In almost all forms of dementia, except those due to pathological causes, such as apoplexy, traumatism, paresis, and the various secondary psychoses arising from irmammatory processes in the cortex, the sexual factor is always a dangerous one. In the latter cases, according to Krafft-Ebing, whose usually accurate judgment in such matters does not appear here to be well borne out by the facts, "perversions of the sexual instinct seem to be infrequent." *
1 Giraud, Annal. Med. Psychol., 1855, No. 1. Emmmghaus also draws attention to the occasional open manifestation of sexual instinct in idiots, comprising public masturbation, exhibition of the genitals, attacks on children, and sodomy. Vid. Maschka's "Handbook." rv,234.
That very grave and frequent perturbations of sexuality do follow both apoplexy and trauma capitis, may be proven by various clinical histories; as a matter of fact, from his own.
Thus, Case 149,* having passed through a cerebral attack which incapacitated him for business, one day locked two young girls in the house, during his wife's absence, gave them liquor, and carried out his sexual purpose. The medical experts established mental weakness, resulting from apoplexy; and his own confession was that he committed the act because of a quite uncontrollable impulse.
So, Case 150,1 subsequently to being injured in the skull by a horse, developed an inordinate and beastly sensuality. His last act was to rape a girl of twelve, and afterward strangle her, to prevent discovery of the lesser crime.
The most general experience is, I think, that whatever the cause of the mental weakness, whether traumatic, idiopathic, or inherited, the sexual manifestations will be found to be very similar, being those chiefly and simply of uninhibited sexual impulse.
In senile and paretic dementia, while episodical and highly intensified manifestations of libido occur, the tendency, fortunately, is toward gradual extinction.
In the prodromal stage of mental obnubilation, however, loose talk, a suggestive picture, touching a woman, or manipulation of the genitals, may readily evoke, in the lessening light of moral consciousness, a passion which may culminate in grossly immoral acts.
Thus a patient, whom I had under treatment and surveillance for paretic dementia, arose one evening during the nurse's absence, deliberately undressed himself, put on a silk hat, and, wholly naked otherwise, rang the bell of a magnificent mansion, in an aristocratic neighborhood, handed his card to the maid at the door, and immediately followed up this polite convention by seizing the girl and attempting to rape her in the vestibule.
Fortunately the latter, a pretty German, was The Value of "experienced;" otherwise, American social prestige Experience Illus- might have suffered by the occurrence. She told me trated afterward that, at her last place, in Bavaria, the young pederasty. It considerably complicates the medico-legal aspects of these cases that many acts of violence are recorded, rapes, murders and criminal assaults, by persons who had not previously given any evidence of sexual activity; leaving it open to inference that such attacks were the result either of accidental emotional impulses, or, possibly, post-epileptic reflexes, transitory in character, and not forming an element of the original condition.
Count, her employer, used to do "shust like dot." Many cases are reported to show the unbridled nature of the passions in this condition. Legrand relates one where a hitherto respectable man, the father of a family, was found masturbating in the street, and sxixdhywing the semen ;a Krafft-Ebing, another of an officer, prominently connected, who made frequent daylight attempts to rape little girls at a watering place; * and both Mendel and Tardieu, the former in "Progressive Paralyse der Irren," and the latter in his "Attentats aux Moeurs," agree in making this mental malady the basis of very many cases of bigamy.
As in dementia and the associated psychoses, not Sexual Phases only is epilepsy characterized, very frequently, by of Epilepsy reckless and intense emotional manifestations of sexual passion, but the epileptiform seizures are often made the occasions of lawless violence. Usually, however, the epileptic will satisfy himself by masturbation, natural intercourse, or, if opportunity offer, 'ibid. • "Lafolie,"p.519. * "PsychopatbiaSexualis," p. 363.
In an epileptic seizure the cerebral disturbance is so profound, and general, that it would be strange did the sexual nerve-tracts escape some sort of stimulation; and that they are frequently so stimulated is proven by many facts within our observation, as well as by the positive statements of several eminent neurologists.
Arndt says that he has known epilepsy to express itself in a most sensual manner toward the sufferer's own mother;1 and Krafft-Ebing relates the case of a young epileptic, of bad heredity, who always, after his epileptic seizures, used to attack his mother and try to violate her.1 Simon mentions the case of an epileptic girl of twenty-three, of good morals, and well educated, who, during her attacks, would shout out obscene words, raise her dress, make the lascivious movements of intercourse, and by gesture invite men to approach her; * and Kiernan records the equally peculiar one of a young man who always had, as his aura, the vision of a beautiful woman, in most lascivious attitudes, which induced intense pleasure and ejaculation.4
In the case examined by Casper, a respectable man attacked four women on the street, one after another, actually succeeding in violating one of them in the presence of two witnesses; and notwithstanding the fact that "his young, pretty, and healthy wife lived hard by."1
Tarnowsky relates a case which, along with the epileptic significance of the act involved, illustrates the fatal passion among noble families in Europe for marrying within their own social class, whatever the physical, mental or moral hindrances.
The gentleman had led a dissolute life, and was subject to occasional epileptic attacks. On the evening of the wedding he appeared before the assembled guests, leaning upon his brother's arm. Bowing to right and left, he was the beau-ideal of high-bred aristocracy and refinement. When he came before his bride, however, his lofty eavoir vivre took a sudden and inordinate tumble. He opened his trousers, took out his penis, and began to masturbate himself before her and the horrified guests. After the paroxysm had passed, he had only a confused memory of the events, and could give no explanation of his acts.8