A loss of color, or an earthy tint of the countenance--a violet appearance of the eyelids--a languid expression of face--an air of fatigue and _nonchalance_, when the patient rises from bed--a difficulty in getting up--are all signs which may lead to the discovery of this pernicious habit. Here we might trace the physical state produced by onanism, if this had not already been done. Unfortunately, it is consumption which sounds the alarm; and this disease must be advanced, too, before the parents seek the cause. Sometimes, the true cause is overlooked, and all remedies are directed to an imaginary one. We will admit, however, that it is not always easy to refer the wasting caused by masturbation to its real origin. A young man, although not addicted to onanism, may lose his strength, grow thin, and present, both morally and physically, the characters belonging to this habit: this effect is often produced by intestinal worms, by dentition, puberty, by a too rapid growth of the body, &c.; and likewise by some chronic diseases of the stomach, intestines, liver, lungs, heart, &c. Hence, we should not be too quick to attribute to masturbation a state which may be produced by other causes. The practitioner who would pronounce too precipitately that a patient indulged in onanism, would commit an error which might be serious in more than one respect.
When a young patient presents signs of consumption, there is cause to suspect that onanism is the cause of it; and modes may be used to ascertain whether this be the case. Sometimes, the patient is watched, as has already been stated. Sometimes, we attempt to discover if any other cause has produced consumption; and when this cause is not found, the existence of onanism is supposed. The patient, for instance, presents all the symptoms of exhaustion, and these increase. We inquire if this state may not result from a want of nourishment, or from improper food--from hard work--from long watching--from melancholy, &c.; if it may not be caused by a disease about which the patient is silent, or by one of those maladies which produce effects similar to those of masturbation. Now, if the gradual sinkings of the patient cannot be explained by any of these causes; if he is weak, pale, thin, &c.; if, notwithstanding abundant and nutritious diet, a moderate degree of labor, the absence of all chagrin, &c.; if he presents no sign of disease--or, rather, if the first symptoms of diseases which he would present are not manifested until after the appearance of those of consumption; farther, if these diseases are too slight to have caused this state; if they cannot explain the numerous and varied symptoms observed, and particularly the countenance, the character of which is so significant, that it alone often reveals onanism: then we may consider, if not as certain, at least as very probable, that the patient is a victim to this habit, and we must act accordingly.