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with impunity for a minute. In a tête à tête there is another disagreeable, which I find worse. I mean the necessity of talking constantly; if you are spoken to you must answer, and if nothing is said, you must take up the conversation. Thus unendurable constraint alone would have disgusted me with society. I find no burden more intolerable than the obligation to speak at once and constant'y. I do not know if this arises from my mortal aversion from all subjection ; but it is quite enough to be obliged to speak to make me infallibly say something foolish.

“What is more fatal is that, instead of knowing how to hold my tongue when I have nothing to say, it is just then that, to pay my debt as quickly as possible, I have a mania for talking. I try in a hurry to stammer, promptly, words without ideas, only too happy if they mean nothing at all. In trying to conquer or hide my inaptitude, I seldom fail to display it.

“I believe that this is the real explanation of why, though I am not a fool, I have often passed for one, even with persons capable of judging; all the more unhappy because my physiognomy and my eyes promise something better, and my failure makes my stupidity all the more shocking to others. This detail, which a particular instance has suggested, will not be useless to any one who follows it. It contains the key of many extraordinary performances of mine, which have been attributed to an untamed humor which I do not possess. I should relish society as well as any one, if I were not sure to exhibit myself, I do not say only to disadvantage, but as something quite different from what I am. The system I have adopted of retirement and writing precisely suits me. No one would ever have known, from my presence, what I was worth; no one would ever have suspected it."-Loc. cit., pp. 151–155.

I think this description has been seldom surpassed in hideous frankness : similar cases are almost daily brought before me, but few could or would describe their condition so fully as Jean Jaques Rousseau has done. The slowness of thought and comprehension, the timidity in conversation, the morbid quickness of feeling, the wretched dwelling on self, and diseased love of solitude, of mind as well as body, are most characteristic.

It would be well for humanity if masturbation did no more than produce even such humiliating mental effects as these. Daily experience teaches us that the evil habit is attended with the worst physical consequences also. These may as well be disposed of before we come to the last, worst, and most constant result, when the practice has become a confirmed habit.

At first we remark but little local irritation of the canal of the urethra. Pain may occur in making water, as well as a frequent desire to empty the bladder; the orifice of the 'meatus is frequently found red, and ejaculation, which before could only be excited by much friction, now takes place immediately; the secretion is watery, and even slightly sanguinolent, and emission is attended with spasm. A sense of weight is felt in the prostate, perinæum, or rectum, and anomalous pains are often complained of in the testes. Nocturnal emissions become very frequent, and are easily excited by slight erotic dreams. These at first are attended with pleasurable sensations, but later the patient is only aware of ejaculation from having his attention the next morning attracted to it by the condition of his linen. In other instances the semen does not pass away in jets, but flows away imperceptibly. In some cases it makes its way back into the bladder, to pass out with the urine. Other patients will tell you that emissions have ceased to occur, but on going to stool, or on the last drops of urine passing from the bladder, a quantity of viscous fluid, varying from a drop to a teaspoonful, dribbles from the end of the penis, which, if collected, or allowed to fall on a piece of glass, and exposed to the microscope, may furnish spermatozoa in greater or less numbers.

The vicious habit having impaired the growth, health, and intellect of the patient, ceases often to be voluntarily indulged in, because pleasure is no longer derived from it. The drain on the system during defæcation or micturition, however, as I have stated above, continues, and what depended at first on an artificial excitement, is kept up by the irritation or inflammation of the urethra, vesiculæ seminales, and spermatic ducts. The too frequent irritation of the testes causes badly eliminated semen to be secreted, which is at once emitted. The mucous membrane is more sensitive than usual (see p. 77), acquires an irritability like that often seen in the bladder, and which irritability appears more or less general. I may mention here that pleasurable sensations seldom attend the expulsion of ill-conditioned semen, probably depending on over-abuse of the sensations, which become subsequently blunted. The patient is now frequently reduced to a state of complete bodily and mental impotence.

We need not pursue the progress of the physical disease further here, as the subsequent symptoms will be more fully described in the chapter on Spermatorrhea.

PROGNOSIS.—My own sad opinion is, that it is not an easy matter to give up the practice. When once the vile habit has become confirmed, the young libertine runs the risk of finding himself, a few years later, but a debauched old man. I have known lads and men of strong energy of will who have by their own confession failed, until they were aided by the other remedies which I shall hereafter describe. Want of resolution is, of course, one cause of failure, and where there is hereditary predisposition to strong sexual excitement, the task is often too great without good counsels and sound medical advice; and I should advise all sufferers not to rely on themselves for a cure, but at once to resort to their usual surgeon, who will give them sympathy and counsel. Let them, above all things, avoid advertising quacks.

If the struggle is severe for a youth to extricate himself from these vicious propensities, experience teaches me that it is very doubtful if, when the practice has been much indulged in, the physical frame will ever be wholly built up again; the haggard expression,' the sunken eye, the long, cadaverous-looking countenance, the downcast expression, which seems to arise from the dread of looking a fellow-creature in the face, may be carried to the grave. Undoubtedly care and attention may do much in remedying the intellectual wreck which we notice in such youths.

1 Since writing the above a very favorable case of recovery has come under my notice. About six years ago a youth consulted me, suffering from some of the worst effects of masturbation. He has lately come to ask my opinion on the advisability of marriage. I find that, intellectually and physically, my patient has to a great extent recovered, but he still retains the peculiar physiognomy which, to me, is very characteristic. There is the hollow, sunken eye still left, although nature has filled up all other interstices. The expression has nearly become natural, but still the practised eye sees that there remains an unsettled look, very different from the calm, steady gaze of other men. In this case I was able to give my sanction to an early marriage, strict continence having always been maintained, only occasional emissions occurring, and I have little doubt, that a few years of married life will still further improve the expression of the face.

It will be remembered that I am describing the results of only the worst and longest continued cases. The probability is that in

many who read these pages and who have at some time or other practised this vice, but have early abandoned it, the symptoms will be of the slightest kind, and a speedy cure may be promised.

Quacks are eager, of course, to represent every case as of the worst description; and I therefore wish clearly to guard myself against being supposed to mean that in my opinion all, or even most persons who have at any time fallen into this wretched habit are doomed to all the results above described. These results are, it is true, the end towards which sufferers are tending if they do not conquer the propensity, but if they do so before the last sad stage is reached, there is good hope for them yet. Nevertheless, the other extreme must be avoided, of thinking lightly of the habit, or denying that it is the cause of disease. A great change on the prognosis of these diseases has come over the profession in this respect of late, and many eminent surgeons now admit that various unrecognizable ailments are caused by these practices; and the "Lancet," in a series of remarkable leading articles, has recently (1870) suggested that all surgical authorities should discuss these ailments in the different manuals and dictionaries, instead of neglecting to treat of them as hitherto.

It is not very long ago that an able physiologist told me he believed that one half the boy population masturbated themselves more or less, and yet that the resultant consequences were very slight. He saw much of conscience-stricken young men who consulted him; but, in his opinion, they exaggerated their sufferings, and writers on the subject had magnified the ill-effects of self-abuse. This gentleman and those professional men who agree in this view have probably only met with slight cases, for there can be no doubt that there are others, whose wretched condition, mental and bodily, can hardly be exaggerated.

There are many false cases, no doubt, which are often misunderstood and have misled even able professional men, but it is not less certain that there are true cases. I could speak, from my own experience, of the many wrecks of high intellectual attainments, and the foul blot which has been made on the virgin page of youth—of shocks from which the youth's nervous system will never, in my opinion, be able to rally—of maladies engendered which no after course of treatment can altogether cure, although surgery may do much to alleviate symptoms as they arise.

One of the chief causes which impede recovery, and interfere with the action of any remedies, is the mental anguish arising from the horror and remorse which the patient experiences. This has been well put by Tissot, who wrote a book on “Onanism a century ago. His observations are as true now as then.

He says:

“When the evil is removed, the picture of their conduct is brought before them in all its hideousness; they find themselves guilty of a crime, of which Divine justice wishes not to supersede the penalty, and which it punishes by death—of a crime reputed as a great crime, even by heathens :

Hoc nihil esse putas ? Scelus est, mihi crede sed ingens
Quartum vis animo concipis ipse tuo.'


“This distress cannot be alleviated by the sympathy of others. Shame obliges the patient to hide his crime from every one, till some unbearable torment force a revelation. Many, indeed, die because they have not been able to muster courage to reveal the cause of the misery. I often receive letters saying, I would rather die than appear before you after such an avowal.

“Feeling that he must be held in detestation by society if his disgrace were known, the idea pursues him incessantly. It appears to me,' says one of my correspondents, that every one reads in my face the infamous cause of my disease, and this idea renders society unbearable ; and what is most frightful, I have no pretext of justification or motive for consolation.'

I need hardly say that, instead of fostering in the least this

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