Gattel investigated 100 consecutive cases of severe functional nervous disorder in Krafft-Ebing’s clinic at Vienna, and found that in every case of neurasthenia in a male (28 in all) there was masturbation, while of the 15 women with neurasthenia, only one is recorded as not masturbating, and she practiced coitus reservatus.  Irrespective of the particular form of the nervous disorder, Gattel found that 18 women out of 42, and 36 men out of 58, acknowledged masturbation. (This shows a slightly larger proportion among the men, but the men were mostly young, while the women were mostly of more mature age.) It must, however, always be remembered that we have no equally careful statistics of masturbation in perfectly healthy persons.  We must also remember that we have to distinguish between the post and the propter, and that it is quite possible that neurasthenic persons are specially predisposed to masturbation.  Bloch is of this opinion, and remarks that a vicious circle may thus be formed.

On the whole, there can be little doubt that neurasthenia is liable to be associated with masturbation carried to an excessive extent.  But, while neurasthenia is probably the severest affection that is liable to result from, or accompany, masturbation, we are scarcely yet entitled to accept the conclusion of Gattel that in such cases there is no hereditary neurotic predisposition.  We must steer clearly between the opposite errors of those, on the one hand, who assert that heredity is the sole cause of functional nervous disorders, and those, on the other hand, who consider that the incident that may call out the disorder is itself a sole sufficient cause.

In many cases it has seemed to me that masturbation, when practiced in excess, especially if begun before the age of puberty, leads to inaptitude for coitus, as well as to indifference to it, and sometimes to undue sexual irritability, involving premature emission and practical impotence.  This is, however, the exception, especially if the practice has not been begun until after puberty.  In women I attach considerable importance, as a result of masturbation, to an aversion for normal coitus in later life.  In such cases some peripheral irritation or abnormal mental stimulus trains the physical sexual orgasm to respond to an appeal which has nothing whatever to do with the fascination normally exerted by the opposite sex.  At puberty, however, the claim of passion and the real charm of sex begin to make themselves felt, but, owing to the physical sexual feelings having been trained into a foreign channel, these new and more normal sex associations remain of a purely ideal and emotional character, without the strong sensual impulses with which under healthy conditions they tend to be more and more associated as puberty passes on into adolescence or mature adult life.  I am fairly certain that in many women, often highly intellectual women, the precocious excess