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This study of official medical and pedagogical attitudes towards masturbation is based on an extensive study of the medical, psychological, and pedagogic literature of the last 250 years. The 314 relevant references are printed at the end of the paper. In investigating the changing attitudes of society to masturbation Spitz has been especially concerned to demonstrate the influence of psycho-analysis in introducing a progressive, non-punitive attitude to the problem. As a result the statistical methods employed by him do not take into account the possibility that the psycho-analytic movement is itself part of a wider social process that has operated in the direction of an increasingly tolerant, non-authoritarian attitude towards sexuality.
According to Spitz the existence of a social (as opposed to religious) moralistic attitude towards masturbation dates from the beginning of the 18th century with the publication of Bekker's Onania. For the next hundred years there was increasing medical interest in the subject, the ill-effects attributed to masturbation ranging from 'impotence to epilepsy', but in general the attitude towards it was therapeutic and the treatments recommended were mild and unsadistic. In the 19th century there was a shift towards a suppressive attitude, with, in the second half of the century, 'sadism becom(ing) the foremost characteristic of the campaign against masturbation'. This sadism was shown in the advocacy of surgical methods of treatment, especially in English-speaking countries. Spitz relates the 19th-century suppressive attitude to the Industrial Revolution, but does not discuss the influence of the discovery of anaesthetics on the advocacy of surgical methods of treatment.
The decline in sadistic and punitive methods of treatment in the 20th century is attributed to the influence of psycho-analysis and began earlier in German- than in English-speaking countries. Actually the figures given by Spitz do not altogether bear this out,