With few exceptions,∗ the classical writers on insanity regarded masturbation as an important and frequent factor in its ætiology. Ellinger,† after a careful study of the patients at Winnenthal, concluded that twenty-five per cent. of them owed their condition to this cause. More modern writers, while admitting it to be an element in the production of mental disease, do not assign anything like so high a proportion, and it is probable that the distinguished alienist cited, must have failed to discriminate between those cases in which masturbation precedes and provokes insanity and those in which it accompanies, follows, and results therefrom. Bucknill and Tuke place insanity from masturbation, or masturbatic insanity, under their Somato-ætiological classification of mental disorders.† The latter (Hack Tuke) says “Reliable facts are of course most difficult to obtain, and such figures reveal little of the real truth, the extensive mischief done [by masturbation] of which there can be no doubt whatever.§ Savage states that masturbation may occur as a cause in either sex, but that it is far less frequently a cause than a symptom of mental derangement. Folsom¶ regards it as an exciting and predisposing factor, creating a morbid psychical state by exalting the sensibility of the youthful nervous system; but adds that it does not often do so. The views of both these, the most recent writers of systematic treatises in the English language, are in accord with some of the leading German authorities. The latter do not recognize a special form of masturbatic insanity in their tables. Schüle∗ speaks of onanistic insanity in the same sense in which Maudsley uses that term, but gives it no place in his classification, disposing of it in a few lines of the text. Krafft-Ebing† recognizes the vice to be an ætiological factor, and speaks of such-and-such forms of insanity as being developed on a masturbatic basis. He, as well as Schüle, with the majority of recent German writers, follows Ellinger in attributing to the masturbatic neurosis a relation to the causation of insanity, analogous to heredity and the great neuroses, such as hysteria, epilepsy, and alcoholism. I am unable to find any dissent among the Germans from the statement approvingly cited by Emming-haus† from Krafft-Ebing, that the clinical forms growing out of this neurosis are too numerous and widely different to permit the erection of a special form of insanity, such as that which the renowned somato-ætiologist Skae § attributed to, and named after, the vice in question. This criticism appears to acquire some support from the lack of unanimity among those writers who have defined and attempted to demarcate such a type. While Skae speaks of a peculiar imbecility and shy habits as characterizing the disorder among the youthful, and suspicion, fear, scared looks, cardiac palpitations, the delusion of having committed the unpardonable sin, and feeble bodies, as found in older victims of this habit, his most distinguished follower attributes to it exaggerated self-feeling, conceited, shallow introspection, frothy emotional religious notions, and a restless, unsettled state, with foolish hatchings of philanthropic schemes.
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