Chapter XV

The motto which I have placed at the head of this chapter on the campaign against venereal diseases and on the attempt to suppress them is taken from an interesting academic essay by the former professor of medicine at Göttingen, K. F. H. Marx, who is well known to have been the physician of Heinrich Heine during the latter’s student life in Göttingen. The title of this essay is “The Diminution of Diseases in Consequence of Advancing Civilization,” p. 35 (Göttingen, 1844).

The hopeful view which is here expressed by the university professor regarding the ultimate eradication of venereal diseases was shared at that time by the eminently =practical physician= Parent-Duchatelet. He appeals, unfortunately, not to medical men and students of social hygiene, but to the police:

“Pursue without cessation the diseases which are diffused by means of prostitutes; =take it as your goal to cause them to disappear from the list of human troubles; do not doubt that your labours will ultimately be crowned with success, although the task may be one that will occupy several generations=.”[331]

Two complete generations had, however, to pass away before =the campaign against venereal diseases and the attempt to suppress them became a burning question of the time=, became a question of =public health= and social hygiene, like those which concern the fight with tuberculosis, with infant mortality, and with alcoholism. Once again I must repeat that the =organized systematic campaign against venereal diseases is still in its very earliest stages=. Strictly speaking, it dates only from seven years ago, when the =first international congress for the prophylaxis of syphilis and other venereal diseases= was held in Brussels, from September 4 to 8, 1899. Almost all the civilized countries, European and other, took part in this congress, and not only physicians and dermatologists, but also lawyers, clergymen, attachés of embassies, authors, and philanthropists, explained their views, and thereby showed that the question of the suppression of venereal diseases was one of equal interest to all classes of society, and one which must exercise the activity of the community at large. At the conclusion of this first international conference in 1899, there was founded the =International Society for the Sanitary and Moral Prophylaxis of Syphilis and other Venereal Diseases=, which has its seat in Brussels, and meets at periodical intervals for international conferences.

Especially in Germany has this organization aroused active interest, and it was soon decided to found a national =German Society for the Suppression of Venereal Diseases=, whose first meeting was held on October 19, 1903, in the hall of the Berlin Rathaus. The meeting was opened by a speech from Albert Neisser, after which Alfred Blaschko spoke on “The Diffusion of Venereal Diseases,” Edmund Lesser on “The Dangers of Venereal Diseases,” Martin Kirchner on “The Social Importance of Venereal Diseases,” and Albert Neisser on “The Aims of the German Society for the Suppression of Venereal Diseases.” The =committee= of the Society consists of Messrs. A. Neisser, president; E. Lesser, vice-president and treasurer; and A. Blaschko, general secretary. The organ of the Society is issued six times yearly, under the title, Reports of the German Society for the Suppression of Venereal Diseases, and has been published for the last four years; it is supplied gratis to members; to non-members the yearly subscription is only three marks. In the spring of the year 1903 there was founded a larger Journal for the Suppression of Venereal Diseases, of which five volumes have hitherto appeared; this serves for the publication of more comprehensive critical studies.

Still in the same year, 1902, there were formed the first =branches= and =local groups= of the German Society for the Suppression of Venereal Diseases in Hanover, Wiesbaden, Breslau, and Berlin. Subsequently other branches were formed in Mannheim, Munich, Cologne, Beuthen, Danzig, Stettin, Posen, Dortmund, Elberfeld, Frankfurt-on-the-Main, Görlitz, Hamburg, Königsberg, Nürnberg, Stuttgart, and Heidelberg.

During the last four years, by means of lectures, the circulation of pamphlets and leaflets, and by public discussions, information regarding the dangers of venereal diseases has been diffused among the widest circles of the population. Of the other activities and measures of the Society we shall have to speak later.

We pass on to the consideration of the principal elements of the modern campaign against venereal diseases. In view of the limits of this work our discussion of this question must necessarily be a brief one. The eradication of venereal diseases must be effected in a =threefold= manner:

1. By measures of =personal prophylaxis= against infection.

2. By the proper =medical treatment= of all cases of venereal disease.

3. By measures belonging to the province of =public hygiene=, to that of =state action=, and to that of =education=.

The =personal prophylaxis= of venereal diseases[332] has made great progress with the increasing scientific knowledge of the causes and modes of infection of these diseases. We know now precisely where and how we can lay down =personal= rules which give us at least a =fairly secure guarantee= that in an individual case venereal infection will not occur. Various points of view must then be taken into consideration, the combined influence of which will alone promise a successful result. No one single measure will suffice to gain this end.

Above all, in this department of the prophylaxis of venereal diseases, experienced physicians, alike of earlier and more recent times, will unanimously agree in this proposition, that the principal preliminary means for the avoidance of venereal infection, means which it is absolutely essential to employ in every instance, consist of =perfect cleanliness= on both sides. He who insists on the most scrupulous cleanliness of body, clothing, and underclothing, will be sure to get rid =immediately= of any uncleanliness acquired in sexual intercourse. Cleanliness and health are often (not always) identical. In any case, the =greatest mistrust= should be felt as regards a person evidently unclean, with a neglected exterior, for this is always a sign that such a person is not particular as regards choice in matters of sexual intercourse. “=Germany, get into your bath!=” Heinrich Laube once exclaimed. This would be a good device to adopt in the campaign against venereal diseases. Every uncleanliness is an irritant; it impairs the intactness of the skin; and especially is this true of any uncleanliness of the genital organs, and above all of the male genital organs, where, under the foreskin, the “smegma” (the sebaceous secretion of the preputial glands) often undergoes decomposition, and gives rise to an inflammation, the so-called =balanitis=, which greatly favours the probability of infection.[333]

If the foreskin has been removed by circumcision, this secretion entirely ceases, and the mucous membrane covering the glans penis is transformed into a thick skin, which is much less readily affected by the causes of infection. There is no doubt that circumcision is to a certain extent a protective measure against syphilitic infection, whilst it does not in any way protect against gonorrhœa. Neustätter has recently collected some very remarkable facts relating to this question.[334]

Breitenstein has contrasted 15,000 indigenous =circumcised= soldiers with 18,000 =uncircumcised= European soldiers of the army of the Dutch Indies, living under similar local and hygienic conditions. Thus, in the year 1895 there were infected with venereal diseases, of the circumcised 16 %, of the uncircumcised 41 %. As regards infections with syphilis, of the circumcised 0·8 % were infected; of the uncircumcised, on the other hand, 4·1 %--that is, five times as many. Similar observations were made by the celebrated English syphilologist Jonathan Hutchinson, one of the most ardent advocates of the general introduction of circumcision as a protective measure against venereal, and above all against syphilitic, infection. Moreover, with regard to the observations made in Java, the difference did not depend upon race, because similar differences have been observed as regards comparative immunity from infection in respect of circumcised Christians, circumcised on account of phimosis and other troubles, whose number is by no means insignificant.

Since, however, it is unlikely that circumcision will come into general use in Europe as a prophylactic measure, it only remains to recommend that, as a fundamental procedure, the greatest possible care should be employed in the daily and delicate cleansing of the preputial sac. By this means inflammation and laceration of these parts will be most effectually prevented, and even without circumcision a certain resisting power will be induced. For washing this region, lukewarm water which has been boiled and cooled may best be employed; then dry the part carefully, so as not to rub off the skin. In the case of women, frequent washings of the external genital organs, and vaginal douches, are also of great importance in regard to the prevention of venereal infection. =Before= and =after= the sexual act, these measures are of especial value, because =often by simple mechanical means=, infective material already deposited may be carried away. The same purpose is subserved by urination, a procedure certainly adapted for washing out gonorrhœal pus which has found its way into the urethra, before the gonococci have had time to establish themselves in the mucous membrane. I know a number of patients who =use no other means of protection in sexual intercourse beyond the observation of extreme cleanliness, by washing and douching, in both sexes=, before and after sexual intercourse, and by passing water immediately after intercourse, and thus have remained free from infection; but who promptly became infected =as soon as they discontinued these simple measures=.

For this reason, these measures, where possible with the assistance of =soap=, which certainly exercises some antiseptic influence, cannot be too warmly recommended, although they naturally =do not offer any absolute security=. They have, however, the advantage that, in the first place, they can always be employed, even when the true protective measures of which we speak below are not available, and that, in the second place, they can always be used in addition to these. It sounds, perhaps, somewhat absurd, and yet it is true, to say that =washing= and =urination= are the =first= and =most important= protective measures against sexual infection.

The second point, which must also be considered important in this connexion, is the =exercise of self-command= before and during the sexual act, as far as this is possible in view of the nature of sexual excitement, which always lessens the personal responsibility, and overcomes reason and understanding. Yet no one should have sexual intercourse when =in a state of alcoholic intoxication=, in which self-control is =completely= lost; as we have shown in an earlier passage (pp. 292-296), there are several reasons why intercourse is apt to be disastrous to a drunken man. Moreover, =love= prefers the dark, but =precaution= prefers =the sunlight=. Before having intercourse with a woman previously unknown to him, a man should inspect her in clear daylight, with a view to her state of health. Suspicious spots on the skin, especially on the forehead and on the trunk; white areas on the lips, the tongue, the throat, and the back of the neck; visible glandular swellings; a marked discharge from the genital organs; ulcerated areas in this region, etc., are of an extremely suspicious nature, and should cause abstinence from intercourse. French physicians go so far as to recommend examination of the inguinal and cervical glands under the harmless form of pretended caresses; but persons without medical education would seldom be sufficiently skilled to be able to detect glandular swellings unless these were unusually well developed. Especially enlargement of the cervical glands--this “pulse of syphilis,” as Alfred Fournier terms it--is a comparatively certain indication of syphilis.

It is dangerous also in many cases to repeat the sexual act =several times= in brief succession, because old experience has taught us that infective material may first make its appearance at the second or third act of coitus, and thus infect then only. This affords an explanation also of a fact often observed--that in intercourse with an infected woman on the part of two healthy men, with but a brief interval between the acts, the one who had intercourse first often remains healthy, whilst the second is infected.

I pass on to consider the =special protective measures= which have long been recommended for the prophylaxis of venereal infection.

1. =The Condom.=--This is the =oldest= and even to-day beyond question the best and =most trustworthy= artificial protective measure. Employed long ago in the days of antiquity, it was in the sixteenth century once more recommended by the Italian physician Fallopius, and therefore is not the invention of a physician “Conton,” after whom it is said to have been named (perhaps the name is connected with that of the French town “Condom”). Hans Ferdy (A. Meyerhof) suggests that the word is derived from “condus”--that is, one who =preserves= or protects--and that the article should properly be called “condus” instead of “condom.”[335]

The condom is a protective membrane, with which the penis is covered before intercourse. We distinguish as “=rubber condoms=” those made of rubber, gutta-percha, or caoutchouc; and as “=cæcal condoms=” those made out of the cæcal mucous membrane of the goat or sheep (incorrectly termed also “isinglass condoms”). The cæcal condom is thinner and more delicate, and blunts sensation less, than the rubber condom. The rubber condom, however, is more =trustworthy=, in respect of durability and its slighter liability to laceration, if the little precaution is not neglected to keep it in a cool place, and to protect it from the long-continued influence of warmth. The habit of carrying about a rubber condom in the pocket for a long time favours its rapidly becoming untrustworthy and easily torn. Cæcal condoms, on the other hand, very readily become fragile and pervious, although the contrary is the common opinion, and they are preferred to rubber condoms in the belief that the dearer article must be the better. Advertisement is exceedingly active in this direction, and every kind of speciality is widely recommended. In England condoms are sometimes sold bearing the portrait of some celebrated person!

The condom is a “=general protective measure=”--that is, it protects against both gonorrhœa and syphilis, in so far as the latter disease, as is usually the case, is transmitted from the genital organs. All the leading physicians engaged more especially in the treatment of venereal diseases are agreed that the condom, when of good quality, when properly applied, and when removed with care (for in the removal material adhering to the outer surface may very readily give rise to infection), constitutes the =very best= and =most certain= of all the protective measures hitherto advocated. It is true that it can be used by men only, but when used by the man it simultaneously protects the woman from gonorrhœal infection, and not rarely also from syphilitic infection.

2. =The Instillation of Solutions of Silver Salts.=[336]--These serve exclusively for the prophylaxis of gonorrhœa, and are not, therefore, general protective measures. We owe their introduction to Blokusewski, who recommended the use of a =two % solution of nitrate of silver=. More recently, the albuminates of silver have been preferred, such as =protargol= in a 10 to 20 % solution, =albargin= in a 4 to 10 % solution, or a solution of 20 % protargol-gelatine. These solutions can be carried about in small drop-bottles--for example, as the “Sanitas” (silver nitrate) of Blokusewski, the “Viro” or the “Phallokos” apparatus (these are trade names for proprietary preparations--solutions of protargol). All solutions of silver salts must be kept in the dark, and after the lapse of any considerable time, some freshly prepared solution must be introduced, for time and the influence of light destroy their efficacy. Immediately after intercourse and urination, one or two drops of the solution are instilled into the urethra, and a drop or two also allowed to run over the frænum præputii.[337]

The views regarding the value of these protective measures are conflicting. Beyond question, they are less trustworthy than the condom. Infection has been observed in spite of the use of instillations. Above all, however, the continued use of these methods gives rise to disagreeable =irritative manifestations= in the urethra and may even cause =catarrhal inflammation=, and thus artificially increase the liability to infection. Hence, these instillations should be reserved for =occasional= use; =habitually=, only the condom should be employed.

3. =Inunction.=--Whereas the instillation of chemical solutions serves to protect against gonorrhœa only, the practice recommended for a much longer time of =anointing= the penis with a simple fatty material, or with an antiseptic ointment, =before= or =after= sexual intercourse, protects against syphilis only. It is obvious that a layer of fatty material covering the penis exercises the purely mechanical function of preventing the passage of infective matters to the skin. It is, however, equally obvious that by the to-and-fro friction during sexual intercourse, especially when this occupies a considerable time, this fatty covering will be rubbed away, so that the virus can find a means of entrance. The protection is thus extremely relative. Still, such authors as Neisser, Max Joseph, Loeb, and Campagnolle, report favourable experiences regarding the prevention of syphilis by the inunction of the penis, for which purpose simple vaseline, or Schleich’s wax-soap cream, which is sold with the “Viro” apparatus, may be employed. In any case, this method is better than nothing at all. He who has no other protective measure available should remember that in every house there is always some fat or ointment obtainable which can be used for this purpose.

In order, whilst using this method, to protect simultaneously against gonorrhœa, it has been recommended that antiseptic ointment should be inserted into the urethra before intercourse, but this is a very unsatisfactory and untrustworthy method.

Well worth attention is the inunction recently recommended by Metchnikoff[338] of =a specific mercurial ointment=, after intercourse, for the destruction of any syphilitic virus which may have been deposited.[339] He used for this purpose, not the strongly irritant blue ointment, but the =white precipitate ointment=, an ointment of the =salicyl-arseniate of mercury= (=enesol=), and, above all, a =30 % calomel ointment=. After any suspicious coitus, this ointment should be rubbed for four or five minutes into the area of possible infection; this should be done without delay; but even after the lapse of eighteen to twenty-four hours an effect has been traced. The experiments on apes inoculated with syphilis gave positive results; also in the case of a student of medicine who voluntarily offered himself for inoculation with the syphilitic virus, the inunction of calomel ointment appears to have prevented the outbreak of the disease.

=In any case, these new methods for the prophylaxis of syphilis demand the most careful attention.= Further experience is needed to determine whether they deserve general application.

4. =Antiseptic Washes.=--Washing of the penis and douching of the vagina with antiseptic lotions (sublimate, lysol, permanganate of potassium) after intercourse are among the most uncertain of protective measures, because the sublimate solution, or whatever may be used, does not find its way into any possible lacerations; and because, in consequence of the profuse secretion of the sebaceous glands of the male and female genital organs, these organs are covered with a layer of fatty material, which prevents the contact of watery fluids, but does not in the same degree prevent the entrance of the syphilitic poison. Antiseptic washes =after= the sexual act have as little value as the same used before the sexual act.

The knowledge of these protective measures--above all, of those named under the first, second, and third headings--ought to be very much more general than it is. Unfortunately, however, in public life such measures are still viewed largely from the standpoint of the moralist as “=indecent=” or “=improper=”; and the criminal law classifies them thus, so that their =public recommendation= and diffusion is still exposed to great hindrances.

At the second congress of the Society for the Suppression of Venereal Diseases, held in Munich in March, 1905, the question of the public recommendation of protective measures was opened to discussion, and was dealt with in two admirable addresses by O. Neustätter[340] and Georg Bernhard.[341] Bernhard proposed that to Section 184, paragraph 3, of the Criminal Code, which declares it to be a punishable offence to “expose for sale articles intended for an indecent use, or to recommend or sell such articles to the public,” should be added a =legal definition= in the following sense: =articles which are used either to prevent venereal diseases or to prevent conception are not regarded as “intended for an indecent use”=; and Neustätter pleaded for an =alteration of the existing state of the law=, in the sense that =the public recommendation of means for the prevention and cure of venereal diseases= should be legally permissible, being restricted merely by certain =regulations against quackery, extortion, and other misuse=. The regulation of the recommendation could best =be associated with the necessary control of the recommendation of therapeutic and preventive measures in general. A supreme sanitary authority= should be constituted, =part of whose duties= should be to =examine the form and contents= of recommendations of this character.

Another juristic relationship of the prophylaxis of venereal diseases concerns =legal protection against venereal infection=. Franz von Liszt,[342] von Bar,[343] and Schmölder,[344] opened the discussion on the biological and criminal aspects of the prophylaxis of venereal diseases at the first congress of the Society for the Suppression of Venereal Diseases, held at Frankfurt-on-the-Main in the year 1903.

Hitherto the heedless or deliberate transmission of venereal disease was punishable only as personal injury, since in the Criminal Code there was no paragraph directly relating to this matter. Only in the Criminal Code of Oldenburg of 1884 was such punishment expressly provided for (Article 387), and by this provision =the intercourse of an infected person with a healthy one was punishable, without regard to the subsequent infection=. In the legal regulations of other countries than Germany, we find several instances in which the witting transmission of venereal infection by means of sexual intercourse is punishable. In Germany a measure proposing this was rejected by the Reichstag in 1900. Von Liszt advocated the introduction of the following paragraph into the Criminal Code:

“One who, being aware that he is suffering from a contagious venereal disorder, performs coitus, or in any other way exposes another human being to the danger of infection, shall be punished with imprisonment for a term of two to three years, and in addition shall be deprived of civil rights.”

Schmölder enlarged this clause by an amendment relating to the punishment of prostitutes disseminating venereal diseases.

On the other hand, von Bar drew attention to the inconveniences and dangers which a punishment of this nature would involve, especially to the dangers of =blackmail=, and to the =duty it would impose on physicians= of breaking their obligations of professional secrecy. Moreover, a proof of the =knowledge= of venereal infection is difficult to obtain; the proof that infection is derived from a definite person is also far from easy. Von Bar opposed the addition of such a clause on this and other grounds. In the discussion upon the motion, this view was shared by C. Fränkel, Ries, Oppenheimer, and others; Neisser was in favour of a punishment of this kind, because then, at any rate, there would be a public recognition of the fact that such an action was open to severe =punishment=, and was a =disgraceful= one; thus, by the mere existence of the paragraph an =educative influence= would be exerted.

In any case, such a punishment would be a two-edged weapon, and as far as present necessity goes, we have sufficient powers in the application to such offences of the paragraphs of the Criminal Code relating to bodily injury.

* * * * *

The second great means for the limitation and entire suppression of venereal diseases is =to deal with them by medical treatment, to cure as speedily as possible persons suffering from syphilis of gonorrhœa, and thus to prevent these persons from becoming sources of fresh infection. Systematic, methodical treatment on a large scale=--that is the =goal= at which we have to aim. To the poor man or woman suffering from venereal infection the same advantages should be opened as to the wealthy voluptuary. The provision of means of treatment of venereal diseases =cannot be too free=. In public hospitals, private clinics, ambulatoria, and sanatoria, in convalescent homes, and polyclinics for prostitutes, everywhere must be provided means for an intelligent treatment of venereal diseases. Just as tuberculosis is now attacked systematically and vigorously, so must it be with venereal diseases.

Since =syphilis= constitutes only about 25 %--only one-fourth part, that is to say--of venereal diseases in general, since also during the last four centuries the disease has shown a natural tendency to decline in virulence, since a mitigation in the intensity of the virus is clearly recognizable, it is in the case of this disease that the =hope of radical success= is especially great.

Our forefathers carried out for us a great part of the campaign against syphilis. The =comparatively mild= course of syphilis in the majority of uncomplicated cases leads us to infer that there has been a relative immunization against syphilitic poison.

Albert Reibmayr remarks that “=during the last 400 years, every human being now living in Europe has had about 4,000 ancestors; of these, however disagreeable the fact may seem, a considerable number must have had to contend with syphilis=.”[345]

But this undoubted fact, that =all of us= have been to a certain extent “=syphilized=,”[346] plays its part to our advantage in the campaign against syphilis--that campaign which our own time has taken up with joyful hope of success.

Above all, let honour be paid to the ever youthful and fresh master and Nestor of European research into the subject of syphilis, Alfred Fournier, the evening of whose life is devoted to the campaign against syphilis as a “social danger.” To the great scientific works of his life he has now added the small, but not less valuable, =explanatory writings=, which are being sold at a low price all over France, and in part also have already been translated into German and English.[347] Their aim is to get the =people= on our side in the campaign against syphilis.

When, in April, 1906, I paid the master a visit, he gave me the last of these popular campaign writings. Its title was in the form of a question:

“En Guérit-on?” (“Is it Curable?”).

And the answer given on p. 4 runs: “=Yes, it is curable, for of all diseases syphilis is the one which can best, most easily, and most certainly be cured.=” And why? Because we have a wonderful specific against this disease, which, when given =at the proper time= and =in the proper manner=, works a miracle. This remedy is

=Mercury=.

I put this name clearly and visibly before the eyes of the reader, a name which for every physician to whose lot it falls to treat cases of syphilis has a truly miraculous sound, a name against which =the unconscientious ignoramuses, the evil-disposed enemies= of the human race have spoken their anathema, one which a great thinker and honourable man like Schopenhauer regarded as a “triumph of medicine,” a fact which he experienced personally in his own body. All honourable, critical, and scientific physicians agree in this opinion. In my work on “The Origin of Syphilis,” vol. i., p. 127, I have expressed the matter in the following words:

“Mercury is and remains--notwithstanding the ignorant and ill-considered hostility of quacks and their kindred--the =divine means= for the treatment of syphilis; mercury is to syphilis what =water is to fire=, in the hands =of that physician who knows how to use the drug rightly=, how to apply it =at the right time= and =in the right form=, who watches closely the =course= of the disease in his patient, and who supports the mercury cure (always of =primary importance=) by other therapeutic measures as indicated.”

Only the =physician=, the scientifically trained medical man, can cure syphilis; the quack certainly cannot; in his hands mercury is truly enough a dangerous “poison.” But he has no right to say, and he speaks deliberate untruths when he says, that we physicians “poison” the “unfortunate” syphilitics with mercury. To such preposterous accusations we can give a brief and incisive answer.

Therefore, during my lecturing journey, undertaken recently[348] under the auspices of the German Society for the Suppression of Venereal Diseases, I prepared the following brief account of the therapeutic employment of mercury in syphilis, which in my opinion suffices to throw the proper light upon the value and importance of the mercurial treatment of the disease; it is a sufficient answer to the “Nature-Healers,” who are opposed to the use of this “poison”:

1. =In innumerable instances it has been observed by the most experienced and scientific physicians, that cases of syphilis treated without mercury run a very severe course, accompanied by the most dangerous symptoms, such as extensive destructive lesions of the skin, lesions of the internal organs, brain syphilis, eating away of the bones, loss of the nose, etc.=

2. =In cases which previously have been treated without mercury, the administration of the latter drug immediately arrests the destructive processes, and saves the patient from death, or from very severe illness, and from physical disfigurement.=

3. =No less an authority than Virchow, in his celebrated treatise “On the Nature of Constitutional Syphilitic Affections,” pp. 7-14 (Berlin, 1859), has shown that the hypothesis of Hermann[349] is entirely devoid of foundation in fact.=

4. =I should feel conscientiously compelled to denounce myself for the commission of grievous bodily harm if I ventured to-day, after the accumulated experience of four centuries, to treat a case of syphilis without mercury.=

What use is it to continue to fight against the disbelief and superstition which clings to mercury? Why should we for ever be occupied in contradicting the false accusations brought against this drug? For four centuries the divine mercury has withstood all attacks, and will continue to withstand them, until a greatly desired and even better measure is discovered--=prophylactic immunization against syphilitic infection=.[350]

How mercury is to be given, whether in the form of the long-prized “=schmierkur=” (=cure by inunction=), or by =hypodermic injection=, or by =ordinary internal use=, must be left in individual cases to the decision of the medical man, for numerous considerations, which can only be properly weighed by the physician, have to be taken into account. A mercury cure is a =serious= matter, but always also one which repays all the trouble that we take. In “En Guérit-on?” Fournier has most admirably described the wonderful results of a =critically considered and carefully conducted= mercury cure. I do not, indeed, belong to the “doctors who build for themselves a house of pure quicksilver,” when they enter the field against the “French” (= syphilis), as the phrase runs in Schiller’s work “The Robbers.” I hold by a =reasonable, measured= use of mercury in the course of the treatment of syphilis, and I advise a good “=after-treatment=” in addition to the treatment with mercury.[351] Mercury, when given in moderate but sufficient doses, not only destroys the syphilitic virus, but also has a very favourable influence on the general condition, and sometimes even gives rise to an increase in the number of the red blood-corpuscles. Thus, mercury is not only not a poison: it is a most valuable =restorative and vitalizing means=. This is well illustrated by the following case, which came under my own observation, and which I recommend to the Nature-Healers, in the hope that it may lead them to revise their views regarding the action of mercury:

The case was that of an official, thirty years of age, who had been under my care several times before since the year 1898 for other troubles (gonorrhœa, etc.), and who was always pale and with hollow cheeks, in no way giving the impression of possessing a constitution with strong powers of resistance. Late in the summer he was infected with syphilis; the attack proved a severe one, running a serious course, complicated by an extremely painful suppurative inflammation of the lymphatic vessels of the penis, and accompanied by fever, lassitude, and a sense of exhaustion. An energetic inunction cure was immediately begun. Under this not only did the morbid symptoms rapidly disappear, but there occurred a remarkable change in the general condition, in the sense of an increase of strength, such as had not existed before the illness. Notwithstanding slight stomatitis, the patient during and after the cure =felt stronger and more fit for work than he ever had before=, and even now this favourable state continues unaltered, as is manifested above all by the increase in the body-weight, by the good appearance, etc. =The patient=, who now, one and a half years after the cure, has had no relapse, =informed me repeatedly and spontaneously that this delightful improvement in his health could only be attributed to his syphilis (!) or to the mercury!=

A =single= mercury cure will suffice, in some cases, to cure syphilis for ever! Regarding this, we have numerous trustworthy observations. In most cases, indeed, during the early years relapses occur, and then we need to use the indispensable mercury cure once more =with care=, and to employ all the other measures which make up the above-mentioned “after-treatment,” the supplementary means being, above all, =iodide of potassium, sulphur= (in the long-celebrated sulphur-baths of Aix, Nenndorf, etc.) and =arsenic= (first recommended by me); also the water cure, brine-baths, and iodide-baths, and a visit to the seaside or to the mountains, and massage, are good accessory means to the cure. Above all, however, =the State of nutrition= of the patient[352] must always be kept under consideration, and assisted where necessary, for which purpose preparations of iron, nutritive preparations like sanatogen, and milk cures, are of value. =Strict abstinence= from alcohol is always necessary in the treatment of syphilis. Alcohol has a =very unfavourable= influence on the syphilitic process, and is often the only cause of continually recurring relapses of this disease.

The =thorough= treatment of syphilis is a matter of several years, during which the patient must repeatedly present himself to the physician for examination, and should any relapse occur, he must be subjected to renewed treatment. Such thoroughness will invariably be rewarded. =Attention to detail= will always bear fruit. Syphilis is =curable=. It is purely fanciful to say that syphilis is never cured, that it pursues its victims up to the end of life, that it knows no pardon. That is not true. =Treat= your syphilitic patients, treat them properly and thoroughly, if necessary for years in succession, and they will be freed from the disease. “Syphilis,” says Fournier, “is a misfortune, but it is a misfortune from which complete recovery is possible.” From the day when the patient becomes aware that he is suffering from syphilis, he must face the situation “in a calm and manly fashion,” and must say to himself:

“Now there is to be a fight between syphilis and me. To work, therefore, and courage! Courage, because science assures me that with the aid of =mercury=, of =hygiene=, and of =time=, an end will come to the syphilis, and because science gives me an absolute assurance that some day I shall be as healthy as I was before, and that I shall again have the right to a family, that I shall attain the freedom and the happiness of being a father!”[353]

With these admirable words of the greatest living authority on syphilis, I close my account of the suppression of syphilis by medical treatment, and turn to the not less important question of the =management of gonorrhœa=.

Recent scientific researches, especially those of A. Neisser and E. Finger, have shown that the infective urethritis of the male produced by gonococci is by no means the “trifling and childish complaint” which it was formerly supposed to be, but, on the contrary, is a very serious and obstinate trouble, often resisting the very best means of treatment, so that it may =persist for years=, and =remain for years infective=. Still worse is it as regards gonorrhœa of the female genital organs, the cure of which is even more difficult, and the consequences of which are even more disastrous than in the case of the male. If the =physician= is needed for the cure of syphilis, still more is this the case as regards gonorrhœa. He only can command the scientific methods, and the very complicated technique of the treatment of gonorrhœa. He only can undertake the =indispensable= control of the treatment by means of =microscopic= and other methods of investigation. Every cobbler thinks he can cure gonorrhœa, and yet it is this disease which, even more than syphilis, demands the most precise knowledge of the local anatomical and pathological conditions. Blaschko rightly says:

“While no one gives a damaged watch to a baker to mend, or a torn coat to a tinsmith, every one seems to believe that in order to restore the most valuable gift of humanity, health, it is unnecessary to possess the profoundest knowledge of the human body, and to understand the nature and the causes of the disease. Anyone who has come to grief in his ordinary profession, but who understands how with a brazen voice to denounce the so-called ‘medicine of the schools,’ and to praise with sufficient confidence his own successes, is supposed to possess the wonderful power, without any exact knowledge at all, of charming all the illnesses of mankind out of the world.”

Gonorrhœa is also a =curable= disease, though curable often with great difficulty. We see this from the fact that, notwithstanding the extraordinarily wide diffusion of gonorrhœa (for a far greater number of infections with gonorrhœa occur than of infections with syphilis), still ultimately the =majority= of the men, and a large proportion of the women, infected with gonorrhœa are =completely cured= of their trouble.

The treatment of gonorrhœa is a complicated affair. =Within the first two days=, by the injection of =powerful caustic agents=, we are sometimes able to cut the matter short and to put an end completely to the gonococci. In every case the patient, as soon as he perceives a discharge, though not yet purulent, from the urethra, should =immediately= consult a physician, in order to determine the nature of his disease, which, in the majority of cases, will be found to be true gonorrhœa. If it is not possible to abort the gonorrhœa, then the disease will have to run its course. The best measure, whenever possible, is =rest in bed= for a week or two, in association with a =mild, unstimulating diet=, and the =absolute prohibition of all alcoholic beverages=--the last is indispensable throughout the duration of the gonorrhœa--the drinking of uva ursi tea, and, if the inflammatory symptoms are severe, the application of cold compresses to the penis. Only when the first more severe symptoms have passed away, by which time, owing to the reaction of the urethral mucous membrane, a large proportion of the exciters of the disease will already have been expelled, is it time to begin =injections= or =irrigations= of the =urethra=, containing medicaments the nature of which must be left to the decision of the experienced =physician=, who will regard each individual case on its own merits. If rest in bed is not possible, the patient must wear a so-called “=suspensory=” bandage, in order to give as much rest as possible to the testicles and the epididymis, which are gravely endangered in every attack of gonorrhœa. If, as often happens, gonorrhœa ascends to the posterior part of the urethra, or to the bladder, or to the prostate, or if, finally, it becomes chronic, then special methods of treatment, with =internal medicines, with local cauterization, massage, distension, medicated bougies, baths=, etc., are needful. The cure will ensue very gradually; relapses are frequent; even cessation of the discharge is no certain sign of cure, as the presence in the still turbid urine of “threads” containing gonococci sufficiently proves. Only when the urine has become perfectly clear, and any threads which it may contain are shown by repeated search to contain no more gonococci; when also the prostate, a favourite seat of the last remnants of gonorrhœa, is free from inflammation, can the cure be regarded as complete. Even more difficult is the determination of a cure in women. But persistency in the treatment, and frequently repeated examinations, will lead also in women to the desired goal, or, at any rate, will overcome the capacity for spreading the infection.

In the campaign against venereal diseases by the methods of medical treatment, the =facilitation= of treatment for the =great masses of impecunious= persons, for the proletariat, is of great value. For them, above all, the provision of Krankenkassen[354] is needed, and it is very satisfactory to note that during recent years the Krankenkassen have especially directed their attention to venereal diseases, since A. Blaschko,[355] A. Neisser,[356] R. Ledermann,[357] and Albert Kohn[358] drew attention to the duties of Krankenkassen in this relationship in a number of admirable works. Krankenkassen are in a position to obtain exact statistics regarding venereal diseases; to diffuse information, verbally and in writing, to the widest extent among their members; to facilitate hospital treatment, and treatment by specialists; to give medical aid as required to infected relatives of the insured; to carry out regularly every year, once or twice, a medical examination of all members, and to distribute among all these writings on the prophylaxis of venereal diseases. The question also of payment on the part of the patient requires new regulations as regards venereal diseases.[359]

Finally, it has been recommended that, in association with the Krankenkassen there should be founded “=daily sanatoria=” (Neisser), “=work sanatoria=” (Saalfeld), “=ambulatory places for treatment=” (Ledermann), and “=convalescent homes=” (Stern), for members of Krankenkassen suffering from venereal disease, and for insured persons similarly affected. All these institutions would, moreover, be valuable to the community at large.

What admirable results are obtainable by such a =systematic= treatment of as far as possible =all= the venereal patients throughout an entire country has been shown by the astonishing decline in the number of cases of venereal diseases in Sweden and Norway, and in Bosnia, where a gratuitous treatment of all such patients at the cost of the state has been introduced. Thus the =organized campaign= against venereal diseases, which during recent years has been initiated in all the civilized countries of Europe, has led more particularly to efforts in the direction of the sufficient treatment and speedy cure of =recent= syphilis and =recent= gonorrhœa.

* * * * *

We pass now to the consideration of the =third= factor in the campaign against venereal disease, which comprises the duty of the =state=, the task of =social hygiene=, and the task of =public pedagogy=.

The =foundation= for the suppression of venereal diseases by state effort consists in a knowledge of the =extent of the diffusion= of these diseases; we need, that is to say, =accurate statistics regarding venereal diseases=.

It is once more the great service of Blaschko to have been the first in Germany to work on these lines.[360]

Dismissing from consideration the distribution of venereal diseases in countries outside of Europe, regarding which he gives interesting reports, we find that the European conditions are of such a nature that the large towns, the centres of industry and manufacture, garrison towns, and university towns, are most severely affected; that the smaller provincial towns suffer less; that the agricultural population is comparatively free from this disease, with the exception of the uncultivated country districts of Russia and of the Balkan States, where the country people suffer from syphilis to a terrible extent. No exact statistical data are at present available regarding the diffusion of venereal diseases in the individual countries of Europe. The best measure of the prevalence of these diseases is afforded by the figures for the different armies. From these we learn that Denmark, Germany, German Austria, and Switzerland, show the most favourable conditions; next come Belgium, France, Spain, Portugal, North and Middle Italy. Worst of all are the conditions in Southern Italy, Greece, Turkey, Russia, and--England. These army statistics are, however, insufficient, for, as a matter of fact, =England= is most favourably placed in respect of the diffusion of venereal diseases. The most exact reports come from the Scandinavian countries, from Norway and Denmark, in which for several years =all physicians= have kept a list of all the infective diseases treated by them, as they are compelled =every week= to make a return to the Board of Public Health. According to these reports, it appears that venereal diseases in Copenhagen constitute the greater part of such diseases in the entire country; but in the period between 1876 and 1895 these diseases have notably =declined= in frequency in Copenhagen, and all venereal diseases have shared in this decline; gonorrhœa constitutes 70 % =of all= cases of venereal disease. With regard to the diffusion of infection, it appears from the Copenhagen statistics that =one= woman with venereal disease serves to transmit it to =four= men; on the other hand, of =four= men with venereal disease, =one= only will transmit that disease to a woman. On the average, there are infected with venereal disease every year 16 to 20 % of all young men between the ages of twenty and thirty years; with gonorrhœa 1 in 8 are infected; with syphilis 1 in 55 are infected. In these last ten years, for every 100 young men living, there have been 119 infections during ten years; that is to say, =on the average every one has been infected once, and a great many have been infected more than once=; in the same period of ten years, for every 100 young men, there have been 18 infected with syphilis--that is to say, 1 for every 5·5.

Especially valuable also are the figures which Blaschko obtained in 1898 from the carefully kept books of a large mercantile Krankenkasse whose operations were diffused throughout Germany; these figures also give the result of an inquiry regarding venereal diseases amongst workmen, waiting-maids, secret prostitutes, and students. The result of these statistics, as regards Berlin, are given briefly in the following table:

+---------------------------------------------------------+ | | |============================== Secret Prostitutes, 30 %. | | | |========================= Students, 25 %. | | | |================ Shop Employees, 16 %. | | | |========= Workmen, 9 %. | | | |==== Soldiers, 4 %. | | | +---------------------------------------------------------+

VENEREAL DISEASES AFFECTING VARIOUS CLASSES OF THE POPULATION OF BERLIN (AFTER BLASCHKO).

According to these statistics, the diffusion of venereal diseases among =shop employees=, =students=, and =secret prostitutes= (chiefly =barmaids= and =waitresses=), is the greatest; it is much =less= among =workmen= and =soldiers=. It further appears, from Blaschko’s inquiry, that =of the men who entered on marriage for the first time when above the age of thirty years, each one had, on the average, had gonorrhœa twice=, and =about one in four or five had been infected with syphilis=. Wilhelm Erb, in Heidelberg, obtained similar results.

Still more remarkable were the results of the statistical investigation which was carried out for the =entire Kingdom of Prussia= by the Prussian Ministry of Ecclesiastical Affairs and Public Instruction on April 30, 1900.[361]

According to this investigation, it appeared that on this day, in Prussia, there were 41,000 persons suffering from venereal disease, among whom 11,000 were infected with recent syphilis; in Berlin, on the same day, there were 11,600 cases of venereal disease, among whom 3,000 were infected with recent syphilis. The general relations are shown in the following table:

VENEREAL DISEASES AFFECTING THE MALE POPULATION OF PRUSSIA, APRIL 30, 1900 (AFTER BLASCHKO).

Thus, for every 10,000 adult men there were on this day persons suffering from venereal diseases to the following numbers: in Berlin, 142; in the remaining large towns, 100; in the smaller towns, 50; and in the whole of Prussia, on the average, 28. Naturally the figures should in reality be larger, for of the physicians to whom inquiries were sent, only 63 % returned an answer. Moreover, the =annual= figure of cases is a very much larger one. Kirchner[362] assumes that =every day= in Prussia more than =100,000 individuals=--that is to say, about 3 per mille--are suffering from a transmissible venereal disease, and he estimates the damage to the national property by typhoid fever as about 8 million marks annually, but that from venereal diseases as not less than =ninety million marks annually=. In these reports of April 30, 1900, the ratio of men to women suffering from recent syphilis was as 3 : 1.

In order to obtain more exact information regarding the diffusion of venereal diseases, and the actual number of those affected by them, it is of very great importance that there should be a =revision= of the duty of medical men in respect of the =notification of diseases=, and also in respect of the duty of =professional secrecy=.[363]

This latter question is also of importance in respect of the prevention of venereal infection in married life. (The question of syphilitic infection of married women by their husbands has recently been considered by Alfred Fournier: “Syphilis in Honourable Women.”)

In addition to the question of the diffusion and frequency of venereal diseases, the greatest interest attaches to the =sources of dangerous infections=--that is to say, the question where men and women most frequently contract venereal disease.

Here also Blaschko has obtained interesting information; he states:

Of 487 syphilitic men, the disease was acquired by 395 (81·1 %) from professional prostitutes (officially inscribed or secret); 23 (4·7 %) from waitresses and barmaids; 23 (4·9 %) from their “intimate”; 45 (9·2 %) from casual acquaintances, shop-girls, or workwomen.

According to this report, it appears that =prostitution=, public and secret (under which heading the waitresses and “casual acquaintances” must be numbered), forms the =principal focus= of venereal infection.

And that wild sexual intercourse is here almost exclusively to blame is shown by the following statistics, given by Blaschko:

Of 67 syphilitic wives, almost all the wives of workmen, 64 were infected by their =husbands=; whereas, =on the contrary=, of 106 husbands, 7 only acquired the disease from their wives; the remaining 99 acquired it by =extra-conjugal sexual intercourse=, either before or after marriage.

Another very valuable set of statistics dealing with the sources of infection has been published by Heinrich Loeb.[364]

These relate to the conditions in Mannheim. It appears that the sources of infection were as follows:

Waitresses and barmaids 155 instances. Maidservants, cooks 67 „ Shop-girls 65 „ Middle-class girls 29 „ Seamstresses and embroidery workers 27 „ Chambermaids 20 „ Factory workwomen 17 „ Artistes, singers, and ballet-girls 16 „ Wife or betrothed 12 „ Tailoresses and modistes 11 „ Ironers 9 „ Book-keepers 4 „ Widows 4 „ Country girls 3 „ Mistresses 3 „ --- Total 442

Here, as we see, the chief types of =secret= prostitution, the =waitresses= and =barmaids=, play the principal part; next, but a long way after, come maidservants and shop-girls. This, however, does not amount to saying that public prostitution is less dangerous. We know that a prostitute who has never been infected with venereal disease is something very rarely seen; that prostitutes under regulation are almost all, especially when still quite young, in an infective state, and that they serve just as much as secret prostitutes for the diffusion of venereal disease. It is a well-known fact that youthful prostitutes are =more dangerous= than women who have long practised prostitution, because the former are all suffering from more or less recent infection, and both gonorrhœa and syphilis are present in them in the stages in which they are still strongly infective. H. Berger bases upon statistical investigations[365] his belief that red-haired girls have the most delicate epithelium, fall sick most rapidly and in the greatest numbers; dark haired women at first suffer less. After they have been prostitutes for some time, there is no important difference between blonde, brown, and black-haired women; but black-haired prostitutes are, in fact, more inclined to infection =later= in their career, because they are more in request.

Now that we have learned that at the present day =prostitution= remains the principal source of venereal infection, the following question immediately demands an answer: =What can the state do in order to remove these sources of infection? and have the measures which the state has hitherto put into operation been of any use in this direction?= To put it shortly, what part has been played by the state =regulation= of prostitution, as hitherto practised, in the campaign against venereal diseases?

With Schmölder,[366] we understand by “regulation” the following practice, which is what obtains in the majority of civilized countries: The police keep a list in which the girls and women regarded by them as prostitutes have their names entered. The “inscribed” (inscrites) receive a “licentia stupri”--that is to say, =the permission to practise professional fornication under continual observation on the part of the police= (the renowned “moral control”[367]), which is associated with a number of commands, prohibitions, and regulations--above all, with the =necessity of submitting to medical examination at definitely stated intervals=, and, where necessary, to =compulsory medical treatment=. At the same time, public prostitution on the part of those who are not inscribed is suppressed as much as possible. Berger has admirably described (“Prostitution in Hanover,” pp. 1-19) the methods of regulation and their consequences. Above all, however, have Blaschko, Schmölder, and Neisser considered the modes of regulation customary at the present day from the moral, legal, and medical points of view, and have in part entirely condemned them (Blaschko and Schmölder), in part declared them to be gravely in need of reform (Neisser).[368]

Among those who have recently discussed the question of the regulation of prostitution, we may mention Anna Pappritz,[369] who condemns the practice; Clausmann, who is in favour of it;[370] Friedrich Hammer, also in favour of it;[371] and, finally, S. Bettmann, who leaves the question open.[372]

In our consideration of the coercive system of regulation, we take a =single standpoint=--namely, that of its possible value for the suppression of venereal diseases. Some demand the =abolition= of regulation on ethical and humanitarian grounds, and we do not wish in any way to make light of these grounds. But they could not be decisive, if, as an actual fact, regulation had an effect either in diminishing the prevalence of venereal diseases or in checking prostitution; but, in truth, the =reverse= is the case!

Schmölder[373] has shown beyond dispute that the compulsory inscription of prostitutes, introduced from France, is in our country an utterly =illegal= measure, arbitrarily enforced by the police. It has been amply proved that this illegal compulsory inscription has actually made prostitutes of many girls who had no inclination to permanent professional prostitution; that this method =produces artificial prostitutes=. What errors of judgment, what abuses of power, occur on the part of the police, in connexion with this compulsory inscription! How often does the inscription result from a denunciation made on grounds of private spite! The “Committee of Fifteen,” constituted for the study of prostitution in New York, declares in its report:

“Men with political insight are of opinion that every limitation of the freedom of the individual is in itself an evil, and that such a limitation can only be justified in cases in which the good derived from the infringement can really be estimated at a very high valuation. A system which permits the police, simply on grounds of suspicion, to arrest a citizen, to submit him to an injurious examination, only with the aim of discovering a disease he is suspected to have, and then to put him into prison, on the suspicion that he might have indulged in immoral intercourse if he had been left at liberty, cannot possibly be regarded as harmonizing with the principles of personal freedom.”[374]

Blaschko and Fiaux have proved that regulation concerns only a =small fraction= of prostitutes, usually the older ones; whereas the =beginners=, who are precisely those most dangerous in respect of venereal infection, and, further, the army of =secret prostitutes=, =half prostitutes=, =occasional prostitutes=, and the =half-world=, remain free from regulation--are probably left free deliberately--and anyhow could not possibly be supervised, on account of the enormous cost of supervision. In Berlin, speaking generally, only =one-fifth= part of the girls arrested are subjected to regulation, four-fifths are simply “warned and discharged”; and even of this fifth part, in reality a large percentage does not come under control because “escape from the lists” renders permanent observation impossible. Fiaux proves that =more than 50 %= of the medical examinations which ought to have been made on the 4,000 women under regulation in Berlin during the years 1888 to 1901, =were in fact neglected=.[375]

It is =certain= that regulated prostitution is =more dangerous= from the point of view of public health than free prostitution. The prostitute remaining under surveillance is in constant fear of compulsory treatment in the lock hospital, and therefore endeavours to conceal her illness =as long as possible, or temporarily to avoid medical examination altogether=. The free prostitute has a personal interest in becoming well again as soon as possible, and generally goes voluntarily and at once to seek treatment from a physician. Thus it happens that, among the regulated prostitutes, the number of those infected =appears= surprisingly small. In addition, we have to consider the =inadequacy of the medical examination=, because the number of the physicians and the time assigned to them are too small. And whilst it appears to be a fact that every third prostitute is infected with gonorrhœa, in Berlin, during the year 1889, as the result of official examination under regulation, only one prostitute in 200 was declared infected, and in 1884 only 1 in 1,873. Moreover, =very many= infected prostitutes under compulsory medical treatment are, as Blaschko proves, allowed to resume their professional occupation in an uncured state, and to diffuse their illness freely once more. The figures given by Blaschko speak very clearly on this point:

+---------------+-------------+-------------------------+ | | | _Annual Percentage of | | | | Prostitutes attacked | | Place. | Date. | by Syphilis._ | | | +------------+------------+ | | | Regulated. | Free. | +---------------+-------------+------------+------------+ |Paris | 1878-1887 | 12·2 | 7·0 | |Brussels | 1887-1889 | 25·0 | 9·0 | |St. Petersburg | 1890 | 33·5 | 12·0 | |Antwerp | 1882-1884 | 51·3 | 7·7 | +---------------+-------------+------------+------------+

From this it is clear that the =abolition= of the regulation of prostitutes will not have an unfavourable, but, on the contrary, will have a thoroughly =favourable=, influence in respect of the frequency of venereal diseases. The conditions in England and Norway show this very clearly. In Christiania, after the abolition of regulation in the year 1888, syphilis declined in frequency--in the first place, because the number of girls who applied for treatment increased, whilst prior to the abolition of regulation they had concealed their illness in order to avoid falling into the hands of the police; and in the second place, because now the fear of venereal infection kept many young men from having intercourse with prostitutes, whereas previously they had erroneously believed that the “control” would free them from the danger of venereal infection. The same was the case in London, where there is no regulation; the frequency of venereal disease has decreased because young men now avoid intercourse with prostitutes as much as possible. In France, the country in which regulation was first introduced, the commission formed for the study of prostitution came to the conclusion that “=regulation of prostitutes should be abolished=.” The principal reason for which the police continue to advocate the preservation of the system of regulation--namely, that they have an interest in the matter on account of the =intimate connexion between many prostitutes and criminality=--will not bear examination. It is true enough that =soutenage=[376] is inseparable from prostitution. Moreover, =the world of criminals= is very near to prostitution, in the first place, because the prostitute also has need of a man on whom she can lean, who can be something to her from the =personal= point of view, to whom she is not simply a chattel;[377] and, in the second place, because the prostitute is, like the criminal, =despised and defamed=--she shares with the criminal the pariah nature. Lombroso’s doctrine that prostitution is throughout equivalent to criminality is certainly not justified. =It is only by the outward circumstances of their life that the bulk of prostitutes are driven into intimate relations with criminality.= And among these outward circumstances, =regulation=, and the =expulsion= of prostitutes from honourable society (which is a necessary part of regulation) play the principal rôle! For this reason, if for this reason alone, regulation must be abolished, because then a strong supplement to criminality from the circles of prostitution would be cut off.

Even before investigators had become convinced of the uselessness and danger of regulation the cry arose: “=Away with the brothels!=” We have already alluded to the continuous =decline= in the number of brothels in all large towns. In 1841 there were in Paris still 235 brothels (to 1,200,000 inhabitants); in 1900 there were only 48 brothels (to 3,600,000 inhabitants); and for St. Petersburg and other large towns a similar decline in the number of brothels can be established, notwithstanding the fact that everywhere the population has markedly increased. This proves that the brothels no longer correspond to any real need.[378] At the present day, owing to the great development of intercourse in modern times, brothels are a public calamity; they bring the quarter of the town in which they exist into disrepute, and deprive the neighbourhood of its proper monetary value. Moreover, the time is past for slave-holding on the part of the brothel-owner. The existence of brothels favours the traffic in girls (the “White Slave Trade”), encourages sexual perversities, and increases the diffusion of venereal diseases. The prostitute living in a brothel is sometimes compelled to have intercourse with ten or twelve men in a single day, and is thus pre-eminently exposed to venereal infection, all the more because she must admit the embraces of =every= man who pays the brothel-keeper money; whilst the prostitute living freely can at least refuse to have anything to do with a man who appears to her to be ill. According to Lecour, Mireur, Diday, and Sperk, prostitutes in brothels suffer from syphilis about =three times as often= as free prostitutes.[379]

Other modifications of brothel life, such as the so-called “=controlled streets=,”[380] the best known of which are in Bremen[381]--that is to say, streets closed to ordinary traffic, the houses of which are inhabited only by prostitutes under control, but the girls being in other respects free and not living under the domination of a brothel-keeper; also the “=Kasernierung=”[382] of prostitutes, their confinement to particular streets, or special “quarters” of the town (“Dirnenquartiere”)[383]--are all to be rejected on the same grounds.

The whole nature of brothel life, and the very serious dangers it involves, have been discussed in excellent works by E. von Düring,[384] Henriette Fürth,[385] Karl Nötzel,[386] and Martin Bruck.[387] They illumine the whole question, and provide sufficient grounds for the condemnation of brothels.

A few authors, however, continue to advocate the preservation of brothels, and some of these wish to enforce medical examination, not only of prostitutes, but also of their masculine clients. This proposition is made, for example, by Ernst Kromayer in his work, which, notwithstanding many Utopian ideas, is nevertheless very stimulating, “The Eradication of Syphilis,” pp. 67, 68 (Berlin, 1898). Von Düring, in his criticism of these ideas, rightly points out that this recommendation would be quite useless in practice, because, in the first place, only a small proportion of men visit brothels at all. In the second place, in the hurry in these resorts no proper examination could be undertaken. In the third place, the doctors who were to be appointed as a kind of medical porters to brothels, would not easily be found to accept such situations. Lassar, who answers this last criticism, is of opinion that the brothel-master, or anybody with a little experience, could easily undertake this examination in the case of men.[388]

But these men would probably also decline the office; and even if they were willing, it is very doubtful if they would be in a position to make the suggested examinations, which, after all, require =real medical skill=; and, finally, the only result would be--to increase the number of quacks. Therefore, this idea of the examination of the male visitors to brothels is Utopian.

No, the true hope lies in =absolute freedom=; in =relieving prostitution from the oppression of the police=; in its gradual =separation from criminality=; in--I am not afraid of the word--in an “=ennoblement=” of prostitution.[389] The “prostitute” (German Dirne = drab) must disappear, and the “human being” must reawaken. The prostituted woman must be readmitted into the social community. No more coercion! =Free and voluntary treatment=, in polyclinics[390] and hospitals; the “=rescue=” of youthful prostitutes,[391] not in the prison-like “=Magdalen Homes=,” but by means of ethically instructive influence =from human being to human being=, of the value of which the “Letters to Prostitutes” of the noble philanthropist Frau Eggers-Smidt,[392] and also the experiences of the Salvation Army,[393] give such admirable evidence.

Very aptly, also, Kromayer has shown to what an extent a change in our present attitude towards sexual intercourse outside the conditions of coercive marriage, the removal of the stamp of infamy from such intercourse, would limit prostitution, and therewith also limit venereal diseases.[394] This is as clear as daylight. But, unfortunately, those very persons who declare the existing conditions in respect of prostitution to be absolutely intolerable will not admit its truth.

The misery of the life of these unhappy creatures must be relieved, but =we= must do it =ourselves=, and soon; for they are not in a position to do so. The last, the highest goal of the campaign against venereal disease is the humanization of the prostitute.[395]

SUPPLEMENTARY NOTE.--In the essay on “The Woman’s Question” in the sociological section of his work, “The Ethic of Free-Thought,” Karl Pearson discusses the question of Prostitution in relation to the Woman’s Question at large. His remarks have especial interest in view of what is said above about “the ennoblement of prostitution” and “the humanization of the prostitute,” and it seems expedient to quote the passage at length (op. cit., 1888, pp. 379-382).--TRANSLATOR.

“The emancipation of woman, while placing her in a position of social responsibility, will make it her duty to investigate many matters of which she is at present frequently assumed to be ignorant. It may be doubted whether the identification of purity and ignorance has had wholly good effects in the past; indeed, it has frequently been the false cry with which men have sought to hide their own anti-social conduct. It is certain, however, that it cannot last in the future, and man will have to face the fact that woman’s views and social action with regard to many sex-problems may widely differ from his own. It is of the utmost importance that woman, not only on account of the part she already plays in the education of the young, but also because of the social responsibilities her emancipation must bring, should have a full knowledge of the laws of sex. Every attempt hitherto to grapple with prostitution has been a failure. What will women do when they thoroughly grasp the problem, and have a voice in the attitude the state should assume in regard to it? At present hundreds do not know of its existence; thousands only know of it to despise those who earn their living by it; one in ten thousand has examined the causes which lead to it, has felt that degradation, if there be any, lies not in the prostitute, but in the society where it exists; not in the women of the streets, but in the thousands of women in society, who are ignorant of the problem, ignore it, or fear to face it. What will be the result of woman’s action in the matter? Can it possibly be effectual, or will it merely tend to embitter the relations of men and women? Possibly an expression of woman’s opinion on this point in society and the press would do much, but then it must be an educated opinion, one which recognizes facts and knows the difficulties of the problem. An appeal to chivalry, to a Christian dogma, to a Biblical text, will hardly avail. The description we have of Calvin’s Geneva shows that puritanic suppression is wholly idle. What form will be taken by the reasoned action of women, cognizant of historical and sexualogical fact?

“Perhaps it may be that women, when they fully grasp the problem, will despair, as many men do, of its solution. They may remark that prostitution has existed in nearly all historic times, and among nearly all races of men. It has existed as an institution as long as monogamic marriage has existed; it may be itself the outcome of that marriage. I do not know whether any trace of a like promiscuity has been found in the animals nearest allied to man--I believe not. The periodic instinct has probably preserved them from it. How mankind came to lose the periodic instinct, and how that loss may possibly be related to the solely human institution of marriage, are problems not without interest. On the one hand, it has been asserted that prostitution is a logical outcome of our present social relations, while, on the other hand, it is held to be a survival of matriarchal licence, and not a sine qua non of all forms of human society. There is very considerable evidence to show that a large percentage of women are driven to prostitution by absolute want, or by the extremities to which a seduced woman is forced by the society which casts her out. This point is important. It may, perhaps, be that our social system, quite as much as man’s supposed needs, keeps prostitution alive. The frequency with which prostitutes, for the sake of their own living, seduce comparative boys, may be as much a cause of the evil as male passion itself. The socialists hold the sale of a woman’s person to be directly associated with the monopoly of surplus labour. Is the emancipated woman likely to adopt this view? and if so shall we not have a wide-reaching social reconstruction forced upon us? That emancipated woman would strive for a vast economic reorganization, as the only means of preserving the self-respect and independence of her sex, is a possibility with the gravest and most wide-reaching consequences. We cannot emancipate woman without placing her in a position of political and social influence equal to man’s. It may well be that she will regard economic and sexual problems from a very different standpoint, and the result will infallibly lead to the formation of a woman’s party, and to a more or less conscious struggle between the sexes. Would this end in an increased social stability or another subjection of sex?

“Woman may, however, conclude that the alternative is true--that prostitution is not the outcome of our present social organisation, but a feature of all forms of human society. She must, then, treat it as a necessary evil or as a necessary good. In the former case she will at least insist on an equal social stigma attaching to both sexes if she does not demand, as in the instance of any other form of anti-social conduct, so far as practicable its legal repression. In the latter case--that is, if its existence really tends in some way to the welfare or stability of society--women will have to admit that prostitution is an honourable profession; they cannot shirk that conclusion, bitter as it may appear to some. The ‘social outcast’ would then have to be recognized as filling a social function, and the problem would reduce to the amelioration of her life, and to her elevation in the social scale. Either there is a means of abolishing prostitution, or all participators must be treated alike as anti-social, or the prostitute is an honourable woman--no other possibility suggests itself. Society has hitherto failed to find a remedy, perhaps because only man has sought for one; woman, when she for the time fully grasps the problem, must be prepared for one, or must recognize the alternatives. There cannot be a doubt, however, that in a matter so closely concerning her personal dignity she will take action, and that, if only in this one matter, her freedom will raise questions, which many would prefer to ignore, and which, when raised, will undoubtedly touch principles apparently fundamental to our existing social organization.”

[330] See note to p. 390.

[331] Parent-Duchatelet, “The Moral Corruption of the Female Sex in Paris,” vol. ii., p. 234 (Leipzig, 1837). Similarly, Julius Donarth remarks (“The Beginnings of the Human Spirit,” p. 19; Stuttgart, 1898): “=Syphilis and alcoholism= can by social arrangement and carefully adapted measures =be suppressed just as much as plague and cholera=.”

[332] The literature of this subject is very extensive. In addition to a comprehensive work dealing with the older literature, by J. K. Proksch, “The Prevention of Venereal Diseases” (Vienna, 1872), I must mention the following: E. Lang, “The Prevention of Venereal Diseases” (Vienna, 1894); M. Joseph, “Prophylaxis of Cutaneous and Venereal Diseases” (Munich, 1900); Neuberger, “The Prophylaxis of Venereal Diseases,” pp. 35-37 (Munich and Berlin, 1904); Felix Block, “How shall We protect Ourselves against Venereal Diseases and their Evil Consequences?” second edition (Leipzig, 1905); E. Boureau, “Conseils Pratiques à la Jeunesse pour Éviter les Avaries” (Paris, 1905); Suarez de Mendoza, “Conseils de Prophylaxie Sanitaire et Morale” (Paris, 1906); same author, “ABC à l’Usage des Mères de Famille pour la Défense de Leurs Foyers contre les Grands Fléaux du XXe Siècle: Tuberculose, Avariose [= Syphilis], Neissérose [= Gonorrhœa], Alcoolisme, Mortalité Infantile” (Paris, 1905); same author, “Avariose des Innocents” (Paris, 1905).

[333] Cf. also the valuable remarks of Robert Hessen, “Cleanliness or Morality?” published in Die Zukunft, June 9, 1906, pp. 367-377 (also separately printed in Munich, 1906).

[334] Otto Neustätter, “The Public Recommendation of Protective Measures,” published in The Journal for the Suppression of Venereal Diseases, vol. v., No. 3, pp. 225-227 (Leipzig, 1905).

[335] H. Ferdy, “The History of the Cæcal Condom,” published in The Journal for the Suppression of Venereal Diseases, 1905, vol. iii., No. 4, pp. 144-147.

[336] Cf. in this connexion the admirable essay, distinguished by a critical spirit, of R. de Campagnolle, “The Value of the Modern Prophylaxis of Gonorrhœa by Means of Instillations,” published in The Journal for the Suppression of Venereal Diseases, 1904, vol. iii., Nos. 1-4, pp. 1-31, 51-115, 148 (with a complete bibliography).

[337] In place of these solutions, Cronquist (“Contributions to the Personal Prophylaxis against Gonorrhœa,” published in Medizinische Klinik, No. 10, 1906) recommends the use of little rods or bougies containing 2 per cent. of =albargin=, which melt from the body-heat when introduced into the urethra (these are sold under the trade name of “antigon-rods”); they are used, like the solutions, immediately after coitus. The advantage they possess is their greater durability.

[338] The same idea had already been advanced in Germany by Eduard Richter and S. Behrmann.

[339] E. Metchnikoff, “The Prophylaxis of Syphilis,” published in Medizinische Klinik, 1906, No. 15, pp. 372, 373. Cf. also Paul Maisonneuve, “Experimentation sur la Prophylaxie de la Syphilis” (Paris, 1906); and A. Neisser. “Experimental Research regarding Syphilis,” pp. 81-83 (Berlin, 1906).

[340] O. Neustätter, “The Public Recommendation of Protective Measures,” published in The Journal for the Suppression of Venereal Diseases, 1905, vol. iv., pp. 203-252.

[341] G. Bernhard, “The Criminal Law and Protective Measures against Venereal Diseases,” ibid., pp. 253-273.

[342] F. von Liszt, “Legal Protection against Dangers to Health from Venereal Diseases,” published in The Journal for the Suppression of Venereal Diseases, 1903, vol. i., pp. 1-25.

[343] Von Bar, “The Need for a Special Law against Blameworthy Venereal Infection,” ibid., pp. 64-72.

[344] R. Schmölder, “Criminal and Civil Juridicial Significance of Venereal Diseases,” ibid., pp. 73-106.

[345] Albert Reibmayr, “The Immunization of Families by Inheritable Diseases (Tuberculosis, Lues, Mental Disorders),” p. 17 (Leipzig and Vienna, 1899).

[346] This conception of “partial syphilization” of our race appears somewhat vague. If we take care to think clearly, and in terms of exact biological knowledge, we shall see that--apart from a spontaneous loss of intensity on the part of the syphilitic virus (of which we have no precise knowledge whatever)--the only known way of accounting for syphilis having become milder is by natural selection, by the death of those who suffered most severely from the disease. Now, in 400 years, ten or twelve human generations, there has hardly been time for the development of immunity to a disease to which at most a small fraction only of the population has ever been exposed. It appears to me, however, that we may reasonably doubt the alleged decline in the severity of syphilis. It must be remembered that the entire absence of mercurial treatment at first, and the misuse of that specific for many years after its value had been proved, will account for much in respect of the apparent greater virulence of medieval as compared with modern syphilis. (See also p. 356, and footnote to that page referring to the writings of Archdall Reid).--TRANSLATOR.

[347] Alfred Fournier, “The Treatment and Prophylaxis of Syphilis.” One vol. Rebman, London.

[348] Cf. Iwan Bloch, “Personal Reminiscences of my Lecturing Journey this Year,” published in Medizinische Klinik, 1906, No. 10.

[349] Hermann is a fanatical medical opponent of mercury. There are, in fact, such oddities. They are very rare birds in the medical world.

[350] Recently R. Kaufmann has collected in a small readable essay the scientific views of the present day, “The Therapeutic Use of Mercury” (Leipzig, 1906). I warmly recommend this book to all who are interested in the question.

[351] Cf. Iwan Bloch, “The After-Treatment of Syphilis,” published in Medizinische Klinik, 1905, No. 4, pp. 88-91.

[352] Cf. Iwan Bloch, “Nutritive Therapeutics in Cases of Syphilis,” published in Medizinische Klinik, 1905, No. 18, pp. 442-446.

[353] Alfred Fournier, “En Guérit-on?” pp. 95, 96 (Paris, 1906).

[354] “=Krankenkassen.=”--I have to employ the German term, since in England we do not possess the institution, nor even the name. In Germany there is a general system of insurance against illness, to which workmen have to contribute a proportion of their wages, the fund being supplemented by contributions from the employers of labour. When ill the workman applies to the Krankenkasse for the necessary medical advice and treatment.--TRANSLATOR.

[355] A. Blaschko, “The Treatment of Venereal Diseases in Krankenkassen” (Berlin, 1890).

[356] A. Neisser, “Krankenkassen and the Campaign against Venereal Diseases,” published in The Journal for the Suppression of Venereal Diseases, 1904, vol. ii., pp. 161-169, 181-194, 221-247.

[357] R. Ledermann, “Do the Provisions of the Law for Insurance against Sickness Provide for the Cure of Venereal Disease?” ibid., 1905, vol. iii., pp. 449-463.

[358] Albert Kohn, “Should Krankenkassen send Delegates to Hygienic Congresses?” ibid., 1906, vol. v., pp. 121-130.

[359] Rudolf Lennhoff, in an address on February 8, 1907, to the local group of Berlin of the German Society for the Suppression of Venereal Diseases on “Venereal Diseases and Social Legislation,” drew especial attention to the necessity of enrolling in the scheme of insurance against illness wider circles of the impecunious population, especially the class of domestic servants. Servants suffering from venereal disease, since at the present day they usually preserve secrecy as to their trouble, in order that they may not lose their place, constitute a dangerous source of infection for their employers and the latters’ children. Therefore, a particularly thorough and speedy treatment of servants suffering from venereal diseases is necessary. It is further necessary to insist that all the employees of the Krankenkassen should observe the duty of professional secrecy. Recently the Landesversicherungsanstalt (an insurance institution) of Berlin started a dispensary of its own in Lichtenberg for patients suffering from venereal disease, in which every year more than 400 patients undergo treatment.

[360] A. Blaschko, “The Diffusion of Venereal Diseases,” published in The Hygiene of Prostitution and of Venereal Diseases, pp. 19-36 (Jena, 1900).

[361] “Diffusion of Venereal Diseases in Prussia, as well as the Measures Necessary in the Campaign against these Diseases,” edited by A. Guttstadt; Berlin, 1901 (Journal of the Royal Prussian Statistical Bureau).

[362] M. Kirchner, “The Social Importance of Venereal Diseases.”

[363] Cf. Chotzen and Simonson, “The Duty of Notification and the Obligation of Professional Secrecy on the Part of Physicians in the Case of Venereal Diseases,” published in The Journal for the Suppression of Venereal Diseases, 1904, vol. ii., pp. 433-474; A. Neisser, “Amendment of § 300 of the Criminal Code, and the Medical Duty of Notification, in Relation to the Suppression of Venereal Diseases,” op. cit., 1905, vol. iv., pp. 1-28; Bernstein, “Medical Professional Secrecy and Venereal Diseases,” ibid., pp. 29-31; M. Flesch, “Medical Professional Secrecy and the Suppression of Venereal Diseases,” ibid., pp. 32-51; Magnus Möller, “The Duty of Professional Secrecy on the Part of Physicians, the Notification of Diseases, and the Ascertainment of the Sources of Infection in the Case of Venereal Diseases,” ibid., 1906, vol. vi., pp. 241-258, 283-301; Ludwig Bendix, “Professional Secrecy on the Part of Physicians,” ibid., 1906, pp. 372-376.

[364] H. Loeb, “Statistics Relating to Venereal Diseases in Mannheim,” published in The Journal for the Suppression of Venereal Diseases, vol. ii., pp. 97, 98 (1904).

[365] H. Berger, “Prostitution in Hanover,” pp. 37, 38 (Berlin, 1902).

[366] Schmölder, “The State and Prostitution,” p. 1 (Berlin, 1900).

[367] Cf. J. Fabry, “The Question of Inscription under Police Surveillance, with especial Regard to the Conditions in Dortmund,” published in The Journal for the Suppression of Venereal Diseases, 1906, vol. v., pp. 325-342.

[368] A. Neisser, “In what Direction can the Regulation of Prostitution be Reformed?” published in The Journal for the Suppression of Venereal Diseases, 1903, vol. i., pp. 163-356.

[369] Anna Pappritz, “Is the Present Method of the Regulation of Prostitution Capable of Reform, and in What Manner?” published in The Journal for the Suppression of Venereal Diseases, 1903, vol. i., pp. 367-372.

[370] Clausmann, “Prostitution, Police, and Justice,” op. cit., 1906, vol. v., pp. 219-225.

[371] Friedrich Hammer, “The Regulation of Prostitution,” published in The Journal for the Suppression of Venereal Diseases, 1904, 1905, vol. iii., pp. 373-385, 426-435.

[372] S. Bettmann, “The Medical Treatment of Prostitutes” (Jena, 1905)--a thorough study of all the available material.

[373] Schmölder, “Professional Fornication and Compulsory Inscription on the List of Prostitutes” (Berlin, 1894).

[374] “The Social Evil, with Especial Reference to Conditions existing in the City of New York. A Report prepared under the Direction of the ‘Committee of Fifteen,’” pp. 91, 92 (New York and London, 1902).

[375] A severe criticism of regulation and its consequences is to be found in the excellent dissertation of Paul Emile Morhardt, “Les Maladies Vénériennes et la Réglementation de la Prostitution au Point de Vue de l’Hygiène Sociale” (Paris, 1906).

[376] Cf. the admirable description of soutenage given by Hans Ostwald, “Soutenage in Berlin” (Berlin and Leipzig, 1905).

[377] “The human being awakens in the prostitute. That is the whole secret and the cause of soutenage.”--H. OSTWALD.

[378] The dislike to the brothels of Paris is confirmed by Lassar (“Prostitution in Paris,” Berliner klinische Wochenschrift, 1892, No. 5).

[379] J. Rutgers (“Sketches from Holland,” published in The Journal for the Suppression of Venereal Diseases, 1906, vol. v., p. 345) has admirably expressed this fact in the following words: “=The danger of infection is directly proportionable to centralization.=”

[380] Anna Pappritz, “What Protection can Brothel Streets Offer?” published in The Journal for the Suppression of Venereal Diseases, 1904, 1905, vol. iii., pp. 417-424.

[381] Stachow, “The Controlled Streets of Bremen,” ibid., 1905, vol. iv., pp. 77-87.

[382] Fabry, “Brothels and Brothel Streets,” ibid., 1905, pp. 167-169 (in favour of “Kasernierung”); Wolff, “The Question of Kasernierung,” ibid., 1905, vol. iv., pp. 73-76 (in favour of “Kasernierung”); F. Block, “The Kasernierung of Prostitution in Hanover” (Hanover, 1907).

[383] F. Zinsser, “The Conditions of Prostitution in the Town of Cologne,” ibid., 1906, vol. v., pp. 201-218.

[384] E. von Düring, “The Brothel Question,” ibid., 1905, pp. 111-128.

[385] H. Fürth, “The Suppression of Venereal Diseases and the Brothel Question,” ibid., pp. 129-156.

[386] K. Nötzel, “Brothels in Russia,” ibid., 1906, pp. 41-66, 81-106.

[387] M. Bruck, “Good Morals and the Brothel Trade,” ibid., pp. 57-62.

[388] O. Lassar, “Prostitution and Venereal Diseases,” published in Hygienische Rundschau, 1891, No. 23.

[389] See note at end of chapter.

[390] B. Marcuse, “Treatment of Prostitutes,” published in The Journal for the Suppression of Venereal Diseases, 1906, pp. 1-8.

[391] F. Schiller, “Rescue-Work and the Suppression of Prostitution,” ibid., 1903, 1904, vol. ii., pp. 294-313, 341-349.

[392] Ibid., 1906, vol. iii., pp. 336-350.

[393] P. Kampffmeyer, “Educational Work in Connexion with Prostitutes,” ibid., pp. 351, 352.

[394] E. Kromayer, “The Physician and the Protection of Motherhood,” published in Mutterschutz, 1905, vol. iii., pp. 351-352.

[395] Quite recently--October, 1906--the =first= step in this direction has been taken. The Chief Commissioner of the Berlin Police addressed to the medical specialists in venereal diseases an inquiry whether they were prepared to treat gratuitously impecunious prostitutes who were not under police control. The girls would then be given a register of these doctors. If they presented themselves for treatment, no particulars about them would be demanded from the physician. The presentation by the patients to the police of a certificate from a medical man =would suffice to exempt them from police control, and from compulsory examination and treatment at the police department of the section of the town to which they belonged=. Further details will be arranged later in co-operation with the Committee of the Society for the Suppression of Venereal Diseases.

In his valuable study, “The Future of Prostitution,” published in the monthly magazine Mutterschutz, July, 1907, pp. 274-288, Havelook Ellis also takes an extremely optimistic view regarding the gradual and inevitable diminution of prostitution by indirect means--that is to say, in this way we are elevating ourselves socially and economically to a higher stage of humanity.

Spotted a typo or a problem in this chapter? Tell us

XVI. STATES OF SEXUAL IRRITABILITY AND SEXUAL WEAKNESS

(Auto-erotism, Masturbation, Sexual Hyperæsthesia and Sexual Anæsthesia, Seminal Emissions, Impotence, and Sexual Neurasthenia).

“The conditions of modern civilization render auto-erotism a phenomenon of increasing social importance.”--HAVELOCK ELLIS.

CONTENTS OF CHAPTER XVI

Wide diffusion of auto-erotic phenomena -- Their significance in relation to civilization -- Physiological and pathological relations -- Their diffusion among animals and among primitive peoples -- The auto-erotic instrumentarium -- Causes of auto-erotism and of masturbation -- New views regarding the masturbation of sucklings -- The sexual tension of puberty -- Sexual toxins -- Mechanical stimuli in sexual tension -- Sedative and anodyne effects of masturbation -- Seduction as the cause of masturbation -- Group-masturbation in schools, etc. -- Diseases as causes of masturbation -- Inheritance of the tendency to masturbation -- Masturbation in the female sex -- Its frequency -- Psychical onanism -- Sexual day-dreams -- Erotic correspondence -- Consequences of masturbation -- Exaggerated views of former times -- Analysis of the harmfulness of masturbation -- Changes of the psyche and of the will -- Explanation of certain phenomena of our time as due to masturbation -- Physical consequences of masturbation -- Local changes in the genital organs -- Abnormalities in the libido sexualis -- Treatment and cure of masturbation -- Clothing -- Trousers and masturbation -- Doctor Bernhard Faust’s book -- Various medical methods employed in the treatment of masturbation.

Sexual neurasthenia -- Its connexion with masturbation -- Relative independence of its symptoms -- Abnormal increase of the sexual impulse (sexual hyperæsthesia) -- Causes -- Peculiar form of nocturnal increase of the sexual impulse -- Satyriasis and priapism -- Nymphomania -- Causes of Nymphomania -- Examples -- Treatment of sexual hyperæsthesia -- Abnormal diminution of the sexual impulse (sexual anæsthesia) -- Causes -- Frequency of sexual frigidity in women -- Causes -- Vaginismus -- Treatment of frigidity in women -- Frigidity and prostitution -- Frigidity and marriage -- Erotomania -- Seminal emissions -- Lallemand’s distinction between normal and abnormal pollutions -- Morbid pollutions -- Diurnal pollutions -- Abnormalities of the genital organs and of the sensation during pollutions -- Spermatorrhœa and prostatorrhœa -- Pollutions in women -- Older and more recent observations -- Medical treatment of pollutions.

Impotence -- Its principal forms -- Malformations of the genital organs -- Castration -- Gonorrhœal diseases -- Azoospermia -- Smallness and injuries of the penis -- Incomplete erections -- Central and peripheral causes of erection -- Functional impotence -- General disorders -- Deleterious influence of alcohol and tobacco -- Nervous impotence -- The psychical impotence of the wedding night -- Examples -- Mental work and potency -- The effect of sudden mental impressions -- Reflective impotence -- Rousseau’s Venetian adventure -- Neurasthenic impotence -- Its forms and symptoms -- Impotence due to abstinence -- Senile impotence -- Treatment of impotence.

Other phenomena of sexual neurasthenia (gastric disorders, etc.) -- Sexual hypochondria -- The treatment of sexual neurasthenia.

Spotted a typo or a problem in this chapter? Tell us

Chapter XVI

Almost as widely diffused as venereal diseases are the abnormal sexual manifestations to be considered in this chapter under the general title of “States of Sexual Irritability and Sexual Weakness.” They arise in part out of the =very nature of mankind=; in part they are the external manifestations of a =natural impulse=, of an instinctive excitement, in which form we see them also in other animals; in part they are connected with man’s =spiritual= nature, with =civilization=. We may, indeed, say that the duplex nature of man, his bodily-spiritual dualism, is most clearly reflected in this phenomenon of his sexuality. In this respect he is wholly human.

It is a great service performed by Havelock Ellis[396] that he was the first to direct attention to the “involuntary” manifestations of the sexual impulse peculiar to mankind, occurring =without= relation to the other sex. He gives them the distinctive name of “=auto-erotism=,” by which he means “the phenomenon of spontaneous sexual excitement manifesting itself =without any stimulus, direct or indirect, supplied by any other person=.” For the most part, therefore, the normal manifestations of art and poetry belong also to the province of auto-erotism, in so far as they are the result of erotic perception; and the same is true of all those manifestations which I have termed “=sexual equivalents=,” all transformations of sexual energy, such as religio-sexual phenomena, the transformation of individual love into the general love of mankind, the stimuli of fashion, and =every powerful activity= by means of which sexual tension finds a mode of discharge, even though this sexual relationship is usually of an unconscious nature, as in the dance, in society games, and other enjoyments.

In my essay on “The Perverse,” pp. 14, 15 (Berlin, 1905), I have shown that there is no doubt that these sexual equivalents, taken in their entirety, have played an extremely important part in the course of the evolution of mankind; that they represent =the natural outlets= for feelings of tension and excessive forces of sexual origin; and that they should not be unnecessarily suppressed, unless we wish to evoke =much worse and far more dangerous= variations of their activity--as, for example, in the political sphere.

Appositely, I find in Friedrich Nietzsche’s “Posthumous Works” (vol. xii. of the “Collected Works,” p. 149; Leipzig, 1901) an interesting remark bearing on the question:

“Many of our impulses find an outlet in a mechanically powerful activity, which =can= be directed by intelligent purpose; unless this is done, these manifestations are destructive and harmful. Hate, anger, =the sexual impulse=, etc., can be =set to the machine= and taught to do useful work--for example, to chop wood, to carry letters, or to drive the plough. =Our impulses must be worked out.= The life of the learned man more especially demands something of the kind.”

What a wise and apt remark! Our whole civilization is permeated with sexual equivalents of this kind; the pleasure of life and the joy of existence are based thereon, however much our puritans and asexual “morality-fanatics” may strive against this fact. And it is well that the sexual impulse has been “civilized,” that there are now so many spontaneous modes of its discharge, that the sphere of auto-erotism increases pari passu with the growth of civilization. Many new, finer, and nobler incitations and stimuli stream therefrom into love and life, upon which they exercise a rejuvenating and strengthening influence. Still, this light throws a shadow, inasmuch as fantastic and unnatural aberrations of the sexual life are also apt to ensue.

Auto-erotism (including its grosser form, masturbation) is therefore, to a certain extent, a =physiological= manifestation; it becomes morbid only in certain conditions--that is to say, in individuals who are previously =morbid=. This is, indeed, an old medical doctrine, that there exists a physiological masturbation faute de mieux, and a morbid masturbation in cases of neurasthenia, mental disorder, and other troubles. The same is true of auto-erotism in its entire extent. When Fürbringer describes masturbation as “an =unnatural= gratification of the sexual impulse,”[397] this is only partly true. There exists a =natural, physiological masturbation=, a =normal= auto-erotism. Metchnikoff shares this view.[398] He says: “=It is man’s constitution itself= that permits the premature development of sexual sensibility, before the reproductive elements are mature.” The ultimate cause of such auto-erotic manifestations as belong neither to the category of “vice” nor to that of “crime” is to be found, he thinks, in a =disharmony= in the nature of man in respect of the premature development of sexual sensibility. For this reason we meet with these manifestations just as much among the lowest races of mankind as we do among civilized peoples; even among =animals= auto-erotism is a widely diffused phenomenon. This can be observed, not only among the monkeys (perhaps already a little civilized) of our Zoological Gardens, which masturbate freely coram publico, but it may be seen also in horses, which shake the penis to and fro until seminal emission occurs; also in mares, which rub themselves against any available firm object. We see the same thing in wild deer. Even elephants masturbate. Among primitive races masturbation is, perhaps, even more general than among civilized races. Among South African tribes, Gustav Fritsch reports, masturbation is actually a popular custom.

Havelock Ellis has described the entire auto-erotic instrumentarium, and it appears from his account that savage races manufacture onanistic stimulatory apparatus for women quite as elaborate as those which are produced by the most highly developed lewd industry of civilized peoples. Most frequently articles in everyday use are employed for auto-erotic gratification--as in Hawaii, bananas; in our own part of the world, cucumbers, carrots, and beetroots. Further, in the vagina and bladder have been found pencils, sticks of sealing-wax, empty reels, bodkins, knitting-needles, needle-cases, compasses, glass stoppers, candles, corks, tumblers, forks, toothpicks, pomade-boxes, cockchafers,[399] hens’ eggs, and, with especial frequency, =hairpins=.

I may allude here, in passing, to the fact that C. Posner refers the discovery of various bodies in the male urethra to other causes than masturbation in some cases. He states that often they have been introduced by other persons than the one in whom they are found, and is of opinion that the introducer is a man with sadistic tendencies, and usually homosexual (see C. Posner, “The Introduction of Foreign Bodies into the Male Urethra, with Remarks on the Psychology of such Cases,” published in Therapie der Gegenwart, September, 1902). In the year 1862 masturbation with the aid of hairpins was so widely practised in Germany that a surgeon invented a special instrument for the removal of hairpins from the female bladder! At the present day this hairpin masturbation is extremely common.[400] Still more elaborate are artificial imitations of the male penis, the so-called godemichés (gaude mihi, dildoes, consolateurs, “bijoux indiscrets,” etc.),[401] of which we find representations in ancient Babylonian sculpture, in Egypt, and in the “Mimiamben” of Herondas[402] (third century before Christ); and since very ancient times they have been in use in Eastern Asia, where the Spaniards found them in the Philippines. Particularly well known are the wax phalli of the Balinesian women. In Europe, as early as the twelfth century, Bishop Burchard of Worms condemned the use of artificial penes. Their use was especially common at the time of the Italian renascence; the technique of their employment became continually more elaborate. The culmination was reached in the eighteenth century France. No less a man than Mirabeau, the celebrated French politician, in his erotic romance, “Le Rideau Levé, ou l’Education de Laure,” describes such an artificial phallus, and I append his description in order to enable the reader to represent to himself the extremely elaborate technique that was used in the application of such auto-erotic instruments:

“The instrument resembled in every respect the natural penis. The only difference consisted in this, that from the apex to the root it was shaped in transverse waves, in order to render the rubbing action more powerful. Made entirely of silver, it was covered with a kind of smooth and very hard varnish, giving it the natural colours. For the rest, it was very light and thin, being hollow. Through the middle of the hollow interior there passed a round tube, made also of silver, and about twice the diameter of a goose-quill, and within this tube was a piston; the tube was firmly closed at the other end by means of a screw. This screw was perforated, and firmly soldered to the base of the head. Consequently there was an empty space between the central tube and the outer wall of the instrument. This outer cavity of the godemiché was filled with water warmed to blood-heat, and then closed with a well-fitting cork. The small central tube was filled with a thin, whitish solution of isinglass (!), which was previously prepared. The warmth of the water was immediately communicated to the isinglass solution; and the latter then represented, as far as was possible, the human semen.”

This description dates from the year 1786! But even to-day apparatus of this kind are advertised in the catalogues of certain traders, under the title of “Parisian Rubber Articles.” Whether they really exist I do not know, for I have never actually seen anything of the kind. Havelock Ellis assumes that they are still used to-day. In brothels, prostitutes use at the present time very primitive leathern phalli, such as were described by Herondas and Aristophanes, for erotic practices and demonstration.

In addition to these, there are numerous other methods of purely peripheral-mechanical masturbation. Thus, the rubbing and movement of the genital organs in bicycle-riding, horse-riding, very frequently in working the treadle of a sewing-machine, and in travelling on the railway, may give rise to masturbatory stimulation. Very commonly in women merely rubbing the thighs against one another is sufficient to induce a sexual orgasm; whereas men almost always need to have recourse to more powerful manipulation, such as manual friction (manustupratio).

What are the general physiological =factors= of auto-erotic phenomena, more especially of masturbation? In this connexion it is interesting to note that =auto-erotism is almost always a precursor of completely developed sexuality=, and manifests itself a long time =before= puberty; and may even appear soon after birth, for the older and more recent medical literature of the subject contains numerous observations of masturbation in =sucklings=, not to speak of masturbation in older children. The auto-erotism of sucklings is =purely peripheral= in its nature, and depends upon the mechanical stimulation of certain parts of the body, the first “erogenic” zones of man. Freud enumerates among the regions of the body by the stimulation of which sexual pleasure is most readily obtained, the lips of the infant, which, in sucking the mother’s breast or its substitute, receive an instinctive perception of pleasure, in which the stimulation produced by the warm flow of milk also plays a part. This “ecstatic sucking” of infants is auto-erotic in character. Not infrequently, while sucking in this voluptuous manner, the infant simultaneously rubs certain sensitive parts of the body, such as the breast and the external genital organs. A kind of orgasm occurs, followed by sleep. Freud aptly compares this phenomenon with the fact that in later life sexual gratification is often the best means of inducing sleep. Freud also regards the masturbation of sucklings as being within certain limits a physiological phenomenon, as exhibiting on the part of Nature an intention “to establish the future primacy of these erogenic zones for sexual activity.”[403]

With the onset of puberty the auto-erotic instincts are newly stimulated; new sources of auto-erotism become active, principally owing to the development of the genital organs and to the evacuation of the reproductive products. Various theories have been propounded to explain by what means the =sexual tension= occurring at puberty is induced, this sexual tension being regarded as the ultimate cause of the masturbation of sexually mature human beings. The most plausible hypothesis is the =chemical= theory of sexual tension and sexual excitement, which was explained in more detail above (p. 47). It may be that, as Freud assumes, a substance generally diffused throughout the organism is destroyed by the stimulation of the erogenic zones, and that the products of decomposition of this substance give rise to a discharge of sexual energy; it may be that the reproductive organs themselves produce such chemical substances, =sexual toxins=. This assumption is supported by the experimental observation that when in animals the ovaries and all the nerves connected with these organs have been removed, and consequently the ordinary periodic recurrence of sexual activity is no longer seen, if now ovarian extract is injected into the body of such animals, rutting once more occurs. Starling introduced the term “=hormone=” to denote these chemical sexual substances. They appear also to play a part in connexion with certain abnormalities and perversions of the sexual impulse--a matter to which we shall return later. R. Kossmann also speaks of a “=neuro-chemical=” injury--a kind of intoxication of the nervous system induced by “retained secretions or excretions of the reproductive organs.”[404]

The same author also advances the =neuro-mechanical= theory of sexual tension. He understands by this that the purely mechanical =distension= of the organs belonging to the reproductive apparatus exercises a =mechanical stimulus= on the genital nerves, and thus has a reflex action upon the centres of the brain and spinal cord, which reflex stimulation is allayed by orgasm and ejaculation. Haig explains the feeling of relief after masturbation, and the consequent discharge of sexual tension, as rather dependent upon the mechanism of the blood-pressure. He remarks:

“Since the sexual act gives rise to a low and falling blood-pressure, it must necessarily alleviate conditions which are due to high and increasing blood-pressure--for example, mental depression and ill-humour--and if my observations are correct, we have here an explanation of the relation between conditions of high blood-pressure with mental and physical depression, on the one hand, and masturbatory practices on the other, for such practices alleviate this condition, and are readily indulged in for this purpose” (quoted by Havelock Ellis).

The statement made to Dr. Garnier by a monk, thirty-three years of age, bears out this view:

“If no nocturnal seminal emissions occur, the tension of the semen gives rise to general depression, headache, and sleeplessness. I admit that sometimes, in order to obtain relief, I lie upon the abdomen, and so produce a seminal discharge. I immediately feel =freed=, as if a =burden= had been lifted from me, and sleep returns” (ibid., p. 273).

Similar motives for masturbation are alleged by many otherwise healthy onanists. They apply, moreover, in an equal degree to the normal, not excessive, sexual intercourse of ordinary human beings. Persons belonging to the most diverse classes of society--men of letters, shopmen, labourers, etc.--of whom I have inquired regarding the effect of seminal emissions, whether produced by masturbation or by coitus, have unanimously agreed in describing to me this sense of “freeing” from a burden, from pressure, from harmful substances accumulated in the body--a sense of mental energy and creative power after such discharges of sexual tension not exceeding normal limits. The frequency of these discharges varies in different individuals; in one the intervals were short, in another they were long. This point has a very important bearing upon the “question of sexual abstinence,” and we shall return to it in the discussion of that topic.

Masturbation is often the means for inducing sleep and repose; it dulls nervous sensibility, and connected with this is the fact that pain is often allayed by masturbation. Here I may refer once more to the previously quoted (p. 44) view of a talented young alienist, Edmund Forster, that, in association with sexual tension, there occurs an increased stimulation of the =pain-perceiving nerves= of the genital organs. It is conceivable that sexual tension, especially if it depends upon chemical causes, also increases pains arising from other areas of the body, and that the discharge of sexual tension would thus alleviate or completely allay these pains. Coe reports (American Journal of Obstetrics, 1889, p. 766) the case of a woman who was accustomed by masturbation to obtain immediate relief of intense menstrual ovarian pains. It is very remarkable that =these pains were accompanied by a powerful sexual impulse=, which ceased when the pain ceased, and did not return during the intermenstrual period. Here we have a striking testimony of the accuracy of Forster’s view. The phrenologist Gall was aware of the manner in which masturbation relieves pain.

In addition to these more natural causes of masturbation, which in themselves suffice to explain the wide diffusion of the practice, we have also to consider masturbation dependent upon =seduction= and upon =morbid states=.

To seduction must be referred all the phenomena of =group-masturbation= (masturbation on the large scale) in =schools=,[405] training-ships, barracks, factories (especially in this case as regards female employees!), prisons, etc. One leads another astray, and masturbation is diffused like an epidemic disease; the individuals are subjected to the influence of the =suggestion of the crowd=, which they are unable to resist. Thomalla describes boarding-schools in which masturbation was practised for a wager, and that boy won the prize in whom seminal emission first occurred! He further speaks of a school club in which obscene readings were held, and in which by means of forbidden pictures the boys were sexually excited until erection occurred, then followed general masturbation, also accompanied by wagers.

This group-masturbation is the best proof of the fact that those who masturbate are not simply individuals with an inherited morbid predisposition; for nothing is easier to suggest than masturbation. Havelock Ellis[406] reports the following case of an unmarried healthy young woman, thirty-one years of age, which throws a strong light on this suggested manifestation:

“When I was about twenty-six years of age, a female friend informed me that she had masturbated already for several years, and was so much enslaved by the habit that she suffered seriously from its ill-effects. I listened to her account with sympathy and interest, but felt rather sceptical, =and I resolved to make the attempt on myself=, with the intention of understanding the matter better, so that I might be able to help my friend. With a little trouble I =succeeded in awakening what had hitherto slumbered in me unknown=. I intentionally allowed the habit to become stronger, and one night--for I usually did it just before going to sleep, never in the morning--I really experienced an extremely agreeable sensation. But the next morning my conscience was aroused, and I felt pains also in the back of the head and along the spine. For a time I discontinued the habit, but later began it again, masturbating with considerable regularity once a month, a few days after each menstruation.... The habit overcame me with alarming rapidity, and I soon became more or less its slave.... In conclusion, I must say that masturbation has proved to me one of the blind chances in my life’s history, out of which I have derived many valuable experiences.”

Frequently local morbid changes in or near the genital organs lead to the practice of masturbation, such as skin troubles, intestinal worms, phimosis, inflammatory states of the penis or near the entrance of the vagina, prurigo and other itching affections of the penis, constipation, urinary anomalies, etc. Further, mental disorders, epilepsy, and degenerative nerve troubles, are frequent causes of masturbation. Masturbation has been observed after epileptic paroxysms in patients who at other times never masturbate. There is no doubt that neurasthenia powerfully predisposes to masturbation. =Excessive= masturbation is almost always the consequence, not the cause, of associated neurasthenia; it is “the manifestation of a disease in course of development or of a permanently existing degenerative predisposition.”[407] To these cases of invincible, habitual, excessive masturbation Oppenheim’s view applies--that the disposition to onanism is often =inherited=. A characteristic instance of this is offered by an observation of Block’s (Havelock Ellis, op. cit., p. 240) in the case of a little girl, who began to masturbate at the early age of two years, and had probably inherited this tendency from her mother and grandmother, for they had both masturbated throughout life, whilst the grandmother had actually died in an asylum of “masturbatory insanity.” In the majority of cases in which =masturbation makes its first appearance in sucklings= we have to do with such an inheritance. In many cases the peculiar oscillatory movements of sucklings may merely be the expression of the sense of general comfort, as Fürbringer believes, and may have nothing to do with actual masturbation; but, on the other hand, it cannot be denied that veritable masturbation may be observed in the first and second years of life. Havelock Ellis, J. P. West, and Louis Mayer have reported such cases. In children somewhat older than this--from three years upwards--seduction and suggestion certainly play a great part. The author of “Splitter” was told by a professor that, when visiting an institution for small children in St. G[allen], he saw a girl about three years of age who was making suspicious movements. The matron, whose attention was called to the matter, said that almost all babies were already infected when they first came to the institution (“Splitter,” p. 375).

Another disputed question relates to the =diffusion of masturbation in the female sex=. Is the practice commoner or less common among women than among men? Metchnikoff[408] is of opinion that in girls it is much less common than in boys, because sexual excitability generally develops much later in the female sex. Female monkeys masturbate only in exceptional cases, whereas in male monkeys masturbation is very common. The circumstance which Metchnikoff adduces in further support of his view of the rarity of masturbation in women--that, namely, most girls are enlightened regarding sexual sensibility only after marriage--proves very little, because the sensations aroused in woman by masturbation are of a very different nature from those produced by coitus, and coitus often first makes them acquainted with entirely new sensations. Tissot regards masturbation as commoner in women than in men; Deslandes believed that there was no difference between the sexes. Lawson Tait, Spitzka, and Dana, inclined rather to Metchnikoff’s view as to the greater rarity of the practice among women. Albert Eulenburg considers masturbation “not quite so common among young women as among young men,” but still “far more common than parents, teachers, and the laity of both sexes as a rule imagine.”[409] Havelock Ellis considers that =after= puberty masturbation is commoner in women because men can then much more readily obtain gratification in a normal manner by means of intercourse with the other sex. Otto Adler estimates the frequency of masturbation to be very great, because he regards it as the principal cause of deficient sexual sensibility in women, which latter condition he also believes to be extremely common, although he does not go so far as to accept Rohleder’s enormous proportion of 95 masturbators in every 100 women (!).[410] L. Löwenfeld, who characterizes Rohleder’s and Berger’s (99 %) estimates as exaggerations, considers that the frequency of masturbation in women is not so great as in men.[411] In reality, masturbation, given similar circumstances and causes, is probably diffused to an approximately equal extent among both sexes.

But this relates only to peripheral-mechanical masturbation; from this “=psychical onanism=” has rightly been separated--that form of masturbation in which, simply by ideas, without the assistance of manual stimulation of the genital organs, sexual excitement is caused and the orgasm is induced. Psychical onanism, of which Eduard Reich[412] remarked that our own time nourishes it to the fullest possible extent, develops in the majority of cases out of masturbation proper. In this form the =imagination= is tasked with representing all the factors of normal sexual gratification. The simple physical act suffices only in the first beginnings of this vice. Every practised onanist understands that he must soon call his imagination to his aid in order to produce sexual gratification, and that ultimately ideas alone dominate the entire libido, and the orgasm often enough terminates an act which in every respect has throughout remained purely ideal.

“So great is the power of imagination,” remarks the experienced Rouband, “that quite alone, without the assistance of physical stimulation, it can produce the venereal orgasm, with ejaculation of the semen, as happened to one of my fellow-students every time he thought of his beloved.”[413]

Hammond even knew an actual sect of such “onanists by means of simple ideal unchastity,” who formed a sort of club or society, and who were known to one another by certain signs.[414] A patient related to him that in his thoughts of women whom he met, or those who were sitting opposite to him in the railway-carriage, he was accustomed to undress them in imagination; he then would represent to himself very plainly their genital organs, and during this representation he experienced very active voluptuous sensations, culminating in ejaculation. Löwenfeld has also observed several such cases. Eulenburg speaks of an “ideal cohabitation.” The ideas are usually of a lascivious nature, but this is not always the case. Von Schrenck-Notzing reports the case of a lady twenty years of age in whom the simple idea of men, but also agreeable sensory perceptions, such as theatrical scenes, or musical impressions, or beautiful pictures, gave rise to the sexual orgasm.[415]

Allied with psychical onanism is the brooding over sexual ideas--the delectatio morosa of the theologians--and erotic excitement associated with dream-imaginations, or “sexual day-dreams” (Havelock Ellis). This is the spinning out of a continuous erotic history with any hero or any heroine, which is carried on from day to day. Most commonly this occurs in bed before going to sleep. Sexual activities form the material of these histories. We often find carefully worked out and more or less erotic day-dreams in young men, and especially in young women, frequently containing perverse elements. This dreaming, according to Havelock Ellis, does not necessarily lead to masturbation, although it often induces seminal discharges. It occurs both in healthy and in abnormal persons, especially in imaginative individuals. Rousseau experienced such erotic day-dreams. The American author Garland, in his novel, “Rose of Dutcher’s Coolly,” has admirably described the part played by a circus-rider in the erotic day-dreams of a =normal healthy girl= during the =period of puberty=.[416]

In close relationship with these psychical-onanistic day-dreams there stands another phenomenon, to which, as far as I know, I was the first to refer, which I have denoted by the term =erotographomania=.[417] There are numerous men and women who induce their lovers--male or female, as the case may be--prostitutes, masseuses, etc., to write to them =letters= with a sexually stimulating content; or also, as very frequently occurs, they themselves write such letters, containing numerous obscenities. Such correspondence, filled with ardent erotism, seems recently to have made its appearance as a peculiar refinement of sexuality; this also has the effect of a kind of psychical onanism. The interchange of obscene letters of this character recently played a part in the trial of two homosexual individuals in East Prussia. There exists, also, a comparatively blameless, more or less physiological, erotographomania of the time of puberty, in which most passionate letters are written to imaginary lovers, and the still obscure sexual impulse finds a satisfaction in these erotic imaginations.

After this brief account of the various forms and varieties of masturbation, we now turn to consider the =consequences= of the practice. In the course of time there has been a remarkable change of views in respect of this matter. The true founder of the scientific literature of masturbation, Tissot, in his celebrated monograph (“Masturbation; or, the Treatment of the Diseases that result from Self-Abuse”; St. Petersburg, 1774), regarded masturbation as the evil of all evils, and deduced from it all possible severe troubles. His book bears as motto the verse by Von Canitz:

“Wenn schnöde Wollust dich erfüllt, So werde durch ein Schreckensbild Verdorrter Totenknochen Der Kitzel unterbrochen.”

[“When base lust fills thy thoughts, Let a horrible picture rise before thy mind Of withered dead men’s bones, So let the sensual stimulation be driven away.”]

It is dominated by a thoroughgoing pessimism. In this view he is followed by Voltaire, in his “Dictionnaire Philosophique,” and by the authors of the first seventy years of the nineteenth century. Such gloomy views are expressed, above all, by Lallemand, in his celebrated book upon involuntary losses of semen; but they are shared by German physicians also, as, for example, B. Hermann Leitner, in his treatise, “De Masturbatione” (Buda-Pesth, 1844), and in the preface to his book we read: “The writers who speak of the terrible results of self-abuse do not exaggerate; on the contrary, their picture is not sufficiently gloomy.”[418] Modern medical science has, however, reduced these exaggerations to a reasonable measure. For this we have, above all, to thank W. Erb and Fürbringer. The old belief in the enormous dangers and the eminent injuriousness of masturbation, still remains as a bugbear in certain popular writings, some of which have been published in hundreds of editions. Who has not heard of the “Selbstbewahrung” (“Self-Abuse”) of Retaus,[419] the prototype of this dangerous literature, which must be regarded as the principal source of sexual hypochondria; frequently, also, it induces direct sexual stimulation, because it does indeed describe the devil, but describes also voluptuousness!

At the present day all experienced physicians who have been occupied in the study of masturbation and its consequences hold the view that =moderate= masturbation in healthy persons, without morbid inheritance, has no bad results at all. It is only excess that does harm; but even excess in healthy persons does less harm than in those with inherited morbid predisposition. I may express the matter in this way: it is not masturbation (Ger. Onanie) that is harmful, but “=onanism=” (Ger. Onanismus)--that is to say, the habitual and excessive practice of masturbation, continued for a number of years, =which certainly has an injurious influence on health=. The boundary line at which the harmless masturbation (Onanie) ceases and the injurious onanism (Onanismus) begins cannot generally be defined. The difference between individuals makes their reactions in this respect very different. For example, Curschmann reports the case of a talented and brilliant author who, notwithstanding the fact that he had masturbated to excess for eleven years, remained physically and mentally vigorous, and pursued his literary labours with notable success. Fürbringer reports a similar case in a University lecturer. The following case, which came under my own observation, shows that even excessive masturbation need not impair health and working powers. A man of letters, forty years of age, probably misled by a nursemaid in the first instance, had masturbated without intermission since the age of five, and since puberty had done so =several times a day= (three to ten times), without any interference with his powers for work. He is a big, powerful, healthy man, of a really imposing appearance. No one would suspect him to be a habitual masturbator. That from the masturbation (Ger. Onanie) of childhood and youth there developed a condition of formal onanism (Ger. Onanismus) in the adult is in this case principally to be ascribed to the continued abuse of alcohol. The patient drinks daily twelve to fourteen glasses of Munich beer. He is also a heavy smoker. No evidence of inherited predisposition to masturbation can be obtained. For the patient the female sex exists only in the imagination; he has very rarely had sexual intercourse, and avoids ladies’ society, although he has good fortune with women. It is the same with masturbation as it is with sexual intercourse: the effects vary according to the individual. Recently masturbation and coitus have been compared in this respect. Sir James Paget in his lecture on “Sexual Hypochondriasis” says: “Masturbation does neither more nor less harm than sexual intercourse practised with the same frequency in the same conditions of general health and age and circumstance.” Erb and Curschmann go even further; for they consider that masturbation has less influence on the nervous system than coitus. =In reality=, however, masturbation is almost always more harmful than coitus. The reasons for this are obvious. In the first place, masturbation is begun much earlier, generally at an age when the body has not yet developed any marked capacity for resistance. Masturbation in childhood is, therefore, especially harmful.[420] Löwenfeld (op. cit., p. 127) is of opinion that self-abuse begun before virility is attained more readily gives rise to weakness of the nervous system than masturbation begun later in life. In neuropathic children he saw several times, as a consequence of masturbation, well-marked general nervousness, paroxysms of anxiety, sleeplessness, and arrest of mental development. In the second place, masturbation is more dangerous than coitus in this way--that it can be carried out =much more frequently=, on account of the more frequent opportunities, so that masturbation four, five, or even more, times in a =single= day is by no means rare. In the third place, the =spiritual influence= of masturbation is much more harmful than that of normal coitus. The “solitary” vice influences the psyche and the character in the mere child. The youthful masturbator seeks solitude, becomes shy of human beings, reserved, morose, unhappy, hypochondriacal. In the adult the sense of the debasing character and of the sinfulness of masturbation is much more lively; self-confidence departs; the masturbator regards himself as absolutely “=enslaved=” by his vice, the eternal =struggle= against the ever-recurring impulse gives rise more to mental depression than to actual physical harm. From this there results a whole series of diseases of the will, for by masturbation much less harm is done to the intellect than to the vital energy, the capacity for spiritual and physical activity. The cold, blasé manner of many young men, who seem never to have known the natural youthful joy of life, the whole “demi-virginity” of modern young girls--all these are without doubt dependent upon masturbation and upon psychical onanism. The egoism of the onanist in the sexual relationship increases his egoism in other respects, gives rise to cold-heartedness, and blunts the more delicate ethical perceptions. The campaign against masturbation as a group manifestation is eminently a social campaign for altruism; it insists that young people should take their share in all questions relating to the common good. Peculiar extravagances and unnatural characteristics in art and literature may also be partly attributed to masturbation. Many works clearly bear its imprints. Thus Havelock Ellis rightly refers in this connexion to the peculiar melancholy in Gogol’s stories, for Gogol masturbated to great excess. It would be possible to mention also certain writings of our own time which inevitably give rise to such a suspicion.

The reader will do well to consult the interesting discussion of masturbation from the philosophical standpoint by Schopenhauer (“Neue Paralipomena,” ed. Grisebach, pp. 226, 227).

The =physical= consequences of immoderate and habitual masturbation may also be really serious. The =eye= especially suffers manifold injuries, as has been proved by the investigations of Hermann Cohn. Irritable states of the conjunctiva, spasms of the eyelids, weakness of accommodation, subjective sensations of light, and photophobia, may result from masturbation. The =heart= also is sympathetically affected. Krehl even speaks of “=masturbator’s heart=” as a consequence of the long-lasting nervous hyperexcitability, which injures the heart and the vessels, and is manifested by irregularity of the pulse and by sensations of pressure and pain in the cardiac region, by palpitation, etc. Discontinuance of the habit leads to an immediate disappearance of all these alarming symptoms. Very important is also the causal connexion between masturbation and =nervous= or =mental disorders=. Here, however, as Aschaffenburg has recently insisted, we must distinguish clearly between masturbation =resulting= from previously existing nervo-psychical troubles, in which a vicious circle develops--for here the masturbation is partly the consequence of the original trouble, partly the cause of an aggravation of this trouble--and the effects of onanism on the =healthy= central nervous system. Here Aschaffenburg is in agreement with the views of those who consider these effects are less serious than earlier writers were accustomed to assume. Aschaffenburg also recognizes that the most harmful effect is to be found in the =psychical= influence of masturbation, in the continuous, but ever-vain, contest against the habit. This is the source of the majority of the hypochondriacal and other troubles. He often succeeded, by the discovery of this psychical mode of origin, in putting an end to a number of morbid manifestations. As soon as the patient =becomes aware= that these have a purely mental cause, he at once feels himself freed from them. That masturbation is =never= a direct cause of mental disorder is now generally recognized by alienists.[421] At the most, masturbation is no more than a favouring element in the production of such disorder. “=Masturbatory insanity=” occurs only in those with marked hereditary predisposition, and who already have been extremely neurasthenic.[422]

But masturbation can unquestionably give rise to =purely local changes= in the genital organs, such as =inflammatory states of the prostate gland=, =spermatorrhœa=, and =prostatorrhœa=; in women =fluor albus=, =excessively painful menstruation=, and =other disturbances of the menstrual function=, and in connexion with these phenomena there may appear the morbid picture of “=sexual neurasthenia=,” which we have soon to describe.

A very serious result of onanism (not of Onanie) is the =disinclination to normal sexual intercourse= to which the habit gives rise, and the =production of sexual perversions=. The former is more marked in the female sex, the latter more in the male sex. Masturbation is the principal cause of sexual frigidity in women and of a disinclination to normal intercourse. Undoubtedly psychical influences here play the principal part; but also a certain blunting of the sensations of the genital organs by means of excessive masturbatory stimulation. They are no longer susceptible to the normal stimulatory influence of coitus. Moreover, masturbation is often effected by stimulation applied to =some definite portion= of the female reproductive organs, most frequently to the clitoris or the labia; and these parts in such cases are not sufficiently stimulated by coitus. In the male the especially sensitive portions of the penis are stimulated alike by masturbation and in coitus, for which reason man, notwithstanding the practice of masturbation, is much more readily able to obtain sexual gratification in the course of ordinary sexual intercourse. Notwithstanding this, there are also certain peculiar methods of masturbation in the male, the effect of which is not attained by coitus. In such cases men also may fail to induce the sexual orgasm by ordinary intercourse.

The close relationship of masturbation to sexual perversions is obvious. The more frequently the onanistic act is repeated, the more the normal sensibility is blunted, the stronger and more peculiar are the stimuli, which must be of a nature diverging from the ordinary, demanded in order to induce a sexual orgasm. The content of the lascivious ideas must be varied more and more frequently, and soon passes entirely into the sphere of the perverse. Gradually these perverse sexual ideas become more firmly rooted, and ultimately develop into complete sexual =perversions=. A classical example of this is the case reported by Tardieu[423] of a man who was in the habit of =masturbating seven or eight times every day=, and ultimately inflamed his imagination to the point of representing the act of intercourse with female corpses. At length he passed to the =practical carrying out= of this horrible idea, which had now assumed definite sadistic characters. He arranged to obtain a view of opened female bodies, killed dogs, dug up human corpses--all in order thereby to provide satisfaction for his imagination, which had been disordered in consequence of masturbation, and thus to obtain sexual gratification. In the etiology of pseudo-homosexuality masturbation unquestionably plays a part--a fact to which Havelock Ellis has drawn attention.[424] The Mexican “mujerados” are trained for pæderasty by means of masturbation repeated several times daily. Ideas of bestial intercourse may even be aroused by masturbation. Von Schrenck-Notzing[425] reports the case of a woman who had masturbated for thirty years, and ultimately came to represent to herself in imagination that she was having intercourse with a stallion.

The prospects of the satisfactory =treatment= and =cure= of masturbation are unquestionably greater in the case of children. To attain perfect success, parents, teachers, and physicians must co-operate. Above all, it is necessary to relieve any local and general morbid conditions favouring the practice of masturbation. The diet should be light and unstimulating, the clothing and bedding light and cool. In the year 1791 the body physician of the Schaumburg-Lippe family, Dr. Bernhard Christian Faust, published a remarkable work under the title “How to Regulate the Human Sexual Impulse,” with a preface by the celebrated pedagogue J. H. Campe (Brunswick, 1791). In this book he maintained the thesis that the principal cause of masturbation in boys was the wearing of =breeches=. According to him, the =wrapping up= of children in swaddling clothes causes premature stimulation of the sexual organs. Later, in consequence of wearing breeches, there is produced “a great and damp warmth, which is especially marked in the region of the sexual organs, where the shirt falls into folds” (p. 46). Also, the boy, “when he wishes to pass water, must take his little penis out of his breeches. At first, and for a long time after he begins to wear them, the little boy cannot manage this himself; other children, maids, and menservants, help him, and pull and play with his sexual parts. By this handling, pulling, and playing, which he himself does, or which others do for him, with his sexual organs, the boy is led (also the girl, who very often assists, and whom the blameless boy, out of gratitude, wishes to help in return) into constant acquaintanceship with parts which he would otherwise have regarded as sacred, unclean, and shameful. The child becomes accustomed to play with his sexual organs, and =occasional masturbation= develops into habitual self-abuse, =all brought about by wearing breeches=” (p. 45). To prevent all this, he suggested that boys from nine to fourteen years of age should wear clothing resembling rather that of girls. Then these children would be “according to Nature, children, and would ripen late; and the human sexual impulse would come under control, and mankind would be better and happier” (p. 217).

Although the far-reaching and systematic development of this thesis appears ludicrous, still, there is an element of truth in it, and unsuitably tight and warm clothing certainly favours the tendency to masturbation.

According to the suggestion of Ultzmann, in the case of nursing infants and of small children, the hands may be confined in little bags or tied to the side of the bed. The methods of the older physicians, who appeared before the child armed with great knives and scissors, and threatened a painful operation, or even to cut off the genital organs, may often be found useful, and may effect a radical cure. The =actual= carrying out of small operations is also sometimes helpful. Fürbringer cured a young fellow in whom no instruction and no punishment had proved effective, by simply cutting off the anterior part of his foreskin with jagged scissors. In the case of a young lady who often in company indulged her passionate impulse towards masturbation, he brought about a cure by repeated cauterization of the vulva. Other physicians perforate the foreskin and introduce a ring. Cages have even been provided for the genital organs to prevent masturbation, the key being kept by the father (!). Enveloping the penis in bandages without any opening has also been tried. Corporal punishment sometimes has a good effect. Of the greatest value is =continuous care, to safeguard the children against seduction=. “Parents, protect your children from servants,” exclaimed Rétif de la Bretonne. Valuable also are =earnest warnings and explanations=, =increase of energy and force of will= (by sports and games, and by work in the garden, and by the setting of tasks which stimulate ambition). =Climatic cures= and =hydro-therapeutic methods= are also valuable means in the treatment of masturbation. The same measures may be employed in the treatment of masturbation in =adults=. In their case, however, =psycho-therapeutics= plays the principal part. In many cases here also local cauterization of the urethra and massage of the prostate may bring about a cure. =Utterly perverse= would it be to introduce youthful onanists to actual sexual intercourse, after the manner of the Parisian “soup-merchants,” as the common speech names them, who, in order to cure their youthful scholars of masturbation, take them into brothels.[426]

* * * * *

Masturbation is intimately connected with =irritable nervous weakness=, or “=neurasthenia=,” this typical disease of civilization, and more especially with the genital form of the disease, “=sexual neurasthenia=.” In an analysis of 333 cases of neurasthenia Collins and Philipp found that 123 cases--that is, more than one-third--resulted from overwork or from masturbation.[427] Freud, von Krafft-Ebing, Savill, Gattel, and Rohleder see in masturbation the true cause of neurasthenia. Fürbringer, Löwenfeld, and Eulenburg are of opinion that other injuries must also come into play in order to produce the typical picture of sexual neurasthenia. It is certain that very frequently the order of causation is reversed, =neurasthenia= being the =primary= and masturbation the secondary disorder. Masturbation is then only a =symptom= of sexual neurasthenia. The same duplex mode of consideration may also be applied to the other morbid phenomena of which the clinical picture of sexual neurasthenia is composed. Every one of these symptoms of irritable weakness, the excessive sexual excitability, the deficient sexual sensibility, the seminal discharges, and the impotence, can, like masturbation, exhibit a certain =independence=, can be induced by various causes, and may lead to sexual neurasthenia; it may be, on the other hand, that they first developed in the soil of sexual neurasthenia. It is often impossible to determine the true =beginning= of the vicious circle. It therefore appears to be more practical to describe the morbid picture of sexual neurasthenia (which we owe to Beard)[428] according to its individual symptoms, as is done also by A. Eulenburg[429] in an admirable essay, and by L. Löwenfeld in his well-known work on “The Sexual Life and Nervous Disorders.”

The =abnormal increase in the sexual impulse= (=sexual hyperæsthesia=, =satyriasis=, =nymphomania=) begins at the point at which the normal sexual impulse is exceeded; and that point is subject to wide individual variations, according to the age, race, habits, and external influences. The normal sexual impulse can also be temporarily increased by special circumstances--as, for example, by prolonged sexual abstinence, and by various kinds of erotic stimulation, without our being justified in speaking of “hyperæsthesia.” This is always an abnormal condition, which may be referred to various causes. It is more frequent in men (“satyriasis”) than in women (“nymphomania”); it may be permanent or periodic; it almost always arises from lascivious =ideas=, and, according to its cause, is accompanied by a greater or less diminution of responsibility, or even by complete lack of responsibility. The readiness with which sexual ideas give rise to an abnormally increased desire and to reaction on the part of the genital apparatus is characteristic of sexual hyperæsthesia; and this may attain such a degree that the man (or woman) may really be “sexually insane,” and, like the wild animals, rush at the first creature he meets of the opposite sex in order to gratify his lust; or he may be overpowered by some abnormal variety of the sexual impulse, so that he seizes in sexual embrace any other living or lifeless object, and in this state may perform acts of pæderasty, bestiality, violation of children, etc. In these most severe cases we can always demonstrate the existence of mental disorder, general paralysis, mania, or periodical insanity, and very often of =epilepsy= (Lombroso), as a cause. In a more chronic and milder form, sexual hyperæsthesia is observed after excessive masturbation, often also in association with a congenitally neuropathic constitution. Löwenfeld describes a peculiar form of =nocturnal= sexual hyperæsthesia occurring in married men, especially men in the forties or fifties, who for various reasons are compelled to abstain from conjugal intercourse, and who live continently. =In the daytime= these patients were free from their trouble; it appeared only at =night=. Soon, or some hours after going to sleep, a =violent, painful, enduring erection of the penis= (=priapism=) set in, which disturbed their sleep, and left them in the morning with a feeling of enervation. In such a case obviously there is a hyperexcitability of the genital erection centre. The erection results as a reflex effect of stimuli proceeding from the genital organs, but manifests itself only when, during sleep, the inhibitions proceeding from the brain are in abeyance. This nocturnal priapism may, according to Löwenfeld’s observations, last for years.[430]

Sexual hyperæsthesia in women, or “=nymphomania=,” is, in its slighter forms, also in most cases a consequence of excessive masturbation. Such women do not so much exhibit a more powerful inclination towards sexual intercourse, which, on the contrary, is incompetent to satisfy their abnormal and perverse sexual excitability. We rather see in them an impulsion to obtain new sensations in their sexual organs in any possible way. These are the women who, for example, consult the gynæcologist as often as possible, because examination with the speculum or other manipulations induce in them sexual excitement. During the climacteric--the time when menstruation ceases--such states are also met with. Nymphomania proper always develops upon the foundation of severe neurasthenia and hysteria, or of direct brain and mental disorder. Then is produced the type of the “=man-mad=” woman, as described by Juvenal in the person of the Empress Messalina, who in the brothel gave herself to all comers, without obtaining complete satisfaction of her sexual desire. Such types exist also at the present day. Thus, the brothers de Goncourt in their Diary reported the case of an old housekeeper who for several decades indulged in the most lascivious love orgies, had innumerable lovers, and a “secret life full of nocturnal orgies in strange beds, full of nymphomaniac lusts.”[431] There recently lived in Charlottenburg the wife of a workman, well known on account of her incredible sexual ardour and man-mania. Her husband, a professional stabber, was imprisoned for life. His wife often gave herself in a single day to four or five different men; every male creature that approached her she asked to perform the sexual act with her.--The following almost incredible case of this nature is reported by Trélat:

Madame V., of a strong constitution, agreeable exterior, good-natured manner, but very reserved, came under the care of Trélat on January 1, 1854. Notwithstanding the fact that she was sixty years of age, she still worked very diligently, and hardly spared herself time for meals. Nothing in her outward appearance or in her actions indicated during her stay in the asylum that she was in any way affected with mental disorder. During the four years not a single obscene word, not a gesture, not the slightest passionate movement, indicated anger or impatience.

Since her earliest years she has pursued handsome men and given herself to them. When a young girl, by this degrading conduct she reduced her parents to despair. Of an amiable character, she blushed when anyone spoke a word to her. She cast her eyes down when in the presence of several persons; but as soon as she was alone with a young or old man, or even with a child, she was immediately transformed; she lifted her petticoats, and attacked with a raging energy him who was the object of her insane love. In such moments she was a Messalina, whereas a few instants before one would have regarded her as a virgin. A few times she met with resistance, and received severe moral lectures, but far more often there was no obstacle to her desires. Although various distressing adventures occurred, her parents arranged for her marriage, in the hope thereby to put an end to the moral disturbance. But her marriage was only a new scandal. She loved her husband passionately; and she loved with the like passion every man with whom she happened to be alone; and she exhibited so much cunning and cleverness that she made a mock of any attempts at watching her, and often attained her end. Now it was a manual worker busy at his trade, now some one walking past her in the street, to whom she spoke, and whom she brought home with her on any possible excuse--a young man, a servant, a child returning from school! In her exterior she appeared so blameless, and she spoke so gently, that every one followed her without mistrust. More than once she was beaten or robbed; but this did not prevent her continuing the same way of life. Even when she had become a grandmother there was no change.

One day she enticed a boy, twelve years of age, into her house, having told him that his mother was coming to see her. She gave him sweets, embraced and kissed him, and as she then began to take off his clothes and approached him with obscene gestures, the boy strove to resist her. He struck her, and he related everything to his brother, twenty-four years of age. The brother entered the house pointed out by the boy, and abused the corrupt woman to the uttermost, saying: “In such circumstances one helps oneself, without having recourse to law, in order not to bring one’s name into disrepute by public proceedings. I hope this disturbance will teach you not to behave in this way again.” While this scene was going on, the woman’s son-in-law chanced to come in, realized the situation before there was time to tell him anything, and at once took sides with the incensed young man.

She was shut up in a convent, where she behaved in so good, sweet, amiable, and modest a manner, that no one would have believed that she had ever committed the slightest fault, and representations were made to the effect that she ought to be allowed to return to her home. All the inmates of the convent had been charmed by the zeal with which she took part in the religious exercises. When she was free again, the scandalous doings were immediately resumed, and so it went on all through her life.

After she had reduced her husband and children to despair, they finally hoped that age would extinguish the fire with which she was consumed. They were mistaken. The more excesses she committed, the more she wanted to commit, the more vigorous she appeared. It is hardly credible that such debased ideas and habits should leave intact such a sweet expression of countenance, a voice so youthful, a behaviour so full of calm repose, and a glance of such clear assurance. She became a widow. Her children, on account of her horrible mode of life, could not any longer keep her at home, and they sent her to a distant place, where they provided her with an allowance. Since she was now old, she was at length compelled to offer payment for the shameful services which she demanded; and as the small allowance she received did not suffice for this purpose, she worked with untiring zeal in order to be able to pay the great number of her lovers.

To see the old, alert woman sitting at her work, as I myself saw her, when aged seventy or upwards, without spectacles, always cleanly and carefully, but not strikingly, dressed, with a simple and honourable appearance, and an open countenance--to suspect her shameful mode of life would never occur to anyone. Several of the wretched men who were paid by her related how diligent she was. She assured Trélat of her morality, in the hope that he would discharge her, and so enable her to resume her mode of life. Trélat could not agree to this, and he succeeded in obtaining from one of these men an accurate account of her shameless loves.

This corrupt woman preserved her repose of manner, her excellent appearance, and her honourable demeanour until her death. She died at the age of seventy-four years from a cerebral hæmorrhage. There was no remarkable change in the brain (Journ. de Méd. de Paris, 1889, No. 16).

With regard to the treatment of abnormal sexual hyperexcitability, the severer forms--satyriasis and nymphomania--urgently need =asylum treatment=. In the slighter forms favourable results will be obtained by means of psycho-therapeutics, the internal use of sedatives (such as monobromide of camphor and bromide of potassium), regulation of the diet, suitable clothing and bedding.[432]

The converse of sexual hyperæsthesia is =sexual anæsthesia=, or the =abnormal diminution of the sexual impulse=. It occurs in both sexes as a =congenital= condition, owing in such cases to atrophy or absence of the genital organs, after exhausting diseases, or in consequence of arrest of development of the reproductive organs from unknown causes. This latter condition is denoted by A. Eulenburg by the name of “=psycho-sexual infantilism=.” The same author also terms sexual anæsthesia “sexual loss of appetite.” It is commoner in women than in men. It is often merely =apparent=--a pseudo-anæsthesia--because the man does not understand how to awaken the still slumbering sexual perceptions (vide supra, p. 86). Recently Otto Adler has written a comprehensive and interesting monograph on this “Deficient Sexual Sensibility in Women” (Berlin, 1904). According to him, the statement of Guttzeit, =that of ten women, four have no sensation at all “in coitu,” and submit to it without any agreeable sensation at all during the friction, and without any intimation of the intense pleasure of ejaculation=--that is, that 40 % of women suffer from coldness and lack of sensibility, from “=frigidity=”--is indeed somewhat exaggerated in respect of the percentage; but still it is a correct expression of the fact that deficient sexual sensibility is much commoner in women than it is in men, in whom Effertz,[433] for example, estimates the frequency of frigidity at only 1 %.[434] In women various circumstances explain the frequency of deficient sexual sensibility. First of all, =masturbation= lowers sexual excitability in women much more than it does in man, and, above all, it blunts sensibility for normal sexual intercourse, both by means of psychical influences and by the insensibility of the external genital organs, owing to deficient stimulation of the clitoris during normal intercourse, whereas this organ is most powerfully stimulated during masturbation. Sexual frigidity also occurs in women in consequence of maladroitness and brutality of the man in coitu, giving rise rather to pain than to voluptuous sensations, and very frequently being the cause of the first onset of the so-called =vaginal spasm=, or “=vaginismus=.”[435] It is also due in some cases to impotence on the part of the man.

In an interesting and valuable work, Carl Laker, in the year 1889, described, as “A Peculiar Form of Perversion of the Sexual Impulse in the Female” (German Archives of Gynæcology, 1889, vol. xxxiv., No. 3, pp. 293 et seq.), cases of sexual frigidity in woman in coitu, which are not to be regarded as cases of “anæsthesia sexualis,” since the =sexual impulse= was normal--indeed, frequently was increased--and it was sexual gratification in normal intercourse which was completely wanting. In these cases gratification was obtainable only by simple or mutual onanism. There existed a normal inclination towards the other sex, associated with mental and physical health. The author assumes that, in consequence of some anatomical abnormality, stimulation of the sensory nerves by which the voluptuous sensation is perceived, especially those of the clitoris, failed to occur; but perhaps by a change of posture in coitu this stimulation can still be effected. The case previously reported by me on page 86 belongs to this category of =relative= or =temporary= sexual anæsthesia; whereas in cases of genuine =absolute= sexual anæsthesia the sexual =impulse= also is in abeyance at the outset, or disappears in consequence of excesses and in female libertines and in prostitutes.

The =treatment= of deficient sexual sensibility in women must, above all, take into consideration psychical influences, and depends, therefore, more on the husband or lover than it does on the physician; the conditions of intercourse must be adapted to the particular circumstances of the case (as by change of posture in coitus, preparatory tenderness, etc.). Painful sensibility in vaginismus can sometimes be cured by mechanical treatment, by the removal of painful remnants of the hymen, by the cure of small lesions, and also by extension by means of the speculum. It also appears, as is evidenced by an observation of Courty, that at the time of impregnation there occurs a stronger stimulation and voluptuous sensation in coitu in women who are at other times frigid.

Sexually frigid women of the lower classes are apt, as Effertz points out, to become prostitutes. During the practice of their profession they always keep a cool head, because they are at first and always sexually insensitive, and can devote their whole energy and regulate all their actions towards the plunder of the man. The following case reported by Effertz (op. cit., p. 51) illustrates this connexion very clearly:

“I was once consulted by a very highly placed hetaira on account of supposed articular rheumatism. When I informed her of my diagnosis of lues, she was greatly moved, and said to me that I should not therefore think the worse of her. She was better than her occupation; she had never followed it on account of evil passions; she was quite insensitive; she had done it only in order to provide for her parents freedom from care in the evening of their life, and to secure the future of her small child. She also told me on this occasion that she owed her success to her coldness, =for which condition she was extremely thankful=. She never gave herself for less than 1,000 marks (£50). At the same time, she made a mock of her colleagues--those stupid and wicked girls who frequently, when their heads were fired by champagne, would give themselves for nothing, and would even run after men.”

Otto Adler describes Madame de Warens, in Rousseau’s “Confessions,” as a type of such a femme de glace. Frigid women marry with comparatively greater frequency than women who are sexually very excitable, because their natural reserve endows them with greater value in the eyes of men, and also offers a certain security for their faithfulness. Such marriages are naturally in almost all cases unhappy, for the man soon grasps the true nature of the case, and since most will say with Ovid, odi concubitus qui non utrimque resolvunt, he seeks outside the house some =response= for his love.[436] In some cases, indeed, frigid women make a pretence of experiencing libido and the sexual orgasm, so that the man is deceived. In some cases, also, notwithstanding a manifest frigidity on the part of the wife, the marriage is none the less happy when the husband is partially or wholly impotent, and voluntarily renounces coitus. Such a case I myself recently observed.

“The case was that of a merchant, physically and bodily in excellent health, aged a little under forty years, who, since the eleventh year of his age down to the present time, has continued to masturbate (between the eleventh and eighteenth years of his life, twice daily). He has often had ejaculation =without= erection. When twenty years of age, he frequently attempted coitus, but could not obtain an erection. Generally speaking, he never had an erection when his attention was directed to the matter, but only without his co-operation, on other occasions than those of attempted sexual intercourse. Thus, until his engagement, in the thirtieth year of his age, he had never completed normal coitus, but had only obtained sexual gratification by means of masturbation, and therefore married with considerable hesitation, although during the eleven months of his engagement he had masturbated much less frequently. On the wedding-night, however, and later, it =appeared= that his wife had a =natural disinclination to coitus=, was =extremely frigid=, and only had traces of sexual sensation when, by means of onanistic stimulation on the part of her husband, her libido was slightly stimulated. Spontaneously she never felt any desire for sexual gratification, not even in consequence of masturbation. The two have lived for seven years in =most happy= married life, and love one another tenderly, =without= ever having completed coitus. This deficient sensibility in the wife, and her failure to respond, have naturally not relieved the impotence of the husband, and he gratifies himself now, as before, by solitary masturbation.”

This case proves that the capacity for love is to a certain extent independent of the strength of the libido; frigid men and women can be thoroughly “erotic”; that is to say, they can experience the need for tenderness, just as “erotomania”--that is to say, the excessive longing for love--is completely different in its nature from satyriasis and nymphomania (= excessive sexual desire).[437]

Julius Pagel and other authors have recently drawn attention to the fact that the condition of “erotomania”--excessive amativeness--was fully described by the ancient and medieval physicians, who regarded it as a morbid state. He published (in the Deutsche Medizinal-Zeitung, 1892, p. 841) under the title, “A Historical Contribution to the Chapter of ‘Cures by Disgust,’” the translation of a passage from the Lilium Medicinæ of Bernhard von Gordon in Montpelier, a well-known and favourite compendium of the beginning of the fourteenth century, in which, following the example of Avicenna, the amor (h)ereos was numbered among the melancholicæ passiones, and was considered to constitute a particular section of the group of diseases of the brain (see the edition of the Lilium Medicinæ, p. 210 (Lyons, 1550)). It is, unfortunately, impossible here to deal at any length with the exceedingly instructive and remarkable contents. One of the methods of treatment was to find an old hag as hideous and repulsive as possible, who was to hold under the nose of the erotomaniac a chemise stained with menstrual blood, saying at the same time, talis est amica tua. We may remark, in passing, that this genuine medieval “cure by disgust” diverges, much to its disadvantage, from the manner in which in antiquity (three centuries before Christ) Erasistratos, the pupil of Aristotle, a celebrated physician of the Alexandrian school, cured the son of King Antiochus, who had fallen in love with his stepmother Stratonica. An account of the ancient therapeutic art is also to be found in another work by J. Pagel, “Introduction to the History of Medicine” (Berlin, 1898). In a comprehensive work, “The History of Love Considered as a Disease,” this topic has recently been considered by Hjalmar Crohns. Here we have a theme the literature of which is very extensive, and which might be suitably dealt with in a special treatise.

In the male, sexual frigidity in the majority of cases is associated with sexual weakness or with impotence--that is to say, with the impossibility of copulating or of procreation. The former variety of sexual incapacity (impotentia cœundi) is, properly speaking, peculiar to the male. The second form--true “sterility” (impotentia generandi)--occurs in women as well as in men.

In the case of male impotence, various symptoms, preliminary disturbances, and associated phenomena, make their appearance, and these we shall have to describe separately, since they often occur as independent disorders.

This is, above all, true of the =outflow of sexual secretions from the urethra=, =seminal losses= (=pollutions=[438] and =spermatorrhœa=), and the evacuation of the =secretion of the prostate gland=, the so-called “=prostatorrhœa=.” The literature of these conditions, which are partly physiological (as a proportion of pollutions) and partly morbid, is enormous. Of fundamental importance, notwithstanding the serious exaggerations of the author, is the celebrated work of Dr. M. Lallemand, “Involuntary Losses of Semen.” In recent times this important province of sexual pathology has been more especially advanced by the researches of leading German physicians, above all by those of Curschmann and Fürbringer.

The most important question with regard to seminal losses or pollutions in any case is this: have we to do with physiological processes, lying within the range of health, or have we to do with morbid processes?

As normal, not morbid, seminal losses Lallemand regarded pollutions in =healthy, sexually mature, continent= individuals, occurring =spontaneously during sleep=, associated with =erection= of the penis and voluptuous sensations. He rightly regarded these as physiologically necessary, indicated their purpose to be the discharge of sexual tension, the prevention of an excessive accumulation of the reproductive products, and compared their effect with that of hæmorrhages from the nose, which are so common in youth, and in most cases are distinctly beneficial. But he drew attention to the =indeterminate, fluctuating boundary-line= between normal and morbid pollutions. This latter point of view is dealt with also by Eulenburg (“Sexual Neurasthenia,” p. 171), in opposition to other authors who regarded all pollutions, even the physiological, as abnormal. In practice, however, it is generally not difficult to distinguish between physiological and morbid seminal losses. The former are characterized, not only by the distinctive signs already mentioned, but also by their occurrence =at longer intervals=, and by the =absence= of any disadvantageous effect upon the general state of health. As soon as pollutions have such a deleterious influence they are morbid; and they are generally morbid when they occur abnormally =early=, before puberty, with abnormal =frequency=, at abnormal =times of the day=, and in association with abnormal =conditions of the genital organs=. According to Fürbringer, the normal intervals between pollutions in the case of continent youths vary between ten and thirty days. Löwenfeld considers pollutions occurring once a week, and even the transient occurrence of pollutions on several successive nights, as a result of sexual excitement, as being still within normal bounds. But if these repeated pollutions within a single week, or even within a single day, continue =for a long time=, we are always concerned with morbid pollutions. These sometimes occur not only at night, but also--a fact to which the German physician Wichmann, in his dissertation De Pollutione Diurna (Göttingen, 1782), drew attention--they occur =by day= (“diurnal pollutions”), in the waking state, without masturbation or coitus, upon slight mechanical or physical stimulation. In such cases erection of the penis is often completely =wanting=; ejaculation of the semen takes place with the organ flaccid, and even without any voluptuous sensation. In many cases, indeed, these pollutions are accompanied by actual =painful= sensations in the genital organs, and instead of voluptuous dreams or thoughts, the nocturnal ejaculation is accompanied by anxious dreams, the daylight pollution by an extremely disagreeable sensation. Commonly in these pollutions ordinary semen is at first evacuated--a mixture of the secretions of the testicles, the prostate, the vesiculæ seminales, and Cowper’s glands--containing numerous =spermatozoa=. After the trouble has lasted a long time the semen becomes thinner (owing to its containing a smaller proportion of the thick testicular secretion) and more transparent; the spermatozoa are less numerous and mostly undeveloped, and ultimately they may be completely absent. Löwenfeld observed a peculiar form of pollution in which the semen was ejaculated only in drops, or might be =completely wanting=--that is to say, there might be a pollution =without= ejaculation, purely a voluptuous orgasm.[439]

In such cases Löwenfeld was able to prove that it is not the loss of semen which weakens, as Lallemand assumed, but that it is the =nervous disturbance= of the lumbar spinal cord which plays the principal part. This irritable weakness of the lumbar spinal cord may have existed for a long time before, or may have developed only as the result of repeated pollutions or of excessive sexual excitement; it may give rise, not only to proper seminal emissions, but, in addition, to “=spermatorrhœa=”--that is to say, to the =outflow of semen accompanying urination or defecation=; and it may also cause the rarer “=prostatorrhœa=”--the outflow of the secretion of the prostate gland. A long duration of all these morbid discharges has a serious effect on the health, and induces the typical picture of sexual neurasthenia. As a =cause= of seminal losses we must mention masturbation, excessive sexual intercourse, chronic inflammation of the urethra (especially after =gonorrhœa=), stricture of the urethra, rectal affections, alcoholism, diabetes, and tabes dorsalis.

In =women=, also, =processes analogous to pollution= may be observed, although much more rarely than in men, and generally as a consequence of masturbation practised for several years. According to Adler (op. cit., p. 130), pollutions--that is to say, evacuations of the secretion of the vaginal glands and of the uterine mucous membrane, as well as of the secretion of Bartholin’s glands near the vaginal inlet--never occur in chaste and intact virgins, but only in women who have already learned the enjoyment of sexual intercourse, and who are subsequently compelled to lead a continent life. For this reason pollutions are a “trouble of young widows,” and occur in young girls only when they have learned to know the nature of sexual pleasure by means of masturbation. Eulenburg remarks (“Sexual Neurasthenia,” p. 174):

“In connexion with lascivious dreams there occur spontaneous, more or less abundant, discharges of the clear muco-gelatinous secretion of the glands. These form a striking manifestation of sexual neurasthenia in women, and can be compared with the morbid pollutions occurring in similar circumstances in male neurasthenics. We hear less about them, however, and they are insufficiently known, even by medical men. For this reason especially, when they occur in association with physical virginity and a normal genital condition in other respects, they do not usually receive sufficient attention.”

The older physicians, especially those of the eighteenth century,[440] described these pollutions in women very well and thoroughly; in erotic and pornographic literature they have always played a great part. An interesting observation on peculiar processes analogous to pollutions is reported by Paul Bernhardt.[441] A hysterical sempstress, twenty-five years of age, as the result of any kind of =annoyance=, experienced sexual excitement completely resembling the sensation of sexual intercourse, and ending with a discharge of mucus. This was, however, never accompanied by any trace of voluptuous sensation; on the contrary, it gave rise to lumbar pains. Also, when she dreamed of anything =disagreeable= or had =nightmare=, this condition recurred. Erotically the patient is very indifferent, and denies the practice of masturbation.

To the category suggested by P. Bernhardt of sexual excitement induced by anxiety and trouble belongs the case reported to me by Dr. Emil Bock of a boy of fifteen years of age, who, when very anxious about his inability to complete a school task, experienced an ejaculation for the first time. To the literature of impotence belongs the work by Nicolo Barrucco, “Sexual Neurasthenia, and its Relations to the Diseases of the Genital Organs.” Regarding physiological pollutions, and the trifling difference between them and normal seminal discharge during coitus, Schopenhauer makes some apt observations in his “Neue Paralipomena,” pp. 230, 231.

In the =treatment= of pollutions, which always demands the most careful medical observation and examination of the individual case, the most important measures are =dietetic and hygienic treatment=, =change of scene= from town to =country=, and especially to =mountain air=, methodical =hydrotherapeutic measures=, =warm baths=, =massage=, =electricity=, =hyperalimentation=, the use of =bromides=, =local treatment of the urethra=, etc., etc.

The last and most important of the phenomena connected with sexual neurasthenia is =sexual weakness= or =impotence= in its various forms.[442]

We distinguish in the male =two principal forms= of impotence: (1) “=Impotentia coeundi=”--that is, incapacity for erection of the penis and the completion of coitus; (2) “=impotentia generandi=”--that is, the impossibility of fertilization (owing to want of semen or to the lack of fertilizing quality in this fluid).

Congenital malformations of the genital organs giving rise to impotence are extremely rare. Gyurkovechky, amongst 6,000 men fit for military service, found three such men only. More frequently are =acquired= defects met with as causes of impotence, such as complete or partial loss of the penis and testicles, as in eunuchs and castrated persons. It is well known that, notwithstanding the removal of the external genital organs, sexual desire may persist; and when the penis is retained, though the testicles have been removed, erection and copulation are possible, providing the castration was effected after puberty. But it is obvious that in most cases potency is very markedly interfered with, and ultimately it may entirely disappear. More light is thrown on the question by the occurrence of impotence after =unilateral= castration. A tragical case of this latter kind is reported by von Gyurkovechky (op. cit., p. 71):

“A former colleague of mine at the University of Vienna had to have one of his testicles removed in consequence of obstinate inflammation resulting from gonorrhœa; thereafter the second testicle underwent complete atrophy. The much-to-be-pitied, handsome, elegant, and amiable young man remained for some years capable of performing coitus, was greatly pleased with himself for this reason, and paid ostentatious court to ladies. Still, he was seldom in a position to perform coitus, and after three years he completely withdrew himself from the society of ladies, and became gradually morose and reserved, until one day he disappeared from Vienna, discontinued his studies, and never let any of us hear from him again. This case has remained very vividly in my memory, and it illustrates most clearly the influence of virile potency upon the entire being of the individual.”

If the second testicle remains intact, the capacity for sexual intercourse is not interfered with; and reproductive capacity also persists, although it may be diminished in degree.

An important source of sterility in the male, in which the capacity for sexual intercourse remains unimpaired, is =bilateral epididymitis=, consequent upon =gonorrhœa=. This represents more than 50 % of all the cases of incapacity for procreation in the male. Finger found in 85 % of cases of epididymitis that the =spermatozoa were absent from the semen= (the so-called “=azoospermia=”); and Fürbringer is led by his own experience to believe that 80 % of men who have had double epididymitis are incapable of procreation. Thus we may really speak of “=gonorrhœal sterility in the male=.” In many sterile marriages the fault lies with the husband, as was first clearly proved by F. Kehrer’s fundamental investigations. And the no less momentous gonorrhœal sterility in women is also, in the majority of cases, ultimately dependent upon the husband, who has presented his wife with “gonorrhœal infection as a wedding gift.”[443]

An extremely =small size= of the penis, also a =relatively small size= of this organ in cases of obesity and tumours, =malformations= of the penis, also the by no means rare mechanical hindrances to erections due to injuries and indurations in the corpora cavernosa (especially as a result of gonorrhœal inflammation)--all these may make coitus impossible. Fürbringer and Finger have also seen peculiar chronic shrinking processes of the corpora cavernosa occur independently of gonorrhœa and tumours. All these conditions give rise to =incomplete= erection, in which the penis is bent at an angle at some point or other, or is curved, so that it cannot be introduced into the vagina (chordee).

All the hitherto described forms of impotentia coeundi are less frequent than those =in which the external genital organs are completely intact=, and in which we have to do simply with =imperfection= or =complete failure of erection= in consequence of various =general disorders=.

Erection of the penis is induced both =centrally= from the brain (by voluptuous ideas), and from the spinal cord (by direct stimulation), and also =peripherally= from the genital organs (by friction of the glans penis), by stimuli proceeding from the urethra, bladder, prostate, seminal vesicles, rectum, and the neighbourhood of the genital organs (as, for example, the buttocks), and may be either of a morbid or of a physiological character. When there are inflammatory conditions of the genital organs, especially gonorrhœa of the anterior and posterior urethra, erections occur very readily. From the full bladder there also proceed stimuli giving rise to erection, thus inducing the well-known “=morning erection=,” utilized by many who would otherwise be completely impotent. Blows on the buttocks also give rise to erections--a subject to which we shall return when we come to discuss flagellation.

The =nature= of erection can be very briefly described as consisting in a stiffening of the penis by the profuse =streaming of blood= into the =reticular spaces= of the =corpora cavernosa=, enlarged by =stimulation= of the =erection nerves=. The consequent erection of the penis is dependent upon the action of a particular muscle--the ischio-cavernosus muscle.

Impotence when the external organs are intact is in most cases due to central causes, and ultimately to psychical causes, even though severe bodily affections or local morbid states play a predisposing part (the so-called “=functional impotence=”).

This impotence is sometimes one of the =earliest= symptoms of =diabetes mellitus= and of =chronic Bright’s disease with contracted kidney=, also of =severe conditions of exhaustion=--to which consumption offers a significant exception, signalized already by the old saying, phthisicus salax--of =obesity=, and of =tabes dorsalis=, in which the sexual potency gradually disappears, but libido outlasts the capacity for erection. Certain =poisons= also particularly damage potency. This is especially the case with =alcohol=, the deleterious influence of which on potency has already been described (pp. 293, 294). Georg Hirth goes so far as to recognize a special “=impotentia alcoholica=.”

“Above all, no alcohol,” says he, “especially not as a means for producing erection. In youth a man needs no such stimulus, and in age he will be apt to find, with the porter in Shakespeare’s ‘Macbeth’ (Act ii., Scene 3), that ‘drink may be said to be an equivocator with lechery,’ for, as he says, ‘it provokes the desire, but it takes away the performance; it makes lechery, and it mars him; it sets him on and takes him off; it persuades him and disheartens him; makes him stand to and not stand to: in conclusion, equivocates him into sleep, and, giving him the lie, leaves him.’”[444]

Fürbringer’s view, that alcohol, taken up to the degree of slight intoxication, rather increases potency, in connexion with which he refers to sexual invalids who are only able to perform sexual intercourse in a state of moderate intoxication, cannot be regarded as generally true. It is possible that in these admitted sexual invalids alcoholic intoxication overcomes =stronger psychical inhibitions=, which in the state of sobriety had hindered erection. For the normal individual alcohol is not a means for the increase of sexual potency, but the reverse.

=The free use of tobacco= certainly also impairs sexual potency.[445] Nicotine and love are as little compatible as alcohol and love. Fürbringer, Hirth, and Eulenburg, ascribe to the excessive use of tobacco a diminution in sexual potency. The following interesting passage is from the Diary of the De Goncourts (op. cit., p. 89):

“=There is an antagonism between tobacco and women. The taste for one diminishes the taste for the other=. So true is this, that passionate Lotharios usually give up smoking, =because they feel or believe that tobacco diminishes their sexual appetite and their powers of love=.”

=Coffee= and =tea=, taken in excess, and, above all, =morphine=, are also antagonistic to potency. Dupuy has observed the frequent occurrence of impotence in men who were in the habit of drinking large quantities of strong coffee (five or six breakfast-cups every day). Sexual potency returned as soon as the use of coffee was discontinued; whilst when the use of the beverage was resumed the impotence again appeared (Comptes Rendus de la Société de Biologie, 1886, No. 27).

The majority of cases of functional disturbances of potency depend upon nervous impotence. It is the form which at the present day the physician most frequently encounters. It is intimately connected with the state of “irritable nervous weakness,” or sexual neurasthenia, the most important symptom of which is represented by “psychical” impotence. There exist, also--and this justifies the independent consideration of psychical impotence--numerous cases of impotence =without= neurasthenia (Fürbringer). This remarkable form occurs especially in perfectly =healthy= young =husbands=, who often before were completely potent, and had previously effected coitus in a perfectly normal manner, or had lived a quiet, continent life, without having injured themselves in any way by masturbation. Such individuals, in consequence of the excitement, shame, and embarrassment of the wedding-night, often suffer from psychical impotence. Réti[446] speaks of “=impotence due to compassion=,” arising from “the sympathy felt with the pains suffered by the still virgin wife” when the attempt at coitus is made.

“The young married pair kiss one another and vie with one another in tenderness, but when the matter becomes serious--when the husband wants to enjoy his rights as a husband--the wife experiences incredible anxiety; she trembles in all her limbs, writhes, screams, and weeps. The man becomes exhausted, and at length, when the wife is resigned, and willing to surrender herself to her fate, he has become unfitted for his share in intercourse.”

It is clear that these forms of psychical impotence, which appear in very various shades, are mostly transient phenomena, and exhibit a good prospect of complete cure.

Much more difficult is the matter when we have to do with cases, becoming commoner every day, of psychical impotence in consequence of =sexual perversions=. Sadistic, masochistic, fetichistic, and homosexual inclinations may, in certain individuals, predominate to such an extent that either copulation cannot be effected without the =preliminary= gratification of these perverse instincts, or else the latter =entirely usurp the place= of normal coitus, which has become, generally speaking, quite impossible (relative and absolute psychical impotence in consequence of sexual perversions). To the former category belong, for example, those cases, which are by no means rarely seen, in which homosexual persons are only able to have intercourse with their wives after preliminary caresses by their male friends; or masochists must be subjected to a preparatory flagellation in order to become potent. In the second category copulation has become quite impossible; the orgasm takes place only in connexion with the activity of the perverse impulse, and there often exists an actual repugnance to normal coitus.

Well known also is that rare relative psychical impotence in which the man can perform coitus only with =prostitutes=, whereas he is impotent as regards decent women. This, however, may often be associated with the existence of sexual perversions, which are gratified only during intercourse with prostitutes.

Another form of relative psychical impotence is =temporary= impotence, in which the potency is entirely subject to =custom=, and a change in the custom induces impotence. Thus, Frenzel reports the case of a man who had always had intercourse with his wife immediately on going to bed, and proved completely impotent when this habit was interrupted, and he now wished to perform the act early in the morning. Only gradually did he recover his lost potency and become able to adapt himself to the changed conditions.[447]

Another form of impotence by no means rare, and occurring in otherwise healthy men, is that produced by powerful =mental= activity or =artistic= production, the impotence of literary men and of artists. It is usually of a transient nature,[448] manifesting itself only during the periods of intellectual activity, and it is explicable in accordance with the law of sexual equivalents, according to which the sexual potency appears in the latent form of spiritual productive activity. A remarkable case of this impotence of literary men is reported by the just quoted Frenzel.[449] Allied with this variety of impotence is the form due to transient =mental distraction=, to =instantaneous ideas=, which suddenly act as psychical inhibitions. These sudden ideas can be of a very varied content--joyful, sad, anxious, annoying; in every case they are capable of annulling the =already existing potency=, and of making the further erection of the penis impossible. Such conditions occur alike in healthy persons and in those who are readily excitable and neurasthenic. A classical instance of this nature is J. J. Rousseau’s adventure with the Venetian courtesan Giulietta, which he describes very vividly in his “Confession.” He went to see her full of passionate desire for sexual enjoyment, but Nature “had put into his head a poison against this unspeakable happiness” for which his heart yearned. Hardly had he glanced at the beautiful girl than an idea came to him which moved him to tears, and completely diverted him from his purpose. He became more deeply absorbed in this idea, the sexual desires completely disappeared, and he was no longer in a position to prove his manhood. To this tragi-comic episode we owe the exclamation of the disappointed girl, which has passed into a proverb: “Lascia le donne e studia la matematica” (“Leave women alone, and go and study mathematics”). In the =reflective love= of Kierkegaard, Grillparzer, Alfred de Musset, and other men of remarkable genius, there is also recognizable an element of impotence.

The majority of all cases of impotence belong to the class of true =nervous, neurasthenic= impotence, and these are diffused especially among the circles who supply the greatest contingent to the ranks of neurasthenics in general--that is, among officers, merchants, physicians, and other classes of the cultured part of our population whose professional duties are arduous. Among the causes of neurasthenic impotence, excessive masturbation and chronic gonorrhœa, with its consequences, play the principal part. Neurasthenic impotence manifests itself, above all, by abnormal conditions of erection and ejaculation, either of which may by itself be diminished or completely prevented; or, again, both may exhibit abnormalities, whilst in some cases even erection may be =very frequent=, =unusually powerful=, and =long-lasting= (the so-called “=priapism=”), whilst ejaculation and voluptuous sensation are completely wanting, and these erections are in most cases accompanied by very =painful= sensations. An extremely characteristic symptom of nervous impotence is a =premature discharge of the semen=, not merely ante portas, but often even at the first signs of activity of the libido sexualis, at which time erection may be very well developed. In other cases, again, erection occurs, but no ejaculation of the semen. Finally, both may be completely wanting (the so-called “=paralytic impotence=”).

* * * * *

The following cases, which came under my own observation, show some of the above-mentioned types of impotence:

1. A man, twenty-nine years of age, married for ten months, complains, after obviously excessively frequent enjoyment of his conjugal rights, of a sense of weakness and weariness after intercourse, such as he has never previously experienced, as well as of a continually earlier ejaculation, latterly even on simple contact of his penis with the vulva. Erection is always present and is powerful. On further inquiry he admitted that in his four-weeks’ honeymoon he had connexion once daily, and thenceforward two or three times a week.

2. A man, twenty-one years of age, states that a year and a half ago for the first time he endeavoured to have sexual intercourse; he has never yet succeeded in completing coitus. Since the age of fourteen years he has suffered from frequent pollutions and from marked sexual excitability. He has often tried to effect coitus, but there has always resulted precipitate ejaculation, with his penis in a flaccid condition. He has, properly speaking, only morning erections, dependent upon a full bladder. It is possible that a marked varicocele on the left side has something to do with the genesis of this impotence.

3. A man, forty-eight years of age, has noticed for some years a distinct decline in sexual potency. Ejaculation always occurs shortly before immissio membri, when the penis is flaccid or only semi-erect. If erection is complete, on the other hand, then ejaculation fails to occur.

Very peculiar, and offering a kind of analogy to vaginismus in women, is impotence consequent upon =excessively painful sensibility of the glans penis=, as a result of sexual neurasthenia or of local inflammatory processes (balanitis, etc.). The pains during coitus in these cases are often so severe that those thus affected completely abandon any attempt at intercourse.

The question =whether impotence can result from sexual abstinence= is still disputed. Fürbringer does not know of any certain cases. According to Virey,[450] by “complete and continuous abstinence from intercourse” in the male the organs by which the semen is prepared--the testicles, the seminal vesicles, and the vasa deferentia--and also the penis, become smaller, “unsightly, wrinkled, and inactive.” Galen reports the same of the athletes of the Roman Empire, men who had to live a life of strict continence. Virey alludes to an “extremely chaste saint, in whom after death no trace of genital organs could be discovered” (!). That absolute abstinence must ultimately limit potency, if only by psychical means, is a priori probable.

Recent observations confirm the view that long-continued absolute sexual abstinence exercises a harmful influence upon potency, and especially upon potentia coeundi. As a proof of this, I may more especially mention two cases of University professors, not yet thirty years of age, both of whom until a little while ago had had no experience of sexual intercourse, one having remained continent during two years of married life! Quite recently both of them repeatedly attempted normal coitus, but with complete failure quoad erectionem. Von Schrenck-Notzing[451] also reported a case of this character not long ago, in which, notwithstanding the strong desire for normal sexual intercourse, in the case of a literary man thirty-five years of age, who prior to marriage had lived a life of =complete abstinence=, and had never practised masturbation, every attempt at coitus proved a failure.

Finally, we have to consider the more or less physiological =presenile and senile impotence= which accompanies the commencement of old age, but naturally occurs at very different times in different individuals, for some men are already old at the age of forty years, and others are not yet old at the age of seventy years. Von Gyurkovechky dates the first decline in the sexual powers from the fortieth year of life, and considers that normally these powers are completely extinguished at about sixty-five years. But there are numerous exceptions. Complete potency in respect of libido, erection, and ejaculation has been observed in men of seventy and eighty years; and isolated cases have even been recorded in which men of ninety and one hundred years have procreated children.[452] In the sense of Metchnikoff and Hirth, who in their writings proclaim the prevention of senility as a hygienic ideal, this physiological potentia senilis is no Utopia, and a future scientific macrobiotic will defer the onset of old age by from ten to twenty years.

“I do not ask,” says Georg Hirth, “that the man in advanced age should play with his sexual powers; but that he should possess =the consciousness of being able to use them=--that I do demand” (“Ways to Love,” p. 462).

The treatment of impotence in the male in its various forms is indeed a difficult matter in individual cases, more especially in view of the great number of existing methods of treatment; but treatment promises good results when it is based upon an exact, critical, individual analysis of the separate causes and symptoms. It is partly =local= and partly =general=. In the case of impotence resulting from excessive masturbation, or in the case of the well-known “gonorrhœal” impotence, good results will be obtained from =slight cauterization of the urethra= and =massage of the prostate=, =local carbonic-acid douches= or carbonic-acid baths, =warm or cold sitz-baths, or electrical treatment=, with which, however, great care must be exercised. In some cases imperfect erection will be benefited by the application of a 10 % =ethereal solution of camphor=, in the form of friction or a spray, to the entire genital region. Mechanical apparatus have also been employed to favour erection, as, for example, the so-called “=schlitten=,” consisting of a conducting instrument for an insufficiently erect penis, made up of two thin, suitably shaped laminæ of metal, or the “=erector=” of Gassen, which works in a similar manner. Apparatus of this nature are useful only to this extent, that they give the penis a certain purchase. We cannot allow that they possess any other effect, any more than Gassen’s other apparatus, the “compressor,” the “cumulator,” and the “ultimo” (Löwenfeld, Fürbringer). Any local changes that can be detected as having some connexion with the occurrence of impotence must receive attention. This is obvious; and no less obvious is the treatment of any general disorders which may give rise to the impotence. As regards the general treatment of impotence, =psychical= influence must first be considered. =In most cases= this must take the form of temporary withdrawal of the thoughts from the sexual sphere in general, for which the strict prohibition of sexual activity (masturbation, etc.) forms the foundation; in addition, =will= and =self-confidence= must be strengthened. In these matters an intelligent wife can do much to supplement the work of the physician. Sometimes a mere =change= in the mode of life or in the relations between husband and wife, above all, a change in the mode of performing sexual intercourse (a change in posture, greater responsiveness on the part of the wife, etc.), may have a manifest curative influence. The treatment of the neurasthenia which may have caused the impotence will also have a favourable effect. Alcohol and tobacco are best entirely forbidden. Innumerable =drugs= have been recommended for the treatment of impotence. The belief in the beneficial effect of cantharides is as much a superstition as the belief in the aphrodisiac action of celery, asparagus, caviare, and truffles. Certainly all these may cause excitement of the genital organs, but this is merely due to an increased flow of blood to these organs, which is of a very fugitive nature, and when the effect is often repeated (especially when cantharides is used for this purpose), it may have serious consequences. The influence of these substances may be compared with the purely stimulating effect of flagellation. More confidence may be placed in =phosphorus=, =strychnine=, and, above all, in =yohimbin=, a drug prepared from the bark of a West African tree,[453] which is warmly recommended in cases of neurasthenic impotence by Mendel and Eulenburg. Having myself seen good results from the use of Yohimbin Riedel in two cases of pre-senile gonorrhœal impotence, I can confirm the favourable judgment of Eulenburg. In the case of pre-senile impotence in a man nearly sixty years of age yohimbin was the only means which, after several years’ intermission, enabled him once more to have erections, and repeatedly to perform coitus. Eulenburg reports the case of a man, which is probably unique, in whom, =after a few days’ use=, yohimbin restored sexual potency after he had been impotent for twelve years! This interesting drug is certainly a valuable enrichment of our aphrodisiac armamentarium, and the first drug of this nature to which the name of a specific against impotence can justly be given.

Quite recently Eulenburg, Posner, Nevinny, and others, have warmly recommended as a true specific in cases of functional impotence a combination of lecithin with the active principle of the Brazilian plant Muira Puama. This new drug is by Eulenburg termed “muiracithin.”

From the above-described individual troubles (masturbation, sexual hyperæsthesia, sexual anæsthesia, pollutions, and impotence) is composed the clinical picture of =sexual neurasthenia=, which, however, is manifested also by other symptoms, among which we must mention certain =perceptions of anxiety= and certain =coercive ideas=, such as the condition, known also to the laity, of =agoraphobia=, which is very frequently met with in sexual neurasthenia; also the fear of travelling alone by railway, or sudden anxiety in the theatre or concert-hall, in the form of the fear of fire, with the accompanying irresistible impulse to rush out into the open; further, =lumbar pains= and =neuralgia of the genital organs=, and =anomalies= and =pains connected with the evacuation of urine=; =an inclination to sexual perversions=; =gastric affections=,[454] such as nervous retching and vomiting, painful cramps of the stomach, loss of appetite, also excessive hunger, nervous dyspepsia, etc.; =migraine= and =heart troubles= of manifold kinds. It is not to be wondered at that when sexual neurasthenia is markedly developed, and when several of the above-described manifestations occur, the disease may pass on into a condition of complete =mental exhaustion=, associated with =morbid irritability= and =hypochondriacal= and =melancholy= ideas. We then ultimately see the development of typical =sexual hypochondria=.

The treatment of sexual neurasthenia--which in the last-described general symptom-complex occurs also in women, associated in their case with =amenorrhœa=, =dysmenorrhœa=, or =menorrhagia=[455]--consists for the most part in the already described treatment of the individual symptoms. In addition, we have to make use of hyperalimentation, =hydro-therapeutic methods=, =gymnastic= treatment, general =massage=, and =climatic= cures.

[396] Havelock Ellis, “The Sexual Impulse and the Sense of Shame.”

[397] Fürbringer’s article, “Masturbation,” in Eulenburg’s Real-Enzykldopädie der gesamten Heilkunde, vol. xvii., p. 523, third edition (Vienna and Leipzig, 1898).

[398] Metchnikoff, “The Nature of Man,” pp. 95-99.

[399] A French erotic work describes how an impotent man, in the hope of obtaining an erection, allowed a cockchafer to crawl about his penis.

[400] Probably the following case of an onanist, sixty-four years of age, is unique. It is reported by A. Wild (“A Contribution to the Refinements of Masturbation,” published in the Münchener Medizinische Wochenschrift, No. 11, 1906). He introduced a twig of a pine-tree into the urethra, and in such a way that when the attempt was made to draw it out, the pine-needles acted as barbs; consequently the twig broke off short, and it was necessary for the medical man to remove it with the aid of dressing forceps!

[401] Cf. the complete historical and literary account of godemichés, given in my “Sexual Life in England,” vol. ii., pp. 284-292 (Berlin, 1903).

[402] Cf. the explanation of this passage by Iwan Bloch, “Were the Ancients aware of the Contagious Character of Venereal Diseases?” published in the Deutsche Medizinische Wochenschrift, No. 5, 1899.

[403] S. Freud, “Three Papers on the Sexual Theory,” pp. 37, 42 (Leipzig and Vienna, 1905).

[404] R. Kossmann, “Is the Medical Man Justified in Recommending Extra-Conjugal Sexual Intercourse?” published in the Journal for the Suppression of Venereal Diseases, 1905, vol. iii., p. 126.

[405] Cf. R. Thomalla, “Masturbation in the School: its Consequences and its Suppression,” published in the Journal for the Suppression of Venereal Diseases, 1906, vol. v., pp. 63-68.

[406] H. Ellis, “The Sexual Impulse and the Sense of Shame.”

[407] Gustav Aschaffenburg, “The Relations of the Sexual Life to the Origin of Nervous and Mental Disorders,” published in the Münchener Medizinische Wochenschrift, 1906, No. 37, p. 1794.

[408] Metchnikoff, “The Nature of Man” (English edition), p. 96.

[409] A. Eulenburg, “Sexual Neuropathy,” p. 80 (Leipzig, 1895).

[410] Otto Adler, “Deficient Sexual Sensibility in Woman,” p. 112 (Berlin, 1904). Mendel observed excessive masturbation in hypochondriacal women (Deutsche Medizinal-Zeitung, 1889, No. 15, p. 180).

[411] L. Löwenfeld, “The Sexual Life and Nervous Disorders,” fourth edition, p. 114 (Wiesbaden, 1906).

[412] Eduard Reich, “Immorality and Immoderation,” p. 122 (Neuwied and Leipzig, 1866).

[413] Felix Roubaud, “Treatise on Impotence and Sterility in Man and Woman,” third edition, p. 7 (Paris, 1876).

[414] W. A. Hammond, “Sexual Impotence in the Male and Female Sexes.”

[415] A. von Schrenck-Notzing, “Therapeutic Suggestion in Cases of Morbid Manifestations of the Sexual Sensibility,” pp. 66, 67 (Stuttgart, 1892).

[416] Cf. Havelock Ellis, “The Sexual Impulse and the Sense of Shame,” pp. 184-186.

[417] Iwan Bloch, “Contributions to the Etiology of Psychopathia Sexualis,” vol. ii., pp. 107, 108 (Dresden, 1903).

[418] On p. 18 of his treatise he goes so far as to say: “There is no disease of the body or the mind which cannot be referred to masturbation.”

[419] Eulenburg refers also to “Persönliche Schutz,” by Laurentius; the “Jugendspiegel,” by Bernhard; the “Johannistrieb,” by B. Mohrmann; the “Krankheit der Welt,” by A. Damm.

[420] According to A. Jacobi (“The History of Pædiatry, and its Relation to Other Arts and Sciences,” p. 66 (Berlin, 1905)), this is not true of quite young children, at ages of from one to ten years, in whom masturbation does less harm than in half-grown or adult individuals.

[421] Cf. H. Rohleder, “Die Masturbation,” pp. 185-192 (Berlin, 1899).

[422] Cf. L. Löwenfeld, op. cit., p. 137.

[423] A. Tardieu, “Étude Médico-Légale sur les Attentats aux Moeurs,” p. 114 (Paris, 1878).

[424] Cf. my “Contributions to the Etiology of Psychopathia Sexualis,” vol. i., p. 135.

[425] Von Schrenk-Notzing, op. cit., p. 9.

[426] Cf. A. Weill, “The Laws and Mysteries of Love,” p. 101 (Berlin, 1895).

[427] Havelock Ellis, op. cit., p. 266.

[428] G. M. Beard, “Sexual Neurasthenia,” second edition (Leipzig and Vienna, 1890).

[429] A. Eulenburg, “Sexual Neurasthenia,” published in Deutsche Klinik, 1902, vol. vi., pp. 163-206.

[430] L. Löwenfeld, op. cit., pp. 273, 274.

[431] Edmond and Jules de Goncourt, “Leaves from a Diary.”

[432] “During my life I have had under observation many a lecherous man and many a wanton woman, and I have always found that, without exception, voluptuous persons clothe themselves very warmly, and sleep under very warm bed-clothes. In earlier years I have reported several cases observed by me of warm clothing of the genital organs on the part of women who distinguished themselves by lasciviousness, and I could increase the number of examples of this kind by several dozen” (E. Reich, “Immorality and Intemperance,” pp. 43, 44).

[433] O. Effertz, “Neurasthenia Sexualis,” p. 46 (New York, 1894).

[434] Effertz estimates the frequency of frigidity in women at about 10 per cent. The truth probably lies midway between the views of Effertz and those of Guttzeit.

[435] By vaginismus we understand involuntary convulsive contraction of the vaginal muscles, associated with abnormal sensibility of the vaginal inlet, dependent on masturbation, or induced by the above-mentioned painful sensations and injuries which occur in maladroit and brutal coitus (this is by far the commonest cause of vaginismus), especially when the penis is very large and the vaginal inlet very small, or when the female genital organs are further forward than usual. Vaginismus generally arises from small injuries and lacerations, produced in this manner; with the physical sense of pain is associated also psychical anxiety with regard to renewed attempts at intercourse; and in this way the reflex spasm is produced. Sometimes the vaginal spasm does not begin until after the penis has been introduced, so that this organ is retained (penis captivus). A few years ago a remarkable case of this kind occurred in Bremen. One of the dock labourers was having sexual intercourse in an out-of-the-way corner of the docks, when the woman became affected with this involuntary spasm, and the man was unable to free himself from his imprisonment. A great crowd assembled, from the midst of which the unfortunate couple were removed in a closed carriage, and taken to the hospital, and not until chloroform had been administered to the girl did the spasm pass off and free the man!

[436] A very clever study of the conditions here described will be found in a recent English novel, “Mr. and Mrs. Villiers,” by Hubert Wales (Heinemann, London, 1907).--TRANSLATOR.

[437] Rozier describes two typical examples of feminine erotomania (“The Secret Aberrations of the Female Sex,” pp. 123-128; Leipzig, 1831).

[438] POLLUTIONS.--This term has not perhaps as yet acquired a right of residence in the English tongue, but I use it because it is needed. There is no other word which can be employed as a general term (1) to include all involuntary emissions of semen, whether nocturnal or diurnal; and (2) to include involuntary sexual orgasm in the female as well as in the male. In the female the term “seminal emission” is inapplicable; but the term “pollution” can be applied in English (as it is in German) to either sex. By American writers the term “pollution” is now generally used (see, for instance, Allen, “Disorders of the Male Sexual Organs,” Twentieth Century Practice, vol. vii., p. 612 et seq.).--TRANSLATOR.

[439] L. Löwenfeld, op. cit., pp. 206, 207.

[440] Swediaur relates: “I have, although much more rarely, seen the aforesaid diseases also in the other sex” (he speaks of diurnal pollutions). “At the present time I have under treatment a woman, twenty-eight years of age, who for a year and a half, since the time when she had a miscarriage, suffers from very frequent involuntary nocturnal pollutions, which are induced by very voluptuous dreams, and are accompanied by all the symptoms of wasting of the spinal cord, which Hippocrates describes as a disease peculiar to the male sex.” Quoted by L. Deslandes, “Masturbation and other Aberrations of Sexual Intercourse,” p. 204 (Leipzig, 1835).

[441] Paul Bernhardt, “Processes Resembling Pollutions Occurring in Women, without Sexual Ideas or Lustful Feelings,” published in Die ärztliche Praxis, 1903, No. 17, pp. 193-197.

[442] The best recent work on impotence is Fürbringer’s “The Disturbances of the Sexual Function in Man,” second edition (Vienna, 1901). See also Frenzel, “On Incapacity for Procreation” (Wittenberg, 1800); F. Roubaud, “Traité de l’Impuissance et de la Stérilité chez l’Homme et chez la Femme” (Paris, 1878); V. von Gyurkovechky, “Pathology and Therapeutics of Impotence in the Male” (Vienna and Leipzig, 1897); J. Steinbacher, “Impotence in the Male,” fifth edition (Berlin, 1892); W. A. Hammond, “Sexual Impotence in the Male and Female Sexes” (Berlin, 1891); A. Eulenburg, “Sexual Neurasthenia” (pp. 177-183); Leopold Casper, “Impotentia et Sterilitas Virilis” (Munich, 1890).

[443] W. Schallmayer, “Infection as a Wedding Gift,” published in the Journal for the Suppression of Venereal Diseases, 1903, vol. iv., pp. 389-419.

[444] G. Hirth, “Ways to Love,” pp. 461, 463.

[445] Jacquemart reports a striking case of impotentia coeundi, which he saw in an engineer who received an appointment in a State tobacco factory. After he had resigned his appointment, the patient fully recovered his sexual powers (cf. Loebisch, article “Tobacco,” in Eulenburg’s Real-Enzyklopädie, 1900, vol. xxiv., p. 19).

[446] S. Réti, “Sexuelle Gebrechen,” second edition, p. 15 (Halle, 1904).

[447] J. S. T. Frenzel, “Impotence,” Part I., p. 164 (Wittenberg, 1800).

[448] In some cases it is said to have given rise to permanent impotence.

[449] Frenzel, op. cit., pp. 155, 156.

[450] J. J. Virey, “Woman,” p. 367 (Leipzig, 1827).

[451] Von Schrenck-Notzing, “Studies in Crimino-Psychology and Psycho-Pathology,” p. 176 (Leipzig, 1902).

[452] The Englishman Thomas Parr, who attained the age of one hundred and fifty-two years, remarried at the age of a hundred and twenty years, and his wife is said “to have noticed no defects in him on account of his age” (cf. William Ebstein, “The Art of Prolonging Human Life,” p. 70 (Wiesbaden, 1891)).

[453] In the drug trade we find two brands, known respectively as “Yohimbin Spiegel” and “Yohimbin Riedel”; both preparations are of equal value. [In a letter to the translator under date January 8, 1908, Dr. Bloch writes that “Yohimbin Riedel” is preferable to “Yohimbin Spiegel.”]

[454] Cf. Alexander Peyer, “Affections of the Stomach Associated with Disorders of the Male Genital Organs” (Leipzig, 1890).

[455] Cf. Koblanck, “Some Clinical Observations on Disturbances of the Physiological Functions of the Female Reproductive Organs,” published in the Zeitschrift für Geburtshilfe und Gynäkologie, vol. xliii., No. 3. Moriz Porosz (“Sexual Truths,” pp. 213-218; Leipzig, 1907) devotes with good reason a special chapter to the neurasthenia of young married women. The change from the virgin state into married life often gives rise to such transient neurasthenic conditions in the young wife, especially when there exists any sort of disharmony in respect of marital intercourse.

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XVII. THE ANTHROPOLOGICAL ASPECT OF PSYCHOPATHIA SEXUALIS

“I hope that in the not distant future, for the advancement of science, physicians will be glad to ally themselves with folk-lorists and ethnologists.”--FREDERICK S. KRAUSS.

CONTENTS OF CHAPTER XVII

Anthropological and clinical views of sexual anomalies -- Ubiquity and enduring nature of psychopathia sexualis -- Secondary rôle of civilization and degeneration -- The fable of “the good old times” -- The ungrounded fear of degeneration -- “Nervous degeneration” in earlier times -- Recent arguments against the degeneration theory -- Metchnikoff’s book, “The Nature of Man” -- Georg Hirth’s idea of “Hereditary Enfranchisement.”

Elements of the anthropological theory of psychopathia sexualis -- The need for variety in sexual relationships -- Sexual perversions in healthy persons -- The effect of external influences -- Morbid impressions -- Artificial production of perversions (repetition, suggestion, imitation, seduction) -- Importance of sexual differentiation -- Congenital character of perversions -- The diffusion of perversions among savage races -- Examples -- Immorality in the country -- Influence of race and nationality -- Of age and sex -- Social differences -- Influence of civilization -- Influence of conventionality -- The unrest of the present day -- Spiritual configuration of modern perversity.

Appendix: Sexual Perversions due to Diseases. -- General survey -- Epilepsy and sexual perversions -- Other mental diseases-Syphilis and sexual perversions -- Abnormalities of the genital organs.

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Chapter XV

XVI. STATES OF SEXUAL IRRITABILITY AND SEXUAL WEAKNESS

Chapter XVI

XVII. THE ANTHROPOLOGICAL ASPECT OF PSYCHOPATHIA SEXUALIS