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TREATMENT OF MASTURBATION
........................... In cases where the presence of an irritable or spasmodic condition of the urethral mucous membrane induces a temporary contraction of the canal, be- sides the use of the endoscope, steel sounds, either cold or warmed, are frequently of service. These can be passed at intervals varying from twice or thrice a week to once a month, - according to the exigencies of the case, and often the cure of the habit of masturbation will depend a great deal upon the cure of a small patch of irritable mucous membrane in the urethra. Of the mechanical forms of treatment two have already been mentioned, to wit: confinement of the genitals in a cage and infibulation; but there is a third one which I wish to men- tion somewhat more fully than it usually is touched upon for the cure of this form of disease. I refer to C A S T R A T I O N, which has seldom been mentioned, and then only in terms of repro- bation as an operation to be avoided. While I agree heartily in the main with this view, cases are reported in medical litera- ture in which it would appear as though it were justifiable, and not only justifiable but necessary, and where the operation seems to have been crowned with success. The first case pub- lished in American medicalliterature that I have been able to discover was one reported by Dr. Josiah Crosby, a well-known American surgeon, who had a wide reputation for sound surgical knowledge and skill throughout the New England states. This case he reported in The Boston Medical and Surgi- cal Journal for I884, and it is of such interest that I give it here in extenso : November 5, 1842, I was ca11ed to visit Mr._______, aged twenty-two years, whose health had been declining for more than six years. He had secluded himself almost entirely from society, and even his family-had not eaten with them for four years-had not been in the street more than twice for two years, and for the last year had kept himself mostly in bed. I found him pale, trembling, and dejected-pulse frequent and feeble, appetite bad, digestion impaired, and rather emaciated. At first he was unwilling to give much account of himself, but after a few visits I obtained the following history of his case : About the age of thirteen years he began to masturbate, and, urged by his companions, he practised it some time before he produced an emission. After this he continued the habit more and more frequently, until he would perform the operation every day for several weeks in succession, and very often twice a day. At the age of sixteen his health was so much impaired he was obliged to suspend all labor and active exercise, and had not been able, at the time I first saw him, to resume either. After this time he says he did not practice masturbation much, but had been constantly troubled with involuntary discharges -that the emissions had become painful and exceedingly prostrating. I learned from his friends that he had been at- tacked twice with furious delirium-both attacks were of short duration-had frequently secreted himself from his family , so that they were alarmed with fears that he would commit sui- cide. During the first four years of his sickness he was drugged with all sorts of medicines for all sorts of diseases by all sorts of doctors, and all the time grew worse, no one ever having suggested to him the true nature of his disease or the cause of it. With very little expectation of benefiting him with medi- cine I prescribed bals. copaib. and tr. cantharid. combined, carb. of iron, cold bathing to the hips and loins, and cold- water injections into the rectum; but finding no impression was made by this method of treatment, and that the nocturnal emissions were so frequent and so exhausting, I did not think it advisable to continue the use of ordinary remedies to cure so desperate a disease. Believing the great constitutional dis- turbance to have been produced and kept up by the severe and oft-repeated shocks given tu the brain and nervous system by the seminal emissions, and that R E M O V I N G T H E T E S T I C L E S would remove the great source of difficulty, I recommended C A S TR A T I O N, with the confident expectation that it would prove successful. He was so miserable, and life itself had become sucha burden to him, that he was not only wi11ing to submit to the operation, but urged me to perform it, which I did on the 29th of November. There was profuse hemorrhage from the right side of the i scrotum during the night after the operation, which greatly reduced him. The healing and recovery from the operation was very slow; and the winter being very cold, there was but i little apparent improvement in his general appearance until warm weather was established. Since that time he has improved rapidly. He has now the appearance of good health, is cheerful and happy, can walk miles with as much ease and elasticity as anyone, and with every prospect of good health and a life of usefulness, he is actively engaged in making arrangements to go into business. For some months after the operation he had a weeping of prostatic fluid; but as soon as his general health improved this trouble disappeared, and he has nothing of it at this time. There was about two drachms of serum within the vaginal coat of the left testicle. The tunica albuginea testis was pale and flabby .The vessels of this coat in the right testicle were very much injected, showing considerable inflammation-there was no effusion. Now, as to the propriety of this operation for the removal of such a disease, I admit there may be much doubt. Cauteriz- ing the urethra was not tried, for the want of a proper instru- ment. This operation, however, is not successful in more than: three-fourths of the cases when it is resorted to under the most favorable circumstances, as appears from the cases reported by Mr .Phillips, of the St. Marylebone lnfirmary .The parents of this young man were poor, had made many expensive trials to cure him without success, and had determined to make no further effort. From these considerations I was f o r c e d t o o p e r a t e, and the happy change produced in the patient and the great relief afforded to the family are abundant evidence of the propriety of the operation in this case. This, as might be expected, drew down from The Boston Medical and Surgical Journal a great deal of severe and, I think, rather harsh criticism, but perhaps that may be for- given, because there is a sentimental repugnance to C A S T R A T I O N, except perhaps it be for disease, and yet this form of masturbation is really a disease. Crosby's patient, I believe, was a sexual pervert, a more or less vicious one, and at times apparently dangerous; a man perhaps whom it would be a mercy to all concerned ( supposing his condition to be incurable ) to have put quietly out of the way. It seems, however, that this operation cured him, restored him to health, so that from being a violent and at times delirious monomaniac, he became a decent, sober, and quiet member of society. The other case was related by Dr. Bell in the same journal for I860, and it took shape in the following extract from the records of the Boston Society for Medical Improvement for that year, being read by the late Dr. Henry J. Bigelow, of Boston, under the heading of two letters which were addressed to him, one by a physician from a neighboring state, request- ing his opinion as to the propriety of C A S T R A T I O N in a case of erotic mania, and the other from Dr .Bell, the superintendent of the Somerville Insane Asylum near Boston, containing his opimon as to the operation in this affection. The first letter reads as follows: "September 27, 1856 Dr. J. H. Bigelow: You will confer a favor on me and my neighborhood if you will give me some inforInation on the following case: There is a young man living near me who has been, I suppose it might be called, partially deranged, for nearly a past year; his mind runs altogether upon having sex- ual intercourse with females, and he grows worse. His conver- sation and thoughts are on that subject. He will attack any female he sees, and keeps himself indecently exposed when females are present. He is now worse than he was three months ago. He was at the Insane Hospital at for about four months, but came home worse than he was when he went. Application has been made to me with regard to C A S T R A T I O N. What do you think of it? I shall wait anxiously for an answer from you, and hope to get one by retum mail. I am, etc. P.S.- This young man is sane on other subjects and will work on the farm some days; but most of the time he is wan- dering about, as he says, after the girls. At times he has violent fits of anger and wants to kill everybody he sees; but he re- members all about it afterward and, when talked to about it, says he will kill somebody if he can't get what he wants. Monument Square, Charlestown, 9th Oct. 1856" My Dear Sir: I received your note per last post. I have often been consulted as to tying up the spermatic arteries, the vasta deferentia, and the removal of the testes in forms of in- sanity connected with spermatorrhrea. I have known it done repeatedly .In one case Dr._________ C A S T R A T E D a clean-gone onanist who subsequently rallied, became an active man, and the doctor told me that he never met him that he did not re- ceive his blessing for the great favor he had conferred upon him. In another case of self-perpetrated C A S T R A T I O N, under a similar state of mind, with which I am acquainted, entire restoration to peace of mind and energy was produced. -On the other hand, in all the lunatic hospital cases where I have known it done, no valuable results followed. At the Ohio Hospital some years ago it was tried on quite an exten- sive scale. No case of improvement followed. Indeed, Dr. Awl told me that in one patient, who previously was quiet and contented, a permanent and dangerous condition of irritability followed. He averred that they had done some d-d thing or other to him, so that things didn't work as they used to. I confess that I should recoil from the kind of remedy sug- gested. I have found that heavy doses of opium, long con- tinued, do control that nymphomaniacal (This refers to the case of a young woman referred to in the above letter. Dr. Bigelow had been consulted by a distinguished physician of Boston about the propriety of removing the ovaries in a desperate case of nymphomania) disposition, dependent on no local irritation. And I should certainly desire to see this tried to its fullest extent before the other was decided on. A man so afllicted ought, by every consideration of public safety, to be shut up in a lunatic hospital, and the laws are ade- quate to this end. I am, dear sir, very faithfully yours, L. V. BELL It will be seen from his letter that Dr. Bell decidedly "re- coils" from the idea of C A S T R A T I O N, although apparently in one case of Dr._______it succeeded ( this may have been Dr.Cros- by's case), as well as in another, where the patient was both patient and doctor. In the Ohio Hospital, where it was tried on quite an extensive scale, no improvement followed. I know that in even suggesting the possible propriety of such an operation I am flying directly in the face of the opin- ion of 99 per cent of my medical brethren, but let me ask them this question: Given the case of a masturbating maniac with dangerous proclivities; who shows violent homicidal or suicidal tendencies; who is liable at any moment to injure his neighbors or himself-the latter perhaps would not be so ob- jectionable-whose only hope for the future would be incar- ceration for life in a lunatic asylum, why should it not be per- missible to try this remedy on the bare possibility of its success? If it succeeds, the PATIENT MAY WELL PART WITH HIS TESTICLES IN EXCHANGE FOR GOOD HEALTH, and, like Dogberry , give God thanks and make no boast of it. If, on the other hand, the operation should not be successful, he is no worse off than before, unless possibly he should resemble the patient whom Dr. Awl mentions who, after C A S T R A T I O N, said "they had done some d-d thing or other to him so that things did not work as they used to"; the prime mistake here, however, was in med- dling with a patient who had previously been quiet and con- tented. It was a pity the hospital people could not let well enough alone. I think the advisability of this operation is a question which we may well ponder seriously and not dismiss with the offhand comment that it is not to be thought of-----that no decent or honorable surgeon would ever consent to do it. We geld vicious members among the lower animals; why not the highest animal----man? Of course, such an operation should be resorted to only after everything else which can possibly promise success had been tried and proved a failure. brief passages for a review , from the book SEXUAL SELF-STIMULATION
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