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.)