In the absence of these definite indications, it is necessary to be cautious in coming to a diagnosis. Failing such caution, mistakes which may entail serious consequences are likely to arise. Two cases are known to me in which, after suspicion had rightly or wrongly been aroused, the child's most harmless movements were regarded as masturbatory in character. If a child becomes aware that its mother or some other person in authority is making such a mistake, the effect will naturally be very unfavourable. We have also to reckon with the fact that children who are somewhat older, from eight or nine years upwards, hardly ever masturbate when others are present, but only when they believe themselves to be unobserved—in bed, in the closet, or when out walking. In such cases it is hardly possible to diagnose masturbation with certainty; more especially in view of the fact that the signs that may betray an older boy—stains on the shirt or other articles of underclothing—are usually lacking during the first two periods of childhood. It must be added that such stains on linen resulting from ejaculation do not at first contain spermatozoa, and for this reason their diagnostic value is greatly lessened (see pp. 52-56). Still, the possible appearance of these stains is a matter to which attention should always be paid, and this in girls as well as in boys. In many instances, also, our diagnosis may be supported by the discovery of articles used for onanistic[80] purposes. In the case of boys we shall seldom, comparatively speaking, be able to do this; although, even in boys, operation is sometimes needed for the removal of articles used for onanistic purposes, which have found their way into the urethra or the bladder. In girls, such operations are more frequently required. Hairpins, pencils, and various other articles used for onanistic purposes, are from time to time removed from the vagina or the female bladder. Other signs that are supposed to indicate the habitual practice of masturbation are of little diagnostic value. It is traditionally held that masturbation in girls leads to elongation of the clitoris, but there appears to be no warrant in fact for this opinion. As I have previously pointed out, laceration of the hymen does not in general result from masturbation. Other signs, such as local irritation or swelling, are hardly ever seen in boys, and in girls are seen only in cases in which they masturbate to excess. In girls, moderate reddening of the external genital organs has no significance whatever; and I take this opportunity of giving a special warning against inferring from the existence of such reddening that masturbation is practised, and also against attaching any importance to this symptom in a case in which a sexual assault is supposed to have been committed on a little girl.

Certain other signs which have been believed to support a diagnosis of masturbation, do not even justify suspicion. Among these reputed signs may be mentioned: black lines under the eyes, pallor of the cheeks, inflammation of the eyes, &c. Generally speaking, it must be said that in sexually immature children nothing but direct observation will justify a definite diagnosis of masturbation, except in cases in which the child itself makes confession to someone in its confidence. For the diagnosis of auto-erotism, however, it is not necessary to establish the occurrence in the child of the voluptuous acme; it suffices for this diagnosis if there occur signs of those general voluptuous sensations which were described on page 58. In many cases in which the practice of masturbation is diagnosed, and in cases in which children themselves confess to masturbating thirty times a day or more, we can hardly suppose that the voluptuous acme or orgasm is attained.

It is sometimes maintained that the early appearance of the physical manifestations of puberty is an indication that psychosexual processes are also occurring prematurely. Thus, Kisch[81] expresses the opinion that in many cases premature sexual development manifests itself in children by the enlargement of the breasts, and by the growth of the axillary and pubic hair, in the absence of the commencement of menstruation, Kussmaul also observed cases in which, in comparatively early girlhood, all the physical signs of puberty were present although menstruation had not yet begun. According to my own experience, we must be careful to avoid taking an exaggerated view of such a connexion. Passionate psychosexual processes may occur in young children in the absence of any physical signs of premature sexual development. An impulse to masturbate may also arise quite independently of the commencement of the adult development of the external genital organs. Psychically determined erections may likewise occur, although the physical development is by no means far advanced. We shall therefore do wisely to avoid taking a narrow view of such a connexion, inasmuch as it may be that the physical signs of puberty on the one hand, and the phenomena of detumescence and contrectation on the other, may occur in conjunction at a very early age, whilst, in other cases, phenomena of the one class or of the other may occur in isolation. This statement is true, not merely of the secondary sexual characters, whose development by no means always affords a measure for the degree of development of the sexual impulse, but it is true also of the reproductive organs themselves. Halban[82] reports the case of a boy six years of age, whose penis was as large as that of a full-grown man, but in whom, apart from the erection, all the characters were infantile. Still more often do we note the independence in many young men of the individual symptoms of sexual development from the growth of the beard, for this latter is often still lacking at an age when the sexual life in general has attained an extensive development. Still less importance must be attached to other occasional signs. According to Marc d'Espine[83] "puberty occurs early in girls with dark hair, grey eyes, a delicate white skin, and of powerful build; late, on the other hand, in girls with chestnut hair, greenish eyes, a coarse, darkly-pigmented skin, and of delicate, weakly build;" but the evidence to justify any such generalisation is lacking. It is possible that the opinion quoted is supported to some extent by certain associated racial peculiarities, but we must be on our guard against accepting inferences of too sweeping a character. Still less, of course, are such peculiarities a trustworthy aid for the diagnosis of the occurrence of sexual acts at an early age.

The safest way of obtaining accurate information as to the practice of masturbation and other sexual acts is by means of confessions made to some person in the child's confidence. Cases are known to me in which children have very readily confided in some elder person. If this does not often occur, the fault commonly lies with the child's elder associates, who do not understand how to establish a truly confidential relationship with the children under their care. If a child finds that no one will speak to it about sexual matters, it must ultimately become secretive about its own sexual life. The child sees very clearly that every word it utters about such things is repressed as improper, and soon learns that the whole field of sexuality is regarded as something unclean, about which not a word must be uttered. The ordinary behaviour of adults inevitably produces this impression in the child's mind, and it will readily be understood what an effect this has in preventing us from gaining information about the sexual life of the child. In many mothers, the abhorrence of the sexual is carried to such an extreme that while in other respects they keep their children scrupulously clean, they feel so strongly that the genital organs must not be touched, that they neglect to secure the ordinary cleanliness of this region of the body.

The best confidant for a young child will usually be the mother, not only because she sees more of the child than the father and because her relationship is a more intimate one than his, but in addition because a woman's insight into certain things generally excels a man's. As a matter of fact, for the reasons stated, masturbation in young children is in most cases discovered by the mother. It will be obvious that I speak here only of those mothers who have real affection for and sympathy with their children, and who share their children's interests; I do not refer to those mothers who think they have adequately fulfilled their maternal duties by paying a nurse or a governess, whilst themselves immersed in the pleasures of society—or perhaps engaged in the preparation and delivery of lectures on the best way of bringing up children, on the Woman's Movement, Woman's Suffrage, and similar topics—or, it may be, attending these same lectures—those who, in any case, prefer some other occupation to the care of their own children.

Above all, let not those who have the care of children be deceived, either by diligence, or by conduct exemplary in other ways, or indeed by earnest study of the Bible, by pious protestations, or by regular attendance at church. I know a boy of twelve, reputed to be extremely religious, and ostensibly on religious grounds going to church every Sunday; but whose real motive in the church-going was the hope to meet the girl of whom he was enamoured. Extensive experience of the conduct of adults should teach us the necessity for extreme caution in these respects. I recall the case of a gentleman whose reputation was that of a paragon of all the virtues. When others of an evening went out to enjoy a glass or two of beer, or in search of even lighter pleasures, he was supposed always to turn homewards, ostensibly in order to work. Only after some years was the fact disclosed that he was an habitual loose-liver, enjoying indiscriminate sexual intercourse with unmarried girls and with his neighbours' wives, although to his friends and comrades he had appeared to be a man of exceptionally strict life, and this above all in sexual relationships. The same may be true also of quite little children. Hebbel relates that in his first year at school be sat next to a boy who appeared to be engaged in the most earnest study of the catechism, whilst under the rose he was pouring into young Hebbel's ear all kinds of obscenities, and was asking him if he was still stupid enough to believe that children were brought by a stork or were found in a basket in the cabbage-patch. Many parents, too, know so little about their children in these respects, that they are utterly astonished when some day their eyes are opened to the facts of the case by their family physician. I knew a boy of fourteen who went regularly to church, and who in other respects was a fine fellow, and a diligent pupil at school He was brought to see me because he was affected with spasmodic movements. On examination, I found him to be suffering from a severe attack of gonorrhoea, which he had contracted in intercourse with his aunt's servant-maid. When I told his mother the truth, she was at first extremely angry at what she was convinced must be a mistake on my part; but further inquiry disclosed the fact that for a year or more the boy had been intimate with prostitutes and other girls.

I have been writing of processes occurring in the reproductive organs, such as erections, seminal and other discharges, and masturbation; and of the means for the recognition of these processes. But it is necessary to recognise that we must not assume without further inquiry that all processes occurring in the genital organs are of a sexual nature, although in individual instances the distinction between the sexual and the non-sexual may be extremely difficult, or even impossible. Thus, of erections occurring before the reproductive glands ripen, not all are of a sexual nature. We know, too, that even in the adult, non-sexual erections may occur. The clearest instances of this are met with in the form of priapism, the principal characteristic of this condition being the occurrence of permanent erection which has nothing at all to do with the sexual impulse. The same is true for the most part of matutinal erections, the precise cause of which is not yet determined. They are commonly referred to distension of the bladder, which is supposed by reflex action to lead to distension of the corpora cavernosa of the penis. It is certain, at any rate, that these matutinal erections are not caused by sexual thoughts, nor as a rule do they induce sexual feelings. We must distinguish between these processes; just as recently we have learned to distinguish herpes progenitalis, the characteristic of which is its localisation to the genital organs, from herpes sexualis, which is directly dependent upon sexual processes. If we regard this distinction between sexual and non-sexual erections as applicable also to erections in childhood, we are justified in assuming that many erections, in infants-in-arms, for instance, are non-sexual in nature, even though in appearance there is nothing to distinguish them from sexual erections. In infants, erections may arise from external stimuli or from distension of the bladder, which must be distinguished from the erections which have a definitely sexual causation. We must, of course, admit the possibility that such primarily non-sexual erections may secondarily give rise to sexual processes; inasmuch as by the stimuli resulting from the erection, the child's attention may be directed to the genital organs. Just as we must guard against regarding every erection in the child as a sexual process, so also must we be cautious in our estimate of the significance of manual stimulations. Children often stimulate various parts of the body. Some children will rub the lobule of the ear, others will suck their fingers, or will stimulate their mouths in other ways. Some children have the offensive habit of picking their nose; and it is evident that many cases in which children stimulate the genital organs manually are on the same footing with nose-picking and numerous similar habits. In such cases we have not to do with a specific genital sensation to which the child responds; but with a stimulus which may be pathological, but is not necessarily sexual. In many cases, indeed, the stimulus is not even pathological. We have to take the following point into consideration. As soon as the child begins to become conscious of the existence of its organs, it fingers them. It does this with its nose and its ears, just as it does with its feet; and it is obvious that the genital organs will receive the same treatment. A gentleman who had grown up in the country related to me that as a child he had often been present when cows were being milked, and that in the evenings, after he had gone to bed, he performed the milking movement on his penis, and was greatly astonished at the fact that no milk flowed forth. He assured me that the like experience had occurred to quite a number of boys who had been his playmates in the country. It is certain that such manipulations of the genital organs, entirely non-sexual in origin, may lead to the practice of masturbation. But we must not immediately conclude that every manipulation of the genital organs in a child is sexually determined.

It is true that many investigators regard numerous movements on the part of children as sexual processes, even when the genital organs are in no way involved. Freud[84] above all, discovers sexuality in the life of the child in cases in which, I am convinced, sexual elements play no part whatever. Sucking movements in children are regarded by Freud as sexual phenomena. He considers that the lips and the fingers are erogenic zones. With just as much reason, every movement might be regarded as sexual—as, for instance, the clenching by a child of its little fists. As long ago as 1879, Lindner,[85] of Budapest, published an able essay about the movements made by children sucking their fingers, lips, &c., and suggested that there was some connexion between these sucking movements and sexual processes. He stated that many children, when sucking the lips, the fingers, the back of the hand or some other part, or when sucking a rubber teat, simultaneously rubbed some other region of the body—in some cases the lobule of the ear, the nipple, or the genital organs; this was sometimes done with one hand only, sometimes, if both hands were free, with both. This statement is perfectly correct. It may happen that the child stops rubbing the genital organs as soon as the sucking is interfered with; or, conversely, the sucking may cease as soon as we withdraw the child's hands from its genital organs. But, even in these cases, the friction of the genital organs does not necessarily possess a specifically sexual character, since friction of the lobule of the ear or of some other part of the body is an equivalent act. It is certain that there is here no intimate connexion between the act of sucking and the sexual life. Thus, there is no proof whatever for the view of Lindner, which has recently been carried to a still greater extreme by Freud, that this "voluptuous sucking" (Wonnesaugen) is a truly sexual process. We may, indeed, assume, as does Rohleder,[86] that such sucking movements occur with especial frequency in children with a congenital morbid predisposition, and that to this extent therefore it is connected with masturbation. But in my opinion it is essential to regard the two movements as clearly independent in character.

Certain other childish habits, such as nail-biting, have also been described as sexual manifestations. What I have said of sucking movements applies to this also. It is true that nail-biting and masturbation may both occur in the same child, and French writers have maintained that there is a causal nexus between the two processes. If we regard nail-biting as a "tic" occurring chiefly in neuropaths, and if we assume that the neuropathic congenital predisposition is the basis of the premature awakening of sexuality, it may be supposed that to that extent there exists a relationship between the two phenomena, inasmuch as we may refer both manifestations to a common cause, viz., the neuropathic predisposition. But there is no justification whatever for regarding, as some do, one manifestation as the direct consequence of the other.

Speaking generally, we shall do wisely to exercise caution in defining the limits of the sexual life of the child. If a boy runs after a girl, and if the two flirt one with the other, it will often be merely from a desire to imitate their elders. In many instances, even, in which the genital organs play a part in such imitation, we must distinguish what is done from the sexual life proper of the child. If children play at "father and mother," if the "midwife" comes, and "childbirth" takes place, the play may certainly depend upon an early awakening of the sexual life; but this is not necessarily the case. There may be no more than innocent imitation of grownups, as the following case shows. A number of little boys and girls, almost all under eight years of age, played at being prostitutes, souteneurs, and men-about-town. The little girls each demanded a penny when they had allowed the little boys to touch their genital organs. It was an extremely characteristic fact that the leader of this band was a feeble-minded boy, whose parents I had advised to send him to an asylum, because, after various dangerous actions, he had attempted one night to kill his little sister eighteen months old by inserting beans in her nose. Such acts as that first described may, of course, depend upon a premature awakening of the sexual impulse; and when a number of children engage in amusements of this kind we not infrequently find that in the leader and seducer the sexual impulse is already awakened, whilst the others act merely in obedience, at first, at least, to an imitative impulse. Certainly, I have known a few instances in which children with premature sexual development very rapidly came to a mutual understanding, and in whom their intimate association was dependent upon prematurely awakened sexual impulses.

Just as sexual acts in which the genital organs play a part occasionally arise, not from premature awakening of the sexual impulse, but from imitation merely, so also, as previously explained, may this happen in the case of more harmless processes. Braggadocio here plays a great part, and also the desire to act like grown-ups. Thus, the boy who runs after girls, and makes appointments with them, sometimes does this merely to show off before his companions, and to produce in them the impression that he is a "manly" fellow. We must take care to separate these cases, also, from those that are genuinely sexual.

If it is difficult to separate the sexual from the merely imitative, no less difficult may it be to distinguish psychosexual processes from others. If a child lavishes caresses on mother, governess, or sister, it may be difficult to discover definite characteristics enabling us to distinguish whether the motive is or is not sexual. But, generally speaking, when a child exhibits an intimate and caressive affection for its mother we shall not incline to think of processes of the sexual life. We cannot dispute the truth of the statement made by various authors, that in these caressive inclinations sexual elements are intermingled. But this talk of the intermingling of sexual sentiments arises in reality only from the fact that neither on theoretical nor on practical grounds are we in a position to draw a clear line of demarcation between the sexual and the non-sexual; and we must avoid stretching this idea of the intermixture of sexual elements beyond the fact that a scientifically based practical distinction is not always possible.

We have to admit that above all in the mind of the child the various feelings comprised under the idea of "sympathy" (friendship, affection for parents, love of children, sexual love) cannot always be marked off each from the other after the manner of provinces on a map. Even jealousy, which is often regarded as characteristic of the erotic sentiments, does not necessarily possess a sexual basis. The boy, in his love for his mother, is jealous of his father, jealous of one of his brothers or sisters, jealous even of a dog to which his mother pays attention. How little jealousy may depend upon a sexual motive, may be learned by the observation of animal life; a dog becomes jealous if its master takes notice of another dog, or even pays attention to his own children. In children, more especially, the extension of jealousy is far greater than it is in adults. Whereas in adults this sentiment is chiefly, if not exclusively, associated with the erotic feelings, in children this is by no means the case. In the child, jealousy may clearly be associated with every possible variety of sympathetic feeling. For this reason, it is impossible for us to draw a distinction between sexual and other psychical processes, simply on the ground of the associated manifestation of jealousy.

On what grounds, then, can we decide that certain processes are of a sexual nature? In many instances, only the subsequent development will show that one process was sexual, another non-sexual. If one day a boy, embracing, as often before, his girl friend, has an erection, and then perhaps endeavours to draw her towards him so that her body presses against his genital organs, or even has an ejaculation with a voluptuous sensation, we may assume the influence of a contrectation impulse, which has existed for some time, but only now has for the first time been localised in the peripheral genital organs. On the other hand, if in the same boy when he hugs his mother no peripheral sexual manifestations occur, either now or subsequently, we must assume that in the earlier embraces of his mother there was no sexual element. But no such simple solution of the difficulty is really possible. It may happen that in the case of feelings originally sexual their further development is inhibited. A boy might experience sexual sentiments towards his mother; but it is very probable that in such a case convention, education, and perhaps also the very frequent association with his mother, would repress the growth of these sentiments. This criticism is a sound one, and in my opinion the materials are lacking to enable us to overcome its force. For why should certain processes occurring in childhood—for example, a boy's impulse to caress his mother—be regarded as non-sexual; and yet the same processes subsequently be regarded as sexual, merely because they ultimately become associated with the phenomena of detumescence? Take the case of a boy seven years of age; he loves and cuddles his mother; he is drawn also to a girl friend of the same age as himself, and kisses her with equal pleasure. The boy grows older, and after some years begins to have definite erections when he embraces and kisses his friend; but nothing of the kind occurs when he embraces and kisses his mother. Now, have we any right to assert, simply owing to the subsequent appearance of these peripheral manifestations in the one case and not in the other, that originally, when between the boy's inclination towards his girl friend and his inclination towards his mother no clear distinction could be drawn, the former was sexual, the latter non-sexual in nature?

The dilemma is unanswerable, unless we admit that, in the child, sympathetic feelings, which we shall subsequently be able to classify without difficulty, are, when they first appear, not always susceptible of any such differentiation; and that for this reason we are just as little able to distinguish a boy's love for his mother from has non-sexual friendship for a little girl, as we are able to distinguish either from a sexual love for another girl. To a very acute observer, certain slight indications may in many cases give some idea of how the matter really stands; but we are here largely concerned with subjective interpretations, rather than with distinctions that are objectively demonstrable. The difficulty of drawing distinctions is all the greater in view of the fact that in the case of non-sexual feelings sexuality constantly plays a certain part. Our sentiments are complex, and compounded of many and various elements; sexual contrasts play their part in family relationships; and it is not by pure chance that harmony exists by preference between father and daughter, and between mother and son. This sexual contrast tends to manifest itself in all displays of family affection. Thus, many men will tell us that in early boyhood they loved to kiss their mother and sisters, rather than their father and brothers. In my experience, the analogous sexual contrast does not show its effects so clearly in the case of women as in the case of men. I cannot be certain if the differences I have observed in this respect depend merely upon chance. It is certainly a fact that men, in their confidences to me, have remarkably often reported childish memories of the working of this sexual contrast. And conversely, many homosexuals have assured me that in boyhood they kissed their father with much greater pleasure than their mother.

Our diagnosis will, naturally, be greatly facilitated in those cases in which the phenomena of contrectation are plainly reflected to the reproductive organs. I, at any rate, believe that in practice such an association suffices completely to establish the diagnosis. We can, indeed, recognise this also in the dream life, at least as soon as the first nocturnal emissions have occurred. In the first edition of my work on Contrary Sexuality (Berlin, 1891), I drew attention to the fact that those affected with perverse sexuality commonly have perverse dreams; and Naecke has further discussed the significance of sexual dreams for the diagnosis of sexual perversions. In children also we shall find in their sexual dreams, especially when these dreams have begun to be accompanied with seminal emissions, a certain assistance in the delimitation of their sexual sentiments from other manifestations of sympathetic sentiment. But this aid in diagnosis is not available till comparatively late in childhood, i.e. not until ejaculation has already begun. Even before this epoch dreams may have a sexual character, and may be conditioned by sexual processes. But practically, before the occurrence of ejaculation and orgasm in dreams, an exact diagnosis is opposed by so many difficulties, that little of value can in this way be gained.

In this chapter we have examined the considerations that must guide us in our study and diagnosis of the sexual life of the child. It is, naturally, an important question, whether signs exist pointing to an abnormal development of the sexual life, and more especially to the growth of a sexual perversion. This matter has been discussed with considerable detail, and I need not, in conclusion, add anything to the emphatic warning previously given, against making apparently perverse manifestations in childhood the basis of a definite diagnosis or prognosis.



CHAPTER VII

IMPORTANCE OF THE SEXUAL LIFE OF THE CHILD

The problem of the significance of sexual phenomena in the child is naturally one of great importance. We have here, in fact, two problems to consider: first, whether the appearance of sexual phenomena in childhood indicates a morbid or in other ways abnormal state; and, secondly, what are the consequences of the occurrence of sexual phenomena in the child. An example will help to illustrate the need for drawing this distinction. Certain malformations of the external ear are indications of the existence of a morbid degenerative condition; but from the malformation itself there is nothing to fear. Similarly with the sexual life of the child, it may happen that a manifestation indicates the existence of morbidity, although the manifestation does not by itself entail upon the child any serious consequences. On the other hand, sexual phenomena in the child deserve in some cases the most attentive study, owing to the dangers likely to result from their occurrence.

With regard to the first question, whether sexual manifestations in the child indicate per se the existence of a morbid state, it is not necessary to say much here, since the subject has been fully discussed in the section on Etiology (see page 148). In any case, we must avoid exaggerating the importance of sexual feelings in the child. Ribbing[87] contends that we must regard it as abnormal when a boy of thirteen or fourteen is obsessed (hante) by erotic ideas. This is true enough if there is real obsession by such ideas, but it is not true if there is no more than an occasional uprising of sexual feelings. On page 118 of this work, I explained that an over-development of the sexual life in the child was an indication of the existence of a congenital morbid predisposition.

Passing to the second question, as to the consequences of the occurrence of sexual phenomena in the child, these consequences may be very various in nature. They arise more especially in the hygienic, social, ethical, educational, forensic, and intellectual domains.

First of all, then, let us consider the dangers to health.

The earlier the sexual impulse awakens, the earlier also arises the danger of sexual practices, and more particularly of masturbation. Common sensations in the genital organs, the feelings associated therewith, the impulse to allay the unsatisfied libido—all these may lead the boy to handle and rub his penis. The girl is affected by similar stimuli. In these cases, the first act of masturbation does not depend upon the desire to enjoy a voluptuous sensation, but results from the impulse to allay vague feelings of uneasiness. Only subsequently, when the child has learned by experience that mechanical stimulation of the genital organs induces voluptuous sensations, or when he has been taught this fact by a seducer, does the desire to produce voluptuous sensations become the mainspring driving to masturbation. The danger, of course, increases, in proportion as the child comes fully to understand that in this way it can produce agreeable sensations, all the more because the child is either unaware of the injurious consequences of the practice, or, if it has been informed of these consequences, the knowledge cannot weigh in the balance against the easily induced enjoyment. But, let me say here at the outset, the dangers of masturbation have been greatly exaggerated. Chiefly since the publication, at the end of the eighteenth century, of Tissot's book on masturbation, but to some extent also even earlier, it has been usual to refer to masturbation the occurrence of innumerable diseases, including mental disorders and locomotor ataxia. I do not propose to reproduce the account given by Tissott, and after him by Hufeland, and also by the innumerable quacks and swindlers who trade in the "cure" of "secret diseases"—these latter, preying upon the fears of humanity, declare that every possible affliction in both sexes may result from masturbation, and recommend innumerable miraculous remedies for these often imaginary ills. Disorders and displacements of the uterus, ulcers and cancer, gastralgia and gastric spasms, jaundice, pains in the nose, are supposed in women to result from masturbation, as well as fluor albus, nymphomania, &c. There is hardly a single organ of the body of which disease and destruction have not by many been referred to masturbation. In reality all this is false. It is more than doubtful whether, as far as adults are concerned, occasional masturbation is necessarily more harmful than normal sexual intercourse. According to my own observations, the principal question is whether, in masturbation, the bodily and mental stimuli employed to obtain sexual gratification involve an especial shock to the nervous system—a greater shock than results from normal sexual intercourse. More powerful shock may, indeed, arise from the fact that the masturbatory act is apt to be repeated with excessive frequency; and we have to admit that the chief danger of masturbation lies in the fact that there is so grave a risk of sexual excess. Owing, too, to the frequency of repetition, a need will very readily arise for an increase in the stimulation, and this may apply alike to the bodily stimuli and to the mental; and the stronger the stimuli have to be, the more powerful also will be the general effect on the nervous system. Thus the danger of shock to the nervous system from masturbation will be seen to depend, first, upon the frequency with which the act is repeated, and, secondly, upon the increasing intensity of the stimulation. To this extent, therefore, masturbation may be more dangerous than normal sexual intercourse; for this latter also, unless it is to exert an unfavourable influence on the health, must not involve mental and bodily stimulation of too powerful a kind. The good effects of sexual intercourse depend upon its adequacy to the feelings, upon the absence of any exhausting imaginative activity, and upon the absence also of artificial bodily stimulation. But artificial stimuli and exhausting imaginative activity are often associated with coitus also, in cases in which the stimulus evoked by the personality of the sexual partner is inadequate. Again, the powerful efforts which must as a rule be made by persons who desire to repeat the act of intercourse several times within a brief period, will have a similar effect upon the system to the powerful imaginative activity in cases of masturbation. The resemblances, on the one hand, and the differences, on the other, between masturbation and normal sexual intercourse, will be apparent to those who carefully consider the facts just stated; and it will also become apparent in what circumstances masturbation must be regarded as injurious. This is all I have to say concerning masturbation in adults.

The idea that masturbation is, generally speaking, dangerous, is by many restricted to the practice during childhood and youth, the belief in its danger at this stage of life being based upon the view that the organs are at this time insufficiently developed. But even this contention cannot be regarded as fully established. I will, in the first place, consider those cases only in which masturbation is practised after the formation of semen has begun, but when the processes by which bodily maturity is attained are not yet fully completed. To the theoretical assumption that masturbation is especially hurtful in cases in which the organs are not yet adequately developed, we may oppose the consideration that the completer development of organs is favoured by exercise. We cannot further discuss such theoretical speculations, which lack the firm foundation of experience. On the whole, I agree with the estimate of the consequences of masturbation expressed by Aschaffenburg,[88] a man to whom we are indebted for the refutation of many extravagant views. Experience teaches that almost all men, healthy and unhealthy, moral and immoral, have masturbated for some years, once or several times a week, towards the end of the second and during the beginning of the third period of childhood. In view of this experience, what right have we to maintain seriously that masturbation is, generally speaking, dangerous to health. It is, of course, possible to contend that these persons would have developed better if they had not masturbated. But there is equal ground for asserting the opposite. We possess no evidence whatever to show that those young persons who never masturbate are in after life stronger and healthier than the others. I know some persons who have never masturbated. In the case of some of these, it was because the impulse to masturbate was lacking; others, notwithstanding the existence of a strong impulse, refrained from masturbation under the influence of religious or ethical motives. In both of these groups, I have seen persons exhibiting the very morbid symptoms which Tissot and his followers referred to masturbation; and I was quite unable to convince myself that abstinence from masturbation secured any notable advantage. Whilst I do not assert that the morbid phenomena which I observed in these individuals arose in consequence of their refraining from masturbation, I consider that there is no justification for the converse assumption in the case of those who did masturbate. I believe that many of those patients who never masturbated were the subjects of congenital morbid predisposition, and that, as a direct consequence of this fact in many of them, the sexual impulse was of minimum intensity or developed exceptionally late; I consider, therefore, that the morbid manifestations in the domain of the nervous system were dependent, not upon the fact that they did not masturbate, but principally upon the congenital morbid predisposition.

Whilst I thus reject the view that masturbation in children is generally dangerous, this must not be regarded as implying that I consider the practice altogether indifferent as far as its influence upon health is concerned. In the child, as in the adult, there is danger in the fact that the act is so easy that it is likely to be repeated very frequently, and thus to become habitual. In addition, the masturbator is apt to require strong physical and mental stimuli, and this increase of the stimulus may become dangerous. A special danger of persistent masturbation is to be found in the possibility that impotence may result. The masturbator, being accustomed to stimulate his genital organs by manipulations, and by various methods increasing in intensity of stimulus, will often find subsequently that the normal stimuli, acting in part in the form of the sensory processes in the genital organs, and in part in the form of the normal psychical influences proceeding from without, are no longer competent to induce the normal sexual reactions (erection and ejaculation). This affects chiefly members of the male sex, but in some instances the same is true also of women. It is true that in women the sexual act is rather of a passive character, erection not being in them essential as it is in the male; but in the case of women also, long-continued masturbation, whether practised in childhood or subsequently, may bring about so intimate a dependence of sexual desire, ejaculation, and gratification, upon the artificial stimuli, that the occurrence of these phenomena in normal coitus may be hindered or completely inhibited.

Some writers contend that sexual perversions, homosexuality, for example, may be induced by masturbation, but I myself doubt this. For such a development to be possible, it is necessary that very special influences should be in operation, more particularly a congenital predisposition, or the cultivation of the perversion by perverse imaginative processes—this latter, indeed, occurring very readily in masturbators. But masturbation to excess is far more likely to induce general neurasthenia than to give rise to sexual perversions. When I speak of excessive masturbation, however, it must be admitted that the term is a relative one. What is harmful excess in one person is not necessarily excess in another. This is true of children as well as of adults. I have seen children who, owing to premature awakening of the sexual life, have begun to masturbate at a very early age, without any serious effect upon health. Having seen such children again in adult life, after the lapse of more than fifteen years, I consider that I have had opportunities for forming a sound judgment upon this point. We have to take into account the fact that when a youthful masturbator subsequently exhibits nervous manifestations, these often result from the anxiety he has experienced on being informed of the serious consequences of masturbation. Not masturbation itself, but fear of the effects of the practice, is here responsible for the resulting injury to health. Experience teaches that a certain sort of popular literature has an especially unfavourable influence in this respect. Moreover, in many cases, self-reproach on moral grounds, it may be in childhood, but more often later in life, must in such persons be regarded as the cause of the appearance of nervous and mental symptoms. The dread of having committed a deadly sin, or an extremely immoral act, explains a part of the results which are commonly referred directly to masturbation. The dangers of masturbation must not be underestimated, but exaggeration must equally be avoided. I do not believe that in children masturbation is, generally speaking, more dangerous than it is in adults; but I consider that masturbation resulting from a spontaneous impulse is less harmful, than when artificial bodily and mental stimuli are freely employed. And though the dangers are slightest when masturbation is not continued for a long period, still, in this connexion, a period of a few years cannot be regarded as so very long; at any rate, practical experience shows us that we must avoid over-estimating the importance of masturbation even if continued for several years.

A particular description must now be given of masturbation as practised in boys before the formation of semen has begun—that is, before the fourteenth or fifteenth year of life. Fere[89] regards orgasm without ejaculation as very dangerous, and compares its effects with the phenomena of fatigue. The nervous discharge occurring in the orgasm may certainly explain the depressed state of many masturbators, also their tired appearance, dilated pupils, and languid movements. We note also mental disturbances as well as physical, especially diminished powers of attention and memory, and somnolence up to the point of narcolepsy. According to Fere, the physical and the mental symptoms alike can be detected by precise investigations. In children suspected of masturbation, dynamometric observations disclosed a notable diminution, to the extent even of one-half, when the children were not kept under constant observation and when other signs of masturbation existed; and in these cases experimental observation also showed a diminution of the power of attention. The test applied was to erase some particular letter of the alphabet from one page of a book. When such a test is employed, the practice of masturbation is said to have an unfavourable effect, and to cause mistakes. I do not think that these so-called precise investigations are of much value, for suggestion on the part of the experimenter, who is sometimes prejudiced, may play a great part in producing the results. Even when transient phenomena of fatigue appear, and are demonstrable by experiment, it does not follow that any permanent injury has been done, and just as little do otherwise transient manifestations of fatigue necessarily indicate anything pathological, or foreshadow the onset of any progressive morbid state.

The clinical material offered in support of the idea that masturbation is especially dangerous in children too young to have an ejaculation should, moreover, be carefully and critically examined. I myself formerly accepted the view of most authoritative writers as to the grave danger of masturbation in these circumstances. But we can no longer do this unconditionally. The gradual change in my own views arose as follows. From the commencement of my medical practice I was frequently consulted about masturbation in children. Many of these cases date from ten, fifteen, and even twenty years back. I have recently instituted inquiries as to the present condition of my former patients. In so far as information was obtainable, I have been astonished to learn how well boys, who from the age of eight, nine, or ten had masturbated for several years, had developed as youths and as full-grown men. I have had similar experiences in the case of girls. Among my patients, I have had girls who masturbated at the age of five or six years; and ten to twenty years later, when some of them have married, I have gathered information regarding their subsequent development, either from the patients themselves or from their associates. Here also it was very remarkable to learn how rarely unfavourable consequences have occurred from the practice of masturbation in early childhood, notwithstanding the dangers commonly supposed to attend thereon. Especially rare have ill consequences been in those cases in which masturbation was not pushed to the point of inducing orgasm, but in which the children have masturbated simply in order to procure agreeable local stimulation. But in some instances also, in which orgasm without ejaculation had been observed, no bad results have occurred. Such results are, however, much more likely to follow in cases in which there has been prolonged sexual excitement preparatory to the orgasm, whilst this latter has been artificially deferred as long as possible. Where this has been habitual, I have, in some of the patients, seen serious consequences, and especially neurasthenic symptoms, result from masturbation. But the persons thus affected were in many cases the subjects of such severe hereditary taint, that it was impossible to decide to what extent their troubles were due to congenital predisposition, and to what extent they were referable to masturbation or to other noxious influences. It is, moreover, probable that when the nervous system is less resistent in consequence of congenital predisposition, the bad effects of masturbation will more readily appear than in those whose inheritance is a sound one.

As a result of these experiences, I feel justified in coming to the following conclusions regarding masturbation during childhood. It has not been proved that masturbation during childhood, with or without ejaculation, is generally dangerous. The possibility of danger resulting from the practice is, however, increased by long-continued and frequently repeated masturbation; also by the artificial postponement of the voluptuous acme, and by congenital predisposition to nervous disorders. My notes of the cases which I have seen during many years of medical practice show that, even in children, masturbation does not necessarily do any harm.

CASE 15.—The girl X., four years of age, was brought to see me because it had been noticed that she frequently tried to handle her genital organs, and also that she stimulated the same organs by means of rubbing movements of the crossed thighs. Her mother had further from time to time noticed rocking movements, associated with a fixed stare, which had aroused suspicions of the occurrence of the sexual orgasm. Various methods were tried to put a stop to these practices, but without result. Hypnotic treatment was not tried, because the child was still too young and her attention wandered too much. Mechanical methods of control were also fruitless. The trouble continued for five years, during all of which time the child was under my own observation. She went to school, where she proved a diligent scholar, and was one of the most successful pupils; her physical condition was also excellent. Thenceforward, for several years, I received no precise information about the patient, although from time to time I saw some of her associates. But after about eight years, I had an opportunity of learning her later history. The child which had begun to masturbate when four years old was now a young lady of eighteen. When fourteen years old she had for some months suffered from chlorosis, but had never been troubled by any other serious illness. I could not learn with certainty whether the habit of masturbation had been discontinued; but there had been no definite evidence of the practice of masturbation, or of any other artificial sexual stimulation, after the age of nine. At the present time X. is perfectly healthy.

CASE 16.—The boy Y. was brought to me when eight years old. It had been noticed that at night, whether sleeping or waking, he very often handled his genital organs. Erection of the penis had also been observed from time to time. His mother and his governess believed that he masturbated every night. When this had been going on for several years, the patient was brought to me for suggestive treatment. Mechanical means were simultaneously employed, his hands being fastened at night in such a way that he could not bring them into contact with his genital organs. But he speedily loosed himself from his bonds. The trouble abated in severity, but continued none the less for several years. I saw the patient again when he was twenty-four years of age. No abnormality whatever could be observed. He had normal sexual potency, and was entirely free from neurasthenic symptoms.

I have hitherto, in this chapter, spoken only of the dangers of auto-erotism. It is hardly necessary to mention the fact that the nervous system of the child may be injuriously affected by other sexual acts, as, for instance, by premature sexual intercourse. The occurrence of such acts is naturally favoured by a premature awakening of the sexual life.

We have also to consider the results of passionate love in children, apart from actual sexual intercourse. In children with congenital neuropathic predisposition, these results may be serious; and, as Bell points out, symptoms of severe nervous shock may ensue, more especially owing to separation from the beloved object, or in consequence of rejected affection. The same writer even records several attempted suicides consequent upon the death of the loved one; two of these occurred in boys of eight and nine years of age respectively; two occurred in girls, aged nine and eleven years. Eulenburg,[90] who has made a special study of suicide and attempted suicide during school-life, in his enumeration of the causes of such acts, mentions several that are germane to our subject. Among these are the following: becoming acquainted with the existence of a liaison on the part of the loved one with another; unfortunate love; love for a married woman; neglect of school work owing to a love-affair and consequent fear of expulsion; and, finally, love-anxiety. It must, however, be freely admitted that Eulenburg's cases relate to schoolboys who were fairly old. Thus, one of these cases was that of a Catholic boy in one of the higher forms, who had formed a liaison with a girl of sixteen in a neighbouring girls' school, and whose Director had intervened, very judiciously, as it appears, on learning of the affair. The other cases in which Eulenburg mentions the age of those concerned were also those of boys no longer very young; in some of these, double murder or double suicide resulted. In the other comprehensive works on suicide, and even in those dealing especially with suicide in children, I have been able to find comparatively little material bearing on this particular question. Brierre de Boismont,[91] indeed, tells us that children occasionally commit suicide on account of jealousy; here, however, he does not refer to sexual jealousy, but to jealousy of a more general character aroused by preference shown to another child. Although such serious consequences occur chiefly or exclusively in children who cannot be regarded as perfectly normal, it is nevertheless possible for erotic influences to act as the final determinant. But such serious results are certainly comparatively rare.

Just as in former times masturbation was believed to be the cause of all kinds of illness, so to-day, according to Freud[92] and his followers, the general sexual experiences of children are responsible for various subsequent illnesses. Four neuroses (neurasthenia, anxiety-neurosis, hysteria, and compulsion-neuroses) are referred by Freud to all sorts of disturbances of the sexual life, past or present. Hysteria and compulsion-neuroses are regarded as a reaction to the sexual experiences of childhood; neurasthenia and anxiety-neurosis are referred to later sexual experiences. Freud originally assumed that during the childhood of hysterical patients sexual seduction by adults or by older children played the chief part; but at a later date he has advocated the view that the imaginative activities of the days of puberty, which intervene between the sexual experiences of childhood and the appearance of the hysterical symptoms, are responsible for the occurrence of the latter. Quite recently, Abraham[93] has insisted that a sexual experience may be of some importance in relation even to the onset of dementia praecox. But I do not consider that Freud's assumption is justified, nor do I think that he adequately excludes the effects of hetero-and auto-suggestion. It is out of the question that in every case of the above-mentioned neuroses, sexual experiences should be the cause; and it is equally erroneous to suppose that every sexual experience in childhood has the effects which he assumes. It is true that Freud and his followers report cases which they regard as proving their thesis. But I am by no means satisfied with these clinical histories. They rather produce the impression that much in the alleged histories has been introduced by the suggestive questioning of the examiner, or that sufficient care has not been taken to guard against illusions of memory. The impression produced in my mind is that the theory of Freud and his followers suffices to account for the clinical histories, not that the clinical histories suffice to prove the truth of the theory. Freud endeavours to establish his theory by the aid of psycho-analysis. But this involves so many arbitrary interpretations, that it is impossible to speak of proof in any strict sense of the term. Dreams are interpreted symbolically at will, and other definite objects are arbitrarily assumed to be symbolic representatives of the genital organs. I detect the principal source of fallacy in this arbitrary interpretation of alleged symbols.

However this may be, there is no justification for the assumption that hysteria or other neuroses are always, or even in the great majority of instances, to be regarded as dependent upon masturbatory or other sexual acts during childhood. We must on no account forget that an illness often has a dozen causes or more; and although one or another of these may have had a preponderating influence in the causation, we have no right arbitrarily to select one of them as the efficient cause. I do not deny that occasionally the sexual life during childhood plays a part in inducing a subsequent neurosis; but this applies only to a comparatively small proportion of cases, and we must guard against exaggeration in the matter.

This is all I have to say concerning the relationships of the sexual life of the child to the occurrence of nervous diseases. The sexual life has, of course, important bearings on health in other ways. The venereal diseases, in most cases, result from sexual intercourse; and it will readily be understood that since early sexual intercourse is rendered more likely by a premature awakening of the sexual life, an increased danger of venereal infection will thus arise. Although infection in children occurs comparatively seldom in consequence of spontaneously practised sexual intercourse, and more frequently as the result of the mishandling of children by perverted or criminal adults, still cases are from time to time observed in which infection with venereal disease arises in children from spontaneously sought sexual intercourse. In Jullien's work[94] we find a striking chapter on gonorrhoea in children, illustrated with appropriate cases. He writes. "In other cases, little boys, sexually premature, make early attempts at sexual intercourse. In Paris we see hardly grown youths appearing at the specialist's clinic, quite proud that they need to be treated for gonorrhoea. The very fact that they present themselves so coolly at the places for the special treatment of venereal diseases, suffices to show that they fully understand the cause of their illness." In Jullien's opinion, venereal disease is especially serious in children, because many of them conceal their condition as long as possible in the hope of avoiding punishment. Barthelemy reported a case in which the parents came to consult him because the boy was passing water every few minutes, and because at school he was repeatedly asking to leave the room in order to go to the urinal. Examination showed that he was suffering from cystitis, and that this was a sequel of gonorrhoea. As regards children of the other sex, I have myself seen cases of gonorrhoea in which sexually immature girls have been infected in sexual intercourse of which they themselves had been the instigators. In most cases, infection in children results from intercourse with grown persons, but it sometimes happens that children infect one another. Little need be said here about the dangers of gonorrhoeal infection. Although in children the course of the disease exhibits many peculiarities, the general results are much the same as in adults, viz., pain, orchitis and epididymitis with atrophy, cystitis, &c.; and in girls, more especially peritonitis. Other venereal infections may of course also occur in children, such as soft chancre and syphilis. No detailed account will be given of these diseases. Although we need further information as to the results of venereal infection in children, in well-informed medical circles the numerous and severe ill consequences of such infections are well understood.

I have in this chapter spoken more especially of the dangers threatening the child's health from the side of its sexual life. These are, of course, not the only dangers; the moral and social dangers are even greater. First of all, in this connexion, we have to consider the practice of masturbation; but in our estimate of its effect upon morals, we must be careful to avoid sanctimoniousness. The question why masturbation is regarded as immoral has never yet been answered, declamation being here commonly mistaken for argument. And yet reasons may be found for the belief that masturbation may sometimes be a positively moral act; as, for instance, when one who is dominated by a very powerful sexual impulse, avoids injury to another by means of masturbation. Consider a case, for example, in which one who masturbates would otherwise transmit venereal infection to another, or would injure another by illegitimate sexual intercourse. In cases of perverse sexual practices in which the offender's liability to punishment was under discussion in the law court, I have more than once called attention to this point. Take the case of a man whose sexual impulse is directed towards children, and who finds great difficulty in restraining himself from sexual malpractices against children. His action is assuredly a far more moral one if he satisfies his impulse by the practice of masturbation, rather than by a sexual assault upon a child! If, notwithstanding these considerations, masturbation is generally regarded as an immoral act, the reason for this opinion must obviously be sought in deeper and more general grounds. In the first place, we have to take into account the fact that according to the moral code of many persons, and certainly according to the official theological code, the only kind of sexual intercourse that is morally permissible is that which is known as "legitimate," i.e. connubial intercourse; extra-connubial intercourse is stigmatised as immoral. Masturbation, like extra-connubial sexual intercourse, is sexual indulgence outside the limits of that which is alone permissible by the canons of theological morality. Owing to the definite teaching of the Church in this matter, the views of the common people are inevitably influenced thereby, although the practical relationships of life are thus completely ignored; above all, the fact is ignored that marriage does not as a rule become possible until long after the awakening of the sexual impulse. The purpose of the proscription by theological morality of illegitimate intercourse and of masturbation is to effect the prevention of all varieties of sexual indulgence except under the form of marriage, and, if possible, under the form of marriage blessed by the Church. The importance attributed to receiving the approval of theological morality is seen from the fact that in all strata of the population, however much alike in private conversation and in political assemblies they may protest against the dominion of the Church, nevertheless almost invariably the ecclesiastical ceremony is superadded to the civil marriage. In our moral estimate of masturbation, we have to take another point into consideration. We have seen that long-continued and excessive masturbation is dangerous to health; now every voluntary action, and every action that is commonly believed to be voluntary, the effects of which are injurious to body or to mind, is considered to be immoral, unless it is performed in pursuit of some lofty aim—as, for instance, in the case of the doctor who exposes himself to some deadly infection for the sake of his patient's welfare. But these reasons do not suffice to account for the fact that masturbation is commonly regarded as a more immoral act than illegitimate sexual intercourse. Here, however, as so often happens, the popular instinct contains a kernel of truth, which in this case relates not so much to the individual ethical judgment as to the general interest. The popular instinct, or we may rather say the soul of the people, commonly regards that as immoral which, if approved, would entail serious general consequences. In this ethical judgment we have, as it were, the manifestation of an instinct of self-preservation on the part of the soul of the people. We must not forget that the practice of masturbation is extraordinarily easy, and that if it were recognised as a morally permissible act, its frequency would be notably increased. The reason last given, namely, the injury to health that may result from masturbation, explains one way in which the practice is opposed to the general interest. But another reason is still more important. The practice of masturbation naturally limits the frequency of sexual intercourse, not only in its illegitimate, but also in its legitimate form. The easier an act is, the more readily, if it is deleterious, will popular sentiment build a protective wall around it. In individual instances, such popular valuations are devoid of logical foundation, and for this very reason it is often impossible to reject them on logical grounds. But they are largely based upon considerations of the general interest, and for this reason it is often just as well that they are impervious to logic. Hence, although in concrete cases of masturbation physicians and schoolmasters will not always take a severe view, and, in certain instances, as explained above, it may even be considered that masturbation is a morally permissible act, this will not affect the general disapproval, in consequence of which a very large number of persons refrain from masturbation. Moreover, the absence of such disapproval would lead to extremely serious consequences. Merely in order to prevent interference with normal sexual intercourse between man and woman, it is necessary that in the popular judgment masturbation, as the greatest enemy of sexual intercourse, should be condemned. In addition to these motives, there are others closely connected with them, which in some cases operate unconsciously. Since masturbation is practised in solitude, if masturbation were regarded as morally permissible to men, the value of woman would diminish, since her wooing and winning would be no longer necessary to man, Analogous considerations naturally apply to masturbation in women. The need that each sex should regard the other as indispensable is a powerful motive in bringing about the popular condemnation of masturbation; and it must further be remembered that the amatory life, and more especially its psychical accompaniments, in truth only attain their fullest development through the mutual intercourse of the sexes.

The general condemnation of masturbation is, in my view, most readily explained on the considerations just outlined. However this may be, we have certainly to reckon with the fact that masturbation is regarded as an immoral act. But inasmuch as the early awakening of the sexual life, or at least the early appearance of the phenomena of detumescence, leads almost inevitably to the practice of masturbation, it will readily be understood that the child is apt to be forced into a line of conduct which conflicts with the generally accepted ethical code.

The social dangers of masturbation are very closely connected with the ethical dangers, and we frequently find them appearing concurrently. In isolated instances, as Lombroso and Ferrero have shown,[95] premature awakening of sexuality may lead to prostitution. In the chapter on Biology and Psychology, a special section is devoted to sexual prematurity, and the authors contend that in Italy this factor plays a greater part than it does elsewhere. It is further characteristic that in erotic literature women who are famous or notorious for their love-adventures are commonly described as having been the subjects of premature sexual development. From the beautiful Helen, who at the age of seven, according to one story, and at the age of twelve, according to another, was deflowered by Theseus, down to modern times, we find that premature sexual development is frequently adduced as a characteristic of such women. Although it is true that in many cases of the seduction of children there is no question of sexual prematurity, still, for a part of the cases, premature sexual development is responsible. For it can hardly be disputed that the crime of the child-seducer is greatly facilitated, if the child meets the seducer halfway. In cases in which sexual offences were committed on little girls, Tardieu[96] made a special class of those in which the offence was frequently repeated upon the same individual. Of the 60 cases of this kind, 29 were in little girls under eleven years of age, and 26 were in girls from eleven to fifteen years. He states that in these chronic victims, he was first of all struck by the premature development of the genital organs and the remarkable prematurity of general sexual development, both of these conflicting with the age and the development of the girls in other respects, Tardieu certainly paid especial attention to the physical peculiarities of the genital organs, and he was inclined to refer the premature development to the early experience of sexual intercourse. But it is possible that the real connexion was the reverse of this—and, indeed, many other observations support such a view—in that owing to their sexual prematurity the children experienced a powerful sexual impulse at an unusually early age, and that for this reason they became the victims of sexual attempts much earlier than others. Kisch[97] also believes that in many cases of premature puberty, premature sexual intercourse is observed, and parturition may even occur at a very early age. He writes: "A girl in whom menstruation began at the age of one year, gave birth to a child when she was ten years old (Montgomery). A girl who began to menstruate when at the age of nine years, became pregnant very shortly afterwards (d'Outreport). The well-known case recorded by Haller, in which at birth the pubic hair was already grown, and in which menstruation began at the age of two years, was also one of very early pregnancy, the girl giving birth to a child when nine years old. Another girl in whom at birth the pubes were already covered with hair began to menstruate when four years old, copulated regularly from the age of eight, and at nine years became pregnant, and was delivered of a vesicular mole with an embryo (Molitor). A girl began to menstruate at the age of two, had a growth of hair on the pubes and developed mammae at the age of three, and became pregnant at the age of eight (Carus). With these cases must be classed that observed by Martin in America of a woman who was a grandmother at the age of twenty-six. Lantier, in his travels in Greece, speaks of a mother of twenty-five with a daughter of thirteen."

Whatever the real sequence of events—whether in a little girl the occurrence of sexual intercourse is favoured by the spontaneous premature awakening of the sexual impulse, or, conversely, it is the premature intercourse which awakens the impulse and keeps it active thereafter—the consequences of premature awakening of the sexual impulse are always extremely serious, and often result in the permanent social extinction of the girl concerned. Although in many cases she may be fortunate enough to escape the fate of the prostitute, none the less in modern civilised countries the loss of virginity is a serious disgrace, by which her future will be affected altogether apart from the moral shocks resulting from sexual intercourse in early childhood, and from the possibility of impregnation. The case is much the same as regards children of the male sex. The fact that a boy is sexually precocious, will greatly facilitate his being led astray by grown females to whom his extreme youth acts as a stimulus. Moreover, his sexual precocity may deliver the boy to the embraces of homosexual men, an outcome which is rendered the more likely by the commonly undifferentiated character of the childish sexual impulse. There are certain homosexual adult males whose impulse is especially directed towards boys still possessing the milk-white face of the child, and his encounter with such a pervert may make all the difference to a sexually premature boy. Although I have been engaged for years in the collection of facts bearing on this question of homosexuality, I have recently been astonished to learn, in an ever-increasing number of cases, how adult homosexuals, men of thirty years and upwards, form homosexual relationships with schoolboys, and regard their right to do this as practically self-evident. It is obvious that this is likely to do grave moral injury to the boy—altogether apart from the fact that the production of homosexuality is thereby greatly facilitated, however much interested homosexuals may contest this assertion. It is clear, too, that boys upon whom such relationships are imposed will sometimes tend to grow up as male prostitutes, just in the same way as little girls prematurely seduced in consequence of an early awakening of sexuality often adopt a life of prostitution.

Children in whom sexuality has awakened are especially dangerous to their associates, since they readily seduce others to sexual malpractices. Thus, it sometimes happens, though happily not often, that children attempt sexual intercourse with one another. A question in forensic medicine formerly much discussed, is the age at which children are first able to effect sexual intercourse. I have no doubt whatever that by the end of the second period of childhood, in a comparatively large number of boys, spontaneous erections occur adequate to allow the introduction of the penis into the vagina to be effected; but no doubt it might be difficult for such a boy to effect complete penetration into the vagina of a girl in whom the hymen was still intact. Pouillet[98] even asserts that all boys have the faculty of erection in quite early childhood; and he places on record the following experiment, whose repetition had better be avoided. If in an infant lying in its cradle the edge of the foreskin be tickled with a feather, we shall at once see the penis swell up and become erect, and the infant will grasp at it with the hand. There is no doubt that boys in whom the sexual impulse is prematurely awakened may be a danger to little girls through attempting intercourse with them. More frequently, however, the danger lies, not in attempts at coitus, but in other improper manipulations and contacts, which may take almost every conceivable form. Mutual masturbation is fairly common among children, or one child may manipulate the genitals of another; such practices occur more often between two boys than between two girls or between boy and girl. But experience shows that other and more advanced sexual acts may occur, though fortunately less often; for instance, paederastic acts between boys, introduction of the penis of one individual into the mouth of another, &c. Ferriani[99] has collected a number of cases of this kind, occurring in youthful criminals. In boys he distinguishes two groups, those from the tenth to the fourteenth, and those from the fourteenth to the eighteenth year of life. He made inquiries regarding the sexual life in 69 boys belonging to the former group, and in 48 belonging to the latter. Of the 69 belonging to the former group, 48 were found to masturbate, in 25 improper sexual acts with the mouth were admitted, in 12 active paederasty, and in 17 passive paederasty. It is evident that these data must not be generalised, for Ferriani's studies related to boys who had been morally neglected from the earliest days of childhood, and who had been sent to prison as thieves, beggars, and vagabonds. A great danger attendant on sexual acts in which one child is led astray by another is, of course, the moral harm which threatens the other associates of such children. Girls and boys are equally exposed to such seduction, and the seducer also may be of either sex. In cases of an altogether exceptional character, danger threatens in this respect from a child's own brothers or sisters. I alluded to this matter in an earlier chapter, on page 71. Among cases which have come under my notice, I may mention one in which a boy began to carry out all kinds of perverse sexual acts with his sister, who was about eight years younger than himself, and continued to do this when he had attained the age of twenty-nine years. Forel[100] sees, rightly, as I believe, especial danger in the leading of others astray by young homosexuals, alike in boys' and in girls' boarding-schools. In some of these cases the seducer's act is merely a manifestation of the early undifferentiated state of the sexual impulse, but in others it is an early sign of a real homosexual development.

I append here certain cases from the literature of the subject showing the great dangers that proceed from such premature sexual development. One case reported by Forel[101] was that of a girl nine years of age. "This girl would stimulate sexually all boys of her own age or somewhat younger whom she could induce to allow her to do so. She did this so secretly, that by mishandling the genital organs of her two little brothers, both younger than herself, she slowly brought one to his death, and in the other caused serious injury to the bladder and urethra. With an older boy, she was accustomed to have actual sexual intercourse in the woods. I could not, in this case, gain any definite information regarding hereditary taint. Such persons commonly become criminals in later life, or at least indulge in the most shameless masturbation or give themselves up to prostitution."

A case which at one time attracted great attention in France may here be given in the actual words of the report. "Leo, thirteen years old, demanded the favours of eleven little girls, offering in return, as the girls confessed, a small reward—a penny or a sweet. Many others must have been compelled by their parents to make no complaint, in order to avoid a mortifying publicity. Leo is the son of a good fellow, a shoemaker by trade, and also a lamplighter. The mother having run away, and the father being often out at work, the boy was left much alone. He would then entice into the house little girls of the neighbourhood, one after another, in order to commit immoral acts with them. One day he invited in a little girl of five. The girl's brother peeped through the window, and saw Leo standing naked in front of Mary, as if he posait pour le torse. Ultimately the matter was reported to the police superintendent of the district, and it transpired that not less than ten or eleven little girls of the quarter had been thus led astray. From time to time he invited into the house a number of good-for-nothings of the same stamp as himself, and here this youthful Casanova organised pleasure-parties of a kind usually unknown to those of his age. The lad was bound over to come up for trial if called upon. Such cases as this are commoner than is generally believed; and perhaps commoner in the country than in the town."

The way in which such practices spread by moral contagion is shown by a report of Ferriani,[102] who made inquiries of nine boys, at ages varying between eight and twelve years, how they had learned to masturbate. I. had been taught by a certain K., II. by I., III. by IV., IV. by I., V. by II., VI. by III., VII. by IV., VIII. by VI., IX. by II. Not long ago, I myself came across such an epidemic, in which there occurred, not only masturbation, but, in addition, all sorts of mutual sexual contacts between boys and girls; a boy of five was the primary seducer, having undertaken the sexual enlightenment of a girl of seven, and beginning this process with the remark that she need no longer believe that babies were brought by a stork. These two went on to improper contact, and subsequently quite a number of children were gradually corrupted by the two.

To the jurist, also, the question of the sexual life of the child is one of great importance. I do not myself share the view of Ferriani and others, that the sexual life of the child, when it awakes prematurely, is a common cause of crime—although this may be true of certain special cases, presently to be described. But the sexual life of the child is of importance from another point of view. In cases in which children are the objects of sexual offences, such as have recently so often come before the courts, the question of the capacity of the children to give evidence frequently plays a great part. The lawyer, who is often ignorant of the extent to which sexual imaginations and sexual acts may prevail among children, is apt to assume that the child is of necessity sexually inexperienced, and for this reason to put a trust in childish evidence which is in many instances not justified by the facts of the case, because the supposed inexperience may not really exist. If judges and magistrates knew how much and how often children's brains are occupied with sexual imaginations, without speaking of the sexual acts which many children have engaged in while still quite young, they would be more guarded than they are at present in their acceptance of children's evidence in sexual matters. Not infrequently, when such a child describes the sexual offence which is supposed to have been committed, it is assumed without further inquiry that the child's account must be accurate, the grounds for this assumption being stated as follows: "How could such an accusation be invented? The poor child has had no previous experience of such matters; what is now described must have actually happened, for it is impossible that an inexperienced child could construct it all out of its own imagination." But to anyone who has seriously studied the sexual life of the child, this logic is utterly fallacious. Still, the argument is none the less a very dangerous one; and as an expert witness I have assisted at several trials as to which I remain convinced to this day that the judge has assumed the offender to be guilty simply because he (the judge) was ignorant of the nature of the sexual life of the child, above all as regards psychosexual imaginations. Some years ago there was tried in Berlin a case in which a wealthy banker was accused of misconduct with a little girl. In the end the accused received a severe sentence. In that trial I was called as an expert witness, and I believe that as regards the principal charge the banker was wrongfully condemned. The principal witness was a girl twelve years of age, and it was her accusation which formed the main ground of the conviction, and this notwithstanding the fact that the child had subsequently withdrawn her charges. In common with other expert witnesses, I pointed out, in rebuttal of the girl's evidence, that the person on whom the alleged offence had been committed was not, as the police magistrate and the judge had both assumed, an inexperienced child, but one in whom sexuality had prematurely awakened, and in whom strongly sensual tendencies were manifest; we showed that in her imaginative activities the sexual life played a leading part, and that the child herself had at an earlier date performed some of the actions with which she charged the accused. But the child had made so favourable an impression on the police magistrate and the judge that they firmly believed her first statement, and held that her subsequent withdrawal of her accusation was due to outside influence. It would be well, in some cases of the kind, to insist upon a complete examination of the girl who makes the accusation, this examination to include her bodily state, to ascertain if there are indications of a prematurely awakened sexual life—for example, any irritation of the genital organs by masturbation. We shall also do well, in such cases, to endeavour to ascertain whether the child is already fully informed concerning the nature of sex. We must always bear in mind that things which may give an indication regarding this are usually kept very secret, and that none of the child's associates may be able to give us any information. Even though among the witnesses we have parents, masters, or governesses all uniting to assure us that the child's mind is still perfectly innocent, and that not a suspicion regarding matters of sex has yet been aroused, the judge should not allow himself to be deceived. Sexual imaginations often dominate the consciousness of the child, at the very time when a display of shamefacedness in relation to such things deceives the onlookers. In such trials, it is sometimes put forward as a defence, that some third person, some police official, the examining judge, or even an enemy of the accused, has reiterated the false accusation to the child, and has, as it were, suggested it. Such an assumption is, for many cases, altogether superfluous, even if we do not believe a word of the child's accusation, for it completely underestimates the power of the childish imagination. The French physician, Bourdin,[103] in his work on Lying Children, gives the case of a little girl who by her good behaviour and affectionate disposition had won the love of her foster-parents. One day they were reading aloud the report of a scandalous trial, while the child was in the room playing with her dolls, and to all appearance paying no attention to the reading. A few days later the foster-parents saw the little girl putting her dolls together in an indecent posture. In answer to earnest inquiries, the child said she was only doing what someone had once done to her; she then went on to make detailed and serious accusations against certain other persons. A clever and experienced physician was asked to investigate the matter before any application was made to the law courts. As a result of a physical examination of the girl, he declared that what she described could not possibly have taken place; and ultimately she admitted that the whole accusation was false. As a reason for her lies, she said, "qu'elle avait voulu faire comme les dames que l'on avait mises dans le journal." Such imaginative activity may occur in healthy children, but it is in the case of those with a morbid inheritance that we have especially to reckon with these possibilities. As with the grown woman, so with the child, the degenerative form of hysteria makes those subject to it untrustworthy witnesses. This applies above all to accusations of sexual offences. Feeble-mindedness is also dangerous in this connexion, for its existence is apt to be overlooked by the judge, although an expert examination of the witness—who, in most of these cases, is of the female sex—would facilitate the diagnosis. Among the feeble-minded, we find, not only sexually premature individuals, but also persons with a tendency to pathological deceit, this latter sometimes manifesting itself in childhood, and of course lessening or completely abolishing the subject's credibility as a witness to the occurrence of alleged sexual offences.

These considerations must not lead us to the opposite extreme, of altogether discrediting the assertions of child-witnesses; but they should convince us of the need for the recognition of a source of fallacy often completely overlooked by parents, namely, the indulgence by children in sexual imaginative activity, and the frequent existence of unsuspected sexual enlightenment. To this extent only do such questions form part of my subject. Following Hans Gross, I have on page 41 already drawn attention to the fact that girls of a certain age are untrustworthy witnesses regarding their own experiences. But to guard against too comprehensive a generalisation in this respect, I must point out that during the second period of childhood a girl may be a highly competent observer, and this precisely for matters in which her interest has been aroused by the development of her sexual life. I may quote from Hans Gross certain remarks bearing on this.[104] "We have to recognise that in the observation and understanding of certain matters, there is no one cleverer than a growing girl. Her school-life, and her personal experiences and occupations, do not adequately occupy her energies. Sexual influences are beginning to become active, and half-unconsciously the girl studies her environment in search of experiences bearing, however remotely, on this sphere. The little interests and amours of the nearer and further environment will be by no one discovered so speedily as by a bright and lively half-grown girl. Every variation in the mutual interest of the pair she has under observation will be noted by such a girl with the keenest sympathy. Long before the two have come to an understanding, she will be aware of their sentiments for one another. She notes when they are drawing nearer together, and she knows at once when they have given open expression to their love. Whether they become engaged or whether they draw apart from one another, the little one knows all about it before any of their intimates. Moreover, such a girl will take note of all the doings of certain of her acquaintances. An interesting beauty, or a young man living near at hand, will have no more watchful observer of all their doings than a young girl of twelve years. She, too, will take note more accurately than anyone else of all the changes of mood of those who are under her observation."

But the sexual life of children is of importance, not only in relation to the question of their credibility as witnesses, but also in respect of our decision as to matters of fact. Sexual attempts on children under fourteen years of age are legally punishable offences, and it is a matter of indifference whether the offender or the child was the instigator. In determining the degree of culpability it is, however, of important whether the child against whom the offence has been committed was innocent and uncorrupted, or was one with previous sexual experiences. In addition to this, we have also to take into account the question whether the child incited to the offence, under the influence of the spontaneous activity of its own sexual impulse. All these considerations will make it clear that from many points of view the sexual life of the child is a matter of forensic importance.

We must not forget that the child itself may be threatened with legal dangers as a result of the activity of its own sexual impulse. The German legal code decrees different degrees of penal responsibility at different ages. Children not yet twelve years of age are not liable to criminal prosecution. A child over twelve, but under eighteen years of age, must be exonerated if when the offence was committed the child did not possess the knowledge enabling him or her to understand its culpability. By the third paragraph of section 176 of the German criminal code, any one who has improper sexual relations with a person under fourteen years of age, or who induces such a person to practise or suffer such relations, is liable to severe punishment.

If, therefore, two children of eleven engage in mutual misconduct, they incur no liability to legal punishment. But two boys of thirteen are liable to prosecution for the practice of mutual masturbation. Each of them has performed an improper act with a child under fourteen years of age, and the liability to punishment in each case depends upon the answer to the question whether the offender possessed sufficient knowledge to enable him to understand his culpability. This knowledge is not identical with the knowledge that the offence was legally punishable; that is to say, either boy would be liable to punishment, even though he had no idea whatever that improper sexual relations with children under fourteen constituted an offence against the law. All that is necessary is that he should possess a sufficient degree of intelligence to understand his culpability, which is quite another thing from his possessing knowledge of his legal liability to punishment. Generally speaking, however, the public prosecutor is disinclined to initiate proceedings in such cases, for the most part because it is held that the necessary understanding of culpability is commonly lacking. But such prosecutions have more than once occurred. In the year 1899, in a little town in the Mark of Brandenburg, proceedings were taken against eighteen school-children, boys and girls, and five pupil-teachers. These twenty-three persons, who appeared in the dock, had all reached an age at which they became liable to criminal prosecution; in the case of a number of other boys and girls who were concerned in the affair, no prosecution could take place. Ultimately, all the accused were discharged, as it was held that when the offence was committed they did not possess the requisite understanding of its culpable character. But by order of the court several of the accused were transferred to a reformatory. Since a prosecution may take place in such cases, a conviction is also possible. It is evident that as soon as a child is twelve years old, it may incur legal liabilities in consequence of the activity of the sexual impulse.

We must not overlook the fact that the intellectual side of development may be influenced by an early awakening of the sexual life, the child inclining, in this case, to occupy its mind with sexual thoughts, to the neglect of educational opportunities. I have seen cases which were regarded as instances of aprosexia,[105] the lack of the power of concentration being attributed to adenoid vegetations, but in which the defect might, with at least as much reason, have been referred to the play of sexual ideas. To the teacher, his pupil's inattentiveness is often an insoluble riddle, merely because he ignores in the child the play of erotic imagination, and, in fact, ignores the child's inner life in general. And yet, in such cases, the child's failure to attend to the work of the class sometimes depends upon nothing more than occupation with thoughts about a beloved person. In other instances, the inattention is due, not to sexual ideas, but to sexual acts. As a patient of my own put the matter: in boyhood, while in the Latin class he was supposed to be learning his amo, amas, amat, he and his school-fellows were studying the subject practically beneath the table. Naturally, the stronger the child's sexual impulse, the more will the attention wander; and although in most cases, in children, the impulse is comparatively weak, in isolated instances it may from the first be abnormally powerful, entailing dangers to the intellectual development as serious as those other dangers previously enumerated. According to Sanford Bell, unfavourable consequences to intellectual development cannot, as a general rule, be attributed to the early amatory inclinations of childhood. All that is likely to be noticed is that on days when the child loved by another is away from school, the latter child will be less attentive than usual. But the circumstances are somewhat different when the object of affection is not a school-fellow. Bell speaks only of cases in which the child-lovers are members of the same class, and he refers to heterosexual inclinations only. In such cases, the results of early amatory inclinations may even be good. Hebbel relates of himself, how zealously as a little boy he attended school, simply in order to meet in the class the girl he loved. The presence of the loved one may, in fact, powerfully stimulate ambition and the desire to work. A little girl who has fallen in love with her schoolmistress or governess, will strive to please the latter by hard work and attention; and, similarly, a boy who loves a boy or a girl classmate, very often attempts to make an impression on the feelings of the loved one by his performances at school. Whilst we recognise the dangers attendant on the development of sexuality in the child, we must not overlook the fact that this development may have its good side.