In both the permanent and periodical phases of the malady, the sexual sphere is frequently invaded. Sometimes the maniacal outbreak, in the periodical form, will assume the sexual character almost exclusively, in which condition most revolting acts are quite unconsciously committed, commonly followed by a period of great moroseness and depression.

While it has been quite generally remarked that the maniacal impulse in women almost invariably takes a sexual direction, we are sometimes at a loss to determine how much of this is due to heightening of the sexual feeling, and how much to withdrawal of rational inhibitory restraint; possibly the latter factor, quite as much as the former, may be regarded as causative.

In the "masturbatory insanity" of asylums, it is frequently difficult to separate the cause from the effect; and, although the statement of Sir William Ellis, that he had no hesitation in ascribing a great proportion of the cases of mental disease to masturbation,1 is partially discredited in the light of modern research, it is yet undeniable that very many cases of mania, idiocy, epilepsy and diseases of the spinal cord do result from it.

Thus, at the State Hospital for Criminal Lunatics, Matteawan, New York, from 1875 to 1897, as I have elsewhere stated, masturbation was the sole assigned cause of insanity in 120 men, out of a total of 1630; being auxiliary to other causes in numerous other cases; while Dr. Clara Barton found, among 121 cases of insanity in young women, no fewer than ten in which masturbation was the sole discoverable cause.1

Griesinger was the first to point out, however, in this apparently strong presentment against the practice, a factor hitherto overlooked: that not so much masturbation itself, as the feeling aroused in sensitive minds by the altitude of society toward the vice, was productive of brain disease; and the general progress of cultivated opinion seems, at present, rather away from the earlier and more arbitrary view. Nevertheless, I repeat, it is undeniable that self-abuse, begun early and long continued, may become a self-sufficient cause of permanent and incurable mania.'

' In confirmation of this view, see Marro, " La Puberta," p. 174, and Spitxka, "Cases of Masturbation," Jour. Menl. Science, July, 1388.

In confirmed mania, sexual delusions and religious hallucinations seem to play the strongest part; while in the simpler forms of maniacal exaltation the deeper sexual purpose is commonly lost in the frivolities which attend its manifestation. Thus, a maniac will take the greatest delight in mock courtship, lewdness of speech, tickling women, or even feeling their legs, breasts and genitals, without the remotest impulse or desire for the sexual act; just as, in the religious equivalent, there is much talk of virginity, purity, and becoming nuns or celibates, without the least idea of the sexual point involved.

It is fortunate for society that in mania, unlike epilepsy and some other neuroses, the sexual instinct seems to be, as a rule, nil. In periodical insanity it frequently becomes furibunda! and violent, manifesting in some cases an unmistakable tendency to reversal;1 but on the whole, outside of the harmless and thoughtless acts of children, sexuality plays a very slight part in the cases of the incurable insane.