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 manifestations 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 be 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 chapter I classed with the second group of the influences affecting the sexual life of the child, namely, those that come into play only after birth. But whatever degree of importance we may attribute to these, it cannot be doubted that congenital predisposition plays a very important part in inducing an early awakening of the sexual life. What we see in this case is similar to what happens in respect of other qualities than the sexual. Some persons are congenitally predisposed to a one-sided development; and in some persons there occurs a phenomenally early development of certain particular talents. It will suffice to remind the reader of children who while still quite young can perform extraordinary arithmetical operations, and of those who at six or seven years of age can play beautifully on the piano or some other instrument. In these latter cases the most important feature is the congenital predisposition, but this predisposition has, of course, to be aroused to activity; and the same is true in the case of the sexual impulse. This explains why it is that the most careful education often fails to prevent the premature commencement of the amatory life; and it explains also, on the other hand, why it is that even in the most unfavourable circumstances, sexual phenomena do not always make their appearance during childhood. I know of persons who have passed the years of childhood in a brothel, amid surroundings obviously calculated to turn their attention to sexuality, but in whom nevertheless during childhood no development of the sexual life appeared to have occurred. The popular saying, "What is bred in the bone will not out of the flesh," may be to some degree an overstatement, but nevertheless corresponds to the actual facts. But we must not go to the other extreme, and refuse to recognise the importance of the influences surrounding the developing child. We must bear in mind that congenital predispositions vary in strength; and a little reflection will convince us that the awakening of the sexual life will be hindered by a favourable environment, but facilitated and accelerated by an unfavourable one. In cases of seduction, the congenital predisposition often plays no more than a secondary part, Sexual acts in childhood resulting from seduction often exhibit a merely imitative character, and do not appear to proceed from an organically conditioned impulse; in such cases the sexual malpractices are often discontinued when the seducing influence is withdrawn; but if this influence is exercised persistently and systematically, it may have a permanent effect even in cases in which the congenital predisposition is slight.
This is all I have to say about the relationship between the congenital predisposition and the external influences of life. Turning now to consider these influences by themselves, we have to distinguish between those that are somatic or physical and those that are psychical in nature. Influences of these two classes may co-operate simultaneously, or may pass one into the other; and, speaking generally, it in by no means always easy to maintain a sharp distinction between them.
Seduction may in some instances arise largely by way of physical stimulation, as, fox example, when another person deliberately handles the genital organs of a child. Nurses sometimes stroke or tickle a child's genitals in order to put an end to a screaming fit. But in some cases--and these are more numerous than is commonly supposed--nursemaids do this under the impulse of their own lustful feelings. Such actions are not necessarily the outcome of a perverse sexual impulse, although they may be due to such an impulse in the form of paedophilia, as I shall have to explain in detail when I come to describe that perversion. Frequently the offenders are not in the least aware of the danger of what they are doing, and do it merely in sport. In many instances the seduction is effected by other children, and often at a very early age. Recently a case was reported to me in which a boy only five years of age led older children astray. In schools, a closet used by both boys and girls is by many considered extremely dangerous. In the country, the fact that children have a long way to go to school often gives opportunity for improper conduct; and this is especially likely to occur if there are copses near the road in which the children can conceal themselves from observation. When children in the country traverse long distances on the way to preparatory confirmation classes, misconduct is exceptionally likely, for such children are now at an age at which the activity of the sexual life is becoming more manifest. Whether the seduction be the work of other children or of adults, the child thus led astray is likely subsequently to induce artificially as often as possible the agreeable sensations with which it has now been made acquainted, more especially in view of the fact that in children the imitative impulse is far more strongly developed than it is in adults, in whom imitative inclinations are counteracted by numerous inhibitions. What is true of seduction is true also of the various affections of the genital organs which induce an impulse to scratch, such as eczema, prurigo, urticaria, &c. Affections of regions adjoining the genital organs may also lead to similar troubles--for instance, threadworms in the rectum or the vagina.
Clothing, also, especially in boys the breeches, may give rise during childhood to unwholesome stimulation. Hufeland, in his Makrobiotik, long ago advised against the wearing of breeches by little boys. The Schaumburg-Lippe body-physician, Faust,[75] in a work published in the year 1791, strongly recommended that boys should not wear breeches. Frequently the climbing of the pole in the gymnasium is regarded as being the etiological factor in the induction of premature masturbation. Experience shows that occasionally the first voluptuous sensations do actually arise during the act of climbing the pole. A similar report is made also in regard to the climbing of trees and of gymnastic exercises on the parallel and horizontal bars. It is obvious that pressure on the genital organs will very readily arise in these ways. But cases are reported in which the child experiences sexual excitement from exercising on the horizontal bar, not when he is straddling the bar, but when he is hanging to it by the hands. It must in these cases remain doubtful whether the sexual excitement results from the pressure of the breeches, or is a direct result of the hanging posture. Where pressure is exerted on the genital organs, it is not always the strength of the stimulus which is most significant. A nursemaid may do much more harm by gently tickling a child's genital organs than by pressing them forcibly. Nor have we to think only of the quality of the stimulus, but also of its newness; for an unfamiliar stimulus may cause sexual excitement simply because it is unfamiliar. Various stimuli have to be considered, in addition to those previously enumerated. I may refer here to flagellation. It is well known that in many children the first experience of sexual excitement results from a whipping; indeed, a perverse mode of sexual sensibility lasting throughout the whole of life may thus originate. I shall return to this matter in the chapter on Sexual Education. I will merely refer here to certain other stimuli which have in many cases aroused sexual excitement for the first time. Penta reports the case of a girl twelve years of age who first experienced sexual excitement during a railway journey. Certain men have informed me that they became sexually excited for the first time while driving over a rough stone pavement. It is obvious in these cases that the rapidly repeated succussion stimulates the peripheral genital organs, and that in this way sexual sensibility is awakened. Havelock Ellis[76] reports cases in which boys first experienced sexual pleasure when wrestling. Thus, a physician wrote regarding a boy of twelve or thirteen, that he experienced an extraordinarily pleasant sensation whilst wrestling with another boy, and that thenceforward he sought every opportunity to wrestle, often three or four times daily, and continued to do this until he was nearly nineteen years of age. Whilst in this instance we are told that contact of the penis with the opponent's hips was effected, and that probably the sexual excitement was induced in this manner, I must point out that a masochistic-sadistic form of excitement may also result from wrestling, and that it is to this that we must refer the sexual desires and voluptuous sensations that are aroused in many males by the act of wrestling.
Chemical stimuli must be regarded as a sub-variety of physical stimuli. It is sometimes asserted that a diet too rich in meat or otherwise too stimulating is dangerous in this regard. But an examination of the available material will show that this opinion lacks foundation. There is no proof that the sexual impulse can be prematurely awakened by a meat diet, or by any other particular diet. I cannot regard such an assertion as proved even as regards alcohol. Although I hold very strongly that no alcohol should be given to children, this is not because there is any proof that in children to whom alcohol is given the awakening of the sexual impulse occurs earlier than in others. But once the awakening of the sexual life has taken place, it is true that alcohol may have an exciting influence, and this in two different ways. On the one hand, if so much alcohol is taken as to interfere with the natural psychical inhibitions, sexual practices may occur that would not otherwise have occurred. On the other hand, also, large quantities of alcohol may often induce an after-effect, after the intoxicating effects have completely passed away, manifesting itself, it may be, in the form of sexual excitement, but also, and chiefly, in the form of common sensations in the genital organs. To complete the account of this matter it is necessary to add that there are many persons who consume large quantities of alcohol, who yet are extremely moderate in sexual relationships. But alcohol should not be administered to children, for reasons altogether independent of its influence upon the sexual life.
Psychical stimuli are perhaps even more important than physical stimuli. Here also seduction has to be considered, especially during the second period of childhood, in which danger may arise from playmates or schoolfellows. This applies equally to children of either sex. Danger may also arise from adults, not only through systematic seduction on the part of grown persons who deliberately debase the mind of youth, but also in other ways. The conversations of adults often lead to sexual acts on the part of children, who understand far more of what is said in their presence than grown-ups commonly believe. While the child is to all appearance immersed in a book, while a girl is playing with her doll, or a boy with his tin soldiers, the parents or some other adults carry on a conversation in the child's presence under the influence of an utterly false belief that the latter's occupation engrosses his or her entire attention. Yet many children, in such cases, are listening to what is being said with all their ears. Especially foolish, however, are those parents who believe that by the employment of innuendo they are able to conceal from any children who may be present the true inwardness of their conversation. In these matters children are as a rule far sharper than their elders are accustomed to believe. It is hardly necessary for me to point out that opportunities for direct observation are especially dangerous to children. I allude more particularly to the case of children living in the same house with prostitutes; but the danger is hardly less when the children have an opportunity of observing their own parents engaged in sexual acts, or even in the mere preparation for such acts. Forel[77] quotes the report of an experienced physician to the effect that the children of peasants who have watched the copulation of animals often attempt to perform such acts with one another, when bathing, or when any other opportunity offers.
In the preceding portions of this 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 cooperate 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 in 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 in 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 in 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. #-#). 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 #. 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 in attained.
It in 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 he 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 an 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 grown-ups, 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 mouths 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 oven 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 boys 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 his 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.