that matter is highly desirable in the case of normal children as well.

Sexual Education.-Concerning the normal physiology of the genital organs at puberty-the appearance of the menses in girls, and of nocturnal emissions in boys-I believe that each child should so far as possible receive individual instruction. This information may be imparted by the parent if he or she has the proper personality. If not, it would much better come from a physician. In my opinion, class instruction is much less desirable.

Sexual Abnormality as a Cause of Exceptional Development. -Some children are undoubtedly exceptional through abnormal development of the sexual organs, which causes either retardation or precocity. Exact knowledge of the cause of these conditions is still lacking, but recent experiments on animals and the clinical reports of several years show us that the endocrinal or ductless glands have a very pronounced influence on sexual development. The two glands that seem to be most important in this respect are the pituitary and the pineal, but we know now that the endocrinal glands do not act entirely independently. A recent case reported in medical literature (Case 93) is illustrative of this: Shortly before his death, a boy of 5 years and 10 months was 42 inches tall, 24 inches around his chest, and had genitals the size of those of a man. His death and his excessive bodily and sexual development were due to a large tumor of the cortex of an adrenal gland, while the pineal and the pituitary glands were normal. Lack of secretion of the pituitary body results among other things in retarded sexual development-the persistence of infantilism so far as the sexual organs and instinct are concerned. It has been thought that the pineal gland, which attains its maximum development between 7 and 13 years of age, and then degenerates, might exercise a retarding influence on the development of the sexual organs, and that precocity might result from a lack of pineal secretion. Recent experiments on young animals, however, show that when fed with this gland they developed both somatically and sexually more rapidly than normal animals of the same species. Extract of the pituitary body has been given in cases of infantilism with good effect, and we shall doubtless soon be able to treat both precocious and retarded sexual development more effectively.

XXII. SOME SEXUAL ABNORMALITIES

By DOCTOR W. F. BLAKE-BURKE, Plainfield, N. J.

Atypical Children and Sexual Problems.-In studying the group of exceptional children which Doctor Groszmann has designated as atypical, we are confronted with many cases in which the sexual life is perverted or at least gravely endangered. This is more particularly true of Class (a) of this group, "Neurotic and Neurasthenic Children." As a matter of fact, a certain school of psychiaters maintains that neurotic and psychopathic tension is invariably and intimately associated with, or even caused by, difficulties and abnormalities in the early sex life of children of both sexes.

The second class of atypical children, " Children of Pathologically Retarded Development," furnishes its quota of sexual perversions and inversions (homosexual manifestations). For it is this retardation in the development of physiologic function, with its bodily counterpart of infantile anatomical conditions in the reproductive organs, which is more or less directly responsible for sexual abnormalities. It would be perfectly correct to say that much of neuropathic and psychic tension is produced through this pathologic retardation of the physiologic growth rate in the sexual sphere when it stands in contrast with overstimulation and rapid growth in other directions.

Infantile Conditions.-The fact obtrudes itself upon our consciousness that the characteristic manifestations of the infantile sexual life persist in the adolescent of these types as inversions and perversions.

These infantile manifestations become exaggerated in the preadolescent or latent period, and labor against the influence of education, thus producing in the adolescent a generally backward mental condition. The sexual life in these children seems to eat up all their energy, to pervert all the strength they need for making normal intellectual progress.

In other cases we find in the adolescent a seemingly normal intellectual development which, however, when put to the test of the ordinary struggle for existence, fails owing to weakened stamina and exhaustion of reserve force.

Timely Training. My own practical observations strongly uphold Doctor Groszmann's contention that it is in the second or latent (prepubertal) period that special educational training will have the best chance of success. It is, therefore, absolutely necessary to watch out for evidences of abnormal sexual manifestations in this period-although it should be admitted that the "normal" for this period has still to be definitely determined. Nevertheless, any pronounced interest in sexual matters and symptoms of self-abuse or sexual aberration will have to be considered as danger-signals. There is little hope for cases of this kind without timely special educational training. For it is the instinct of sex with which every child is born which furnishes energies of tremendous power which are needed in the normal life evolution of the child, but which are deviated or sublimated in the latent period. Educational methods following the cultural development of the race will use them as barriers against which the storm and stress of adolescent days will battle in vain. Out of the period of mere sex-instinct, represented in the development of the race by the period of sex-worship and sex-fetichism, which reverberates in many of the early sex mannerisms of children, must rise the consciousness of higher entities in human reproduction.

The infantile form of the sex-instinct is intimately associated with other bodily functions, especially those of secretions which are located in or near the sex-organs. Allow them to continue unchanged through the latent period, and they will recrudesce as inversions and perversions in the adolescent. Ignorance of the infantile sexual life; misappreciation of the grave significance of abnormal sexual manifestations in the latent period, be it from prudery or ignorance; repression of sexual consciousness on the part of the child himself, from terror, shame, or ignorance, are at the root of abnormal developments in the later sex life.

The result is that mental development is retarded; even the ordinary somatic changes of adolescence are often absent. The natural purpose of sex development is obscured, the individual lingers in the preparatory stage and is led into harmful practices; and in the cases of more profound infantilism in this province we find even anatomical vestiges of hermaphroditism pointing back to the beginning of the formation of the sexual organs during intrauterine life.

Constipation.-Constipation in children of the type to which I have alluded is very often obstinate and of special significance. In many cases it yields to proper methods of treatment: diet, exercise, mental discipline, and suggestion, etc. Several cases have come to the writer's attention in which these methods seemed unavailing for quite some time. Two cases are of especial interest; in both, there seemed to be intentional retention of fecal matter for purposes of sexual stimulation. Both had suffered from constipation from early childhood, so that it must be assumed to have been a causal element in the production of abnormal sexual feelings. After this had been recognized by the boys in question, it was purposely used for the gratification of these feelings which had been found pleasurable.

Other Irritations.-There are, of course, other irritations leading to similar results. Abnormalities in the urinary tract and hyperacidity of the urine may irritate the sexual parts and cause sexual reflexes and masturbation. In boys, an ill-fitting saddle of a bicycle or horse may produce an irritation. In girls, riding a bicycle, or riding a horse astride, or even working a sewingmachine, has led to violent masturbation. The sedentary habits of the ordinary school child, especially during the preadolescent period, have played sad havoc with the awakening instincts. The child who wriggles in his seat, or seems to lose himself in self-absorption, with a fixed stare, needs a teacher's immediate attention.

It is thus seen that too much attention to the fundamental bodily functions of preadolescents, even of young children, cannot be paid by parents and family physicians; and that in the treatment of sexual aberrations, observation must be directed to these contributing factors. What has not been accomplished during the latent period in a child's development will present particular difficulties of management. We are dealing not only with psychopathic or neuropathic symptoms pure and simple, but with a perpetuation and recrudescence of infantile symptoms of sex-consciousness. While it is true that there is a distinct medical aspect to these cases, the matter of re-education is paramount, and this educational process will be most successful when begun before or during the latent period. An early diagnosis is essential.

XXIII. TREATMENT OF JUVENILE DELINQUENTS

By JOHN ADAMS COLLIVER, A.B., M.D., Los Angeles, Cal.

A Medico-Socio-Psychological Problem.-The treatment of juvenile delinquents is not purely a medical subject, of course; but a medico-socio-psychological problem. The real delinquent, the repeater, has formed a bad and antisocial habit, and his case is, therefore, chronic. In order to bring about corrective results it is necessary to consider the subject from an etiological, pathological (perversion), curative, and prophylactic point of view.

Etiology. The analysis of a few thousand cases examined by me shows that nearly 95 per cent are from broken homes; that is, where one or both parents are dead, or morally or mentally unable to discipline their children or themselves. Thus, the child has little or no home training of any value. This condition is always associated with bad environment, idleness, rarely with overwork, and is productive of vice and perverted habits which affect the child by the force of bad examples. On the other hand, the 5 per cent from good homes have been overindulged. It is useless to try remedies if the above-mentioned contributory factors are overlooked.

Pathology. Perversion.-Under this heading we consider two kinds of cases: those which cannot be helped, and those which can. In the first class we find about 18 per cent who are mentally defective. These, of course, should be graded and schooled accordingly. Another species of this same class is afflicted with so-called manias. I have seen numerous cases where the child was apparently normal, but possessing a peculiar mania for stealing certain things, as money, tools, jewelry, women's clothing,1 bicycles, and the like. These were stolen solely for the irresistible pleasure of doing it.

I do not believe there is a characteristic criminal type among children; nor that a blow on the head will produce criminality, notwithstanding the fact that many parents believed that the badness in their children dated from such a blow. Scarcely a week passed for several years in which some did not appear in court with such pleadings. I have never seen a case of delinHere we may be dealing with a perverted sexual instinct.-M. P. E. G.