The sexual question

VENEREAL DISEASES[5]

We cannot give here a complete description of the venereal diseases, which constitute a terrible evil for humanity, by bringing a great deal of misfortunes and decadence into family and social life. Let us first point out the common error which attributes to sexual excess the evil effects which are really due to venereal disease. Although it may be uncommon, one may be infected by these diseases after an innocent kiss, a cut finger, by sitting on a privy contaminated by a person suffering from venereal disease, by the use of contaminated linen, etc., etc. A pachydermatous Don Juan, on the contrary, may abandon himself to the wildest sexual excess without being infected, if he is prudent and has good luck. On the other hand, young men may be infected after having been with a prostitute only once in their lives, and thus ruin their whole existence.

There are three kinds of venereal disease, which we will describe in a few words. To these may be added certain parasites, such as crab-lice and the itch, which are easily communicated by sexual intercourse with infected persons, but also in other ways.

Gonorrhea or Clap.—This disease consists in a purulent inflammation of the urethra caused by a microbe called the gonococcus. When treated properly it may be cured in a few weeks, but very often the inflammation becomes chronic and attacks the neighboring organs. Chronic clap, or "morning-drop," may lead in the male to permanent stricture of the urethra, which in turn may produce retention of urine, catarrh of the bladder and disease of the kidneys, which may be fatal. One attack of gonorrhea in no way protects against a second infection, but rather predisposes to it, and when this disease becomes chronic exacerbations or relapses of the acute stage often occur without fresh infection.

In women the results of gonorrhea are, if possible, still worse than in men, because it is more difficult to cure. A prostitute affected with gonorrhea may infect an enormous number of men, and in this case medical inspection of brothels is no guarantee. The gonococci are concealed in all the corners and folds of the internal genital organs of woman, where they set up inflammation of the womb, the Fallopian tubes and even the ovaries, which may lead to adhesions between the abdominal organs. Women affected with chronic gonorrhea generally become sterile. When the womb and the ovaries are affected there is much suffering and the woman may be confined to bed for some years. Stricture of the urethra and inflammation of the bladder are more rare in women than in men, as the result of gonorrhea.

But gonorrhea is not confined to the adults of both sexes. The innocent child, who at birth has to pass through its mother's vulva, when this is affected with gonorrhea, undergoes a baptism of gonococci which attack the conjunctiva of the eyes and set up a severe purulent inflammation, called ophthalmia of the newly born (ophthalmia neonatorum). This is one of the chief causes of total blindness, and if the child is not entirely blind, there are often large white patches left on the cornea which considerably interfere with sight. Gonorrheal ophthalmia may also occur in adults by conveying pus from the urethra to the eyes by the fingers.

Syphilis.—This disease is still more formidable than gonorrhea. It is caused by a microbe which has been recently discovered (Spirochæta pallida). Syphilis is much more chronic than gonorrhea and commences with a small sore indurated at its base and called the hard chancre. This is situated on the genital organs or elsewhere; in the mouth, for instance, when this has been in contact with the buccal or genital organs of a person infected with syphilis. The syphilitic poison spreads through the body by means of the blood and lymph. At the end of a few weeks eruptions appear on the body and face, and then commences a series of disasters the cause of which may be suspended over the victim for his whole life, like the sword of Damocles, even when he believes himself cured; for the cure of syphilis is often uncertain. This disease may remain latent for months and years, to reappear later on in different organs and cause fresh lesions.

Syphilis causes ulcers of the skin and mucous membranes; it sometimes causes decay of the bones; it may cause disease of the internal organs, such as the liver and lungs; it affects the walls of the blood vessels, causing them to become hard and brittle (atheroma); it causes disease of the eyes, especially of the iris and retina, tumors (or gummata) in the brain, paralysis etc. In fact, it spares none of the organs of the body.

Among the most terrible results of syphilis we must mention locomotor ataxy (sclerosis of the posterior columns of the spinal cord), with its lightning pains and paralysis of the legs and arms; also general paralysis of the insane, which by causing gradual atrophy of the brain, destroys one after the other, sensations, movements and all the mental faculties. These two diseases, which are so common at the present day, only occur in old syphilitics, five to twenty years, or more often ten to fifteen years after infection, and as a rule in persons who think they have been completely cured. Both these diseases are fatal. Before causing death, locomotor ataxy causes intolerable pain for several years. General paralysis first gives rise to grandiose ideas, and after disintegrating the human personality bit by bit, ends by transforming the individual into a being much inferior to animals, and of an aspect as miserable as it is repulsive. A general paralytic in his last stage is little more than a vegetating ruin, in whom the nervous activities are decomposed little by little, after the gradual disappearance of all the mental faculties. This is the result of slow atrophy of the brain and gradual destruction of its microscopic elements, or neurones.

The early stages of syphilis may easily pass unnoticed owing to their partly latent and completely painless character. Small eruptions may be mistaken for other affections, and mercurial treatment generally disperses the symptoms of primary and secondary syphilis. But syphilitics who are apparently cured are never safe from being attacked, after perhaps many years, with locomotor ataxy, general paralysis or the tertiary or quaternary manifestations of syphilis, such as disease of the bones, internal organs, eyes, brain, etc. The sores of the first two or three years of syphilis are contagious but painless, and hence do not prevent coitus when they occur in the genitals. After three years syphilis becomes less contagious, but there is no definite time limit and cases have been recorded in which contagious lesions occurred ten or fifteen years after the onset of the disease.

A syphilitic man may transmit the disease to his children without infecting his wife, and these children may die before birth or may be born with congenital syphilis. This is due to the spermatozoa being infected with syphilis. However, this is fortunately not always the case, for many cured syphilitics have healthy children. A child affected with congenital syphilis (from the father) may infect the mother during pregnancy; this is called "syphilis by conception." Congenital syphilis may also cause locomotor ataxy and general paralysis.

It is difficult to enumerate all the infirmities which syphilis in the parents may transmit to the children. Syphilis often renders marriage sterile. It is more frequent in men than in women, because the number of prostitutes is small compared with the number of men who go with them; a single prostitute may contaminate a whole regiment. On their part, the clients of prostitutes convey gonorrhea and syphilis to their wives, thus spreading in society this abominable plague and all the evils resulting from it.

Soft Chancre.—The third kind of venereal disease is the soft chancre, thus called in distinction to hard chancre, which is the primary sore of syphilis. Soft chancre is the least dangerous and the least common of the three diseases. It consists of an ulcer which remains localized to the genital organs (unless it is complicated with syphilis, which is frequent). The ulcerated parts are destroyed, but the sore heals generally without trouble.

Venereal diseases constitute one of the worst satellites of the sexual appetite. If men were not so ignorant and careless, it would be on the whole easy to avoid them and cause their gradual disappearance. One of the most absurd and infamous organizations which can be imagined is that of the State regulation of prostitution which, under the pretext of hygiene, compels prostitutes to be registered by the police or to live in brothels. They then undergo regular medical examination, the object of which is to prevent those who are diseased from practicing their trade, and compel them to be treated in hospital. We shall see later on that this system absolutely fails in its object, for the simple reason that the treatment of venereal diseases is by no means the panacea which many people imagine.

The first attack of gonorrhea in man is very often spontaneously cured, while unskillful treatment often aggravates it. The relapses of this disease, on the other hand, especially in their chronic form, often resist all kinds of treatment and sometimes become incurable. The gonococci become hidden in the folds of the deep parts of the mucous membrane, both in men and women, and cannot all be destroyed. With regard to syphilis, mercurial treatment, although remarkable in its immediate effect, requires prolonged administration. And it is by such means that it is proposed to make prostitutes clean! There is only one radical cure for venereal diseases; that is not to contract them! However, this does not prevent us from recommending all those who are affected with them to seek immediate treatment by a skilled specialist.

It is sad to see ladies of high position defending such barbarous institutions as proxenetism (the business of keeping brothels) and the regulation of prostitution, imagining that they thereby protect their daughters against seduction. Such aberration can only be explained by suggestive influence on the part of men. Among men, and especially among many physicians, the belief in the efficacy of regulation depends on a mixture of blind routine, faith in authority and want of judgment, combined perhaps with more or less unconscious eroticism. We shall consider this point in detail later on.

One of the most tragic effects of venereal disease is the contamination of an innocent wife, whose whole life, hitherto chaste and pure, becomes brutally deprived of its fruits, and whose dreams of the ideal and hopes of happiness become swamped in the mire with which prostitution has contaminated her. Is it surprising that love in such cases becomes replaced by bitterness and despair? Some modern authors, such as Brieux (Les Avariés) and André Couvreur (La Graine), have pictured in their dramas and novels the tragic effects of venereal disease and heredity in the family, as well as their social consequences. What is deplorable, is the enormous proportion of persons who are infected with venereal diseases.

SEXUAL PSYCHOPATHOLOGY

With the exception of what is called sexual inversion and pathological love of the insane, sexual psychopathology (i.e., sexual pathology of mind) is chiefly limited to the domain of the sexual appetite, and originates mainly in fetichism (see Chapter V), to which it is closely allied. Let us first examine certain anomalies which partly concern the lower nervous functions.

First of all a general question presents itself. Hereditary or congenital sexual anomalies have been distinguished from those which are said to result from vicious habits. Krafft-Ebing, in his celebrated book which we have already quoted, makes a capital difference between these two causes, and stigmatizes the acquired vices with great indignation. I do not deny that there is reason for the distinction, but we must take exception to two fundamental errors in the manner in which the facts are presented.

In the first place, the difference between hereditary and acquired sexual anomalies is only relative and gradual, so that it is necessary to avoid opposing one against the other. When an anomaly arrives spontaneously in the first sexual glimmer of the child's mind during its development, it is obvious that it is the expression of a profound hereditary taint, the result of blastophthoria or of unfortunate combinations of ancestral energies which have been associated by the conjugation of the two procreative germs. In such a case it is comparatively easy to prove that this is a pathological symptom independent of the will of the individual. But a continuous series of degrees in the intensity of a hereditary predisposition to a certain sexual anomaly, or to other anomalies or peculiarities apt to provoke this anomaly, insensibly connects the purely hereditary pathological appetite with that which is simply the effect of acquired vicious habits. In this way a strong hereditary predisposition may exaggerate a moderate normal sexual appetite, or may give it a pathological direction under influences which would have had no effect in a less predisposed individual. Again, a slightly marked tendency to homosexuality in a man may increase under the seductive influence of a passionate invert, when the same individual would have lost this tendency if he had fallen seriously in love with a woman. On the other hand, the invert would have no influence on an individual who was not predisposed.

If the hereditary disposition is very strong, it is developed spontaneously or under the influence of very slight circumstances. If it is mediocre, it may remain latent and even become extinct when favorable circumstances do not awaken it. When it is entirely absent the most powerful seduction and the most evil influence cannot give rise to the corresponding anomaly. These facts are sufficient to show what abuse is made of the term acquired vice. Under this heading are designated a number of peculiarities the roots of which are to a great extent contained in the germ of heredity.

The power of words on the human mind produces antinomies which do not really exist; such is the case with the terms vice and disease. Vices depend on a hereditary mnemic disposition, of varying strength and more or less pathological, or at any rate unilateral (i.e., developed in one direction only, or connected with a single group of objects); according to the good or evil influence of the environment they may develop, become limited or even fail to appear. Inversely, we may say that many diseases, especially of the brain, are the source of vices.

In the second place, it follows from this fundamental principle, that the vicious and apparently acquired conduct of certain individuals should not be considered as the product of perverted free will, but rather as the unfortunate and destructive result of a bad hereditary disposition developed under the influence of the bad habits of a corrupt environment. This environment being itself composed of men, there is a vicious circle of cause and effect which will not escape the mind of the thoughtful reader. Bad habits are made by hereditary forces, and bad habits develop in their turn by custom, and may even create, by blastophthoria, vicious hereditary dispositions. The indignation of the moralists who condemn vicious persons are very like the temper of a child who strikes the fire which burnt him.

REFLEX ANOMALIES

We have already mentioned vaginismus, which is often produced in women by the first coitus. Priapism in man is somewhat analogous to vaginismus. It is produced by an exaggerated reflex irritability of the nerve centers for erection, and results in continual and painful erections, which sometimes end in ejaculation without sensation. Another anomaly, more or less reflex and very frequent, produces voluptuous sensations and premature ejaculation after short and incomplete erections. In some nervous women also, the venereal orgasm occurs very rapidly and briefly. These anomalies belong to the domain of medicine and are of little importance for our subject.

PSYCHIC IMPOTENCE

Psychic impotence is a symptom which occurs accidentally in the normal state and very frequently in psychopathological conditions.

A representation or idea of any kind, may suddenly paralyze by suggestive action the normal reflex mechanism of the center for erection. The blood ceases to accumulate in the corpora cavernosa and erection is either arrested or not produced at all. For example, a very excited lover, who has had strong erections at the moment when he prepared to copulate, may be suddenly overcome with the idea that he will fail, or by some other thought which paralyzes erection and renders coitus impossible. The remembrance of such a failure and the distress and shame attached to it, even efforts to produce erection indirectly for another attempt, constitute further causes of inhibition of the cerebro-spinal activity; they temporarily extinguish the sexual appetite, and prevent by their interference the automatic mechanism of erection which they strive to produce. The greater the fear of failure, the more the psychic impotence increases. This phenomenon may be limited to a certain woman, but it is more often general. Sometimes an incomplete erection is produced, which is insufficient.

This condition, which depends on auto-suggestion, is best treated by hypnotic suggestion. The sentiment of impotence powerfully depresses a man, and the depression increases his impotence. This condition often, however, disappears by itself.

A special variety of psychic impotence is that in which erection takes place, but the idea of ejaculation predominates so much that it paralyzes the voluptuous sensations, and causes ejaculation to occur without pleasure, or even erection to cease.

Impotence may occur at the first coitus, or may come on gradually. It is often produced suddenly at the time of marriage in persons who have hitherto been very capable, even in Don Juans. Men may have normal erections and pollutions, but these may be stopped by counter-suggestions at each attempt at coitus. Habitual masturbation may in some cases contribute to produce impotence, but we must not generalize from such cases, nor construct a dogma from them, for continence may also be a cause of impotence.

All these details, which are combined in all kinds of ways with other sexual troubles, but which are also produced alone in men who are otherwise normal, throw much light on the relation of the momentary mental state of man to his sexual appetite and the accomplishment of coitus.

I do not know under what heading the following case should be placed:

This case is very instructive in several ways, for it gives a good example of the nature of the sexual instinct in woman; it also shows how the auto-suggestion of emissions occurring only during sleep may hinder copulation in the waking state. But such phenomena are extremely rare.

It is hardly necessary to say that there is no true impotence in woman; but the same mental paralysis may occur as in man, preventing orgasm and often causing disgust.

SEXUAL PARADOXY

By this term is understood the appearance of the sexual appetite, or even of love, at an abnormal age. Infantile paradoxy is, however, very different to senile paradoxy.

Infantile paradoxy must not be confounded with certain forms of masturbation, to which we shall return. Some races, especially in the tropics, have a much earlier sexual development than others; depending more on race than climate. In some, sexual maturity occurs in boys between the age of twelve and fourteen, and in girls between nine and ten years, while in others the former are hardly mature at twenty and the latter before seventeen or eighteen. Again, individual variations may be very great in the same race. But, owing to hereditary satyriasis or nymphomania, we sometimes in our own country see sexual appetite appear in children of eight, seven, or even three or four years of age, in a spontaneous manner without any external excitation. Lombroso mentions the case of a girl three years old who had an irresistible tendency to onanism. I have myself observed the two following cases:

In this case I was told that there was no hereditary taint, but such statements prove nothing. Individuals of this kind generally become criminals, or else give themselves up to masturbation or prostitution.

Occasionally, the sexual appetite may be preserved for a long time in old men, or reappear for a time, with or without sexual power, but as a rule, the paradoxy of old men is the initial symptom of senile dementia. As this disorder is only commencing when sexual excitation occurs, it is not noticed, and the patient is regarded as an immoral, vicious or criminal individual. I have seen a patient of this kind masturbate openly in an asylum, so great was his sexual excitation.

In most old men affected with senile sexual paradoxy, the sexual appetite is directed toward very young girls or even children, which aggravates their case from the legal point of view. Very often this appetite is perverted and assumes one of the forms we shall speak of later. Some of these old men are still capable, but others are not, and then their excitation only manifests itself in manipulations of the genital organs, etc. Such cases play a considerable part in law scandals. The patient (for so he must be called) often becomes the victim of blackmail on the part of vicious girls or children, incited by unnatural parents. One often sees also, at the onset of senile dementia, an old man become enamored of some prostitute or adventuress who makes him marry her and thus takes possession of his fortune. The law generally makes the matter valid, under the pretext that individual liberty must be respected. Such sanction consists in reality in sacrificing a patient for the profit of a female swindler.

SEXUAL ANÆSTHESIA OR CONGENITAL ABSENCE OF THE SEXUAL SENSE AND APPETITE

Sexual sensations are so intimately connected with the sexual appetite that it is difficult to separate them. No doubt in the adult a certain degree of sexual appetite may exist without any voluptuous sensation, but this is a secondary phenomenon.

Complete sexual anæsthesia is very rare in man; it is not a special form of anomaly, but the reduction to zero of a normal sensation and the appetite which corresponds to it. The characteristic feature of these cases is that, contrary to what occurs in eunuchs and cryptorchids, not only the testicles, but all the correlative sexual attributes (the beard, voice, character, etc.) are normally developed, and are in no way inverted as in homosexual individuals. Sexual anæsthesia causes no more suffering than color-blindness, but like the latter it occasions individual troubles resulting from misunderstanding. The sexual anæsthetic, having a more or less false idea of marriage, often marries in complete ignorance, and the results are then disastrous, thanks to our laws and customs.

In women, sexual anæsthesia is very common. Krafft-Ebing is wrong in maintaining that in all such cases the women are always neurotic. A number of absolutely normal and intelligent women remain all their life completely cold from the sexual point of view, apart from the normally passive character of the female sex in coitus. It is rather the very libidinous woman who is pathological.

We have seen that the normal sexual sentiment of woman is developed rather in the direction of love, and desire for children. Erotic men often complain of the sexual coldness of their wives, which is disagreeable to them; for pleasure in one sex excites and completes that of the other. Cold women submit to coitus as a duty, or at any rate only mentally enjoy their husband's caresses.

Sexual anæsthesia occurs normally in old age. It may occur at an earlier age, owing to destruction or atrophy of the sexual glands, great excesses, or on the contrary, extreme continence. Certain diseases and psychoses may also cause it.

The following are a few examples of sexual anæsthesia:

SEXUAL HYPERÆSTHESIA, OR EXAGGERATION OF THE SEXUAL APPETITE

This anomaly may be congenital, for example, in the sexual paradoxy of children. Every one knows the Don Juans and Messalinas with their insatiable appetites. These types of sexual hyperæsthesia are certainly less frequent and more abnormal in women than in men, but the intensity is as great or greater.

Sexual hyperæsthesia manifests itself by desires excited by every sensorial perception relating to the opposite sex, or simply by objects which recall it to the imagination; so that fetichism plays a great part in this condition. The feeling of satiety is hardly experienced at all, or only for a short time after each orgasm. Nymphomaniacs and satyrs are possessed by an insatiable sexual desire, often associated with certain sensations of anguish. This hyperæsthesia, even when it is not hereditary, may be developed up to a certain point by continued or repeated artificial excitations.

In women it is during or after menstruation that the sexual appetite and consequently sexual hyperæsthesia are generally strongest, but there are many individual variations in this respect, and sometimes the opposite occurs.

The effect of sexual hyperæsthesia is to direct the appetite toward any object capable of satisfying it. When the other sex is wanting, masturbation is generally resorted to. All mucous membranes (anus, mouth, etc.) and even inanimate objects may serve to satisfy the pathologically exalted appetite of such individuals. Men most distinguished in other respects may abandon themselves to the most foolish or abominable practices.

Animals are often used to satisfy the hyperæsthetic sexual appetite in both sexes. The healthy woman is not prone to such desires, unless of psychopathic taint. Men visit prostitutes, and become excited at the sight of every woman who is neither too old nor too repulsive. Some individuals of this kind are pursued night and day by erotic images, which may even become an obsession and a veritable torment.

A further degree of sexual hyperæsthesia is called Satyriasis in man, and nymphomania in woman. I have observed in women two very different varieties of sexual hyperæsthesia. In one, true nymphomania, the subjects are attracted toward man bodily and mentally with an elementary force; in these the whole brain follows the appetite in quite a feminine manner. Other women, on the contrary, are driven to masturbation by a purely peripheral excitation; they have erotic dreams with venereal orgasms which torment rather than please them; but they do not fall in love easily, and may have difficulty in the choice of a husband. Their mind alone remains feminine, full of tact and delicacy in its sentiments, while their lower nerve centers react in a more masculine and at the same time more pathological manner. There are many transitional forms between these two extremes.

Sexual hyperæsthetics are often unhappy, and consult the physician for relief from the perpetual excitation which torments them. They attempt to master themselves and check their appetite in all ways, and are sometimes affected with nervous or mental depression. It is important, however, to recognize the fact, that many sexual hyperæsthetics remain quite fresh and active, and attain an advanced age, provided they escape alcohol and venereal disease.

When sexual hyperæsthesia results chiefly from artificially acquired habits it may often be cured by hypnotic suggestion, and establishing self-control; but when it is hereditary and very intense, and especially when it is connected with infantile paradoxy or other anomalies, castration may be the only efficient remedy. When it is chiefly acquired, any strong diversion which turns the mind from sexual preoccupation to other subjects may have an excellent curative effect. The most intense hereditary cases may constitute a plague for the individual and for society, and it is then that castration may become a blessing by calming the obsessed patient, by giving him the opportunity for useful occupation, and by preventing him from abusing his fellows and procreating beings similar to himself.

Nymphomaniacs often have polyandrous instincts, and they then become more insatiable than men. Several cases of this kind have been published in the press, and examples of such women are not rare in history. When a woman is possessed by passion she often loses all sense of shame, all moral sense and all discretion, as regards the object of her desires. She pays no attention to anything which is opposed to her passion, but may be full of reserve, tact and good-feeling in all other respects. Cases of this kind, however, have always a more or less marked pathological character.

In man, satyriasis is very frequent. It often happens that a husband continually forces his wife to coitus, even during menstruation. We have mentioned already the case of an old peasant of seventy who thus abused his poor old wife. In such cases conjugal infidelity very commonly occurs. The cynicism of such individuals may go so far that they have intercourse with prostitutes or servants in the presence of their wives, or even abuse their own children. The wife behaves in these cases in different ways according to her character. Many tolerate everything and do not complain, for the sake of their children; others leave the husband or divorce him; some commit suicide.

It would seem quite natural for nymphomaniacs to marry satyrs, but we must bear in mind the evil results for posterity from such an accumulation of the sexual appetite.

MASTURBATION OR ONANISM

The term onanism is derived from the name of Onan, son of Juda and Suah and grandson of Israel. According to the Old Testament, Onan's father wished him to marry his brother's widow and have children by her; but this did not please Onan, and he provoked ejaculation of semen by friction, in order to avoid having children by his sister-in-law. "This offended God who slew him."

We have already shown that in the child the sexual appetite manifests itself in a kind of obscure presentiment and vague sensations in the genital organs. If a young man cannot satisfy his sexual appetite naturally, the latter when it increases in strength provokes erotic dreams and nocturnal emissions; or artificial excitation of the penis may be practiced to produce orgasms: the latter phenomenon is called masturbation.

Masturbation in man is performed by friction of the penis with the hand or against some soft body. In the latter case especially erotic images of naked women or female sexual organs is associated with onanism. This kind of masturbation may be called compensatory, because it does not depend on an anomaly of the sexual appetite, but serves to satisfy a natural want by compensation. There are a whole series of manipulations employed for the same object, which constitute the psychic equivalent of compensating masturbation. In remote garrisons and in boys' schools the more libidinous individuals, usually those mentally tainted, often practice mutual masturbation or sodomy. This is the sex complex of the degenerate individual and in an effort to exterminate these pathological manifestations, they are being penalized by law, throughout the civilized world. It is unnecessary to prolong this enumeration. Those we have mentioned are the most common and it is agreed that men who are addicted to these practices are decidedly psychopathic, whether it may be caused by faulty heredity or anomaly in the psychology of the individual, this still remains to be proven. In reality they are often normal in other respects, but simply affected with sexual hyperæsthesia. Sometimes they are feeble-minded individuals who have recourse to such practices because they are derided by women. Others are cynics, more or less vicious in other respects.

Compensatory masturbation is extremely widespread, but it is as a rule neither recognized nor admitted because it is easy to conceal. Although depressing for those whose will power is overcome by an excitation which they cannot conquer, it is relatively the least dangerous form of onanism. At the most it leads to a certain amount of nervous and mental exhaustion by abuse of the facility of thus procuring a venereal orgasm. The loss of substance from frequent seminal ejaculations is also more or less weakening, although the secretion from the prostate plays a much greater part than the semen. But what especially affects the nervous system, is the repeated loss of the will, and the failure of resolutions made many times to overcome the desire for orgasm.

Here, as elsewhere, effect is too often confounded with cause. Because men of feeble will power are addicted to onanism, it is imagined that the latter is the cause of the weakness of will. In itself, a seminal ejaculation provoked by masturbation is no more dangerous than a nocturnal emission; both are often accompanied by nervous sensations which are more disagreeable and exhausting than normal coitus. I must, however, point out that the effects of moderate masturbation in the adult have been greatly exaggerated, either by confounding the effect with its cause, or for mercenary objects, by driving timid persons to charlatans or to prostitutes.

The active sexual appetite of man, increased by the accumulation of semen, is absent in woman. She does not have nocturnal emissions accompanied by voluptuous sensations which spontaneously awaken sexual desire. For this reason a pathological sexual excitability is necessary to spontaneously provoke in woman voluptuous dreams or masturbation. For the same reason we cannot speak of compensatory masturbation in woman. Onanism, however, is not uncommon among women, although less frequent than in men. It results either from artificial and local excitations, from bad example, or from pathological hyperæsthesia. When once the habit is acquired, repetition is produced by the difficulty of resisting voluptuous desires.

Women perform masturbation by friction of the clitoris with the finger, or by introducing various hard and rounded objects into the vagina and imitating the movements of coitus; often also by rubbing the crossed thighs against each other. In the insane, masturbation is sometimes practiced to an excessive extent. Some hysterical women introduce objects into the urethra during masturbation and cause severe inflammation of the bladder.

Another variety of sexual excitation which is often substituted for coitus among women, is the practice of mutual licking of the clitoris with the tongue (cunnilingus). Although not so dangerous as has been maintained, these habits are aberrations of the sexual appetite, and it is needless to say that every human being should abstain from them out of self-respect.

The man who, for some reason or another, cannot obtain normal coitus should content himself with nocturnal emissions, and the woman with voluptuous dreams, and should both abstain from active and voluntary excitations. For my part, I consider prostitution, or "love" which is bought, as a variety of compensatory masturbation, and not as normal copulation. Coitus with a prostitute, generally infected with venereal disease, who receives new clients continually, has as little affinity with love as with the normal object of the sexual appetite—reproduction; and its moral value is certainly inferior to that of onanism.

A second form of masturbation occurs in very young children from accidental irritation; in boys from phimosis; in girls from itching due to worms (oxyuris) about the anus and vulva. Innocent as regards its cause, this form of onanism may become dangerous by habit. Attention should therefore be paid to phimosis and worms, and the former treated by circumcision and the latter by the usual remedies.

A third kind of masturbation is caused by example and imitation. This often occurs in schools and among children in general; and in this way very precocious sexual excitation may develop and become a habit difficult to suppress. The onanism of young children is certainly worse than that which begins after puberty; it not only renders the child idle and bashful, or increases these faults; but it also interferes with nutrition and digestion and develops a tendency to sexual perversion and to impotence. It often ceases, however, after careful supervision, combined with physical exercise and fresh air, and direction of the attention to other things. On the whole, the danger of this form of onanism has also been exaggerated. In most cases it is cured, when it is not based on abnormal predispositions or on an indolent and feeble character. Love and normal sexual intercourse are naturally the best remedies for masturbation due to seduction and habit, as soon as the subject has reached sexual maturity.

We may include as a fourth form of masturbation the cases of paradoxy which we have mentioned previously. In this case onanism is produced spontaneously as the result of psycho-sexual precocity or hereditary pathological satyriasis.

With the exception of the last paradoxical form which is based on incurable satyriasis, all the kinds of onanism which we have mentioned hitherto can only be successfully treated by kindness and confidence, combined with work and direction of the mind to wholesome and attractive subjects; not by threats or punishment. The new reformatory schools called Landerziehungsheime (Vide Chapter XVII) are an excellent remedy for onanism, for they keep the child occupied from morning to night and hardly leave him any time for bad habits; when he goes to bed he is too tired to do anything but sleep. However, great prudence and active supervision is required in these cases.

The fifth class is constituted by the onanism of sexual inverts, and may be called essential onanism. This concerns men whose sexual appetite is directed toward their own sex instead of the other. They are called homosexual, and mutual onanism is, so to speak, the normal satisfaction of their inverted appetite. We shall refer to this again later on. While normal sexual intercourse is the best and most rational remedy for compensatory masturbation, there is no question of it here. Marriage is the worst and most scandalous remedy in such cases. It is therefore of the greatest importance in order to judge of the nature of the masturbation, to inquire into the kind of erotic images with which it is associated. If, in the case of a man, the images are those of women, it is simply a case of compensatory masturbation; but if the images are masculine, it is a case of sexual inversion. If masturbation is not accompanied by any images, the question remains doubtful. In young children this is explained by the fact that the psycho-sexual irradiations are not yet developed; but after puberty the absence of images as an object of eroticism suggests a certain anomaly and sometimes depends on a latent tendency to inversion.

Relation of Masturbation to Hypochondriasis.—Some onanists become much distressed, and reproach themselves for having spoilt their lives by their bad habit. They give way to lamentations before their doctor and their acquaintances, wring their hands with despair, and beg every one to come to their aid. They look upon themselves as poor sinners whose lives have been ruined, either by their own fault or by others. They have read Lamert's "Personal Preservation," or other sensational books which excite both the fear and the sexual desire of weak characters, whom they are intended to exploit. These poor devils believe themselves lost, and are truly pitiable objects. These form the types which are paraded as terrible examples in books on onanism which make timid persons' hair stand on end.

When these unfortunate onanists are questioned on all the circumstances of the act of which they accuse themselves, we generally arrive at the following results:

We recognize that we have to deal with psychopathic or neurotic subjects more or less tainted by heredity, timid and shunning their fellows, easily impressed by imagination, possessed of unhealthy sentiments and ideas; in fact, hypochondriacs, predisposed to look upon every sensation or slight indisposition as a grave disorder threatening their health or life. They thus live in perpetual anxiety. This mental anomaly has for a long time preceded the onanism, even if they have masturbated, which is often even not the case.

Among the numerous patients of this kind that I have treated, there were many who had simply had nocturnal emissions since puberty, but they regarded themselves as lost men through masturbation! Many others no doubt practice compensatory masturbation, generally because their timid nature prevents them from frequenting prostitutes, or committing other sexual excesses, while the way in which they analyze their sensations easily leads them to onanism. On the other hand, they are generally so afraid that they do not give way to excessive masturbation, perhaps only once or twice a week or even less often, so that the normal frequency of coitus, according to Luther, is often not attained and seldom exceeded. Among these persons we find few precocious or excessive onanists. I admit, however, that a hypochondriacal constitution predisposes somewhat to onanism.

But, what I wish to lay stress upon, is that the onanists who are full of lamentation and self-reproach are neither the most numerous nor those who commit the greatest excess. The worst onanists, those who provoke several ejaculations daily, belong to the category of sexual hyperæsthetics. These have not the classical aspect attributed to them by tradition; they are not pale and terrified creatures, but rather lewd individuals who are early transformed into impudent Don Juans. They may be as courageous, as clever and as strong as others and yet be disposed to all kinds of evil tricks and follies. It is, therefore, not true, as is so often said, that it is possible to recognize a masturbator by his face or manner.

These excessive onanists no doubt do themselves harm in various ways, but the great error of taking sexual hypochondriasis for the type of onanists, is to confound cause with effect. Sexual hypochondriasis is in no way the effect of onanism, but precedes it, and onanism is rather its effect, or is simply associated with it. It is obvious that onanism, by its depressing effect, aggravates a mind beset with hypochondriacal anxieties.

It results from these facts, first, that a sexual hypochondriac should be treated as a hypochondriac and not as an onanist; secondly, that the worst slaves of masturbation are not to be looked for among pale and dejected individuals.

Among women, especially young girls, hypochondriasis is not common and cases of sexual hypochondriacs who accuse themselves of masturbating are rare among them. Women who masturbate generally keep their secret and are apparently very little affected by it. However, onanism does them nearly as much harm as men; it is true they have no loss of semen, but the repetition and intensity of the nervous irritation are greater than in man, and it is this which causes most exhaustion. In spite of this, it is curious to observe that women who masturbate are generally less ashamed than men, and are apparently less depressed by it. We must bear in mind that the loss of semen by masturbation has in man a peculiarly depressing effect, for it lacks its object and represents an absolutely abnormal satisfaction of the sexual appetite.

It may be objected that this difference is due to another cause, that women who masturbate have less moral tone and are especially depraved individuals. I agree that this is often the case, but far from always. The intensity of the sexual excitability in women has nothing in common with their character; it may be associated with high intelligence, with high moral and æsthetic qualities, and even with a strong will. On the other hand, deficiency in moral sense and will may occur with sexual frigidity, and, as we have already seen, may lead to sexual excess without any voluptuous sensation, in accordance with the peculiarities of feminine sentiment. These facts show how complex are the causes of a given effect in the sexual domain.