4. B., aged 21; imbecile. While alone in a forest with his sister of

nineteen, he demanded that she allow coitus. She refused. He threatened to strangle her, and stabbed her with a knife. The frightened girl fondled his penis, and he then left her and quietly went on with his work. B. has a deformed, microcephalic skull, and has no sense of the significance of his act. Emminghaus (_op. cit._, p. 234) reports the case of an exhibitionist:— Case 146. A man, aged 40, married, had for sixteen years been accustomed to exhibit himself in parks, at dusk, to little girls and servants, and drew their attention to himself by whistling. After having been frequently punished for it, he avoided the places, but he carried on his practice elsewhere. Hydrocephalus. Mental weakness of slight degree. Mild sentence passed. Case 147. X., of tainted family; imbecile; defective and perverted in intellect, feeling, and will. For help and protection he was brought before an officer. It was complained that he had repeatedly exposed his genitals to servant-girls, and had shown himself at windows with the upper portion of his body naked. No other manifestations of sexual instinct. No onanism reported. (Sander, _Archiv f. Psych._, i, p. 655.) Case 148. _Pederasty with a Child._—On April 8, 1884, at ten o’clock A.M., while X. was sitting on the street, holding a boy of eighteen months on her lap, a certain Vallario approached and took the child from X., saying he was going to take it for a walk. He went the distance of half a kilometre, and returned, saying that the child had fallen from his arms, and thus injured its anus. The anus was torn, and blood was pouring from it. At the place where the deed was done, traces of semen were found. V. confessed his horrible crime, and, at his final trial, he acted so strangely that an examination of his mental condition was made. He had impressed the prison attendants as being an imbecile. V., aged 45, mason, defective morally and intellectually, is dolicho-microcephalic; has narrow, deformed facial bones, and the halves of the face and the ears are asymmetrical; the brow is low and retreating; genitals normal. V. shows general diminution of cutaneous sensibility, is imbecile, and has no ideas. He lives in the present, has no ambition, and does nothing of his own will. He has no desires and no emotional feeling. He has never had coitus. Nothing more could be ascertained about his vita sexualis. Proofs of intellectual and moral idiocy, due to microcephaly; the crime is referred to a perverse, uncontrollable sexual impulse. Sent to an asylum. (Virgilio, _il Manicomio_, V. year, No. 3.) A case mentioned by L. Meyer (_Arch. f. Psych._, Bd. i, p. 103) shows how female imbeciles may indulge in shameless prostitution and immorality.[121] STATES OF ACQUIRED MENTAL WEAKNESS. The numerous anomalies of the vita sexualis in senile dementia have been described in the section on “General Pathology.” In other conditions of acquired mental weakness,—those due to apoplexy; trauma capitis; to the secondary stages of psychoses; or to inflammatory processes in the cortex (lues, paretic dementia),—perversions of the sexual instinct seem to be infrequent; and here the immoral sexual acts seem to depend on abnormally increased or uninhibited sexual feeling, which, in itself, is not abnormal. (1) _Dementia Consecutive to Psychoses._ Casper (_Klin. Novellen_, Fall 31) reports a case that belongs here. It is that of a physician, aged 33, who attempted rape on a child. He was weakened mentally, as a result of hypochondriacal melancholia. He excused his deed in a very silly way, and had no appreciation of the moral and criminal meaning of the act, which was apparently the result of a sexual impulse that could not be controlled on account of his mental weakness. Case 21, in Liman’s _Zweifelhafte Geisteszuständen_, is an analogous case (dementia after melancholia; offense against morals by exhibition). (2) _Dementia After Apoplexy._ Case 149. B., aged 52. He passed through a cerebral attack, and was no longer able to carry on his business as a merchant. One day, in the absence of his wife, he locked two girls in the house, gave them liquors to drink, and then carried out sexual acts with the children. He commanded them to say nothing, and went to his business. The medical expert established mental weakness, resulting from repeated apoplexies. B., who, up to this time, had been wellbehaved, says he committed the criminal act because of an uncontrollable and incomprehensible impulse; and that, when he came to himself, he was ashamed, and sent the girls away. Since his apoplectic attack, B. had been weak-minded, incapable of business, and hemiplegic; but, soon after arrest, he made an unskillful attempt at suicide. He often cried childishly. His moral and intellectual energy in opposing his sensual impulses was certainly much weakened. No sentence. (Giraud, _Ann. méd. Psychol._ March, 1881.) (3) _Dementia After Injury of Head._ Case 150. K., when fourteen years old, was injured on the head by a horse. The skull was fractured in several places, and several pieces of bone required removal. From that time K. was weak mentally, passionate, and ill-tempered. Gradually he developed an inordinate and truly beastly sensuality, which drove him to the most immoral acts. One day he raped a girl of twelve, and strangled her for fear of discovery. Arrested, he confessed. The medical experts declared him responsible, and he was executed. The autopsy revealed ossification of almost all the sutures, remarkable asymmetry of the halves of the skull, and evidences of healed fractures. The affected hemisphere had bands of cicatricial tissue running through it, and was one-third smaller than the other. (_Friedreich’s Blätter_, 1885, Heft 6.) (4) _Acquired Mental Weakness, Probably Resulting from Lues._ Case 151. X., officer, had repeatedly committed immoral acts with little girls; among other things, he had induced them to perform manustupration on him, had exposed his genitals, and handled theirs. X., formerly healthy, and of blameless life, was infected with syphilis in 1867. In 1879 paralysis of the left abducens occurred. Thereafter mental weakness was noticed, with a change of his disposition and character. Headache, occasional incoherence of speech, failure of power of thought and logic, occasional inequality of pupils, and paresis of the right facial muscles, were observed. X., aged 37, shows no trace of lues when examined. The paralysis of the left abducens is still present. The left eye is amblyopic. He is mentally weak. Concerning the trial that was before him, he said it was nothing but a harmless misunderstanding. Indications of aphasia. Weakness of memory, particularly for recent events. Superficial emotional reaction; rapid exhaustion of memory and ability to speak. Proved: that the ethical defect and the perverse sexual impulse are the symptoms of an abnormal condition of brain induced by lues. Suspension of criminal proceedings. (Personal case. _Jahrbücher für Psychiatrie._) (5) _Paretic Dementia._ Here the sexual life is usually abnormally affected; in the incipient stages of the disease, as well as in episodical states of excitement, it is intensified, and sometimes perverse. In the final stages libido and sexual power usually become _nil_. Just as in the prodromal stage of the senile forms, one sees here, in connection with more or less evident losses in the moral and intellectual spheres, expressions of an apparently intensified sexual instinct (obscene talk, openness in intercourse with the opposite sex, thoughts of marriage, frequenting of brothels, etc.), which is characteristic of the clouding of consciousness. Seduction, abduction, and public scandal are here the order of the day. At first there is still some appreciation of the circumstances, though the cynicism of the acts is striking enough. As the mental weakness increases, such patients become criminal by reason of exhibition, masturbation in the streets, and attempts at immoral acts with children. If conditions of mental excitement come on, attempts at rape are committed, or, at least, grossly immoral acts,—the patient attacks women on the street, appears in public in very imperfect dress; or, half-clothed, tries to force his way into strange houses, to cohabit with the wife of an acquaintance, or to marry the daughter on the spot. Numerous cases belonging to this category are cited by Tardieu (“Attentats aux moeurs”); Mendel (“Progressive Paralyse der Irren,” 1880, p. 123); Westphal (_Arch. f. Psych._, vii, p. 622); and a case by Petrucci (_Annal. méd. Psychol._, 1875) shows that bigamy may also occur here. The brutal disregard of consequences with which the patients in the advanced stages attempt to satisfy their sexual instinct, is characteristic. In a case reported by Legrand (“La folie,” p. 519), the father of a family was found masturbating in the open street. After the act he consumed his semen. A patient seen by me, an officer, of a prominent family, in broad daylight, made attacks on little girls at a watering-place. A similar case is reported by Dr. Régis (“De la dynamie ou exaltation fonctionnelle au début de la paral. gén.,” 1878). Cases reported by Tarnowsky (_op. cit._, p. 82) show that also pederasty and bestiality may occur in the prodromal stages and course of this malady. _Epilepsy._—Epilepsy is allied to the acquired states of mental weakness because it often leads to them, and then all the possibilities of reckless satisfaction of the sexual impulse that have been mentioned may occur. Moreover, in many epileptics the sexual instinct is very intense. For the most part, it is satisfied by masturbation, now and then by attacks on children, and by pederasty. Perversion of the instinct with perverse sexual acts seems to be infrequent. Much more important are the numerous cases in literature in which epileptics, who, during intervals, present no signs of active sexual impulse, but manifest it in connection with epileptic attacks, or during the time of equivalent or post-epileptic exceptional mental states. These cases have scarcely yet been studied clinically, and forensically not at all; but they deserve careful study. In this way certain cases of violence and rape would be understood, and legal murders prevented. From the following facts, it will certainly be clear that the cerebral changes which accompany the epileptic outbreak may induce an abnormal excitation of the sexual instinct. Besides, in the exceptional mental states of epileptics, they are unable to resist their impulses, by reason of the disturbance of consciousness. For years I have known a young epileptic, of bad heredity, who, always after frequent epileptic seizures, attacks his mother, and tries to violate her.[122] After a time he comes to himself, and has no memory of his acts. In the intervals he is very strict in morals, and has but slight sexual inclination. Some years ago I became acquainted with a young peasant, who, during epileptic attacks, masturbated shamelessly, but during the intervals was above reproach. Simon (“Crimes et délits,” p. 220) mentions an epileptic girl of twenty-three, well educated, and of the best morals, who, in attacks of vertigo, would shout out obscene words, then raise her dress, make lascivious movements, and try to tear open her under-garments. Kiernan (_Alienist and Neurologist_, January, 1884) reports the case of an epileptic who always had, as an aura, the vision of a beautiful woman in lascivious attitudes, which induced ejaculation. After some years, with treatment with potassium bromide, the vision was changed to that of a devil attacking him with a pitchfork. The instant this reached him, he became unconscious. The same author speaks of a very respectable man who had, two or three times a year, epileptic attacks of furor and dysthymia, with impulses to pederasty, which lasted a week or two; and of a lady who, with epilepsy that came on during the climacterium, had sexual desire for boys. Case 152. W., of good heredity, previously healthy; before and after, sound mentally, quiet, kind, temperate. On April 18, 1877, he had no appetite. On the 14th, in the presence of his wife and children, he demanded coitus, first of his wife’s friend, who was present, then of his wife. Taken away, he had an epileptoid attack; after this he became wildly maniacal and destructive, threw hot water on those that tried to approach him, and threw a child in the stove. Then he soon became quiet, but for some days remained confused, and finally came to himself with no memory of the events of his attack. (Kowalewsky, _Jahrbücher f. Psych._, 1879.) Another case, examined by Casper (_Klin. Novellen_, p. 267), may be attributed to epilepsy (larvated). A respectable man attacked four women, one after another, in the open street (once before two witnesses), and violated one of them, “notwithstanding that his young, pretty, and healthy wife” lived hard by. The epileptic significance of the sexual acts in the following cases is unequivocal:— Case 153. L., official, aged 40; a kind husband and father. During four years he has offended public morals twenty-five times, for which he has had to endure long imprisonment. In the first seven complaints he was accused of exposing his genitals to girls from eleven to thirteen years old, while riding by them, and calling their attention by obscene words. While in confinement, he had exposed his genitals at a window which opened on a popular street. L.’s father was insane; his brother was once met on the street wearing only a shirt. During his military service L. had had two attacks of severe fainting. Since 1859 he had suffered with peculiar attacks of vertigo, at such times becoming weak, tremulous, and deathly pale; it grew dark before his eyes, and he saw bright stars, and was forced to get support in order to keep upright. After violent attacks, great weakness, profuse sweating. Since 1861 he had been very irritable, which, respected though he was as an official, caused him much trouble in his work. His wife noticed the change in him. He had days when he would run about the house as if insane, holding his head between his hands, striking the wall, and complaining of headache. In 1864 he fell to the ground four times, lying there stiff, with eyes open. Confused states of consciousness were also proved to have occurred. L. declared that he had not the slightest remembrance of the crime of which he was accused. Observation showed further and more violent attacks of epileptic vertigo. L. was not sentenced. In 1875 paretic dementia developed with a rapidly fatal result. (Westphal, _Arch. f. Psych._, vii, p. 113.) Case 154. A rich man of twenty-six had lived for a year with a girl with whom he was very much in love. He cohabited infrequently, and was never perverse. Twice during the year, after excessive indulgence in alcohol, he had had epileptic attacks. One evening after dinner, where he had taken much wine, he hurried to the house of his mistress, and into her sleeping-apartment, although the servant told him she was not at home. From there he hastened into a room where a boy of fourteen was sleeping, and began to violate him. At the cry of the child, whose prepuce and hand he had injured, the servant hurried to them. He left the boy and attacked the maid; after that he went to bed and slept twelve hours. When he awoke, he had an indistinct remembrance of intoxication and coitus. Thereafter there were repeated epileptic attacks. (Tarnowsky, _op. cit._, p. 52.) Case 155. X., of high social position, led a dissolute life for some time, and had epileptic attacks. He became engaged. On his wedding-day, shortly before the ceremony, he appeared, on his brother’s arm, before the assembled guests. When he came before his bride, he exposed his genitals and began to masturbate. He was at once taken to an expert in mental disease. On the way he constantly masturbated, and for some days was actuated by this impulse, which gradually decreased in intensity. After this paroxysm the patient had only a confused memory of the events, and could give no explanation of his acts. (Tarnowsky, _op. cit._, p. 53.) Case 156. Z., aged 27; very bad heredity; epileptic. He violated a girl of eleven, and then killed her. He lied about the deed. Absence of memory, _i.e._, mental confusion at the time of the crime, was not proved. (Pugliese, _Arch. di Psich._, viii, p. 622.) Case 157. V., aged 60, physician, violated children. Sentenced to imprisonment for two years. Dr. Marandon later proved the existence of epileptoid attacks of apprehensiveness, dementia, erotic and hypochondriacal delusions, and occasional attacks of fear. (Lacassagne, _Lyon. méd._, 1887, No. 51.) Case 158. On August 4, 1878, H., aged 15, was picking gooseberries with several little girls and boys as her companions. Suddenly she threw L., aged 10, to the ground and exposed her, and ordered A., aged 8, and O., aged 5, to bring about conjunctio membrorum with the girl; and they obeyed. H. had a good character. For five years she had been subject to irritability, headache, vertigo, and epileptic attacks. Her mental and physical development had been arrested. She had not menstruated, but she manifested menstrual molimena. Her mother is suspected to be epileptic. For three months H., after seizures, had frequently done strange things, and afterward had no memory of them. H. seems to have been deflowered. Mental defect is not apparent. She said she had no memory of the act of which she was accused. According to her mother’s testimony, she had an epileptic attack on the morning of August 4th, and she had been, on that account, told by her mother not to leave the house. (Pürkauer, _Friedreich’s Blätter f. ger. Med._, 1879.) Case 159. _Immoral Acts of an Epileptic in States of Abnormal Unconsciousness._—T., revenue-collector; aged 52; married. He is accused of having practiced immorality with boys for about seventeen years, by practicing masturbation on them, and by inducing them to carry out the act on himself. The accused, a respected officer, is overcome by the terrible crime attributed to him, and declares that he knows nothing of the deeds of which he is accused. His mental integrity is questionable. His family physician, who has known him twenty years, emphasizes his peculiar, retiring disposition and his mercurial moods. His wife asserts that T. once tried to throw her in the water, and that he sometimes had outbreaks in which he tore off his clothing, and tried to throw himself out of windows. T. knew nothing of these attacks. Other witnesses testified to strange changes of mood and peculiarities of character. A physician reports the observation of occasional attacks of vertigo and convulsions in him. T.’s grandmother was insane; his father was affected with chronic alcoholism, and of late years had had epileptiform attacks. The father’s brother was insane, and had killed a relative while in a delirious state. Another uncle of T. had killed himself. Of T.’s three children, one was weak-minded, another cross-eyed, and the third was subject to convulsions. The accused asserted that he had occasional attacks in which consciousness was so reduced that he did not know what he was about. These attacks were ushered in by an aura-like pain in the back of his neck. He was then impelled to go out in the air. He did not know where he went. His wife had perfectly satisfied him sexually. For eighteen years he had had chronic eczema (actual) of the scrotum, which had often caused him to have extraordinary sexual excitement. The opinions of the six experts were contradictory (sane,—attacks of larvated epilepsy); the jury disagreed, so that he was dismissed. Dr. Legrand du Saulle, who was called as an expert witness, found that, until his twenty-second year, T. had urinated in bed from ten to eighteen times a year. After that time the enuresis nocturna had ceased; but, from that time, states of mental confusion, lasting from an hour to a day, had occurred occasionally, and they left the patient without any memory of them. Soon again T. was arrested for public immorality, and sentenced to imprisonment for fifteen months. In prison he grew sick, and apparently much weaker mentally. For this reason he was pardoned, but the mental weakness increased. T. was noticed to have repeated epileptoid convulsions (tonic convulsion with tremor and loss of consciousness). (Auzouy, _Annal. méd. psychol._, 1874, Nov.; Legrand du Saulle, “Étude méd. légale,” etc., p. 99.) The following case of immoral acts with children, observed by the author and reported in _Friedreich’s Blätter_, will serve to conclude this group,[123] so important in its legal bearings. It is the more important, in that a state of unconsciousness was established at the time of the act, and because, for allied reasons, the facts related in Latin show how a complicated and refined act becomes possible in such a state of unconsciousness. Case 160. P., aged 49; married; hospital beneficiary. He was accused of having committed the following terrible acts with two girls—D., aged ten, and G., aged nine,—whom he had taken to his work-shop on May 25, 1883. D. testifies: “I was in the meadow with G. and my sister J., aged three. P. called us into his shop and fastened the door. Tum nos exosculabatur, linguam in os meum demittere tentabat faciemque mihi lambebat; sustulit me in gremium, bracas aperuit, vestes meas sublevavit, digitis me in genitalibus titillabat et membro femina mea fricabat ita ut humida fierem. When I cried, he gave me twelve kreuzers, and threatened to shoot me if I told on him. At last he tried to persuade me to come again the next day.” G. testified: “P. nates et genitalia D. æ exosculatus, iisdem me conatibus aggressus est. Deinde filiolum quoque tres annos natum in manus acceptum osculatus est nudatumque parti suæ virili appressit. Postea quæ nobis essent nomina interrogavit ac censuit, genitalia D. æ meis multo esse majora. Quin etiam nos impulit, ut membrum suum intueremur, manibus comprehenderemus et videremus, quantopere id esset erectum.” At his examination, May 29th, P. said he had but an indistinct recollection of having fondled, caressed, and made presents to a little girl a short time before. If he had done anything more, it must have been in an irresponsible condition. Besides, he had suffered for years with weakness in his head, as result of an injury. On June 22d he knew nothing of the events of May 25th, and nothing of his examination on May 29th. This amnesia was shown, also, on cross-examination. P. comes of a family affected with cerebral disease; a brother was epileptic. P. was formerly a drinker. Years before, he had actually suffered an injury to his head. Since then, from time to time, he has had attacks of mental disturbance, introduced by moroseness, irritability, tendency to alcoholic excesses, apprehension, and delusions of persecution sufficient to induce threats and deeds of violence. At the same time, he would have auditory hyperæsthesia, vertigo, headache, and cerebral congestion,—all this, with great mental confusion and amnesia for the whole period of the attack, which would sometimes last for weeks. During the intervals he was subject to headache, which started from the seat of injury on the head (a small scar in the skin over the right temple), which was painful on pressure. With exacerbation of the headache, he became very irritable, morose to an extent that inclined him to suicide, and mentally like one drunk. In 1879, while in such a state, he made an impulsive attempt at suicide, of which he afterward had no memory. Soon after this, being sent to hospital, he gave the impression of being epileptic, and, for a long time, was treated with pot. bromide. At the end of 1879 he was taken to the infirmary, no actual epileptic attack having been observed. During his lucid intervals he was a virtuous, industrious, good-natured man, and had never shown any sexual excitement; and, until this time, never sexual inclinations, even during his mental confusion. Moreover, until lately, he had lived with his wife. At the time of the criminal act, he had shown signs of an approaching attack, and had asked the physician to prescribe pot. bromide. P. asserted that, since the injury to his head, he had been intolerant of heat and alcohol, which immediately brought on headache and confusion. The medical examination proved the truth of his assertions about mental weakness, irritability, and poor sleep. If pressure were made at the seat of the trauma, P. became congested, irritable, confused, and trembled all over; he appeared excited; consciousness was disturbed, and remained so for hours. At times, when he is free from the sensations that start from the scar, he seems kind, free, willing, and open, though he is mentally weak and cloudy. P. was not sentenced. (_Vide Friedreich’s Blätter_ for full report.) PERIODICAL INSANITY. Just as in cases of non-periodical mania, an abnormal intensity or a noticeable prominence of the sexual sphere is very often manifested in the periodical attacks (_v. infra_, “Mania”). The following case, reported by Servaes (_Arch. f. Psych._), shows that it then may also be perverted:— Case 161. Catharine W., aged 16; she has not yet menstruated; previously healthy. Seven weeks before admission (December 3, 1872), melancholic depression and irritability. November 27th, maniacal outbreak, lasting two days; thereafter, melancholic. December 6th, normal condition. December 24th (twenty-eight days after the first maniacal attack), silent, shy, depressed. December 27th, exaltation (jolly, laughing, etc.), with violent love for an attendant (female). December 31st, suddenly melancholic catalepsy, which disappeared after two hours. January 20, 1873, new attack like the previous one. A similar one on February 18th, with traces of menses. The patient had no memory whatever for what occurred in the paroxysms, and blushed scarlet with astonishment and shame when told about them. Thereafter there were abortive attacks, which entirely disappeared, to give place to the normal mental condition in June. In a case reported by Gock (_Arch. f. Psych._, v), which was probably circular insanity, in a man of very bad heredity, during the stage of exaltation there was manifestation of sexual feeling for men. In this case, however, the patient thought himself a girl, and it is questionable whether the sexual inclination was induced by the delusion or by a contrary sexual instinct. In connection with these cases of abnormal manifestation of the sexual instinct are those which, as a symptom of mania, manifest an abnormal and frequently a perverse sexual instinct in an impulsive way, analogous to dipsomania, which forms the nucleus of the psychical disturbance, while in the intervals the sexual instinct is neither intense nor perverse. Quite a pure case of such periodical psychopathia sexualis, connected with the process of menstruation, is the following, reported by Anjel (_Arch. f. Psych._, xv, H. 2):— Case 162. A quiet lady, near the climacteric. Very bad heredity. In her youth, attacks of petit mal. Always eccentric, quick-tempered; very moral; childless marriage. Several years ago, after a violent emotional disturbance, a hystero-epileptic attack, with post-epileptic insanity of several weeks’ duration. Thereafter there was sleeplessness for several months. Following this, there was always menstrual insomnia, and the impulse to embrace and kiss boys of ten, and fondle their genitals. During this excitement there was no desire for coitus; certainly not for intercourse with adults. The patient often speaks openly of this impulse, and asks to be watched, as she is not to be trusted. In the intervals she anxiously avoids all talk of it, is very modest, and in nowise passionate sexually. With reference to the still imperfectly-known cases of periodical psychopathia sexualis of this kind, Tarnowsky (_op. cit._, p. 38) has made valuable contributions, though his cases were not all of a periodic nature; and one of the cases, taken from a work of the author’s, is not rightly understood (Case 8, p. 37), since sodomy was only subsidiary, and the abnormal intense libido sexualis was not periodic. Tarnowsky reports cases where married, cultured men, the fathers of families, were, from time to time, compelled to perform the most terrible sexual acts, while during the intervals they were sexually normal, abhorred their paroxysmal sexual acts, and shuddered before the expectation of their repetition. If a new paroxysm came on, the normal sexual instinct disappeared; a state of mental excitement arose with insomnia, and thoughts and impulses to commit the perverse sexual acts, with anxious confusion and an increasing impulse to the abhorred indulgence. In this state the act was a relief, because it ended the condition. The analogy with dipsomania is complete. For other cases (of periodical pederasty), _vide_ Tarnowsky, _op. cit._, p. 41. The case there reported, on page 46, belongs in the category of epilepsy. The following case, reported by Anjel (_Arch. f. Psych._, xv, H. 2), is one of the most typical of the convulsive-like occurrence of sexual excitement:— Case 163. A gentleman of high social position, aged 45; generally respected and beloved; heredity good; very moral; married fifteen years. Previously normal sexually; the father of several healthy children, and living in happy matrimony. Eight years ago he suffered a violent fright. For some weeks thereafter he had a feeling of apprehension and cardiac attacks. Then came attacks, at intervals of several months or a year, of what the patient called his “moral catarrh.” He became sleepless. After three days, loss of appetite, increasing irritability, strange appearance; fixed stare, staring into space; paleness, changing with redness; tremor of the fingers; red, shining eyes, with peculiar glassy expression; and violent, quick manner of speech. There was a desire for girls of from five to ten years, even for his own daughters. He would beg his wife to guard the children. For days at a time, while in this state, he would shut himself in his room. Previously he was compelled to pass school-girls on the street, and he found a peculiar pleasure in exposing his genitals before them, by acting as if about to urinate. For fear of exposure, he shuts himself in his room, full of desire, incapable of movement, and torn by feelings of fear. Consciousness seems to be undisturbed. The attacks last from eight to fourteen days. The cause of their return is not clear. Improvement is sudden; there is great desire for sleep, and, after this is satisfied, he is again well. In the interval there is nothing abnormal. The author assumes an epileptic foundation, and considers the attacks to be the psychical equivalents of epileptic convulsions (!). _Mania._—With the general excitation that here exists in the psychical organ, the sexual sphere is likewise often implicated. In maniacal individuals of the female sex, this is the rule. In certain cases, it may be questionable whether the instinct, which, in itself, is not intensified, is simply recklessly manifested, or whether it is present in actual abnormal intensity. For the most part, the latter is the true assumption,—certainly so where sexual delusions and their religious equivalents are constantly expressed. In accordance with the degrees of intensity of the disease, the intensified instinct is expressed in different forms. In simple maniacal exaltation in men, courting, frivolity, and lasciviousness in speech, and frequenting of brothels, are observed; in women, inclination for the society of men, personal adornment, perfumes, talk of marriage and scandals, suspicion of the virtue of other women; or there is manifested the religious equivalent,—pilgrimages, missionary work, desire to go into a cloister or to become the servant of a priest; and in this case there is much talk about innocence and virginity. At the height of mania there may be seen invitations to coitus, exhibition, obscenity, great excitation at sight of women, tendency to smear the person with saliva, urine, and even fæces; religio-sexual delusions,—to be under the protection of the Holy Ghost, to have given birth to Christ, etc.; open onanism, and pelvic movements of coitus. In maniacal men care must be taken to prevent shameless masturbation and sexual attacks on women. SATYRIASIS AND NYMPHOMANIA. States of mental excitement, in which an abnormal intense sexual impulse is prominent, are called satyriasis (in males) and nymphomania (in women), or uteromania. Moreau considers these cases peculiar to themselves, but he is certainly in error. The sexual complexus of symptoms is always but the partial manifestation of a general psychosis (mania, hallucinatory insanity?). The essential element of the state of sexual excitement is a condition of psychical hyperæsthesia with involvement of the sexual sphere. The imagination calls up only sexual images, which may lead to hallucinations, illusions, and true hallucinatory delirium. The most indifferent ideas excite sensual association, and the lustful coloring of the ideas and apperceptions is very much intensified. The abnormal state of consciousness implicates the whole course of feeling and desire, and is accompanied by general physical excitement like that that accompanies coitus (v. “Physiology”). Often the genitals are in a constant state of turgor (priapism in males). The man affected with this sexual passion seeks to satisfy his desire at any price, and, therefore, becomes very dangerous to women. _Faute de mieux_, he practices onanism or sodomy. The nymphomaniacal woman seeks men by exhibition, or to attract them by her sensual conduct; at the sight of men she is intensely excited sexually, and satisfies herself by masturbation, or by pelvic movements of coitus. Satyriasis is infrequent. Nymphomania is more frequently observed, and not seldom in the climacteric. It may occur in senility. Abstinence,[124] with constant excitation of the sexual sphere as a result of psychical or peripheral irritation (pruritus pudendi, oxyuris, etc.), may cause these conditions, but probably only in those predisposed. The assertion that it may also result from poisoning by cantharides seems to depend upon confounding it with priapism. The primary lustful feeling that accompanies priapism due to cantharides soon becomes painful. Satyriasis and nymphomania are acute abnormal psycho-sexual states. There are also cases that, not without reason, might be called chronic satyriasis or nymphomania. To these belong the men who, for the most part as a result of abusus veneris, or more particularly of masturbation, suffer with neurasthenia sexualis, and at the same time have intense libido sexualis. The imagination, as in acute cases, is in a state of excitement, and the mind full of obscene images; so that the most elevated ideas are besmirched with the most cynical images and thoughts. The thought and desire of such men are solely directed to the sexual sphere; and since their flesh is weak, led on by their fancy, they come to indulge in the grossest perversions of the sexual act. Analogous cases in women may be called chronic nymphomania. They naturally lead to prostitution. Legrand du Saulle (“La folie,” p. 510) reports interesting cases which apparently are pure. _Melancholia._—The thoughts and feelings of melancholiacs are not favorable for the excitation of sexual desires. At the same time, these patients sometimes masturbate. In my experience such cases have always been hereditarily predisposed and previously given to onanism. The act did not seem to be so much due to a lustful desire as to be induced by habit, _ennui_, anxiety, and the impulse to change temporarily the painful mental condition. _Hysteria._—In this neurosis the sexual life is very frequently abnormal; indeed, always in predisposed individuals. All the possible anomalies of the sexual function may occur here, with sudden changes and peculiar activity; and, on an hereditary degenerate basis and in moral imbecility, they may appear in the most perverse forms. The abnormal change and inversion of the sexual feeling are never without effect upon the patient’s disposition. The following case, reported by Giraud, is one of this nature worthy of repetition:— Case 164. Marian L., of Bordeaux. At night, while the household was asleep under the influence of narcotics she had administered, she had given the children of the house to her lover for sexual enjoyment, and had looked on at the immoral acts. It was found that L. was hysterical (hemianæsthesia and convulsive attacks), but before her illness she had been a moral, trustworthy person. Since her illness she had become a shameless prostitute, and lost all moral sense. In the hysterical the sexual sphere is often abnormally excited. This excitement may be intermittent (menstrual?). Shameless prostitution, even in married women, may result. In a milder form the sexual impulse expresses itself in onanism, going about in a room naked, smearing the person with urine and other things, or wearing male attire, etc. Schüle (_Klin. Psychiatrie_, 1886, p. 237) finds very frequently an abnormally intense sexual impulse “which disposes girls, and even women living in happy marriage, to become Messalinas.” The author cited knows cases in which, on the wedding-journey, attempts at flight with men, who had been accidentally met, were made; and respected wives who entered into _liaisons_, and sacrificed everything to their insatiable impulse. In hysterical insanity the abnormally intense sexual impulse may express itself in delusions of jealousy, unfounded accusations against men for immoral acts,[125] hallucinations of coitus,[126] etc. Occasionally frigidity may occur, with absence of lustful feeling,—due, for the most part, to genital anæsthesia. _Paranoia._—Abnormal manifestations in the sexual sphere, in the various forms of paranoia, are not infrequent. Many of these cases are developed on sexual abuse (masturbatic paranoia) or sexual excitement; and, according to experience, in individuals psychically degenerate, with other functional signs of degeneracy, the sexual sphere is, for the most part, deeply implicated. In paranoia religiosa and erotica the abnormally intense and, under certain circumstances, perverse sexual instinct is most clearly manifested. In the first variety, however, the condition of sexual excitation is expressed not so much in a direct method of satisfaction of the sexual desires as (there are exceptions) in platonic love,—in enthusiastic admiration of a person of the opposite sex who is pleasing æsthetically. Under certain circumstances, the enthusiasm is for a fanciful person, a portrait, or a statue. A love for the opposite sex that is weak and purely mental, too, often has its basis in weakness of the genitals due to long-continued masturbation; and, under the guise of virtuous admiration of a beloved person, great lasciviousness and sexual perversion are often concealed. Episodically, especially in women, violent sexual excitement may occur as a nymphomania. For the most part, paranoia religiosa rests upon sexuality which manifests itself in a sexual impulse that is abnormally early and intense. The libido finds satisfaction in masturbation or religious enthusiasm, the object of which may be a certain minister, saint, etc. The psycho-pathological relations between the sexual and religious domains have been described in detail on p. 8 _et seq._ Apart from masturbation, sexual crimes are relatively frequent in religious paranoia. Marc’s work (p. 160) contains a remarkable example of religious insanity. Giraud (_Annal. méd. psychol._) has reported a case of rape of a little girl by a religious paranoiac, aged 43, who was temporarily erotic. Here, also, belongs a case of incest (Liman, _Vierteljahrsschr. f. ger. Med._). Case 165. M. impregnated his daughter. His wife, mother of eighteen children, and herself pregnant by her husband, lodged the complaint. M. had had religious paranoia for two years. “It was revealed to me that I should beget the Eternal Son with my daughter. Then a man of flesh and blood would arise by my faith, who would be eighteen hundred years old. He would be a bridge between the Old and New Testaments.” This command, which he deemed divine, was the cause of his insane act. Sexual acts that have a pathological motive sometimes occur in persecutory paranoia. Case 166. A married woman of thirty had, by means of money and sweetmeats, enticed a boy of five, who played near her, handled his genitals, and then attempted coitus. She was a teacher, who had been betrayed and then cast off. Previously moral, for some time she had given herself to prostitution. The explanation of her immoral change was given, when it was found that she had various delusions of persecution, and thought she was under the secret influence of her seducer, who impelled her to sexual acts. She also believed that the boy had been put in her way by her seducer. Coarse sensuality as a motive for her crime came less into consideration, as it would have been easy for her to satisfy sexual desire in a natural way. (Küssner, _Berl. klin. Wochenschrift._) Cullerre (“Perversions sexuelles chez les persécutés,” in _Annal. médico-psychol._, March, 1886) has reported similar cases,—the case of a patient who, suffering with paranoia sexualis persecutoria, tried to violate his sister, giving as a reason that the impulse was given him by Bonapartists. In another case a captain, suffering with delusions of persecution by electro-magnetism, was driven to pederasty,—a thing he abhorred. In a similar case the persecutor impelled to onanism and pederasty. V. PATHOLOGICAL SEXUALITY IN ITS LEGAL ASPECTS. The laws of all civilized nations punish those who commit perverse sexual acts. Inasmuch as the preservation of chastity and morals is one of the most important reasons for the existence of the commonwealth, the state cannot be too careful, as a protector of morality, in the struggle against sensuality. This contest is unequal; because only a certain number of the sexual crimes can be legally combated, and the infractions of the laws by so powerful a natural instinct can be but little influenced by punishment. It also lies in the nature of the sexual crimes, that but a part of them ever reach the knowledge of the authorities. Public sentiment, in that it looks upon them as disgraceful, lends much aid. Criminal statistics prove the sad fact that sexual crimes are progressively increasing in our modern civilization.[127] This is particularly the case with immoral acts with children under the age of fourteen. The moralist sees in these sad facts nothing but the decay of general morality, and in some instances comes to the conclusion that the present mildness of the laws punishing sexual crimes, in comparison with their severity in past centuries, is in part responsible for this. The medical investigator is driven to the conclusion that this manifestation of modern social life stands in relation to the predominating nervousness of later generations, in that it begets defective individuals, excites the sexual instinct, leads to sexual abuse, and, with continuance of lasciviousness associated with diminished sexual power, induces perverse sexual acts. It will be clearly seen, from what follows, how such an opinion is justified, especially with respect of the increasing number of sexual crimes committed on children. It is at once evident, from what has gone before, that neuropathic, and even psychopathic, states are largely determinate for the commission of sexual crimes. Here nothing less than the responsibility of many of the men who commit such crimes is called in question. Psychiatry cannot be denied the credit of having recognized and proved the psycho-pathological significance of numerous monstrous, paradoxical sexual acts. Law and Jurisprudence have thus far given but little attention to the facts resulting from investigations in psychopathology. Law is, in this, opposed to Medicine, and is constantly in danger of passing judgment on individuals who, in the light of science, are not responsible for their acts. Owing to this superficial treatment of acts that deeply concern the interests and welfare of society, it becomes very easy for justice to treat a delinquent, who is as dangerous to society as a murderer or a wild beast, as a criminal, and, after punishment, release him to prey on society again; on the other hand, scientific investigation shows that a man mentally and sexually degenerate _ab origine_, and therefore irresponsible, must be removed from society for life, but not as a punishment. A judge who considers only the crime, and not its perpetrator, is always in danger of injuring not only important interests of society (general morality and safety), but also those of the individual (honor). In no domain of criminal law is co-operation of judge and medical expert so much to be desired as in that of sexual delinquencies; and here only anthropological and clinical investigation can afford light and knowledge. The nature of the act can never, in itself, determine a decision as to whether it lies within the limits of mental pathology, or within the bounds of mental physiology. The perverse act does not indicate perversion of instinct. At any rate, the most monstrous and perverse sexual acts have been committed by persons of sound mind. The perversion of feeling must be shown to be pathological. This proof is to be obtained by learning the conditions attending its development, and by proving the existence of a general neuropathic or psychopathic condition. The _species facti_ is important; but it allows, however, only presumptions, since the same sexual act, according as it is committed by an epileptic, paralytic, or a man of sound mind, takes on other features and peculiarities, in accordance with the manner in which it is done. Periodical recurrence of the act under identical circumstances, and an impulsive manner in carrying it out, give rise to weighty presumptions that it is of pathological significance. The decision, however, must follow after referring the act to its psychological motive (abnormalities of thought and feeling), and after showing this elementary anomaly to be but one symptom of a general neuropathic condition,—either an arrest of mental development, or a condition of psychical degeneration, or a psychosis. The cases discussed in the portion of this work devoted to general and special pathology will certainly be useful to the medical expert, in assisting him to discover the motive of the act. To obtain the facts necessary to allow a decision of the question whether immorality or abnormality occasioned the act, a medico-legal examination is required,—an examination which is made according to the rules of science; which takes account of both the past history of the individual and the present condition,—the anthropological and clinical data. The proof of the existence of an original, congenital anomaly of the sexual sphere is important, and points to the need of an examination in the direction of a condition of psychical degeneration. An acquired perversity, to be pathological, must be found to depend upon a neuropathic or psychopathic state. Practically, paretic dementia and epilepsy must first come to mind. The decision concerning responsibility will depend on the demonstration of the existence of a psychopathic state in the individual convicted of a sexual crime. This is indispensable, to avoid the danger of covering simple immorality with the cloak of disease. Psychopathic states may lead to crimes against morality, and at the same time remove the conditions necessary to the existence of responsibility, under the following circumstances:—