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towns and cities and parade their vile advertisements and nostrums on the pages of our daily papers.

The following is a very good illustration of this class of

cases :

A young man about twenty-four years of age came to me with the statement that he had recently become engaged to be married; that now he was in great distress of mind and was hardly able to sleep because he found he should not be able to consummate the marriage relation; that when a boy he had learned to masturbate and practiced it for several years, but had for a long time given it up, since which time he had been subject to seminal discharges at times, and there existed little or no sensation about the genitals ; they were lax and flabby, and he had no doubt that his semen was running away from him every time he had an evacuation of the bowels. He was fast losing flesh and vigor, and something must be done at once. Now, it is of very little use to tell such a person that his condition is far less grave than he supposes, and that he need not be alarmed, that he is sure to come out all right if he goes on the even tenor of his way—that he does not require much from the physician in the way of treatment. Such a statement, instead of assuring and comforting him, as you design to have it, will only lead him to think that you do not understand his condition, and in nine cases out of ten he will leave your office and hunt up that of some physician, or more likely that of some quack, who will tell him that his condition is indeed a very grave one, but that he can, in two weeks' time, set him all right, and put him into a condition to be married, which he proceeds to do at a charge of fifty or one hundred dollars.

Persons comprising the above-mentioned classes are generally of a neurotic or sanguine temperament; they are highly sensitive to objective and subjective experiences, and will require special moral, and occasionally medical, treatment, but they rarely become insane.

What I desire to call special attention to in connection with this mention of them now is the marked effect which has been produced by the habit of masturbation upon those centres of the nervous system upon which the emotional activities depend; sooner or later these may become greatly influenced or deranged by such practices in persons of a highly sensitive and nervous organization; and more often long before marked physical changes occur.

There is yet another class which does not often come under the attention or care of the general practitioner. These persons differ from those already alluded to in that they generally have an inheritance of insanity, or some other neurosis; one or the other of the parents has either been insane or consumptive, or addicted to the excessive use of alcohol, or other vices.

When the system is burdened with such an inheritance, and the inhibitory centres are undeveloped or anæmic, or an unstable condition of the brain exists from any other cause, the practice of self-abuse is more likely to become excessive, and appears to produce a more profound influence upon the intellectual faculties; the brain is more susceptible to its effects, and manifests this by a derangement of its activities and a failure in its energy in such forms as are hereafter to be referred to. It may therefore be assumed that the effects of the habit of masturbation upon individuals will differ very much and will depend primarily upon the age, constitution, temperament, and inheritance.

The very young and sensitive and illy-balanced individual will become more nervous and sensitive, and therefore

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apprehensive of effects which he is all the time magnifying and regarding as sure to become greater in the future, while another, who has a lymphatic temperament and a larger measure of inhibition, tends toward reserve and hesitation and is disposed to shun society, especially that of females.

It should, however, be remarked that by far the larger proportion of young persons who are insane and addicted to this habit while in this state, are not insane as a consequence of its former practice. The habit is a consequence and not a cause of their disease.

A super-sensitive or excited condition of certain portions of the brain, which has resulted from other causes, not unfrequently extends to those portions which preside over the sexual organs, and these in consequence are aroused into a morbid activity, which leads the patient into the practice. This is especially the case with females

. who become affected with what is termed nymphomania, and are occasionally found in all asylums. I very well remember such a case in the person of an old woman more than seventy years of age who must have been dead to all normal sexual feelings for years, whose conduct was so indecent as to require her seclusion for considerable periods. It is not unfrequently the case with highly excited and maniacal patients, and especially with those who are partially demented; and so long as the nerve centres are exhausted by the continual practice of this habit there exists little probability of improvement in the mental condition.

Symptoms.-As has already been intimated, there are cases in which the habit becomes the chief factor in causing mental derangement. The records of many such are found in the journals of all asylums. It almost always arises during the period of adolescence, though it may also appear at the grand climacteric, and even in old age; and

is quite likely to appear during the latter period if it has existed in the first.

Indulgence in excessive sexual intercourse when long protracted ordinarily tends to produce a profound impression upon the nervous system, and is attended by debility and depression. It has also been regarded as one of the most efficient causes of general paralysis. While we have no reason to suppose that masturbation may be regarded as a cause of that form of disease, yet its effects upon the nervous system are very injurious, though they terminate in a different form of disease. The symptoms are in some respects such as would be anticipated from the effects of a large drain upon the system-namely, those of debility. The individual loses flesh and nerve; the hands are often cold and clammy; the action of the heart is easily disturbed and irregular; sleep is broken and lessened; the appetite capricious, the tongue soft and indented from its pressure upon the teeth; food is not well assimilated; and the person complains more or less of debility and general wretchedness.

After a longer or shorter duration of these physical conditions, or in connection with them, the symptoms of change and derangement of the mind appear. The person is inclined to seek seclusion and shuns society, especially that of females; will not look you in the eye, prevaricates, deceives ; has little of settled purpose, becomes depressed, and not infrequently exhibits a suicidal tendency. The depression, however, does not amount to melancholia, nor does the general appearance of conduct at all resemble that of a person affected with that form of disorder. This condition does not usually continue very long under the quiet, regularity, and publicity of asylum life, and is often succeeded by one of irritability, self-importance, and self-satisfaction, a readiness to easily take offense, and quarrelsomeness. The patient is disposed to think he is insulted by attendants or patients or that he is neglected. He loses all sense of modesty, and is ready to talk of his disgusting habit, though he rarely openly practices it, as is sometimes the case in the excitement of maniacs.

CASE 1.—The following case, E. A., age twenty-five, was admitted in July, 1884, and will illustrate some of the abovementioned conditions. He is reported to have been so much of an invalid for years as to necessitate his remaining in bed much of the time ; is of a neurotic temperament, and has been for several years excitable. About a year ago he began to have nervous twitchings of the muscles about the neck, of a choreic character, and a short time before admission began to express delusions of fear; thought efforts were made to poison him ; that he was to be arrested, and he sought to leave home on this account and to secrete himself; has suffered from insomnia; endeavored to commit suicide once by hanging, and once by jumping from a second-story window. He has been a masturbator for many years.

After his admission he was somewhat incoherent, dull, and listless, and when he talked spoke in a rambling, meaningless way; was pale and anæmic; heart action irregular; hands cold and clammy; he became easily disturbed and excited, and inquired where he was. After two or three days a camisole was applied to prevent his masturbating and with good effect. He soon began to give indications of more mental action, and even requested that it might be kept on him; said that he had long been addicted to the bad habit, and desired to break it off; whenever the camisole was removed he was kept under close observation. After some weeks he again became excited, talked


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