chapter I

have attempted to distinguish individual influences from general influences, to distinguish congenital influences affecting the germinal rudiments from environmental influences acting after birth, and to distinguish psychical stimuli from physical stimuli. But it is obvious that the maintenance of a sharp distinction in these respects is very difficult, and indeed often quite impossible. A few additional considerations will elucidate this statement. Let us consider, for instance, seduction: here the separation of the psychical from the physical element cannot possibly be effected, because, as a rule, in these cases the two elements co-operate simultaneously. Let us consider the cases in which, owing to a congenital racial peculiarity, the sexual life awakens earlier than is usual among ourselves. In such cases, the manners and customs of the race in which this early development of sexuality is usual will be found to be especially adapted to attract the child's attention to sexual matters earlier than is here customary. It suffices to remind the reader of the celebrations of puberty and of the early marriages common among such races. Here it is hardly possible to separate the congenital characters from the effects of environment. But although, for the reasons given, the discrimination between the individual factors may be exceedingly difficult, still an attempt at discrimination must be made, more especially in view of the fact that a purposive sexual education can be attempted only when due consideration has been paid to the various etiological factors.

It would naturally be of the utmost importance to be able to foresee the cases in which it is likely that the sexual processes of childhood would undergo an exceptionally early development. But as a rule we are unable to do this; and we must therefore be satisfied with the attempt to determine in individual cases whether manifestations of the sexual life occur during childhood, and if so, which manifestations. But even here we encounter difficulties, which in many instances are insuperable, but in others arise from the incompetence of adults. This is all the more deplorable because the effectiveness of sexual education is minimised through the lack of insight. Just as in the practice of medicine an accurate diagnosis is an indispensable prerequisite to correct therapeutics, so also here. Since in the earliest years the child has no conscious understanding of sexual processes, whilst children in whom a sexual consciousness has begun to dawn conceal most carefully from their elders all manifestations of their sexual life, diagnosis is possible only through knowledge of mankind in conjunction with tact.

Let us first consider the phenomena of contrectation. We shall notice sometimes that a little boy, perhaps seven years of age or even younger, will withdraw from the society of other boys, and will seek the company of some particular individual, for example that of a girl friend of his sister, of about his own age. Similar phenomena occur in girls. A little girl in her tenth year will frequently be noticed to find something to speak to her mother about whenever a particular male friend of the family visits the house. Even a shrewd and observant mother will often fail to take note of the reason why on these occasions her little daughter invariably comes into the room. The child will have every possible kind of excuse ready to enable her to seek the company of this

## particular person. At times this goes further. We then notice that the

child endeavours to come into physical contact with the object of affection, showing him great tenderness, and showering on him caresses.

Such a desire for intimate physical caresses must always arouse the suspicion that sexual feelings have now been awakened. We must not, of course, assume that every childish caress is sexually determined; but we should always bear in mind this possibility in cases in which the child's desire to caress someone is well marked. If such feelings manifest themselves towards the end of the first period of childhood or at the beginning of the second, observation will be comparatively easy, for the younger the child is the less competent is it to conceal its feelings. The consciousness that there is anything wrong in the gratification of such sentiments awakens as a rule very gradually indeed.

Similarly, it will be far easier in the case of children to observe peripheral processes in the genital organs than it is to make such observations in adults. Thus, even in the case of infants in arms, but more often in the case of boys who are somewhat older, the mother or the nurse may be surprised to observe erections when the boy is undressed for his bath or some other reason, or when he has kicked off the bedclothes at night. In other cases the child may be seen handling his genital organs, either openly or beneath his clothing. Often, in the absence of manual stimulation, the child adopts some other means of stimulating his genital organs. Thus, in girls the legs will be crossed, and the thighs rubbed lightly each against the other. In other cases, both in boys and in girls, the child will lean against a piece of furniture in what appears to be a perfectly innocent manner; but in reality pressure is being exercised on the genital organs, it may be by the corner of a table, it may be by the back of a chair; and then the stimulus is strengthened by various movements. In some such way children will effect masturbatory stimulation and obtain sexual gratification, in the presence, not only of their mother, but in that of quite a number of other persons. Guttceit[78] reports the case of a woman who squatted down so that her bare heel came into contact with the genitals, and she then masturbated by rubbing the two parts together. I myself have known the case of a young girl who sat with her legs beneath her, and masturbated with the boot she was wearing. In many instances we are enabled, by watching the child's movements, to ascertain with such certainty what it is doing, that no confirmatory evidence is needed. We notice, especially, that when the orgasm is approaching, the movements change in character and rhythm. The eyes become bright, and the face assumes an excited and voluptuous expression. This may be observed even in infants in arms. Townsend[79] reports the case of an infant, eight months old, "who would cross her right thigh over the left, close her eyes and clench her fists; after a minute or two there would be complete relaxation, with sweating and redness of face; this would occur about once a week or oftener; the child was quite healthy, with no abnormal condition of the genital organs."

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 Näcke 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.

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