Death by onanism

Victorian society was famously paranoid about the dangers of masturbation. For teachers, priests and those with responsibility for young people, it was a question of morals and the corruption of youth – but the medical profession also agreed that self-abuse was a vice with terrible consequences. The old cliché that the practice ‘makes you go blind’ was not said just to frighten teenage boys – it was a view sincerely held by many physicians. Others suggested that masturbation caused heart disease, or proposed deeply unpleasant treatment regimes to make the problem go away.

Though many people will associate this fear with the nineteenth century, its roots go back a lot further – as least as early as the 1720s, when a pamphlet entitled Onania; or, The heinous sin of self-pollution, and all its frightful consequences, in both sexes, considered was published in London – and subsequently became a bestseller on both sides of the Atlantic.

This article, published in the Transactions of the Physico-medical Society of New York in 1817, is another striking example. It is also an interesting example of faulty diagnosis. The author was a physician from Connecticut, Dr William Tully:An instance of death from onanism

E.B., aged sixteen, of active habits, of bodily size rather less than medium, and as it respects strength of constitution less vigorous than most youths of his age, complained the 3rd of October, 1812, of indisposition.

‘Feeling ill’ is not a terribly useful description, but thankfully the doctor had a history to fall back on:

For some weeks previous to this, his friends had observed, that his countenance was becoming pale and unhealthy; that universal emaciation was stealing upon him, and that he constantly manifested unusual peevishness. His appetite during this period was not observably augmented or impaired, except for liquids. This thirst, for some time, had been uniform and considerable.

Although this set of symptoms is still quite vague, many doctors today would find one potential diagnosis immediately suggesting itself. Hint: it isn’t excessive masturbation.

As the changes, however, in the state of his health, had been from day to day hardly appreciable, and as he made no complaints of illness, little attention had been paid to these circumstances. About the 20th of September, an occasion resented, and he was observed to manifest an extraordinary relish and craving for new cider.

Today in America ‘apple cider’ (as opposed to ‘hard cider’) is a non-alcoholic beverage, but I believe that in 1812 Connecticut it would have been weakly alcoholic. Do correct me if I’m wrong.

From thenceforth, he sought every opportunity of indulging this appetite, almost without limit; and made use of stratagems to obtain the gratification of his desires, to which he had previously been a stranger. His desire for food, from this period, diminished; and though tolerably active in his customary employments, yet a rapid diminution of strength was observed.

There are good reasons for thinking this entire pattern of behaviour highly significant from a diagnostic point of view. More of that later.

About the 1st of October, an unusual secretion of urine, and an almost incessant disposition to empty the bladder, was perceived. On the 3rd, as mentioned above, he first complained of indisposition, and on the morning of the 4th, first had medical advice.

When Dr Tully visited the patient shortly afterwards, these were the symptoms he found:

Extreme emaciation, but not so much diminution of strength as to prevent walking about; complexion very pale; expression of the eyes, and whole countenance haggard and wild, though no mental derangement could be perceived; no appetite for food; great thirst; skin dry and cool; tongue dry, and covered with a reddish brown crust; pulse about 130 beats in a minute very small, and receding under slight pressure; indescribable, dull, distressing sensations about the precordia, and in the back; shortness of breath, frequent micturition, and copious discharges of urine, which was limpid and colourless. The preceding night had been passed in a very sleepless and restless manner.

And this is when Dr Tully made a discovery that, he believed, explained the whole case:

At this time, it was ascertained, that he had been in the habitual nocturnal practice of onanism for about six months, frequently repeating it five or six times in a night.

That is, admittedly, quite a lot.

On being questioned, whether he had not been sensible of the pernicious effect of this baneful practice, it was found, that for some time previous, he had experienced unpleasant and distressing sensations, as an immediate consequence of every orgasm; but so much was he under the dominion of this deadly habit, as to be unable to resist its influence, notwithstanding his conviction of its fatal consequences.

Dr Tully barely needed to hear any more.

In short, it was judged, that his whole malady was the ultimate result of this practice.

Its primary effects, seemed to have been derangement of the digestive organs; and the secondary ones, the symptoms above detailed.

The doctor prescribed baking soda and vinegar in the hope of ‘obtaining the exhilarating effects of disengaged carbonic acid in the stomach.’ Wine, opium and cinchona bark (containing quinine, good for fevers) were also administered, and the patient given nutritious broths. But their patient quickly deteriorated, and by 10 pm had become comatose. In the early hours of the following morning he died.

Dr Tully was in no doubt what had caused his patient’s death: masturbation.

The ill effects of the practice, which apparently gave rise to the preceding case, have been questioned by John Hunter, in his Treatise on the Venereal; but with due deference to his exalted reputation, I must say, that his argument of its universality, and the little apparent evidence against it, in my opinion, apply equally well to intemperance in the use of distilled spirits.

John Hunter was indeed sceptical of the idea that masturbation caused serious illness, writing that ‘the only true objection to this selfish enjoyment is the probability of its being repeated too frequently.’

While happy to admit that many of his contemporaries exaggerate the dangers, Dr Tully is adamant that the ‘sin of Onan’ has potentially fatal consequences.

That popular treatises upon it, tend rather to increase than diminish the evil, I readily admit; but as a physician, I am firmly convinced, that many a vigorous constitution, which though it does mot sink under it, yet receives such a shock by it, as is frequently followed by premature old age, and a host of infirmities.

Dr Tully ventures to suggest a refinement to the prevailing opinion on the mechanism of illness caused by masturbation:

It has been the commonly received opinion, that the part of the system first affected by Onanism, is the brain, and its production through the spina dorsi; but I have long been convinced, that the stomach is first peculiarly deranged, and these other parts in consequence. In this case, paleness, emaciation, and an unusual appetite for liquids, were the first observable symptoms. Speedily, however, further depravity of appetite, is manifest, and this of such a nature, as to be followed with a certain degree of diabetes.

And here Dr Tully stumbles agonisingly close to the likely truth of the case – though he mistakes cause for effect. Emaciation, insatiable thirst and an almost incessant need to urinate are classic symptoms of acute type 1 diabetes. So much so that a modern doctor reading the case report above would probably get no further than the first paragraph before thinking, ‘Could this be type 1 diabetes?’ It’s impossible to be certain, of course, but there is little in the rest of the case report that would cast doubt on this diagnosis.

One other aspect of the article struck me as interesting. In the later literature on the evils of masturbation, an archetype of the habitual masturbator emerged. This description of the ‘typical patient’ is taken from William Acton’s The Functions and Disorders of the Reproductive Organs, first published in 1857:

The frame is stunted and weak, the muscles undeveloped, the eye is sunken and heavy, the complexion is sallow, pasty, or covered with spots of acne, the hands are damp and cold, and the skin moist.

The echoes of Dr Tully’s 1817 case report are striking: the smaller-than-average frame, the general impression of feebleness and emaciation, the unhealthy complexion. This may not be an original observation, but I’ve not seen it made before, either: perhaps this entire archetype arose because doctors mistook diabetics for masturbators.

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