emembered 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 in masturbation has been a main
cause, not necessarily the sole efficient cause, in pr