results cautiously stated by Griesinger.  This distinguished alienist thought that, when practiced in childhood, masturbation might lead to insanity.  Berkhan, in his investigation of the psychoses of childhood, found that in no single case was masturbation a cause.  Vogel, Uffelmann, and Emminghaus, in the course of similar studies, have all come to almost similar conclusions.[323] It is only on a congenitally morbid nervous system, Emminghaus insists, that masturbation can produce any serious results.  “Most of the cases charged to masturbation,” writes Kiernan (in a private letter), basing his opinion on wide clinical experience, “are either hebephrenia or hysteria in which an effect is taken for the cause.”  Christian, during twenty years’ experience in hospitals, asylums, and private practice in town and country, has not found any seriously evil effects from masturbation.[324] He thinks, indeed, that it may be a more serious evil in women than in men.  But Yellowlees considers that in women “it is possibly less exhausting and injurious than in the other sex,” which was also the opinion of Hammond, as well as of Guttceit, though he found that women pushed the practice much further than men, and Naecke, who has given special attention to this point, could not find that masturbation is a definite cause of insanity in women in a single case.[325] Koch also reaches a similar conclusion, as regards both sexes, though he admits that masturbation may cause some degree of psychopathic deterioration.  Even in this respect, however, he points out that “when practiced in moderation it is not injurious in the certain and exceptionless way in which it is believed to be in many circles.  It is the people whose nervous systems are already injured who masturbate most easily and practice it more immoderately than others”; the chief source of its evil is self-reproach and the struggle with the impulse.[326] Kahlbaum, it is true, under the influence of the older tradition, when he erected katatonia into a separate disorder (not always accepted in later times), regarded prolonged and excessive masturbation as a chief cause, but I am not aware that he ever asserted that it was a sole and sufficient cause in a healthy organism.  Kiernan, one of the earliest writers on katatonia, was careful to point out that masturbation was probably as much effect as cause of the morbid nervous condition.[327] Maudsley (in Body and Mind) recognized masturbation as a special exciting cause of a characteristic form of insanity; but he cautiously added:  “Nevertheless, I think that self-abuse seldom, if ever, produces it without the co-operation of the insane neurosis."[328] Schuele also recognized a specific masturbatory insanity, but the general tendency to reject any such nosological form is becoming marked; Krafft-Ebing long since rejected it and Naecke decidedly opposes it.  Kraepelin states that excessive masturbation can only occur in a dangerous degree in predisposed subjects; so,