Medical Background

Though physicians throughout recorded history have been interested in diseases and infirmities that affect sexual performance, the concept that certain forms of sexual behavior constitute a disease in and of themselves is a modern phenomenon. It also seems to be restricted to western Europe and people and cultures descended from or influenced by western European culture.

One reason for the development of the concept of sexual "deviation" as a disease can be found in some of the early modern challenges to the humoral theory of medicine. Early in the eighteenth century, the great clinician Hermann Boerhaave, a dominant figure in medical thought, had written in his Institu-tiones Medicae (1728) that the rash expenditure of semen brought on lassitude, feebleness, a weakening of motion, fits, wasting, dryness, fevers, aching of the cerebral membranes, obscuring of the senses, particularly that of sight, decay of the spinal cord, fatuity, and similar evils. Though Boerhaave's idea undoubtedly was based on observations of the general lassitude usually afflicting men and women after orgasm, it was also an encroachment of traditional Christian teaching about sex into the medical field.

Boerhaave's observations of sex as a causal factor in some forms of illness also fit into a new medical theory known as "vitalism," based on the work of Georg Ernst Stahl as well as others. Stahl (1768) had taught that there was a unity of soul and body, a unity symbolized by the anima, which protected the body from deterioration. When the tonic movements of normal life were altered by the body or its organs, disease supervened. Disease was thus little more than the tendency of the anima (or of nature) to reestablish the normal order of these movements as quickly and efficiently as possible.

A contemporary (and rival) of Stahl, Frederich Hoffmann, equated life with movement, whereas death corresponded to the cessation of movement. The living organism was composed of fibers having a characteristic neurogenic tonus (the capacity to contract and dilate being regulated by the nervous system) centered in the brain. When tonus was normal, the body was healthy, but every modification of tonus brought a disturbance of health. Thus, a man who indulged in masturbation gradually damaged his memory because of the strain on the nervous system.

Building on this foundation were other physicians, including John Brown and Théophile de Bordeu. Brown's medical philosophy, summarized in his Elements of Medicine (1803), is based at least in part on his own experience with gout. In theorizing about his gout, he concluded that "debility" was the cause of his disorders and that the remedy was to be sought in "strengthening measures." To overcome his gout he had to strengthen himself, avoid debilitating foods, and treat himself with wine and opium.

Whether his gout was cured remains debatable, but from his experience he erected a medical philosophy known as "brunonianism." Basic to his belief system was the notion of excitability, defined as the essential distinction between the living and the dead. The seat of excitability was the nervous system, and all bodily states were explained by the relationship between excitability and excitement. Too little stimulation was bad, whereas excessive stimulation had the potential of being worse because it could lead to debility by exhausting the excitability. Excitability was compared to fire. If there was not enought air (insufficient excitement), the fire would smolder and die out, but under a forced draft (too much excitement), the fire would burn excessively, become exhausted, and go out.

This led Brown to conclude that there were two kinds of diseases, those arising from excessive excitement (sthenia) and those from deficient excitement (asthenia). Too much stimulation carried an asthenic ailment into a sthenic one. Contact between the sexes, through kissing and being in each other's presence, gave an impetuosity to the nerves, and intercourse itself, though it gave temporary relief, could release too much turbulent energy if carried to excess and could thus cause difficulty. Taking a somewhat different approach but ending up with a similar conclusion was de Bordeu, who maintained that the lymphatic glands as well as the muscular nervous system had vital activity. Secretions, including seminal secretion, drained the vital essences residing in every part of the body.

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