As a result of these experiences, I feel justified in coming to the following conclusions regarding masturbation during childhood. It has not been proved that masturbation during childhood, with or without ejaculation, is generally dangerous. The possibility of danger resulting from the practice is, however, increased by long-continued and frequently repeated masturbation; also by the artificial postponement of the voluptuous acme, and by congenital predisposition to nervous disorders. My notes of the cases which I have seen during many years of medical practice show that, even in children, masturbation does not necessarily do any harm.
Case 15.—The girl X., four years of age, was brought to see me because it had been noticed that she frequently tried to handle her genital organs, and also that she stimulated the same organs by means of rubbing movements of the crossed thighs. Her mother had further from time to time noticed rocking movements, associated with a fixed stare, which had aroused suspicions of the occurrence of the sexual orgasm. Various methods were tried to put a stop to these practices, but without result. Hypnotic treatment was not tried, because the child was still too young and her attention wandered too much. Mechanical methods of control were also fruitless. The trouble continued for five years, during all of which time the child was under my own observation. She went to school, where she proved a diligent scholar, and was one of the most successful pupils; her physical condition was also excellent. Thenceforward, for several years, I received no precise information about the patient, although from time to time I saw some of her associates. But after about eight years, I had an opportunity of learning her later history. The child which had begun to masturbate when four years old was now a young lady of eighteen. When fourteen years old she had for some months suffered from chlorosis, but had never been troubled by any other serious illness. I could not learn with certainty whether the habit of masturbation had been discontinued; but there had been no definite evidence of the practice of masturbation, or of any other artificial sexual stimulation, after the age of nine. At the present time X. is perfectly healthy.
Case 16.—The boy Y. was brought to me when eight years old. It had been noticed that at night, whether sleeping or waking, he very often handled his genital organs. Erection of the penis had also been observed from time to time. His mother and his governess believed that he masturbated every night. When this had been going on for several years, the patient was brought to me for suggestive treatment. Mechanical means were simultaneously employed, his hands being fastened at night in such a way that he could not bring them into contact with his genital organs. But he speedily loosed himself from his bonds. The trouble abated in severity, but continued none the less for several years. I saw the patient again when he was twenty-four years of age. No abnormality whatever could be observed. He had normal sexual potency, and was entirely free from neurasthenic symptoms.
I have hitherto, in this chapter, spoken only of the dangers of auto-erotism. It is hardly necessary to mention the fact that the nervous system of the child may be injuriously affected by other sexual acts, as, for instance, by premature sexual intercourse. The occurrence of such acts is naturally favoured by a premature awakening of the sexual life.
We have also to consider the results of passionate love in children, apart from actual sexual intercourse. In children with congenital neuropathic predisposition, these results may be serious; and, as Bell points out, symptoms of severe nervous shock may ensue, more especially owing to separation from the beloved object, or in consequence of rejected affection. The same writer even records several attempted suicides consequent upon the death of the loved one; two of these occurred in boys of eight and nine years of age respectively; two occurred in girls, aged nine and eleven years. Eulenburg,[90] who has made a special study of suicide and attempted suicide during school-life, in his enumeration of the causes of such acts, mentions several that are germane to our subject. Among these are the following: becoming acquainted with the existence of a liaison on the part of the loved one with another; unfortunate love; love for a married woman; neglect of school work owing to a love-affair and consequent fear of expulsion; and, finally, love-anxiety. It must, however, be freely admitted that Eulenburg's cases relate to schoolboys who were fairly old. Thus, one of these cases was that of a Catholic boy in one of the higher forms, who had formed a liaison with a girl of sixteen in a neighbouring girls' school, and whose Director had intervened, very judiciously, as it appears, on learning of the affair. The other cases in which Eulenburg mentions the age of those concerned were also those of boys no longer very young; in some of these, double murder or double suicide resulted. In the other comprehensive works on suicide, and even in those dealing especially with suicide in children, I have been able to find comparatively little material bearing on this particular question. Brierre de Boismont,[91] indeed, tells us that children occasionally commit suicide on account of jealousy; here, however, he does not refer to sexual jealousy, but to jealousy of a more general character aroused by preference shown to another child. Although such serious consequences occur chiefly or exclusively in children who cannot be regarded as perfectly normal, it is nevertheless possible for erotic influences to act as the final determinant. But such serious results are certainly comparatively rare.
Just as in former times masturbation was believed to be the cause of all kinds of illness, so to-day, according to Freud[92] and his followers, the general sexual experiences of children are responsible for various subsequent illnesses. Four neuroses (neurasthenia, anxiety-neurosis, hysteria, and compulsion-neuroses) are referred by Freud to all sorts of disturbances of the sexual life, past or present. Hysteria and compulsion-neuroses are regarded as a reaction to the sexual experiences of childhood; neurasthenia and anxiety-neurosis are referred to later sexual experiences. Freud originally assumed that during the childhood of hysterical patients sexual seduction by adults or by older children played the chief part; but at a later date he has advocated the view that the imaginative activities of the days of puberty, which intervene between the sexual experiences of childhood and the appearance of the hysterical symptoms, are responsible for the occurrence of the latter. Quite recently, Abraham[93] has insisted that a sexual experience may be of some importance in relation even to the onset of dementia præcox. But I do not consider that Freud's assumption is justified, nor do I think that he adequately excludes the effects of hetero-and auto-suggestion. It is out of the question that in every case of the above-mentioned neuroses, sexual experiences should be the cause; and it is equally erroneous to suppose that every sexual experience in childhood has the effects which he assumes. It is true that Freud and his followers report cases which they regard as proving their thesis. But I am by no means satisfied with these clinical histories. They rather produce the impression that much in the alleged histories has been introduced by the suggestive questioning of the examiner, or that sufficient care has not been taken to guard against illusions of memory. The impression produced in my mind is that the theory of Freud and his followers suffices to account for the clinical histories, not that the clinical histories suffice to prove the truth of the theory. Freud endeavours to establish his theory by the aid of psycho-analysis. But this involves so many arbitrary interpretations, that it is impossible to speak of proof in any strict sense of the term. Dreams are interpreted symbolically at will, and other definite objects are arbitrarily assumed to be symbolic representatives of the genital organs. I detect the principal source of fallacy in this arbitrary interpretation of alleged symbols.
However this may be, there is no justification for the assumption that hysteria or other neuroses are always, or even in the great majority of instances, to be regarded as dependent upon masturbatory or other sexual acts during childhood. We must on no account forget that an illness often has a dozen causes or more; and although one or another of these may have had a preponderating influence in the causation, we have no right arbitrarily to select one of them as the efficient cause. I do not deny that occasionally the sexual life during childhood plays a part in inducing a subsequent neurosis; but this applies only to a comparatively small proportion of cases, and we must guard against exaggeration in the matter.
This is all I have to say concerning the relationships of the sexual life of the child to the occurrence of nervous diseases. The sexual life has, of course, important bearings on health in other ways. The venereal diseases, in most cases, result from sexual intercourse; and it will readily be understood that since early sexual intercourse is rendered more likely by a premature awakening of the sexual life, an increased danger of venereal infection will thus arise. Although infection in children occurs comparatively seldom in consequence of spontaneously practised sexual intercourse, and more frequently as the result of the mishandling of children by perverted or criminal adults, still cases are from time to time observed in which infection with venereal disease arises in children from spontaneously sought sexual intercourse. In Jullien's work[94] we find a striking chapter on gonorrhoea in children, illustrated with appropriate cases. He writes. "In other cases, little boys, sexually premature, make early attempts at sexual intercourse. In Paris we see hardly grown youths appearing at the specialist's clinic, quite proud that they need to be treated for gonorrhoea. The very fact that they present themselves so coolly at the places for the special treatment of venereal diseases, suffices to show that they fully understand the cause of their illness." In Jullien's opinion, venereal disease is especially serious in children, because many of them conceal their condition as long as possible in the hope of avoiding punishment. Barthélemy reported a case in which the parents came to consult him because the boy was passing water every few minutes, and because at school he was repeatedly asking to leave the room in order to go to the urinal. Examination showed that he was suffering from cystitis, and that this was a sequel of gonorrhoea. As regards children of the other sex, I have myself seen cases of gonorrhoea in which sexually immature girls have been infected in sexual intercourse of which they themselves had been the instigators. In most cases, infection in children results from intercourse with grown persons, but it sometimes happens that children infect one another. Little need be said here about the dangers of gonorrhoeal infection. Although in children the course of the disease exhibits many peculiarities, the general results are much the same as in adults, viz., pain, orchitis and epididymitis with atrophy, cystitis, &c.; and in girls, more especially peritonitis. Other venereal infections may of course also occur in children, such as soft chancre and syphilis. No detailed account will be given of these diseases. Although we need further information as to the results of venereal infection in children, in well-informed medical circles the numerous and severe ill consequences of such infections are well understood.
I have in this chapter spoken more especially of the dangers threatening the child's health from the side of its sexual life. These are, of course, not the only dangers; the moral and social dangers are even greater. First of all, in this connexion, we have to consider the practice of masturbation; but in our estimate of its effect upon morals, we must be careful to avoid sanctimoniousness. The question why masturbation is regarded as immoral has never yet been answered, declamation being here commonly mistaken for argument. And yet reasons may be found for the belief that masturbation may sometimes be a positively moral act; as, for instance, when one who is dominated by a very powerful sexual impulse, avoids injury to another by means of masturbation. Consider a case, for example, in which one who masturbates would otherwise transmit venereal infection to another, or would injure another by illegitimate sexual intercourse. In cases of perverse sexual practices in which the offender's liability to punishment was under discussion in the law court, I have more than once called attention to this point. Take the case of a man whose sexual impulse is directed towards children, and who finds great difficulty in restraining himself from sexual malpractices against children. His action is assuredly a far more moral one if he satisfies his impulse by the practice of masturbation, rather than by a sexual assault upon a child! If, notwithstanding these considerations, masturbation is generally regarded as an immoral act, the reason for this opinion must obviously be sought in deeper and more general grounds. In the first place, we have to take into account the fact that according to the moral code of many persons, and certainly according to the official theological code, the only kind of sexual intercourse that is morally permissible is that which is known as "legitimate," i.e. connubial intercourse; extra-connubial intercourse is stigmatised as immoral. Masturbation, like extra-connubial sexual intercourse, is sexual indulgence outside the limits of that which is alone permissible by the canons of theological morality. Owing to the definite teaching of the Church in this matter, the views of the common people are inevitably influenced thereby, although the practical relationships of life are thus completely ignored; above all, the fact is ignored that marriage does not as a rule become possible until long after the awakening of the sexual impulse. The purpose of the proscription by theological morality of illegitimate intercourse and of masturbation is to effect the prevention of all varieties of sexual indulgence except under the form of marriage, and, if possible, under the form of marriage blessed by the Church. The importance attributed to receiving the approval of theological morality is seen from the fact that in all strata of the population, however much alike in private conversation and in political assemblies they may protest against the dominion of the Church, nevertheless almost invariably the ecclesiastical ceremony is superadded to the civil marriage. In our moral estimate of masturbation, we have to take another point into consideration. We have seen that long-continued and excessive masturbation is dangerous to health; now every voluntary action, and every action that is commonly believed to be voluntary, the effects of which are injurious to body or to mind, is considered to be immoral, unless it is performed in pursuit of some lofty aim—as, for instance, in the case of the doctor who exposes himself to some deadly infection for the sake of his patient's welfare. But these reasons do not suffice to account for the fact that masturbation is commonly regarded as a more immoral act than illegitimate sexual intercourse. Here, however, as so often happens, the popular instinct contains a kernel of truth, which in this case relates not so much to the individual ethical judgment as to the general interest. The popular instinct, or we may rather say the soul of the people, commonly regards that as immoral which, if approved, would entail serious general consequences. In this ethical judgment we have, as it were, the manifestation of an instinct of self-preservation on the part of the soul of the people. We must not forget that the practice of masturbation is extraordinarily easy, and that if it were recognised as a morally permissible act, its frequency would be notably increased. The reason last given, namely, the injury to health that may result from masturbation, explains one way in which the practice is opposed to the general interest. But another reason is still more important. The practice of masturbation naturally limits the frequency of sexual intercourse, not only in its illegitimate, but also in its legitimate form. The easier an act is, the more readily, if it is deleterious, will popular sentiment build a protective wall around it. In individual instances, such popular valuations are devoid of logical foundation, and for this very reason it is often impossible to reject them on logical grounds. But they are largely based upon considerations of the general interest, and for this reason it is often just as well that they are impervious to logic. Hence, although in concrete cases of masturbation physicians and schoolmasters will not always take a severe view, and, in certain instances, as explained above, it may even be considered that masturbation is a morally permissible act, this will not affect the general disapproval, in consequence of which a very large number of persons refrain from masturbation. Moreover, the absence of such disapproval would lead to extremely serious consequences. Merely in order to prevent interference with normal sexual intercourse between man and woman, it is necessary that in the popular judgment masturbation, as the greatest enemy of sexual intercourse, should be condemned. In addition to these motives, there are others closely connected with them, which in some cases operate unconsciously. Since masturbation is practised in solitude, if masturbation were regarded as morally permissible to men, the value of woman would diminish, since her wooing and winning would be no longer necessary to man, Analogous considerations naturally apply to masturbation in women. The need that each sex should regard the other as indispensable is a powerful motive in bringing about the popular condemnation of masturbation; and it must further be remembered that the amatory life, and more especially its psychical accompaniments, in truth only attain their fullest development through the mutual intercourse of the sexes.
The general condemnation of masturbation is, in my view, most readily explained on the considerations just outlined. However this may be, we have certainly to reckon with the fact that masturbation is regarded as an immoral act. But inasmuch as the early awakening of the sexual life, or at least the early appearance of the phenomena of detumescence, leads almost inevitably to the practice of masturbation, it will readily be understood that the child is apt to be forced into a line of conduct which conflicts with the generally accepted ethical code.