On the whole, there can be little doubt that neurasthenia is liable to be associated with masturbation carried to an excessive extent. But, while neurasthenia is probably the severest affection that is liable to result from, or accompany, masturbation, we are scarcely yet entitled to accept the conclusion of Gattel that in such cases there is no hereditary neurotic predisposition. We must steer clearly between the opposite errors of those, on the one hand, who assert that heredity is the sole cause of functional nervous disorders, and those, on the other hand, who consider that the incident that may call out the disorder is itself a sole sufficient cause. In many cases it has seemed to me that masturbation, when practiced in excess, especially if begun before the age of puberty, leads to inaptitude for coitus, as well as to indifference to it, and sometimes to undue sexual irritability, involving premature emission and practical impotence. This is, however, the exception, especially if the practice has not been begun until after puberty. In women I attach considerable importance, as a result of masturbation, to an aversion for normal coitus in later life. In such cases some peripheral irritation or abnormal mental stimulus trains the physical sexual orgasm to respond to an appeal which has nothing whatever to do with the fascination normally exerted by the opposite sex. At puberty, however, the claim of passion and the real charm of sex begin to make themselves felt, but, owing to the physical sexual feelings having been trained into a foreign channel, these new and more normal sex associations remain of a purely ideal and emotional character, without the strong sensual impulses with which under healthy conditions they tend to be more and more associated as puberty passes on into adolescence or mature adult life. I am fairly certain that in many women, often highly intellectual women, the precocious excess in masturbation has been a main cause, not necessarily the sole efficient cause, in producing a divorce in later life between the physical sensuous impulses and the ideal emotions. The sensuous impulse having been evolved and perverted before the manifestation of the higher emotion, the two groups of feelings have become divorced for the whole of life. This is a common source of much personal misery and family unhappiness, though at the same time the clash of contending impulses may lead to a high development of moral character. When early masturbation is a factor in producing sexual inversion it usually operates in the manner I have here indicated, the repulsion for normal coitus helping to furnish a soil on which the inverted impulse may develop unimpeded.