Forel likewise (_Die Sexuelle Frage_, 1906, p. 276), remarking on the much greater prevalence of erotic manifestations among insane women than insane men (and pointing out that it is by no means due merely to the presence of a male doctor, for it remains the same when the doctor is a woman), considers that it proves that in women the sexual impulse resides more prominently in the higher nervous centers and in men in the lower centers. (As regards the great prevalence of erotic manifestations among the female insane, I may also refer to Claye Shaw's interesting observations, "The Sexes in Lunacy," _St. Bartholomew's Hospital Reports_, vol. xxiv, 1888; also quoted in Havelock Ellis, _Man and Woman_, p. 370 et seq.) Whether or not we may accept Näcke's and Forel's interpretation of the facts, which is at least doubtful, there can be little doubt that the sexual impulse is more fundamental in women. This is indicated by Näcke's observation that among idiots sexual manifestations are commoner in females than in males. Of 16 idiot girls, of the age of 16 and under, 15 certainly masturbated, sometimes as often as fourteen times a day, while the remaining girl probably masturbated; but of 25 youthful male idiots only 1 played with his penis. (P. Näcke, "Die Sexuellen Perversitäten in der Irrenanstalt," _Psychiatrische Bladen_, 1899, No. 2, pp. 9, 12.) On the physical side Bourneville and Sollier found (_Progrès médical_, 1888) that puberty is much retarded in idiot and imbecile boys, while J. Voisin (_Annales d'Hygiène Publique_, June, 1894) found that in idiot and imbecile girls, on the contrary, there is no lack of full sexual development or retardation of puberty, while masturbation is common. In women, it may be added, as Ball pointed out (_Folie érotique_, p. 40), sexual hallucinations are especially common, while under the influence of anesthetics erotic manifestations and feelings are frequent in women, but rare in men. (Havelock Ellis, _Man and Woman_, p. 256.) The fact that the first coitus has a much more profound moral and psychic influence on a woman than on a man would also seem to indicate how much more fundamental the sexual region is in women. The fact may be considered as undoubted. (It is referred to by Marro, _La Pubertà_, p. 460.) The mere physical fact that, while in men coitus remains a merely exterior contact, in women it involves penetration into the sensitive and virginal interior of the body would alone indicate this difference.