The first class includes cases in which there is more or
less congenital abnormality, but otherwise a fair or even complete degree
of mental integrity; they are usually young adults, they are more or less
precisely conscious of the end they wish to attain, and it is often only
with a severe struggle that they yield to their impulses. In the second
class the beginnings of mental or nervous disease have diminished the
sensibility of the higher centers; the subjects are usually old men whose
lives have been absolutely correct; they are often only vaguely aware of
the nature of the satisfaction they are seeking, and frequently no
struggle precedes the manifestation; such was the case of the overworked
clergyman described by Hughes,[61] who, after much study, became morose
and absent-minded, and committed acts of exhibitionism which he could not
explain but made no attempt to deny; with rest and restorative treatment
his health improved and the acts ceased. It is in the first class of cases
alone that there is a developed sexual perversion. In the cases of the
second class there is a more or less definite sexual intention, but it is
only just conscious, and the emergence of the impulse is due not to its
strength but to the weakness, temporary or permanent, of the higher
inhibiting centers.
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