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PART II.

DISORDERS IN CHILDHOOD.

It were well if the child's reproductive organs always remained in a quiescent state till puberty. This is unfortunately not the case.

Amongst the earliest disorders that we notice is sexual precocity.

CHAPT. I.-SEXUAL PRECOCITY.

In many instances, either from hereditary predisposition, bad companionship, or other evil influences, sexual feelings become excited at a very early age, and this is always attended with injurious, often with the most deplorable consequences. Slight signs are sufficient to indicate when a boy has this unfortunate tendency. He shows marked preferences. You will see him single out one girl, and evidently derive an unusual pleasure (for a boy) in her society. His penchant does not take the ordinary form of a boy's good nature, but little attentions that are generally reserved for a later period prove that his feelings is different, and sadly premature. He may be apparently healthy, and fond of playing with other boys; still there are slight, but ominous indications of propensities fraught with danger to himself. His play with the girl is different from his play with his brothers. His kindness to her is a little too ardent. He follows her, he does not know why. He fondles her with tenderness painfully suggestive of a vague dawning of passion. No one can find fault with him. He does nothing wrong. Parents and friends are delighted at his gentleness and politeness, and not a little amused at the early flirtation. If they were wise they would rather feel profound anxiety; and he would be an unfaithful or unwise medical friend who did not, if an opportunity occurred, warn them that such a boy, unsuspicious and innocent as he is, ought to be carefully watched, and removed from every influence calculated to foster his abnormal propensities.

The premature development of the sexual inclination is not alone repugnant to all we associate with the term childhood, but is also fraught with danger to dawning manhood. On the judicious treatment of a case such as has been sketched, it probably depends whether the dangerous propensity shall be so kept in check as to preserve the boy's health and innocence, or whether one more shattered constitution and wounded conscience shall be added to the victims of sexual precocity and careless training. It ought not to be forgotten that in such cases a quasi-sexual power often accompanies these premature sexual inclinations. Few, perhaps, except medical men, know how early in life a mere infant may experience erections. Frequently it may be noticed that a little child, on being taken out of bed in the morning, cannot make water at once. It would be as well if it were recognized by parents and nurses that this often depends upon a more or less complete erection.

PREDISPOSING CAUSES.—What the cause of this early sexual predisposition in a young child may be, it is difficult to lay down with certainty in any given case. My own belief is, that there are sexual predisposing causes. I should specify hereditary predisposition as by no means the least common. It cannot be denied that as children soon after birth inherit a peculiar conformation of features or frame from the parent, so they frequently evince, even in the earlier years of childhood, mental characteristics and peculiarities that nothing but hereditary predisposition can account for. I believe that, as in body and mind, so also in the passions, the sins of the father are frequently visited on the children. No man or woman, I am sure, can have habitually indulged their own sexual passions to the exclusion of higher and nobler pleasures and employments, without at least running the risk of finding that a disposition to follow a similar career has been inherited by their offspring. It is in this way only that we can explain the early and apparently almost irresistible propensity in generation after generation indulging in similar habits and feelings. No doubt vicious tendencies are frequently, perhaps most frequently acquired. But I firmly believe that moral as well as physical diseases, when acquired, can be transmitted to the progeny.

Exciting CAUSES.—There are, however, not a few directly exciting causes which can, and do frequently, not only foster this terrible proclivity to early sexual feeling when acquired by inheritance, but even of themselves alone beget it.

We see in some children, at a very early age, an almost ungovernable disposition to touch or handle the sexual organs. This most dangerous habit is not unfrequently, I believe, produced by irritation of the rectum arising from worms. In other instances it arises from some morbid irritability of the bladder. Of the existence of this latter cause another symptom often appears, viz., the constant wetting of the bed at night.

There is, besides, in many persons, as will be mentioned hereafter (p. 77), a morbid sensibility of the external organs, that is excessively troublesome and often painful. This symptom may, I believe, appear very early in life, and, if not removed, lead to consequences that will be aggravated by youthful ignorance and want of self-control. It is to be wished, that all medical men attached to large institutions where young boys are collected, would bear this in mind. However natural the delicacy they feel in investigating such ailments, yet in this, perhaps above all other evils, prevention is better than cure.

Irritation of the glans penis arising from the collection of secretion under the prepuce is another cause which should not be neglected. Since the time that my attention was first called to this subject I have had abundant evidence that the influence of a 'long prepuce in producing sexual precocity has not been sufficiently noted. In the child the prepuce entirely covers the glans penis, keeping it in that constantly susceptible state that the contact of two folds of mucous membrane induces. We must recollect, moreover, that the child has never been taught to draw back the foreskin, and although the smegma is but sparely, if at all, secreted in early childhood, yet that it may under excitement, make its appearance, and if so ought to be removed, as in the adult, by daily ablution.'

i Careful ablution of the glans and prepuce every morning will be beneficial for all persons, and if it is neglected, annoyance will be experienced, especially by those who have a long prepuce, from the collection of the secre

A long and narrow prepuce is, in my opinion, a much more common cause of evil habits than parents or medical men have any idea of. The collection of smegma between the glans and the prepuce is almost certain to produce irritation.

PREVENTIVE TREATMENT.—The first point to be observed will already have suggested itself-cleanliness. Yet I have never heard of any steps being taken by those having the care of youth to induce boys to adopt cleanlier habits in this respect. Children are educated to remove dirt from every other part of their bodies (where it is of less importance in its consequences than it is here), but probably a nurse, parent, schoolmaster, or even doctor, would be somewhat astonished at its being proposed that a boy of twelve should be told (for if not told he will never do it) to draw back the prepuce and thoroughly cleanse the glans penis every day in his bath. In my own experience of the treatment of children, I have found this practice so beneficial, that I never hesitate to recommend it in any cases where there is the least sign of irritation from this or similar causes.

The only objection which can be suggested to recommend thorough cleanliness in early childhood is the supposed risk of directing the boy's attention to manipulations, which may excite sexual desires.

This vague alarm that we must not allude to these sexual matters because forsooth some ill consequences may arise has no longer any influence on me. Daily experience teaches me that much prejudice has too long existed on these questions. I am fully convinced from the acknowledgments of patients that the effects of advice to young men has had no such tendency. Even if the dreaded evil should arise, the same boy who had received such recommendation, supposing the advice was followed by any morbid sensations, would come to the same medical friend and state the consequences, in the full assurance that he would retion round the glans penis; but it should be remembered that this white secretion is natural, and not a symptom of disease. Quacks have frequently so wrought upon the fears of ignorant patients, especially those whose consciences were not clear, as to induce them to think they were labouring under some peculiar affection, whereas a little soap and water would have acted as a sufficient remedy.

ceive sympathy and any further advice that might be necessary. I am convinced of the fact that when any such irritation or derangement exists, if the proper steps (of which cleanliness is the most effectual) are not taken to check it, the child will in ignorance handle the organs, and the dangers arising in this way are much greater than those attendant on mere ablution, especially in cold water.

Nothing of course can be more important than carefully to guard against unnecessary manipulation from whatever cause. Children should be early taught not to play with the external organs. Without giving any reason, they may be desired to keep their hands away, which will in most cases be sufficient, if there is no physical exciting cause. The smallest sign, however, of the existence of any such cause should never be neglected. If, for instance, a child wets his bed, —which is generally almost the first indication the parents have of the presence of irritation, the organs should be examined, and the boy's other habits watched. The irritation is only too likely to determine blood to the part, and the unpleasant symptoms, moreover, show a nervous susceptible temperament, which always requires careful attention.

The cases in which an operation may be required on the prepuce are for the surgeon's decision, and are not within the scope of our present remarks. It has been, indeed, suggested by persons fully competent to form an opinion that the universal performance of circumcision would be of no small benefit. This, however, can be only a speculation. Circumcision is never likely to be introduced amongst us, and there is no doubt that cleanliness will suffice in most cases to remove all ill effects arising from the existence of the prepuce.

1 In a state of nature the foreskin serves as a complete protection to the glans penis; nevertheless to the sensitive, excitable, civilized individual, the prepuce often becomes a source of serious mischief. In warm climates, the collection of the secretions between it and the glans is likely to cause irritation and its consequences; and this danger was perhaps the origin of circumcision. The existence of the foreskin predisposes to many forms of syphilis, and I am fully convinced that the excessive sensibility induced by a narrow foreskin, and the difficulty of withdrawing it, is often the cause of emissions,

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