A loss of color, or an earthy tint of the countenance—a violet appearance of the eyelids—a languid expression of face—an air of fatigue and nonchalance, when the patient rises from bed—a difficulty in getting up—are all signs which may lead to the discovery of this pernicious habit. Here we might trace the physical state produced by onanism, if this had not already been done. Unfortunately, it is consumption which sounds the alarm; and this disease must be advanced, too, before the parents seek the cause. Sometimes, the true cause is overlooked, and all remedies are directed to an imaginary one. We will admit, however, that it is not always easy to refer the wasting caused by masturbation to its real origin. A young man, although not addicted to onanism, may lose his strength, grow thin, and present, both morally and physically, the characters belonging to this habit: this effect is often produced by intestinal worms, by dentition, puberty, by a too rapid growth of the body, &c.; and likewise by some chronic diseases of the stomach, intestines, liver, lungs, heart, &c. Hence, we should not be too quick to attribute to masturbation a state which may be produced by other causes. The practitioner who would pronounce too precipitately that a patient indulged in onanism, would commit an error which might be serious in more than one respect.
When a young patient presents signs of consumption, there is cause to suspect that onanism is the cause of it; and modes may be used to ascertain whether this be the case. Sometimes, the patient is watched, as has already been stated. Sometimes, we attempt to discover if any other cause has produced consumption; and when this cause is not found, the existence of onanism is supposed. The patient, for instance, presents all the symptoms of exhaustion, and these increase. We inquire if this state may not result from a want of nourishment, or from improper food—from hard work—from long watching—from melancholy, &c.; if it may not be caused by a disease about which the patient is silent, or by one of those maladies which produce effects similar to those of masturbation. Now, if the gradual sinkings of the patient cannot be explained by any of these causes; if he is weak, pale, thin, &c.; if, notwithstanding abundant and nutritious diet, a moderate degree of labor, the absence of all chagrin, &c.; if he presents no sign of disease—or, rather, if the first symptoms of diseases which he would present are not manifested until after the appearance of those of consumption; farther, if these diseases are too slight to have caused this state; if they cannot explain the numerous and varied symptoms observed, and particularly the countenance, the character of which is so significant, that it alone often reveals onanism: then we may consider, if not as certain, at least as very probable, that the patient is a victim to this habit, and we must act accordingly.
But, of all the proofs, it is most important to obtain an avowal of the habit from the patient. First, it removes all doubt; then it renders the action of the physician more frank, and consequently more efficacious. He is no longer fearful of wounding his feelings—of compromising his character, by showing a wrongly founded suspicion; of awaking the attention of the young patient to a subject of which he was ignorant, or of teaching it to him. Advice, remonstrances, punishments, and all the moral remedies, are now easily applicable; and if therapeutic or coercive measures are called for, the patient can no longer deny their utility, and reject their use. Finally, an avowal places the physician, parents, instructors—in short, all who have authority over the patient—in a position to proceed directly to their aim, and thereby attain it.
An avowal never takes place spontaneously: to obtain it is difficult. With males, one need not be so particular; but we must be careful with females. On this topic, no positive advice can be given: much must be left to the tact of the practitioner. We will only add, that we have more than once simply given advice; and we could see, from the manner in which it was received, that our conjectures were right. The physician, however, should always attempt to acquire the confidence of the onanist, to place him at his ease. They have no frankness when a person is stern, or when a moral lecture is expected. The physician should confine himself to his profession. In his eye, onanism should be regarded as a cause of disease—as a cause similar to an excess of labor, bad regimen—in fact, like any influence which might prove injurious to the health. If he should moralize, he would probably be debarred from that confidence which would enable him to give advice, and prescribe the resources of the art.
Masturbation is often overlooked, because it is thought that the hand is a necessary agent in producing it: this is far from being the case; as it may be indulged in, by both sexes, without the aid of the hands. When this is suspected, it is soon discovered, by the manners, face, and silence of the onanist: there is something unusual in the appearance of the patient, which is readily observed; and generally, also, the thighs are crossed, or, at least, are pressed closely together.
To prevent the development of the habit, and, when it is developed, to arrest it, are the two indications prescribed by hygeia. These two indications may be embraced in one—that of preventing the occurrence of onanism. If, for instance, you have before you the case of two individuals, one of whom is not addicted to onanism, while the other may be, you should prevent one from continuing, and the other from commencing it. In the two cases, the means used have the same tendency; only when you wish to prevent the habit commenced, you have need of more efforts than in the first case, where it does not exist. These means are, then, preventive—essentially preventive; for, whatever may be their mode of action, they all tend to prevent the act. Although the prevention of onanism, and the arrest of the habit, are apparently different, yet we shall state the mode of attaining this double result, to avoid repetitions.
In masturbation, we must consider three things—the desire, the will, and the power. Onanism is not possible, where these three conditions do not exist: there is no wish without desire; and the latter is often completely mastered by the former, and both present no result, if there be no possibility of indulging. Hence, to prevent masturbation, and to arrest it, the desire, the wish, the power to indulge, must not exist. These are, as it has been seen, three distinct indications. It is sufficient to attain one of them. It is easily seen, that by appeasing the desire, the will is aided; and the obstacles opposed would be more efficacious, the less vivid the desire, and the weaker the will. It is, therefore, sufficiently understood, that the three indications we have mentioned, although very distinct, require each of them special means, the attainment of one of which renders that of the others useless, while they all can and may be pursued conjointly.
§ 1. FIRST INDICATION. TO PREVENT THE OCCURRENCE OF THE DESIRE TO MASTURBATE, TO PREVENT ITS RETURN, AND TO ABRIDGE ITS POWER.
The desire of masturbation is very distinct from venereal desires, which may be felt without experiencing the other. This desire is special: it is that of onanism, and no other. The influences, also—the result of which is more or less proximate, and which is to excite the genital sense—are only the indirect and predisposing causes of onanism. The direct and efficient causes are those which lead to the indulgence of it, and the preferring of it to coition. Consequently, two indications relate to the desire of masturbation: one consists in preventing the exaltation of the venereal sense, or in appeasing it; and the second, in preventing or destroying the special causes of the desire of onanism. We proceed to study these two indications in succession.
1. Rules relative to the general or indirect causes of onanism.—The genital sense, and, consequently, the venereal desires, may be felt too vividly and too early, in consequence of different circumstances, which may be divided into two groups. Some belong to the human body, and consist in certain innate acquired arrangements of the organization, in consequence of which the venereal sense presents more or less susceptibility. Others consist in different influences, as education, food, climate, kind of life, &c.; which may act on the sensibility in general, and particularly on that of the genital system. We will begin with the rules connected with the former.