Plain Facts for Old and Young by John Harvey Kellogg

condition of mind which does not exist in youth who are not addicted to this vice. As previously remarked, no single one of the above signs should be considered as conclusive evidence of the habit in any individual; but any one of them may, and should, arouse suspicion and watchfulness. If the habit really exists, but a short time will elapse before other signs will be noticed, and when several point in the same direction, the evidence may be considered nearly, if not quite, conclusive. But persistent watching will enable the positive signs to be detected sooner or later, and then there can no longer be doubt. It is, of course, necessary to give the individual no suspicion that he is being watched, as that would put him so effectually on his guard as, possibly, to defy detection. Positive Signs.--The absolutely positive signs of solitary vice are very few. Of course the most certainly positive of all is detection in the act. Sometimes this is difficult, with such consummate cunning do the devotees of this Moloch pursue their debasing practice. If a child is noticed to seek a certain secluded spot with considerable regularity, he should be carefully followed and secretly watched, for several days in succession if need be. Many children pursue the practice at night after retiring. If the suspected one is observed to become very quickly quiet after retiring, and when looked at appears to be asleep, the bedclothes should be quickly thrown off under some pretense. If, in the case of a boy, the penis is found in a state of erection, with the hands near the genitals, he may certainly be treated as a masturbator without any error. If he is found in a state of excitement, in connection with the other evidences, with a quickened circulation as indicated by the pulse, or in a state of perspiration, his guilt is certain, even though he may pretend to be asleep; no doubt he has been addicted to the vice for a considerable time to have acquired so much cunning. If the same course is pursued with girls, under the same circumstances, the clitoris will be found congested, with the other genital organs, which will also be moist from increased secretion. Other conditions will be as nearly as possible the same as those in the boy. Stains upon the night shirt or sheets, occurring before puberty, are certain evidences of the vice in boys, as they are subject, before that time, to no discharge which will leave a stain resembling that from the seminal fluid, except the rare one from piles. In the very young, these stains do not occur; but when the habit is acquired before puberty, a discharge resembling semen takes place before the ordinary period. Of course, the stains from urine will be easily distinguished from others. The frequent occurrence of such stains after puberty is a suspicious circumstance. A discharge in some respects similar may occur in girls. Before puberty, the effect of the vice upon the genital organs is to cause an unnatural development, in both sexes, of the sensitive portions. When this is marked, it is pretty conclusive evidence of the vice. In girls, the vagina often becomes unnaturally enlarged, and leucorrhoea is often present. After puberty, the organs usually diminish in size, and become unnaturally lax and shrunken. All of these signs should be thoroughly mastered by those who have children under their care, and if not continually watching for them, which would be an unpleasant task, such should be on the alert to detect the signs at once when they appear, and then carefully seek for others until there is no longer any doubt about the case. RESULTS OF SECRET VICE. The physician rarely meets more forlorn objects than the victims of prolonged self-abuse. These unfortunate beings he meets every day of his life, and listens so often to the same story of shameful abuse and retributive suffering that he dreads to hear it repeated. In these cases, there is usually a horrid sameness--the same cause, the same inevitable results. In most cases, the patient need not utter a word, for the physician can read in his countenance his whole history, as can most other people at all conversant with the subject. In order to secure the greatest completeness consistent with necessary brevity, we will describe the effects observed in males and those in females under separate heads, noticing the symptoms of each morbid condition in connection with its description. EFFECTS IN MALES. We shall describe, first, the local effects, then the general effects, physical and mental. Local Effects.--Excitement of the genital organs produces the most intense congestion. No other organs in the body are capable of such rapid and enormous engorgement. When the act is frequently repeated, this condition becomes permanent in some of the tissues, particularly in the mucous membrane lining the urethra. This same membrane continues into and lines throughout the bladder, kidneys, and all the urinary organs, together with the vesiculae seminales, the ejaculatory ducts, the vasa deferentia, and the testes. In consequence of this continuity of tissue, any irritation affecting one part is liable to extend to another, or to all the rest. We mention this anatomical fact here as a help to the understanding of the different morbid conditions which will be noticed. _Urethral Irritation_.--The chronic congestion of the urethra after a time becomes chronic irritability. The tissue is unusually sensitive, this condition being often indicated by a slight smarting in urination. It often extends throughout the whole length of the urethra, and becomes so intense that the passage of a sound, which would occasion little if any sensation in a healthy organ, produces the most acute pain, as we have observed in numerous instances, even when the greatest care was used in the introduction of the instrument. Shooting pains are often felt in the organ, due to this irritation. Pain is in some cases most felt at the root, in others, at the head. It often darts from one point to another. Just before and just after urination the pain is most severe. _Stricture_.--Long-continued irritation of the mucous membrane of the urethra produces, ultimately, inflammation and swelling of the same in some portion of its extent. This condition may become permanent, and then constitutes real stricture, a most serious disease. More often the swelling is but transient, being due to some unusual excess, and will subside. Sometimes, also, a temporary stricture is produced by spasmodic contraction of the muscular fibers surrounding the urethra, which is excited by the local irritation. This kind of stricture is often met in the treatment of spermatorrhoea. Enlarged Prostate.--This painful affection is a frequent result of the chronic irritation in the urethra, which the gland surrounds, the morbid action being communicated to it by its proximity. A diseased action is set up which results in enlargement and hardening. It is felt as a hard body just anterior to the anus, and becomes by pressure the source of much additional mischief. Sometimes the disease progresses to dangerous ulceration. It is attended by heat, pressure, and pain between the anus and the root of the penis. Urinary Diseases.--The same congestion and irritability extend to the bladder and thence to the kidneys, producing irritation and inflammation of those organs. Mucus is often formed in large quantities; sometimes much is retained in the bladder. Earthy matter is deposited, which becomes entangled in the mucus, and thus a concretion or stone is produced, occasioning much suffering, and perhaps death. We saw, not long since, a case of this kind. The patient was nearly sixty years of age, and had practiced masturbation from childhood. In consequence of his vice, a chronic irritation of the urethra had been produced, which was followed by enlargement of the prostate, then by chronic irritation of the bladder and the formation of stone. His sufferings were most excruciating whenever he attempted to urinate, which was only accomplished with the greatest difficulty and suffering. One of the unpleasant results of irritation of the lining membrane of the bladder is inability to retain the urine long, which requires frequent urination and often causes incontinence of urine. _Priapism_.--This same morbid sensitiveness may produce priapism, or continuous and painful erection, one of the most "terrible and humiliating conditions," as Dr. Acton says, to which the human body is subject. The horrid desperation of patients suffering under this condition is almost inconceivable. It is, fortunately, rare, in its most severe forms; but hundreds suffer from it to a most painful degree as one of the punishments of transgression of nature's laws; and a most terrible punishment it is. _Piles, Prolapsus of Rectum, etc._--As the result of the straining caused by stricture, piles, prolapsus of the rectum, and fissure of the anus are not infrequently induced, as the following case observed at Charity Hospital, New York, illustrates:-- The patient had a peculiar deformity of the genital organs, _hypospadias_, which prevented sexual intercourse, in consequence of which he gave himself up to the practice of self-abuse. He had become reduced to the most deplorable condition of both mind and body, and presented a most woebegone countenance. In addition to his general ailments, he suffered from extreme prolapsus of the rectum and a most painful anal fissure. His condition was somewhat bettered by skillful surgical treatment. _Extension of Irritation_.--Serious and painful as are the affections already noticed, those which arise from the extension of the congestion and irritation of the urethra to those other organs most intimately connected with the function of generation are still more dreadful in themselves, and far more serious in their consequences. The irritation extends into the ejaculatory ducts, thence backward into the seminal vesicles, and downward through the vasa deferentia to the testes. These organs become unnaturally excited, and their activity is increased. The testicles form an abnormal amount of spermatozoa; the seminal vesicles secrete their peculiar fluid too freely. From these two sources combined, the vesicles become loaded with seminal fluid, and this condition gives rise to a great increase of sexual excitement. In cases of long standing, the irritation of the urethra at the openings of the ejaculatory ducts, a point just in front of the bladder, advances to inflammation and ulceration. Here is now established a permanent source of irritation, by which the morbid activity of the testes and seminal vesicles is kept up and continually increased. This condition is indicated by frequent twitchings of the ejaculatory and compressor muscles in the perineum. It is also indicated by a burning sensation at the root of the penis after urination, which, in severe cases, amounts to very serious pain. _Atrophy, or Wasting of the Testes_.--The first result of the irritation communicated to the testes, is, as already remarked, increased activity; but this is attended by swelling in some cases, more or less pain, tenderness, and, after a time, diminution in size. This degenerative process likewise affects the seminal fluid, which becomes more or less deteriorated and incapable of producing healthy offspring, even while it retains the power of fecundating the ovum, which it also ultimately loses if the disease is not checked by proper treatment, when the individual becomes hopelessly impotent, a happy result for the race, for it prevents the possibility of his imparting to another being his debilitated constitution. _Varicocele_.--This morbid condition consists in a varicose state of the spermatic veins. It is almost always found upon the left side, owing to an anatomical peculiarity of the spermatic vein of that side. It has been supposed to be a result of masturbation and its effects, but is certainly caused otherwise in many cases. It is not infrequently found in these patients; but Prof. Bartholow contends that even in such cases we should "consider its presence, in general, as accidental." Atrophy of the left testicle is often produced by the pressure of the distended veins; but this does not produce impotence. It occasionally occurs simultaneously on both sides, and greatly aggravates the effects of self-abuse, if it is not itself an effect of the vice. Nocturnal Emissions.--Seminal emissions during sleep, usually accompanied by erotic dreams, are known as nocturnal pollutions or emissions, and are often called _spermatorrhoea_, though there is some disagreement respecting the use of the latter term. Its most proper use is when applied to the entire group of symptoms which accompany involuntary seminal losses. The masturbator knows nothing of this disease so long as he continues his vile practice; but when he resolves to reform, and ceases to defile himself voluntarily, he is astonished and disgusted to find that the same filthy pollutions occur during his sleep without his voluntary participation. He now begins to see something of the ruin he has wrought. The same nightly loss continues, sometimes being repeated several times in a single night, to his infinite mortification and chagrin. He hopes the difficulty will subside of itself, but his hope is vain; unless properly treated, it will probably continue until the ruin which he voluntarily began is completed. This disease is the result of sexual excesses of any kind; it is common in married men who have abused the marriage relation, when they are forced to temporary continence from any cause. It also occurs in those addicted to mental unchastity, though they may be physically continent. It is not probable that it would ever occur in a person who had been strictly continent and had not allowed his mind to dwell upon libidinous imaginations. Exciting Causes.--The exciting causes which serve to perpetuate this difficulty are chiefly two; viz., local irritation and lewd thoughts. The first cause is usually chiefly located in the urethra, and especially at the mouths of the ejaculatory ducts. Distention of the seminal vesicles with a superabundance of seminal fluid also acts as a source of irritation. Constipation, worms, and piles have an irritative influence which is often very seriously felt. Unchaste thoughts act detrimentally in a two-fold way. They first stimulate the activity of the testes, thus increasing the overloading of the seminal vesicles. Lascivious thoughts during wakefulness are the chief cause of lascivious dreams. Emissions do not usually occur during the soundest sleep, but during that condition which may be characterized as dozing, which is most often indulged in early in the morning after the soundest sleep is passed. This fact has an important bearing upon treatment, as will be seen hereafter. At first, the emissions are always accompanied by dreams, the patient usually awaking immediately afterward; but after a time they take place without dreams and without awaking him, and are unaccompanied by sensation. This denotes a greatly increased gravity of the complaint. Certain circumstances greatly increase the frequency of the emissions, and thus hasten the injury which they are certain to accomplish if not checked; as, neglect to relieve the bladder and bowels at night, late suppers, stimulating foods and drinks, and anything that will excite the genital organs. Of all causes, amorous or erotic thoughts are the most powerful. Tea and coffee, spices and other condiments, and animal food have a special tendency in this direction. Certain positions in bed also serve as exciting or predisposing causes; as sleeping upon the back or abdomen. Feather beds and pillows and too warm covering in bed are also injurious for the same reason. In frequency, emissions will vary in different persons from an occasional one at long and irregular intervals to two or three a week, or several--as many as four in one case we have met--in a single night. The immediate effect of an emission will depend somewhat upon the frequency of occurrence and the condition of the individual. If very infrequent, and occurring in a comparatively robust person, after the seminal vesicles have become distended with seminal fluid, the immediate effect of an emission may be a sensation of temporary relief. This circumstance has led certain persons to suppose that emissions are natural and beneficial. This point will receive attention shortly. If the emissions are more frequent, or if they occur in a person of a naturally feeble constitution, the immediate effect is lassitude, languor, indisposition and often inability to perform severe mental or physical labor, melancholy, amounting often to despair and even leading to suicide, and an exaggeration of local irritation, and of all the morbid conditions to be noticed under the head of "General Effects." Headache, indigestion, weakness of the back and knees, disturbed circulation, dimness of vision, and loss of appetite, are only a few of these. Are Occasional Emissions Necessary or Harmless?--That an individual may suffer for years an involuntary seminal loss as frequently as once a month without apparently suffering very great injury, seems to be a settled fact with physicians of extensive experience, and is well confirmed by observation; yet there are those who suffer severely from losses no more frequent than this. But when seminal losses occur more frequently than once a month, they will certainly ultimate in great injury, even though immediate ill effects are not noticed, as in exceptional cases they may not be. If argument is necessary to sustain this position, as it hardly seems to be, we would refer to the fact that seminal losses do not occur in those who are, and always have been, continent both mentally and physically, when such rare individuals can be found. They occur the most rarely in those who the most nearly approach the standard of perfect chastity; so that whenever they occur, they may be taken as evidence of some form of sexual excess. This fact clearly shows that losses of this kind are not natural. Emission not Necessary to Health.--If it be argued that an occasional emission is necessary to relieve the overloaded seminal vesicles, we reply, the same argument has been used as an apology for unchastity; but it is equally worthless in both instances. It might be as well argued that vomiting is a necessary physiological and healthful act, and should occur with regularity, because a person may so overload his stomach as to make the act necessary as a remedial measure. Vomiting is a diseased action, a pathological process, and is occasioned by the voluntary transgression of the individual. Hence, it is as unnecessary as gluttony, and must be wasteful of vitality, even though rendered necessary under some circumstances. So with emissions. If a person allows his mind to dwell upon unchaste subjects, indulges in erotic dreams, and riots in mental lasciviousness, he may render an emission almost necessary as a remedial effort. Nevertheless, he will suffer from the loss of the vital fluid just the same as though he had not, by his own concupiscence, rendered it in some degree necessary. And as it would have been infinitely better for him to have retained and digested food in his stomach instead of ejecting it--provided it were wholesome food--so it would have been better for him to have retained in his system the seminal fluid, which would have been disposed of by the system and probably utilized to very great advantage in the repair of certain of the tissues. Eminent Testimony.--An eminent English physician, Dr. Milton, who has treated many thousands of cases of this disease, remarks in a work upon the subject as follows:-- "Anything beyond one emission a month requires attention. I know this statement has been impugned, but I am quite prepared to abide by it. I did not put it forward till I considered I had quite sufficient evidence in my hands to justify me in doing so." "An opinion prevails, as most of my readers are aware, among medical men, that a few emissions in youth do good instead of harm. It is difficult to understand how an unnatural evacuation can do good, except in the case of unnatural congestion. I have, however, convinced myself that the principle is wrong. Lads never really feel better for emissions; they very often feel decidedly worse. Occasionally they may fancy there is a sense of relief, but it is very much the same sort of relief that a drunkard feels from a dram. In early life the stomach may be repeatedly overloaded with impunity, but I suppose few would contend that overloading was therefore good. The fact is that emissions are invariably more or less injurious; not always visibly so in youth, nor susceptible of being assessed as to the damage inflicted by any given number of them, but still contributing, each in its turn, a mite toward the exhaustion and debility which the patient will one day complain of." Diurnal Emissions.--As the disease progresses, the irritation and weakness of the organs become so great that an erection and emission occur upon the slightest sexual excitement. Mere proximity to a female, or the thought of one, will be sufficient to produce a pollution, attended by voluptuous sensations. But after a time the organs become so diseased and irritable that the slightest mechanical irritation, as friction of the clothing, the sitting posture, or riding horseback, will produce a discharge which may or may not be attended by sensation of any kind. Frequently a burning or more or less painful sensation occurs; erection does not take place. Even straining at stool will produce the discharge, or violent efforts to retain the feces when there is unnatural looseness. The amount of the discharge may vary from a few drops to one or two drams, or even more. The character of the discharge is of considerable importance. When it occurs under the circumstances last described, viz., without erection or voluptuous sensations, it may be of a true seminal character, or it may contain no spermatozoa. This point can be determined by the microscope alone. The discharge is the result of sexual excitement or irritation, nevertheless, and indicates a most deplorable condition of the genital organs. The patient is sometimes unnecessarily frightened by it, and often exaggerates the amount of the losses, and the symptoms arising from them. However, when a single nocturnal emission occasions such detrimental results, what must be the effect of repeated discharges occurring several times a day, or every time an individual relieves his bowels, urinates, or entertains an unvirtuous thought! If the losses were always seminal, the work of ruin would soon be complete; fortunately, those discharges which are the most frequent are only occasionally of a true seminal character. It is not true, however, as has been claimed by some writers, one at least, that they are never seminal, as we have proved by repeated microscopic examinations. Cause of Diurnal Emissions.--The causes of these discharges are spasmodic action of the muscles involved in ejaculation, which is occasioned by local irritation, and pressure upon the seminal vesicles by the distended rectum or bladder. They denote a condition of debility and irritation which may well occasion grave alarm. In occasional instances, the internal irritation reaches such a height that blood is discharged with the seminal fluid. Internal Emissions.--As the disease progresses, external discharges finally cease, in some cases, or partially so, and the individual is encouraged by that circumstance to think that he is recovering. He soon discovers his error, however, for he continues to droop even though the discharges apparently cease altogether. This seems a mystery until some medical friend or a medical work calls his attention to the fact that the discharges now occur internally instead of externally, the seminal fluid passing back into the bladder and being voided with the urine. An examination of the urine reveals the presence of cloudy matter appearing much like mucus, or a whitish sediment. A microscopic examination shows this matter to be composed largely of zoosperms, which decides its origin. An Important Caution.--It is necessary, however, to caution the reader not to pronounce every whitish sediment or flocculent matter found in the urine to be a seminal discharge, for the great majority are of a different character. They are, most frequently, simply mucus or phosphates from the bladder. Seminal fluid cannot be distinguished from mucus by any other than a careful microscopic examination. A microscope of good quality and capable of magnifying at least one hundred and fifty diameters is required, together with considerable skill in the operator. Quacks have done an immense amount of harm by frightening patients into the belief that they were suffering from discharges of this kind when there was, in fact, nothing more than a copious deposit of phosphates, which is not at all infrequent in nervous people, especially after eating. When the condition described does really exist, however, the patient cannot make too much haste to put himself under the care of a competent physician for treatment. If there is even a reasonable suspicion that it may exist, he should have his urine carefully examined by one competent to criticize it intelligently. By many authors, the term spermatorrhoea is confined entirely to this stage of the disease. It is said that the forcible interruption of ejaculation has been the cause of this unfortunate condition in many cases. Such a proceeding is certainly very hazardous. One more caution should be offered; viz., that the occasional presence of spermatozoa in the urine is not a proof of the existence of internal emissions, as a few zoosperms may be left in the urethra after a voluntary or nocturnal emission, and thus find their way into the urine as it is discharged from the bladder. Impotence.--In the progress of the disease a point is finally reached when the victim not only loses all desire for the natural exercise of the sexual function, but when such an act becomes impossible. This condition may have been reached even before all of the preceding symptoms have been developed. Ultimately it becomes impossible to longer practice the abominable vice itself, on account of the great degeneration and relaxation of the organs. The approach of this condition is indicated by increasing loss of erectile power, which is at first only temporary, but afterward becomes permanent. Still the involuntary discharges continue, and the victim sees himself gradually sinking lower and lower into the pit which his own hands have dug. The misery of his condition is unimaginable; manhood lost, body a wreck, and death staring him in the face. This is a brief sketch of the local effects of the horrid vice of self-abuse. The description has not been at all overdrawn. We have yet to consider the general effects, some of which have already been incidentally touched upon in describing nocturnal emissions, with their immediate results. General Effects.--The many serious effects which follow the habit of self-abuse, in addition to those terrible local maladies already described, are the direct results of two causes in the male; viz.,