least exertion in walking or standing; she sways when standing with closed eyes, tendon-reflexes exaggerated; there is a sense of oppression, intercostal neuralgia, and all the signs of neurasthenic dyspepsia; and cardialgia, nausea, flatulence, meteorism, and alternate constipation and diarrhoea.  She chiefly complains of a feeling of weight and pain in the abdomen, caused by the slightest movement, and of a form of pollution (with clitoridian spasms), especially near menstruation, with copious flow of mucus, characteristic pains, and hyperexcitability.  Menstruation was irregular and profuse.  Examination showed tumid and elongated nymphae, with brown pigmentation; rather large vagina, with rudimentary hymen; and retroflexion of uterus.  After much persuasion the patient confessed that, when a girl of 12, and as the result of repeated attempts at coitus by a boy of 16, she had been impelled to frequent masturbation.  This had caused great shame and remorse, which, however, had not sufficed to restrain the habit.  Her mother having died, she lived alone with her invalid father, and had no one in whom to confide.  Regarding herself as no longer a virgin, she had refused several offers of marriage, and thus still further aggravated her mental condition. (Eulenburg, Sexuale Neuropathie, p. 31.)

Since Beard first described neurasthenia, many diverse opinions have been expressed concerning the relationships of sexual irregularities to neurasthenia.  Gilles de la Tourette, in his little monograph on neurasthenia, following the traditions of Charcot’s school, dismisses the question of any sexual causation without discussion.  Binswanger (Die Pathologie und Therapie der Neurasthenie), while admitting that nearly all neurasthenic persons acknowledge masturbation at some period, considers it is not an important cause of neurasthenia, only differing from coitus by the fact that the opportunities for it are more frequent, and that the sexual disturbances of neurasthenia are, in the majority of cases, secondary.  Rohleder, on the other hand, who takes a very grave view of the importance of masturbation, considers that its most serious results are a question of neurasthenia.  Krafft-Ebing has declared his opinion that masturbation is a cause of neurasthenia.  Christian, Leyden, Erb, Rosenthal, Beard, Hummel, Hammond, Hermann Cohn, Curschmann, Savill, Herman, Fuerbringer, all attach chief importance to neurasthenia as a result of masturbation.  Collins and Phillip (Medical Record, March 25, 1899), in an analysis of 333 cases of neurasthenia, found that 123 cases were apparently due to overwork or masturbation.  Freud concludes that neurasthenia proper can nearly always be traced to excessive masturbation, or to spontaneous pollutions. (E.g., Sammlung Kleiner Schriften zur Neurosenlehre, first series, p. 187.) This view is confirmed by Gattel’s careful study (Ueber die Sexuellen Ursachen der Neurasthenie und Angstneurose, 1898).