Athol Johnson discovers a new and hopeful treatment for masturbation
The following article was published in The Lancet – then, as now, one of the leading British medical journals – in 1860. You will note that Mr Johnson also recommends clitoridectomy in serious cases of masturbation in girls, but considers that this will rarely be necessary, since they are less prone to the habit than boys.
The subject of this communication is one of high importance in its relation to the physical as well as to the moral well-being of too large a number of persons in early life. Its repulsive nature, however, and the natural desire to ignore the existence of such a practice as onanism, have prevented the attention of our profession from being willingly turned to it, and have caused too frequently those who are actually suffering from its effects, or who can be terrified into the belief that such may be the case, to fall easy victims to the rapacity of advertising quacks and of ignorant extortioners. Even now, I shall gladly confine my observations to the disease (for such it really becomes) of onanism as we meet with it in infancy or early childhood.
The following case, which I was lately urged to take charge of at the Hospital for Sick Children, will serve as a fair specimen of the course the affection takes, the origin from which it may spring, and the consequences it may induce.
[The case of George A]
George A--, six years of age, was admitted under my care in January of the present year. He had been in good heath till he was two years and ten months old, at which time he was sent from home into the country, where he was put to sleep with a girl fourteen or fifteen years of age. Soon after this his health appeared to fail, and he became weak and ailing, but without any definite malady. Under tonic treatment some improvement took place, followed, however, by frequent relapses, and five months ago a new symptom manifested itself in the shape of deafness. He was then removed to London, and again came under the care of his parents, who were distressed to find, in addition to his deafness, that his appearance was much changed, and that from being a fine, stout child he had the aspect of a little old man.
It was soon noticed that his hand was frequently applied to his penis, which was often in a state of erection, and that the prepuce was somewhat elongated. He was taken to a dispensary, where he was sounded, under the impression that a calculus might be present, but no stone was detected, and in fact no irritation of the bladder really existed. Suspicion arising on the part of his parents, a close watch was set upon him, when it was discovered that he was nightly in the habit of practising onanism. To put a stop to this, various means were adopted, including severe punishments by his father, after which he would promise to abstain, but during sleep he would get restless and excited, and on waking up would continue the practice, emission taking place.
His hands were then fastened out of bed, but he still effected his purpose by a peculiar convulsive or instinctive movement of the thighs. Repeated immersion in cold water at these times, and all other plans suggested having been employed ineffectually, as a last resource he was brought to the hospital. The child confesses readily that the practice began from the time of sleeping with the girl, and that it had been continued at least once nightly ever since. He promises and appears anxious to leave it off, but owns that he cannot restrain himself when he gets excited.
He was directed to sleep with his hands out of bed, and under the immediate surveillance of the night nurse. After the first night or two, the restlessness and movements were resumed, but of course immediately arrested. He was then placed on bromide of potassium, and afterwards on belladonna. Perfect cleanliness was inculcated, especially with regard to any secretion between the foreskin and the glans; and bathing etc was ordered. At the same time he was informed that it would be necessary, on account of his health, to perform an operation, with the hope that the dread of this might prove effectual; but the nocturnal excitement still continued, and I have at last removed a portion of the foreskin, without placing him under chloroform. Since the operation he has been perfectly quiet, and he has now left the hospital, with instructions that he is to be brought back if any relapse occurs.
[Discussion]
This case shows us how deeply rooted the vicious habit may become even at a very early age, for it was probably commenced in this instance soon after the child attained his third year; it also points out the ill consequences which may arise from placing male children to sleep with young females, and the care which should be taken in this respect even in infancy. My attention has been more drawn to this danger from my having another case at the same time under my care at the Children's Hospital, in which a boy seven years old was admitted with severe gonorrhoea and buboes, apparently contracted from a servant girl fifteen years of age, with whom he had been in the habit of sleeping.
[Literature review]
It must not be thought that the case of onanism I have related is a very exceptional one, nor that it is confined to the male sex, for it prevails amongst very young girls much oftener than is generally supposed. Many writers have noticed the very early age at which children give themselves up to it. Barthez and Rilliet, for instance, in their celebrated work on the "Diseases of Children", state that it cannot be concealed that "it is often very young children who abandon themselves to it with fury;" and they place this among the causes which may give rise to tuberculosis. M. Marjolin is reported, in the Gazette des Hospitaux, to have stated that "the youngest children are not exempt from the vice; that it is observed at the Hopital des Enfans Malades, and even sometimes, which may appear almost incredible, in children still at the breast. Fournier and Bergin assert that they have several times observed it in infants, and detail the case of a girl four years of age, who gave herself up to masturbation, as it were instinctively. The real nature of the affection was not discovered for four years, and, notwithstanding the means adopted, the child ultimately expired in a state of frightful marasmus, carrying on the practice to the very last moment of her existence. Vogel, too, alludes to a little girl three years of age, in whom repeated attacks of epilepsy occurred, after onanism had been indulged in for six months. Zimmerman notices the frequency of the occurrence; and Dr Van Bambeke relates three cases in children from three to twenty months old, the first child being a male, the other two females.
In infancy, and even at a slightly more advanced age, the attention of the parents is the less directed to the practice because the hand is commonly not employed, the irritation being effected by a kind of instinctive or convulsive movement of the thighs, as was seen in the boy at the Children's Hospital. These movements, when noticed, are naturally not attributed to their real cause, but referred to the irritation of worms, or to some other innocent origin, and allowed to go on unchecked.
According to Dr Van Bambeke, who has written an interesting article on the subject in L'Union Medicale, the face of the infant at this time becomes injected and covered with sweat, the eyes are brilliant, and the child is abstracted from objects around. It generally lies down rather than sits, fixing itself against some object by way of fulcrum. The spasmodic condition, he continues, is followed by pallor and depression; and in one of the little girls, in whom the periods of excitement were very frequent, the erectile organs had acquired a pretty considerable development.
[Evil consequences of masturbation]
The consequences of this practice are probably more serious at an early age than at a later period. In infancy the nervous system, especially its excito-motory portion, is highly excitable, and its functions are performed with great activity; but reaction and subsequent exhaustion are keenly felt. It is probable, therefore, that the repeated and violent excitation of the system may lead to derangement as regards both its intellectual and organic functions. The irritability of the mind and body, the peevishness, the alteration of the habits and general tone, together with the deterioration of the mental faculties occasionally observed in children, may possibly, in some cases, be attributable to this cause, and be the less amenable to treatment as their origin is hardly likely to be suspected. The disturbance of the nervous system is attended, usually, with some derangement of digestion and nutrition – functions of the highest importance at this age. The appetite becomes capricious, the muscles get weak and flabby, there is general wasting and, in some cases, a decided state of marasmus. I have already stated that Barthez and Rilliet place this vice amongst the causes which may lead to tuberculosis.
The special senses, too, are occasionally impaired; that of hearing, for example, in the child whose case I have given; and of vision, as noticed by Mr Kane, who attributes some forms of night-blindness, as well as of amaurosis, to indulgences of this description. I may mention also that Marjolin asserts that "almost all children affected with Pott's disease" (of the spinal column) "give themselves up to onanism with a sort of fury"; though whether, supposing any connexion to exist between the two, the disease of the spine is the consequence or the cause of the practice may possibly admit of a question.
As a predisposing cause we may possibly refer to the excitability of the nervous system in early life, which is much more marked – at least as regards the generative organs – in some children than in others, and varies, perhaps, in different nations; for I hope that in this country the habit in question is more uncommon than would appear to be the case in France. At the period of dentition, this irritability of the nervous system is more noticeable; and Dr Van Bambeke is inclined to assign the origin of the practice, in many cases, to this cause.
[Treatment in infancy]
Everything, however, which contributes to the excitation of he genitals may lead to the evil, for an act from which a pleasurable sensation is once experienced by the infant, may, unfortunately, degenerate into a habit. When any suspicion, therefore, exists great care should be taken with respect to the child's bed, which should be neither too soft nor too warm, whilst the custom should be early acquired of sleeping with the arms outside the clothes. In males, a deposit of sebaceous secretion under the prepuce, and around the corona glandis, frequently occasions considerable pruritis, especially when a tendency to phymosis is present; and in both sexes the irritation of the parts from the existence of herpetic or other slight inflammatory affections may induce masturbation. The genital organs, therefore, ought in all cases to be carefully examined, and any source of irritation at once removed. The existence of thread-worms in the rectum, or between the labia, where they may often insinuate themselves, should likewise be sought for, and means taken for their extirpation. The condition of the urine should also be attended to, for irritation of the neck of the bladder from certain conditions of this secretion, leads to great excitement of the genitals and, not unfrequently, to their being pulled about, as is seen so commonly in cases of actual or suspected stone.
In infancy, if these points are looked to, and if care is taken instantly to check the movements as soon as the attention of the other is directed to their nature, a victory may soon be gained; for surveillance in these cases, as Dr Van Bambeke remarks, is easy, the infant seeking no concealment. Cleanliness, of course, is of the greatest importance, and the sudden dash of cold water over the parts, at the very time of the excitement, will perhaps produce such a shock as to arrest the practice at once and for ever.
[Treatment in childhood]
At a somewhat later age – that is, in early childhood – when the habit has been persevered in for some time, the cure becomes more difficult. Any appeal to the moral sense, of any description of the evil consequences which may ultimately ensue, though recommended by some authors, I believe to be not merely useless, but injurious. If the child has not already acquired the vice you run a great risk of teaching it to him; and if he has, an indefinite and unknown future evil will never lead such a child to abandon a present gratification. Great prudence, therefore, should be exercised in our investigations; and it may be desirable to be acquainted with a test which Dr Donne asserts will enable us occasionally to recognise the existence of the practice – namely, the examination of the urine, which will present, shortly after the completion of the paroxysm, some mucus mixed with oxalate of lime.
The same care should be exercised at this age as in infancy in the removal of any exciting cause which can be discovered; the greatest cleanliness should be enjoined, cold bathing ordered, and the condition of the urine carefully attended to. During the day, a full amount of muscular exercise should be enforced, so that at night the consequent fatigue should render sleep prompt and necessary. Careful surveillance should be employed, and the hands kept outside the bedclothes, or actually fastened down; in extreme cases, too, we may adapt a shield of gutta percha, or other suitable material, so constructed as to prevent friction of the parts either by the hand or in the manner already alluded to. I have made a short trial of bromide of potassium, in consequence of its asserted emasculating properties; and of belladonna, on account of its great power in relieving the irritation which leads to nocturnal enuresis; neither of these remedies, however, had much effect.
[Benefits of circumcision]
The means I have related will often fail of even temporary benefit, for the act can be accomplished simply by the muscular movements already alluded to. In such cases we must, I believe, break the habit by inducing such a condition of the parts as will cause too much local suffering to allow of the practice being continued. For this purpose, if the prepuce is long, we may circumcise the male patient with present and probably with future advantage; the operation, too, should not be performed under chloroform, so that the pain experienced may be associated with the habit we wish to eradicate. In the female, Dr Gros has advocated, in like manner, complete to partial amputation of the clitoris; this, however, would seldom be called for, except, perhaps, in those cases where furious masturbation is associated with congenital malformation of the organ.
In both sexes, if the use of the knife should be considered unavoidable, and the practice be still continued after all obvious exciting causes have been removed, various irritating applications may be used locally, so as to render any movements of the parts painful. These are most likely to be called for in boys, for in female children, with the exception of the congenital cases I have alluded to, the practice seems to be more easily checked by surveillance than it is in males.
[Conclusion]
In conclusion, I have only again to call attention to the great care and caution to be exercised in the selection of those, whether of the same or of the opposite sex, with whom we allow children even of tender years to sleep or associate familiarly. Bad habits are easily acquired, but are lost with difficulty; ill health at the time and formidable disease in the future, mental impairment and moral degradation, may be the lamentable consequences of negligence in this respect on the part of the parents.
Athol A.W. Johnson, FRCS,* "An injurious habit occasionally met with in infancy and early childhood", The Lancet, 7 April 1860, p. 344-5
* Surgeon to the Hospital for Sick Children and Lecturer on Physiology at St George's Hospital
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