§ 3. THIRD INDICATION. REMOVE FROM THOSE WHO HAVE THE WISH TO MASTURBATE THE POWER OF DOING SO.
Masturbation is possible only under the two following conditions: first there must be an opportunity to indulge in secret; next there must be a possibility of indulging. Hence by frustrating these conditions we can prevent onanism, the wishes of the onanist to the contrary notwithstanding.
The opportunities for onanism are all embraced under one term, isolation. It is necessary for the onanist to be alone. Hence watchfulness, that precaution which makes the young man constantly observes, which exposes him every moment to detection and consequently to shame, to reproaches and to punishment for his fault, is a powerful means of preventing it.
Watchfulness should be particularly practised over young people, when they are undressed, in bed, in the bath or in the privy. Hence the young patient should undress, go to bed and rise under your inspection. If this be not sufficient, he should share your bed. This measure is frequently the only way to prevent onanism. In large boarding schools there should be no private rooms: the sleeping chambers should be extensive, and a lamp, which would give sufficient light to assist your watchfulness, but not enough to prevent sleep, should burn in it all night. The masters and those who have charge of the pupils ought to examine in silence at different hours and the most perfect quiet should exist in the apartment. Here too the hours of retirement and of rising should be calculated according to the ages, so that the suspected or guilty might never go to bed except to sleep. Be watchful of those who stay long in privies: those however with ample accommodations are not so dangerous as those which are single. In some schools the doors of the privies are open at the top, so that an adult can look into them. Need we add that persons who are suspected should be watched in the bath.
Onanism is executed with the hand and thighs on the sexual parts or by rubbing these parts against external bodies. Different modes have been proposed to obviate and prevent these. The most simple of all is to oblige the children to keep their hands out of bed. This plan when it can be observed is often sufficient, particularly in boys. Besides this we knew of only one remedy, the purpose of what can be concealed, viz., the application of a cold cataplasm to the sexual parts, a plan we have recommended several times. Pavet de Courtielle proposes the use of a chemise reaching below the feet and which is drawn together at the bottom: this remedy may be efficacious. The remedies which remain to be treated of are essentially coercive: hence the chance of success is smaller the older and stronger the patients are.
The hands may be tied to keep them from the sexual organs, and the feet also may be tied so as to keep the thighs separated. The child too may be placed in a straight waistcoat fastened behind, which may force the arms to rest on the chest. Different apparatus has been contrived also to keep the thighs asunder. One is composed of thick pieces of cork which are attached to the inside of the thighs. Drawers opening behind are sometimes used: these serve to imprison the lower part of the trunk.
A kind of truss is sometimes used to preserve the sexual parts from external contact. The principal piece of this is of metal, either silver or tin: for females its form is triangular, and for boys it represents a sort of mould, in which the penis and scrotum may be placed: the bandage is kept in place by springs, like those of herniary bandages. To add to the security of this apparatus it is sometimes applied to a dress which opens only behind. In young and feeble children these means are exceedingly efficacious, as experience has proved. The art of the onanist has even sometimes evaded these bandages. The following case occurred in the practice of Reveille Pariset; a little girl 7 years old, whose health failed every day having been detected in onanism, her mother instead of reproaching her, gave her to understand that it was the custom to apply a bandage to girls of her age. This bandage was fitted very accurately and attained the purpose desired; the health of the child being rapidly established. Soon however the symptoms reappeared and more violently than before. The bandage was examined and it was found to be undisturbed. She however was watched and it was found that she used a quill for the purposes of onanism, which she slipped in under the bandage. After this, the mother stayed with her daughter all the time, and by her vigilance the child was saved.
These mechanical bandages have other inconveniences which limit their use. First they cannot be employed in boarding schools as they become the subject of remark; and then they keep up in the genital organs a constant heat, irritation and moisture. The edges of the principal piece also may cause deep excoriations. For all this, however they are often useful and ought not to be neglected.
CHAPTER II.
OF THE MODE OF REPAIRING THE INJURIES ARISING FROM VENEREAL EXCESSES.
In therapeutics we proceed in two ways; sometimes tracing the symptoms to their cause, we attempt to destroy this cause in the organ in which it is situated, and sometimes we attend only to symptoms. The same plan is applicable to the abuses of the genital organs, which as we have already seen forms a real disease.
The most efficient way to arrest the evil caused by these abuses, is to stop them. When this is done, order is established very rapidly. Hence the preservative means are in our view better than any remedial measures. Often however, when these excesses have been frequently repeated and long continued, the genital organs continue without provocation the work which was commenced by onanism. Thus involuntary pollutions keep up and increase a degree of exhaustion and other complaints which would otherwise disappear. In this case the treatment to be followed is to arrest the pollutions. These generally result, as we have said, from an inflammation of the seminal passages analogous to that existing in the urethra in blenorrhœa. This fact has lately been demonstrated anatomically by Lallemand and M. Davila. Hence the treatment of involuntary spermatorrhœa resembles in many respects that of chronic catarrh. The following are the principal remedies to be employed.
First must be placed cold applications to the genital organs; of these pure water and ice are more generally and successfully employed. In using these, Coelius Aurelian employed sponges. Wichmann wet cloths, and Ste. Marie, who preferred ice, used a bladder. Cold washes and affusions to the part and cold douches to the perineum, and hipbaths and seabaths have also been used. Lallemand who repudiates enemata too hot or warm thinks that those which are cold may be useful. Sulphurous baths have likewise been employed by Lallemand, in the manner described in his work in diseases of the genito-urinary organs. Davila in his thesis relates instances cured in this mode, and also the case of a young man who was cured of a diurnal pollution by introducing into the urethra a sound, which was retained there as long as the patient could bear it. Lallemand entertains the same opinion, and has also employed acupuncture and he says with success. He has known patients who after the application of needles between the posterior parts of the bursœ and the anus, have passed three or four months without pollutions.
Some practitioners have succeeded by directing their remedies to the cerebellum and the spinal marrow.
Many medicines have been administered internally for losses of semen. Those most in repute are the preparations of iron and quinine, either separately or together. Ferruginous waters, particularly those of Spa, and the oxides of iron, have often been used. Wichmann recommends several glasses of Spa water every morning combined with some preparation of cinchona: Serrurier has related a case showing the efficacy of this treatment. Lallemand thinks that cinchona and generally all remedies which contain tannin, only benefit temporarily. Many authors also disapprove of the use of astringents and tonics in spermatorrhœa, attributing to them among other inconveniences, that of causing constipation.
Many narcotic substances have also been used. We have related a case where thridace has succeeded. Belladonna also might be useful. In a patient mentioned by Serrurier, opium seems to have exasperated the complaint. Davila however thinks that opiates have been prescribed with success: but he dreads the constipation which they generally cause. Other remedies as the mineral acids, phosphoric lemonade, lime water, some preparations of lead, magnesia, ipecac, &c. have been used. Might not advantage be derived from the use of balsam copaiva and pulverized cubebs in some cases of spermatorrhœa.
We have already made some remarks on regimen, when speaking of the mode of avoiding or calming the venereal sense, and our rules for restoring individuals exhausted by onanism, will be stated hereafter.
The object of the treatment stated is to remedy the disease, caused by the loss of semen. A mode has been proposed by Wender to prevent this physically; this consists in the compression of the canal of the urethra: it is accomplished by means of a pair of forceps made of flexible wood, six to seven inches long, and from twelve to eighteen lines thick. This forceps is used by passing the penis between its two branches, one being above, and the other below; the two extremities are then tied with a cord. In this manner the penis is compressed and slightly confined; which is sufficient, says Wender, to remove all voluptuous sensation from this part, and to arrest the pollution. He has given the details of a case obtained by these means, and by the proper administration of tonics.
Wender’s forceps may have several inconveniences, and may frequently fail of the proposed end. But has it not been too much ridiculed, and is it not susceptible of improvement? Serrurier thinks that the idea may be turned to advantage, and Reveillé Pariset assures us that he has used it twice in cases of pollution, and with success. (Revue. Med., April, 1828, p. 94.)
Having mentioned the course to pursue in order to reach the seat of the disease, that is, the voluntary and involuntary pollutions, let us now speak of their effects. One of two things must happen; either these pollutions pursue their work, or finally the economy becomes insensible to their action. The first supposition is that least favorable to success: the physician prescribes for effects while the cause continues to act; he doctors, as it is called, for symptoms; and it is the same as if one should attempt to cure gastritis or pleuritis, without attending to the pleura or stomach. This, however, is no reason for abstaining completely from treatment. We may also sometimes retard the progress of the disease, or calm any painful and disquieting symptom. The physician has a much better prospect of success, when there is no longer a habit to destroy the health, and when no pollutions occur. We shall not attempt in this place to give the treatment proper for the different diseases which may be produced by onanism. Myelitis, dementia, amaurosis, epilepsy, &c., &c., whether caused by onanism or not, require special remedies, which are stated in works which treat of these affections. We would remark, however, that when these diseases are caused by onanism, it is perfectly futile for the physician to attempt to treat the disease, unless the habit of self pollution be arrested. In this place we will only mention that consumption, that exhaustion, in fact, that deterioration, which we have described in the third chapter of our first part.
Onanistic deterioration presents two very distinct phenomena: 1st, the consumption of the strength; 2d, the excitement of the senses. Thus, then, to restore the strength without increasing, and even, if possible, to diminish the general disposition to receive impressions, are the two indications to be fulfilled.
But before commencing, it is well to remember that this cannot be done in a few days. A disease which is gradual in its appearance is removed in the same manner. The physician who would attempt to hurry it by employing active remedies, would soon exhaust the system.
The best mode of reparation is found in diet: the body must be recruited by food, and inasmuch as only those things are nutritious which are digested, the first rule to be observed is, that all the conditions of good digestion are properly observed. Inasmuch as these conditions present nothing special in respect to onanists, we shall be very brief, referring to our previous remarks on this subject. It must first be considered, that in patients accustomed to onanism the digestive functions are always deranged, or are liable to be so.
The slightest error in diet may aggravate this state considerably; which is, in itself, an evil, and may add to the trouble of cure. Hence, if the rules of a good regimen should always be vigorously observed, this necessity is still more imperious when patients indulge in onanism.
Every article of food which is difficult to digest should be forbidden, and among articles which can be digested, those should be selected which contain the most nourishment, and are the least exciting. Thus condiments, which are but slightly nutritious, and are very exciting, ought never to be used, unless they are indispensably necessary to digestion, and then only in very small quantities. Milk is very nutritious, and does not excite; it should therefore be preferred by all those who are exhausted. If cow’s milk be found difficult of digestion, asses’ milk and that of woman has been recommended. But if this article be difficult of digestion, it should be prohibited, for then it is injurious. The flesh of young animals, particularly veal and poultry, is good; but beef and mutton is still better, for they contain more nutritious matter in a smaller compass. These articles, when roasted or broiled, are better than when boiled. Fresh fish is generally a suitable article of food: we allude to those kinds which are easily digested, as shad, perch, &c. Soups, especially those of beef, turtle, and the different broths, should always, in order to be digested, be mingled with solid articles of food, and should even take their place, if these latter cannot be digested.
Farinaceous substances, and especially bread, rice, potatoe, &c., are very suitable, because they are nutritious, and but slightly stimulant; but they are often bad to digest.
The rule little and often, is the rule to follow, in regard to the division of food. The patient has always taken too much food: if he feels perfectly satisfied, or if he experiences any inconvenience after it, the quantity of nourishment should be so regulated that nothing of this kind could occur. The meals should be taken frequently, only because they are small. We prefer to give broth warm, or more frequently still, cold, by spoonfuls, and have seen a benefit from it.
Drinks are not very nutritious, and generally stimulate much. Those which are given to strengthen, only do so for a few moments. They excite, and do not nourish. If the patient takes them to quench thirst, he should take as little as possible, for they also must be digested. In this respect wines may be useful. To choose among them, the experience of the patient must be consulted. A general rule governs the use of drinks at meals, viz.: to attain the proposed end with the smallest quantity of drink. Very dry wines, liquors, coffee, tea, &c., ought not to be permitted, unless absolutely necessary to digestion. The use of Selzer water, and particularly of Spa water, may be very advantageous. Very cold drinks are often the only ones suitable to the stomach.
Medicines have often been administered, either to strengthen the system, or to re-establish the digestive powers. Of these, the most useful are preparations of iron, quinine, and bitters. It is possible to improve the digestive organs with these drugs, and also with others; but this is not the place to give the treatment of diseases which are marked by difficulty of digestion. I know that some tonics may be used with great advantage, especially if they are given in such doses as to have no direct and immediate effect, particularly if their local action on the stomach and intestines be not too powerful.
Very cold baths, like every remedy capable of having an intense effect, should be forbidden to patients exhausted by onanism. But if the baths are simply cold, and particularly if they are taken in running water, or in the sea, they may strengthen the constitution. Dry, or aromatic frictions on the limbs, or along the vertebral column, are useful. The exercise should be moderate exercise, for too much fatigue exhausts the strength, instead of increasing it, and might excite or hasten the development of one of the diseases produced by onanism. A pure and dry air, like that breathed in hilly countries, may also have a favorable influence on the economy generally, or on digestion.