In those very frequent cases of pubescent insanity which are accompanied by masturbation we must recognize that the self abuse is often as much a symptom as a cause of the insanity. Some children get to be "pitiful mind wrecks" at this period of life, partly through their own errors, partly on account of their vicious hereditary tendencies, and very largely on account of the lack of a proper education which would teach them self control. But in every pubescent child, a certain derangement of the emotions and disquiet of mind may be confidently looked for.
In addition to the mental disturbances, many of the bodily ailments which afflict a child are in reality nothing but the accompaniments of puberty. This is more commonly true in relation to the female sex, because the girl suddenly blossoms into a woman, the change transforming her whole nature in a short period of time, and because the feminine reproductive functions are vastly more pervasive in their physical influence on woman in proportion to her more important sexual role in nature. Periodicity is the law with women, and it must necessarily disturb the equilibrium of their systems once every lunar month, unless they are pregnant or suckling; and any irregularity or suppression of this function, instead of being a relief, is a marked and sure cause of systemic derangement.
In growing children of both sexes, at about the age of puberty, not only is the blood richer in the elements of fibrin and red blood corpuscles, but the circulation is also more vigorous, so that there are apt to be congestions of various organs, relief from which is afforded by the familiar nosebleeds of children. These nose-bleeds are more common in boys, for menstruation more or less takes its place in girls; but if this phenomenon fails to operate in the latter, there is then not infrequently a "vicarious menstruation", i.e., relief is afforded by hemorrhages from other organs for instance, from the lungs, stomach, bowels, nose, etc.
In normal children, as previously observed, there is before puberty an entire freedom from any ideas about sexual affairs; but it is a well known fact, based on observation, that many very young children take to handling of the genitals with very apparent satisfaction of some sort. Nurses frequently have a most pernicious custom of quieting children by manipulation of their genitals; and thus, perhaps several years before puberty, the little ones get into the habit of practising auto stimulation without in the least appreciating its moral or physical wickedness.
Others are led to masturbation by some local irritation; as from a too long or too tight foreskin, worms in the rectum, haemorrhoids, fissure of the anus, intolerable itching about the anus or vulva, accumulation of a cheesy substance smegma beneath the foreskin, or, in short, by any cause which produces congestion or inflammation in the genital zone. To prevent attention to these parts it is often necessary for the physician to obviate any abnormal conditions which may be present in children of either sex, e.g., to relieve constipation, to allay the intense itching, to dislodge the worms from the rectum, and, in the case of boys, to practise circumcision. With any line of treatment the child must in addition be early taught self mastery and self reliance.
The time of puberty and the next few succeeding years are supereminently important as constituting the formative and critical period of life; for habits and the general trend of the mind get their motif then, and the individual hardly ever materially changes thereafter, at least in his tendencies and sexual enthusiasms. The sensations which are experienced at this time compel the attention of the mind; and though they may at first be vague and indefinite, yet before long the new influence of the reproductive energy promotes unmistakable feelings which, unless controlled, may lead to various forms of illicit gratification.
Teachers and parents, culpably ignorant themselves, too often treat children as though they had no sexual organs at all; being all too content if they advance well in their studies. But assuredly they practise the most pernicious prudery by not looking for and anticipating those influences which so often lead pubescent young people astray to the ruin of their bodies and characters. Evil practices are exceedingly apt to be learned if these matters are left to Nature and to the child's companions for settlement; for in most schools masturbation and other forms of vice are actually cultivated by that portion of the scholars who are viciously inclined, and who, unfortunately, do the most talking.