The Influence of Tradition-The Theological Conception of Lust-Tendency of These Influences to Degrade Sexual Morality-Their Result in Creating the Problem of Sexual Abstinence-The Protests Against Sexual Abstinence-Sexual Abstinence and Genius-Sexual Abstinence in Women-The Advocates of Sexual Abstinence-Intermediate Attitude-Unsatisfactory Nature of the Whole Discussion-Criticism of the Conception of Sexual Abstinence-Sexual Abstinence as Compared to Abstinence from Food-No Complete Analogy-The Morality of Sexual Abstinence Entirely Negative-Is It the Physician’s Duty to Advise Extra-Conjugal Sexual Intercourse?-Opinions of Those Who Affirm or Deny This Duty-The Conclusion Against Such Advice-The Physician Bound by the Social and Moral Ideas of His Age-The Physician as Reformer-Sexual Abstinence and Sexual Hygiene-Alcohol-The Influence of Physical and Mental Exercise-The Inadequacy of Sexual Hygiene in This Field-The Unreal Nature of the Conception of Sexual Abstinence-The Necessity of Replacing It by a More Positive Ideal.

When we look at the matter from a purely abstract or even purely biological point of view, it might seem that in deciding that asceticism and chastity are of high value for the personal life we have said all that is necessary to say. That, however, is very far from being the case. We soon realize here, as at every point in the practical application of sexual psychology, that it is not sufficient to determine the abstractly right course along biological lines. We have to harmonize our biological demands with social demands. We are ruled not only by natural instincts but by inherited traditions, that in the far past were solidly based on intelligible grounds, and that even still, by the mere fact of their existence, exert a force which we cannot and ought not to ignore.

In discussing the valuation of the sexual impulse we found that we had good ground for making a very high estimate of love. In discussing chastity and asceticism we found that they also are highly to be valued. And we found that, so far from any contradiction being here involved, love and chastity are intertwined in all their finest developments, and that there is thus a perfect harmony in apparent opposition. But when we come to consider the matter in detail, in its particular personal applications, we find that a new factor asserts itself. We find that our inherited social and religious traditions exert a pressure, all on one side, which makes it impossible to place the relations of love and chastity simply on the basis of biology and reason. We are confronted at the outset by our traditions. On the one side these traditions have weighted the word “lust”-considered as expressing all the manifestations of the sexual impulse which are outside marriage or which fail to have marriage as their direct and ostentatious end-with deprecatory and sinister meanings. And on the other side these traditions have created the problem of “sexual abstinence,” which has nothing to do with either asceticism or chastity as these have been defined in the previous chapter, but merely with the purely negative pressure on the sexual impulse, exerted, independently of the individual’s wishes, by his religious and social environment.

The theological conception of “lust,” or “libido,” as sin, followed logically the early Christian conception of “the flesh,” and became inevitable as soon as that conception was firmly established. Not only, indeed, had early Christian ideals a degrading influence on the estimation of sexual desire per se, but they tended to depreciate generally the dignity of the sexual relationship. If a man made sexual advances to a woman outside marriage, and thus brought her within the despised circle of “lust,” he was injuring her because he was impairing her religious and moral value. The only way he could repair the damage done was by paying her money or by entering into a forced and therefore probably unfortunate marriage with her. That is to say that sexual relationships were, by the ecclesiastical traditions, placed on a pecuniary basis, on the same level as prostitution. By its well-meant intentions to support the theological morality which had developed on an ascetic basis, the Church was thus really undermining even that form of sexual relationship which it sanctified.

Gregory the Great ordered that the seducer of a virgin shall marry her, or, in case of refusal, be severely punished corporally and shut up in a monastery to perform penance. According to other ecclesiastical rules, the seducer of a virgin, though held to no responsibility by the civil forum, was required to marry her, or to find a husband and furnish a dowry for her. Such rules had their good side, and were especially equitable when seduction had been accomplished by deceit. But they largely tended in practice to subordinate all questions of sexual morality to a money question. The reparation to the woman, also, largely became necessary because the ecclesiastical conception of lust caused her value to be depreciated by contact with lust, and the reparation might be said to constitute a part of penance. Aquinas held that lust, in however slight a degree, is a mortal sin, and most of the more influential theologians took a view nearly or quite as rigid. Some, however, held that a certain degree of delectation is possible in these matters without mortal sin, or asserted, for instance, that to feel the touch of a soft and warm hand is not mortal sin so long as no sexual feeling is thereby aroused. Others, however, held that such distinctions are impossible, and that all pleasures of this kind are sinful. Tomas Sanchez endeavored at much length to establish rules for the complicated problems of delectation that thus arose, but he was constrained to admit that no rules are really possible, and that such matters must be left to the judgment of a prudent man. At that point casuistry dissolves and the modern point of view emerges (see, e.g., Lea, History of Auricular Confession, vol. ii, pp. 57, 115, 246, etc.).

Even to-day the influence of the old traditions of the Church still unconsciously survives among us. That is inevitable as regards religious teachers, but it is found also in men of science, even in Protestant countries. The result is that quite contradictory dogmas are found side by side, even in the same writer. On the one hand, the manifestations of the sexual impulse are emphatically condemned as both unnecessary and evil; on the other hand, marriage, which is fundamentally (whatever else it may also be) a manifestation of the sexual impulse, receives equally emphatic approval as the only proper and moral form of living. There can be no reasonable doubt whatever that it is to the surviving and pervading influence of the ancient traditional theological conception of libido that we must largely attribute the sharp difference of opinions among physicians on the question of sexual abstinence and the otherwise unnecessary acrimony with which these opinions have sometimes been stated.

On the one side, we find the emphatic statement that sexual intercourse is necessary and that health cannot be maintained unless the sexual activities are regularly exercised.

“All parts of the body which are developed for a definite use are kept in health, and in the enjoyment of fair growth and of long youth, by the fulfilment of that use, and by their appropriate exercise in the employment to which they are accustomed.” In that statement, which occurs in the great Hippocratic treatise “On the Joints,” we have the classic expression of the doctrine which in ever varying forms has been taught by all those who have protested against sexual abstinence. When we come down to the sixteenth century outbreak of Protestantism we find that Luther’s revolt against Catholicism was in part a protest against the teaching of sexual abstinence. “He to whom the gift of continence is not given,” he said in his Table Talk, “will not become chaste by fasting and vigils. For my own part I was not excessively tormented [though elsewhere he speaks of the great fires of lust by which he had been troubled], but all the same the more I macerated myself the more I burnt.” And three hundred years later, Bebel, the would-be nineteenth century Luther of a different Protestantism, took the same attitude towards sexual abstinence, while Hinton the physician and philosopher, living in a land of rigid sexual conventionalism and prudery, and moved by keen sympathy for the sufferings he saw around him, would break into passionate sarcasm when confronted by the doctrine of sexual abstinence. “There are innumerable ills-terrible destructions, madness even, the ruin of lives-for which the embrace of man and woman would be a remedy. No one thinks of questioning it. Terrible evils and a remedy in a delight and joy! And man has chosen so to muddle his life that he must say: ’There, that would be a remedy, but I cannot use it. I must be virtuous!’”

If we confine ourselves to modern times and to fairly precise medical statements, we find in Schurig’s Spermatologia (1720, pp. 274 et seq.), not only a discussion of the advantages of moderate sexual intercourse in a number of disorders, as witnessed by famous authorities, but also a list of results-including anorexia, insanity, impotence, epilepsy, even death-which were believed to have been due to sexual abstinence. This extreme view of the possible evils of sexual abstinence seems to have been part of the Renaissance traditions of medicine stiffened by a certain opposition between religion and science. It was still rigorously stated by Lallemand early in the nineteenth century. Subsequently, the medical statements of the evil results of sexual abstinence became more temperate and measured, though still often pronounced. Thus Gyurkovechky believes that these results may be as serious as those of sexual excess. Krafft-Ebing showed that sexual abstinence could produce a state of general nervous excitement (Jahrbuch fuer Psychiatrie, Bd. viii, Heft 1 and 2). Schrenck-Notzing regards sexual abstinence as a cause of extreme sexual hyperaesthesia and of various perversions (in a chapter on sexual abstinence in his Kriminalpsychologische und Psychopathologische Studien, 1902, pp. 174-178). He records in illustration the case of a man of thirty-six who had masturbated in moderation as a boy, but abandoned the practice entirely, on moral grounds, twenty years ago, and has never had sexual intercourse, feeling proud to enter marriage a chaste man, but now for years has suffered greatly from extreme sexual hyperaesthesia and concentration of thought on sexual subjects, notwithstanding a strong will and the resolve not to masturbate or indulge in illicit intercourse. In another case a vigorous and healthy man, not inverted, and with strong sexual desires, who remained abstinent up to marriage, suffers from psychic impotence, and his wife remains a virgin notwithstanding all her affection and caresses. Ord considered that sexual abstinence might produce many minor evils. “Most of us,” he wrote (British Medical Journal, Au, 1884) “have, no doubt, been consulted by men, chaste in act, who are tormented by sexual excitement. They tell one stories of long-continued local excitement, followed by intense muscular weariness, or by severe aching pain in the back and legs. In some I have had complaints of swelling and stiffness in the legs, and of pains in the joints, particularly in the knees;” he gives the case of a man who suffered after prolonged chastity from inflammatory conditions of knees and was only cured by marriage. Pearce Gould, it may be added, finds that “excessive ungratified sexual desire” is one of the causes of acute orchitis. Remondino ("Some Observations on Continence as a Factor in Health and Disease,” Pacific Medical Journal, Jan., 1900) records the case of a gentleman of nearly seventy who, during the prolonged illness of his wife, suffered from frequent and extreme priapism, causing insomnia. He was very certain that his troubles were not due to his continence, but all treatment failed and there were no spontaneous emissions. At last Remondino advised him to, as he expresses it, “imitate Solomon.” He did so, and all the symptoms at once disappeared. This case is of special interest, because the symptoms were not accompanied by any conscious sexual desire. It is no longer generally believed that sexual abstinence tends to produce insanity, and the occasional cases in which prolonged and intense sexual desire in young women is followed by insanity will usually be found to occur on a basis of hereditary degeneration. It is held by many authorities, however, that minor mental troubles, of a more or less vague character, as well as neurasthenia and hysteria, are by no means infrequently due to sexual abstinence. Thus Freud, who has carefully studied angstneurosis, the obsession of anxiety, finds that it is a result of sexual abstinence, and may indeed be considered as a vicarious form of such abstinence (Freud, Sammlung Kleiner Schriften zur Neurosenlehre, 1906, pp. 76 et seq.).

The whole subject of sexual abstinence has been discussed at length by Nystroem, of Stockholm, in Das Geschlechtsleben und seine Gesetze, Ch. III. He concludes that it is desirable that continence should be preserved as long as possible in order to strengthen the physical health and to develop the intelligence and character. The doctrine of permanent sexual abstinence, however, he regards as entirely false, except in the case of a small number of religious or philosophic persons. “Complete abstinence during a long period of years cannot be borne without producing serious results both on the body and the mind.... Certainly, a young man should repress his sexual impulses as long as possible and avoid everything that may artificially act as a sexual stimulant. If, however, he has done so, and still suffers from unsatisfied normal sexual desires, and if he sees no possibility of marriage within a reasonable time, no one should dare to say that he is committing a sin if, with mutual understanding, he enters into sexual relations with a woman friend, or forms temporary sexual relationships, provided, that is, that he takes the honorable precaution of begetting no children, unless his partner is entirely willing to become a mother, and he is prepared to accept all the responsibilities of fatherhood.” In an article of later date ("Die Einwirkung der Sexuellen Abstinenz auf die Gesundheit,” Sexual-Problème, July, 1908) Nystroem vigorously sums up his views. He includes among the results of sexual abstinence orchitis, frequent involuntary seminal emissions, impotence, neurasthenia, depression, and a great variety of nervous disturbances of vaguer character, involving diminished power of work, limited enjoyment of life, sleeplessness, nervousness, and pre-occupation with sexual desires and imaginations. More especially there is heightened sexual irritability with erections, or even seminal emissions on the slightest occasion, as on gazing at an attractive woman or in social intercourse with her, or in the presence of works of art representing naked figures. Nystroem has had the opportunity of investigating and recording ninety cases of persons who have presented these and similar symptoms as the result, he believes, of sexual abstinence. He has published some of these cases (Zeitschrift fuer Sexualwissenschaft, Oct., 1908), but it may be added that Rohleder ("Die Abstinentia Sexualis,” ib., Nov., 1908) has criticized these cases, and doubts whether any of them are conclusive. Rohleder believes that the bad results of sexual abstinence are never permanent, and also that no anatomically pathological states (such as orchitis) can be thereby produced. But he considers, nevertheless, that even incomplete and temporary sexual abstinence may produce fairly serious results, and especially neurasthenic disturbances of various kinds, such as nervous irritability, anxiety, depression, disinclination for work; also diurnal emissions, premature ejaculations, and even a state approaching satyriasis; and in women hysteria, hystero-epilepsy, and nymphomaniacal manifestations; all these symptoms may, however, he believes, be cured when the abstinence ceases.

Many advocates of sexual abstinence have attached importance to the fact that men of great genius have apparently been completely continent throughout life. This is certainly true (see ante, . But this fact can scarcely be invoked as an argument in favor of the advantages of sexual abstinence among the ordinary population. J.F. Scott selects Jesus, Newton, Beethoven, and Kant as “men of vigor and mental acumen who have lived chastely as bachelors.” It cannot, however, be said that Dr. Scott has been happy in the four figures whom he has been able to select from the whole history of human genius as examples of life-long sexual abstinence. We know little with absolute certainty of Jesus, and even if we reject the diagnosis which Professor Binet-Sangle (in his Folie de Jesus) has built up from a minute study of the Gospels, there are many reasons why we should refrain from emphasizing the example of his sexual abstinence; Newton, apart from his stupendous genius in a special field, was an incomplete and unsatisfactory human being who ultimately reached a condition very like insanity; Beethoven was a thoroughly morbid and diseased man, who led an intensely unhappy existence; Kant, from first to last, was a feeble valetudinarian. It would probably be difficult to find a healthy normal man who would voluntarily accept the life led by any of these four, even as the price of their fame. J.A. Godfrey (Science of Sex, pp. 139-147) discusses at length the question whether sexual abstinence is favorable to ordinary intellectual vigor, deciding that it is not, and that we cannot argue from the occasional sexual abstinence of men of genius, who are often abnormally constituted, and physically below the average, to the normally developed man. Sexual abstinence, it may be added, is by no means always a favorable sign, even in men who stand intellectually above the average. “I have not obtained the impression,” remarks Freud (Sexual-Problème, March, 1908), “that sexual abstinence is helpful to energetic and independent men of action or original thinkers, to courageous liberators or reformers. The sexual conduct of a man is often symbolic of his whole method of reaction in the world. The man who energetically grasps the object of his sexual desire may be trusted to show a similarly relentless energy in the pursuit of other aims.”

Many, though not all, who deny that prolonged sexual abstinence is harmless, include women in this statement. There are some authorities indeed who believe that, whether or not any conscious sexual desire is present, sexual abstinence is less easily tolerated by women than by men.

Cabanis, in his famous and pioneering work, Rapports du Physique et du Moral, said in 1802, that women not only bear sexual excess more easily than men, but sexual privations with more difficulty, and a cautious and experienced observer of to-day, Loewenfeld (Sexualleben und Nervenleiden, 1899, , while not considering that normal women bear sexual abstinence less easily than men, adds that this is not the case with women of neuropathic disposition, who suffer much more from this cause, and either masturbate when sexual intercourse is impossible or fall into hystero-neurasthenic states. Busch stated (Das Geschlechtsleben des Weibes, 1839, vol. i, pp. 69, 71) that not only is the working of the sexual functions in the organism stronger in women than in men, but that the bad results of sexual abstinence are more marked in women. Sir Benjamin Brodie said long ago that the evils of continence to women are perhaps greater than those of incontinence, and to-day Hammer (Die Gesundheitlichen Gefahren der Geschlechtlichen Enthaltsamkeit, 1904) states that, so far as reasons of health are concerned, sexual abstinence is no more to be recommended to women than to men. Nystroem is of the same opinion, though he thinks that women bear sexual abstinence better than men, and has discussed this special question at length in a section of his Geschlechtsleben und seine Gesetze. He agrees with the experienced Erb that a large number of completely chaste women of high character, and possessing distinguished qualities of mind and heart, are more or less disordered through their sexual abstinence; this is specially often the case with women married to impotent men, though it is frequently not until they approach the age of thirty, Nystroem remarks, that women definitely realize their sexual needs.

A great many women who are healthy, chaste, and modest, feel at times such powerful sexual desire that they can scarcely resist the temptation to go into the street and solicit the first man they meet. Not a few such women, often of good breeding, do actually offer themselves to men with whom they may have perhaps only the slightest acquaintance. Routh records such cases (British Gynaecological Journal, Feb., 1887), and most men have met with them at some time. When a woman of high moral character and strong passions is subjected for a very long period to the perpetual strain of such sexual craving, especially if combined with love for a definite individual, a chain of evil results, physical and moral, may be set up, and numerous distinguished physicians have recorded such cases, which terminated at once in complete recovery as soon as the passion was gratified. Lauvergne long since described a case. A fairly typical case of this kind was reported in detail by Brachet (De l’Hypochondrie, and embodied by Griesinger in his classic work on “Mental Pathology.” It concerned a healthy married lady, twenty-six years old, having three children. A visiting acquaintance completely gained her affections, but she strenuously resisted the seducing influence, and concealed the violent passion that he had aroused in her. Various serious symptoms, physical and mental, slowly began to appear, and she developed what seemed to be signs of consumption. Six months’ stay in the south of France produced no improvement, either in the bodily or mental symptoms. On returning home she became still worse. Then she again met the object of her passion, succumbed, abandoned her husband and children, and fled with him. Six months later she was scarcely recognizable; beauty, freshness and plumpness had taken the place of emaciation; while the symptoms of consumption and all other troubles had entirely disappeared. A somewhat similar case is recorded by Camill Lederer, of Vienna (Monatsschrift fuer Harnkrankheiten und Sexuelle Hygiene, 1906, Heft 3). A widow, a few months after her husband’s death, began to cough, with symptoms of bronchial catarrh, but no definite signs of lung disease. Treatment and change of climate proved entirely unavailing to effect a cure. Two years later, as no signs of disease had appeared in the lungs, though the symptoms continued, she married again. Within a very few weeks all symptoms had disappeared, and she was entirely fresh and well.

Numerous distinguished gynaecologists have recorded their belief that sexual excitement is a remedy for various disorders of the sexual system in women, and that abstinence is a cause of such disorders. Matthews Duncan said that sexual excitement is the only remedy for amenorrhoea; “the only emmenagogue medicine that I know of,” he wrote (Medical Times, Fe, 1884), “is not to be found in the Pharmacopoeia: it is erotic excitement. Of the value of erotic excitement there is no doubt.” Anstie, in his work on Neuralgia, refers to the beneficial effect of sexual intercourse on dysmenorrhoea, remarking that the necessity of the full natural exercise of the sexual function is shown by the great improvement in such cases after marriage, and especially after childbirth. (It may be remarked that not all authorities find dysmenorrhoea benefited by marriage, and some consider that the disease is often thereby aggravated; see, e.g., Wythe Cook, American Journal Obstetrics, Dec., 1893.) The distinguished gynaecologist, Tilt, at a somewhat earlier date (On Uterine and Ovarian Inflammation, 1862, , insisted on the evil results of sexual abstinence in producing ovarian irritation, and perhaps subacute ovaritis, remarking that this was specially pronounced in young widows, and in prostitutes placed in penitentiaries. Intense desire, he pointed out, determines organic movements resembling those required for the gratification of the desire. These burning desires, which can only be quenched by their legitimate satisfaction, are still further heightened by the erotic influence of thoughts, books, pictures, music, which are often even more sexually stimulating than social intercourse with men, but the excitement thus produced is not relieved by that natural collapse which should follow a state of vital turgescence. After referring to the biological facts which show the effect of psychic influences on the formative powers of the ovario-uterine organs in animals, Tilt continues: “I may fairly infer that similar incitements on the mind of females may have a stimulating effect on the organs of ovulation. I have frequently known menstruation to be irregular, profuse, or abnormal in type during courtship in women in whom nothing similar had previously occurred, and that this protracted the treatment of chronic ovaritis and of uterine inflammation.” Bonnifield, of Cincinnati (Medical Standard, Dec., 1896), considers that unsatisfied sexual desire is an important cause of catarrhal endometritis. It is well known that uterine fibroids bear a definite relation to organic sexual activity, and that sexual abstinence, more especially the long-continued deprivation of pregnancy, is a very important cause of the disease. This is well shown by an analysis by A.E. Giles (Lancet, March 2, 1907) of one hundred and fifty cases. As many as fifty-six of these cases, more than a third, were unmarried women, though nearly all were over thirty years of age. Of the ninety-four married women, thirty-four had never been pregnant; of those who had been pregnant, thirty-six had not been so for at least ten years. Thus eighty-four per cent, had either not been pregnant at all, or had had no pregnancy for at least ten years. It is, therefore, evident that deprivation of sexual function, whether or not involving abstinence from sexual intercourse, is an important cause of uterine fibroid tumors. Balls-Headley, of Victoria (Evolution of the Diseases of Women, 1894, and “Etiology of Diseases of Female Genital Organs,” Allbutt and Playfair, System of Gynaecology,) believes that unsatisfied sexual desire is a factor in very many disorders of the sexual organs in women. “My views,” he writes in a private letter, “are founded on a really special gynaecological practice of twenty years, during which I have myself taken about seven thousand most careful records. The normal woman is sexually well-formed and her sexual feelings require satisfaction in the direction of the production of the next generation, but under the restrictive and now especially abnormal conditions of civilization some women undergo hereditary atrophy, and the uterus and sexual feelings are feeble; in others of good average local development the feeling is in restraint; in others the feelings, as well as the organs, are strong, and if normal use be withheld evils ensue. Bearing in mind these varieties of congenital development in relation to the respective condition of virginity, or sterile or parous married life, the mode of occurrence and of progress of disease grows on the physician’s mind, and there is no more occasion for bewilderment than to the mathematician studying conic sections, when his knowledge has grown from the basis of the science. The problem is suggested: Has a crowd of unassociated diseases fallen as through a sieve on woman, or have these affections almost necessarily ensued from the circumstances of her unnatural environment?” It may be added that Kisch (Sexual Life of Woman), while protesting against any exaggerated estimate of the effects of sexual abstinence, considers that in women it may result, not only in numerous local disorders, but also in nervous disturbance, hysteria, and even insanity, while in neurasthenic women “regulated sexual intercourse has an actively beneficial effect which is often striking.”

It is important to remark that the evil results of sexual abstinence in women, in the opinion of many of those who insist upon their importance, are by no means merely due to unsatisfied sexual desire. They may be pronounced even when the woman herself has not the slightest consciousness of sexual needs. This was clearly pointed out forty years ago by the sagacious Anstie (op. cit.) In women, especially, he remarks, “a certain restless hyperactivity of mind, and perhaps of body also, seems to be the expression of Nature’s unconscious resentment of the neglect of sexual functions.” Such women, he adds, have kept themselves free from masturbation “at the expense of a perpetual and almost fierce activity of mind and muscle.” Anstie had found that some of the worst cases of the form of nervosity and neurasthenia which he termed “spinal irritation,” often accompanied by irritable stomach and anæmia, get well on marriage. “There can be no question,” he continues, “that a very large proportion of these cases in single women (who form by far the greater number of subjects of spinal irritation) are due to this conscious or unconscious irritation kept up by an unsatisfied sexual want. It is certain that very many young persons (women more especially) are tormented by the irritability of the sexual organs without having the least consciousness of sexual desire, and present the sad spectacle of a vie manquee without ever knowing the true source of the misery which incapacitates them for all the active duties of life. It is a singular fact that in occasional instances one may even see two sisters, inheriting the same kind of nervous organization, both tormented with the symptoms of spinal irritation and both probably suffering from repressed sexual functions, but of whom one shall be pure-minded and entirely unconscious of the real source of her troubles, while the other is a victim to conscious and fruitless sexual irritation.” In this matter Anstie may be regarded as a forerunner of Freud, who has developed with great subtlety and analytic power the doctrine of the transformation of repressed sexual instinct in women into morbid forms. He considers that the nervosity of to-day is largely due to the injurious action on the sexual life of that repression of natural instincts on which our civilization is built up. (Perhaps the clearest brief statement of Freud’s views on the matter is to be found in a very suggestive article, “Die ‘Kulturelle’ Sexualmoral und die Moderne Nervositaet,” in Sexual-Problème, March, 1908, reprinted in the second series of Freud’s Sammlung Kleiner Schriften zur Neurosenlehre, 1909). We possess the aptitude, he says, of sublimating and transforming our sexual activities into other activities of a psychically related character, but non-sexual. This process cannot, however, be carried out to an unlimited extent any more than can the conversion of heat into mechanical work in our machines. A certain amount of direct sexual satisfaction is for most organizations indispensable, and the renunciation of this individually varying amount is punished by manifestations which we are compelled to regard as morbid. The process of sublimation, under the influence of civilization, leads both to sexual perversions and to psycho-neuroses. These two conditions are closely related, as Freud views the process of their development; they stand to each other as positive and negative, sexual perversions being the positive pole and psycho-neuroses the negative. It often happens, he remarks, that a brother may be sexually perverse, while his sister, with a weaker sexual temperament, is a neurotic whose symptoms are a transformation of her brother’s perversion; while in many families the men are immoral, the women pure and refined but highly nervous. In the case of women who have no defect of sexual impulse there is yet the same pressure of civilized morality pushing them into neurotic states. It is a terribly serious injustice, Freud remarks, that the civilized standard of sexual life is the same for all persons, because though some, by their organization, may easily accept it, for others it involves the most difficult psychic sacrifices. The unmarried girl, who has become nervously weak, cannot be advised to seek relief in marriage, for she must be strong in order to “bear” marriage, while we urge a man on no account to marry a girl who is not strong. The married woman who has experienced the deceptions of marriage has usually no way of relief left but by abandoning her virtue. “The more strenuously she has been educated, and the more completely she has been subjected to the demands of civilization, the more she fears this way of escape, and in the conflict between her desires and her sense of duty, she also seeks refuge-in neurosis. Nothing protects her virtue so surely as disease.” Taking a still wider view of the influence of the narrow “civilized” conception of sexual morality on women, Freud finds that it is not limited to the production of neurotic conditions; it affects the whole intellectual aptitude of women. Their education denies them any occupation with sexual problems, although such problems are so full of interest to them, for it inculcates the ancient prejudice that any curiosity in such matters is unwomanly and a proof of wicked inclinations. They are thus terrified from thinking, and knowledge is deprived of worth. The prohibition to think extends, automatically and inevitably, far beyond the sexual sphere. “I do not believe,” Freud concludes, “that there is any opposition between intellectual work and sexual activity such as was supposed by Moebius. I am of opinion that the unquestionable fact of the intellectual inferiority of so many women is due to the inhibition of thought imposed upon them for the purpose of sexual repression.”

It is only of recent years that this problem has been realized and faced, though solitary thinkers, like Hinton, have been keenly conscious of its existence; for “sorrowing virtue,” as Mrs. Ella Wheeler Wilcox puts it, “is more ashamed of its woes than unhappy sin, because the world has tears for the latter and only ridicule for the former.” “It is an almost cynical trait of our age,” Hellpach wrote a few years ago, “that it is constantly discussing the theme of prostitution, of police control, of the age of consent, of the ‘white slavery,’ and passes over the moral struggle of woman’s soul without an attempt to answer her burning questions.”

On the other hand we find medical writers not only asserting with much moral fervor that sexual intercourse outside marriage is always and altogether unnecessary, but declaring, moreover, the harmlessness or even the advantages of sexual abstinence.

Ribbing, the Swedish professor, in his Hygiene Sexuelle, advocates sexual abstinence outside marriage, and asserts its harmlessness. Gilles de la Tourette, Fere, and Augagneur in France agree. In Germany Fuerbringer (Senator and Kaminer, Health and Disease in Relation to Marriage, vol. i, asserts that continence is possible and necessary, though admitting that it may, however, mean serious mischief in exceptional cases. Eulenburg (Sexuale Neuropathie, doubts whether anyone, who otherwise lived a reasonable life, ever became ill, or more precisely neurasthenic, through sexual abstinence. Hegar, replying to the arguments of Bebel in his well-known book on women, denies that sexual abstinence can ever produce satyriasis or nymphomania. Naecke, who has frequently discussed the problem of sexual abstinence (e.g., Archiv fuer Kriminal-Anthropologie, 1903, Heft 1, and Sexual-Problème, June, 1908), maintains that sexual abstinence can, at most, produce rare and slight unfavorable results, and that it is no more likely to produce insanity, even in predisposed individuals, than are the opposite extremes of sexual excess and masturbation. He adds that, so far as his own observations are concerned, the patients in asylums suffer scarcely at all from their compulsory sexual abstinence.

It is in England, however, that the virtues of sexual abstinence have been most loudly and emphatically proclaimed, sometimes indeed with considerable lack of cautious qualification. Acton, in his Reproductive Organs, sets forth the traditional English view, as well as Beale in his Morality and the Moral Question. A more distinguished representative of the same view was Paget, who, in his lecture on “Sexual Hypochondriasis,” coupled sexual intercourse with “theft or lying.” Sir William Gowers (Syphilis and the Nervous System, 1892, also proclaims the advantages of “unbroken chastity,” more especially as a method of avoiding syphilis. He is not hopeful, however, even as regards his own remedy, for he adds: “We can trace small ground for hope that the disease will thus be materially reduced.” He would still, however, preach chastity to the individual, and he does so with all the ascetic ardor of a mediaeval monk. “With all the force that any knowledge I possess, and any authority I have, can give, I assert that no man ever yet was in the slightest degree or way the worse for continence or better for incontinence. From the latter all are worse morally; a clear majority are worse physically; and in no small number the result is, and ever will be, utter physical shipwreck on one of the many rocks, sharp, jagged-edged, which beset the way, or on one of the many beds of festering slime which no care can possibly avoid.” In America the same view widely prevails, and Dr. J.F. Scott, in his Sexual-Instinct (second edition, 1908, Ch. III), argues very vigorously and at great length in favor of sexual abstinence. He will not even admit that there are two sides to the question, though if that were the case, the length and the energy of his arguments would be unnecessary.

Among medical authorities who have discussed the question of sexual abstinence at length it is not, indeed, usually possible to find such unqualified opinions in its favor as those I have quoted. There can be no doubt, however, that a large proportion of physicians, not excluding prominent and distinguished authorities, when casually confronted with the question whether sexual abstinence is harmless, will at once adopt the obvious path of least resistance and reply: Yes. In only a few cases will they even make any qualification of this affirmative answer. This tendency is very well illustrated by an inquiry made by Dr. Ludwig Jacobsohn, of St. Petersburgh ("Die Sexuelle Enthaltsamkeit im Lichte der Medizin,” St. Petersburger Medicinische Wochenschrift, March 17, 1907). He wrote to over two hundred distinguished Russian and German professors of physiology, neurology, psychiatry, etc., asking them if they regarded sexual abstinence as harmless. The majority returned no answer; eleven Russian and twenty-eight Germans replied, but four of them merely said that “they had no personal experience,” etc.; there thus remained thirty-five. Of these E. Pflueger, of Bonn, was skeptical of the advantage of any propaganda of abstinence: “if all the authorities in the world declared the harmlessness of abstinence that would have no influence on youth. Forces are here in play that break through all obstacles.” The harmlessness of abstinence was affirmed by Kraepelin, Cramer, Gaertner, Tuczek, Schottelius, Gaffky, Finkler, Selenew, Lassar, Seifert, Gruber; the last, however, added that he knew very few abstinent young men, and himself only considered abstinence good before full development, and intercourse not dangerous in moderation even before then. Brieger knew cases of abstinence without harmful results, but himself thought that no general opinion could be given. Juergensen said that abstinence in itself is not harmful, but that in some cases intercourse exerts a more beneficial influence. Hoffmann said that abstinence is harmless, adding that though it certainly leads to masturbation, that is better than gonorrhoea, to say nothing of syphilis, and is easily kept within bounds. Struempell replied that sexual abstinence is harmless, and indirectly useful as preserving from the risk of venereal disease, but that sexual intercourse, being normal, is always more desirable. Hensen said that abstinence is not to be unconditionally approved. Rumpf replied that abstinence was not harmful for most before the age of thirty, but after that age there was a tendency to mental obsessions, and marriage should take place at twenty-five. Leyden also considered abstinence harmless until towards thirty, when it leads to psychic anomalies, especially states of anxiety, and a certain affectation. Hein replied that abstinence is harmless for most, but in some leads to hysterical manifestations and indirectly to bad results from masturbation, while for the normal man abstinence cannot be directly beneficial, since intercourse is natural. Gruetzner thought that abstinence is almost never harmful. Nescheda said it is harmless in itself, but harmful in so far as it leads to unnatural modes of gratification. Neisser believes that more prolonged abstinence than is now usual would be beneficial, but admitted the sexual excitations of our civilization; he added that of course he saw no harm for healthy men in intercourse. Hoche replied that abstinence is quite harmless in normal persons, but not always so in abnormal persons. Weber thought it had a useful influence in increasing will-power. Tarnowsky said it is good in early manhood, but likely to be unfavorable after twenty-five. Orlow replied that, especially in youth, it is harmless, and a man should be as chaste as his wife. Popow said that abstinence is good at all ages and preserves the energy. Blumenau said that in adult age abstinence is neither normal nor beneficial, and generally leads to masturbation, though not generally to nervous disorders; but that even masturbation is better than syphilis. Tschiriew saw no harm in abstinence up to thirty, and thought sexual weakness more likely to follow excess than abstinence. Tschish regarded abstinence as beneficial rather than harmful up to twenty-five or twenty-eight, but thought it difficult to decide after that age when nervous alterations seem to be caused. Darkschewitcz regarded abstinence as harmless up to twenty-five. Fraenkel said it was harmless for most, but that for a considerable proportion of people intercourse is a necessity. Erb’s opinion is regarded by Jacobsohn as standing alone; he placed the age below which abstinence is harmless at twenty; after that age he regarded it as injurious to health, seriously impeding work and capacity, while in neurotic persons it leads to still more serious results. Jacobsohn concludes that the general opinion of those answering the inquiry may thus be expressed: “Youth should be abstinent. Abstinence can in no way injure them; on the contrary, it is beneficial. If our young people will remain abstinent and avoid extra-conjugal intercourse they will maintain a high ideal of love and preserve themselves from venereal diseases.”

The harmlessness of sexual abstinence was likewise affirmed in America in a resolution passed by the American Medical Association in 1906. The proposition thus formally accepted was thus worded: “Continence is not incompatible with health.” It ought to be generally realized that abstract propositions of this kind are worthless, because they mean nothing. Every sane person, when confronted by the demand to boldly affirm or deny the proposition, “Continence is not incompatible with health,” is bound to affirm it. He might firmly believe that continence is incompatible with the health of most people, and that prolonged continence is incompatible with anyone’s health, and yet, if he is to be honest in the use of language, it would be impossible for him to deny the vague and abstract proposition that “Continence is not incompatible with health.” Such propositions are therefore not only without value, but actually misleading.

It is obvious that the more extreme and unqualified opinions in favor of sexual abstinence are based not on medical, but on what the writers regard as moral considerations. Moreover, as the same writers are usually equally emphatic in regard to the advantages of sexual intercourse in marriage, it is clear that they have committed themselves to a contradiction. The same act, as Naecke rightly points out, cannot become good or bad according as it is performed in or out of marriage. There is no magic efficacy in a few words pronounced by a priest or a government official.

Remondino (loc. cit.) remarks that the authorities who have committed themselves to declarations in favor of the unconditional advantages of sexual abstinence tend to fall into three errors: (1) they generalize unduly, instead of considering each case individually, on its own merits; (2) they fail to realize that human nature is influenced by highly mixed and complex motives and cannot be assumed to be amenable only to motives of abstract morality; (3) they ignore the great army of masturbators and sexual perverts who make no complaint of sexual suffering, but by maintaining a rigid sexual abstinence, so far as normal relationships are concerned, gradually drift into currents whence there is no return.

Between those who unconditionally affirm or deny the harmlessness of sexual abstinence we find an intermediate party of authorities whose opinions are more qualified. Many of those who occupy this more guarded position are men whose opinions carry much weight, and it is probable that with them rather than with the more extreme advocates on either side the greater measure of reason lies. So complex a question as this cannot be adequately investigated merely in the abstract, and settled by an unqualified negative or affirmative. It is a matter in which every case requires its own special and personal consideration.

“Where there is such a marked opposition of opinion truth is not exclusively on one side,” remarks Loewenfeld (Sexualleben und Nervenleiden, second edition, . Sexual abstinence is certainly often injurious to neuropathic persons. (This is now believed by a large number of authorities, and was perhaps first decisively stated by Krafft-Ebing, “Ueber Neurosen durch Abstinenz,” Jahrbuch fuer Psychiatrie, 1889, . Loewenfeld finds no special proclivity to neurasthenia among the Catholic clergy, and when it does occur, there is no reason to suppose a sexual causation. “In healthy and not hereditarily neuropathic men complete abstinence is possible without injury to the nervous system.” Injurious effects, he continues, when they appear, seldom occur until between twenty-four and thirty-six years of age, and even then are not usually serious enough to lead to a visit to a doctor, consisting mainly in frequency of nocturnal emissions, pain in testes or rectum, hyperaesthesia in the presence of women or of sexual ideas. If, however, conditions arise which specially stimulate the sexual emotions, neurasthenia may be produced. Loewenfeld agrees with Freud and Gattel that the neurosis of anxiety tends to occur in the abstinent, careful examination showing that the abstinence is a factor in its production in both sexes. It is common among young women married to much older men, often appearing during the first years of marriage. Under special circumstances, therefore, abstinence can be injurious, but on the whole the difficulties due to such abstinence are not severe, and they only exceptionally call forth actual disturbance in the nervous or psychic spheres. Moll takes a similar temperate and discriminating view. He regards sexual abstinence before marriage as the ideal, but points out that we must avoid any doctrinal extremes in preaching sexual abstinence, for such preaching will merely lead to hypocrisy. Intercourse with prostitutes, and the tendency to change a woman like a garment, induce loss of sensitiveness to the spiritual and personal element in woman, while the dangers of sexual abstinence must no more be exaggerated than the dangers of sexual intercourse (Moll, Libido Sexualis, 1898, vol. i, ; id., Kontraere Sexualempfindung, 1899, . Bloch also (in a chapter on the question of sexual abstinence in his Sexualleben unserer Zeit, 1908) takes a similar standpoint. He advocates abstention during early life and temporary abstention in adult life, such abstention being valuable, not only for the conservation and transformation of energy, but also to emphasize the fact that life contains other matters to strive for beyond the ends of sex. Redlich (Medizinische Klinik, 1908, N also, in a careful study of the medical aspects of the question, takes an intermediate standpoint in relation to the relative advantages and disadvantages of sexual abstinence. “We may say that sexual abstinence is not a condition which must, under all circumstances and at any price, be avoided, though it is true that for the majority of healthy adult persons regular sexual intercourse is advantageous, and sometimes is even to be recommended.”

It may be added that from the standpoint of Christian religious morality this same attitude, between the extremes of either party, recognizing the advantages of sexual abstinence, but not insisting that they shall be purchased at any price, has also found representation. Thus, in England, an Anglican clergyman, the Rev. H. Northcote (Christianity and Sex Problems, pp. 58, 60) deals temperately and sympathetically with the difficulties of sexual abstinence, and is by no means convinced that such abstinence is always an unmixed advantage; while in Germany a Catholic priest, Karl Jentsch (Sexualethik, Sexualjustiz, Sexualpolizei, 1900) sets himself to oppose the rigorous and unqualified assertions of Ribbing in favor of sexual abstinence. Jentsch thus expresses what he conceives ought to be the attitude of fathers, of public opinion, of the State and the Church towards the young man in this matter: “Endeavor to be abstinent until marriage. Many succeed in this. If you can succeed, it is good. But, if you cannot succeed, it is unnecessary to cast reproaches on yourself and to regard yourself as a scoundrel or a lost sinner. Provided that you do not abandon yourself to mere enjoyment or wantonness, but are content with what is necessary to restore your peace of mind, self-possession, and cheerful capacity for work, and also that you observe the precautions which physicians or experienced friends impress upon you.”

When we thus analyze and investigate the the three main streams of expert opinions in regard to this question of sexual abstinence-the opinions in favor of it, the opinions in opposition to it, and the opinions which take an intermediate course-we can scarcely fail to conclude how unsatisfactory the whole discussion is. The state of “sexual abstinence” is a completely vague and indefinite state. The indefinite and even meaningless character of the expression “sexual abstinence” is shown by the frequency with which those who argue about it assume that it can, may, or even must, involve masturbation. That fact alone largely deprives it of value as morality and altogether as abstinence. At this point, indeed, we reach the most fundamental criticism to which the conception of “sexual abstinence” lies open. Rohleder, an experienced physician and a recognized authority on questions of sexual pathology, has submitted the current views on “sexual abstinence” to a searching criticism in a lengthy and important paper. He denies altogether that strict sexual abstinence exists at all. “Sexual abstinence,” he points out, in any strict scenes of the term, must involve abstinence not merely from sexual intercourse but from auto-erotic manifestations, from masturbation, from homosexual acts, from all sexually perverse practices. It must further involve a permanent abstention from indulgence in erotic imaginations and voluptuous reverie. When, however, it is possible thus to render the whole psychic field a tabula rasa so far as sexual activity is concerned-and if it fails to be so constantly and consistently there is no strict sexual abstinence-then, Rohleder points out, we have to consider whether we are not in presence of a case of sexual anæsthesia, of anaphrodisia sexualis. That is a question which is rarely, if ever, faced by those who discuss sexual abstinence. It is, however, an extremely pertinent question, because, as Rohleder insists, if sexual anæsthesia exists the question of sexual abstinence falls to the ground, for we can only “abstain” from actions that are in our power. Complete sexual anæsthesia is, however, so rare a state that it may be practically left out of consideration, and as the sexual impulse, if it exists, must by physiological necessity sometimes become active in some shape-even if only, according to Freud’s view, by transformation into some morbid neurotic condition-we reach the conclusion that “sexual abstinence” is strictly impossible. Rohleder has met with a few cases in which there seemed to him no escape from the conclusion that sexual abstinence existed, but in all of these he subsequently found that he was mistaken, usually owing to the practice of masturbation, which he believes to be extremely common and very frequently accompanied by a persistent attempt to deceive the physician concerning its existence. The only kind of “sexual abstinence” that exists is a partial and temporary abstinence. Instead of saying, as some say, “Permanent abstinence is unnatural and cannot exist without physical and mental injury,” we ought to say, Rohleder believes, “Permanent abstinence is unnatural and has never existed.”

It is impossible not to feel as we contemplate this chaotic mass of opinions, that the whole discussion is revolving round a purely negative idea, and that fundamental fact is responsible for what at first seem to be startling conflicts of statement. If indeed we were to eliminate what is commonly regarded as the religious and moral aspect of the matter-an aspect, be it remembered, which has no bearing on the essential natural facts of the question-we cannot fail to perceive that these ostentatious differences of conviction would be reduced within very narrow and trifling limits.

We cannot strictly coordinate the impulse of reproduction with the impulse of nutrition. There are very important differences between them, more especially the fundamental difference that while the satisfaction of the one impulse is absolutely necessary both to the life of the individual and of the race, the satisfaction of the other is absolutely necessary only to the life of the race. But when we reduce this question to one of “sexual abstinence” we are obviously placing it on the same basis as that of abstinence from food, that is to say at the very opposite pole to which we place it when (as in the previous chapter) we consider it from the point of view of asceticism and chastity. It thus comes about that on this negative basis there really is an interesting analogy between nutritive abstinence, though necessarily only maintained incompletely and for a short time, and sexual abstinence, maintained more completely and for a longer time. A patient of Janet’s seems to bring out clearly this resemblance. Nadia, whom Janet was able to study during five years, was a young woman of twenty-seven, healthy and intelligent, not suffering from hysteria nor from anorexia, for she had a normal appetite. But she had an idea; she was anxious to be slim and to attain this end she cut down her meals to the smallest size, merely a little soup and a few eggs. She suffered much from the abstinence she thus imposed on herself, and was always hungry, though sometimes her hunger was masked by the inevitable stomach trouble caused by so long a persistence in this regime. At times, indeed, she had been so hungry that she had devoured greedily whatever she could lay her hands on, and not infrequently she could not resist the temptation to eat a few biscuits in secret. Such actions caused her horrible remorse, but, all the same, she would be guilty of them again. She realized the great efforts demanded by her way of life, and indeed looked upon herself as a heroine for resisting so long. “Sometimes,” she told Janet, “I passed whole hours in thinking about food, I was so hungry. I swallowed my saliva, I bit my handkerchief, I rolled on the ground, I wanted to eat so badly. I searched books for descriptions of meals and feasts, I tried to deceive my hunger by imagining that I too was enjoying all these good things. I was really famished, and in spite of a few weaknesses for biscuits I know that I showed much courage." Nadia’s motive idea, that she wished to be slim, corresponds to the abstinent man’s idea that he wishes to be “moral,” and only differs from it by having the advantage of being somewhat more positive and personal, for the idea of the person who wishes to avoid sexual indulgence because it is “not right” is often not merely negative but impersonal and imposed by the social and religious environment. Nadia’s occasional outbursts of reckless greediness correspond to the sudden impulses to resort to prostitution, and her secret weaknesses for biscuits, followed by keen remorse, to lapses into the habit of masturbation. Her fits of struggling and rolling on the ground are precisely like the outbursts of futile desire which occasionally occur to young abstinent men and women in health and strength. The absorption in thoughts about meals and in literary descriptions of meals is clearly analogous to the abstinent man’s absorption in wanton thoughts and erotic books. Finally, Nadia’s conviction that she is a heroine corresponds exactly to the attitude of self-righteousness which often marks the sexually abstinent.

If we turn to Freud’s penetrating and suggestive study of the problem of sexual abstinence in relation to “civilized” sexual morality, we find that, though he makes no reference to the analogy with abstinence from food, his words would for the most part have an equal application to both cases. “The task of subduing so powerful an instinct as the sexual impulse, otherwise than by giving it satisfaction,” he writes, “is one which may employ the whole strength of a man. Subjugation through sublimation, by guiding the sexual forces into higher civilizational paths, may succeed with a minority, and even with these only for a time, least easily during the years of ardent youthful energy. Most others become neurotic or otherwise come to grief. Experience shows that the majority of people constituting our society are constitutionally unequal to the task of abstinence. We say, indeed, that the struggle with this powerful impulse and the emphasis the struggle involves on the ethical and aesthetic forces in the soul’s life ‘steels’ the character, and for a few favorably organized natures this is true; it must also be acknowledged that the differentiation of individual character so marked in our time only becomes possible through sexual limitations. But in by far the majority of cases the struggle with sensuality uses up the available energy of character, and this at the very time when the young man needs all his strength in order to win his place in the world."

When we have put the problem on this negative basis of abstinence it is difficult to see how we can dispute the justice of Freud’s conclusions. They hold good equally for abstinence from food and abstinence from sexual love. When we have placed the problem on a more positive basis, and are able to invoke the more active and fruitful motives of asceticism and chastity this unfortunate fight against a natural impulse is abolished. If chastity is an ideal of the harmonious play of all the organic impulses of the soul and body, if asceticism, properly understood, is the athletic striving for a worthy object which causes, for the time, an indifference to the gratification of sexual impulses, we are on wholesome and natural ground, and there is no waste of energy in fruitless striving for a negative end, whether imposed artificially from without, as it usually is, or voluntarily chosen by the individual himself.

For there is really no complete analogy between sexual desire and hunger, between abstinence from sexual relations and abstinence from food. When we put them both on the basis of abstinence we put them on a basis which covers the impulse for food but only half covers the impulse for sexual love. We confer no pleasure and no service on our food when we eat it. But the half of sexual love, perhaps the most important and ennobling half, lies in what we give and not in what we take. To reduce this question to the low level of abstinence, is not only to centre it in a merely negative denial but to make it a solely self-regarding question. Instead of asking: How can I bring joy and strength to another? we only ask: How can I preserve my empty virtue?

Therefore it is that from whatever aspect we consider the question,-whether in view of the flagrant contradiction between the authorities who have discussed this question, or of the illegitimate mingling here of moral and physiological considerations, or of the merely negative and indeed unnatural character of the “virtue” thus set up, or of the failure involved to grasp the ennoblingly altruistic and mutual side of sexual love,-from whatever aspect we approach the problem of “sexual abstinence” we ought only to agree to do so under protest.

If we thus decide to approach it, and if we have reached the conviction-which, in view of all the evidence we can scarcely escape-that, while sexual abstinence in so far as it may be recognized as possible is not incompatible with health, there are yet many adults for whom it is harmful, and a very much larger number for whom when prolonged it is undesirable, we encounter a serious problem. It is a problem which confronts any person, and especially the physician, who may be called upon to give professional advice to his fellows on this matter. If sexual relationships are sometimes desirable for unmarried persons, or for married persons who, for any reason, are debarred from conjugal union, is a physician justified in recommending such sexual relationships to his patient? This is a question that has frequently been debated and decided in opposing senses.

Various distinguished physicians, especially in Germany, have proclaimed the duty of the doctor to recommend sexual intercourse to his patient whenever he considers it desirable. Gyurkovechky, for instance, has fully discussed this question, and answered it in the affirmative. Nystroem (Sexual-Problème, July, 1908, states that it is the physician’s duty, in some cases of sexual weakness, when all other methods of treatment have failed, to recommend sexual intercourse as the best remedy. Dr. Max Marcuse stands out as a conspicuous advocate of the unconditional duty of the physician to advocate sexual intercourse in some cases, both to men and to women, and has on many occasions argued in this sense (e.g., Darf der Arzt zum Ausserehelichen Geschlechtsverkehr raten? 1904). Marcuse is strongly of opinion that a physician who, allowing himself to be influenced by moral, sociological, or other considerations, neglects to recommend sexual intercourse when he considers it desirable for the patient’s health, is unworthy of his profession, and should either give up medicine or send his patients to other doctors. This attitude, though not usually so emphatically stated, seems to be widely accepted. Lederer goes even further when he states (Monatsschrift fuer Harnkrankheiten und Sexuelle Hygiene, 1906, Heft 3) that it is the physician’s duty in the case of a woman who is suffering from her husband’s impotence, to advise her to have intercourse with another man, adding that “whether she does so with her husband’s consent is no affair of the physician’s, for he is not the guardian of morality, but the guardian of health.” The physicians who publicly take this attitude are, however, a small minority. In England, so far as I am aware, no physician of eminence has openly proclaimed the duty of the doctor to advise sexual intercourse outside marriage, although, it is scarcely necessary to add, in England, as elsewhere, it happens that doctors, including women doctors, from time to time privately point out to their unmarried and even married patients, that sexual intercourse would probably be beneficial.

The duty of the physician to recommend sexual intercourse has been denied as emphatically as it has been affirmed. Thus Eulenburg (Sexuale Neuropathie, , would by no means advise extra-conjugal relations to his patient; “such advice is quite outside the physician’s competence.” It is, of course, denied by those who regard sexual abstinence as always harmless, if not beneficial. But it is also denied by many who consider that, under some circumstances, sexual intercourse would do good.

Moll has especially, and on many occasions, discussed the duty of the physician in relation to the question of advising sexual intercourse outside marriage (e.g., in his comprehensive work, Aerztliche Ethik, 1902; also Zeitschrift fuer Aerztliche Fortbildung, 1905, Nos. 12-15; Mutterschutz, 1905, Heft 3; Geschlecht und Gesellschaft, vol. ii, Heft 8). At the outset Moll had been disposed to assert the right of the physician to recommend sexual intercourse under some circumstances; “so long as marriage is unduly delayed and sexual intercourse outside marriage exists,” he wrote (Die Contraere Sexualempfindung, second edition, , “so long, I think, we may use such intercourse therapeutically, provided that the rights of no third person (husband or wife) are injured.” In all his later writings, however, Moll ranges himself clearly and decisively on the opposite side. He considers that the physician has no right to overlook the possible results of his advice in inflicting venereal disease, or, in the case of a woman, pregnancy, on his patient, and he believes that these serious results are far more likely to happen than is always admitted by those who defend the legitimacy of such advice. Nor will Moll admit that the physician is entitled to overlook the moral aspects of the question. A physician may know that a poor man could obtain many things good for his health by stealing, but he cannot advise him to steal. Moll takes the case of a Catholic priest who is suffering from neurasthenia due to sexual abstinence. Even although the physician feels certain that the priest may be able to avoid all the risks of disease as well as of publicity, he is not entitled to urge him to sexual intercourse. He has to remember that in thus causing a priest to break his vows of chastity he may induce a mental conflict and a bitter remorse which may lead to the worst results, even on his patient’s physical health. Similar results, Moll remarks, may follow such advice when given to a married man or woman, to say nothing of possible divorce proceedings and accompanying evils.

Rohleder (Vorlesungen ueber Geschlechtstrieb und Gesamtes Geschlechtsleben der Menschen) adopts a somewhat qualified attitude in this matter. As a general rule he is decidedly against recommending sexual intercourse outside marriage to those who are suffering from partial or temporary abstinence (the only form of abstinence he recognizes), partly on the ground that the evils of abstinence are not serious or permanent, and partly because the patient is fairly certain to exercise his own judgment in the matter. But in some classes of cases he recommends such intercourse, and notably to bisexual persons, on the ground that he is thus preserving his patient from the criminal risks of homosexual practices.

It seems to me that there should be no doubt whatever as to the correct professional attitude of the physician in relation to this question of advice concerning sexual intercourse. The physician is never entitled to advise his patient to adopt sexual intercourse outside marriage nor any method of relief which is commonly regarded as illegitimate. It is said that the physician has nothing to do with considerations of conventional morality. If he considers that champagne would be good for a poor patient he ought to recommend him to take champagne; he is not called upon to consider whether the patient will beg, borrow, or steal the champagne. But, after all, even if that be admitted, it must still be said that the physician knows that the champagne, however obtained, is not likely to be poisonous. When, however, he prescribes sexual intercourse, with the same lofty indifference to practical considerations, he has no such knowledge. In giving such a prescription the physician has in fact not the slightest knowledge of what he may be prescribing. He may be giving his patient a venereal disease; he may be giving the anxieties and responsibilities of an illegitimate child; the prescriber is quite in the dark. He is in the same position as if he had prescribed a quack medicine of which the composition was unknown to him, with the added disadvantage that the medicine may turn out to be far more potently explosive than is the case with the usually innocuous patent medicine. The utmost that a physician can properly permit himself to do is to put the case impartially before his patient and to present to him all the risks. The solution must be for the patient himself to work out, as best he can, for it involves social and other considerations which, while they are indeed by no means outside the sphere of medicine, are certainly entirely outside the control of the individual private practitioner of medicine.

Moll also is of opinion that this impartial presentation of the case for and against sexual intercourse corresponds to the physician’s duty in the matter. It is, indeed, a duty which can scarcely be escaped by the physician in many cases. Moll points out that it can by no means be assimilated, as some have supposed, with the recommendation of sexual intercourse. It is, on the contrary, he remarks, much more analogous to the physician’s duty in reference to operations. He puts before the patient the nature of the operation, its advantages and its risks, but he leaves it to the patient’s judgment to accept or reject the operation. Lewitt also (Geschlechtliche Enthaltsamkeit und Gesundheitsstoerungen, 1905), after discussing the various opinions on this question, comes to the conclusion that the physician, if he thinks that intercourse outside marriage might be beneficial, should explain the difficulties and leave the patient himself to decide.

There is another reason why, having regard to the prevailing moral opinions at all events among the middle classes, a physician should refrain from advising extra-conjugal intercourse: he places himself in a false relation to his social environment. He is recommending a remedy the nature of which he could not publicly avow, and so destroying the public confidence in himself. The only physician who is morally entitled to advise his patients to enter into extra-conjugal relationships is one who openly acknowledges that he is prepared to give such advice. The doctor who is openly working for social reform has perhaps won the moral right to give advice in accordance with the tendency of his public activity, but even then his advice may be very dubiously judicious, and he would be better advised to confine his efforts at social reform to his public activities. The voice of the physician, as Professor Max Flesch of Frankfort observes, is more and more heard in the development and new growth of social institutions; he is a natural leaders in such movements, and proposals for reform properly come from him. “But,” as Flesch continues, “publicly to accept the excellence of existing institutions and in the privacy of the consulting-room to give advice which assumes the imperfection of those institutions is illogical and confusing. It is the physician’s business to give advice which is in accordance with the interests of the community as a whole, and those interests require that sexual relationships should be entered into between healthy men and women who are able and willing to accept the results of their union. That should be the physician’s rule of conduct. Only so can he become, what to-day he is often proclaimed to be, the leader of the nation." This view is not, as we see, entirely in accord with that which assumes that the physician’s duty is solely and entirely to his patient, without regard to the bearing of his advice on social conduct. The patient’s interests are primary, but they are not entitled to be placed in antagonism to the interests of society. The advice given by the wise physician must always be in harmony with the social and moral tone of his age. Thus it is that the tendency among the younger generation of physicians to-day to take an active interest in raising that tone and in promoting social reform-a tendency which exists not only in Germany where such interests have long been acute, but also in so conservative a land as England-is full of promise for the future.

The physician is usually content to consider his duty to his patient in relationship to sexual abstinence as sufficiently fulfilled when he attempts to allay sexual hyperaesthesia by medical or hygienic treatment. It can scarcely be claimed, however, that the results of such treatment are usually satisfactory, and sometimes indeed the treatment has a result which is the reverse of that intended. The difficulty generally is that in order to be efficacious the treatment must be carried to an extreme which exhausts or inhibits not only the genital activities alone but the activities of the whole organism, and short of that it may prove a stimulant rather than a sedative. It is difficult and usually impossible to separate out a man’s sexual activities and bring influence to bear on these activities alone. Sexual activity is so closely intertwined with the other organic activities, erotic exuberance is so much a flower which is rooted in the whole organism, that the blow which crushes it may strike down the whole man. The bromides are universally recognized as powerful sexual sedatives, but their influence in this respect only makes itself felt when they have dulled all the finest energies of the organism. Physical exercise is universally recommended to sexually hyperaesthetic patients. Yet most people, men and women, find that physical exercise is a positive stimulus to sexual activity. This is notably so as regards walking, and exuberantly energetic young women who are troubled by the irritant activity of their healthy sexual emotions sometimes spend a large part of their time in the vain attempt to lull their activity by long walks. Physical exercise only proves efficacious in this respect when it is carried to an extent which produces general exhaustion. Then indeed the sexual activity is lulled; but so are all the mental and physical activities. It is undoubtedly true that exercises and games of all sorts for young people of both sexes have a sexually hygienic as well as a generally hygienic influence which is undoubtedly beneficial. They are, on all grounds, to be preferred to prolonged sedentary occupations. But it is idle to suppose that games and exercises will suppress the sexual impulses, for in so far as they favor health, they favor all the impulses that are the result of health. The most that can be expected is that they may tend to restrain the manifestations of sex by dispersing the energy they generate.

There are many physical rules and precautions which are advocated, not without reason, as tending to inhibit or diminish sexual activity. The avoidance of heat and the cultivation of cold is one of the most important of these. Hot climates, a close atmosphere, heavy bed-clothing, hot baths, all tend powerfully to excite the sexual system, for that system is a peripheral sensory organ, and whatever stimulates the skin generally, stimulates the sexual system. Cold, which contracts the skin, also deadens the sexual feelings, a fact which the ascetics of old knew and acted upon. The garments and the posture of the body are not without influence. Constriction or pressure in the neighborhood of the sexual region, even tight corsets, as well as internal pressure, as from a distended bladder, are sources of sexual irritation. Sleeping on the back, which congests the spinal centres, also acts in the same way, as has long been known by those who attend to sexual hygiene; thus it is stated that in the Franciscan order it is prohibited to lie on the back. Food and drink are, further, powerful sexual stimulants. This is true even of the simplest and most wholesome nourishment, but it is more especially true of flesh meat, and, above all, of alcohol in its stronger forms such as spirits, liqueurs, sparkling and heavy wines, and even many English beers. This has always been clearly realized by those who cultivate asceticism, and it is one of the powerful reasons why alcohol should not be given in early youth. As St. Jerome wrote, when telling Eustochium that she must avoid wine like poison, “wine and youth are the two fires of lust. Why add oil to the flame?" Idleness, again, especially when combined with rich living, promotes sexual activity, as Burton sets forth at length in his Anatomy of Melancholy, and constant occupation, on the other hand, concentrates the wandering activities.

Mental exercise, like physical exercise, has sometimes been advocated as a method of calming sexual excitement, but it seems to be equally equivocal in its action. If it is profoundly interesting and exciting it may stir up rather than lull the sexual emotions. If it arouses little interest it is unable to exert any kind of influence. This is true even of mathematical occupations which have been advocated by various authorities, including Broussais, as aids to sexual hygiene. “I have tried mechanical mental work,” a lady writes, “such as solving arithmetical or algebraic problems, but it does no good; in fact it seems only to increase the excitement.” “I studied and especially turned my attention to mathematics,” a clergyman writes, “with a view to check my sexual tendencies. To a certain extent I was successful. But at the approach of an old friend, a voice or a touch, these tendencies came back again with renewed strength. I found mathematics, however, the best thing on the whole to take off my attention from women, better than religious exercises which I tried when younger (twenty-two to thirty).” At the best, however, such devices are of merely temporary efficacy.

It is easier to avoid arousing the sexual impulses than to impose silence on them by hygienic measures when once they are aroused. It is, therefore, in childhood and youth that all these measures may be most reasonably observed in order to avoid any premature sexual excitement. In one group of stolidly normal children influences that might be expected to act sexually pass away unperceived. At the other extreme, another group of children are so neurotically and precociously sensitive that no precautions will preserve them from such influences. But between these groups there is another, probably much the largest, who resist slight sexual suggestions but may succumb to stronger or longer influences, and on these the cares of sexual hygiene may profitably be bestowed.

After puberty, when the spontaneous and inner voice of sex may at any moment suddenly make itself heard, all hygienic precautions are liable to be flung to the winds, and even the youth or maiden most anxious to retain the ideals of chastity can often do little but wait till the storm has passed. It sometimes happens that a prolonged period of sexual storm and stress occurs soon after puberty, and then dies away although there has been little or no sexual gratification, to be succeeded by a period of comparative calm. It must be remembered that in many, and perhaps most, individuals, men and women, the sexual appetite, unlike hunger or thirst, can after a prolonged struggle, be reduced to a more or less quiescent state which, far from injuring, may even benefit the physical and psychic vigor generally. This may happen whether or not sexual gratification has been obtained. If there has never been any such gratification, the struggle is less severe and sooner over, unless the individual is of highly erotic temperament. If there has been gratification, if the mind is filled not merely with desires but with joyous experience to which the body also has grown accustomed, then the struggle is longer and more painfully absorbing. The succeeding relief, however, if it comes, is sometimes more complete and is more likely to be associated with a state of psychic health. For the fundamental experiences of life, under normal conditions, bring not only intellectual sanity, but emotional pacification. A conquest of the sexual appetites which has never at any period involved a gratification of these appetites seldom produces results that commend themselves as rich and beautiful.

In these combats there are, however, no permanent conquests. For a very large number of people, indeed, though there may be emotional changes and fluctuations dependent on a variety of circumstances, there can scarcely be said to be any conquest at all. They are either always yielding to the impulses that assail them, or always resisting those impulses, in the first case with remorse, in the second with dissatisfaction. In either case much of their lives, at the time when life is most vigorous, is wasted. With women, if they happen to be of strong passions and reckless impulses to abandonment, the results may be highly enervating, if not disastrous to the general psychic life. It is to this cause, indeed, that some have been inclined to attribute the frequent mediocrity of women’s work in artistic and intellectual fields. Women of intellectual force are frequently if not generally women of strong passions, and if they resist the tendency to merge themselves in the duties of maternity their lives are often wasted in emotional conflict and their psychic natures impoverished.

The extent to which sexual abstinence and the struggles it involves may hamper and absorb the individual throughout life is well illustrated in the following case. A lady, vigorous, robust, and generally healthy, of great intelligence and high character, has reached middle life without marrying, or ever having sexual relationships. She was an only child, and when between three and four years of age, a playmate some six years older, initiated her into the habit of playing with her sexual parts. She was, however, at this age quite devoid of sexual feelings, and the habit dropped naturally, without any bad effects, as soon as she left the neighborhood of this girl a year or so later. Her health was good and even brilliant, and she developed vigorously at puberty. At the age of sixteen, however, a mental shock caused menstruation to diminish in amount during some years, and simultaneously with this diminution persistent sexual excitement appeared spontaneously, for the first time. She regarded such feelings as abnormal and unhealthy, and exerted all her powers of self-control in resisting them. But will power had no effect in diminishing the feelings. There was constant and imperious excitement, with the sense of vibration, tension, pressure, dilatation and tickling, accompanied, it may be, by some ovarian congestion, for she felt that on the left side there was a network of sexual nerves, and retroversion of the uterus was detected some years later. Her life was strenuous with many duties, but no occupation could be pursued without this undercurrent of sexual hyperaesthesia involving perpetual self-control. This continued more or less acutely for many years, when menstruation suddenly stopped altogether, much before the usual period of the climacteric. At the same time the sexual excitement ceased, and she became calm, peaceful, and happy. Diminished menstruation was associated with sexual excitement, but abundant menstruation and its complete absence were both accompanied by the relief of excitement. This lasted for two years. Then, for the treatment of a trifling degree of anæmia, she was subjected to a long, and, in her case, injudicious course of hypodermic injections of strychnia. From that time, five years ago, up to the present, there has been constant sexual excitement, and she has always to be on guard lest she should be overtaken by a sexual spasm. Her torture is increased by the fact that her traditions make it impossible for her (except under very exceptional circumstances) to allude to the cause of her sufferings. “A woman is handicapped,” she writes. “She may never speak to anyone on such a subject. She must live her tragedy alone, smiling as much as she can under the strain of her terrible burden.” To add to her trouble, two years ago, she felt impelled to resort to masturbation, and has done so about once a month since; this not only brings no real relief, and leaves irritability, wakefulness, and dark marks under the eyes, but is a cause of remorse to her, for she regards masturbation as entirely abnormal and unnatural. She has tried to gain benefit, not merely by the usual methods of physical hygiene, but by suggestion, Christian Science, etc., but all in vain. “I may say,” she writes, “that it is the most passionate desire of my heart to be freed from this bondage, that I may relax the terrible years-long tension of resistance, and be happy in my own way. If I had this affliction once a month, once a week, even twice a week, to stand against it would be child’s play. I should scorn to resort to unnatural means, however moderately. But self-control itself has its revenges, and I sometimes feel as if it is no longer to be borne.”

Thus while it is an immense benefit in physical and psychic development if the eruption of the disturbing sexual emotions can be delayed until puberty or adolescence, and while it is a very great advantage, after that eruption has occurred, to be able to gain control of these emotions, to crush altogether the sexual nature would be a barren, if not, indeed, a perilous victory, bringing with it no satisfaction. “If I had only had three weeks’ happiness,” said a woman, “I would not quarrel with Fate, but to have one’s whole life so absolutely empty is horrible.” If such vacuous self-restraint may, by courtesy, be termed a virtue, it is but a negative virtue. The persons who achieve it, as the result of congenitally feeble sexual aptitudes, merely (as Gyurkovechky, Fuerbringer, and Loewenfeld have all alike remarked) made a virtue of their weakness. Many others, whose instincts were less weak, when they disdainfully put to flight the desires of sex in early life, have found that in later life that foe returns in tenfold force and perhaps in unnatural shapes.

The conception of “sexual abstinence” is, we see, an entirely false and artificial conception. It is not only ill-adjusted to the hygienic facts of the case but it fails even to invoke any genuinely moral motive, for it is exclusively self-regarding and self-centred. It only becomes genuinely moral, and truly inspiring, when we transform it into the altruistic virtue of self-sacrifice. When we have done so we see that the element of abstinence in it ceases to be essential, “Self-sacrifice,” writes the author of a thoughtful book on the sexual life, “is acknowledged to be the basis of virtue; the noblest instances of self-sacrifice are those dictated by sexual affection. Sympathy is the secret of altruism; nowhere is sympathy more real and complete than in love. Courage, both moral and physical, the love of truth and honor, the spirit of enterprise, and the admiration of moral worth, are all inspired by love as by nothing else in human nature. Celibacy denies itself that inspiration or restricts its influence, according to the measure of its denial of sexual intimacy. Thus the deliberate adoption of a consistently celibate life implies the narrowing down of emotional and moral experience to a degree which is, from the broad scientific standpoint, unjustified by any of the advantages piously supposed to accrue from it."

In a sane natural order all the impulses are centred in the fulfilment of needs and not in their denial. Moreover, in this special matter of sex, it is inevitable that the needs of others, and not merely the needs of the individual himself, should determine action. It is more especially the needs of the female which are the determining factor; for those needs are more various, complex and elusive, and in his attentiveness to their gratification the male finds a source of endless erotic satisfaction. It might be thought that the introduction of an altruistic motive here is merely the claim of theoretical morality insisting that there shall be a firm curb on animal instinct. But, as we have again and again seen throughout the long course of these Studies, it is not so. The animal instinct itself makes this demand. It is a biological law that rules throughout the zooelogical world and has involved the universality of courtship. In man it is only modified because in man sexual needs are not entirely concentrated in reproduction, but more or less penetrate the whole of life.

While from the point of view of society, as from that of Nature, the end and object of the sexual impulse is procreation, and nothing beyond procreation, that is by no means true for the individual, whose main object it must be to fulfil himself harmoniously with that due regard for others which the art of living demands. Even if sexual relationships had no connection with procreation whatever-as some Central Australian tribes believe-they would still be justifiable, and are, indeed, an indispensable aid to the best moral development of the individual, for it is only in so intimate a relationship as that of sex that the finest graces and aptitudes of life have full scope. Even the saints cannot forego the sexual side of life. The best and most accomplished saints from Jerome to Tolstoy-even the exquisite Francis of Assisi-had stored up in their past all the experiences that go to the complete realization of life, and if it were not so they would have been the less saints.

The element of positive virtue thus only enters when the control of the sexual impulse has passed beyond the stage of rigid and sterile abstinence and has become not merely a deliberate refusal of what is evil in sex, but a deliberate acceptance of what is good. It is only at that moment that such control becomes a real part of the great art of living. For the art of living, like any other art, is not compatible with rigidity, but lies in the weaving of a perpetual harmony between refusing and accepting, between giving and taking.

The future, it is clear, belongs ultimately to those who are slowly building up sounder traditions into the structure of life. The “problem of sexual abstinence” will more and more sink into insignificance. There remain the great solid fact of love, the great solid fact of chastity. Those are eternal. Between them there is nothing but harmony. The development of one involves the development of the other.

It has been necessary to treat seriously this problem of “sexual abstinence” because we have behind us the traditions of two thousand years based on certain ideals of sexual law and sexual license, together with the long effort to build up practices more or less conditioned by those ideals. We cannot immediately escape from these traditions even when we question their validity for ourselves. We have not only to recognize their existence, but also to accept the fact that for some time to come they must still to a considerable extent control the thoughts and even in some degree the actions of existing communities.

It is undoubtedly deplorable. It involves the introduction of an artificiality into a real natural order. Love is real and positive; chastity is real and positive. But sexual abstinence is unreal and negative, in the strict sense perhaps impossible. The underlying feelings of all those who have emphasized its importance is that a physiological process can be good or bad according as it is or is not carried out under certain arbitrary external conditions, which render it licit or illicit. An act of sexual intercourse under the name of “marriage” is beneficial; the very same act, under the name of “incontinence,” is pernicious. No physiological process, and still less any spiritual process, can bear such restriction. It is as much as to say that a meal becomes good or bad, digestible or indigestible, according as a grace is or is not pronounced before the eating of it.

It is deplorable because, such a conception being essentially unreal, an element of unreality is thus introduced into a matter of the gravest concern alike to the individual and to society. Artificial disputes have been introduced where no matter of real dispute need exist. A contest has been carried on marked by all the ferocity which marks contests about metaphysical or pseudo-metaphysical differences having no concrete basis in the actual world. As will happen in such cases, there has, after all, been no real difference between the disputants because the point they quarreled over was unreal. In truth each side was right and each side was wrong.

It is necessary, we see, that the balance should be held even. An absolute license is bad; an absolute abstinence-even though some by nature or circumstances are urgently called to adopt it-is also bad. They are both alike away from the gracious equilibrium of Nature. And the force, we see, which naturally holds this balance even is the biological fact that the act of sexual union is the satisfaction of the erotic needs, not of one person, but of two persons.