Reviewing the general question of the supposed grave symptoms and signs of masturbation, and its pernicious results, we may reach the conclusion that in the case of moderate masturbation in healthy, well-born individuals, no seriously pernicious results necessarily follow.[338] With regard to the general signs, we may accept, as concerns both sexes, what the Obstetrical and Gynecological Society of Berlin decided in 1861, in a discussion of it in women, that there are none which can be regarded as reliable.[339]

We may conclude finally, with Clouston, that the opposing views on the subject may be simply explained by the fact that the writers on both sides have ignored or insufficiently recognized the influence of heredity and temperament.  They have done precisely what so many unscientific writers on inebriety have continued to do unto the present day, when describing the terrible results of alcohol without pointing out that the chief factor in such cases has not been the alcohol, but the organization on which the alcohol acted.  Excess may act, according to the familiar old-fashioned adage, like the lighted match.  But we must always remember the obvious truth, that it makes a considerable difference whether you threw your lighted match into a powder magazine or into the sea.

While we may thus dismiss the extravagant views widely held during the past century, concerning the awful results of masturbation, as due to ignorance and false tradition, it must be pointed out that, even in healthy or moderately healthy individuals, any excess in solitary self-excitement may still produce results which, though slight, are yet harmful.  The skin, digestion, and circulation may all be disordered; headache and neuralgia may occur; and, as in normal sexual excess or in undue frequency of sexual excitement during sleep, there is a certain general lowering of nervous tone.  Probably the most important of the comparatively frequent results—­though this also arises usually on a somewhat morbid soil—­is neurasthenia with its manifold symptoms.  There can be little doubt that the ancient belief, dating from the time of Hippocrates, that sexual excesses produce spinal disease, as well as the belief that masturbation causes insanity, are largely due to the failure to diagnose neurasthenia.

The following case of neurasthenia, recorded by Eulenburg, may be given as a classical picture of the nervous disturbances which may be associated with masturbation, and are frequently regarded as solely caused by habits of masturbation:  Miss H.H., 28 years of age, a robust brunette, with fully developed figure, without any trace of anaemia or chlorosis, but with an apathetic expression, bluish rings around the eyes, with hypochondriacal and melancholy feelings.  She complains of pressure on the head ("as if head would burst"), giddiness, ringing in the ears, photopsia, hemicrania, pains in the back and at sacrum, and symptoms of spinal adynamia, with a sense of fatigue on the