MASTOID CELLS, Suppuration of—see Ear, Diseases of. MASTURBATION.
The physician's advice is often sought for by parents who have detected their children in the act of practising this degrading habit. A careful examination of the genitals should be made, and any source of irritation removed if possible. Thus an adherent prepuce is a common cause which should be remedied by forcibly drawing back the foreskin so as to expose the glans thoroughly. A pinhole prepuce should he dilated or slit, and a long prepuce will demand circumcision. The operation removes a constant source of suggestive irritation, and, moreover, makes a long break in the habit, which should be followed up by close supervision and moral treatment.
In girls any unhealthy condition of the genital organs may lead to the establishment of the habit, and absolute cleanliness, with close supervision, may lead to a removal of the trouble. With older girls, who have been educated by others into the practice, only moral treatment will be of use. These cases are most unsatisfactory, as too often the habit of masturbation gets hold of those in whom the moral sense is but feebly developed.
It is sometimes a symptom of mental deficiency or the first indication of some psychical disturbance, and has too often been regarded even by specialists as the cause instead of the result of insanity.
Where moral treatment fails, resort to mechanical methods of prevent ing the act may be tried by tying the hands after undressing at bed-time, 35 and by arranging that the patient shall not sleep alone, or when the habit is practised during dreaming, by causing the patient to sleep with a hard body like an empty cotton-reel fastened over the spine, so that when Ile turns upon his back during sleep its pressure awakes him. The plan of blistering the penis or labia is a severe and almost brutal method, open to serious objection, and not even likely to be followed by any permanent benefit.
The regular emptying of the rectum by laxatives and the removal of threadworms or anal irritation from whatever cause are not to be over looked. The habit has been known to arise from the irritation caused by
the presence of a stone in the bladder.
Precocious sexual excitement is to be minimised by the avoidance of bad companions and indulgence in filthy conversation and impure litera ture. Free open-air exercise, pushed to the extent of inducing fatigue before bed-time, plain, unstimulating food, change of scene, of amusements and of surroundings, and attention to every measure calculated to improve the physical tone, should be advised.
Drugs are not to be depended upon when moral treatment fails, but where there is a continual struggle between an unhealthy, precocious, sexual appetite, and a weakened will, victory may be won for the latter occasionally by the administration of Bromides in conjunction with cold baths. Blistering over the oeciput and upper cervical spines is occasion ally useful in allaying the excitability of the sexual centres.
The physician is often consulted by physically healthy patients who have practised the habit of masturbation for a time during boyhood, and become hypochondriacal or almost insane after the perusal of some sample of pernicious quack literature on the subject. In such cases the firm assurance of tlie physician that the habit has left no injury behind it generally restores the patient's mind to a healthy state.
Regarding preventive treatment, it is a debatable question whether boys should be warned against the evils of a practice of which they may know nothing, and there cannot he a doubt hut that in some few cases such warning may produce the opposite effect, though many authorities who have had considerable experience of the training of boys follow the practice of sounding an alarm as a matter of routine. To be free from objections such warning must he most judiciously administered to innocent and sensitive youths.
For the cure of masturbation in insane patients, Clarke has successfully performed neureetomy, removing inch of each of the nerves on the dorsum of the penis through a transverse incision .; inch from the root of the organ.