There are infrequent cases in which the sexual instinct persists until a great age. “Senectus non quidem annis sed viribus magis æstimatur” (Zittmann). Oesterlen (Maschka, Handb., iii, p. 18) mentions the case of a man aged 83, who was sentenced to three years’ imprisonment by a Wurtemberg court on account of sexual misdemeanors. Unfortunately nothing is said of the nature of the crime or of the mental condition of the criminal.[[33]]
The manifestation of sexual instinct in old age is not in itself pathological; but presumption of pathological conditions must necessarily be entertained when the individual is decrepit and his sexual life has already long become extinct; and when the impulse, in a man whose sexual needs were in his early life, perhaps, not very marked, manifests itself with greater strength, and strives for even perverse satisfaction in a shameless and impulsive manner. In such cases there is at once suggested a presumption of pathological conditions. Medical science recognizes the fact that such an impulse depends upon the morbid alterations of the brain which lead to senile dementia. This abnormal manifestation of sexual life may be the precursor of senile dementia, and make its appearance even long before there are any well-defined manifestations of intellectual weakness. The attentive and experienced observer will always be able to detect in this prodromal stage an alteration of character in pejus, and a deterioration of the moral sense accompanying the peculiar sexual manifestation.
The libido of those passing into senile dementia is at first expressed in lascivious speech and gesture. The next objects of the attempts of these senile subjects of brain atrophy and psychical degeneration are children. This sad and dangerous fact is explained by the better opportunity they have of falling in with children, but more especially by a feeling of imperfect sexual power. Defective sexual power and greatly diminished moral sense explain the additional fact of the perversity of the sexual acts of these aged men. They are the equivalents of the impossible physiological act.
The annals of legal medicine distinguish, as such, exhibition of the genitals,[[34]] lustful handling of the genitals of children,[[35]] inducing them to perform manustupration of the seducer, and performing masturbation[[36]] or flagellation on the victim.
In this stage the intellect may still be sufficiently intact to allow avoidance of publicity and discovery, while the moral sense is too far gone to allow consideration of the moral significance of the act and resistance to the impulse. With the progress of dementia, these acts are more and more shamelessly committed. Then care on account of defective sexual power disappears, and adults also become the objects of the senile passion; but the defective sexual power necessitates equivalents for coitus. Not infrequently sodomy results, and, as Tarnowsky (op. cit., p. 77) points out, in the sexual act performed with geese, chickens, etc., the sight of the dying animal and its death-struggles at the time of coitus afford complete satisfaction. The perverse sexual acts with adults are quite as horrible, and may be explained psychologically in the same way.
Case 49, in the author’s “Text-Book of Legal Psychopathology,” second ed., p. 161, demonstrates how enormously increased sexual lust may be during the course of senile dementia. Quum senex libidinosus germanam suam filiam æmulatione motus necaret et adspectu pectoris sciosi puellæ moribundæ delectaretur.
Erotic delirium and states of satyriasis may occur, in the course of the malady, with or without maniacal episodes, as the following case shows:—
Case 1. J. René, always given to indulgence in sensuality and sexual pleasures, but always with regard for decorum, has shown, since his seventy-sixth year, a progressive loss of intelligence and increasing perversion of his moral sense. Previously bright and outwardly moral, he now wasted his property in concourse with prostitutes, frequented brothels only, asked every woman on the street to marry him or allow coitus, and thus became so publicly obnoxious that it was necessary to place him in an asylum. There the sexual excitement increased to a veritable satyriasis, which lasted until he died. He masturbated continuously, even before others; took delight only in obscene ideas; thought the men about him were women, and followed them with indecent proposals (Legrand du Saulle, “La Folie,” p. 533).
Moreover, women previously moral, when affected with senile dementia, may manifest similar conditions of great sexual excitement (nymphomania, furor uterinus).
It may be seen from a reading of Schopenhauer,[[37]] that, as a result of senile dementia, the abnormally excited and perverse instinct may be directed exclusively to persons of the same sex (v. infra). The manner of the satisfaction is here passive pederasty, or, as I ascertained in the following case, mutual masturbation:—