A case was reported from New Orleans in which menstruation began at the age of three months and continued regularly thereafter. This was a case of premature general growth; at the age of four years the girl was over 4 feet high, and her breasts were the size of a large orange. As a general rule, in these cases of premature development of the reproductive organs in girls, the great size of the breasts attracts especial attention. According to Kisch (op. cit., p. 78), these girls with precocious menstruation and premature sexual development very commonly exhibit also a comparatively high body-weight, great development of fat, and early dentition; they look older than their years, and their genital organs also develop very early, with hair on the pubes and in the axillæ; the labia majora and the breasts resemble those of full-grown women, and the pelvis also has the adult form. Commonly also the sexual impulse develops early, whilst in other respects the mental development lags behind the physical.
In the post-mortem room, corresponding conditions are occasionally found in the ovaries; and some writers express the opinion that such premature sexual development is commoner than would appear from the comparative rarity of reports on the subject. Unquestionably, examination of the ovaries of young girls not infrequently leads to the discovery of ripe ovarian follicles; in one case this happened in the body of a female infant born prematurely. In a girl five years of age, fifteen follicles were counted in the ovaries. Liégeois,[55] in post-mortem examinations, twice found mature ova in girls two years of age.
Similar cases of premature sexual development are occasionally seen also in boys. For example, Breschet, in the year 1820, reported the case of a boy three years of age who exhibited all the signs of puberty. His voice resembled that of a young man of sixteen to eighteen. The length of the flaccid penis was 9.6 cm. (3¾ inches), its diameter at the root was 7.2 cm. (2¾ inches); the length of the organ when erect was 13.5 cm. (5¼ inches). In the presence of girls or women the boy's penis became erect, his whole manner became more vivacious, and his hands were directed towards the genital organs of these females. Masturbation was never observed. The boy showed many additional signs of premature development. For instance, the central incisors of the upper jaw were cut at the age of three months. Breschet also quotes a case published by Mead, in which a boy had undergone the puberal development before the end of the first year of his life; when five years of age, he died of pulmonary consumption, attended with all the signs of old age. The same writer records another case, that of a boy five years of age, whose genital organs were fully developed, who had a well-grown beard, and exhibited, in short, all the (physical) characteristics of complete sexual maturity. In accordance with the theoretical views of that day, more especially as a result of the wide acceptance of the phrenological doctrines of Gall, it was generally believed that an exceptional development of the cerebellum (which was supposed by Gall to be the seat of the sexual impulse) was the determining cause of such premature awakening of the sexual impulse.
Contrasted with the cases just described, are those in which there is a retardation of the whole course of sexual development, so that the signs of sexual maturity are not manifested until an age greatly exceeding the average "age of puberty." In respect of one symptom or several, many individuals may remain throughout life in an infantile condition. This is occasionally seen, for example, in dwarfs. It would be of great interest, from this point of view, to make a careful study of the sexual behaviour of dwarfs. In this respect, dwarfs appear to vary greatly. These differences depend, in part, at least, upon the fact that many persons are classified as dwarfs who do not, strictly speaking, belong to this category. This statement applies more especially to those whose growth has been impaired by rickets; for, properly speaking, those only should be designated dwarfs who are, though small, generally well-proportioned; and the term should not be applied to those in whom the defective stature is consequent on rachitis or some similar disease. It appears doubtful, however, if the confusion of terms just mentioned explains all the observed differences in the sexuality of those commonly spoken of as "dwarfs." From data communicated to me concerning a fairly large community of dwarfs, living in a single place, and in whom the dwarfing appears to have no connexion with rickets, it would seem that in the case of true dwarfs there is considerable variation in sexual behaviour. This particular group of dwarfs constitute a society of persons living and working together. Although they are all living in close association, there seems to be a striking lack of warmth in their sexual relationships. Notwithstanding the fact that they have been living together for ten years, they still address one another formally as "Mr." and "Miss." In the case of the male dwarfs, with one exception all had fully developed genital organs; the exceptional instance was that of a member of the community then thirty years of age, in whom the genitals were rudimentary. All were endowed with normal sexual impulse, but this was directed towards persons of normal stature. In one of these dwarfs, an Italian, the genital organs remained undeveloped and hairless until he attained the age of twenty-eight; then these organs underwent the normal degree of growth, and at the same time pubic hair appeared. As already mentioned, the sexual inclinations of dwarfs appear as a rule to be directed towards fully grown persons, and I knew one dwarf twenty years of age who never missed an opportunity of pressing up against a certain very pretty young lady. These observations of my own regarding the sexual inclinations in dwarfs are confirmed by other cases recorded in the literature of the subject, although in isolated instances sexual attraction between a male and a female dwarf has been observed to eventuate in the birth of a child.
This is the place in which to refer to those cases of which a brief mention was made in the first chapter, to which von Krafft-Ebing has given the name of sexual paradoxy. Activity of the sexual impulse is sometimes observed at an age at which this impulse is normally quiescent. The term applies alike to cases in which the sexual impulse becomes active in early childhood, and to cases in which the impulse persists to an advanced age. Whilst the cases in which the phenomena of contrectation alone occurred have commonly been overlooked, considerable attention has been paid to those cases in which the sexual impulse manifests itself by peripheral changes, more especially by premature impulse towards masturbation or towards actual sexual congress with one of the other sex. It was shown, however, in the last chapter, that active manifestations of the sexual impulse during childhood are not always paradoxical. If we examine cases which have been published as coming under this latter category (I limit myself here to cases occurring in childhood, and am not speaking of sexual paradoxy in old age), we find that they are characterised more particularly by the strength with which the peripheral sexual impulse manifests itself. There is, in fact, a marked distinction between cases, according as we have to do with an occasional general sensation in the genital organs, or with masturbation to excess and with sexual assaults upon others. But we must not describe as sexual paradoxy all manifestations of the sexual life occurring in early childhood. A reference to the last chapter will show that the cases of sexual paradoxy, when accurately studied, differ from the normal rather quantitatively than qualitatively. During the first period of childhood, and more especially during the first few years of life, a case in which sexual activity in a child threatens the well-being of members of that child's social environment is so sharply differentiated from the normal that there can hardly arise even momentary hesitation regarding the paradoxical nature of the manifestation. On the other hand, we shall do well to follow von Krafft-Ebing in excluding from the category of sexual paradoxy those cases in which sexual excitement is caused solely by peripheral inflammatory stimuli, balanitis (inflammation of the glans penis), threadworms, and the like. These are not instances of sexual paradoxy, because the essential characteristic of the latter is that it originates centrally, even though its manifestations take a peripheral form.
I will now recount three cases which I regard as pathological in nature, and as examples of a paradoxical sexual impulse.
Case 7.—The girl X., six years of age, stated by the mother to be free from all morbid inheritance, produces the general impression of being a nervous subject. She is affected with facial muscular spasms, especially affecting the corners of the mouth, the eyelids, and the neck. Her mental development, as far as can be judged from my own observations and from the account given by the parents, is perfectly normal; but attention is at once attracted by the appearance of premature development. The mother states that in the second year of life, owing to the carelessness of a nursemaid, the child fell out of her cradle, without, however, sustaining any manifest injury. The mother does not think there is any reason to suppose that the child has ever been led astray in sexual matters. For the past two years or more, the mother has noticed that the child likes to press up against articles of furniture in such a way that her genital organs come into contact with narrow edges or corners; for example, the back of a chair, and especially a small portfolio-stand in the room. At first the child did this very often. Then the mother forbade it, and the father whipped her several times for doing it; since then it has been done more furtively, but the mother has none the less often seen it done. When the child is in bed she plays with the genital organs with her fingers. A definite orgasm occurs: there are spastic twitchings of the whole body, the eyes brighten, the respiratory rhythm changes; all these changes, occurring as they do in association with the artificial stimulation of the genital organs, combine to prove that we have not to do here with a simple spasmodic neurosis, but with the artificial induction of the sexual orgasm. The process is, moreover, confined to peripheral manifestations. The most careful observation failed to show the existence, in association with the sexual excitement, of any especially tender sentiments towards other individuals.
Case 8.—The boy Y. was brought to see me when he was eight and a half years of age. From the second year of life he had been noticed to be subject to masturbatory impulses, attended from the first with erection of the penis. The practice of masturbation increased to such a degree that before the boy was four years of age it was found necessary to keep him separate, as far as possible, from his brothers and sisters to save these latter from being corrupted by him. But notwithstanding this precaution, by the time he was five years old he had begun to make sexual attacks on a sister one year older than himself. He was cunning enough to arrange matters in such a way that he was alone with his sister, at times when the usual safeguards to keep him separate from the other children were suspended—for example, when his parents were away, and when his governess (who had been made fully acquainted with the circumstances) was keeping some assignation of her own. (All this was fully elucidated at a later date. The distressed parents were foolish enough to imagine that a child with inherited morbid predispositions of this character could be adequately safeguarded by means of hired help; they were painfully disillusioned when it appeared that the hired assistant, instead of watching the child, was pursuing her own pleasures—a point in which she merely imitated the parents, themselves earnest pleasure-seekers, deluding themselves with the belief that everything possible was being done for their child.) Although the parents had known all about the boy's habit of masturbation for many years past, it was only through a fortunate accident, and after the sexual malpractices with the sister had been going on for a long time, that these at length came to light. It appears that the boy had from time to time made sexual advances to other girls than his sister. One day, while playing with the little daughter belonging to a neighbouring family, he endeavoured to lead this child sexually astray. The little girl told her parents what had happened, and these latter consequently refused to allow her to play with Y. any more. This prohibition led Y.'s parents to inquire into the whole matter with great care. It was then discovered that for years past Y. had been engaged in sexual misconduct with his sister, his usual method being to play with her genital organs with his hands. In the girl, the frequent repetition of this act had given rise to abrasions and local inflammations.
The following case, the leading features of which are the early age at which seminal ejaculation occurred, and the marked hyperæsthesia of the sexual impulse, may also be regarded as an example of sexual paradoxy. This patient exhibits a number of different perverse modes of sexual sensibility, some of which have persisted to the present day.
Case 9.—Z., now thirty years of age, admits prolonged sexual excesses, and divides his sexual history into two periods: the first period extends from the age of seven to the age of twelve, before he had learned the use of alcohol; during the second period, from the age of thirteen to the age of thirty-years, his sexual excesses occurred under the influence of alcohol. He gives his own history in the following terms:—