bare heel came into contact with the genitals, and she
then masturbated by rubbing the two parts together. I myself have known
the case of a young girl who sat with her legs beneath her, and
masturbated with the boot she was wearing. In many instances we are
enabled, by watching the child's movements, to ascertain with such
certainty what it is doing, that no confirmatory evidence is needed. We
notice, especially, that when the orgasm is approaching, the movements
change in character and rhythm. The eyes become bright, and the face
assumes an excited and voluptuous expression. This may be observed even
in infants in arms. Townsend[79] reports the case of an infant, eight
months old, "who would cross her right thigh over the left, close her
eyes and clench her fists; after a minute or two there would be complete
relaxation, with sweating and redness of face; this would occur about
once a week or oftener; the child was quite healthy, with no abnormal
condition of the genital organs."

In the absence of these definite indications, it is necessary to be
cautious in coming to a diagnosis. Failing such caution, mistakes which
may entail serious consequences are likely to arise. Two cases are known
to me in which, after suspicion had rightly or wrongly been aroused, the
child's most harmless movements were regarded as masturbatory in
character. If a child becomes aware that its mother or some other person
in authority is making such a mistake, the effect will naturally be very
unfavourable. We have also to reckon with the fact that children who are
somewhat older, from eight or nine years upwards, hardly ever masturbate
when others are present, but only when they believe themselves to be
unobserved--in bed, in the closet, or when out walking. In such cases it
is hardly possible to diagnose masturbation with certainty; more
especially in view of the fact that the signs that may betray an older
boy--stains on the shirt or other articles of underclothing--are usually
lacking during the first two periods of childhood. It must be added that
such stains on linen resulting from ejaculation do not at first contain
spermatozoa, and for this reason their diagnostic value is greatly
lessened (see pp. 52-56). Still, the possible appearance of these stains
is a matter to which attention should always be paid, and this in girls
as well as in boys. In many instances, also, our diagnosis may be
supported by the discovery of articles used for o