutics of Impotence in the Male” (Vienna and Leipzig, 1897); J. Steinbacher, “Impotence in the Male,” fifth edition (Berlin, 1892); W. A. Hammond, “Sexual Impotence in the Male and Female Sexes” (Berlin, 1891); A. Eulenburg, “Sexual Neurasthenia” (pp. 177-183); Leopold Casper, “Impotentia et Sterilitas Virilis” (Munich, 1890).
[443] W. Schallmayer, “Infection as a Wedding Gift,” published in the Journal for the Suppression of Venereal Diseases, 1903, vol. iv., pp. 389-419.
[444] G. Hirth, “Ways to Love,” pp. 461, 463.
[445] Jacquemart reports a striking case of impotentia coeundi, which he saw in an engineer who received an appointment in a State tobacco factory. After he had resigned his appointment, the patient fully recovered his sexual powers (cf. Loebisch, article “Tobacco,” in Eulenburg’s Real-Enzyklopädie, 1900, vol. xxiv., p. 19).
[446] S. Réti, “Sexuelle Gebrechen,” second edition, p. 15 (Halle, 1904).
[447] J. S. T. Frenzel, “Impotence,” Part I., p. 164 (Wittenberg, 1800).
[448] In some cases it is said to have given rise to permanent impotence.
[449] Frenzel, op. cit., pp. 155, 156.
[450] J. J. Virey, “Woman,” p. 367 (Leipzig, 1827).
[451] Von Schrenck-Notzing, “Studies in Crimino-Psychology and Psycho-Pathology,” p. 176 (Leipzig, 1902).
[452] The Englishman Thomas Parr, who attained the age of one hundred and fifty-two years, remarried at the age of a hundred and twenty years, and his wife is said “to have noticed no defects in him on account of his age” (cf. William Ebstein, “The Art of Prolonging Human Life,” p. 70 (Wiesbaden, 1891)).
[453] In the drug trade we find two brands, known respectively as “Yohimbin Spiegel” and “Yohimbin Riedel”; both preparations are of equal value. [In a letter to the translator under date January 8, 1908, Dr. Bloch writes that “Yohimbin Riedel” is preferable to “Yohimbin Spiegel.”]
[454] Cf. Alexander Peyer, “Affections of the Stomach Associated with Disorders of the Male Genital Organs” (Leipzig, 1890).
[455] Cf. Koblanck, “Some Clinical Observations on Disturbances of the Physiological Functions of the Female Reproductive Organs,” published in the Zeitschrift für Geburtshilfe und Gynäkologie, vol. xliii., No. 3. Moriz Porosz (“Sexual Truths,” pp. 213-218; Leipzig, 1907) devotes with good reason a special chapter to the neurasthenia of young married women. The change from the virgin state into married life often gives rise to such transient neurasthenic conditions in the young wife, especially when there exists any sort of disharmony in respect of marital intercourse.
CHAPTER XVII
THE ANTHROPOLOGICAL ASPECT OF PSYCHOPATHIA SEXUALIS
“I hope that in the not distant future, for the advancement of science, physicians will be glad to ally themselves with folk-lorists and ethnologists.”—Frederick S. Krauss.