years ago I was called upon to give my opinion as an expert in a case of pederasty.
On looking through my observations on this subject, and comparing them with the corresponding chapters of the most widely known manuals of forensic medicine, I was struck with the want of agreement between the assertion of official science on the one hand and clinical facts on the other. Each fresh technical examination taught me more clearly to recognize not only how insufficient was the knowledge contained in the manuals dealing with perversity of genesic activity, but also the incorrectness of many of the guiding principles of examination into the actual circumstance. Later studies on this matter by KRAFFT-EBING, LOMBROSO, CHAR- COT, MAONAN and other alienists have rendered
XVIII INTRODUCTION.
it quite impossible to adhere to former views, and yet further confirm my conviction of the truth of the conclusions I have deduced from clinical observation.
At present the difference of opinion between the medical jurist and the clinical physician has become so broad, that it appears to be highly necessary, in order to explain these contradictions, to indicate the foundations on which approximately correct answers to medico-forensic questions may be based, and to prepare the way for wider, more united and more fruitful study of the subject.
The medical jurist sees depravity, over- satiated lust, inveterate vice, wickedness, and so on, where the clinical observer recognizes with certainty the symptoms of a morbid condition with its typical evolution and result. Where the former would punish vice, the latter enters a plea for the necessity of methodical therapeutics. On the other hand, there is a whole series of acts, which are relatively but lightly punished by the law, in which the medical jurist sees only impropriety, caprice or play carried too far, recognizing all the time the moral responsibility of the culprit, whereas the clinical observer discerns therein the outset of a grave malady, the
INTRODUCTION. XIX
beginning of an incurable psychical disturbance, requiring careful watching and treatment. Lastly, the clinical doctor discovers real depravity and complete moral decay in cases, where the medical jurist is more often inclined to suppose the wrong-doer a victim of violence or of fraud.
It is certainly not difficult to understand, why, in any question as to perversity of the genesic activity, the observations and conclu- sions of the clinical physician must take precedence in the discovery of the truth. The medical jurist has exclusively to do with incriminated persons, who first of all seek to escape punishment and therefore mostly deny quite obvious facts. Even in the rare cases of frank admission of culpability the accused sees no reason for describing the intimate causes and motives of his actions. The physician appears naturally in his eyes more as an accuser than as a defender; and when, having made up his mind to undergo the sentence, he confesses the facts, he has no object to gain in making an avowal, one generally fraught with ill -con sequences to himself, of his perverted sexual instincts and the impulses that drive him to gratify his genesic sense in abnormal ways. It is but
XX INTRODUCTION.
seldom that the medical jurist can obtain the diaries of such individuals, their . corre- spondence or other interesting documents, such as are for instance to be found in the classical treatises of Caspar and of Tardieu. But such diaries and autobiographies show very prominently the usual fault of all productions of the kind, viz. the wish to excite interest, to exhibit their good aspects only. In this way the description becomes exaggerated, untrue and utterly deceptive. The clinical physician on the contrary has not to examine incriminated persons. The sufferer comes to him spontaneously to seek for advice. He hopes for assistance from the physician and in all sincerity confides his ailments to him, even in their slightest details. There is no room here for preme- ditated fraud or conscious un veracity. The physician is therefore in a position to distinguish the initial symptoms of an anomaly or of a malady, to follow its development and observe its progress during a number of years. By such means he obtains a complete, consistent and decisive view of the disease.
The representatives of two specialities are the most frequently consulted by such patients:
INTRODUCTION. XXI
physicians devoted to the treatment of mental diseases and specialists for diseases of the genital organs. To the first the applicants are mostly persons with well-defined symptoms, in whom there also exists concurrent perversity of the genesic instinct, not to mention other derangements of the nervous system. The disturbance of the genesic activity is here only an accessory symptom among the series of the other more serious cerebral phenomena which trouble the patient. The specialists for mental diseases have besides opportunities for observing in their asylums the ultimate form of those maladies, which at their inception are manifested in perversity of the genesic action and terminate in complete madness.
Specialists for diseases of the genital organs are resorted to by such as find themselves suffering from any manifestations of organic anomaly, however slight, from arrested devel- opment or from the premonitory signs of incipient disease, when a diminution of the sexual power comes into prominence above all other symptoms, or finally when syphilitic infection makes an avowal inevitable of some perversity of the genesic sense of one sort or another.
XXH INTRODUCTION.
Amongst those consulting the specialist of this class are: The Young Man who after attaining the age of manhood becomes aware of complete impotency where women are concerned, and is obscurely conscious of abnormal sexual promptings within; the Old Man, whose sexual activity has long ago disappeared, but who suddenly feels a new sensual impulse, an exaggerated wantonness and morbid stimulation of desire; the Husband, who idolizes his wife and from time to time gives way to the irrepressible sexual impulse, but who feels impelled to accomplish the conjugal act in some quite unusual and to his own consciousness disgusting manner; the Voluptuary, who has become aware of a diminution of his genesic power and does not know whether it is to be attributed to a quantitative or a qualitative alteration of function. All these haste first of all to the specialist in maladies of the genital organs for advice. Again it is to him the habitual pederast makes his involuntary confession, who has accidentally become inoculated with syphilis, and the boy who has recently been seduced and finds himself attacked by some trouble of the anus or rectum. The avowal of their failing is usually a source of great
INTRODUCTION. XXIII
moral mortification to patients. It is often made in writing, with precautions of mystery and secrecy ; and then a frank confession can only be expected, if the physician avoids meeting it with reproof, but holds himself ready to give his assistance.
I may further remark in this place, that nearly all pederasts, of whatever rank, are more or less known to each other, at least in large towns, and that they generally go for advice to the same physician, whose task of obtaining open and frank confessions with regard to such abnormal genesic facts is much facilitated by the fact.
In the course of my 25 years of medical practice, I have had more particularly to do with various phases of disease affecting the genital organs. And as I carefully noted all my observations I was able to make a large collection of facts bearing upon morbid manifestations of the genesic sense.
The actual criminal and the undoubted madman are two extremes, between which is found a host of unrecognized sufferers, and vicious subjects burdened with an abnormal function of the genesic action; of these two classes the latter will furnish the greater part of the material for the following investigation.
XXIV INTRODUCTION.
Intrust that [observations, not emanating from the prosecuting bench, nor from the registers of lunatic asylums, observations taken on persons belonging to society in general, who have not been bereft of their legal status,
