Chapter VI

ETIOLOGY AND DIAGNOSIS

The last chapter dealt with pathological phenomena in the sexual life of the child. From the considerations urged in this and in earlier chapters, it will have become apparent that sexual manifestations in childhood are not necessarily to be regarded as pathological. This conclusion does not conflict with the assumption that certain factors influence the sexual life of the child. The numerous individual differences suffice to indicate the existence of such factors. Many of these are of a pathological character, but others have no connexion with the domain of pathology. Among the factors thus influencing the sexual life of the child, we can distinguish those affecting the germinal rudiments from those which exercise their influence later. Those of the former group first demand our attention.

In certain families, the early awakening of sexuality is observed with remarkable frequency. These are often neuropathic or psychopathic families, and moreover the early awakening of the sexual life is frequently associated with neuropathic or psychopathic symptoms. But this is by no means always the case, and often enough such persons belong to healthy families and are themselves healthy. We are therefore not entitled to regard the occurrence of sexual manifestations in childhood as a proof of degeneration or of a morbid inheritance. But equally erroneous is the opposite view, that the early awakening of sexuality is an indication of exceptional endowments. It is true that in many persons of genius premature sexual passion has been observed, and such manifestations are by no means always confined to the contrectation impulse. We learn, too, in our consulting rooms, that not infrequently the most diligent schoolboys exhibit at a comparatively early age the phenomena alike of contrectation and of detumescence. But the fallacy of drawing general conclusions from this fact is shown by the additional fact that in idiots and imbeciles premature awakening of the sexual life is also of common occurrence. In cases such as were formerly described as moral insanity, but which in Germany to-day are classed with imbecility, sexual assaults on others are very common at an early age. This is true also of other forms of idiocy and imbecility. In asylums for such patients, feeble-minded children not infrequently make sexual attempts on nurses and on other inmates. In this connexion, we have to consider both components of the sexual impulse, the phenomena of contrectation as well as those of detumescence. In the case of low-grade idiots, we often see the phenomena of pure detumescence, without the accompaniment of any sexual inclination directed towards another person; this is simply physical masturbation, performed under the promptings of an organic impulse. But not only in imbeciles and idiots, and in persons of genius, but also in those with perfectly normal mental endowments, the sexual impulse, and more especially the phenomena of contrectation, may appear at a very early age. Persons with artistic tendencies develop in this way with comparative frequency. We must, for these reasons, guard against the misconception that the early awakening of sexuality is _per se_ pathological. The fact that the study of the sexual life has been undertaken chiefly by medical men, and above all by neurologists and alienists, has inevitably introduced a certain bias into the results of the investigation. Opportunities for the study of the sexual life of normal persons have been comparatively rare; for those in whom the early awakening of sexuality has been recorded have for the most part sought medical advice and treatment for some other reason, and the physician has taken the opportunity to make inquiries into the patient's sexual history. The boundary-line between what is pathological and what is normal can be determined only by an extended study of the sexual life in normal persons. By very numerous inquiries I have done my best to effect this; and a careful examination of the accumulated material leads to the above-mentioned conclusion, that an early awakening of the sexual life is commoner in those with an abnormal nervous system than it is in healthy persons: but it also appears that an abnormal sensitiveness of a non-pathological character, such as is exhibited by persons with the artistic temperament, and likewise a disposition excitable to a degree which cannot yet be called morbid, predispose the subjects to an early awakening of sexuality.

To attain to clear views on this question, it is necessary to bear certain distinctions in mind: first, as regards the different periods of childhood; and, secondly, as regards the two components of the sexual impulse (detumescence and contrectation). My own investigations have led me to draw the following conclusions. _During the first period of childhood, that is to say, up to the end of the seventh year of life, the occurrence of manifestations of the sexual impulse must arouse suspicions of the existence of a congenital morbid predisposition._ But as regards the phenomena of detumescence, which are confined to the peripheral genital organs, we must make an exception to this rule if they do not appear spontaneously, but result either from local inflammatory or other morbid changes, or from deliberate seduction of the child to the performance of sexual manipulations; at any rate, in such cases, the probability of the existence of _congenital morbid predisposition_ is greatly diminished. _I am also forced to regard as suspicious the occurrence of phenomena of contrectation during the first period of childhood, although not to the same extent as are the peripheral manifestation of the sexual impulse--and I hold this view notwithstanding the numerous cases recorded by Sanford Bell. Passing to the second period of childhood, the phenomena of contrectation may appear at the very beginning of this period, that is, during the eighth year of life, without justifying the inference that any morbid predisposition exists. Regarding the phenomena of detumescence, we must not hold them to be necessarily morbid when they make their appearance during the last years of the second period of childhood; but when this occurs earlier, during the tenth or eleventh year of life for instance, some suspicion may reasonably be aroused._ In this general survey of the material, it did not appear that any important difference existed between the two sexes in the matters under consideration; but I believe that in girls the phenomena of contrectation often make their appearance somewhat earlier than in boys, whereas, on the other hand, the occurrence of the phenomena of detumescence at an early age is more likely to indicate the existence of congenital morbid predisposition in girls than it is in boys.

In the delimitation of the pathological from the healthy, I have endeavoured to lay down broad general lines. It must not be supposed that precisely at the close of the first period of childhood, that is to say, at the end of the seventh year of life, the sexual life, and our opinions as to the significance of its manifestations, undergo sudden alterations. Our estimates as to the significance of phenomena occurring during the early months of the eighth year of life, will not differ materially from our estimates as to the significance of the same phenomena when they occur during the last months of the seventh year. My conclusions have no more than a general application, based as they are on the recorded experiences and on my own personal observations of numerous persons, healthy and diseased.

Let us consider further what are the factors favouring an early awakening of the sexual life. I have previously mentioned the fact that in certain families a remarkably early sexual development is quite common. This is true also of certain races. But the data bearing on this question are not quite so trustworthy as might be wished. The fact that among certain nations marriage sometimes takes place at a remarkably early age, is no certain proof of the early awakening of sexuality in persons of this nationality; for the marriage may be a purely ceremonial affair, and may be effected long before the individual is ripe for sexual intercourse or for procreation; and the first act of intercourse may not take place until several years after the ceremony of marriage. Among ourselves, marriage, especially in the case of men, does not as a rule take place until long after the age of puberty, and it therefore seems to us very remarkable when, in another race, men marry ten years earlier; but this must not be taken as a proof that sexual development occurs at an earlier age. We can gain some knowledge of the subject from the statistical inquiries which have been made regarding the appearance of that manifestation of puberty which is most readily available for such inquiries, namely, the first occurrence of menstruation. Ribbing[67] has made a study of this question, and gives the following figures regarding the commencement of menstruation in women of different nationalities in various places: Swedish Lapland, 18 years; Christiania, 16 years, 9 months, 25 days; Berlin, 15 years, 7 months, 6 days; Paris 15 years, 7 months, 18 days, and 14 years, 5 months, and 17 days; Madeira, 14 years, 3 months; Sierra Leone and Egypt, 10 years. From these data we should naturally he led to infer that there would be great variations in the age at which other manifestations of the sexual life first make their appearance, and experience justifies this inference.

Some writers attribute to climate a great influence in this respect; whilst others regard this view as erroneous, and believe that the differences observed depend rather on racial peculiarities. By advocates of the former view it is assumed that a hot climate leads to the early appearance of menstruation, whilst a cold climate retards the development of this function. Those who dispute the influence of climate bring forward instances of a contrary kind. Thus, among the Samoyede Eskimos, menstruation begins at the age of twelve or thirteen, notwithstanding the fact that they dwell within the Arctic circle; whereas, among the Danes and the Swedes, menstruation begins at about the age of sixteen or seventeen years. Again, we are told that among the Creoles of the Antilles, as in France, menstruation rarely begins before the fourteenth year, whilst in the same islands, girls of African race begin to menstruate, as in Africa, at ten or eleven years of age.[68] These objections to the climatic theory are certainly serious ones. But when we are considering the possible influence of climate upon menstruation, we have to remember that it is possible that climate may exert its influence cumulatively in successive generations, and may not produce its full effect upon the age at which menstruation begins, until after the lapse of several generations. We certainly lack evidence to show that in isolated individuals a change of climate affects the first appearance of menstruation. But it is not impossible that climate may exert such an influence in the course of several generations. Such a view would appear to receive support from our observations on animals, for the sexual life of the latter is notably influenced by the seasons, and change of season resembles in many respects change of climate. In most animals, and more especially in those living in a state of nature, the sexual impulse becomes active at stated intervals only, and these intervals are related to the duration of pregnancy in such a way that the birth of the young occurs always at a season in which the nutritive conditions are favourable. It is widely assumed that even in the human species there remain vestiges of such a periodicity in the sexual impulse. I have discussed this matter very fully elsewhere,[69] and will here do no more than draw attention to the fact that the poetry of spring, which sings partly of love alone, and partly of the relations between love and the annual awakening of nature, bears upon the influence of this season of the year upon the sexual impulse. It seems that the spring also exerts an influence upon the love-sentiments of the child. It is possible that suggestion here plays a certain part, inasmuch as from childhood onwards poetry and many observations teach that there is a connexion between love and the season of spring. Sanford Bell considers that the importance of spring in this connexion depends on the fact that at this season children begin to meet one another in the open, subject to less restraint, and perhaps more frequently. But he does not exclude the possible existence of an inherited vestige of periodicity in the sexual impulse.

It is widely assumed that among the higher social classes the awakening of the sexual life occurs earlier than among the lower. But it can hardly be said that trustworthy statistics exist to illustrate this point; and the most we can admit is that it may be true of the commencement of menstruation--though even here the data available hardly suffice to afford proof of the thesis. It is said that in girls of the upper classes menstruation begins on the average at an earlier age than in girls of the lower classes; and also that menstruation begins earlier in towns than in the country. Rousseau[70] asserted this long ago, taking his facts from Buffon, who attributed the fact to the sparer and poorer fare of the country folk. Rousseau, while admitting that menstruation began later in the country districts, considered that diet had nothing to do with the matter, since even where (as in Valais) the peasants enjoyed a liberal fare, puberty, in both sexes, occurred later than in the majority of towns, in which an excessively rich diet was often customary. He believed that the difference between town and country in this respect depended rather upon the more enduring repose of the imagination in the country, this latter itself arising from the greater fixity of customs in the rural districts. Speaking generally, however, the question whether in the country the sexual life awakens later than it does in the towns, cannot be said to have been decisively answered.

Closely connected with the question of the alleged later awakening of the sexual life in the country is the belief that in the country children are also more moral and remain longer uncorrupted.

I myself do not believe that children are more moral in the country, or that they here remain longer uncorrupted than in towns, whether large or small. Nor is it proved that in former times the country possessed any advantage in these respects, as compared with our own days and with the modern town. The entire fable of rural innocence appears to rest, not upon an actual comparison between town and country, but rather upon the more lively interest felt in town life, and especially in the life of the great towns: in towns, immorality has been more carefully studied and more often _described_; and on account of the greater concentration of town life, it is also more readily apparent. But any one who studies erotic literature and descriptions of manners and customs, at any rate, anyone who studies these without prejudice, will find ample ground for the opinion that even in earlier times morality stood in the country on no higher level than in the towns. The opinion that country life was more moral has existed from very early times, and it is interesting to observe the way in which in erotic literature we at times encounter a satirical use of this fact, describing the painful disillusionment of a man who has hoped to find perfect innocence in his loved one from the country, and has been bitterly disappointed.

I do not propose to give numerous examples of rural immorality in earlier times; two will suffice, both dating from the eighteenth century, and both bearing on the seduction of children. Laukhard,[71] born in the year 1758, at Wendelsheim, in the Lower Palatinate, tells us how, when six years of age, he was introduced by a manservant into the secrets of the sexual life, so that he was speedily in a position "to take part, with consummate ability and to the admiration of all, in the most shameless lewd sports and conversations of the menials of the household." And Laukhard adds in a note that, in the Palatinate, obscenity was so universal, and among the common people the general conversation was so utterly shameless, that a Prussian grenadier would have blushed on hearing the foul talk of the Jacks and Gills of the Palatinate. He also relates that he soon found an opportunity of practising with one of the servant-girls what the manservant who had been his instructor had extolled to him as the _non plus ultra_ of the higher knowledge. If we compare with this the descriptions given by Rétif de la Bretonne, who was born in the year 1734 in the village of Sacy in Lower Burgundy, and was the son of a well-to-do peasant, and if we study a number of similar accounts of country life, we shall hardly be inclined to take a very roseate view regarding rural morals in former days. We learn from Rétif,[72] that while still quite a little boy, only four years of age, he had the most diverse sexual experiences with a grown-up girl, Marie Piôt, after she had induced an erection of his penis by tickling his genital organs. These and numerous similar accounts, which we find in the works of writers of previous centuries, are not likely to sustain the conviction that rural morals were formerly distinguished by exceptional purity.

But if this claim must be disputed as regards rural life in former times, it is still more certain that we must deny that to-day a higher moral level obtains in the country than in the towns, and this is true above all as regards children. It is certain that sexual activity in children does not begin later in the country. My views as to present conditions in the country are derived mainly from information directly communicated to myself. From a number of grown-up persons, now residing in the metropolis, but born and bred in the country, I have received details of their own early sexual experiences. I have in addition had opportunities for direct personal inquiries in rural districts and in the smaller country towns. Lastly, I have received reports voluntarily furnished to me by persons still residing in the country. Combining all these sources of information, I am justified in asserting that in the country sexual practices among children are of exceedingly common occurrence.

Just as the recent increasing development of large towns has been regarded as responsible for immorality and for premature sexual

## activities in children, so also has modern civilisation in general been

blamed for the same results. There has always existed a tendency to depreciate the morals of contemporary periods, and to exalt in comparison the morals of an earlier day. In books of earlier generations, in those, for instance, which appeared between the middle of the eighteenth century and the middle of the nineteenth century, we find, just as we find in the writings of our own day, lamentations upon existing corruption, especially as regards the morals of children, and panegyrics upon the morality of an earlier time. But when we examine the documents of the past, we find adequate proof of the fact that morals stood at no higher level in former times than to-day, and, more

## particularly, we learn that the sexual morals of children were no better

then than now. If this were otherwise, how could we explain the fact that, in the year 1527, for instance, the Town Council of Ulm issued an order to the brothel-keepers of that town that they were no longer to admit to the brothels boys of from twelve to fourteen years of age, but rather were to drive them away with birch-rods. This fact, with many others, is recorded by Hans Boesch;[73] and collectively they suffice to prove, not merely that the children of former times were no whit more moral than those of our own day, but also that the awakening of sexual

## activity occurred just as early then as now.

But although I contest the alleged general influence of the life of large towns and of modern civilisation upon the morality and the sexual

## activities of children, I admit at once that peculiar conditions of

place and time may exert a great influence in these respects. Frequently, no detailed analysis of these conditions is possible; but sometimes such an analysis can be effected. Only by the assumption that these special influences exist can we understand how it is that such marked differences exist at different times in the same place. I know certain schools in Berlin in which masturbation, and even mutual masturbation, are widely diffused; and I know others regarding which in this respect no unfavourable reports can be made. I know, indeed, of schools about which I have received from former pupils, persons whose trustworthiness I have absolutely no reason to doubt, reports which prove that a remarkably high level of sexual morality must have existed in these schools. On the other hand, ex-pupils of other schools, attended by boys of very various classes of the population, have informed me that at these schools there was hardly a boy who did not masturbate. It is not always possible to ascertain the causes of such differences. One child, perhaps, may corrupt an entire class. But I believe also that the influence of the schoolmasters, and especially that of the headmaster, may be of enormous importance in this respect. Similar differences exist in the country. It is even believed by some that there are differences between the Catholic and Protestant inhabitants of the rural districts. How extensive may be the differences even within a comparatively small area, is shown by an example, which I will quote, from C. Wagner.[74] One of the districts studied by him was the Province of Jagst in Würtemberg, and he reports that there is a striking difference between the Alt-Würtemberg and the Franconian districts. The report states that in the former district the greater number of parents appear to recognise it as their sacred duty to bring up their children properly and to watch over their development. Moral depravity could not be said to be general among the children of this region. Very different was it in the Franconian districts, in which not only were the children cared for much less perfectly, but in which also "the children saw and heard much too early things which impair or destroy the innocence and purity of the heart." We are told that shamelessness in the satisfaction of natural needs was general; some cases of self-abuse were reported; and obscene and lascivious conversation was common. The causes assigned for this in the report are: overcrowding in the dwellings, there being in some cases but a single bed for children of school age of different sexes; also that children had been present when cattle were performing the sexual act. Often in the country we are told that children have been corrupted by grown persons, through sleeping in the same bed with the latter.

What has just been said bears upon the influences which at the opening of this