How far masturbation in moderately healthy persons living without normal sexual relationships may be considered normal is a difficult question only to be decided with reference to individual cases. As a general rule, when only practiced at rare intervals, and _faute de mieux_, in order to obtain relief for physical oppression and mental obsession, it may be regarded as the often inevitable result of the unnatural circumstances of our civilized social life. When, as often happens in mental degeneracy,--and as in shy and imaginative persons, perhaps of neurotic temperament, may also sometimes become the case,--it is practiced in preference to sexual relationships, it at once becomes abnormal and may possibly lead to a variety of harmful results, mental and physical.[345] It must always be remembered, however, that, while the practice of masturbation may be harmful in its consequences, it is also, in the absence of normal sexual relationships, frequently not without good results. In the medical literature of the last hundred years a number of cases have been incidentally recorded in which the patients found masturbation beneficial, and such cases might certainly have been enormously increased if there had been any open-eyed desire to discover them. My own observations agree with those of Sudduth, who asserts that "masturbation is, in the main, practiced for its sedative effect on the nervous system. The relaxation that follows the act constitutes its real attraction.... Both masturbation and sexual intercourse should be classed as typical sedatives."[346]