Masturbation was not an object for prescientific or Galenic medicine, which reigned supreme from the 2nd century AD until the late Middle Ages. For 1500 years until the 17th century of Western history, the precepts guiding medical practices were based on the Galenic conception of the body as a flux of fluid humors: black bile, yellow bile, blood, and phlegm. Maintaining good health required the balance of these humors in their correct proportions; disease was signaled by either an excess or deficiency in these fluids (9). Hence, masturbation was considered quite therapeutic in certain cases, because it led to the evacuation of excessive seed in the body (10). Therefore, medieval physicians such as Avicenna, Albert the Great, and Riverius recommended the "friction of the genitals" for health purposes (11,12). This understanding of masturbation implied that it was not a moral issue within premodern medical thought. Even though some premodern physicians such as Boorde and Boerhaave in the 17th century warned of the debilitating psychological and physical effects of masturbation, they did not speak of it as a moral issue (13).a However, this would change profoundly in the modern period as a consequence of the influence of church edicts against masturbation.
aE. H. Hare (1962) documents the debilitating effects ascribed by Boerhaave in his Institutes of Medicine (1701): "the semen discharged too lavishly occasions a weariness, weakness, indisposition of motion, convulsions, leanness, dryness, heats and pains in the membranes of the brain, with a dullness of the senses, more especially of the sight, a tabes dorsalis, foolishness and disorder of the kinds." However, we can see no specific mention of masturbation per se (although it was included under sexual activity) until the beginning of the 18th century, and no belief that it was specifically harmful.
Masturbation was always a subject of discussion in religious circles; the church had condemned it as a minor variant of illicit sexual activities that were explicitly outside the realm of procreation and, therefore, were against nature (11,14,15). The church doctrine on masturbation was unequivocal: any kind of masturbation was forbidden and the physician who recommended it for health was no less a sinner than the person who engaged in it.b From the beginning of the Middle Ages, the position of the church evolved from a complex argument based on a stridently debated distinction between nocturnal emissions and voluntary pollutions. Its most vehement interdictions were aimed at the latter rather than the former, which were classified as a mere venial sin. In contrast, voluntary pollution was considered a mortal sin or sin against nature because it provoked sexual pleasure without carnal union (15). This claim was backed by the authority of two Biblical texts. The first from Genesis invoked the crime of Onan, who was punished by God for "spilling his seed" (Gen: 38; 6-10). The second is found in the first letter of St. Paul to the Corinthians (6; 9-10), who insisted that those guilty of "mollities" would be banned along with fornicators and sodomites from the Kingdom of God. The condemnation of the Church was not restricted to the bare act itself but extended to the lascivious thoughts that accompanied it. Thus, for example, thinking of the Virgin Mary aggravated the mortal sin into a "horrendum sacriligium" and imagining oneself in the company of a married woman was equivalent to adultery (14).
Hence, before the 18th century, the medieval physician and the medieval priest viewed masturbation differently. Before the second half of the 18th century, none among the theologians and jurists who condemned masturbation as a sin against nature based his verdict on medical grounds. On the other hand, few if any medieval doctors spoke of masturbation as a sin, much less as a mortal one (16).
The publication in 1710 in England of Onania, or The Heinous Sin of Self Pollution and its Frightful Consequences in Both Sexes Considered, with Spiritual and Physical Advice to Those Who Have Already Been Injured by This Abominable Practice and Seasonal Admonition to the Youth of the Nation of Both Sexes, was a signal event in the West.c Though written from within the Christian perspective (11,17), it marked the merger between the once distinct medical and religious positions on masturbation. By insisting that masturbation had reached epidemic proportions, the author aimed at fostering "Virtue and Christian Purity and to Discourage Vice and Uncleanliness." The book was extremely popular; it began as a 60-page pamphlet, and by the 16th edition had bIn the fourth Lateran council of 1215 under Innocent III, it was stated, "since the soul is much more precious than the body, we forbid any physician under pain of anathema, to prescribe anything for bodily health of sick persons that may endanger their souls."
cAuthorship and date of publication are still subject to dispute according to most commentators, though the scholarly consensus seems to vacillate between John Marten and the priest Becker.
grown to 194 pages accompanied by a 142-page supplement comprising letters from sufferers, repented sinners, and supporters.
The book is divided into three sections: causes, consequences, and diseases caused by self-pollution. Masturbation was not only condemned as a sin, but by tracing its consequence upon both the body and the soul, the author inserted the moral consequences into the medical outcomes. For example, masturbation was linked to stunted growth, phimosis and paraphimosis, strangury, priapism, gonorrhea, ulcers, thin and waterish seed, fainting fits, epilepsy, consumption, loss of erection, premature ejaculation, and infertility. The book is notable for not only raising the specter of masturbation as a medical, moral issue but for describing the ill effects of masturbation on women. Hence, masturbation was believed to cause the relaxation of private parts and "retentive faculty" leading to infertility, because male semen could no longer be held within the woman. Moreover, according to the author of Onania, women who masturbated were prone to hysterical fits, barrenness, imbecility, fluor albis (leucorrhea), multiple miscarriages, and infertility. In addition, masturbators suffered physical transformations: "meager jaws, pale looks, feeble hams, legs without calves, their generative faculties weakened if not destroyed... dryness, emaciation, spirit sunk, body wasted, strength decayed" (14). Moreover, their entire progeny and the very future of the human race apparently lay in the balance: "from the wretches that survive, children may be expected so sick and weakly that they are a misery to themselves, a dishonor to the Human race and a scandal their parents" (18).
The remedies for this "heinous sin" were both physical and moral. While the recommendations of marriage repentance and renunciation were the usual fare of moral injunctions, the author distinguished himself as a clever marketer by hawking 10-shilling "strengthening tinctures," 12-shilling "prolific powders," and "Aromatik Snuff' (18). After the publication of Onania, the term "onanism" made its appearance for the first time in the encyclopedia, defined roughly as the involuntary efflux of semen (synonyms were "mastupratio, manstupratio, and manustupratio"). By tying together the medical and moral reflections on masturbation, Onania provided a fecund frame for the proliferation of moral anxieties and the multiplication of medical interventions around "nature's handmaiden."
The repercussions of this pamphlet were felt on the European continent and absorbed within the burgeoning spirit of the French Enlightenment. However, it was the book written in 1758 by the Swiss physician Samuel August Tissot that raised masturbation to the position of a "colossal boogey" (13). In this book, published in Latin as Tentamen de Morbis ex Manustrupatione and translated into French in 1760 as L'Onanisme ou Dissertation Physique sur les Maladies Produites par la Masturbation, Tissot departs from the English Onania and its moral-theological overtones (19). Instead, Tissot makes much of his scientific grounding by asserting that 1 oz of sperm is equal to exactly 40 oz of blood. Hence, at this purported ratio of exchange, it was not surprising that Tissot considered sperm a very valuable fluid, calling it a "precious liquid." This idea was echoed almost 100 years later by Dr. George Calhoun of the United States, who stated, "the production of semen takes place much more slowly than that of any other secretion in the human body. This is owing to the route that semen has to take. If all seminal canals were extended in one line, it would be about 5208 ft long... the immense length shows that it is difficult for the semen to reproduce but that its excessive loss must be attended with disastrous consequences on the whole organism" (14).
Tissot's scientific aims extended to the mental effects of masturbation. Following the third law of Newton on action and reciprocal reaction, Tissot theorized that orgasms were spasms of extreme nervous activity that necessitated an equal and opposing depression of the nerves. This dampening of the nervous activity caused permanent derangement when it occurred too frequently, making the individual more susceptible to apoplexy, paralysis, insanity, and other nervous diseases (17). This idea contributed to the 19th century notion of "masturbatory insanity" caused by permanent brain damage due to constant irritation.
Therefore, according to Tissot, masturbation denuded the body of blood and, thus, gave rise to grave physical and mental consequences. Included among these were weakening of the digestive system, loss of or excessive appetite, vomiting, indigestion, breakdown of the respiratory system, general debility and lassitude, as well as damages to the faculties and memory. The consequences to women were even more grave, because masturbation led to hysteria, "vapeurs affreuses," incurable jaundice, stomach cramps, prophase and ulceration of the womb, and clitoral rashes, for example. The young were particularly vulnerable, as the loss of "precious liquid" stunted their natural physical development and contributed to feeblemindedness (14,17).
By providing a pathological model of masturbation rooted in the seemingly scientific and secular domain, Tissot's book sparked the 19th century medico-scientific masturbation phobia in the United States. Masturbation was transformed from one of the many forms of seminal and excretory loss into a sexual practice potentially fatal to individuals and society alike (20,21).
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