An abominable, disgusting habit

A course of lectures on painThere are plenty of common myths about Victorian social mores, but anything you have read about their disapproval of onanism (masturbation) is likely to be true. Nineteenth-century medics were apparently united in their condemnation of the practice, which was believed to cause not just blindness, but all manner of serious physical ailments – many of them potentially fatal. One extraordinary example is contained in a lecture given by John Hilton, a surgeon at Guy’s Hospital in London, and reported in The Lancet in 1863:

Regarding onanism and its treatment, surgeons are often consulted, and it is a very important matter. It is a habit very difficult to contend with in practice. I know of no way to prevent onanism except by freely blistering the penis, in order to make it raw and so sore that it cannot be touched without pain. This plan is sure to cure onanism. 

I should think so. It also sounds unpleasantly cruel, not to mention unnecessary.

I have adopted this plan of treatment, during more than twenty years. Gentlemen have come to me and said, “I have for many years suffered from this abominable, disgusting habit, and I have tried to cure myself of it, but I cannot; for my morbid inclination overcomes my disgust when awake, and I think when asleep I am sometimes pursuing it. Can you offer any suggestion?”

“I think when asleep I am sometimes pursuing it” reminds me of the sort of denial a small child makes when caught stealing sweets: “I didn’t take any, and it was only one or two.” Mr Hilton’s advice for his young patients is just about the most Victorian thing I’ve ever heard:

“Paint this strong solution of iodine over the whole of the skin of the penis every night; and if that does not make the organ too sore for you to touch it, then apply in the same way a strong blistering fluid to the penis.” The result of my experience in practice has been that in almost every instance the continuance of the habit has been thus entirely prevented.

Imagine volunteering for this course of treatment! Mr Hilton appends a representative case sent to him by a colleague:

W. R., aged fifteen, is one of eight children, all of delicate constitution, and himself prone to convulsions in his infancy. After repeated exposure to cold and wet, he called upon his surgeon, Sept. 4th, 1860, complaining of pain in the sacrum [base of the spine] and left hip and thigh. He was relieved by purgatives and salines.

Neither of which are likely to have done him much good. The doctor examined him and found that the boy was constipated and had pain that ran all the way down his spine and affected the left leg. He prescribed laxatives, and liniments to be rubbed into the back. Alas! to little effect:

Within a week there was great pain along the cervical portion of the spine, extending to the left arm. Says the motion of the shoulder is very painful; elbow free; left hand closed tightly, and any touch either of the fingers or wrist caused him great pain. Slight pressure anywhere on the spine produced great pain, according to his own statement.

At this point I began to suspect some sort of infection, maybe rheumatic fever. But then other striking symptoms began to appear.

Sept. 19th. Left hand firmly closed; both thighs drawn up; knees bent, and cannot be extended; toes of left foot inverted, and whole limb very sensitive. The mouth is closed for a few minutes two or three times a day.

This symptom, known as trismus or locked jaw, is well known as being characteristic of tetanus. But it has many other possible causes.

This went on till Oct. 3rd, when a physician from London saw him. This gentleman, in consultation, thought that he recognized an important pathological state of the brain or spinal marrow, and pointed out with great precision the pathological anatomy which was sure to be found at the expected post-mortem examination. This prospect made the friends of the patient very anxious indeed.

Well, yes, it would. Doctors today are generally encouraged not to discuss a theoretical future post-mortem in front of the patient concerned.

On October 7th he was no better; head symptoms were now added, and for a minute or two he became unconscious.

The doctor now brought out the big guns, and prescribed… rhubarb pills. Strangely, these had no effect; fits were now added to his other symptoms, and the trismus became more frequent.

October 30th. As the patient was getting worse I was requested to see him. I found him sitting in his chair, the left forearm flexed, with the left thumb turned inwards towards the palm of the hand, and the fingers flexed over it; his face flushing very readily. The skin was cool, and there was no thirst; the pulse was not quick, but the heart was very excitable; the tongue clean; the pupils diluted; skin exquisitely sensitive to the touch when attention was directed to that point, but not when the mind was diverted from it. The contraction of the limb and hand was constant, but could be overcome by persevering efforts on my part, giving way very suddenly. The spine was tender the whole of the way down. I requested that he might be denuded [undressed].

At this point I’m going to hazard a guess at a diagnosis. In fact, to hedge my bets I’m going to suggest two:

  1. Tetanus. The classic lockjaw symptom is present, together with spasms, stiffness of the neck and muscle rigidity. These are highly suggestive. However, there is no mention of fever or irregular heartbeat, and the history does not include any indication of a skin wound which might have allowed the pathogen entry to the bloodstream.
  2. Pott’s disease. This is a form of tuberculosis in which the bacterium invades the bones of the spine rather than the lungs. It was extremely common in the early 19th century. The first symptom of the disease is typically back pain, as observed in this case – and when the infection reaches the cervical vertebrae (the bones of the neck) trismus is often the result. On the other hand, the prognosis with Pott’s is often terrible – the entire spine can crumble – the outcome in this case was, thankfully, much better.

Any other ideas? Medics, please feel free to offer your own thoughts below. The attending physician’s mind was going in an entirely different direction, however…

The penis was very sensitive, and the skin prolonged; the genital organs were cold, but highly sensitive; the hands were cold and damp. He had insisted on sleeping by himself, and in a room to himself. The patient watched especially my examination of the genitals, and when I at that moment looked at him seriously, averted his face as if ashamed. I felt convinced that the whole of the symptoms were the result of onanism.

Of course! Suddenly it all makes sense. Only compulsive masturbation could cause such a drastic set of clinical symptoms.

On October 30th I insisted upon his not sleeping alone, so that he might not be able to continue his habit unobserved, and ordered five grains of mercurial ointment to be rubbed once a day into the axilla [armpit], so as to divert his mind from the thing I had in view, and I desired that a blistering fluid might be applied to the penis every night.

I’m really not sure that rubbing ointment into my armpit would do the slightest thing to distract me from the ‘other thing’.

In about three or four days the hands relaxed und opened, the legs remaining contracted; this contraction continued during sleep. The trismus persisted, but with longer periods of muscular relaxation. The local genital irritation was kept up, small doses of morphia were given at night, and the ointment used till the 20th of November. The mouth was a little sore, having been made so by the mercury. The ointment was then omitted, but the application to the penis was maintained.

Ouch. But the patient’s recovery continued apace. On November 23rd the surgeon sent Mr Hilton a final report:

“My dear Sir,—Young B. is, and has been quite well; he is now in London. He was cured by the end of last November (one month from my visit). A slight gleet [blister] remained for months after; I did nothing for it but cold baths, &c. The application I painted the whole penis well with was the compound tincture of iodine, made stronger by ten or twelve grains of iodine to each ounce. It ‘touched him up well’ I can tell you; but I don’t think his friends ever had any idea what we considered the cause of his illness.”

I’m sure the patient was deeply grateful for this fact.

3 thoughts on “An abominable, disgusting habit”

  1. As a regular reader, I’m accustomed by now to some of the more incredulous stories that you’ve encountered during the course of your research, not to mention some even more incredible conclusions. However, I can’t understand this case. Excuse my complete lack of medical knowledge, but how on earth could the application of mercurial ointment to the armpit – as well as blistering the penis – possibly cure the patient’s suspected tetanus?

    Unless some earlier treatment (administered before onanism was suspected) happened to cure the boy, I can only question the truthfulness of the doctor’s account. Any prognosis from you or I is purely conjecture, of course, but I still can’t seem to get my head around this one.

  2. This case certainly leaves several questions hanging. The main difficulty is working out what the boy was suffering from: it might even have been a psychiatric illness which manifested as physical pain and muscle spasm. A professional medic might have some idea, but my knowledge is limited.
    As to the reasons for his recovery, there are I think two options:
    1. The mercury ointment did in fact have some effect. This is extremely unlikely, but not impossible: mercury compounds are well absorbed by the skin and were highly regarded as a treatment for syphilis until well into the 20th century. Their use was discontinued when it became clear just how toxic they were, but there seems to be some disagreement as to whether they actually displayed any antibiotic activity. However, it’s far more likely, in my view, that
    2. He just got better. Tetanus is a killer, but the majority of patients who contract it will regain full health. This may simply have been a mild case which lasted a few months and cleared up spontaneously. Cases of this kind (termed ‘spontaneous remission’) have often allowed incompetent or charlatan doctors to take credit for a cure even when their therapies did precisely nothing. The patient may have recovered, but it was nothing to do with the medicine they received – which is probably true in this case.

    1. Spontaneous remission; a very fortunate outcome for a patient, yet a convenient one for a quack. Thanks for clearing this up!

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