Psychopathia sexualis: With especial reference to contrary sexual instinct / A medico-legal study
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Title: Psychopathia sexualis: With especial reference to contrary sexual instinct

Author: R. von Krafft-Ebing

Translator: Charles Gilbert Chaddock

Release date: March 26, 2021 [eBook #64931]
Most recently updated: October 18, 2024

Language: English

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*** START OF THE PROJECT GUTENBERG EBOOK PSYCHOPATHIA SEXUALIS: WITH ESPECIAL REFERENCE TO CONTRARY SEXUAL INSTINCT ***

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Psychopathia Sexualis,
WITH ESPECIAL REFERENCE TO
Contrary Sexual Instinct:
A MEDICO-LEGAL STUDY.

By Dr. R. von KRAFFT-EBING,

Professor of Psychiatry and Neurology, University of Vienna.

AUTHORIZED TRANSLATION
OF THE
SEVENTH ENLARGED AND REVISED GERMAN EDITION,
BY
CHARLES GILBERT CHADDOCK, M.D.,

Professor of Nervous and Mental Diseases, Marion-Sims College of Medicine, St. Louis; Fellow of the Chicago Academy of Medicine; Corresponding Member of the Detroit Academy of Medicine; Associate Member of the American Medico-Psychological Association, etc.

PHILADELPHIA AND LONDON:

THE F. A. DAVIS CO., PUBLISHERS.

1893.

Entered according to Act of Congress, in the year 1892, by

THE F. A. DAVIS COMPANY,

In the Office of the Librarian of Congress, at Washington, D. C., U. S. A.

All rights reserved.

Philadelphia, Pa., U. S. A.:

The Medical Bulletin Printing House,

1916 Cherry Street.

PREFACE TO THE FIRST EDITION.

Very few ever fully appreciate the powerful influence which sexuality exercises over feeling, thought, and conduct, both in the individual and in society. Schiller, in his poem, “Die Weltweisen,” recognizes it with the words:—

“Einstweilen bis den Bau der Welt
Philosophie zusammenhält,
Erhält sie das Getriebe
Durch Hunger und durch Liebe.”[1]

It is remarkable that the sexual life has received but a very subordinate consideration on the part of philosophers.

Schopenhauer (“The World as Will and Idea”) thought it strange that love had been thus far a subject for the poet alone, and that, with the exception of superficial treatment by Plato, Rousseau, and Kant, it had been foreign to philosophers.

What Schopenhauer and, after him, the Philosopher of the Unconscious, E. v. Hartmann, philosophized concerning the sexual relations is so imperfect, and in its consequences so distasteful, that, aside from the treatment in the works of Michelet (“L’amour”) and Mantegazza (“Physiology of Love”), which are to be considered more as brilliant discussions than as scientific treatises, the empirical psychology and metaphysics of the sexual side of human existence rest upon a foundation which is scientifically almost puerile.

The poets may be better psychologists than the psychologists and philosophers; but they are men of feeling rather than of understanding, and at least one-sided in their consideration of the subject. They cannot see the deep shadow behind the light and sunny warmth of that from which they draw their inspiration. The poetry of all times and nations would furnish inexhaustible material for a monograph on the psychology of love; but the great problem can be solved only with the help of Science, and especially with the aid of Medicine, which studies the psychological subject at its anatomical and physiological source, and views it from all sides.

Perhaps it will be possible for medical science to gain a stand-point of philosophical knowledge midway between the despairing views of philosophers like Schopenhauer and Hartmann[2] and the gay, näive views of the poets.

It is not the intention of the author to lay the foundation of a psychology of the sexual life, though without doubt psychopathology would furnish many important sources of knowledge to psychology.

The purpose of this treatise is a description of the pathological manifestations of the sexual life and an attempt to refer them to their underlying conditions. The task is a difficult one, and, in spite of years of experience as alienist and medical jurist, I am well aware that what I can offer must be incomplete.

The importance of the subject for the welfare of society, especially forensically, demands, however, that it should be examined scientifically. Only he who, as a medico-legal expert, has been in a position where he has been compelled to pass judgment upon his fellow-men, where life, freedom, and honor were at stake, and realized painfully the incompleteness of our knowledge concerning the pathology of the sexual life, can fully understand the significance of an attempt to gain definite views concerning it.

Even at the present time, in the domain of sexual criminality, the most erroneous opinions are expressed and the most unjust sentences pronounced, influencing laws and public opinion.

He who makes the psychopathology of sexual life the object of scientific study sees himself placed on a dark side of human life and misery, in the shadows of which the godlike creations of the poet become hideous masks, and morals and æsthetics seem out of place in the “image of God.”

It is the sad province of Medicine, and especially of Psychiatry, to constantly regard the reverse side of life,—human weakness and misery.

Perhaps in this difficult calling some consolation may be gained, and extended to the moralist, if it be possible to refer to morbid conditions much that offends ethical and æsthetic feeling. Thus Medicine undertakes to save the honor of mankind before the Court of Morality, and individuals from judges and their fellow-men. The duty and right of medical science in these studies belong to it by reason of the high aim of all human inquiry after truth.

The author would take to himself the words of Tardieu (“Des attentats aux moeurs”): “Aucune misère physique ou morale, aucune plaie, quelque corrompue qu’elle soit, ne doit effrayer celui qui s’est voué a la science de l’homme et le ministère sacré du médecin, en l’obligeant à tout voir, lui permet aussi de tout dire.”[3]

The following pages are addressed to earnest investigators in the domain of natural science and jurisprudence. In order that unqualified persons should not become readers, the author saw himself compelled to choose a title understood only by the learned, and also, where possible, to express himself in terminis technicis. It seemed necessary also to give certain particularly revolting portions in Latin[4] rather than in German.

It is hoped that this attempt to present to physician and jurist facts from an important sphere of life will receive kindly acceptance and fill an actual hiatus in literature; for, with the exception of certain single descriptions and cases, the literature presents only the writings of Moreau and Tarnowsky, which cover but a portion of the field.[5]

TRANSLATOR’S PREFACE.

The distinguished author of “Psychopathia Sexualis” speaks for himself and his work in its preface; but there are not wanting others to speak for him.

Dr. A. von Schrenck-Notzing, of Munich, writes[6]:—

“It may be questioned whether it is justifiable to discuss the anomalies of the sexual instinct apart, instead of treating of them in their proper place in psychiatry. As a rule, they are certainly only symptoms of a constitutional malady, or of a weakened state of the brain, which manifest themselves in the various forms of sexual perversion.

“Moreover, attention has been directed to the baneful influence possibly exerted by such publications as ‘Psychopathia Sexualis.’ To be sure, the appearance of seven editions of that work could not be accounted for were its circulation confined to scientific readers. Therefore, it cannot be denied that a pornographic interest on the part of the public is accountable for a part of the wide circulation of the book. But, in spite of this disadvantage, the injury done by implanting knowledge of sexual pathology in unqualified persons is not to be compared with the good accomplished. History shows that uranism was very wide-spread long before the appearance of ‘Psychopathia Sexualis.’ The courts have constantly to deal with sexual crimes in which the responsibility of the accused comes in question.

“For the physician himself, sexual anomalies, treated as they are in a distant manner in text-books on psychiatry, are in greater part a terra incognita. Exact knowledge of the causes and conditions of development of sexual aberrations, and of the influence on them of hereditary constitution, education, the impressions of every-day life, and modern refined civilization, is the prerequisite for a rational prophylaxis of sexual aberrations, and for a correct sexual education. Without careful study of the circumstances which attend the development of sexual anomalies, we should never be in a position to use effectual therapeusis. The majority of these unfortunates—Krafft-Ebing calls them Nature’s step-children—are devoid of insight into their malady; like insane patients destitute of understanding of the ethical development of man, they are happy in their abnormal instinctive tendency. For this reason, in spite of the great prevalence of uranism, very few of its subjects seek medical treatment. While the terminal forms of sexual aberrations end in asylums for the insane, the doubtful cases, in which incompleteness of development or apparent viciousness render correct diagnosis difficult, make up the majority. But a thorough knowledge of the aberrations of the sexual instinct is absolutely indispensable to the jurist. The reasons given are thus sufficiently important to demonstrate the need of a hand-book on ‘psychopathia sexualis.’”

These words also hold true for English-speaking physicians and jurists,—who can scarcely fail to welcome the translation of a work so systematic and comprehensive as “Psychopathia Sexualis”; a work conceived and executed in the highest scientific and humane spirit; a work which not only broadens and systematizes our knowledge of psycho-sexual phenomena, but also demonstrates, in the results of hypnotic suggestion, how important mental therapeusis must ultimately become in the hands of the physician; a work which is a trustworthy guide in the study of the concrete case of sexual crime, and a philosophical treatise on the inter-relations of sexual criminality, disease, and criminal anthropology.

The difficulties of translation have not been slight; but minor errors cannot destroy the author’s meaning.

For much encouragement in the work of translation my gratitude to Dr. James G. Kiernan and Dr. G. Frank Lydston, of Chicago, both well-known investigators in this domain of psychopathology, is here expressed; and to Dr. William A. Stone, Assistant Superintendent at the Michigan Asylum, Kalamazoo, I am greatly indebted for assistance in the preparation of the manuscript.

Charles Gilbert Chaddock.

St. Louis, Mo.,

November, 1892.

TABLE OF CONTENTS.

| | PAGE
I. | Fragment of a Psychology of the Sexual Life, | 1
| Power of the sexual instinct, | 1
| Sexuality as the foundation of ethical feeling, | 1
| Love as a passion, | 2
| History of development of sexuality, | 2
| Modesty, | 2
| Christianity, | 4
| Monogamy, | 4
| Woman’s place in Islam, | 5
| Sensuality and morality, | 5
| Decadence of sexual morality, | 6
| Development of sexual feelings in the individual; puberty, | 7
| Sensuality and religious enthusiasm, | 9
| Relations between the spheres of religion and sexuality, | 9
| Sensuality and art, | 10
| Idealizing tendency of first love, | 11
| True love, | 11
| Sentimentality, | 11
| Platonic love, | 12
| Love and friendship, | 12
| Difference between male and female love, | 13
| Celibacy, | 14
| Unfaithfulness, | 15
| Marriage, | 15
| Desire for adornment, | 16
| Facts of physiological fetichism, | 17
| Religious and erotic fetichism, | 17
| Eyes, odors, voices, and mental qualities as fetiches, | 21
| Hair, hand, and foot of woman as fetiches, | 22
II. | Physiology, | 23
| Sexual maturity, | 23
| Duration of sexual instinct, | 23
| Sexual sense, | 24
| Localization (?), | 24
| Physiological development of sexuality, | 24
| Erection; erection-centre, | 24
| Sexuality and the olfactory sense, | 26
| Flagellation an excitant of sexual desire, | 28
| Sects of flagellants, | 28
| Paullini’s “Flagellum Salutis,” | 29
| Erogenous zones, | 31
| Control of the sexual instinct, | 32
| Cohabitation, | 32
| Ejaculation, | 33
III. | General Pathology, | 34
| Frequency and importance of pathological manifestations, | 34
| Schema of the sexual neuroses, | 34
| Spinal neuroses, | 35
| Cerebral neuroses, | 36
| Paradoxia sexualis, | 37
| Anæsthesia sexualis (congenital), | 42
| Anæsthesia sexualis (acquired), | 47
| Hyperæsthesia sexualis, | 48
| Paræsthesia sexualis, | 56
| Perversion and perversity, | 56
| Sadism, | 57
| An attempt to explain sadism, | 57
| Sadistic lust-murder, | 62
| Anthropophagy, | 64
| Violation of corpses, | 67
| Injury of women, | 70
| Defilement of women, | 79
| Symbolic sadism, | 81
| Sadism with any object, | 82
| Whipping of boys, | 82
| Sadistic acts with animals, | 84
| Sadism in woman, | 87
| Masochism, | 89
| Relation of passive flagellation to masochism, | 101
| Ideal masochism, | 115
| Symbolic masochism, | 116
| Rousseau, | 119
| Larvated masochism, | 123
| Feminine masochism, | 137
| An attempt to explain masochism, | 139
| Masochism and sadism, | 148
| Fetichism, | 152
| Part of the female body as a fetich, | 157
| Female attire as a fetich, | 167
| Special materials as fetiches, | 180
| Contrary sexual instinct, or homo-sexuality, | 185
| Acquired homo-sexuality, | 188
| Simple reversal of sexual feeling, | 191
| Eviration and defemination, | 197
| Transition to metamorphosis sexualis paranoica, | 202
| Metamorphosis sexualis paranoica, | 216
| Congenital homo-sexuality, | 222
| Psychical hermaphroditism, | 230
| Urnings, | 255
| Effemination and viraginity, | 279
| Androgyny and gynandry, | 304
| Diagnosis, prognosis, and therapy of contrary sexuality, | 319
IV. | Special Pathology, | 358
| Pathological sexuality in the various forms of mental disease, | 358
| Imbecility, | 359
| Dementia, | 361
| Paretic dementia, | 363
| Epilepsy, | 364
| Periodical insanity, | 370
| Psychopathia sexualis periodica, | 371
| Mania, | 372
| Satyriasis and nymphomania, | 373
| Melancholia, | 374
| Hysteria, | 375
| Paranoia, | 376
V. | Pathological Sexuality in its Legal Aspects, | 378
| Dangers to society from sexual crimes, | 378
| Increase of sexual crimes, | 378
| Causes, | 378
| Defective appreciation of such crimes by jurists, | 379
| Conditions necessary to remove legal responsibility, | 381
| Exhibition, | 382
| Violation of statues, | 396
| Rape and lust-murder, | 397
| Bodily injury, injury to property, and torture of animals dependent on sadism, | 401
| Fetichism, | 401
| Violation of children, | 402
| Sodomy, | 404
| Pederasty, | 408
| Cultivated pederasty, | 414
| Social life of pederasts, | 415
| Ball of the woman-haters, | 417
| Pædicatio mulierum, | 420
| Lesbian love, | 428
| Necrophilia, | 430
| Incest, | 431
| Immoral acts with persons in the care of others, | 432

I. A FRAGMENT
OF A
PSYCHOLOGY OF THE SEXUAL LIFE.

The propagation of the human species is not committed to accident or to the caprice of the individual, but made secure in a natural instinct, which, with all-conquering force and might, demands fulfillment. In the gratification of this natural impulse are found not only sensual pleasure and sources of physical well-being, but also higher feelings of satisfaction in perpetuating the single, perishable existence, by the transmission of mental and physical attributes to a new being. In coarse, sensual love, in the lustful impulse to satisfy this natural instinct, man stands on a level with the animal; but it is given to him to raise himself to a height where this natural instinct no longer makes him a slave: higher, nobler feelings are awakened, which, notwithstanding their sensual origin, expand into a world of beauty, sublimity, and morality.

On this height man overcomes his natural instinct, and from an inexhaustible spring draws material and inspiration for higher enjoyment, for more earnest work, and the attainment of the ideal. Maudsley (Deutsche Klinik, 1873, 2, 3) rightly calls the sexual feeling the foundation for the development of the social feeling. “Were man to be robbed of the instinct of procreation and all that arises from it mentally, nearly all poetry and, perhaps, the entire moral sense as well, would be torn from his life.”

Sexuality is the most powerful factor in individual and social existence; the strongest incentive to the exertion of strength and acquisition of property, to the foundation of a home, and to the awakening of altruistic feelings, first for a person of the opposite sex, then for the offspring, and, in a wider sense, for all humanity.

Thus all ethics and, perhaps, a good part of æsthetics and religion depend upon the existence of sexual feeling.

Though the sexual life leads to the highest virtues, even to the sacrifice of the ego, yet in its sensual force lies also the danger that it may degenerate into powerful passions and develop the grossest vices.

Love as an unbridled passion is like a fire that burns and consumes everything; like an abyss that swallows all,—honor, fortune, well-being.

It seems of high psychological interest to trace the developmental phases through which, in the course of the evolution of human culture to the morality and civilization of to-day, the sexual life has passed.[7] On primitive ground the satisfaction of the sexual appetite of man seems like that of the animal. Openness in the sexual act is not shunned; man and woman are not ashamed to go naked. To-day we see savages in this condition (comp. Ploss, “Das Weib,” p. 196, 1884); as, for example, the Australians, the Polynesians, and the Malays of the Philippines. The female is the common property of the males, the temporary booty of the strongest, who strive for the possession of the most beautiful of the opposite sex, thus carrying out instinctively a kind of sexual selection.

Woman is a movable thing, a ware, an object of bargain and sale and gift; a thing to satisfy lust and to work.

The appearance of a feeling of shame before others in the manifestation and satisfaction of the natural instinct, and modesty in the intercourse of the sexes, form the beginning of morality in the sexual life. From this arose the effort to conceal the genitals (“And they knew that they were naked”) and the secret performance of the sexual act.

The development of this degree of culture is favored by the rigors of climate and the necessity for complete protection of the body thus entailed. Thus in part the fact is explained that among northern races modesty may be proved anthropologically earlier than among southern races.

A further stage in the development of culture in sexual life is marked when the female ceases to be a movable thing. She becomes a person; and if still for a long time placed far below the male socially, yet the idea that the right of disposal of herself and her favors belongs to her is developed.

Thus she becomes the object of the male’s wooing. To the barbarous sensual feeling of sexual desire the beginnings of ethical feeling are added. The instinct is intellectualized. Property in women ceases to exist. Individuals of the opposite sexes feel themselves drawn toward each other by mental and physical qualities, and show love for each other only. At this stage woman has a feeling that her charms belong only to the man of her choice, and wishes to conceal them from others. Thus, by the side of modesty, the foundations of chastity and faithfulness—as long as the bond of love lasts—are laid.

Woman attains this degree of social elevation earlier when, at the transition from nomadic life to a state of fixed habitation, man obtains a house and home, and the necessity arises for him to possess in woman a companion for the household,—a housewife.

Among the nations of the East, the Egyptians, the Israelites, and the Greeks, and among those of the West, the Germans, early attained this stage of culture. Among all these races, at this stage of advancement, the esteem in which virginity, chastity, modesty, and sexual faithfulness are held is in marked contrast with other nations which offer the female of the house to the guest for his sexual enjoyment.[8]

That this stage in the culture of sexual morality is quite high and makes its appearance much later than other developmental forms of culture—as, for example, æsthetics—is seen from the condition of the Japanese, with whom it is the custom to marry a woman only after she has lived for a year in the tea-houses (which correspond with European houses of prostitution), and to whom the nakedness of women is nothing shocking. At all events, among the Japanese every unmarried woman can prostitute herself without lessening her value as a future wife,—a proof that with this remarkable people woman possesses no ethical worth, but is valued in marriage only as a means of enjoyment, procreation, and work.

Christianity gave the most powerful impulse to the moral elevation of the sexual relations by raising woman to social equality with man and elevating the bond of love between man and woman to a religio-moral institution.[9]

The fact that in higher civilization human love must be monogamous and rest on a lasting contract was thus recognized. If nature does no more than provide for procreation, a commonwealth (family or state) cannot exist without a guaranty that the offspring shall flourish physically, morally, and intellectually. Christendom gained both mental and material superiority over the polygamous races, especially Islam, through the equalization of woman and man, and by establishing monogamous marriage and securing it by legal, religious, and moral ties.

If Mohammed was actuated by a desire to raise woman from her place as a slave and means of sensual gratification to a higher social and matrimonial plane, nevertheless, in the Mohammedan world woman remained far below man, to whom alone divorce was allowed and also made very easy.

Islam kept woman from any participation in public life under all circumstances, and thus hindered her intellectual and moral development. In consequence of this the Mohammedan woman has ever remained essentially a means of sensual gratification and procreation; while, on the other hand, the virtues and capabilities of the Christian woman, as housewife, educator of children, and equal companion of man, have been allowed to unfold in all their beauty. Islam, with its polygamy and harem-life, is glaringly contrasted with the monogamy and family life of the Christian world.

The same contrast is apparent in a comparison of the two religions with reference to the conception of the hereafter. The picture of eternity seen by the faith of the Christian is that of a paradise freed from all earthly sensuality, promising the purest of intellectual happiness; the fancy of the Mussulman fills the future life with the delights of a harem full of houris.

In spite of all the aids which religion, law, education, and morality give civilized man in the bridling of his passions, he is always in danger of sinking from the clear height of pure, chaste love into the mire of common sensuality.

In order to maintain one’s self on such a height, a constant struggle between natural impulses and morals, between sensuality and morality, is required. Only characters endowed with strong wills are able to completely emancipate themselves from sensuality and share in that pure love from which spring the noblest joys of human life.

It is yet questionable whether, in the course of the later centuries, mankind has advanced in morality. It is certain, however, that the race has become more modest; and this phenomenon of civilization—this hiding of the animal propensities—is, at least, a concession that vice makes to virtue.

From a reading of Scherr’s works (“History of German Civilization”) one would certainly gain the impression that, in comparison with those of the Middle Ages, our own ideas of morals have become refined, even when it must also be allowed that in many instances finer manners, without greater morality, have taken the place of earlier obscenity and coarseness of expression.

When widely separated periods of history are compared, no doubt is left that public morality, in spite of occasional temporary retrogression, makes continuous progress, and that Christianity is one of the most powerful of the forces favoring moral progress.

To-day we are far beyond the sexual conditions which, as shown in the sodomitic worship of the gods, in the life of the people, and in the laws and religious practices, existed among the ancient Greeks,—to say nothing of the worship of Phallus and Priapus among the Athenians and Babylonians, of the bacchanals of ancient Rome, and the prominent place prostitutes took among these peoples. In the slow and often imperceptible progress which human morality makes there are variations or fluctuations, just as in the individual sexuality manifests an ebb and flow.

Periods of moral decadence in the life of a people are always contemporaneous with times of effeminacy, sensuality, and luxury. These conditions can only be conceived as occurring with increased demands upon the nervous system, which must meet these requirements. As a result of increase of nervousness, there is increase of sensuality, and, since this leads to excesses among the masses, it undermines the foundation of society,—the morality and purity of family life. When this is destroyed by excesses, unfaithfulness, and luxury, then the destruction of the state is inevitably compassed in material, moral, and political ruin. Warning examples of this character are presented by Rome, Greece, and France under Louis XIV and XV.[10] In such times of political and moral destruction monstrous perversions of the sexual life were frequent, which, however, may in part be referred to psycho-pathological or, at least, neuro-pathological conditions existing in the people.

It is shown by the history of Babylon, Nineveh, Rome, and also by the “mysteries” of life in modern Capitals, that large cities are the breeding-places of nervousness and degenerate sensuality. The fact which may be learned from reading Ploss’s work is remarkable, viz., that perversion of the sexual instinct (save among the Aleutians, and in the form of masturbation among the females of the East and the Nama Hottentots) does not occur in uncivilized or half-civilized races.[11]

The study of the sexual life in the individual must begin at its development at puberty, and follow it through its different phases to the extinction of sexual feelings. In his “Physiology of Love,” Mantegazza describes the longings and impulses of awakening sexual life, of which presentiments, indefinite feelings, and impulses have existed long before the epoch of puberty. This epoch is, physiologically, the most important. In the abundant increase of feelings and ideas which it engenders is manifested the significance of the sexual factor in mental life.

These impulses, at first vague and incomprehensible, arising from the sensations which are awakened by organs which were previously undeveloped, are accompanied by a powerful excitation of the emotions. The psychological reaction of the sexual impulse at puberty expresses itself in a multitude of manifestations which have in common only the mental condition of emotion and the impulse to express in some way, or render objective, the strange emotionality. Religion and poetry lie close to it, which, after the time of sexual development is past and these originally incomprehensible feelings and impulses have cleared up, receive powerful incentives from the sexual sphere. He who doubts this has only to think how often religious enthusiasm occurs at the time of puberty; how frequent sexual episodes are in the lives of the saints;[12] how powerfully sensuality expresses itself in the histories of religious fanatics; and in what revolting scenes, true orgies, the religious festivals of antiquity, no less than the “meetings” of certain sects in modern times, express themselves,—to say nothing of the lustful mysteries which characterized the cults of the ancients. On the other hand, we see that unsatisfied sensuality very frequently finds an equivalent in religious enthusiasm.[13]

This relation between religious and sexual feeling is also shown on the basis of unequivocal psycho-pathological states. It suffices to recall how intense sensuality makes itself manifest in the clinical histories of many religious maniacs; the motley mixture of religious and sexual delusions that is so frequently observed in psychoses (e.g., in maniacal women, who think they are or will be the Mother of God), but particularly in masturbatic insanity; and, finally, the sensual, cruel self-punishments, injuries, self-castrations, and even self-crucifixions resulting from abnormal sexual-religious feeling.

Any attempt to explain the relations between religion and love has difficulties to encounter. Many analogies present themselves. The feeling of sexual attraction and religious feeling (considered as a psychological fact) consist of two elements.

In religion the primary element is a feeling of dependence,—a fact which Schleiermacher recognized long before the later studies in anthropology and ethnography, founded on the observation of primitive conditions, had led to the same conclusion. It is only at a higher stage of culture that the second and essentially ethical element—love of God—enters into religious feeling. In the place of the evil spirits of the primitive peoples came the two-faced—now kind, now angry—creations of the more complicated mythologies, until, finally, the God of love, as the giver of eternal happiness, is reverenced, whether this be hoped for from Jehovah, as a blessing on earth; from Allah, as a physical blessing in Paradise; from Christ, as eternal bliss in heaven; or as the Nirvana of the Buddhists.

In sexual desire, love, the expectation of unbounded happiness is the primary element. The feeling of dependence is of secondary development. The nucleus of this feeling exists in both parties, but it may remain undeveloped in one. As a rule, owing to her passive part in procreation and social conditions, it is more pronounced in woman; but exceptionally this is true of men having minds that approach the feminine type.

In both the religious and sexual spheres love is mystical, transcendental. In sexual love the real purpose of the instinct, the propagation of the species, does not enter into consciousness; and the strength of the desire is greater than any that consciousness of purpose could create. In religion, however, the good sought and the object of devotion are of such nature that they cannot become a part of empirical knowledge. Therefore, both mental processes give unlimited range to the imagination.

But both have an immortal object, in as far as the bliss which the sexual sentiment creates in fancy seems incomparable and infinite in contrast with all other pleasurable feelings; and the same is true of the promised blessings of faith, which are conceived to be eternal and supreme.

From the correspondence between the two states of consciousness, with reference to the commanding importance of their objects, it follows that they both often attain an intensity that is irresistible, and which overcomes all opposing motives. Owing to their similarity in that their objects cannot be attained, it follows that both easily degenerate into silly enthusiasm, in which the intensity of feeling far surpasses the clearness and constancy of the ideas. In both cases, in this enthusiasm, with the expectation of a happiness that cannot be attained, the necessity of unconditional submission plays a part.

Owing to the correspondence in many points between these two emotional states, it is clear that when they are very intense the one may take the place of the other; or one may appear by the side of the other, since every intensification of one element of mental life also intensifies its associations. The constant emotion thus calls into consciousness now one and now the other of the two series of ideas with which it is connected. Either of these mental states may become transformed into the impulse to cruelty (actively exercised or passively suffered).

In the religious life this is expressed by sacrifice. Primarily this is done with the idea that the victim is materially enjoyed by the deity; then, in reverence, as a sign of submission, as a tribute; and, finally, with the belief that sins and transgressions against the deity are thus atoned for and blessing obtained. If, however, the offering consist of self-punishment, which occurs in all religions, in individuals of very excitable religious nature, it serves not only as a symbol of submission and as an equivalent in the exchange of present pain for future bliss, but everything that is thought to come from the deity, all that happens in obedience to divine mandate or to the honor of the godhead, is felt directly as pleasure. Thus religious enthusiasm leads to ecstasy, to a condition in which consciousness is so preoccupied with feelings of mental pleasure that the concept of suffering endured can only be apperceived without its painful quality.

The exaltation of religious enthusiasm may lead actively to pleasure in the sacrifice of another, if pity be overcompensated by feelings of religious pleasure.

Sadism, and particularly masochism (v. infra), show that in the sphere of the sexual life there may be similar phenomena. Thus the well-established relations between religion, lust, and cruelty[14] may be comprehended in the following formula: States of religious and sexual excitement, at the acme of their development, may correspond in the amount and quality of excitement, and, therefore, under favoring circumstances, one may take the place of the other. Both, in pathological conditions, may become transformed into cruelty.

The sexual factor proves to be no less influential in awakening æsthetic feelings. What would poetry and art be without a sexual foundation? In (sensual) love is gained that warmth of fancy without which a true creation of art is impossible; and in the fire of sensual feelings its glow and warmth are preserved. It may thus be understood why great poets and artists have sensual natures.

This world of ideals reveals itself with the inception of the processes of sexual development. He who, at this period of life, cannot become enthusiastic for all that is great, noble, and beautiful, remains a Philistine all his life. At this epoch does not the least of natural poets forge verses?

At the limits of physiological reaction there are events which take place at the time of puberty in which these obscure feelings of longing express themselves in paroxysms of despair of self and the world, which may go on to tædium vitæ, and are often accompanied by a desire to do harm to others (weak analogies of a psychological connection between lust and cruelty).

Youthful love has a romantic, idealistic character. It elevates the beloved object to apotheosis. In its inception it is platonic, and turns to forms of poetry and romance. With the awakening of sensuality there is danger that this idealizing power may be brought to bear upon persons of the opposite sex who are mentally, physically, and socially of inferior station. Thus there may occur méssalliances, seductions, and errors, with the whole tragedy of a passionate love that comes in conflict with the dictates of social position and prospects, and sometimes terminates in suicide or double suicide.

Over-sensual love can never be lasting and true. For this reason the first love is, as a rule, very fleeting; because it is nothing else than the flare of a passion, the flame of a fire of straw.

Only the love that rests upon a recognition of the social qualities of the beloved person, only a love which is willing not only to enjoy present pleasures, but to bear suffering for the beloved object and sacrifice all, is true love. The love of a strongly constituted man shrinks before no difficulties or dangers in order to gain and keep possession of its object.

Love expresses itself in acts of heroism and daring. Such love is in danger, under certain circumstances, of becoming criminal, if moral principles be weak. Jealousy is an ugly spot in this love. The love of a weakly constituted man is sentimental. It sometimes leads to suicide when it is not returned or meets with obstacles, while, under like conditions, the strongly constituted man may become a criminal.

Sentimental love is in danger of becoming a caricature, i.e., when the sensual element is weak (the Knight of Toggenburg, Don Quixote, many minnesingers and troubadours of the Middle Ages).

Such love is flat and soft, and may be even silly; but the true expression of this powerful feeling awakens appropriate pity, respect, or sorrow in the hearts of others.

Frequently this weak love expresses itself in equivalents—in poetry, which, however, under such circumstances, is effeminate; in æsthetics which are overdrawn; in religion, in which it gives itself up to mysteries and religious enthusiasm; or, where there is a more powerful sensual foundation, founds sects or expresses itself in religious insanity. The immature love of the age of puberty has something of all this in it. Of all the poems and rhymes written at this time of life, they only are readable that are the product of poets divinely endowed.

Notwithstanding all the ethics which love requires in order to develop into its true and pure form, its strongest root is still sensuality. Platonic love is an impossibility, a self-deception, a false designation for related feelings.

In as far as love rests upon sensual desire, it is only conceivable in a normal way as existing between individuals of opposite sex and capable of sexual intercourse. If these conditions are wanting or destroyed, then, in the place of love, comes friendship.

The rôle which the retention of sexual functions plays in the case of a man, both in originating and retaining the feeling of self-respect, is remarkable. In the deterioration of manliness and self-confidence which the onanist, in his weakened nervous state, and the man that has become impotent, present, may be estimated the significance of this factor.

Gyurkovechky (männl. Impotenz. Vienna, 1889) says, very justly, that old and young men essentially differ mentally, on account of the condition of their virility, and that impotence has a detrimental effect upon the feeling of well-being, mental freshness, activity, self-confidence, and the play of fancy. This loss becomes the more important the younger a man is when he loses his virility and the more sensually he was constituted.

Under such circumstances a sudden loss of virility may induce severe melancholia, and even lead to suicide. For such natures life without love is unbearable.

But, also, in cases where the reaction is not so deep, the man bereft of his virility is morose and spiteful, egotistic, jealous, contrary, listless, has but little self-respect or sense of honor, and is cowardly. Analogies are seen in the Skopzens,[15] who, after their castration, change for the worse.

The loss of virility is still more noticeable in certain weakly constituted individuals, where it expresses itself in formal effemination (v. infra).

In a woman who has become a matron the condition is of much less importance psychologically, though it is noticeable. If the past period of sexual life has been satisfactory, if children delight the heart of the aging mother, then she is scarcely conscious of the change of her personality.

The situation is different, however, where sterility or circumstances have kept a woman from the performance of her natural functions and denied her that happiness.

These facts place in a clear light the differences which exist between man and woman in the psychology of the sexual life, and in all the sexual functions and desires.

Undoubtedly man has a much more intense sexual appetite than woman. As a result of a powerful natural instinct, at a certain age, a man is drawn toward a woman. He loves sensually, and is influenced in his choice by physical beauty. In accordance with the nature of this powerful impulse, he is aggressive and violent in his wooing. At the same time, this demand of nature does not constitute all of his mental existence. When his longing is satisfied, love temporarily retreats behind other vital and social interests.

With a woman it is quite otherwise. If she is normally developed mentally, and well bred, her sexual desire is small. If this were not so the whole world would become a brothel and marriage and a family impossible. It is certain that the man that avoids women and the woman that seeks men are abnormal.

Woman is wooed for her favor. She remains passive. This lies in her sexual organization, and is not founded merely on the dictates of good breeding.

Nevertheless, the sexual sphere occupies a much larger place in the consciousness of woman than in that of man. The need of love in her is greater than in man, and is continual, not intermittent; but this love is rather more spiritual than sensual. While a man loves a woman first as wife and then as mother of his children, a woman is primarily conscious of a man as the father of her children and then as husband. In the choice of a life-companion a woman is influenced much more by the mental than the physical qualities of a man. When she has become a mother she divides her love between child and husband. Sensuality disappears in the mother’s love. Thereafter, in marital intercourse, the wife finds less sensual satisfaction than proof of the love of her husband.

A woman loves with her whole soul. To her love is life; to a man it is the joy of life. To him misfortune in love is a wound; but it costs a woman her life, or at least her happiness. A psychological question worthy of consideration is whether a woman can truly love twice in her life. Certainly the mental inclination of woman is monogamous, while in man it is polygamous.

The weakness of men in comparison with women lies in the great intensity of their sexual desires. Man becomes dependent upon woman, and the more, the weaker and more sensual he becomes; and this just in proportion as he becomes neuropathic. Thus may be understood the fact that, in times of effeminateness and luxury, sensuality flourishes luxuriantly. Then arises the danger to society that mistresses and their dependents may rule the state and compass its ruin (the mistresses of the courts of Louis XIV and XV; the prostitutes of ancient Greece).

The biographies of many statesmen of ancient and modern times show that they were the instruments of women, owing to their great sensuality, which had its foundation in their neuropathic constitutions. The fact that the Catholic Church enjoins celibacy upon its priests, in order to emancipate them from sensuality and preserve them entirely for the purpose of their calling, is an example of discerning psychological knowledge of mankind; but it is unfortunate that the priests, living in celibacy, lose the elevating effect which love and matrimony exert upon the development of character.

From the fact that man by nature plays the aggressive rôle in sexual life, he is in danger of overstepping the limits which morality and law have set. The unfaithfulness of a wife, in comparison with that of a husband, is morally much more weighty, and should be more severely punished legally. The unfaithful wife dishonors not only herself, but also her husband and her family, not to speak of the possibility of pater incertus. Natural instinct and social position favor unfaithfulness on the part of a husband, while the wife is afforded much protection. In the case of an unmarried woman, sexual intercourse is something quite different from what it is in an unmarried man. Of a single man society demands decency; of a woman, also chastity. In the cultivated social life of to-day, woman, occupying a sexual position and concerning herself in the interests of society, can only be thought of as a wife.

The aim and ideal of woman, even when she is sunken in the mire of vice, is, and remains, marriage. Woman, as Mantegazza justly remarks, desires not only satisfaction of her sexual feeling, but also protection and support for herself and her children. A man of right feeling, no matter how sensual he may be, demands a wife that has been, and is, chaste. The emblem and ornament of a woman seeking this, her only worthy purpose in life, is modesty. Mantegazza finely characterizes modesty as “one of the forms of psychical self-respect” in woman. This is not the place for anthropological and historical consideration of this, the most beautiful attribute of woman. Probably, feminine modesty is an hereditarily evolved product of the development of civilization.[16]

In remarkable contrast with it, there is occasional exposition of physical charms, conventionally sanctioned by the law of fashion, in which even the most discreet maiden allows herself to indulge in the ball-room. The reasons which lead to this display are evident. Fortunately the modest girl is as little conscious of them as of the reason for the occasionally recurring mode of making certain portions of the body more prominent (panniers); to say nothing of corsets, etc.

In all times, and among all races, women show a desire to adorn themselves and be charming.[17] In the animal kingdom nature has distinguished the male with the greater beauty. Men designate women as the beautiful sex. This gallantry clearly arises from the sensual desire of men. As long as this personal adornment has a purpose only in itself, or the true psychological reason of the desire to please remains unknown to the woman, nothing can be said against it. When it is done with knowledge, the effort is called flirting.

Under all circumstances a dandified man is ridiculous. We are accustomed to this slight weakness in a woman, and find no fault with it, so long as it is but a subordinate manifestation. When it has become the all-absorbing aim, the French apply to it the word coquetry.

Woman far surpasses man in the natural psychology of love, partly because, through heredity and education, her native element is love; and partly because she has finer feelings (Mantegazza). Even in a man of the very highest breeding, it cannot be found objectionable that he recognizes woman as a means of satisfying his natural instinct. But it becomes his duty to belong only to the woman of his choice. In a civilized state this becomes a binding social obligation,—marriage; and, inasmuch as the wife requires for herself and children protection and support, it becomes a marriage right.

It is of great importance psychologically, and, for certain pathological manifestations to be later described, indispensable, to examine the psychological events which draw a man and a woman together and unite them; so that, of all other persons of the same sex, only the beloved one seems desirable.

If one could demonstrate design in the processes of nature,—adaptation cannot be denied them,—the fact of fascination by a single person of the opposite sex, with indifference toward all others, as it occurs between true and happy lovers, would appear as a wonderful creative provision to insure monogamous unions for the promotion of their object.

To the scientific observer, however, this love, or “harmony of souls,” this “heart-bond,” does not, by any means, appear as a “soul-mystery;” but, in the majority of cases, it may be referred to certain physical or mental peculiarities, as the case may be, by which the attractiveness of the beloved person is exerted.

Thus we speak of what is called fetich and fetichism. In the term fetich we are wont to comprehend objects, or parts, or simply peculiarities of objects, which, by virtue of associative relations to an intense feeling, or to a personality or idea that awakens deep interest, exert a kind of charm (“fetisso,” Portuguese), or, at least, owing to peculiar individual coloring, produce a very deep impression which does not belong to the external sign (symbol, fetich) in itself.[18]

The individual valuation of the fetich, which may go to the extent of an unreasoning enthusiasm in the individual affected, is called fetichism. This interesting psychological phenomenon is explicable by an empirical law of association,—the relation of a particular to a general concept,—in which, however, the essential thing is the pleasurable emotional coloring of the particular concept peculiar to the individual. It is most common in two related mental spheres,—those of religious and erotic feelings and ideas. Religious fetichism differs in relation and significance from sexual fetichism, for it found, and still finds, its original motive in the delusion that the object of the fetichism, or the idol, possesses divine attributes, and that it is not simply a symbol; or peculiar wonder-working (relics) or protective (amulet) virtues are superstitiously ascribed to the fetich.

It is otherwise with erotic fetichism, which finds its psychological motive in fetiches which consist of physical or mental qualities of a person, or even merely of objects which a person has used. These always awaken intense associative ideas of the personality as a whole, and, moreover, are always colored with a lively feeling of sexual pleasure. Analogies with religious fetichism are always discernible; for, under certain circumstances, in the latter, the most insignificant objects (bones, nails, hair, etc.) become fetiches, and are associated with pleasurable feelings which may reach the intensity of ecstasy.

With respect of the development of physiological love, it is probable that its nucleus is always to be found in an individual fetich (charm) which a person of one sex exercises over a person of the opposite sex.

The case is the simplest where the sight of a person of the opposite sex occurs simultaneously with sensual excitement, and the latter is thus increased.

Emotional and visual impressions are brought into associative connection, and this association is strengthened in proportion as the recurring emotion awakens the visual memory-picture, or the latter (another meeting) renews sexual excitement, which may possibly reach the intensity of orgasm and pollution (dream-picture). In this case the whole physical personality has the effect of a fetich.

As Binet and others show, merely parts of the whole, simply peculiarities, either physical or mental, may affect the person of the opposite sex as a fetich, when the perception of them is associated with (accidental) sexual excitement (or induces it).

It is well known from experience that accident determines this mental association, that the objects of the fetich may be individually very diverse, and that thus the most peculiar sympathies (and antipathies) arise.

These physiological facts of fetichism explain the individual sympathies between husband and wife; the preference of a certain person to all others of the same sex. Since the fetich represents a symbol that is purely individual, it is clear that its effect must be individual. Since it is colored by the most intense pleasurable feeling, it follows that possible faults in the beloved object are overlooked (“Love is blind”), and an exaltation of it is induced that to others is incomprehensible, and even silly under some circumstances. Thus it is clear why lovers are not understood by their unaffected fellow-men; and why they deify their idols, develop a true cult of devotion, and invests them with attributes which objectively they do not possess. Thus we may understand why love appears sometimes more like a passion, sometimes as a formal, exceptional mental state, in which the unattainable seems attainable, the ugly beautiful, the profane sacred, and every other interest, every duty, disappears.

Tarde (Archives de l’anthropologie criminelle, v year, No. 30) rightfully emphasizes the fact that the fetich may vary with nations as well as with individuals, but that the general ideal of beauty remains the same among civilized people of the same era.

Binet deserves great credit for having studied and analyzed in detail the fetichism of love. The particular sympathies all spring from it. Thus one is attracted to slender, another to plump beauties, to blondes or brunettes. For one a peculiar expression of the eyes; for another a peculiar tone of the voice, or a particular (even an artificial) odor (perfume); or the hand, the foot, the ear, etc., may be the individual fetich (charm),—the beginning of a complicated chain of mental processes which, as a whole, represent love, i.e., the longing to possess, physically and mentally, the beloved object.

This fact is important, as showing a condition for the origin of a fetichism that falls within physiological limits. The fetich may constantly retain its significance without being pathological; but this is possible only when the particular concept is developed to a general concept; when the resulting love comes to take as its object the whole mental and physical personality.

Normal love can be nothing but a synthesis, a generalization. Ludwig Brunn,[19] under the heading, “The Fetichism of Love,” cleverly says:—

“Thus normal love appears to us as a symphony of tones of all kinds. It results from the most various stimuli. It is likewise polytheistic. Fetichism recognizes only the tone of a single instrument; it results from a certain stimulus; it is monotheistic.”

On slight reflection any one will see that real love (this word is only too often abused) can be spoken of only when the whole person is both physically and mentally the object of adoration. Love must always have a sensual element, i.e., the desire to possess the beloved object, to be united with it and fulfill the laws of nature. But when merely the body of the person of the opposite sex is the object of love, when satisfaction of sensual pleasure is the sole object, without desire to possess the soul and enjoy mutual communion, love is not genuine, no more than that of platonic lovers, who love only the soul and avoid sensual pleasure (many cases of contrary sexuality). For the former merely the body, for the latter simply the soul, is a fetich, and the love fetichism. Such cases certainly represent transitions to pathological fetichism. This assumption is even more justified when, as a further criterion of real love, mental[20] satisfaction must be given by the sexual act.

There remains to be mentioned, within the physiological phenomena of fetichism, the fact that among the many things that may become fetiches there are certain ones that gain such significance for a majority of persons.

As such for a man may be mentioned the hair, the hand, the foot of a woman, the expression of her eyes. Certain ones of these gain a remarkable significance in the pathology of fetichism. These facts clearly play a rôle in the feminine mind, either consciously or unconsciously.

One of the greatest cares of women is the cultivation of the hair, to which often an unreasonable amount of time and money is devoted. How a mother cares for her little daughter’s hair! What a part the hair-dresser plays! Falling of the hair would cause despair in a young lady. I recall a proud lady who became insane over it, and died by suicide. Young ladies like to talk of coiffures, and are envious of beautiful hair.[21]

Beautiful hair is a powerful fetich with many men. In the legend of the Loreley, who lured men to destruction, the golden hair, which she combs with a golden comb, appears as a fetich. Frequently the hand and foot possess an attractiveness no less powerful, when, indeed, often (though by no means invariably) masochistic and sadistic feelings aid in determining the peculiar kind of fetich.

By a transference through association of ideas, the gloves or shoes may obtain the significance of a fetich.

Brunn (op. cit.) justly points out that among the customs of the Middle Ages drinking from the shoe of a beautiful woman (still to be found in Poland) played a remarkable part in gallantry and homage. The shoe also plays an important rôle in the legend of Aschenbrödel.

The expression of the eyes is particularly important as a means of kindling the sparks of love. A neuropathic eye frequently affects persons of both sexes as a fetich. “Madame, vos beaux yeux me font mourir d’amour” (Molière).

There is superfluity of examples showing that odors of the body may become fetiches.

This fact is also taken advantage of in the ars amandi of woman, either consciously or unconsciously. Ruth sought to attract Boaz by perfuming herself. The demi-monde of ancient and modern times is noted for its use of perfume. Jäger, in his “Discovery of the Soul,” calls attention to many olfactory sympathies.

Cases are known where men have married ugly women simply because their personal odors were exceedingly pleasing.

Binet makes it probable that the voice may also become a fetich. He relates a case in point of Dumas, who used it in his novel, “La Maison du Vent.” It was the case of a wife who fell in love with a tenor’s voice, and thus became untrue to her husband. Belot’s romance, “Les Baigneuses de Trouville,” speaks in favor of this assumption. Binet thinks that many marriages with singers are due to the fetich of their voices. He also calls attention to the interesting fact that among singing-birds the voice has the same sexual significance as odors among quadrupeds. The birds allure by their song, and the male that sings most beautifully flies at night to his charmed mate.

The pathological facts of masochism and sadism show that mental peculiarities may also act as fetiches in a wider sense.

Thus the fact of idiosyncrasies is explained, and the old saying, “De gustibus non est disputandum,” retains its force.

II. PHYSIOLOGY.

During the time of the physiological processes in the reproductive glands, desires arise in the consciousness of the individual which have for their purpose the perpetuation of the species (sexual instinct).

Sexual desire during the years of sexual maturity is a physiological law. The duration of the physiological processes in the sexual organs, as well as the strength of the sexual desire manifested, vary, both in individuals and in races. Race, climate, heredity, and social circumstances have a very decided influence upon it. The greater sensuality of southern races as compared with the sexual needs of those of the North is well known. Sexual development in the inhabitants of tropical climes takes place much earlier than in those of more northern regions. In women of northern countries ovulation, recognizable in the development of the body and the occurrence of a periodical flow of blood from the genitals (menstruation), usually begins about the thirteenth or fifteenth year; in men puberty, recognizable in the deepening of the voice, the appearance of hair on the face and the mons veneris, and the occasional occurrence of pollutions, etc., takes place about the fifteenth year. In the inhabitants of tropical countries, however, sexual development takes place several years earlier in women,—sometimes as early as the eighth year.

It is worthy of remark that girls who live in cities develop about a year earlier than girls living in the country, and that the larger the town the earlier, ceteris paribus, the development takes place.

Heredity, however, has no small influence on libido and sexual power. Thus there are families in which, with great physical strength and longevity, great libido and virility are preserved until a great age, while in other families the vita sexualis develops late and is early extinguished.

In women the time of the activity of the reproductive glands is shorter than in men, in whom the sexual function may last until a great age. Ovulation ceases about thirty years after puberty. This period of cessation of activity of the ovaries is called the change of life (climacterium). This biological phase does not represent merely a cessation of function and final atrophy of the reproductive organs, but also a transformation of the whole organism. In Middle Europe the sexual maturity of men begins about the eighteenth year, and their virility reaches its acme at forty. After that age it slowly declines.

The potentia generandi ceases usually at the age of sixty-two, but potentia cœundi may be present even in old age. The existence of the sexual instinct is continuous during the time of sexual life, but it varies in intensity. Under physiological conditions it is never intermittent (periodical), as in animals. In men it manifests an organic variation of intensity in consonance with the collection and expenditure of semen; in women the increase of sexual desire coincides with the process of ovulation, and in such a way that libido sexualis is greater after the menstrual period.

Sexual instinct—as emotion, idea, and impulse—is a function of the cerebral cortex. Thus far no definite region of the cortex has been proved to be exclusively the seat of sexual sensations and impulses.[22]

Owing to the close relations which exist between the sexual instinct and the olfactory sense, it is to be presumed that the sexual and olfactory centres lie close together in the cerebral cortex. The development of the sexual life has its beginning in the organic sensations which arise from the developing reproductive glands. These excite the attention of the individual. Readings and the experiences of every-day life (which, unfortunately, to-day are too early and too frequently suggestive) convert these notions into clear ideas. These become accentuated by organic sensations which are pleasurable. With this accentuation of erotic ideas by lustful feelings, an impulse to induce these (sexual desire) is developed.

Thus there is established a mutual dependence between the cerebral cortex (as the place of origin of sensations and ideas) and the reproductive organs. The latter, by reason of physiological processes (hyperæmia, secretion of semen, ovulation), give rise to sexual ideas, images, and impulses.

The cerebral cortex, by means of apperceived or reproduced sensual ideas, reacts on the reproductive organs, inducing hyperæmia, secretion of semen, erection, ejaculation. This results by means of centres for vasomotor innervation and ejaculation, which are situated in the lumbar portion of the cord and lie close together. Both are reflex centres.

The erection-centre (Goltz, Eckhard) is an intermediate station placed between the brain and the genital apparatus. The nervous paths which connect it with the brain probably run through the pedunculi cerebri and the pons. This centre may be excited by central (psychical and organic) stimuli, by direct irritation of the nerve-tract in the pedunculis cerebri, pons, or cervical portion of the cord, as well as by peripheral irritation of the sensory nerves (penis, clitoris, and annexa). It is not directly subordinated to the will.

The excitation of this centre is conveyed to the corpora cavernosa by means of nerves (nervi erigentes—Eckhard) running in the first three sacral nerves.

The action of the nervi erigentes, which renders erection possible, is an inhibitory one. They inhibit the ganglionic nervous mechanism in the corpora cavernosa upon the action of which the smooth muscle-fibres of the corpora cavernosa are dependent (Kölliker and Kohlrausch). Under the influence of the action of the nervi erigentes these fibres of the corpora cavernosa become relaxed and their spaces fill with blood. Simultaneously, as a result of the dilatation of the capillary net-work of the corpora cavernosa, pressure is exerted upon the veins of the penis and the return of blood is impeded. This effect is aided by contraction of the bulbo cavernosus and ischio cavernosus muscles, which are inserted by means of an aponeurosis on the dorsal surface of the penis.

The erection-centre is under the influence of both exciting and inhibitory innervation arising in the cerebrum. Ideas and sense-perceptions of sexual content have an exciting effect. Also, according to observations made on men that have been hung, it is evident that the erection-centre may be excited by excitation of the tract in the spinal cord. Observations on the insane and those suffering with cerebral disease show that this is also possible as a result of organic irritation in the cerebral cortex (psycho-sexual centre?). Spinal diseases (tabes, especially myelitis) affecting the lumbar portion of the cord, in their earlier stages, may directly excite the erection-centre.

Reflex excitation of the centre is possible and frequent in the following ways: by irritation of the (peripheral) sensory nerves of the genitals and surrounding parts by friction; by irritation of the urethra (gonorrhœa), of the rectum (hæmorrhoids, oxyuris), of the bladder (distension with urine, especially in the morning, irritation of calculi); by distension of the vesicular seminales with semen; by hyperæmia of the genitals, occasioned by lying on the back, and thus inducing pressure of the intestines upon the blood-vessels of the pelvis.

The erection-centre may also be excited by irritation of the nervous ganglia which are so abundant in the prostatic tissue (prostatitis, introduction of catheter, etc.).

The experiment of Goltz, according to whom, when (in dogs) the lumbar portion of the cord is severed, erection is more easily induced, shows that the erection-centre is also subject to inhibitory influences from the brain.

In men the fact that the will and emotions (fear of unsuccessful coitus, surprise inter actum sexualem, etc.) may inhibit the occurrence of erection, and cause it, when present, to disappear, also indicates this.

The duration of erection is dependent upon the duration of its exciting causes (sensory stimuli), the absence of inhibitory influences, the nervous energy of the centre, and the early or late occurrence of ejaculation (v. infra).

The central and highest portion of the sexual mechanism is the cerebral cortex. It is justifiable to presume that there is a definite region of the cortex (cerebral centre) which gives rise to sexual feelings, ideas, and impulses, and is the place of origin of the psycho-somatic processes which we designate as sexual life, sexual instinct, and sexual desire. This centre is excitable to both central and peripheral stimuli.

Central stimuli, in the form of organic excitation, may be due to diseases of the cerebral cortex. Physiologically they consist of psychical stimuli (memory and sensory perceptions).

Under physiological conditions these stimuli are essentially visual perceptions and memory-pictures (i.e., lascivious stories) and also tactile impressions (touch, pressure of the hand, kiss, etc.).

Within physiological limits auditory and olfactory perceptions certainly play but a very subordinate rôle. Under pathological conditions (v. infra) the latter have a very decided influence in inducing sexual excitement.

Among animals the influence of olfactory perceptions on the sexual sense is unmistakable. Althaus (“Beiträge zur Physiol. und Pathol. des Olfactorius.” Archiv für Psych., xii, H 1) declares that the sense of smell is important with reference to the reproduction of the species. He shows that animals of opposite sexes are drawn to each other by means of olfactory perceptions, and that almost all animals, at the time of rutting, emit a very strong odor from their genitals. An experiment by Schiff is confirmatory of this. He extirpated the olfactory nerves in puppies, and found that, as the animals grew, the male was unable to distinguish the female. On the other hand, an experiment by Mantegazza (“Hygiene of Love”), who removed the eyes of rabbits and found that the defect constituted no obstacle to procreation, shows how important in animals the olfactory sense is for the vita sexualis.

It is also remarkable that many animals (musk-ox, civet-cat, beaver) possess glands on their sexual organs, which secrete materials having a very strong odor.

Althaus also shows that in man there are certain relations existing between the olfactory and sexual senses. He mentions Cloquet (“Osphrésiologie,” Paris, 1826), who calls attention to the sensual pleasure excited by the odors of flowers, and tells how Richelieu lived in an atmosphere loaded with the heaviest perfumes, in order to excite his sexual functions.

Zippe (Wien. Med. Wochenschrift, 1879, Nr. 24), in connection with a case of kleptomania in an onanist, likewise establishes such relations, and cites Hildebrand as authority, who in his popular physiology says: “It cannot be doubted that the olfactory sense stands in remote connection with the sexual apparatus. Odors of flowers often occasion pleasurable sensual feelings, and when one remembers the passage in the ‘Song of Solomon,’ ‘And my hands dropped with myrrh and my fingers with sweet-smelling myrrh upon the handles of the lock,’ one finds that it did not escape Solomon’s observation. In the Orient the pleasant perfumes are esteemed for their relation to the sexual organs, and the women’s apartments of the Sultan are filled with the perfumes of flowers.”

Most, professor in Rostock (comp. Zippe), relates: “I learned from a sensual young peasant that he had excited many a chaste girl sexually, and easily gained his end, by carrying his handkerchief in his axilla for a time, while dancing, and then wiping his partner’s perspiring face with it.”

The case of Henry III shows that contact with a person’s perspiration may be the exciting cause of passionate love. At the betrothal feast of the King of Navarre and Margaret of Valois, he accidentally dried his face with a garment of Maria of Cleves, which was moist with her perspiration. Although she was the bride of the Prince of Condé, Henry conceived immediately such a passionate love for her that he could not resist it, and made her, as history shows, very unhappy. An analogous instance is related of Henry IV, whose passion for the beautiful Gabriel is said to have originated at the instant when, at a ball, he wiped his brow with her handkerchief.

Professor Jäger, the “discoverer of the soul,” refers to the same thing in his well-known book (2d ed., 1880, chap. xv, p. 173); for he regards the sweat as important in the production of sexual effects and as being especially seductive.

One learns from reading the work of Ploss (“Das Weib”) that attempts to attract a person of the opposite sex by means of the perspiration may be discerned in many forms in popular psychology.

In reference to this, a custom which holds among the natives of the Philippine Islands when they become engaged, as reported by Jäger, is remarkable. When it becomes necessary for the engaged pair to separate, they exchange articles of wearing-apparel, by means of which each becomes assured of faithfulness. These objects are carefully preserved, covered with kisses, and smelled.

The love of certain libertines and sensual women for perfumes[23] indicates a relation between the olfactory and sexual senses.

A case mentioned by Heschl (Wiener Zeitschrift f. pract. Heilkunde, March 22, 1861) is remarkable, where the absence of both olfactory lobes was accompanied by imperfectly developed genitals. It was the case of a man aged 45, in all respects well developed, with the exception of the testicles, which were not larger than beans and contained no seminal canals, and the larynx, which seemed to be of feminine dimensions. Every trace of olfactory nerves was wanting, and the trigona olfactoria and the furrow on the under surface of the anterior lobes were absent. The perforations of the ethmoid plate were sparingly present, and occupied by nerveless processes of the dura instead of by nerves. In the mucous membrane of the nose there was also an absence of nerves. Finally, the clearly-defined relation of the olfactory and sexual senses in mental diseases is worthy of notice, in that in the psychoses of both sexes dependent on masturbation, as well as in insanity due to disease of the sexual organs of the female, or during the climacteric[24], olfactory hallucinations are especially frequent, while in cases where a sexual cause is wanting they are very infrequent.

I am inclined to doubt[25] that olfactory impressions in man, under normal conditions, as in animals, play an important rôle in the excitation of the sexual centre. On account of the importance of this consensus for the understanding of pathological cases, it is necessary here to thoroughly consider the relations existing between the olfactory and sexual senses.

The sexual sphere of the cerebral cortex may be excited, in the sense of an excitation of sexual concepts and impulses, by processes in the generative organs. This is possible as a result of all conditions which also excite the erection-centre by means of centripetal influence (stimulus resulting from distension of the seminal vesicles; enlarged Graafian follicle; any sensory stimulus, however produced, about the genitals; hyperæmia and turgescence of the genitals, especially of the erectile tissue of the corpus cavernosum of the penis and clitoris, as a result of luxurious, sedentary life; plethora abdominalis, high external temperature, warm beds, clothing; taking of cantharides, pepper, and other spices).

Libido sexualis may also be induced by stimulation of the gluteal region (castigation, whipping).[26]

This fact is not unimportant for the understanding of certain pathological manifestations. It sometimes happens that in boys the first excitation of the sexual instinct is caused by a spanking, and they are thus incited to masturbation. This should be remembered by those who have the care of children.

On account of the dangers to which this form of punishment of children gives rise, it would be better if parents, teachers, and nurses were to avoid it entirely.

Passive flagellation may excite sensuality, as is shown by the sects of flagellants, so wide-spread in the thirteenth and fifteenth centuries. They were accustomed to whip themselves, partly as atonement and partly to kill the flesh (in accordance with the principle of chastity promulgated by the Church,—i.e., the emancipation of the soul from sensuality).

These sects were at first favored by the Church; but, since sensuality was only excited the more by flagellation, and the fact became apparent in unpleasant occurrences, the Church was finally compelled to oppose it. The following facts from the lives of the two heroines of flagellation, Maria Magdalena of Pazzi and Elizabeth of Genton, clearly show the significance of flagellation as a sexual excitant. The former, a child of distinguished parents, was a Carmelite nun in Florence (about 1580), and, by her flagellations, and, still more, through the results of them, she became quite celebrated, and is mentioned in the Annals. It was her greatest delight to have the prioress bind her hands behind her and have her whipped on the naked loins in the presence of the assembled sisters.

But the whippings, continued from her earliest youth, quite destroyed her nervous system, and perhaps no other heroine of flagellation had so many hallucinations (“Entzückungen”). While being whipped her thoughts were of love. The inner fire threatened to consume her, and she frequently cried, “Enough! Fan no longer the flame that consumes me. This is not the death I long for; it comes with all too much pleasure and delight.” Thus it continued. But the spirit of impurity wove the most sensual, lascivious fancies, and she was several times near losing her chastity.

It was the same with Elizabeth of Genton. As a result of whipping she actually passed into a state of bacchanalian madness. As a rule, she rested when, excited by unusual flagellation, she believed herself united with her “ideal.” This condition was so exquisitely pleasant to her that she would frequently cry out, “O love, O eternal love, O love, O you creatures! cry out with me, love, love!”

It is known, on the authority of Taxil (op. cit., p. 175), that rakes sometimes have themselves flagellated, or pricked until blood flows, just before the sexual act, in order to stimulate their diminished sexual power.

These facts find an interesting confirmation in the following experiences, taken from Paullini’s “Flagellum Salutis” (1st ed., 1698; reproduction, Stuttgart, 1847):—

“There are some nations, viz., the Persians and Russians, where the women regard blows as a peculiar sign of love and favor. Strangely enough, the Russian women are never more pleased and delighted than when they receive hard blows from their husbands, as John Barclay relates in a remarkable narrative. A German, named Jordan, went to Russia, and, pleased with the country, he settled there and took a Russian wife, whom he loved dearly and to whom he was always kind in everything. But she always wore an expression of dissatisfaction, and went about with sighs and downcast eyes. The husband asked the reason, for he could not understand what was wrong. ‘Aye,’ she said, ‘though you love me you do not show me any sign of it.’ He embraced her and begged to be told what he had carelessly and unconsciously done to hurt her feelings, and to be forgiven, for he would never do it again. ‘I want nothing,’ was the answer, ‘but what is customary in our country,—the whip, the real sign of love.’ Jordan observed the custom and accustomed himself to it, and then his wife began to love him dearly. Similar stories are told by Peter Petrius, of Erlesund, with the addition that the husbands, immediately after the wedding, among other indispensable household articles, provide themselves with whips.”

On page 73 of this remarkable book, the author says further: “The celebrated Count of Mirindula, John Picus, relates of one of his intimate acquaintances that he was an insatiable fellow, but so lazy and incapable of love that he was practically impotent until he had been roughly handled. The more he tried to satisfy his desire, the heavier the blows he needed, and he could not attain his desire until he had been whipped until the blood came. For this purpose he had a suitable whip made, which was placed in vinegar the day before using it. He would give this to his companion and on bended knees beg her not to spare him, but to strike blows with it, the heavier the better. The good count thought this singular man found the pleasure of love in this punishment. While in other respects he was not a bad man, he understood and hated his weakness. Coelius Rhodigin relates a similar story, as does also the celebrated jurist, Andreas Tiraquell. In the time of the skillful physician, Otten Brunfelsen, there lived in Munich, then the Capital of the Bavarian Electorate, a debauchee who could never perform his [sexual] duties without a severe preparatory beating. Thomas Barthelin also knew a Venetian who had to be beaten and driven before he could have intercourse,—just as Cupid himself moved reluctantly driven by his followers with sprays of hyacinth. A few years ago there was in Lübeck a cheesemonger, living on Mill Street, who, on a complaint to the authorities of unfaithfulness, was ordered to leave the city. The prostitute with whom he had been went to the judges and begged in his behalf, telling how difficult all intercourse had become for him. He could do nothing until he had been mercilessly beaten. At first the fellow, from shame and to avoid disgrace, would not confess, but after earnest questioning he could not deny it. There is said to have been a man in the Netherlands who was similarly incapable, and could do nothing without blows. On the decree of the authorities, however, he was not only removed from his position, but also properly punished. A credible friend, a physician in an important city of the kingdom, told me, on July 14th, last year, how a woman of bad character had told a companion, who had been in the hospital a short time before, that she, with another woman of like character, had been sent to the woods by a man who followed them there, cut rods for them, and then exposed his nates, commanding them to belabor him well. This they did. It is easy to conclude what he then did with them. Not only men have been excited and inflamed to lasciviousness, but also women, that they too might experience greater intensity of pleasure. For this reason the Roman woman had herself whipped and beaten by the lupercis. Thus Juvenal writes:—

“‘Steriles moriuntur, et illis

Turgida non prodest condita psycido Lyde:

Nec prodest agili palmas præbere Luperco.’”

In men, as well as in women, erection and orgasm, or even ejaculation, may be induced by irritation of various other regions of the skin and mucous membrane. These “erogenous” zones in woman are, while she is a virgin, the clitoris, and, after defloration, the vagina and cervix uteri.

In woman the nipple particularly seems to possess this quality. Titillatio hujus regionis plays an important part in the ars erotica. In his “Topographical Anatomy,” 1865, Bd. i, p. 552, Hyrtl cites Val. Hildebrandt, who observed a peculiar anomaly of the sexual instinct in a girl, which he called suctusstupratio. She had her mammæ sucked by her lover, and finally, by gradually drawing on her nipples, she became able to suck them herself,—an act that gave her most intense pleasure. Hyrtl also calls attention to the fact that cows sometimes suck the milk from their own udders. L. Brunn (Zeitg. f. Literatur, etc., d. Hamburg. Correspondent, 1889, Nr. 21), in an interesting article on “Sensuality and Love of Kin,” points out how zealously the nursing mother gives herself to nursing the babe, “for love of the weak, undeveloped, helpless being.”

It is easy to assume that, by the side of the ethical motives, the fact that the sucking may be attended by feelings of physical pleasure plays a part. The remark of Brunn, which is correct in itself, but one-sided, that, according to Houzeau’s experience, among the majority of animals it is only during the time of nursing that the relations between mother and offspring are close, and thereafter indifferent, also speaks in favor of this assumption.

Bastian found the same thing (blunting of the feeling for the offspring after weaning) among savages.

Under pathological conditions, as is shown by Chambard, among others, in his thesis for the doctorate, other portions of the body (in hysterical persons) about the mammæ and genitals may attain the significance of “erogenous” zones.

In man, physiologically, the only “erogenous” zone is the glans penis, and, perhaps, the skin of the external genitals.

Under pathological conditions the anus may become an “erogenous” area. Thus anal auto-masturbation, which seems to be only too frequent, and passive pederasty would be explained. (Comp. Gamier, “Anomalies sexuelles,” Paris, p. 514; F. Moll, “Conträre Sexualempfindung,” p. 163.)

The psycho-physiological process comprehended in the idea of sexual instinct is composed of (1) concepts awakened centrally or peripherally; (2) the pleasurable feelings associated with them.

The longing for sexual satisfaction (libido sexualis) arises from them. This desire grows stronger constantly, in proportion as the excitation of the cerebral sphere accentuates the feeling of pleasure by appropriate concepts and activity of the imagination; and the pleasurable sensations are increased to lustful feeling by excitation of the erection centre and the consequent hyperæmia of the genitals (entrance of liquor prostaticus into the urethra, etc.).

If circumstances are favorable for the performance of the sexual act satisfactorily, the constantly-increasing desire is complied with; if, however, conditions are unfavorable, inhibitory concepts occur, overcome the sexual longing, and prevent the sexual act.

To civilized man cultivation of a readiness with ideas which inhibit sexual desire is necessary and distinctive. The moral freedom of the individual, and the decision whether, under certain circumstances, excess, and even crime, be committed or not, depend, on the one hand, upon the strength of the instinctive concepts and the accompanying organic sensations; on the other, upon the power of the inhibitory concepts. Constitution and, especially, organic influences have a marked effect upon the instinctive impulses; education and cultivation of self-control have a decisive influence on the opposing concepts.

The exciting and inhibitory powers are variable quantities. Over-indulgence in alcohol in this respect is very fatal, since it awakens and increases libido sexualis, while at the same time it reduces moral resistance.

The Act of Cohabitation.[27]

The essential condition for the man is sufficient erection. Anjel (Arch. für Psych., viii, H. 2) calls attention to the fact that in sexual excitement the erection centre is not alone influenced,—the nervous excitement is distributed to the entire vasomotor system of nerves. The proof of this is the turgescence of the organs in the sexual act, injection of the conjunctiva, prominence of the eyes, dilatation of the pupils, and cardiac palpitation (resulting from paralysis of the vasomotor nerves of the heart, which arise from the cervical sympathetic, and the consequent dilatation of the cardiac arteries, and the increased stimulation of the cardiac ganglia induced by the consequent hyperæmia of the cardiac walls). The sexual act is accompanied by a pleasurable feeling, which, in the male, is conditioned by the passage of semen through the ductus ejaculatorii to the urethra, caused by sensory stimulation of the genitals. The pleasurable sensation occurs earlier in the male than in the female, grows rapidly in intensity until the moment of commencement of ejaculation, reaching its height in the instant of free emission, and disappears quickly post ejaculationem.

In the female the pleasurable feeling occurs later and comes on more slowly, and generally outlasts the act of ejaculation.

The distinctive event in coitus is ejaculation. This function is dependent on a centre (genito-spinal), which Budge has shown to be situated at the level of the fourth lumbar vertebra. It is a reflex centre. The stimulus that excites it is the ejection of sperma from the vesiculæ seminales into the pars membranacea urethræ, which follows reflexly from stimulation of the glans penis. As soon as the collection of semen, with ever-increasing pleasurable sensation, has reached a sufficient amount to be effectual as a stimulus of the ejaculation-centre, the centre acts. The reflex motor path lies in the fourth and fifth lumbar nerves. The action consists of a convulsive excitation of the bulbo-cavernosus muscle (innervated by the third and fourth sacral nerves), which forces the semen out.

In the female as well, at the height of sexual and pleasurable excitement, a reflex movement occurs. It is induced by stimulation of the sensory genital nerves, and consists of a peristaltic movement in the tubes and uterus as far down as the portio vaginalis, which presses out the mucous secretions of the tubes and uterus. Inhibition of the ejaculation centre is possible as a result of cortical influence (want of desire in coitus, emotions in general; influence of the will, in a measure).

Under normal conditions, with the completion of the sexual act, libido sexualis and erection disappear, and the psychical and sexual excitement gives place to a comfortable feeling of lassitude.

III. GENERAL PATHOLOGY.[28]

(NEUROLOGICAL AND PSYCHOLOGICAL.)

Abnormality of the sexual functions proves to be especially frequent in civilized races. This fact is explained in part by the frequent abuse of the sexual organs, and in part by the circumstance that such functional anomalies are often the signs of an abnormal constitution of the central nervous system, which is, for the most part, hereditary (“functional signs of degeneration”).

Since the generative organs stand in important functional connection with the entire nervous system, and especially with its psychical and somatic functions, it is easy to understand the frequency of general neuroses and psychoses arising in sexual (functional or organic) disturbances.

Schema of the Sexual Neuroses.
I. Peripheral.[29] | 1. Sensory. | a. Anæsthesia.
b. Hyperæsthesia.
c. Neuralgia.
2. Secretory. | a. Aspermia.
b. Polyspermia.
3. Motor. | a. Pollutions (spasm).
b. Spermatorrhœa (paralysis).
II. Spinal. | 1. Affections of the erection centre.
2. Affections of the ejaculation centre.
III. Cerebral. | 1. Paradoxia.
2. Anæsthesia.
3. Hyperæsthesia.
4. Paræsthesia.

II. SPINAL NEUROSES.

1. Affections of the Erection Centre.

(a) Irritation (priapism) arises reflexly from peripheral sensory irritants (e.g., gonorrhœa); directly, from organic irritation of the nerve-tracts from the brain to the erection centre (spinal disease in the lower cervical and upper dorsal regions), or of the centre itself (certain poisons); or from psychical irritation. In the latter case satyriasis exists, i.e., abnormal duration of erection, with libido sexualis. In simply reflex or direct organic irritation, libido sexualis may be wanting, and the priapism be accompanied by unpleasant feelings.

(b) Paralysis from destruction of the centre or of the nerve-tracts (nervi erigentes), in diseases of the spinal cord (paralytic impotence). A milder form is that of lessened excitability of the centre, resulting from overstimulation (in sexual excesses, especially in onanism), or from alcoholic intoxication, abuse of bromides, etc. It may be accompanied by cerebral anæsthesia, and often with anæsthesia of the external genitals. Cerebral hyperæsthesia is here more frequent (increased libido sexualis, lust). A peculiar form of diminished excitability is shown in those cases where the centre responds only to certain stimuli. Thus there are men for whom sexual contact with their virtuous wives does not supply the necessary stimulus for the excitation of an erection, but in whom it occurs when the act is attempted with a prostitute, or in the form of some unnatural sexual act. As far as psychical stimuli are here concerned, they may be inadequate (v. infra, paræsthesia and perversion of sexual instinct).

(c) Inhibition. The erection centre may become functionally incapable as a result of cerebral influence. This inhibitory influence is an emotion (disgust, fear of contagion), or an idea[30] of impotence. There are many men in the first condition who have an unconquerable loathing for their wives, or fear of infection, or are suffering with perverse sexual feelings. In the latter condition are neuropathic individuals (neurasthenics, hypochondriacs), frequently weakened sexually (masturbators), who have reason, or think they have, to mistrust their sexual power. This idea acts as an inhibitory concept, and makes the act with the person concerned of the opposite sex temporarily or absolutely impossible.

(d) Irritable weakness. In this condition there is abnormal impressionability of the centre, but accompanied by rapid diminution of its energy. There may be functional disturbance of the centre itself, or weakness of the innervation through the nervi erigentes; or there may be weakness of the ischio-cavernosus muscle. Cases in which the erection is ineffectual, on account of abnormally early ejaculation, form a transition to the following anomalies:—

2. Affections of the Ejaculation Centre.

(a) Abnormally easy ejaculation from absence of cerebral inhibition, resulting from excessive psychical excitement or irritable weakness of the centre. In this case, under certain circumstances, the simple conception of a lascivious situation is sufficient to set the centre in action (high degree of spinal neurasthenia, usually resulting from sexual abuse). A third possibility is hyperæsthesia of the urethra, by virtue of which, when the semen enters it, an immediate and excessive reflex action of the ejaculation centre is induced. In such a case, simple proximity to the female genitals may be sufficient to induce ejaculation (ante portam).

In case of hyperæsthesia of the urethra as a cause, the ejaculation may be accompanied by painful, instead of pleasurable, sensations. Usually, in cases where there is hyperæsthesia of the urethra, there is, at the same time, irritable weakness of the centre. Both functional disturbances are important in the production of pollutio nimia and diurna.

The accompanying pleasurable feeling may be pathologically absent. This occurs in defective men and women (anæsthesia, aspermia?), and, further, as a result of disease (neurasthenia, hysteria); or (in prostitutes) it follows overstimulation and the blunting thus induced. The intensity of the pleasurable feeling depends on the degree of psychical and motor excitement accompanying the sexual act. Under pathological conditions this may become so pronounced that the movements of coitus take on the character of involuntary convulsive movements, and even pass into general convulsions.

(b) Abnormally difficult ejaculation. It is occasioned by inexcitability of the centre (absence of libido, paralysis of the centre: organic, from disease of brain or spinal cord; functional, from sexual abuses, marasmus, diabetes, morphinism), and, in this case, for the most part, in connection with anæsthesia of the genitals and paralysis of the erection centre. Or it is the result of a lesion of the reflex arc, or of peripheral anæsthesia (urethra), or of aspermia. The ejaculation occurs not at all, or tardily, in the course of the sexual act, or only afterward, in the form of a pollution.

III. CEREBRAL NEUROSES.

1. Paradoxia, i.e., sexual excitement occurring independently of the period of the physiological processes in the generative organs.

2. Anæsthesia (absence of sexual instinct). Here all organic impulses arising in the sexual organs, as well as all concepts, and visual, auditory, and olfactory sense-impressions, fail to excite the individual sexually. This is physiological in childhood and old age.

3. Hyperæsthesia (increased desire, satyriasis). In this state there is an abnormally increased impressionability of the vita sexualis to organic, psychical, and sensory stimuli (abnormally intense libido, lustfulness, lasciviousness). The stimulus may be central (nymphomania, satyriasis) or peripheral, functional or organic.

4. Paræsthesia, (perversion of the sexual instinct, i.e., excitability of the sexual functions to inadequate stimuli).

These cerebral anomalies fall within the domain of psychopathology. The spinal and peripheral anomalies may occur in combination with them, but these affect persons, as a rule, that are free from mental disease. They may occur in various combinations, and become the cause of sexual crimes. For this reason, they demand consideration in the following description. However, the cerebral anomalies claim the principal interest, since they very frequently lead to the commission of perverse and even criminal acts.

A. Paradoxia. Sexual Instinct Manifesting itself Independently of Physiological Processes.

1. Sexual Instinct Manifested in Childhood.

Every physician conversant with nervous affections and diseases incident to childhood is aware of the fact that manifestation of sexual instinct may occur in very young children. The observations of Ultzmann concerning masturbation in childhood[31] are worthy of attention in relation to it. It is necessary here to differentiate between the numerous cases where, as a result of phimosis, balanitis, or oxyuris in rectum or vagina, young children have itching of the genitals, and experience a kind of pleasurable sensation from manipulations thus induced, and thus come to practice masturbation; and those cases in which sexual ideas and impulses occur in the child as a result of cerebral processes without peripheral causes. It is only in this latter class of cases that we have to do with the early manifestation of sexual instinct. In such cases it may always be regarded as an accompanying symptom of a neuro-psychopathic constitutional condition. A case of Marc’s (“Die Geisteskrankheiten,” etc., von Ideler, i, p. 66) illustrates very well these conditions. The subject was a girl of eight years, of respectable family, who was devoid of all child-like and moral feelings, and had masturbated from her fourth year; at the same time she consorted with boys of the age of ten or twelve. She had thought of killing her parents, that she might become her own mistress and give herself up to pleasure with men. In these cases of early manifestation of libido the children come also to masturbate; and, since they are greatly predisposed constitutionally, they frequently sink into dementia, or become subjects of severe degenerative neuroses or psychoses.

Lombroso (Archiv di Psichiatria, iv, p. 22) has collected a number of cases of children affected with very decided hereditary taint, which belong in this category. One was that of a girl who masturbated shamelessly and almost constantly at the age of three. Another girl began at the age of eight, and continued to practice masturbation when married, and even during pregnancy. She was pregnant twelve times. Five of the children died early, four were hydrocephalic, and two boys began to masturbate,—one at the age of seven, the other at the age of four.

Zambaco (L’Encéphale, 1882, Nr. 1, 2) tells the disgusting story of two sisters affected with premature and perverse sexual desire. The elder, R., masturbated at the age of seven, practiced lewdness with boys, stole wherever she could, seduced her four-year-old sister into masturbation, and at the age of ten was given up to the practice of the most revolting vices. Even ferrum candens ad clitoridem had no effect in overcoming the practice, and she masturbated with the cassock of a priest while he was exhorting her to reformation.

2. Re-awakening of Sexual Instinct in Old Age.[32]

There are infrequent cases in which the sexual instinct persists until a great age. “Senectus non quidem annis sed viribus magis æstimatur” (Zittmann). Oesterlen (Maschka, Handb., iii, p. 18) mentions the case of a man aged 83, who was sentenced to three years’ imprisonment by a Wurtemberg court on account of sexual misdemeanors. Unfortunately nothing is said of the nature of the crime or of the mental condition of the criminal.[33]

The manifestation of sexual instinct in old age is not in itself pathological; but presumption of pathological conditions must necessarily be entertained when the individual is decrepit and his sexual life has already long become extinct; and when the impulse, in a man whose sexual needs were in his early life, perhaps, not very marked, manifests itself with greater strength, and strives for even perverse satisfaction in a shameless and impulsive manner. In such cases there is at once suggested a presumption of pathological conditions. Medical science recognizes the fact that such an impulse depends upon the morbid alterations of the brain which lead to senile dementia. This abnormal manifestation of sexual life may be the precursor of senile dementia, and make its appearance even long before there are any well-defined manifestations of intellectual weakness. The attentive and experienced observer will always be able to detect in this prodromal stage an alteration of character in pejus, and a deterioration of the moral sense accompanying the peculiar sexual manifestation.

The libido of those passing into senile dementia is at first expressed in lascivious speech and gesture. The next objects of the attempts of these senile subjects of brain atrophy and psychical degeneration are children. This sad and dangerous fact is explained by the better opportunity they have of falling in with children, but more especially by a feeling of imperfect sexual power. Defective sexual power and greatly diminished moral sense explain the additional fact of the perversity of the sexual acts of these aged men. They are the equivalents of the impossible physiological act.

The annals of legal medicine distinguish, as such, exhibition of the genitals,[34] lustful handling of the genitals of children,[35] inducing them to perform manustupration of the seducer, and performing masturbation[36] or flagellation on the victim.

In this stage the intellect may still be sufficiently intact to allow avoidance of publicity and discovery, while the moral sense is too far gone to allow consideration of the moral significance of the act and resistance to the impulse. With the progress of dementia, these acts are more and more shamelessly committed. Then care on account of defective sexual power disappears, and adults also become the objects of the senile passion; but the defective sexual power necessitates equivalents for coitus. Not infrequently sodomy results, and, as Tarnowsky (op. cit., p. 77) points out, in the sexual act performed with geese, chickens, etc., the sight of the dying animal and its death-struggles at the time of coitus afford complete satisfaction. The perverse sexual acts with adults are quite as horrible, and may be explained psychologically in the same way.

Case 49, in the author’s “Text-Book of Legal Psychopathology,” second ed., p. 161, demonstrates how enormously increased sexual lust may be during the course of senile dementia. Quum senex libidinosus germanam suam filiam æmulatione motus necaret et adspectu pectoris sciosi puellæ moribundæ delectaretur.

Erotic delirium and states of satyriasis may occur, in the course of the malady, with or without maniacal episodes, as the following case shows:—

Case 1. J. René, always given to indulgence in sensuality and sexual pleasures, but always with regard for decorum, has shown, since his seventy-sixth year, a progressive loss of intelligence and increasing perversion of his moral sense. Previously bright and outwardly moral, he now wasted his property in concourse with prostitutes, frequented brothels only, asked every woman on the street to marry him or allow coitus, and thus became so publicly obnoxious that it was necessary to place him in an asylum. There the sexual excitement increased to a veritable satyriasis, which lasted until he died. He masturbated continuously, even before others; took delight only in obscene ideas; thought the men about him were women, and followed them with indecent proposals (Legrand du Saulle, “La Folie,” p. 533).

Moreover, women previously moral, when affected with senile dementia, may manifest similar conditions of great sexual excitement (nymphomania, furor uterinus).

It may be seen from a reading of Schopenhauer,[37] that, as a result of senile dementia, the abnormally excited and perverse instinct may be directed exclusively to persons of the same sex (v. infra). The manner of the satisfaction is here passive pederasty, or, as I ascertained in the following case, mutual masturbation:—

Case 2. Mr. X., aged 80, of high social position, from a family having hereditary taint. He was always very sensual and a cynic, of uncontrollable temper, and, according to his own confession, as a young man, preferred masturbation to coitus. However, he never showed signs of contrary sexual instinct, and kept mistresses, raising a child by one. At the age of forty-eight he married, out of inclination, and begat six children, and never gave his wife cause for complaint. I could obtain but an incomplete history of his family. It was certain that his brother was suspected of love for men, and that a nephew became insane as a result of excessive masturbation.

The patient, always peculiar and quick-tempered, for years has been growing more extreme in character. He has become exceedingly suspicious, and slight opposition to his wishes induces attacks of anger which may become actual raving, and in which he may raise his hand against his wife. For a year there have been unmistakable signs of incipient senile dementia. The patient has become forgetful, localizes past events incorrectly, and has false ideas of time. For fourteen months it has been noticed that he manifests affection for certain male servants, especially for a gardener’s boy. Otherwise rude and overbearing to servants, he surfeits his favorite with favors and presents, and commands his family and his house officials to treat the boy with the greatest respect. The aged patient awaits the hour of rendezvous in true sexual excitement. He sends his family away, that he may be with his favorite undisturbed, and remains shut up with him for hours; and when the doors are opened again, he is found lying on the bed exhausted. Besides this object of his passion, the patient had intercourse episodically with other servants. It is certain that he enticed them, asked them for kisses, exhibited himself, allowed manipulation ad genitalia, and practiced mutual masturbation. By these practices absolute demoralization was brought about. The family was powerless; for any opposition caused violent outbreaks of anger and even threats against his relatives. The patient was completely without appreciation of his perverse sexual acts; and therefore the only course left to the afflicted family was to remove all authority from his hands and place him in an asylum. No erotic inclination toward the opposite sex was observed, though the patient occupied a sleeping-apartment with his wife. With reference to the perverse sexuality and the defective moral sense of this unfortunate man, it is worthy of note that he questioned the servants of his daughter-in-law as to whether she had a lover.

B. Anæsthesia Sexualis (Absence of Sexual Feeling).

1. As a Congenital Anomaly.

Only those cases can be regarded as unquestionable examples of absence of sexual instinct dependent on cerebral causes, in which, in spite of generative organs normally developed and the performance of their functions (secretion of semen, menstruation), the corresponding emotions of sexual life are absolutely wanting. These functionally sexless individuals are seldom seen, and are, indeed, always persons having degenerative defects, and in whom other functional cerebral disturbances, states of psychical degeneration, and even anatomical signs of degeneration, are observed. Legrand du Saulle describes a classical case that falls under this head (Annales médico-psychol., May, 1876).

Case 3. D., aged 33, had a mother who suffered with insanity of persecution. The mother’s father also suffered with persecutory insanity, and committed suicide. Her mother was insane, and this woman’s mother became insane in the puerperal state. Three of her mother’s children died in babyhood, and those that lived longer had an abnormal character. As early as his thirteenth year, D. was troubled with the thought of becoming insane. At fourteen he attempted suicide. Later, vagabondage, and, as a soldier, repeated insubordination and crazy pranks. His intelligence was very limited; no sign of degeneration, genitals normal. At seventeen or eighteen he had emissions of semen, had never masturbated or had sexual feeling, and never had sought intercourse with women.

Case 4. P., aged 36, common laborer, was received at my clinic in the beginning of November on account of spastic spinal paralysis. He declares he comes of a healthy family. A stutterer from his youth. Cranium microcephalic (cf. 53 cm.). Patient somewhat imbecile. He was never sociable, never had a sexual emotion. The sight of a woman never had anything enticing for him. He never had a desire to masturbate. Erections frequent, but only on waking in the morning with a full bladder, and without a trace of sexual feeling. Pollutions very infrequent,—about once a year, in sleep,—and usually while dreaming that he is concerned with a female. These dreams, however, as his dreams in general, are not markedly erotic. He says the act of pollution is not accompanied by any pleasurable sensation. Patient does not feel this absence of sexual sensations. He gives the assurance that his brother, aged 34, is in exactly the same sexual condition as himself, and he makes it seem probable that a sister, aged 21, is in a similar state. A younger brother, he says, is normal sexually. The examination of his genitals reveals nothing abnormal besides phimosis.

Hammond (“Sexual Impotence”), even with his wide experience, reports only the following three cases of anæsthesia sexualis:—

Case 5. Mr. W., aged 33; strong, healthy, with normal genitals. He had never experienced libido, and had vainly sought to awaken his defective sexual instinct by means of obscene stories and intercourse with prostitutes. On the occasion of such attempts he experienced only disgust, with even a feeling of nausea, and became nervously and mentally exhausted. Only once, when he forced the situation, did he have a transitory erection. W. had never masturbated, and had had pollutions about once every two months from his seventeenth year. Important interests demanded that he marry. He had no horror feminæ, and longed for a home and a wife, but felt that he was incapable of the sexual act. He died, unmarried, in the American civil war.

Case 6. X., aged 27; genitals normal; never felt libido. Mechanical or thermic stimuli easily induced erection, but instead of libido sexualis there was regularly a desire for alcoholic indulgence. Such excesses also induced erections, and he then sometimes masturbated. He had a disinclination for women and a loathing of coitus. If, with an erection, he made an attempt at coitus, it disappeared at once. Death in coma during an attack of cerebral hyperæmia.

Case 7. Mrs. O., normally developed, healthy, menstruated regularly; aged 35, fifteen years married. She never experienced libido, and never had any erotic excitement in sexual intercourse with her husband. She was not averse to coitus, and sometimes seemed to experience pleasure in it, but she never had a wish for repetition of cohabitation.

In connection with such pure cases of anæsthesia there should be considered other cases in which the mental side of the vita sexualis is a blank leaf in the life of the individual, but where elementary sexual sensations manifest themselves at least in masturbation (comp. the transitional Case 6). According to Magnan’s ingenious classification, which, however, is not strictly correct and somewhat too dogmatic, in such cases the sexual life is so limited as to be designated spinal. Possibly in some such cases there exists virtually a mental side of the vita sexualis, but it is very weak, and undermined by masturbation before it attains development. These represent the transitional cases from the congenital to the acquired (psychical) anæsthesia sexualis. This danger threatens many masturbators of vicious constitution. It is psychologically interesting that when the sexual element is early vitiated, then an ethical defect is manifested.

The two following cases, previously published by me in the Archiv für Psychiatrie, vii, are given here as illustrations worthy of consideration:—

Case 8. F. J., aged 19, student; mother was nervous, sister epileptic. At the age of four, acute brain affection, lasting two weeks. As a child he was not affectionate, and was cold toward his parents; as a student he was peculiar, retiring, preoccupied with self, and given to much reading. Well endowed mentally. Masturbation from fifteenth year. Eccentric after puberty, with continual alternation between religious enthusiasm and materialism,—now studying theology, now natural sciences. At the university his fellow-students took him for a fool. He read Jean Paul almost exclusively, and wasted his time. Absolute absence of sexual feeling toward the opposite sex. Once he indulged in intercourse, experienced no sexual feeling in the act, found coitus absurd, and did not repeat it. Without any emotional cause whatever, he often had a thought of suicide. He made it the subject of a philosophical dissertation, in which he contended that it was, like masturbation, a justifiable act. After repeated experiments, which he made on himself with various poisons, he attempted suicide with fifty-seven grains of opium; but he was saved, and sent to an asylum.

Patient is destitute of moral and social feelings. His writings disclose incredible frivolity and vulgarity. His knowledge is of a wide range, but his logic is peculiarly distorted. There is no trace of emotionality. He treats everything (even the sublime) with incomparable cynicism and irony. He pleads for the justification of suicide with false philosophical premises and conclusions, and, as one would speak of the most indifferent affair, he declares that he intends to accomplish it. He regrets that his penknife has been taken from him. If he had it he would open his veins as Seneca did,—in the bath. A short time before a friend had given him, instead of a poison as he supposed, a cathartic. Instead of having been a means to send him to the other world, it had sent him to the water-closet. Only the Great Operator could eradicate his foolish and fatal idea by removing his senses, etc.

The patient has a large, rhombic, distorted skull, the left half of the forehead being flatter than the right. The occiput is very straight. Ears far back, widely projecting, and the external meatus forms a narrow slit. Genitals very lax; testicles unusually soft and small.

Now and then the patient suffers with onomatomania. He is compelled to think of the most useless problems and give up to an interminable distressing and worrying thought; and is so fatigued after it that he is no longer capable of any rational thought. After some months the patient was sent home unimproved. There he spent his time in reading and frivolities, and busied himself with the thought of founding a new Christianity, because Christ had been subject to grand delusions and had deceived the world with wonders (!). After remaining at home some years the sudden occurrence of a maniacal outbreak brought him again to the asylum. He presented a mixture of primordial delirium of persecution (devil, anti-christ, persecution, poisoning, persecutory voices) and delusions of grandeur (Christ, redemption of the world), with impulsive, incoherent actions. After five months there was a remission of this intercurrent acute mental disease, and the patient returned to the level of his original intellectual peculiarity and moral defect.

Case 9. E., aged 30, journeyman-painter, was arrested while trying to cut off the scrotum of a boy he had caught in the woods. He gave as a motive for this act that he wished to cut into it in order that the world should not multiply. Often in his youth, with like purpose, he had cut into his own genitals.

It is impossible to learn anything of his ancestry. From his childhood he was mentally abnormal, violent, never lively, very irritable, irascible, selfish, and weak-minded. He hated women, loved solitude, and read much. He sometimes laughed to himself and did silly things. Of late years his hatred of women had increased, especially of those that were pregnant, they being responsible for the misery of the world. He also hated children, and cursed his father. He entertained communistic ideas, and berated the rich and the ministry, and God, who had allowed him to come into the world so poor. He declared that it would be better to castrate all children than to allow others to come into the world that could only be fated to endure poverty and misery. He had always had the intention, from his fifteenth year, to castrate himself, in order to have no part in increasing unhappiness and adding to the number of men. He hated the female sex because it was a means of procreation. Only twice in his life had he allowed women to practice manustupration on him, and, with the exception of this, he had never had anything to do with them. Occasionally he had sexual desire, but never for a natural satisfaction of it. When nature did not help him, he occasionally helped himself by means of masturbation.

He is a powerful, muscular man. The formation of the genitals presents no abnormality. On the scrotum and penis are numerous scars, which resulted from his attempts at self-emasculation, but which, he asserts, were not carried out on account of pain. Genu valgum of right limb. No evidence of onanism could be discovered. He is moody, defiant, irritable. Social feelings are absolutely foreign to him. With the exception of imperfect sleep and frequent headaches, there are no functional disturbances.

From cases of this kind, depending on cerebral causes, there must be distinguished others where the absence of function arises from an absence or malformation of the generative organs, as in certain hermaphrodites, idiots, and cretins. A case belonging here is found in Maschka’s hand-book.

Case 10. Complainant pleads for divorce on account of impotence of her husband, who has never had intercourse with her. She is thirty-one years old, and a virgin. The husband is somewhat weak mentally, physically strong; the genitals well developed. He declares that he has never had a complete erection or a flow of semen, and says that he is totally indifferent about intercourse with women.

Ultzmann’s[38] observations show that anæsthesia sexualis is not caused by aspermia simply. He shows that even in congenital aspermia the vita sexualis and sexual power may be entirely satisfying; an additional proof that defective libido ab origine is to be sought for in cerebral conditions.

The naturæ frigidas of Zacchias are examples of a milder form of anæsthesia. They are met more frequently among women than among men. The characteristic signs of this anomaly are: slight inclination to sexual intercourse, or pronounced disinclination to coitus without sexual equivalent, and failure of corresponding psychical, pleasurable excitation during coitus, which is indulged in simply from sense of duty. I have often had occasion to hear complaints from husbands about this. In such cases the wives have always proved to be neuropathic ab origine. Some were at the same time hysterical.

2. Acquired Anæsthesia.

Acquired diminution of sexual instinct, extending through all degrees to extinction, may depend on various causes. These may be organic and functional, psychical and somatic, central and peripheral. The diminution of libido, as age advances, and its temporary disappearance after the sexual act, are physiological. The variations with reference to the duration of the sexual instinct are dependent upon individual factors. Education and manner of life have a great influence upon the intensity of the vita sexualis. Intense mental activity (hard study), physical exertion, emotional depression, and sexual continence decidedly diminish sexual inclination. Continence at first induces increase, but sooner or later, according to constitutional conditions, the activity of the generative organs decreases, and with it libido. At all events, in a person sexually mature, a close connection exists between the activity of the generative glands and the degree of libido. That this relation is not determinate is shown by the cases of sensual women, who, after the climacterium, continue to have sexual intercourse, and may manifest states of sexual excitement (cerebral). Also in eunuchs it is seen that libido may long outlast the production of semen.

On the other hand, however, experience teaches that libido is essentially conditioned by the function of the generative glands, and that the facts mentioned are exceptional manifestations. As peripheral causes of diminution or extinction of libido, may be mentioned castration, degeneration of the sexual glands, marasmus, sexual excesses in the form of coitus and masturbation, and alcoholism [cocainism]. In the same way, the disappearance of libido in general disturbances of nutrition (diabetes, morphinism, etc.) may be explained. Finally, the atrophy of the testicles should be remembered, which has sometimes been observed to follow focal lesions of the brain (cerebellum).

A diminution of the vita sexualis, from degeneration of the tracts of the cord and genito-spinal centre, occurs in diseases of the spinal cord and brain. A central interference with the sexual instinct may be organically induced by cortical disease (dementia paralytica in its advanced stages); functionally, by hysteria (central anæsthesia?) and emotional insanity (melancholia, hypochondria).

C. Hyperæsthesia (Abnormally Increased Sexual Desire).

Pathology has no easy task, in the single case, when it has to decide whether the impulse to sexual satisfaction has reached a pathological degree. Emminghaus (“Psychopathologie,” p. 225) declares that the immediate re-awakening of desire after satisfaction, with its occupation of the entire attention, and no less the excitation of libido by the sight of persons and things which in themselves should have but an indifferent sexual effect, are decidedly abnormal. In general, sexual instinct and its corresponding needs are in proportion to physical strength and age. Sexual desire rapidly increases after puberty, until it reaches a marked degree; is strongest from the twentieth to the fortieth year, and then slowly decreases. Married life seems to preserve and control the instinct. Sexual intercourse with many persons increases the desire.

Since woman has less sexual need than man, a predominating sexual desire in her arouses a suspicion of its pathological significance; and the more, when this finds expression in desire for adornment, coquetry, or male society, which, passing beyond the limits set by good breeding and manners, becomes quite noticeable.

The constitution, in both sexes, is of the greatest significance. An abnormally strong sexual instinct is frequently accompanied by a neuropathic constitution; and such individuals pass a great part of their lives heavily burdened with the weight of this constitutional anomaly of their sexual life. The power of the sexual impulse in such cases may at times rise to the importance of an organic necessity, and really endanger the freedom of the will. The want of satisfaction of this impulsive desire may, under such conditions, induce a condition allied to actual rutting, or a psychical condition, accompanied by emotions of fear, in which the individual gives up to the impulse, and responsibility becomes doubtful. If the individual does not give up to his powerful impulse, he is in danger, by reason of his enforced abstinence, of ruining his nervous system by inducing a neurasthenia, or seriously increasing such a condition if it be already present. In normally constituted individuals, too, the sexual instinct is an inconstant quantity. Aside from the temporary indifference following satisfaction, and the diminution of sexual desire in long-continued continence after a certain reactionary stage of sexual desire is overcome, the manner of life has a great influence. Those living in large cities, who are constantly reminded of sexual things and incited to sexual enjoyment, certainly have more sexual desire than those living in the country. A dissipated, luxurious, sedentary manner of life, preponderance of animal food, and the consumption of spirits, spices, etc., have a stimulating influence on the sexual life. In woman the sexual inclination is post-menstrually increased. At this time, in neuropathic women, the excitement may reach a pathological degree.

The great libido of consumptives is remarkable. Hofmann tells of a consumptive peasant who satisfied his wife sexually on the evening before his death.

The sexual acts are coitus (eventually rape) and, faute de mieux, masturbation; and, with defective moral sense, pederasty or bestiality. If sexual power is diminished or extinct, with excessive sexual desire, all manner of perversity of sexual acts becomes possible.

Excessive libido may be peripherally or centrally induced. The former manner of origin is the more infrequent. Pruritus and eczema of the genitals may cause it; and likewise certain substances, like cantharides, which powerfully stimulate sexual desire. Not infrequently, in women at the climacteric, sexual excitement occurs, occasioned by pruritus; and also in cases where there is neuropathic taint. Magnan (Annales médico-psychol., 1885, p. 157) reports the case of a lady who was afflicted mornings with attacks of frightful erethismus genitalis, and the case of a man, aged 55, who was tormented at night by unbearable priapism. In each case there was a neurosis.

The central origin of sexual excitement is of frequent occurrence[39] in persons having neurotic taint or hysteria, and in conditions of psychical exaltation. Here, where the cortex and the psycho-sexual centre are in a condition of hyperæsthesia (abnormal excitability of the imagination, increased ease of association), not only visual and tactile impressions, but also auditory and olfactory sensations, may be sufficient to call up lascivious concepts.

Magnan (op. cit.) reports the case of a young woman who had an increasing sexual desire from puberty, and satisfied it by masturbation. Gradually she grew to become sexually excited at the sight of any man pleasing to her; and, since she was unable to control herself, she would sometimes shut herself up in a room until the storm had passed. At last she gave herself up to men of her choice, that she might get rest from her tormenting desire; but neither coitus nor masturbation brought relief, and she went to an asylum.

The case of a mother of five children is added, who, in despair about her inordinate sexual impulse, attempted suicide, and then sought an asylum. There her condition improved, but she never trusted herself to leave it.

There are several illustrative cases in men and women in the author’s article, “On Certain Anomalies of Sexual Instinct,” Cases 6 and 7 (Archiv für Psychiatrie, vii, 2); Cases 3 and 5 are given here.

Case 11. On the afternoon of July 7, 1874, Clemens, engineer, being on his way, on business, from Trieste to Vienna, left the train at the town of Bruck, and, passing through the town to the neighboring village of St. Ruprecht, attempted a rape on an old woman, aged 70, whom he found alone in a house. He was seized by the neighbors and arrested by the local police. At his hearing he declared that he had tried to find the pound, in order to satisfy his sexual desire with a bitch. He said that he often suffered with such sexual excitement. He did not deny his act, but excused it as the result of disease. The heat, the motion of the cars, and anxiety about his family, to which he wished to go, had confused him and made him ill. Shame and remorse were not shown. His conduct was open, his mien gay; eyes red and bright, head hot, tongue coated; pulse full, soft, beating over 100; fingers somewhat tremulous. The statements of the accused were precise, but hurried; his glance uncertain, and with an unmistakable expression of lasciviousness. To the medical expert summoned to examine him, he gave the impression of one suffering with disease,—as if he were in the beginning of alcoholic insanity.

C. is forty-five years old, married, father of one child. He does not know what diseases his parents or other members of his family have had. In childhood he was weak and neuropathic. At the age of five his head was injured by a blow with a hoe. A scar one-half cm. broad by one cm. long, situated on the right parietal and frontal bones, dates from that injury. The bone is here somewhat depressed. The overlying skin is united to the bone. Pressure at this point causes pain, which radiates along the lower branch of the trigeminus. This spot is also frequently spontaneously painful. In his youth he had frequent attacks of “fainting”; before puberty, pneumonia, rheumatism, and intestinal catarrh. At the age of seven he experienced a peculiar inclination for men,—i.e., for a certain superior. Whenever he saw this man he had a peculiar feeling in his heart; kissed the ground he walked on. At ten he fell in love with a certain deputy. Later he had an enthusiasm for men, though it was entirely platonic. He began to masturbate at the age of fourteen; first intercourse at seventeen. Then the earlier manifestations of contrary sexual feeling disappeared entirely. At that time he passed through a peculiar acute psychopathic condition, which he described as a kind of clairvoyance. From fifteen, hæmorrhoids, with symptoms of plethora abdominalis. When he had profuse hæmorrhoidal hæmorrhage, which occurred usually every three or four weeks, he was better. At other times he was constantly in a condition of painful sexual excitement, which he satisfied partly by means of onanism and partly by coitus. Every woman he met excited him; even when he was among female relatives he was impelled to make indecent proposals. Sometimes it was possible for him to master his desire; sometimes he was driven to indecent acts. If, after these, he was kicked out-of-doors, it seemed perfectly right to him; for he thought that he needed such correction and support against his powerful impulse, which was a burden to him. No periodicity in this sexual excitement was recognizable.

Until 1861 he committed excesses in venery and was several times infected with gonorrhœa and chancres. In 1861, marriage. He was sexually satisfied, but became a burden to his wife on account of his great sensuality. In 1864 he passed through an attack of mania in the hospital at Fiume, and in the same year he again fell ill, and was taken to the insane asylum at Ybbs, where he remained until 1867. There he suffered with recurrent mania accompanied by great sexual excitement. He says that intestinal catarrh and anxiety were the cause of his illness at that time.

Thereafter he was well, but he suffered much on account of his excessive sexual desire. If he were absent from his wife but a short time, the impulse became so powerful that man or animal was indifferent to him for the satisfaction of his lust. In summer these impulses were much stronger, and were always accompanied by abdominal plethora. Something that he remembered in medical reading, made him think that in his case the ganglionic system was more powerful than the cerebral. In October, 1873, on account of business, he had to leave his wife. From that time until Easter, with the exception of occasional masturbation, there was no sexual indulgence. After that he made use of women and bitches. From the middle of June until July 7, he had no opportunity for sexual indulgence. He felt nervously excited, relaxed, and as if he were going crazy. Of late he had slept badly. A longing for his wife, who lived in Vienna, drove him to leave his business. He obtained leave of absence. The heat and the noise of the train confused him, and he could no longer hold out against his sexual excitement and the pressure of blood in his abdomen. Everything danced before his eyes. He left the car at Bruck, and was absolutely confused, not knowing where he went; and for a moment the thought came to him to throw himself in the water; all was like a mist before his eyes. Then he saw a woman, exposed his genitals, and tried to embrace her. She cried for help, and thus he was arrested.

After the attempt it suddenly became clear to him what he had done. He openly confessed his crime, which he remembered in all its details, but which seemed to him to be something abnormal. He could not help it. For some days after this, C. suffered with headache and congestions, and was now and then excited and restless, and slept badly. His mental functions are undisturbed, but he is, nevertheless, a congenitally peculiar man, with a character weak and devoid of energy. The facial expression has something lascivious and peculiar about it. He suffers with hæmorrhoids. The genitals present nothing abnormal. The cranium is narrow and retreating at the forehead. Body large and well nourished. With the exception of diarrhœa, there is no disturbance of the vegetative functions.

Case 12. Mrs. E., aged 47. Uncle on father’s side was insane; father was sanguine, and given to excess in venery. Patient’s brother died of an acute cerebral affection. Patient from childhood has been nervous, eccentric, and romantic; and while little more than a child manifested excessive sexual desire, and at ten began sexual indulgence. At nineteen, marriage. Unhappy married life; her husband, who was normal, did not satisfy her, and until recent years she constantly had other friends besides her husband. She was well aware of the immorality of her life, but felt her powerlessness against her insatiable desire, which she sought to keep, at least outwardly, a secret. Later she thought that she had suffered with a “mania for men.” Patient has borne six children. Six years ago she was thrown from a wagon and received a severe cerebral concussion. Following this there was melancholia, with delusions of persecution, which sent her to the asylum. She is approaching the climacterium, and of late the menses have been profuse and too frequent. Since this period she is pleased to note that the previously powerful sexual impulse has declined. Proper behavior. Slight degree of descensus uteri and prolapsus ani.

Hyperæsthesia sexualis may be continuously present with exacerbations, or it may be intermittent or periodic. In the latter case it is a cerebral neurosis per se (vide “Special Pathology”), or an accompanying symptom of a condition of general psychical excitement (mania; episodically in dementia paralytica, dementia senilis, etc.).

Lentz has published a remarkable case of intermittent satyriasis (Bulletin de la société de méd. légale de Belgique, Nr. 21):—

Case 13. For three years the generally respected farmer D., married, aged 35, has manifested states of sexual excitement, with increasing frequency and severity, which, during the past year, have become true paroxysms of satyriasis. It was impossible to discover hereditary or other organic cause. D. was compelled, at times when his sexual excitement was excessive, to perform the sexual act from ten to fifteen times in twenty-four hours, without deriving any feeling of satisfaction. Gradually he developed a condition of general nervous hyper-irritability (éréthisme général) with increased emotional irritability to the extent of pathological outbreaks of anger, and impulse to over-indulgence in alcohol, which induced symptoms of alcoholism. His attacks of satyriasis became so violent that consciousness was interfered with, and the patient raged about in blind impulse to sexual acts. He demanded that his wife give herself to other men or to animals in his presence; that she allow copulation with him, presentibus filiabus, because this would afford him greater enjoyment. Memory for the events at the height of these attacks, in which the extreme irritability even led to outbreaks of maniacal rage, was entirely wanting. D. himself thought that he must have had moments in which he no longer had control of his senses, and without satisfaction from his wife would have been compelled to seize the next best female. After an attack of violent emotion, these attacks of sexual excitement suddenly disappeared entirely.

The two following cases show how powerful, dangerous, and painful sexual hyperæsthesia may become in those afflicted with this anomaly:—

Case 14. Hyperæsthesia Sexualis—Delirium Acutum ex Abstinentia.—On May 29, 1882, F., aged 29, single, shoemaker, was received at the clinic. Father was of passionate temper; mother neuropathic, and had an insane brother. Patient had never been seriously ill previously, and was not a drinker, but had always been sexually very passionate. Five days before, he was taken acutely ill mentally. He made two attempts at rape in broad daylight, before witnesses, and when arrested talked in delirium only of obscene things, and masturbated without stint, and for three days had been raving mad. On admission he presented the picture of a severe acute delirium, with violent motor symptoms of irritation, and fever. Under treatment with ergotin a cure was effected.

On January 5, 1888, second admission, in a state of violent mania. On January 4, he had become morose, irritable, whining, and sleepless; and then, after vain assaults on women, had manifested symptoms of increasing angry excitement.

On January 6, progress of the condition to severe acute delirium (great disturbance of consciousness, jactation, grinding of the teeth, grimacing, and other motor symptoms of irritation; temperature as high as 40.7° C.); impulsive masturbation. Recovery was complete by January 11, under energetic treatment with ergotin.

After his recovery the patient gives an interesting account of the cause of his illness. Always very passionate sexually; first coitus at the age of sixteen. Continence caused headache, great psychical irritability, lassitude, great loss of pleasure in work, and sleeplessness. Since he had few opportunities in the country to satisfy his desire, he had recourse to masturbation. It was necessary for him to masturbate once or twice daily. No coitus in two months. Increasing sexual excitement; could think of nothing save means for the gratification of his impulse. Masturbation was not sufficient to banish the constantly increasing torment ex abstinentia. During the last four days violent impulse to coitus; increasing sleeplessness and irritability. There was only a summary recollection of the height of the illness. Patient recovered in December. A very respectable man; he considers his inordinate desire decidedly pathological, and is anxious about his future.

Case 15. On July 11, 1884, R., aged 33, servant, was admitted suffering with paranoia persecutoria and neurasthenia sexualis. Mother was neuropathic; father died of spinal disease. From childhood he had an intense sexual desire, of which he became conscious as early as his sixth year. From this age, masturbation; from fifteenth year, faute de mieux, pederasty; occasionally, sodomitic indulgences. Later, abusus coitus in marriage cum uxore. Now and then even perverse impulse to commit cunnilingus and to administer cantharides to his wife, because her libido did not equal his own. His wife died after a short period of married life. Patient’s circumstances became straightened, and he had no means to indulge himself sexually. Then masturbation again; employment of lingua canis to induce ejaculation. At times, priapism and conditions approaching satyriasis. He was then driven to masturbate, in order not to become stuporous. Beneficial diminution of the libido nimia, with the gradually predominating sexual neurasthenia and hypochondria.

The following case, valuable for an understanding of many Messalinas, some of whom are historically celebrated, is a classical example of pure hyperæsthesia sexualis, which I take from Trelat’s “Folie lucide”:—

Case 16. Mrs. V. has suffered with a passion for men since her earliest youth. Of good family, well bred, of pleasant disposition, exceedingly modest, she was, as a little girl, a terror to her family, because she could scarcely be alone with a person of the opposite sex, no matter whether it was with child or man of any age, without exposing herself immediately and demanding satisfaction for her sexual passion, even going so far as to lay hold of him. An attempt was made to cure her by marriage. She loved her husband passionately, but even with him she could not keep from demanding coitus of every one with whom she could be alone, no matter whether it was servant, laborer, or school-boy.

Nothing could cure her of this impulse. Even when she became a grandmother, she was still a Messalina. One day she locked a twelve-year-old boy in her room and tried to seduce him. The boy defended himself and escaped. She was severely punished by his brother. All was in vain. She was put in a cloister. There she was an example of morality, and gave not the slightest cause for blame. Immediately after her return the scandal began again. The family banished her, and set aside money to support her. She earned by her own hand-work enough to buy herself lovers. Any one seeing this neatly dressed matron, of good manners and amiable disposition, would never suspect how recklessly passionate she still was at the age of sixty-five. On January 7, 1854, her family, in despair at new scandals, placed her in an asylum. She lived there until May, 1858, when she died of apoplexia cerebri, in her seventy-third year. Her conduct in the asylum was exemplary. Left to herself, and under favorable conditions, her sexual impulses manifested themselves shortly before her death. With the exception of this, during an observation of four years by physicians of the asylum, she never showed a sign of mental abnormality.

D. Paræsthesia of Sexual Feeling (Perversion of the Sexual Instinct).

In this condition there is perverse emotional coloring of the sexual ideas. Ideas physiologically and psychologically accompanied by feelings of disgust, give rise to pleasurable sexual feelings; and the abnormal association finds expression in passionate, uncontrollable emotion. The practical results are perverse acts (perversion of the sexual instinct). This is more easily the case if the pleasurable feelings, increased to passionate intensity, inhibit any opposing ideas with corresponding feelings of disgust; or the influence of such opposing concepts may be impossible on account of the absence or loss of all ideas of morality, æsthetics, and law. This loss, however, is only too frequently found where the spring of ethical ideas and feelings (a normal sexual instinct) has been poisoned from the beginning.

With opportunity for the natural satisfaction of the sexual instinct, every expression of it that does not correspond with the purpose of nature,—i.e., propagation,—must be regarded as perverse. The perverse sexual acts resulting from paræsthesia are of the greatest importance clinically, socially, and forensically; and, therefore, they must here receive careful consideration; all æsthetic and polite disgust must be overcome.

Perversion of the sexual instinct, as will be seen from what follows, is not to be confounded with perversity in the sexual act; since the latter may be induced by conditions which are not psychopathology. The concrete perverse act, monstrous as it may be, is not decisive. In order to differentiate between disease (perversion) and vice (perversity), one must investigate the whole personality of the individual and the original impulse leading to the perverse act. Therein will be found the key of diagnosis (v. infra).

Paræsthesia may occur in combination with hyperæsthesia. This association seems to be frequent clinically. Sexual acts are then confidently to be expected. The perverse direction of sexual activity may be toward sexual satisfaction with the opposite or the same sex. Thus two great groups of perversions of the sexual life may be distinguished.

1. Sexual Inclination toward Persons of the Opposite Sex, with Perverse Activity of the Instinct.

1. Association of Active Cruelty and Violence with Lust—Sadism.[40]—That lust and cruelty frequently occur together is a fact that has long been recognized and not infrequently observed. Writers of all kinds have called attention to this phenomenon.[41] The not infrequent cases where individuals of very excitable sexual natures bite or scratch the companion in intercourse fall within physiological limits.[42] The older authors have called attention to the relation between lust and cruelty.

Blumröder (“Ueber Irresein,” Leipzig, 1836, p. 51) saw a man who had several wounds bitten into the pectoral muscle, which a woman, in great sexual excitement, had given him at the acme of lustful feeling during coitus. Blumröder (“Ueber Lust und Schmerz,” Friedreich’s Magazin für Seelenkunde, 1830, ii, 5) calls especial attention to the psychological connection between lust and murder. In relation to this, he especially refers to the Indian myths of Siva and Durga (Death and Lust); to human sacrifice with sensual mysteries; and to sexual instinct at puberty with a lustful impulse to suicide, with whipping, pinching, and pricking of the genitals, in the blind impulse to satisfy sexual desire. Lombroso (“Verzeni e Agnoletti,” Rome, 1874) also cites numerous examples of the occurrence of a desire to murder with greatly increased lust.

On the other hand, when murderous lust has been excited, lust itself often follows. Lombroso (op. cit.) alludes to the fact, mentioned by Mantegazza, that, with fear of being plundered by bandits, there was always a dread of brutal lust.[43] These examples form transitions to the pronounced pathological cases.

The examples of the degenerate Cæsars (Nero, Tiberius) are also instructive. They took delight in having youths and maidens slaughtered before their eyes. Not less so is the history of that monster, Marschalls Gilles de Rays (Jacob, “Curiosités de l’histoire de France,” Paris, 1858), who was executed in 1440, on account of mutilation and murder, which he had practiced for eight years on more than eight hundred children. As the monster confessed it, it was from reading Suetonius and the descriptions of the orgies of Tiberius, Caracalla, etc., that the idea was gained of locking children in his castles, torturing them, and then killing them. This inhuman wretch confessed that in the commission of these acts he enjoyed inexpressible pleasure. He had two assistants. The bodies of the unfortunate children were burned, and only a number of heads of particularly beautiful children were preserved—as memorials.

In an attempt to explain the association of lust and cruelty, it is necessary to return to a consideration of the quasi-physiological cases, in which, at the moment of most intense lust, very excitable individuals, who are otherwise normal, commit such acts as biting and scratching, which are usually the result of anger. It must further be remembered that love and anger are not only the most intense emotions, but also the only two forms of active (sthenic) emotion. Both seek their object, try to possess themselves of it, and naturally exhaust themselves in a physical effect on it; both throw the psycho-motor sphere into the most intense excitement, and thus, by means of this excitation, reach their normal expression.

From this stand-point it is clear how lust impels to acts that otherwise are expressive of anger.[44] The one, like the other, is a state of exaltation, an intense excitation of the whole psycho-motor sphere. Thus there arises an impulse to react on the object that induces the stimulus, in every possible way, and with the greatest intensity. Just as maniacal exaltation easily passes to furibund destructiveness, exaltation of the sexual emotion often induces an impulse to expend itself in senseless and apparently harmful acts. To a certain extent these are psychical accompaniments; but it is not simply an unconscious excitation of innervation of muscles (which also sometimes occurs as blind violence); it is a true hyperbulia, a desire to exert the most intense effect on the individual giving rise to the stimulus. The most intense means, however, is the infliction of pain.

Through such cases of infliction of pain, during the most intense emotion of lust, we approach the cases in which a real injury, wound, or death, is inflicted on the victim.[45] In these cases, the impulse to cruelty, which may accompany the emotion of lust, becomes unbounded in a psychopathic individual; and, at the same time, owing to defect of moral feeling, all normal inhibitory ideas are absent or weakened. Such monstrous, sadistic acts have, however, in men, in whom they are much more frequent than in women, another source in physiological conditions. In the intercourse of the sexes, the active or aggressive rôle belongs to man; woman remains passive, defensive.[46] It affords a man great pleasure to win a woman, to conquer her; and in the ars amandi, the modesty of a woman who keeps herself on the defensive until the moment of surrender, is an element of great psychological significance and importance. Under normal conditions a man meets obstacles which it is his part to overcome, and for which nature has given him an aggressive character. This aggressive character, however, under pathological conditions, may likewise be excessively developed, and express itself in an impulse to subdue absolutely the object of desire, even to destroy or kill it.[47][48]

If both these constituent elements occur together,—the abnormally intensified impulse to a violent reaction toward the object of the stimulus, and the abnormally intensified desire to conquer the woman,—then the most violent outbreaks of sadism occur.

Sadism is thus nothing else than an excessive and monstrous pathological intensification of phenomena,—possible, too, in normal conditions in rudimental forms,—which accompany the psychical vita sexualis, particularly in males. It is, of course, not at all necessary, and not even the rule, that the sadistic individual should be conscious of his instinct. What he feels is, as a rule, only the impulse to cruel and violent treatment of the opposite sex, and the coloring of the idea of such acts with lustful feelings. Thus arises a powerful impulse to commit the imagined deeds. When the actual motive of this instinct is not comprehended by the individual, the sadistic acts have the character of impulsive deeds.

When the association of lust and cruelty is present, not only does the lustful emotion awaken the impulse to cruelty, but vice versâ; cruel ideas and acts cause sexual excitement, and in this way are used by perverse individuals.[49]

A differentiation of original and acquired cases of sadism is scarcely possible. Many individuals, tainted ab origine, for a long time do everything to conquer the perverse instinct. If they are potent, at first they are able to lead a normal vita sexualis, often with the assistance of subjective ideas of a perverse nature. Later, after the opposing motives of an ethical and æsthetic kind have been gradually overcome, and after the constantly repeated experience that the natural act does not bring complete satisfaction, the abnormal instinct bursts forth. Owing to this late expression, in acts, of an originally perverse disposition, the appearances are those of an acquired perversion. As a rule, it may be safely assumed that this psychopathic state exists ab origine.

Sadistic acts vary in monstrousness with variation in the power of the perverse instinct over the individual afflicted, and with variation in the strength of opposing ideas that may be present, which almost always are more or less weakened by original ethical defect, hereditary degeneracy, or moral insanity. Thus there arises a long series of forms which begins with capital crime and ends with silly acts which afford the perverse desires of the sadistic individual merely symbolic satisfaction.

Sadistic acts may be further differentiated with reference to their nature: either as they are indulged in after consummated coitus by which the libido nimia remains unsatisfied; or, with diminished virility, as they are used to stimulate the diminished power; or, finally, where virility is absolutely wanting, as they become an equivalent for the impossible coitus, for the induction of ejaculation. In the last two cases, notwithstanding the impotence, there is still intense libido; or there was, at least, intense libido in the individual at the time when the sadistic acts became habitual. Sexual hyperæsthesia is always to be regarded as the basis of sadistic inclinations. The impotence which occurs so frequently in the psychopathic and neuropathic individuals here considered, as a result of excesses indulged in from early youth, is usually dependent upon spinal weakness. Often, too, there is a kind of psychical impotence, induced by concentration of thought on the perverse act with simultaneous fading of the idea of normal satisfaction. No matter what the external form of the act may be, the mentally perverse predisposition and instinct of the individual are essential to an understanding of it.

(a) Lust-Murder[50] (Lust Potentiated as Cruelty, Murderous Lust Extending to Anthropophagy).—The most horrible example, and one which most pointedly shows the connection between lust and a desire to kill, is the case of Andreas Bichel, which Feuerbach published in his “aktenmässige Darstellung merkwürdiger Verbrechen.”

B. puellas stupratas necavit et dissecuit. With reference to one of his victims, at his examination he expressed himself as follows: “I opened her breast and with a knife cut through the fleshy parts of the body. Then I arranged the body as a butcher does a beef, and hacked it with an axe into pieces of a size to fit the hole which I had prepared up in the mountain for burying it. I may say that while opening the body I was so greedy that I trembled, and could have cut out a piece and eaten it.”

Lombroso, too (“Geschlechtstrieb und Verbrechen in ihren gegenseitigen Beziehungen.” Goltdammer’s Archiv, Bd. xxx), mentions cases falling in the same category. A certain Phillipe indulged in choking prostitutes, post-actum, and said: “I am fond of women, but it is sport for me to choke them after having enjoyed them.”

A certain Grassi (Lombroso, op. cit., p. 12) was one night seized with sexual desire for a relative. Irritated by her remonstrance, he stabbed her several times in the abdomen with a knife, and also stabbed her father and uncle who attempted to hold him back. Immediately thereafter he hastened to visit a prostitute in order to cool his sexual passion in her arms. But this was not sufficient. He then murdered his father and slaughtered several oxen in the stable.

It cannot be doubted, from what has gone before, that a great number of so-called lust-murders depend upon a combination of hyperæsthesia and paræsthesia sexualis. As a result of this perverse coloring of the feelings, further acts of bestiality with the body may result,—e.g., cutting it up and wallowing in the intestines. The case of Bichel points to this possibility.

A modern example is that of Menesclou (Annales d’hygiène publique), who was examined by Lasègue, Brouardel, and Motet, declared to be mentally sound, and executed.

Case 17. A four-year-old girl was missing from her parents’ home, April 15, 1880. On April 16th, Menesclou, one of the occupants of the house, was arrested. The forearm of the child was found in his pocket, and the head and entrails, in a half-burned condition, were taken from the stove. Parts of the body were found in the water-closet. The genitals could not be found. M., when asked their whereabouts, became embarrassed. The circumstances, as well as an obscene poem found on his person, left no doubt that he had violated the child and then murdered her. M. expressed no remorse, asserting that his deed was an accident. His intelligence is limited. He presents no anatomical signs of degeneration; is somewhat deaf, and scrofulous.

M., aged 20; convulsions at the age of nine months. Later, he suffered from poor sleep (enuresis nocturna); was nervous, and developed tardily and imperfectly. From the time of puberty he was irritable, showed evil inclinations; was lazy; could not be taught, and in all trades proved, to be of no use. He grew no better even in the House of Correction. He was made a marine, but there, too, he proved useless. When he returned home he stole from his parents, and spent his time in bad company. He did not run after women, but gave himself up passionately to masturbation, and occasionally indulged in sodomy with bitches. His mother suffered with mania menstrualis periodica. An uncle was insane, and another an inebriate. The examination of M.’s brain showed morbid changes of the frontal lobes, of the first and second temporal convolutions, and of a part of the occipital convolutions.

Case 18. Alton, a clerk in England, goes out of town for a walk. He lures a child into a thicket, and returns after a time to his office, where he makes this entry in his note-book: “Killed to-day a young girl; it was fine and hot.” The child was missed, searched for, and found cut into pieces. Many parts, and among them the genitals, could not be found. A. did not show the slightest trace of emotion, and gave no explanation of the motive or circumstances of his horrible deed. He was a psychopathic individual, and occasionally subject to states of depression with tædium vitæ. His father had had one attack of acute mania. A near relative suffered from mania with homicidal impulses. A. was executed.

In such cases it may even happen that appetite for the flesh of the murdered victim arises, and, in consequence of this perverse coloring of the idea, parts of the body may be eaten.

Case 19. Leger, vine-dresser, aged 24. From youth moody, silent, shy of people. He starts out in search of a situation. He wanders about eight days in the forest, there catches a girl twelve years old, violates her, mutilates her genitals, tears out her heart, eats of it, drinks the blood, and buries the remains. Arrested, at first he lied, but finally confessed his crime with cynical cold-bloodedness. He listened to his sentence of death with indifference, and was executed. At the post-mortem examination, Esquirol found morbid adhesions between the cerebral membranes and the brain (Gorget, “Darstellung der Prozesse Leger, Feldtmann,” etc., Darmstadt, 1827).

Case 20. Tirsch, hospital beneficiary of Prag, aged 55, always silent, peculiar, coarse, very irritable, grumbling, revengeful, was sentenced to twenty years’ imprisonment, on account of violating a girl ten years old. He had attracted attention on account of outbursts of anger from insignificant causes, and also on account of tædium vitæ. In 1864, on account of the refusal of an offer of marriage which he made to a widow, he developed a hatred toward women, and on July 8th he went about with the intention of killing one of this hated sex. Vetulam occurentem in silvam allexit, coitum poposcit, renitentem prostravit, jugulum feminæ compressit “furore captus.” Cadaver virga betulæ desecta verberare voluit neque tamen id perfecit, quia conscientia sua hæc fieri vetuit, cultello mammae et genitalia desecta domi cocta proximis diebus cum globis comedit. On September 12th, when he was arrested, the remains of this meal were found. He gave as the motive of this act “inner impulse.” He himself wished to be executed because he had always been persecuted. In confinement there were great emotional irritability and occasional outbursts of fury, preceded by refusal of food, which made isolation, lasting several days, necessary. It was authoritatively established that the most of his earlier excesses were coincident with outbreaks of excitement and fury (Maschka, Prager Vierteljahrsschrift, 1866, i, p. 79).

The Whitechapel murderer, who still eludes the vigilance of the police, probably belongs in this category of psycho-sexual monsters.[51] The constant absence of uterus, ovaries, and labia, in the victims (ten) of this modern Bluebeard, allows the presumption that he seeks and finds still further satisfaction in anthropophagy.

In other cases of lust-murder, for physical and mental reasons (vide supra), violation is omitted, and the sadistic crime alone becomes the equivalent of coitus. The prototype of such cases is the following one of Verzeni. The life of his victim hung on the rapid or retarded occurrence of ejaculation. Since this remarkable case presents all the peculiarities which modern science knows concerning the relation of lust to lust-murder with anthropophagy, and especially since it was carefully studied, it receives detailed description here:—

Case 21. Vincenz Verzeni, born in 1849; since January 11, 1872, in prison; is accused (1) of an attempt to strangle his nurse Marianne, four years ago, while she lay sick in bed; (2) of a similar attempt on a married woman, Arsuffi, aged 27; (3) of an attempt to strangle a married woman, Gala, by grasping her throat while kneeling on her body; (4) on suspicion of the following murders:—

In December a fourteen-year-old girl, Johanna Motta, set out for a neighboring village between seven and eight o’clock in the morning. Since she did not return, her master set out to find her, and discovered her body near the village, lying by a path in the fields. The corpse was frightfully mutilated with numerous wounds. The intestines and genitals had been torn from the opened body, and were found near by. The nakedness of the body and erosions on the thighs made it seem probable that there had been an attempt at rape; the mouth filled with earth pointed to suffocation. In the neighborhood of the body, under a pile of straw, were found a portion of flesh torn from the right calf, and pieces of clothing. The perpetrator of the deed remained undiscovered.

On August 28, 1871, a married woman, Frigeni, aged 28, set out in the fields early in the morning. Since she did not return by eight o’clock, her husband started out to fetch her. He found her a corpse, lying naked in the field, with the mark of a thong around her neck, with which she had been strangled, and with numerous wounds. The abdomen had been slit open, and the intestines were hanging out.

On August 29, at noon, as Maria Previtali, aged 19, went through a field, she was followed by her cousin, Verzeni. He dragged her into a field of grain, threw her to the ground, and began to choke her. As he let go of her for a moment to ascertain whether there were any one near, the girl got up and, by her supplicating entreaty, induced Verzeni to let her go, after he had pressed her hands together for some time.

Verzeni was brought before a court. He is twenty-two years old. His cranium is of more than average size, but asymmetrical. The right frontal bone is narrower and lower than the left, the right frontal prominence being less developed, and the right ear smaller than the left (by 1 centimetre in length and 3 centimetres in breadth); both ears are defective in the inferior half of the helix; the right temporal artery is somewhat atheromatous. Bull-necked; enormous development of the zygomæ and inferior maxilla; penis greatly developed, frænum wanting; slight divergent alternating strabismus (insufficiency of the internal rectus muscle, and myopia). Lombroso concludes, from these signs of degeneration, that there is a congenital arrest of development of the right frontal lobe. As seemed probable, Verzeni has a bad ancestry,—two uncles are cretins; a third, microcephalic, beardless, one testicle wanting, the other atrophic. The father shows traces of pellagrous degeneration, and had an attack of hypochondria pellagrosa. A cousin suffered from cerebral hyperæmia; another is a confirmed thief.

Verzeni’s family is bigoted and low-minded. He himself has ordinary intelligence; knows how to defend himself well; seeks to prove an alibi and cast suspicion on others. There is nothing in his past that points to mental disease, but his character is peculiar. He is silent and inclined to be solitary. In prison he is cynical. He masturbates, and makes every effort to gain sight of women.

Verzeni finally confessed his deeds and their motive. The commission of them gave him an indescribably pleasant (lustful) feeling, which was accompanied by erection and ejaculation. As soon as he had grasped his victim by the neck, sexual sensations were experienced. It was entirely the same to him, with reference to these sensations, whether the women were old, young, ugly, or beautiful. Usually, simply choking them had satisfied him, and he then had allowed his victims to live; in the two cases mentioned, the sexual satisfaction was delayed, and he had continued to choke them until they died. His satisfaction in this garroting was greater than in masturbation. The abrasions of the skin on Motta’s thighs were produced by his teeth, while sucking her blood in most intense lustful pleasure. He had torn out a piece of flesh from her calf and taken it with him to roast at home; but on the way he hid it under the straw-stack, for fear his mother would suspect him. He also carried pieces of the clothing and intestines some distance, because it gave him great pleasure to smell and touch them. The strength which he possessed in these moments of intense lustful pleasure, was enormous. He had never been a fool; while committing his deeds he saw nothing around him (apparently as a result of intense sexual excitement, annihilation of apperception—instinctive action). After such acts he was always very happy, enjoying a feeling of great satisfaction. He had never had pangs of conscience. It had never occurred to him to touch the genitals of the martyred women, or to violate his victims. It had satisfied him to throttle them and suck their blood. These statements of this modern vampire seem to rest on truth. Normal sexual impulses seem to have remained foreign to him. Two sweethearts that he had, he was satisfied to look at; it was very strange to him that he had no inclinations to strangle them or press their hands; but he had not had the same pleasure with them as with his victims. There was no trace of moral sense,—remorse and the like.

Verzeni said himself that it would be a good thing if he were to be kept in prison, because with freedom he could not resist his impulses. Verzeni was sentenced to imprisonment for life (Lombroso, “Verzeni e Agnoletti,” Rome, 1873). The confessions which Verzeni made after, his sentence, are interesting:—

“I had an unspeakable delight in strangling women, experiencing during the act erections and real sexual pleasure. It was even a pleasure only to smell female clothing. The feeling of pleasure while strangling them was much greater than that which I experienced while masturbating. I took great delight in drinking Motta’s blood. It also gave me the greatest pleasure to pull the hair-pins out of the hair of my victims.

“I took the clothing and intestines, because of the pleasure it gave me to smell and touch them. At last my mother came to suspect me, because she noticed spots of semen on my shirt after each murder or attempt at one. I am not crazy, but in the moment of strangling my victims I saw nothing else. After the commission of the deeds I was satisfied and felt well. It never occurred to me to touch or look at the genitals or such things. It satisfied me to seize the women by the neck and suck their blood. To this very day I am ignorant of how a woman is formed. During the strangling and after it, I pressed myself on the entire body without thinking of one part more than another.”

Verzeni arrived at his perverse acts entirely independently, after having noticed, when he was twelve years old, that he experienced a peculiar feeling of pleasure while wringing the necks of chickens. After this he had often killed great numbers of them, and then said that a weasel had been in the hen-coop (Lombroso, Goltdammer’s Archiv, Bd. xxx, p. 13).

Lombroso mentions an analogous case (Goldtdammer’s Archiv) which occurred in Vittoria (Spain):—

Case 22. A certain Gruyo, aged 41, with a blameless past life, having been three times married, strangled six women in the course of ten years. They were almost all public prostitutes and quite old. After the strangling he tore out their intestines and kidneys per vaginam. Some of his victims he violated before killing, others, on account of the occurrence of impotence, he did not. He set about his horrible deeds with such care that he remained undetected for ten years.

(b) Mutilation of Corpses.—Following the preceding horrible group of perversions of the sexual instinct, which arise from hyperæsthesia and paræsthesia sexualis with retained virility, come naturally the necrophiles; for in these cases, just as with lustful murderers and analogous cases, an idea which in itself awakens a feeling of horror, and before which a healthy person would shudder, is accompanied by lustful feelings, and thus leads to the impulse to indulge in acts of necrophilia.

The cases of mutilation of bodies mentioned in literature seem to be pathological; but, with the exception of the celebrated one of Sergeant Bertrand (v. infra), they come far from being described and observed with exactness. In certain cases there may be nothing more than the possibility that unbridled desire sees in the idea of death no obstacle to its satisfaction. The seventh case mentioned by Moreau is perhaps such a one:—

A man, aged 23, attempted to rape a woman, aged 53. Struggling, he killed her and then violated her, threw her in the water, and fished her out again for renewed violation. The murderer was executed. The meninges of the anterior lobes were thickened and adherent to the cortex.

French writers have recorded numerous examples of necrophilia. Two cases concerned monks, where they were performing the watch for the dead. In a third case the subject was an idiot, who also suffered from periodical mania, and after commission of rape was sent to an insane asylum, and there mutilated female bodies in the mortuary.

In other cases, however, there is undoubtedly direct preference of a corpse to the living woman. When no other act of cruelty—cutting into pieces, etc.—is practiced on the cadaver, it is probable that the lifeless condition itself forms the stimulus for the perverse individual. It is possible that the corpse—a human form absolutely without will—satisfies an abnormal desire, in that the object of desire is seen to be capable of absolute subjugation, without possibility of resistance.

Brierre de Boismont (Gazette médicale, July 21, 1859) relates the history of a corpse-violator who, after bribing the watchman, had gained entrance to the corpse of a girl of sixteen, who belonged to a family of high social position. At night a noise was heard in the death-chamber, as if a piece of furniture had fallen over. The mother of the dead girl effected an entrance, and saw a man dressed in his night-shirt springing from the bed where the body lay. It was at first thought that the man was a thief, but the real explanation was soon discovered. It was afterward ascertained that the culprit, a man of good family, had often violated the bodies of young women. He was sentenced to imprisonment for life.

The story of a prelate, reported by Taxil (“La prostitution contemporaine,” p. 171), is of great interest as an example of necrophilia. From time to time he would visit houses of prostitution in Paris and order a prostitute, dressed in white like a corpse, to be laid out on a bed. At the appointed hour he would appear in the room, which, in the meantime, had been elaborately prepared as a room of mourning; then he would act as if reading a mass for the soul, and finally throw himself on the girl, who, during the whole time, was compelled to play the rôle of a corpse.[52]

The cases in which the perpetrator injures and cuts up the corpse are clearer. Such cases come next to those of lust-murder, in that, in these individuals, cruelty, or at least an impulse to attack the female body, is connected with lust. It is possible that a remnant of moral sense deters from the cruel act on a living woman, and possibly the fancy passes beyond lust-murder and rests on its result, the corpse. Here, also, it is possible that the idea of defenselessness of the body plays a rôle.

Case 23. Sergeant Bertrand, a man of delicate physical constitution and of peculiar character; from childhood silent and inclined to solitude.

The details of the health of his family are not satisfactorily known; but the occurrence of mental diseases in his ancestry is ascertained. It is said that while he was a child he was affected with destructive impulses, which he himself could not explain. He would break whatever was at hand. In early childhood, without teaching, he learned to masturbate. At nine he began to feel inclinations toward persons of the opposite sex. At thirteen the impulse to sexual intercourse became powerfully awakened in him. He now masturbated excessively. When he did this his fancy always created a room filled with women. He would imagine that he carried out the sexual act with them, and then killed them. Immediately thereafter he would think of them as corpses, and of how he defiled them. Occasionally, in such situations, the thought of carrying out a similar act with male corpses would come up, but it was always attended with a feeling of disgust.

In time he felt the impulse to carry out such acts with actual corpses. For want of human bodies, he obtained those of animals. He would cut open the abdomen, tear out the entrails, and masturbate during the act. He declares that in this way he experienced inexpressible pleasure. In 1846 these bodies no longer satisfied him. He now killed dogs, and proceeded with them as before. Toward the end of 1846 he first felt the desire to make use of human bodies. At first he had a horror of it. In 1847, being by accident in a grave-yard, he ran across the grave of a newly-buried corpse. Then this impulse, with headache and palpitation of the heart, became so powerful that, although there were people near by, and he was in danger of detection, he dug up the body. In the absence of a convenient instrument for cutting it up, he satisfied himself by hacking it with a shovel.

In 1847 and 1848, during two weeks, as reported, the impulse, accompanied by violent headache, to commit brutalities on corpses, actuated him. Amidst the greatest dangers and difficulties, he satisfied this impulse some fifteen times. He dug up the bodies with his hands, in nowise sensible, in his excitement, to the injuries he thus inflicted on himself. When he had obtained the body, he cut it up with a sword or pocket-knife, tore out the entrails, and then masturbated. The sex of the bodies is said to have been a matter of indifference to him, though it was ascertained that this modern vampire had dug up more female than male corpses. During these acts he declares himself to have been in an indescribable state of sexual excitement. After having cut them up, he had sometimes reinterred the bodies.

In July, 1848, he accidentally came across the body of a girl of sixteen. Then, for the first time, he experienced a desire to carry out coitus on a cadaver. “I covered it with kisses and pressed it wildly to my heart. All that one could enjoy with a living woman is nothing in comparison with the pleasure I experienced. After I had enjoyed it for about a quarter of an hour, I cut the body up, as usual, and tore out the entrails. Then I buried the cadaver again.” Only after this, as B. declares, had he felt the impulse to use the bodies sexually before cutting them up, and thereafter he had done it in three instances. The actual motive of the exhuming of the bodies, however, was then, as before, to cut them up; and the enjoyment in so doing was greater than in using the bodies sexually. The latter act had always been nothing more than an episode of the principal one, and had never quieted his desires; therefore, he had always cut up the body afterward or mutilated another body. The medico-legal examiners gave an opinion of “monomania.” Court-martial sentence to one year’s imprisonment. (Michéa, Union méd., 1849; Lunier, Annal. méd.-psychol., 1849, p. 153; Tardieu, “Attentats aux moeurs,” 1878, p. 114; Legrand, “La folie devant les tribun.,” p. 524.)

(c) Injury of Women (Stabbing, Flagellation, etc.).—Following lust-murder and violation of corpses, come cases closely allied to the former, in which injury of the victim of lust and sight of the victim’s blood are a delight and pleasure for degenerate men. The notorious Marquis de Sade,[53] after whom the combination of lust and cruelty has been named, was such a monster. Coitus only excited him when he could prick the object of his desire until the blood came. His greatest pleasure was to injure prostitutes and then bind their wounds.

Here also belongs the case of a captain mentioned by Brierre de Boismont, who always compelled the object of his affection to place leeches ad pudenda before coitus, which was very frequent. Finally this woman became very anæmic and, as a result of this, insane.

The following case, borrowed from my own clientele, very clearly shows the connection between lust and cruelty, with desire to shed and see blood:—

Case 24. Mr. X., aged 25; father syphilitic, died of paretic dementia; mother hysterical and neurasthenic. He is a weak individual, constitutionally neuropathic, and presents several anatomical signs of degeneration. When a child, hypochondria and imperative conceptions; later, constant alternation of exaltation and depression. While yet a child of ten, the patient felt a peculiar lustful desire to see blood flow from his fingers. Thereafter he often cut or pricked himself in the fingers, and took great delight in it. Very early, erections were added to this, and also if he saw the blood of others; for example, when he saw a servant-girl cut her finger it gave him an intense lustful feeling. From this time his vita sexualis became more and more powerful. Without any teaching he began to masturbate, and always during the act there were memory-pictures of bleeding girls. It now no longer sufficed him to see his own blood flow; he longed to see the blood of young females, especially those that were attractive to him. Often he could scarcely overcome the impulse to injure two cousins and a certain servant. But also young women that were in themselves not attractive induced this impulse when they excited him by some peculiarity of dress or adornment, especially coral jewelry. It was necessary for him to overcome these desires; but in his imagination bloody thoughts were constantly present, and induced lustful excitement. There was an inner relation existing between both thoughts and feelings. Often there were other cruel fancies. He imagined himself in the rôle of a tyrant who had the people shot in crowds with grape-shot. He was compelled to fancy a scene as it would be if enemies were to take a city and mutilate, torture, kill, and rape the young women. In times of quiet this patient, who had a mild disposition and was not morally defective, was shamed and horrified by such cruel, lustful fancies, and they always became immediately latent as soon as his sexual excitement had been satisfied by masturbation.

After a few years the patient became neurasthenic. Then simple imaginary representation of blood and scenes of blood was sufficient to induce ejaculation. In order to free himself from his vice and his cruel imagination, he began to indulge in sexual intercourse with females. Coitus was possible, but only when the patient called up the idea that the girl’s fingers were bleeding. Without the assistance of this idea no erection was possible. The cruel thought of cutting was limited to the woman’s hand. At times of greatest sexual excitement, simply the sight of the hand of an attractive woman was sufficient to induce violent erections. Frightened by the popular stories about the injurious results of onanism, he abstained and fell into a condition of severe general neurasthenia, with hypochondriacal dysthymia and tædium vitæ. Careful and watchful medical treatment cured the patient after a few months. He has remained mentally well three years; but now, as before, he is very sensual, though it is very seldom that he is troubled by his earlier bloody ideas. X. has given up masturbation entirely. He finds satisfaction in natural sexual indulgence, is virile, and it is no longer necessary for him to call up ideas of blood.

The following case, reported by Tarnowsky (op. cit., p. 61), shows that such lustful, cruel impulses may be simply episodical, and occur in certain exceptional states of mind in neurotic individuals:—

Case 25. Z., physician; neuropathic constitution, reacting badly to alcohol. Under ordinary circumstances capable of normal coitus, as soon as he has indulged in wine he finds that his increased libido is no longer satisfied by simple coitus. In this condition he is compelled to prick the nates puellæ or to make stabs with the lancet, to see blood, and feel the entrance of the blade into the living body, in order to have ejaculation and experience complete satiety of his lust.

The majority of those afflicted with this form of the perversion seem insensible to the normal stimulus of woman. In the first case (24), the assistance of the idea of blood was necessary in order to obtain erection. The following case is that of a man who, by masturbation, etc., in early youth, had diminished his power of erection so that the sadistic act took the place of coitus:

Case 26. The girl-stabber of Bozen (reported by Demme, “Buch der Verbrechen,” Bd. ii, p. 341). In 1829, H., aged 30, soldier, became the subject of legal investigation. At different times and in different places, he had wounded girls with bread-knives or pocket-knives, by stabbing them in the abdomen, probably in the region of the genitals. He gave, as a motive for these acts, heightened sexual impulse, increasing to the intensity of fury, which found satisfaction only in the thought and act of stabbing persons of the female sex. This impulse would pursue him for days at a time. He would then pass into a confused mental state, which would clear away only when the impulse had been satisfied by the deed. In the act of stabbing he had a satisfaction like that of completed coitus, which was increased by the sight of the blood that ran from the knife. In his tenth year the sexual instinct became powerfully manifest. At first he gave himself up to masturbation, and felt physically and mentally weakened by it. Before he became a girl-stabber he had satisfied his sexual lust in violation of immature girls, by causing them to practice masturbation on him, and by sodomy. Gradually the thought came to him of how pleasurable it would be to stab a young and pretty girl in the region of the genitals, and take delight in the sight of the blood running from the knife.

Among his effects were found copies of objects of art and obscene pictures, painted by himself, of Mary’s conception, and of the “congealed thought of God” in the lap of the Virgin. He was considered a peculiar, very irritable man, shy of people, given to women, moody, and glum. He was apparently a person[54] that had become impotent through earlier sexual excesses, and who was thus predisposed, by the continuance of intense libido sexualis, and heredity, to perversion of the sexual life.

Case 27. In the “sixties” the inhabitants of Leipzig were frightened by a man who was accustomed to attack young girls on the street and stab them in the upper-arm with a dagger. Finally arrested, he was recognized as a sadist, who, at the instant of stabbing, had an ejaculation, and with whom the wounding of the girls was an equivalent for coitus. (Wharton, “A Treatise on Mental Unsoundness,” § 623. Philadelphia, 1873.)[55]

Impotence exists, likewise, in the next three cases. It may be psychical, however, in that the principal tone of the vita sexualis lies in the sadistic inclination, and the normal elements are distorted:—

Case 28. The girl-cutter of Augsburg (reported by Demme, “Buch der Verbrechen,” vii, p. 281). Bartle, wine-merchant. He was subject to lively sexual excitement at the age of fourteen, though decidedly opposed to its satisfaction by coitus, his aversion going so far as disgust for the female sex. At that time he already had the idea to cut girls, and thus satisfy his sexual desire. He refrained from it, however, on account of lack of opportunity and courage. He practiced masturbation, and now and then had pollutions with erotic dreams of girls that had been cut. At the age of nineteen he first cut a girl. During the act he had a seminal emission, and experienced intense pleasure. From that time the impulse became constantly more powerful. He chose only young and pretty girls, and, as a rule, asked them before the deed whether they were still single. The ejaculation or sexual satisfaction occurred only when he was sure that he had actually wounded the girls. After such an act he always felt tired and bad, and was also troubled with qualms of conscience. Until thirty-two years old he carried on this process of cutting, but always with care not to wound the girls dangerously. From that time until his thirty-sixth year he was able to control his impulse. Then he sought to satisfy himself by simply pressing the girls on the arm or neck; but this gave rise to erections and not to ejaculation. Then he sought to attain his object by pricking the girls with a knife in its sheath; but this did not suffice. Finally, he stabbed with the open knife and had complete success, for he thought that a girl when stabbed bled more and had more pain than one that was merely, cut. In his thirty-seventh year he was detected and arrested. In his dwelling was found a collection of daggers, sword-canes, and knives. He said that the mere sight of these weapons, and still more the grasping of them, gave him an intense feeling of sensual pleasure, with violent excitement. According to his confession he had injured, in all, fifty girls. His external appearance was rather pleasing. He lived in very good circumstances, but was peculiar and shy.

Case 29. J. H., aged 25, in 1883 came for consultation concerning severe neurasthenia and hypochondria. Patient confesses that he has practiced onanism since his fourteenth year, infrequently up to his eighteenth year; but since that time he has been unable to resist the impulse. Up to that time he had no opportunity to approach females, for he had been anxiously cared for and never left alone, on account of his invalidism. He had had no real desire for this unknown pleasure; but he accidentally learned what it was when one of his mother’s maids cut her hand severely on a pane of glass she had broken while washing windows. While helping to stop the blood he could not keep from sucking up the blood that flowed from the wound, and in the act he experienced extreme erotic excitement, with complete orgasm and ejaculation.

From this time, in every possible way, he sought to see, and if possible to taste, the fresh blood of females. That of young girls was preferred by him. He spared no pains or expense to obtain this pleasure. At first he availed himself of a young servant who allowed her finger to be pricked with a needle or lancet at his request. When his mother discovered this, she discharged the girl. Then he was driven to prostitutes as a substitute, with success frequently enough, though with some difficulty. In the intervals he practiced onanism and manustupration per feminam, which, however, never afforded him complete satisfaction, but, on the contrary, caused listlessness and self-reproach. On account of his nervous difficulties he visited many sanitariums, and he was twice a voluntary patient in institutions. He used hydrotherapy, electricity, and strengthening cures, without particular success. For a time it was possible, by means of cold sitz-baths, monobromate of camphor, and bromides, to diminish his sexual excitability and onanistic impulse. However, when the patient felt himself free again, he would immediately fall into his old passions and spare no pains or money in order to satisfy his sexual desire in the abnormal manner described.

Case 30 (communicated by Dr. A. Moll, Berlin). L. T., aged 21; merchant in a Rhenish city. He belongs to a family in which there are several nervous and psychopathic members. A sister suffers with hysteria and melancholia.

The patient was always of quiet disposition and timid. At school he frequently kept apart from other pupils, particularly when they talked about girls. In the presence of ladies he thought every expression he made was an offense against decency. Thus, for example, he thought it very improper, in the presence of ladies, married or unmarried, to speak of going to bed, rising, etc. In the elementary classes the patient learned well. Later he became more indolent and did not make good progress.

August 17, 1890, the patient visited Dr. Moll on account of abnormal symptoms of a sexual kind. He did this on the advice of a physician, X., a relative, in whom he had previously confided. The patient conveys the impression of being very apprehensive and shy, and in answer to questions says that he is very timorous, and that particularly in the presence of others all his self-confidence and assurance leave him. Dr. X. confirmed this statement.

The beginning of his sexual life the patient was able to refer to his seventh year. At that age he frequently played with his genitals, and was often punished for it. In this onanism, in which he said he had erection, he constantly thought of whipping a woman on the naked nates with a rod until the skin raised in weals. “It delighted me,” said the patient, “when I thought that she was a proud, beautiful lady, and that I performed the act in the presence of others, especially women, particularly with the idea that she might feel the power I had over her. For this reason I early sought reading about punishment, e.g., about the abuse of Roman slaves. However, I had erections only when the conceived abuse consisted of blows delivered on the back or nates. At first I thought this kind of excitement would disappear in time, and said nothing about it to any one.”

Masturbation, early indulged in, the patient continued to practice, and always with the same thought. After his thirteenth or fourteenth year he had ejaculation with the act. Decimum septimum annum agens primum feminam adiit coëundi causa neque coitum perficere potuit libidine et erectione deficientibus. Mox autem iterum apud alteram coitum conatus est nullo succesu. Tum feminam per vim verberavit. Tantopere erat excitatus ut mulierem dolore clamantem atque lamentantem verberare non desierit. He never thought of any legal punishment for his acts, and, in fact, escaped it. In this procedure erection, orgasm, and ejaculation occurred. The patient performed the act in such a way that he took the woman between his knees, with the penis in contact with her body, but without emissio penis in vaginam, which seemed entirely superfluous to him.

But the patient afterward experienced such a feeling of shame about the beating, and was overcome with such great depression, that he often contemplated suicide. In the following three years he still visited women occasionally. But he never again asked one to allow him to beat her. He sought to obtain erection by thinking of the beating; but this was without result, and manustupration by the woman did not induce erection. Finally, after an unsuccessful attempt of this kind, the patient determined to give his confidence to a physician.

The patient made several other statements concerning his vita sexualis. His abnormal sexual desire had troubled him by its intensity. He went to sleep with sexual thoughts; they troubled him through the night and were still with him when he awoke. He was never safe for any length of time from the impulsion of the abnormal ideas that excited him; to which, indeed, he gave himself up willingly, and from which he could free himself for a short time only by onanism.

In response to my question, the patient stated that any other means of punishment of women than beating the back, and nates particularly, had no charm for him. Neither binding them, walking on them, nor striking them, gives him such pleasure. This is to be emphasized the more, since the whipping given the woman affords him sexual pleasures because its effect on her is “humiliating, mortifying,” and because she should “feel that she is completely in his power.” Too, it would give the patient no pleasure to beat a woman on any other part of her body than those mentioned, or to cause her pain in any other way than by blows. Multum minorem ei affert voluptatem si nates suæ a muliere verberantur; tamen ea res sæpe ejaculationem seminis effecit, sed hæc fieri putat erectione deficienti. Inter verbera autem penem in vaginam immittendo nullam voluptatem se habere ratus qualibet parte corporis feminæ pene tacte semen ejaculat. Just as in beating the woman his pleasure lay in humiliating her, so with the relations reversed he was sexually excited by the fact that the beating humiliated him and he felt himself to be completely in the woman’s power. No other personal humiliation than a beating on his nates could excite him. To allow himself to be bound or walked on by a woman is repugnant to him.

The patient’s dreams, as far as they were of an erotic nature, were directed in the same way as his sexual inclinations while awake; actual ejaculation also often took place in dreams. Whether the perverse sexual thoughts first occurred in dreams or the waking state, the patient is not able to state, owing to the fact that his memory goes back so far,—to his seventh year. But he thinks that these thoughts first occurred to him while awake. In his dreams it frequently seemed to him that he was striking a man, which also caused ejaculation. In the waking state it excited him but very little to think of striking a man. The nude form of a man had no attraction whatever for him, while the nude form of a woman had a decided charm for him, though his libido found its real satisfaction only when the acts previously described took place; and, as he states, he feels no desire for coitus in vaginam.

The treatment of the patient is directed to the attainment of normal coitus with normal desire, where possible; for it may be assumed that, with success in making his sexual life normal, the patient’s shyness and apprehensiveness, which cause him great annoyance, may be much easier removed. The treatment followed by me (Dr. Moll) during three months and a half was as follows:—

1. The patient, who had a great desire to be cured, was most strictly forbidden to give himself up to the perverse thoughts. Of course, I did not give him the foolish advice not to think of blows at all. The patient could not follow such advice, since the thoughts come to him without any act of his own, even when he accidentally reads the word “blow” (schlagen). I forbade him only ever to voluntarily give himself to such thoughts. I advised him more particularly to do everything in order to turn his ideas in another direction.

2. I allowed him, commanded him even, to think of nude women, because many nude females interested him, even though, as he thought, they did not excite him sexually.

3. I sought, by means of hypnosis—which was hard to induce—and suggestion, to fortify the patient in this as far as possible. All attempts at coitus were forbidden in order to save the patient from a discouraging result.

Within two months and a half this treatment led to the result that, as the patient stated, the perverse ideas occurred much less frequently and were constantly retreating to the background; indeed, according to the patient’s statement, erections occurred with the thoughts of nude women, became more frequent, and often induced him to masturbate with the thought of coitus without the occurrence of any idea of blows. Erotic dreams occurred but infrequently. These were concerned sometimes with normal coitus, sometimes with blows.

After two months and a half of the treatment I advised the patient to attempt coitus. Since then he has tried four times. I advised him to choose always a woman who pleased him, and sought to increase his sexual excitement before coitus by means of tincture of cantharides. The four attempts, the last of which took place on November 29, 1890, resulted as follows: At the first, prolonged manipulation of the penis by the woman was necessary in order to induce erection. Then immisio in vaginam and ejaculation with orgasm took place. During the whole act there occurred no thought of beating the woman or being beaten, but the woman in herself excited him sufficiently for the performance of coitus. At the second attempt the result was better and more quickly attained; manipulation ad genitalia by the woman was not long required. In the third attempt coitus was attained only after the patient had thought of beating for a long time, and had thus induced erection; but beating was not indulged in. At the fourth attempt coitus was attained without any thought of beating and without any manipulation ad genitalia.

Of course, the case described cannot yet be regarded in any way as cured. Though the patient were able to perform coitus in a normal or nearly normal way, that does not mean that he will always be able to do it in the future; moreover, the thought of beating still affords him great pleasure, even though it occurs much less frequently than formerly. Yet there is a possibility that the abnormal desire, which has been weakened, will remain weakened in the future, and perhaps disappear.

This carefully observed case is, for several reasons, particularly interesting. It discloses clearly one of the hidden roots of sadism,—the impulse to complete subjugation of the woman, which here became consciously entertained. This is the more remarkable since it occurred in an individual decidedly timid, and in other respects modest and even apprehensive. The case also shows clearly that powerful libido, which even impels the individual to overcome all obstacles, may be present, while at the same time coitus is not desired, because the principal intensity of feeling is, ab origine, connected with the cruel part of the sadistic (lustful and cruel) circle of ideas. This case also contains weak elements of masochism (v. infra).

Cases are by no means infrequent in which men with perverse inclinations induce prostitutes, by paying them high prices, to allow themselves to be whipped and even wounded by them. Works on prostitution contain reports of them (vide Coffignon, “La Corruption à Paris,” etc.).

(d) Defilement of Women.—The perverse sadistic impulse, to injure women and put contempt and humiliation upon them, is also expressed in the desire to defile them with disgusting or, at least, foul things.

The following case, published by Arndt (Vierteljahrsschr. f. ger. Medicin, N. F. xvii, H. 1), belongs here:—

Case 31. A., medical student at Greifswald, accusatus quod iterum iterumque puellis honestis parentibus natis in publico genitalia sua e bracis dependentia plane nudata quæ antia summo amiculo (overcoat) tecta erant, ostenderat. Nonnunquam puellas fugientes secutus easque ad se attractas urina oblivit. Hæc luce clara facta sunt; nunquam aliquid hæc faciens locutus est.

A. is twenty-three years old, powerfully built, neat in dress, and decent in manners. Indication of cranium progeneum; chronic pneumonia of the apex of the right lung; emphysema. Pulse, 60; in excitement, not more than 70 to 80. Genitals normal. Complaints of occasional disturbances of digestion and hardness of the abdomen, vertigo; excessive excitement of the sexual desires, which early led to onanism. The sexual desire has never been directed toward a natural method of satisfaction. Complaints of occasional attacks of depression, or thoughts of deprecation of self, and of perverse impulses, for which he could find no motive; such as laughing at serious things, throwing his money in the water, and running about in the pouring rain. The father of the culprit is of a nervous temperament; his mother is subject to nervous headache. A brother suffered with epileptic convulsions.

From his youth the culprit presented a nervous temperament, was inclined to convulsions and attacks of syncope, and when he was severely scolded would fall into a state of momentary stiffness. In 1869 he studied medicine in Berlin. In 1870 he went to the war as a hospital-assistant. His letters at this time betray a peculiar torpidity and weakness. On his return home, in 1871, his emotional irritability was noticed by those about him. Thereafter frequent complaints of bodily ailments; unpleasantness resulting from a love affair. In November, 1871, he pursued his studies diligently in Greifswald. He was considered very gentlemanly. In confinement he is quiet, calm, and sometimes self-absorbed. His acts he attributes to painful sexual excitement, which of late had become excessive. He declared that he had been fully conscious of his perverse acts, and had afterward been ashamed of them. He had not experienced actual sexual satisfaction in their commission. He obtained no correct insight into his position. He considered himself a kind of martyr,—fallen a victim to an evil power. Presumption of irresponsibility, as a result of absence of free will.

The impulse to defile occurs also, paradoxically, in the aged, when there is a re-appearance of sexual instinct, which, under such circumstances, is so often expressed in perverse acts. Thus Tarnowsky reports (p. 76) the following case:—

Case 32. I knew such a patient, who had a woman dressed in a décolleté ball-dress lie down on a low sofa in a brightly lighted room. Ipse apud januam alius cubiculi obscurati constitit adspiciendo aliquantulum feminam, excitatus in eam insiluit excrementa in sinus ejus deposuit. Hæc faciens ejaculationem quandam se sentire confessus est.

An officer of Vienna informs me that men, by means of large sums of money, induce prostitutes to suffer ut illi viri in ora earum spuerent et fæces et urinas in ora explerent.[56]

The following case by Dr. Pascal (“Igiene dell’amore”) seems also to belong here:—

Case 33. A man had an inamorata. His relation with her was that he had her allow him to blacken her hands with coal or soot, and then she had to sit before a mirror in such a way that he could see her hands in it. While conversing with her, which was often for a long time, he looked constantly at her mirrored hands, and finally, after a time, he would take his leave, fully satisfied.

The following case, communicated by a physician, may be of interest in relation to this subject:—

An officer was known in a brothel in K. only by the name of “Oil.” “Oil” induced erection and ejaculation only by having puell. publ. nudam step into a tub filled with oil, while he rubbed the oil all over her body.

These acts lead to the presumption that certain cases of injury of females (e.g., sprinkling with sulphuric acid, ink, etc.) depend upon a perverse sexual impulse; at least, here it is a kind of injury, and those injured are always females, and the perpetrators males. At least in the future, in crimes of this kind, pains should be taken to examine the vita sexualis of the culprits.

The case of Bachmann, given below, throws a clear light on the sexual nature of such crimes; for, in this case, the sexual motive in the deed is proven.

(e) Other Attacks on Females—Symbolic Sadism.—The foregoing groups do not exhaust the forms in which the sadistic impulse toward women is expressed. If the impulse is not overmastering, or there is yet sufficient moral resistance, it may happen that the perverse inclination is satisfied by an act that is apparently quite senseless and silly, but which has a symbolic meaning for the perpetrator. This seems to be the meaning of the two following cases:—

Case 34. (Dr. Pascal, “Igiene dell’amore.”) A man was accustomed to go, on a certain day once a month, to an inamorata and cut her “bang.” This gave him the greatest pleasure. He made no other demands on the girl.

Case 35. A man in Vienna regularly visits several prostitutes only to lather their faces and then to remove the lather with a razor, as if he were shaving them. He never hurts the girls, but becomes sexually excited and ejaculates during the procedure.

The significance of the following cases, in which a sadistic comedy is played, is clearer:—

Case 36. A man always announces to a puella publica his intended visits. She must stand at the window, awaiting him, with her face done up, and, on his entrance into the room, complain of severe toothache. He is sorry for her, asks particularly about the pain, takes the cloth off and puts it on again; but he never has coitus, and finds his satisfaction simply in this act.[57]

The following case, which, unfortunately, was not carefully examined scientifically, is peculiar to itself:—

In an examination before a criminal court in Vienna, the following facts were brought to light: Count N., accompanied by a young girl, appeared in the public garden of an hotel, and, by his actions there, gave public offense. He demanded of his companion that she kneel down before him and implore him with folded hands. Then she was compelled to lick his boots. Finally, he demanded of her, publicly, “an unheard-of thing” (osculum ad nates, or the like), and only desisted after she had sworn to do it at home.

In this case, the most remarkable thing was the desire of the perverse individual to humiliate the woman before witnesses (comp. the fancies of sadists, Case 29); further, that the desire to humiliate the woman came entirely into the foreground, and acts of a purely symbolic nature were undertaken. Of course, with these, in this imperfectly-observed case, acts of cruelty were probable.

(f) Sadism with Other Objects—Whipping of Boys.—Besides the sadistic acts with females described, others occur with other living, sensitive objects,—children and animals. There may be a full consciousness that the impulse is really directed toward women, and that only faute de mieux the next attainable objects (pupils) are abused. But the condition of the perpetrator may be such that the impulse to cruel acts enters consciousness accompanied only by lustful excitement, while its real object (which alone can explain the lustful coloring of such acts) remains in the dark.

The first alternative suffices as an explanation of the cases which Dr. Albert describes (Friedreich’s Blätter f. ger. Med., p. 77, 1859),—cases in which lustful teachers whipped their pupils on the naked nates without cause. We must think of the second alternative, the sadistic impulse with unconsciousness of its object, when boys are immediately excited sexually at the sight of punishment of their companions, and are thus determined in their later vita sexualis, as in the following cases:—

Case 37. K., aged 37, merchant, applied to me in the fall of 1889 for advice concerning an anomaly of his vita sexualis, which made him fear invalidism and impossibility of future happiness in marriage.

Patient came of a nervous family. As a child he was delicate, weak, and nervous. Healthy except for measles; he later became strong.

At the age of eight, while at school, he saw how the teacher punished the boys taking their heads between his thighs and spanking them with a ferule. This sight caused the patient lustful excitement. “Without any idea of the danger and enormity of onanism,” he satisfied himself with it, and from that time often masturbated, during which he always called up the memory-picture of a boy being punished.

Thus it continued until his twentieth year. Then he learned the significance of onanism, was terribly frightened, and tried to overcome his impulse to masturbate; but he fell into the practice of psychical onanism, which he regarded as innocuous and morally defensible, and for which he made use of the memory-pictures of boys being whipped, previously mentioned.

Patient now became neurasthenic, suffered with pollutions, and tried to cure himself by visiting brothels; but he could not induce erection. Then he sought to obtain normal sexual feelings by means of social intercourse with ladies; but he recognized that he was entirely insensible to the charms of the fair sex.

The patient is an intelligent man, normally developed, and of æsthetic taste. There is no inclination to persons of his own sex. My advice consisted of means to combat the neurasthenia and pollutions; interdiction of psychical and manual onanism; avoidance of all sexual excitants; and, possibly, hypnotic treatment to ultimately induce a return of the vita sexualis to its normal condition.

Case 38. Abortive sadism. N., student, came under observation in December, 1890. He had practiced masturbation from early youth. According to his statements, he became sexually excited when he saw his father whip the children, and, later, when he saw the teacher whip his companions. When a spectator of such scenes, he always experienced lustful feelings. He could not say exactly when this first occurred, but it may have been at about the age of six. He could not tell exactly when he began to masturbate, but he stated with certainty that his sexual instinct was first awakened by the punishment of others, and thus he unconsciously came to practice onanism. The patient remembered clearly that from the age of four to the age of eight he was frequently spanked, and that this caused him pain, never lustful pleasure.

Since he did not always have opportunity to see others whipped, he began to imagine how others were punished. This excited his lust, and he would then masturbate. Whenever he could, he managed to see others punished at school. Now and then he also felt desire to whip others. At the age of twelve he induced a comrade to allow him to whip him. He found great sexual pleasure in it. When, however, his companion beat him in return, he experienced nothing but pain.

The impulse to beat others was never very strong. The patient experienced more satisfaction in filling his imagination with scenes of whipping. He never indulged in any other sadistic acts, and never had any desire to see blood, etc. Until his fifteenth year his sexual indulgence consisted of onanism, indulged in after such fancies. After that (dancing lessons, association with girls), the early fancies disappeared almost entirely, and were accompanied by but weak lustful feelings; so that the patient gave them up entirely. In their place came thoughts of coitus in a natural way, without anything sadistic.

The patient indulged in coitus for the first time “on account of his health.” He then tried to abstain from onanism, but was not successful, though he often indulged in coitus, and with more pleasure than he had in onanism. He wished to be freed from onanism as something vicious. He had coitus once a month, but masturbated once or twice every night. He was normal sexually, with the exception of the onanism. There was no neurasthenia; genitals normal.

Case 39. P., aged 15, of high social position, came of an hysterical mother, whose brother and father died in an asylum. Two children of the family died, in early childhood, of convulsions. The patient is talented, virtuous, and quiet; but at times he is very disobedient, stubborn, and passionate. He has epilepsy, and practices onanism. One day it was learned that P., with money, induced a comrade of fourteen, B., to allow himself to be pinched on the arm, back, and thigh. When B. cried, P. became excited and struck at B. with his right hand, while with his left he made manipulations in the left pocket of his trousers. P. confessed that to maltreat his friend, of whom he was very fond, gave him peculiar delight; and that ejaculation while hurting his friend gave him much more pleasure than when he masturbated alone, (v. Gyurkovechky, “Pathol. und Therapie der männl. Impotenz.,” p. 80, 1889.)

That in all these cases of sadistic abuse of boys there can be no thought of a combination of sadism and contrary sexual instinct, as often occurs (v. infra) in individuals of contrary sexuality, is shown—aside from the absence of all positive signs of it—by a study of the next group, where, in association with the object of injury,—animals,—the instinct for women is seen to appear repeatedly.

(g) Sadistic Acts with Animals.—In numerous cases, sadistically perverse men that are afraid of criminal acts with human beings, or that care only for the sight of the suffering of a sensitive being, make use of the sight of dying animals, or torture animals, to stimulate or excite their lust.

The case of a man in Vienna, which is reported by Hofmann in his “Text-Book of Legal Medicine,” is noteworthy in relation to this. According to the evidence of several prostitutes, before the sexual act he was accustomed to excite himself by torturing chickens and pigeons and other birds, and, therefore, was called “Hendlmann” (chicken).

For the elucidation of such cases the observation of Lombroso is of value, according to whom two men had ejaculation when they killed chickens or pigeons, or wrung their necks.

The same author, in his “Uomo delinquente,” p. 201, speaks of a poet of some reputation, who became powerfully excited sexually whenever he saw calves slaughtered, and also at the sight of bloody flesh.

According to Mantegazza (op. cit., p. 114), among degenerate Chinamen, a horrible sport consists of committing sodomy with geese, and cutting their necks off tempoire ejaculationis!

Mantegazza (“Fisiologia del piacere,” 5th ed., pp. 394, 395) mentions the case of a man who once saw chickens killed, and from that time had a desire to wallow in their warm, steaming entrails, because he experienced a feeling of lust while doing it.

Thus, in these and similar cases, the vita sexualis is so constituted ab origine that the sight of blood, death, etc., excites lustful feeling. It is so in the following case:—

Case 40. C. L., aged 42, engineer, married, father of two children; from a neuropathic family; father irascible, a drinker; mother hysterical, subject to eclamptic attacks. The patient remembers that in childhood he took particular pleasure in witnessing the slaughtering of domestic animals, especially swine. He thus experienced lustful pleasure and ejaculation. Later he visited slaughter-houses, in order to delight in the sight of flowing blood and the death throes of the animals. When he could find opportunity, he killed the animals himself, which always afforded him a vicarious feeling of sexual pleasure.

At the time of full maturity he first attained to a knowledge of his abnormality. The patient was not exactly opposed in inclination to women, but close contact with them seemed to him repugnant. On the advice of a physician, at twenty-five he married a woman who pleased him, in the hope of freeing himself of his abnormal condition. Although he was very partial to his wife, it was only seldom, and after great trouble and exertion of his imagination, that he could perform coitus with her; nevertheless, he begat two children. In 1866 he was in the war in Bohemia. His letters written at that time to his wife, were composed in an exalted, enthusiastic tone. He was killed in the battle of Königgrätz.

If, in this case, the capability of normal coitus was much impaired by the predominance of perverse ideas, in the next it seems to have been entirely repressed:—

Case 41. (Dr. Pascal, “Igiene dell’ amore.”) A gentleman visited prostitutes, had them purchase a living fowl or rabbit, and required them to torture the animal. He had in mind the head and tearing out the eyes and entrails. If he found a girl who would consent, and go about it right cruelly, he was delighted, and paid her and went his way without asking anything more or touching her.

The last two sections show that the suffering of any living being may become a source of perverse sexual enjoyment to sadistically constituted persons, and that there may be sadism with almost any [living] object. However, it would be erroneous and an exaggeration to try to explain by sadistic perversion all the remarkable and surprising acts of cruelty that occur; and, in the innumerable cruelties, as they here and there occur in history or in certain psychological manifestations among the people at the present time, it would be erroneous to assume sadism as a motive.

Cruelty arises from various sources, and is natural to primitive man. Compassion, in contrast with it, is a secondary manifestation, and acquired late. The instinct to fight and destroy, so important an endowment in prehistoric conditions, is long afterward operative; and, in the ideas engendered by civilization, like that of “the criminal,” it finds new objects, even though its original object—“the enemy”—still exists. That not simply the death, but also torture, of the conquered is demanded, is in part explained by the sense of power, which satisfies itself in this way; and in part by the insatiableness of the impulse of vengeance. Thus all cruelty and all historical enormities may be explained without recourse to sadism (which may often have been in operation, but which cannot be assumed, since it is relatively an infrequent perversion).

At the same time, there is still another powerful psychical element to take into consideration, which explains the attraction that is still exerted by executions, etc.; and that is, the pleasure there is in intense and unusual impressions and rare sights, in contrast with which, in coarse and blunted beings, pity is silent.

But undoubtedly there are individuals for whom, in spite of, or even by reason of, their lively compassion, all that is connected with death and suffering has a mysterious attraction; who, with inward opposition, and yet following a dark impulse, occupy themselves with such things, or at least with pictures and notices of them. Still, this is not sadism, as long as no sexual element enters into consciousness; and yet it is possible that, in unconscious life, slender threads connect such manifestations with the hidden depths of sadism.

(h) Sadism in Woman.—That sadism—a perversion, as we have seen, frequent in men—is much less frequent in women, is easily explained. In the first place, sadism, in which the need of subjugation of the opposite sex forms a constituent element, in accordance with its nature, represents a pathological intensification of the masculine sexual character; in the second place, the obstacles which oppose the expression of this monstrous impulse are, of course, much greater for a woman than for a man. Yet sadism occurs in women; and it can only be explained by the primary constituent element,—the general hyper-excitation of the motor sphere. Only two cases have thus far been scientifically studied.

Case 42. A married man presented himself with numerous scars of cuts on his arms. He told their origin as follows: When he wished to approach his wife, who was young and somewhat “nervous,” he first had to make a cut in his arm. Then she would suck the wound, and during the act become violently excited sexually.

This case recalls the wide-spread legend of the vampires, the origin of which may perhaps be referred to such sadistic facts.[58]

In a second case of feminine sadism, for which I am indebted to Dr. Moll, of Berlin, by the side of the perverse impulse, as so frequently occurs, there is anæsthesia for the normal activities of the sexual life; and here there are also traces of masochism (v. infra).

Case 43. Mrs. H., of H., aged 26, comes of a nervous family, in which nervous or mental diseases are said not to have occurred; but the patient herself presents signs of hysteria and neurasthenia. Although eight years married, and the mother of a child, Mrs. H. never had desire to perform coitus. Very strictly educated as a young girl, until her marriage she remained almost innocent of any knowledge of sexual matters. She has menstruated regularly since her fifteenth year. There does not seem to be any essential abnormality of the genitals. To the patient coitus is not only not a pleasure, but even an unpleasant act; and repugnance to it has constantly increased. The patient cannot understand how any one can call such an act the greatest delight of love, which, to her, is something far higher and unconnected with such a sensual impulse. At the same time, it should be mentioned that the patient really loves her husband. In kissing him, too, she experiences a decided pleasure, which she cannot exactly describe. But she cannot conceive how the genitals can have anything to do with love. In other respects Mrs. H. is a decidedly intelligent woman, of feminine character.

Si oscula dat conjugi, magnum voluptatem percipit in mordendo eum. Gratissimum ei esset conjugem mordere eo modo ut sanguis fluat. Contenta esset, si loco coitus morderetur a conjuge ipsæque eum mordere liceret. Tamen eam pœniteret, si morsu magnum dolorem faceret. (Dr. Moll.)

In other cases of sadism which history and literature afford, we are compelled to think of a reversal of the feminine sexual character,—a partial viraginity,—in order to explain the sadistic acts.

In history there are examples of famous women who, to some extent, had sadistic instincts. These Messalinas are particularly characterized by their thirst for power, lust, and cruelty. Among them are Valeria Messalina herself, and Catherine de Medici, the instigator of the Massacre of St. Bartholomew, whose greatest pleasure was found in having the ladies of her court whipped before her eyes, etc.

The gifted Henry von Kleist, who was undoubtedly mentally abnormal, gives a masterly portrayal of complete feminine sadism in his “Penthesilea.” In scene xxii, Kleist describes his heroine with Achilles, whom she had been pursuing in the fire of love, betrayed into her hands, as, overcome with lustful, murderous fury, she tears him in pieces and sets her dogs on him: “She strikes, tearing the armor from his body; they set their teeth in his white breast,—she and her dogs, the rivals, Oxus and Sphynx,—they on the right side, she on the left; and as I approached blood dripped from her hands and mouth.” And later, when Penthesilea becomes satiated: “Did I kiss him to death? No. Did I not kiss him? Torn in pieces? Then it was a mistake; kissing rhymes with biting, and one who loves with the whole heart might easily mistake the one for the other.”[59]

2. The Association of Passively Endured Cruelty and Violence, with Lust—Masochism.[60]—Masochism is the opposite of sadism. While the latter is the desire to cause pain and use force, the former is the wish to suffer pain and be subjected to force.

By masochism I understand a peculiar perversion of the psychical vita sexualis, in which the individual affected, in sexual feeling and thought, is controlled by the idea of being completely and unconditionally subject to the will of a person of the opposite sex; of being treated by this person as by a master,—humiliated and abused. This idea is colored by lustful feeling; the individual affected lives in fancies, in which he creates situations of this kind, and often attempts to realize them. By this perversion his sexual instinct is not infrequently made more or less insensible to the normal stimulus of the opposite sex,—incapable of a normal vita sexualis,—psychically impotent. But this psychical impotence does not in any way depend upon a horror sexus alterius, but upon the fact that this perverse instinct finds an adequate satisfaction differing from the normal,—in woman, to be sure, but not in coitus.

But cases also occur, in which, with the perverse impulse, there is also sensibility, in a measure, to normal stimuli, and intercourse under normal conditions takes place. In other cases the impotence is not purely psychical, but physical, i.e., spinal; for this perversion, like almost all other perversions of the sexual instinct, is developed only on the basis of a psychopathic and, for the most part, hereditarily predisposed individuality; and, as a rule, such individuals give themselves up to excesses, particularly masturbation, to which the difficulty of attaining what their fancy creates, drives them again and again.

The number of cases of undoubted masochism thus far observed is very large. Whether masochism occurs associated with normal sexual instincts, or exclusively controls the individual; whether, and to what extent, the individual subject to this perversion strives to realize his peculiar fancies or not; whether he has thus more or less diminished his virility or not,—depends upon the degree of intensity of the perversion in the single case, and upon the strength of the opposing ethical and æsthetic motives, as well as the relative power of the physical and mental organization, of the affected individual. The essential thing, from the psychopathic point of view, and the common element in all these cases, is the fact that the sexual instinct is directed to ideas of subjugation and abuse by the opposite sex.

What has been said with reference to the impulsive character (indistinctness of motive) of the resulting acts, and with reference to the original (congenital) nature of the perversion in sadism, is also true in masochism.

In masochism there is also a gradation of the acts from the most repulsive and monstrous to the silliest, in accordance with the degree of intensity of the perverse instinct, and the power of the remnants of moral and æsthetic motives that oppose it. The ultimate consequences of masochism, however, are opposed by the instinct of self-preservation, and, therefore, murder and serious injury, which may be committed in sadistic excitement, have here, as far as known, no passive equivalent in reality; but the perverse desires of masochistic individuals may, in imagination, attain these extreme consequences (v. infra, Case 54).

Moreover, the acts to which masochists give themselves up, are performed in some cases in connection with coitus, i.e., as preparatory measures; in others, as substitutes for coitus when that is impossible. Here, too, this depends only upon the condition of sexual power, which has been diminished for the most part physically and mentally by the activity of the sexual ideas in the perverse direction, and not upon the nature of the act itself.

(a) The Desire for Abuse and Humiliation as a Means of Sexual Satisfaction.—The following detailed autobiography of a masochist, gives an exhaustive description of a typical case of this remarkable perversion:—

Case 44. I come of a neuropathic family, in which, with all kinds of peculiarities of character and manner of life, there are several abnormalities of a sexual nature. My imagination has always been very lively, and was very early directed to sexual matters. As far as I can remember, I was much given to onanism long before puberty. Even at that time my thoughts were, for hours at a time, directed to intercourse with females. But the relations in which I placed myself with the opposite sex were entirely peculiar. I fancied that I was a prisoner and absolutely in a woman’s power, and that this woman used her power to hurt and abuse me in every way possible. In this, whipping and blows played an important part in my fancy, and there were many other acts and situations which all expressed the condition of vassalage and subjection. I saw myself constantly kneeling before my ideal, trod upon, loaded with chains, and imprisoned. Severe punishments of all kinds were inflicted on me, to test my obedience and please my mistress. The more severely I was humiliated and abused, the more I indulged in these thoughts. (At the same time I developed a great preference for velvet and fur, which I liked to touch and smooth, and which likewise excited me sexually.)

I remember well that when a child I received many actual whippings at the hands of females. They never caused me any other feeling than pain and shame; never have I thought to connect such realities with my fancies. A threat to punish me severely and correct me agitated me painfully; but in my fancy I assumed a desire on the part of my “mistress” to enjoy my suffering and humiliation, which entranced me. Too, I have never brought into relation with my fancies the acts and orders of the females that have taken care of me. I was early able to discover the truth about the relation of the sexes; but this knowledge made no impression on me. The idea of sensual pleasure remained connected with the fancies with which it was originally associated. I also had the desire to touch females, to embrace and kiss them, but I looked for the greatest delight only in their maltreatment, and in situations in which they would cause me to feel their power. I soon came to realize that I differed from other men, and preferred to be alone and absorbed in my dreams. In my boyhood, real girls and women had but little interest for me; for I saw no possibility of having them act in the way I desired. On lonely paths in the forest I whipped myself with branches that had fallen from the trees, and allowed my imagination to play in the habitual way. I reveled in the sight of pictures of commanding women, particularly if, like queens, they wore furs. I read everything related to my cherished ideas. “Rousseau’s Confessions,” which then fell into my hands, was a great discovery. I found a condition described that resembled mine in essentials. I was still more astonished at the similarity of my ideas to those I read of in the writings of Sacher-Masoch. I devoured them all with avidity, though the blood-curdling scenes often far outdid my imagination, and then excited my aversion. Later, in order to supply new food for my fancy, I began to write descriptions of erotic scenes to my taste, and to make drawings of situations which, up to this time, I had painted only in imagination. In this, reality was entirely an indifferent matter to me. In the presence of a woman I was devoid of every sensual feeling; at most, at the sight of a feminine foot, there would come a fleeting wish to be trod upon by it.

This indifference, however, was only in relation to pure sensuality. In late boyhood and early youth I was subject to an enthusiastic partiality for young girls of my acquaintance, with all the extravagances common to this youthful enthusiasm. But it never occurred to me to connect the world of my sensual thoughts with these pure ideals. I never had to overcome such a thought; one never came to me. This is the more remarkable, since to me my lustful fancies seemed very strange and unattainable in reality, but in no wise vile or obnoxious. This, too, was a kind of poetry with me; but it was divided into two worlds,—on the one hand was my heart, or, rather, my æsthetically excited fancy; on the other, my sensually inflamed imagination. While my “elevated” feeling always had a certain young girl for its object, at other times I saw myself at the feet of a mature woman, who treated me as previously described. I never placed any lady of my acquaintance in this rôle. In dreams the two spheres of my erotic ideas occurred alternately, but never combined. Only the images of the sensual sphere induced pollutions.

In my nineteenth year I allowed myself, with outward reluctance, but with inward desire, to be taken by friends to visit prostitutes. But there I experienced nothing but repugnance and aversion, and left as soon as possible, without having felt the faintest trace of sensual excitement. Later, on my own initiative, I repeated the attempt, in order to convince myself as to whether I was impotent or not; for I was much troubled by my unexpected failure in the first instance. The result was always the same,—I felt no excitement at all, and had not the slightest erection. In the first place, it was not possible for me to regard a real woman as an object of sensual gratification; and, furthermore, I could not renounce the conditions and situations which were the principal things in sexualibus for me, and about which nothing could induce me to speak a word. Imissio penis—the act to be undertaken by me—seemed to me absolutely senseless and unclean. Again, in the second place, there was also my repugnance for common women, and fear of infection.

In the meantime, in secret, my sexual life went on in the old fashion. Whenever my old fancies came to mind, violent erection occurred, and I provoked ejaculations almost daily. I began to suffer with all kinds of nervous troubles, and now regarded myself as impotent, in spite of powerful erections and intense desire when I was alone. Nevertheless, from time to time I continued my experiments with prostitutes. In time I overcame my timidity, and in part my aversion to contact with common women; but I remained absolutely cold.

After I had, with advancing years, overcome to some extent my shyness and my inclination to indulge in dreams, in my sexual thought there was an approach to the normal, as I began to direct my interest to real persons. I was even successful in directing sensual thoughts to women of my acquaintance, without carrying over any of my peculiar ideas from the other sphere. Thus I had some affairs with respectable girls. Embracing and kissing occurred; desire was excited, but not the power,—at least, it was too weak to allow me to think that under normal circumstances I should be virile. Of course, the attention I gave to the excitation of my sexual power was not calculated to favor this. Thus, always greatly ashamed, I broke off the relations.

With this, my old habit continued. I was still a great onanist, even though with lessened power. But my fancy no longer satisfied me entirely. I now began to follow both respectable women and others on the street; in winter, particularly those wearing velvet and furs. I often followed prostitutes to their homes, and had them perform manustupration. I always thought I should find more real pleasure in that than in my fancies; but it was always less. When the woman took off her garments, my interest followed them. The empty clothing has never attracted me very strongly, but more than the nude female. The real object of my interest was the attired woman. In this, velvet and furs play the most important part; but also all other articles of attire attracted me, and particularly the form as brought out by lacing and padding. I had scarcely any other interest in the nude female form than an æsthetic one. I have always had a very great interest in the shoes of women, particularly in slippers with high heels, which is always connected with the thought of being trod upon, or of submissively kissing the foot.

At last I overcame the last vestige of my shyness, and one day, to realize my dreams, had myself whipped, trod upon, etc., by a prostitute. The result was a great disappointment. What was done to me I felt to be rough, repugnant, and silly. The blows caused me nothing but pain; the situation, repugnance and shame. Nevertheless, I induced an ejaculation mechanically, with which, with the help of my imagination, I transformed the real situation into that for which I longed. This—the really desired situation—differed from the actual essentially in that I created in imagination a woman who abused me with the same pleasure that I experienced in her maltreatment of me.

All my sexual fancies were erected on the assumption in the woman of a tyrannical, cruel disposition, to which I wished to be subject. The act expressing the relation was a secondary matter to me. After the first attempt at an impossible realization, it was perfectly clear to me toward what my longing was directed. To be sure, in my lustful dreams, I had often passed beyond all ideas of abuse, and conceived a commanding woman, with an imperious mien, a word of command, a kiss on the foot, etc; but now I fully realized what it was that attracted me, and that flagellation was only the strongest means of expressing the principle, and in itself secondary.

In spite of this disappointment, after the first step, I did not abandon my efforts to realize my erotic ideas. I was confident that, when once accustomed to the new reality, my fancy would find food in it for more intense activity. For my purpose I sought the most suitable women, and instructed them carefully in a complicated comedy. In this I occasionally found that the way had been prepared for me by predecessors of like disposition. The value of these comedies, for the effect of my fancy on my sensuality, remained problematical. What these acts and scenes did for me, in the way of intensifying the subsidiary circumstances of the desired situation, caused a diminution of the intensity of the principal element, which my unaided fancy, without the consciousness of planned, coarse deception, could more easily bring up before me. My physical sensations, under the various punishments, were changeable. The more perfect the self-deception, the more perfectly the pain was felt as pleasure.

Or, more correctly, the punishment was then conceived as a symbolic act. From this arose the illusion of the desired situation, which was then accompanied by an intense psychical feeling of pleasure. The lustful feeling then spread out over the whole body in lustful physical sensations, and thus the perception of the painful quality of the punishment was overcome. The process in the moral punishments—the humiliations to which I subjected myself—was similar, but simpler; because it was confined to the mental sphere. These were also attended with pleasurable feeling when the self-deception succeeded. It was seldom, however, that it succeeded well, and never perfectly; there always remained a disturbing element in consciousness. Therefore, in the intervals, I returned to solitary onanism. Moreover, in the other case, the conclusion of the act was usually an ejaculation provoked by onanism; often an ejaculation without the aid of mechanical means.

Thus I went on for many years, with diminishing power, but with slightly diminished desire, and with the power of my peculiar sexual idea over me unchanged. And at present the condition of my vita sexualis is the same. Coitus, which I have never performed, still seems to me a strange and unclean act. I learned about it from descriptions of sexual dissipations. My own sexual ideas seem natural, and do not in the least offend my sensitive taste. Their realization, as previously mentioned, for various reasons, leaves me unsatisfied. I am pleased with pretty girls and women of respectability, but for a long time I have ceased to approach them. I have never attained, not even partially, a direct, actual realization of my sexual fancy. As often as I have come into close relation with females, I have felt the woman’s will to be beneath mine, never vice versâ. I have never met a woman manifesting a desire of mastery in sexual things. Women who wish to rule in the household and exercise petticoat sovereignty are entirely different from my erotic ideals.

My whole personality presents many abnormalities besides the perversion of my vita sexualis; my neuropathic condition is expressed in many mental and physical symptoms. Besides, I think I recognize in myself an original abnormality of character in the nature of a resemblance to the feminine type; at least, I regard as of this nature my great weakness of will, and my great lack of courage in the presence of men and animals, which is in contrast with my coolness in the face of peril. My external appearance is entirely masculine.

The author of this autobiography also made me the following communication:—

“I always sought to find out whether the peculiar ideas that ruled me sexually were entertained by other men. Since the first stories about it accidentally came to my ears, I have sought everywhere to learn of it. Since it is really a process of inner consciousness, it is, of course, not easy to identify it, and it cannot always be done with certainty; but I assume the existence of masochism where I find perverse sexual acts that cannot be explained except by this dominating idea. I look upon this anomaly as wide-spread.

“I have heard numerous stories about it from prostitutes here in Berlin, and in Vienna; and I thus learned how numerous my fellow-sufferers are. I am always careful not to describe my own experiences, or ask whether they know of such; but I allow these persons to relate their experiences just as they will.

“Simple flagellation is so common that almost every prostitute is familiar with it; but cases of real masochism are very frequent. The men subject to this perversion submit themselves to the most refined cruelties. In this they always act the same farce with the instructed prostitutes,—humiliating subjection of the man, treading upon him, commands, threats, and scoldings that have been committed to memory; then flagellation, blows on various portions of the body, and all kinds of punishment, pricking with needles, etc. The scenes often end with coitus, but more frequently with ejaculation without it. Twice prostitutes have shown me heavy iron chains with handcuffs, which their patrons had made for them to put on them; and the dried peas, on which they kneeled; the seat set with needles, on which they sat at command; and many other similar things. Often the perverted man wishes the woman to tie his penis so tightly as to cause pain; to prick it with needles, make cuts in it with a knife, or beat it with a stick. Even the act of hanging is indulged in, it being cut short at just the right moment. Others have themselves scratched with a knife or dagger, but in the act the woman must threaten them with death. In all these things the symbolism of subjection is the most important factor. The woman is usually called ‘mistress’; the man, ‘slave.’

“A man of high social standing, dressed as a servant, sat on the box of a carriage and drove his mistress about. Here there may have been a conscious imitation of the ‘Venus in Furs.’ It seems to me that the writings of Sacher-Masoch have done much to develop this perversion in those predisposed. It is peculiar that the inexplicable enthusiasm for furs is so frequently combined with this perversion. It, as well as that for velvet, has been peculiar to me from my earliest youth.

“All these comedies with prostitutes are for masochists only troublesome substitutes. Whether there is such a thing as a realization of masochistic dreams in love relations or not, I do not know. If it occur, it is certainly very infrequent; for this taste in women (sadism in women, as described by Sacher-Masoch) is very difficult to find; and, too, the expression of sexual abnormalities finds greater obstacles in the modesty of women, etc., than in men. I myself have never noticed the slightest indications of anything of this kind, and have never been able to attempt an actual realization of my fancies. Once a man confidingly told me of his masochistic perversion, and said he had found his ideal.”

The two following cases are similar to the foregoing:—

Case 45. Mr. Z., aged 29, technicist, came for consultation because of a fear of tabes. Father was nervous and died tabetic. Father’s sister was insane. Several relatives are very nervous and peculiar. On closer examination the patient is found to have sexual, spinal, and cerebral asthenia. He presents no symptoms of tabes dorsalis, nor does he give a history of them. Questions concerning abuse of the sexual organs bring out a confession of masturbation practiced since youth. In the course of the examination the following interesting psycho-sexual anomalies came out: At the age of five the vita sexualis began with the impulse to whip himself, as well as with the desire to see others whipped. In this he never thought of individuals as of one sex or the other. Faute de mieux he practiced flagellation on himself and, in time, this induced ejaculation. Long before this he had begun to satisfy himself with masturbation, and always during the act reveled in imaginary scenes of whipping. After growing up he twice visited brothels to have himself flogged by prostitutes. For this purpose he chose the prettiest girl he could find; but he was disappointed, and did not even have an erection, to say nothing of ejaculation. He recognized that the flagellation was subsidiary, and that the idea of subjection to the woman’s will was the important thing. He realized this on the second trial. When he had the “thought of subjection,” he was perfectly successful. In time, by straining his imagination with masochistic ideas, he performed coitus without flagellation; but he found little satisfaction in it; so that he performed sexual intercourse in a masochistic way. He found pleasure in masochistic scenes, in the sense of his original desire for flagellation, only when he was flagellated ad podicem, or, at least, only when he called up such a situation in imagination. At times of great excitability it was even sufficient if a pretty girl told stories of such scenes. He would thus have an orgasm, and usually ejaculation.

A very effectual fetichistic idea was early associated with this. He noticed that he was attracted and satisfied only by women wearing high heels and short jackets (“Hungarian fashion”). He does not know how he arrived at this fetichistic idea. Boys’ legs with high heels also pleased him, but this charm was purely æsthetic, without any sensual coloring; and he said he had never noticed anything homo-sexual in himself. The patient referred his fetichism to his partiality for calves (legs). He is charmed by ladies’ calves only when elegant shoes are on the feet. Nude legs—feminine nudity in general—do not in the least affect him sexually. A subordinate fetichistic idea for the patient is the masculine ear. It is a lustful pleasure for him to pet the ears of handsome men, i.e., men having beautiful ears. With men this pleasure is slight, but with women it gives him great enjoyment.

He also has a weakness for cats. He thinks them simply beautiful; and their movements are very attractive to him. The sight of a cat can raise him from a feeling of the deepest depression. Cats seem to him sacred; he sees something divine in them! He does not know the reason for this idiosyncrasy.

Of late he has also frequently had sadistic ideas about punishing boys. In these imaginary flagellations both men and women play a part, but particularly the latter; and then his enjoyment is much more intense.

The patient finds that, with that which he recognizes and feels as masochism, there is something else which he prefers to designate “pageism.”

While his masochistic fancies and acts are entirely of a coarse, sensual nature, his “pageism” consists of the idea of being a page to a beautiful girl. He conceives her as perfectly chaste, but piquant; his relation to her, that of a slave, but perfectly chaste,—a purely platonic submission. This reveling in the idea of serving such a “beautiful creature” as a page, is colored by a pleasurable feeling; but this is in no way sexual. He experienced in it an exquisite feeling of moral satisfaction, in contrast with the sensually-colored masochism; and, therefore, he could but regard it as something of a different nature.

At first sight there was nothing remarkable in the patient’s appearance; but his pelvis is abnormally broad, the ilia are flat, and the pelvis, as a whole, tilted and decidedly feminine. Eyes, neuropathic. He also mentions that he often has itching and lustful irritation at the anus, and that there (“erogenous” area), ope digiti, he can satisfy himself.

The patient is troubled about his future. Help would be possible for him if he could but excite in himself an interest in women, but his will and imagination were too weak for that.

What the patient designates as “pageism” does not differ in any way from masochism, as may be seen when it is compared with the following cases of symbolic masochism, and others; and, further, upon the consideration that in this perversion coitus is avoided as an inadequate act; and from the fact that in such cases there is often a fantastic exaltation of the perverse ideal:—

Case 46. X, writer, aged 28, predisposed. Sexually hyperæsthetic from childhood. At the age of six he had dreams of being whipped ad nates by a woman. After them he would awake in intense lustful excitement; and thus he came to practice onanism. When eight years old he once asked the cook to whip him. From his tenth year, neurasthenia. Until his twenty-fifth year he had dreams of flagellation, or similar waking fancies, and indulged in onanism. Three years ago he had an impulse to have himself whipped by a puella. The patient was undeceived, for neither erection nor ejaculation occurred. At twenty-seven, another effort, with the thought to enforce erection and ejaculation. This was finally made possible by the following artifice: While coitus was attempted, the puella had to tell him how she had mercilessly flogged other impotent men, and threaten him with the same. Besides this, it was necessary for him to fancy that he was bound, entirely in the woman’s power, helpless, and most painfully beaten by her. Occasionally, in order to become potent, it was necessary to have himself actually bound. Thus coitus was possible. Pollutions were accompanied by lustful feeling only when he (infrequently) dreamed that he was abused, or that he looked on while a puella whipped others. He never had an intense, lustful pleasure in coitus. The only things in women that interest him are the hands. Powerful women with big fists are his preference. At the same time, his desire for flagellation is only ideal; for with his great cutaneous sensitiveness, at the most, a few strokes are sufficient. Blows from men were repugnant to him. He wishes to marry. From the impossibility of asking a decent woman to perform flagellation, and the doubt about being potent with such a woman, spring his embarrassment and desire to recover.

In the foregoing three cases, for the most part, passive flagellation serves the individual subject to this perversion of masochism as an expression of the desired situation of subjection to the woman. The same means is needed by a large number of masochists. But passive flagellation is a process which, as is known, has a tendency to induce erection reflexly by irritation of the nerves of the nates.[61] This effect of flagellation is used by weakened debauchees to help their diminished power; and this perversity—not perversion—is very common. It is, therefore, necessary to ascertain in what relation the passive flagellation of the masochists stands to these dissipated individuals who are not psychically perverse, but physically weakened.

It is not difficult to show that masochism is something essentially different from flagellation, and more comprehensive; that flagellation is rather a by-play,—one of the many means used for the purpose of masochistic gratification in the sense of subjection to the woman. For the masochist the principal thing is subjection to the woman; the punishment is only the expression of this relation,—the most intense effect of it he can bring upon himself. For him the act has only a symbolic value, and is a means to the end of mental satisfaction of his peculiar desires. The essential thing is the desire for ill-treatment, as a sign of this subjection. Besides flagellation, and often without it, there are many other things which serve to express this subjection; as is shown by the following series of cases. This fact establishes a presumption of the existence of an original anomaly of sexual feeling,—a paræsthesia sexualis. On the other hand, the individual that is weakened and not a subject of masochism, and who has himself flagellated, desires only a mechanical irritation of his spinal centre.

Whether, in a given case, it is simple (reflex) flagellation or masochism, is made clear by the individual’s statements, and often by the secondary circumstances. The determination depends upon the following facts:—

In the first place, the impulse to passive flagellation exists ab origine in the masochist. The desire is felt before there has been any experience of the reflex effect, often first in dreams; as, for example, in Case 48. Secondly, with the masochist, as a rule, the flagellation is only one of many and various punishments which come into his mind as fancies and are often realized. In these other punishments, and the frequent acts expressing purely symbolic humiliations, which occur by the side of flagellation, there can, of course, be no thought of a reflex physical irritative effect. Thirdly, it is significant that, in the masochist, when the desired flagellation is carried out, it need have no aphrodisiac effect at all. Very often, indeed, there is a more or less perfect disappointment; in fact, always, if the masochist is not successful in his desire to create, by means of the pre-arranged programme, the illusion of the desired situation (to be in the woman’s power), so that the woman ordered to carry out the act seems to be nothing more than the executive agent of his own will. If one cannot tickle one’s self, no more can one feel one’s self subject to a woman directed by one’s own will. In reference to this important point, compare the three foregoing cases and Case 50.

Between masochism and simple (reflex) flagellation, there is a relation somewhat analogous to that existing between contrary sexual instinct and acquired pederasty. It does not lessen the value of this opinion that, in the masochist, the flagellation may also have the known reflex effect; or that a whipping received in childhood may have aroused lust for the first time, and thus simultaneously excited the latent masochistically-constituted vita sexualis. In this event, the case must be characterized by the conditions mentioned above, under the heads of “secondly” and “thirdly,” in order to be masochistic. If the details of the origin of the case are not known, other circumstances, such as those mentioned above under “secondly,” would make it clearly masochistic. This is illustrated in the two following cases:—

Case 47. A patient of Tarnowsky’s had a person in his confidence rent a house during his attacks, and instruct its personnel (three prostitutes) in what was to be done with him. He would come there, and was there undressed, manustuprated, and flagellated, as ordered. He pretended to offer resistance, and begged for mercy; then, as ordered, he was allowed to eat and sleep. But in spite of protest he was kept there, and beaten if he did not submit. Thus the affair would go on for some days. When the attack was over, he was dismissed; and he returned to his wife and children, who had no suspicion of his disease. The attacks occurred once or twice a year. (Tarnowsky, op. cit.)

Case 48. X., aged 34, greatly predisposed, suffers with contrary sexual instinct. For various reasons he had no opportunity to satisfy himself with men, in spite of great sexual desire. Occasionally he dreamed that a woman whipped him, and then had a pollution.

Through this dream he came to have prostitutes beat him as a substitute for love with men. Occasionally he would obtain a prostitute, undress himself completely (while she was not to take off a thing), and have her tread upon him, whip, and beat him. Qua re summa libidine affectus pedem feminæ lambit quod solum eum libidinosum facere potest: tum ejaculationem assequitur. Then disgust at the morally-debasing situation occurred, and he retired as quickly as possible.

Cases occur, however, in which passive flagellation alone constitutes the entire content of the masochistic fancies, without other ideas of humiliation, etc., and without any clear consciousness of the real nature of this expression of submission. Such cases are difficult to differentiate from those of simple reflex flagellation. A knowledge of the primary origin of the desire, before any experience of reflex stimuli (v. supra, under “first”), is the only thing that makes the differential diagnosis certain; taken with the circumstance that genuine masochists are perverse in their youth, and that the realization of their desires usually comes late, or undeceives them (v. supra, under “thirdly”); for the whole thing, for the most part, belongs to the sphere of the imagination.

The following case is of this nature:—

Case 49. Autobiography.—In January, 1891, I received the following letter from a gentleman in Hungary: “In depression and despair of a life that shuts me out from all that makes human happiness, I come to you with the last gleam of hope of rescue from a condition which, if it continue, can end only tragically.

“I am thirty years old, and come of a mother who suffered with periodical insanity. As early as my fourteenth year abnormal sexual tendencies were noticeable in me. It always gave me a certain lustful pleasure to be whipped by boys of my own age, particularly when I was taken over the knee and spanked. It particularly delighted me when this was done by handsome young persons or boys having well formed legs and closely-fitting trousers. By means of such ideas I also came to masturbate; and I practiced onanism quite frequently,—almost daily, and, in fact, in absolute ignorance of the terrible results of the vice. Thus it continued until my eighteenth year, when, thus far absolutely unsuspecting, I was made aware of the vicious results of the practice.

“From this time began the terrible struggle with the desire to give it up, which I only too often abandoned. The fancies mentioned did not leave me; I longed to be whipped by handsome young persons aged from twenty to twenty-two years, wearing tight trousers. My fancy was filled especially with young soldiers and hussars. At times I was able to repress my imagination and avoid onanism; but I then had pollutions with dreams of the same nature.

“After my twentieth year, to my astonishment, the sexual inclination toward women, which I had noticed in comrades of my own age, and the occurrence of which I expected in myself, did not appear. I was cold toward women, and embarrassed in their presence. At the same time, feminine nudity was not unpleasant; on the contrary, there was something attractive about it, but my sensuality was not excited.

“I twice attempted coitus; I was not troubled about being in bed with the girl, but rather kissed and embraced her with pleasure, and even had traces of erection, but that was all. Since then I have had no hope, and occasionally returned to onanism, which I had avoided for some months previously. Nevertheless, I cultivated social intercourse with ladies, and particularly young girls; and I was esteemed in society, and liked for my graceful dancing. I was always hoping that in this way my unhappy tendency would be overcome successfully, but in vain; it grew constantly stronger. Thus I have lived hours of wretchedness; and the ghost of suicide has passed before me. I once confided in a physician in Pesth, but he had only the usual remedies for persons suffering with sexual weakness,—cold baths, quieting medicines, intercourse with women, etc.

“I tried everything in vain, until by accident a book on contrary sexual instinct fell into my hands, and gave me the last ray of hope. I have a respected position as a merchant, and appreciate thoroughly the joys of family life; and I have an opportunity to marry, under the most favorable circumstances, a young girl whom I love, and who loves me. But I feel the cruel impossibility of this step. I suffer terribly in thinking about these repulsive abnormalities. My only hope lies in a cure by means of hypnosis. May it not be in vain!”

Pity and a scientific interest induced me to invite the writer of the preceding lines to come to see me. Early in February Mr. D. came. He was distinguished, pleasing, and masculine in appearance. Examination of the case showed it to be one of masochism. He distinctly remembered that, when he once saw fellow-pupils whipped by the teacher, it gave him a feeling of lustful pleasure. He cannot remember that he was ever whipped by a teacher. His masochism had been an absolutely primary manifestation, and incomprehensible to him. Only gradually and faute de mieux had he come to practice onanism, during which ideas of flagellation, in which he played the passive rôle, filled his mind. He had never had desire to be whipped by the teacher; he always wished to be flogged by fellow-pupils and well-grown young persons. Since maturity he had never been able to induce himself to satisfy his masochistic inclinations.

In intercourse with puellis he had repeatedly had the thought to have himself whipped by them; but since this was not accompanied by sensual feeling, it was not carried out. The patient declares that his inclinations toward persons of his own sex are purely masochistic. In other respects he finds nothing interesting in men. Until his eighteenth year the patient had also sadistic tendencies. He was enthusiastic about the position of the pedagogue and wanted to be a teacher in order to be able to flog boys. This ideal sadism later disappeared entirely. The patient complains that he feels alone in the world, like a pariah, and that he is different from other men. But his libido toward women had much diminished, possibly as a result of his masturbation. He had no erection at the sight of feminine charms, but the sight of a riding-whip or a cane excited him powerfully sexually. When he attempted coitus, no masochistic ideas occurred. Such ideas arose, however, whenever he saw attractive young men. He believed that if he were freed from his ideas of flagellation, he would be helped; for his sensuality would then direct itself in a normal path.

The patient has neuropathic eyes, but is free from all degenerative signs. In the direction of hereditary taint, it is noteworthy that his maternal grandfather was peculiar, and shot himself while in a psychopathic condition. The patient feels well, save for slight neurasthenic troubles. Patellar reflex increased. The genitals are perfectly normal. His dreams with pollutions are exclusively about flagellation by young persons, particularly soldiers with tight trousers.

The principles of treatment laid down were: 1. Removal of the symptoms of neurasthenia. 2. Suggestive treatment looking to (a) avoidance of onanism; (b) indifference toward his own sex and the disappearance of thoughts of flagellation, both while awake and asleep; (c) libido exclusively toward persons of the opposite sex, the occurrence of erections at sight of beautiful women, complete power with women, and dreams of women exclusively. At the first sitting, by means of Bernheim’s method, the patient passed quickly into a state of deep lethargy. At the second sitting (February 5) a cataleptic condition of the muscles was induced. Sittings almost daily. It was seen that stroking the brow induced deeper hypnosis with catalepsy, which, however, did not go beyond deep lethargy. Suggestion was begun in the third sitting.

February 10. The patient says that he has no longer any interest in men, but a growing interest in women. He begins to dream of women.

February 13. He feels himself free from masochism during the day, and canes and whipping do not interest him any more. At night he still has “weak” dreams of flagellation concerning men, but without lustful feeling or pollution. A short time ago he had had a dream that was entirely strange, and without erotic coloring, to the effect that he whipped himself.

February 19. The patient attempted coitus with a puella pleasing to him. Erection was incomplete, and ejaculation did not occur; so he gave up the attempt. The patient finds that his libido toward women is still very slight. He was not discouraged by his failure, and expected ultimate success; for he felt free from his abnormal tendencies, and like another man. On February 20, unfortunately, the patient had to discontinue treatment, being called home by duties there.

The fact that traces of sadism (v. infra), were simultaneously present, lends certainty to the diagnosis of this rudimentary case as one of masochism. The purely psychical character of this latter perversion is unquestionable. At the same time, the case is combined with incompletely developed contrary sexual instinct, an association not infrequent in masochists and sadists.

In contrast with this case of rudimentary masochism, in which there is some difficulty of diagnosis, follows a typical case of masochism, in which the whole circle of ideas peculiar to this perversion appears completely developed. This case, in which there is a detailed personal description of the whole psychical state, is different from Case 44 only in that here there is no thought of a realization of the perverse fancies; and that, notwithstanding the perversion of the vita sexualis, normal stimuli are so far effectual that sexual intercourse is possible under normal conditions.

Case 50. I am thirty-five years old, mentally and physically normal. Among all my relatives, in the direct as well as in the lateral line, I know of no case of mental disease. My father, who, at my birth, was thirty years old, as far as I know, had a preference for voluptuous, large women.

Even in my early childhood I loved to revel in ideas about the absolute mastery of one man over others. The thought of slavery had something exciting in it for me, and alike whether from the stand-point of master or servant. That one man could possess, sell, or whip another, caused me intense excitement; and in reading “Uncle Tom’s Cabin” (which I read at about the beginning of puberty), I had erections. Particularly exciting for me was the thought of a man’s being hitched up before a wagon in which another man sat with a whip, driving and whipping him. Until my twentieth year these ideas were purely objective and sexless,—i.e., the one in subjugation in my fancy was another (not myself), and the master was not necessarily a woman. These ideas were, therefore, without effect on my sexual instinct,—i.e., on the way in which it was expressed. Though these ideas caused erections, yet I have never masturbated in my life; and from my nineteenth year I had coitus without the help of these ideas and without any relation to them. I always had a great preference for elderly, voluptuous, large women, though I did not scorn younger ones.

After my twenty-first year my ideas became objective, and it became an essential thing that the “mistress” should be a woman over forty years old, tall, and powerful. From this time I was always, in my fancies, the subject; the “mistress” was a rough woman, who made use of me in every way, also sexually; who harnessed me before a carriage, and made me take her for a drive; whom I must follow like a dog; at whose feet I must lie naked, and be punished—i.e., whipped—by her. This was the constant element in my ideas, around which all others were grouped. In these fancies I always found endless pleasure, which caused erection, but never ejaculation. As a result of the induced sexual excitement, I would immediately seek a woman, preferably one corresponding exteriorly with my ideal, and have coitus with her without any actual imitation of my fancies, and sometimes also without any thought of them during the act. At the same time, I also had inclination toward women of a different kind, and had coitus with them without being impelled to it by my fancy.

Notwithstanding all this, my life was not exceedingly abnormal sexually; yet these ideas were certain to occur periodically, and they have remained essentially unchanged. With growing sexual desire, the intervals constantly grew shorter. At the present time the ideas come every two or three weeks. If I have had coitus, the occurrence of the fancies is perhaps postponed. I have never attempted to realize my very definite and characteristic ideas,—i.e., to connect them with the objective world,—but I have contented myself with reveling in the thoughts; because I was convinced that my ideal would not allow even an approach to realization. The thought of a comedy with paid prostitutes always seemed to me silly and purposeless; for a person hired by me could never take the place in my imagination of a “cruel mistress.” I doubt whether there are sadistically constituted women like Sacher-Masoch’s heroines. But, if there were such women, and I had the fortune (!) to find one, still, in a world of reality, intercourse with her would always seem only like a farce to me. Indeed, I can say that, were I to become the slave of a Messalina, I believe that, owing to the other necessary renunciations, my desired manner of life would soon pall on me, and in my lucid intervals I should try to obtain my freedom at all hazards.

Yet I have found a way in which to induce, in a certain sense, a realization. After my sexual desire has been intensely excited by reveling in my fancy, I go to a prostitute and there call up before my mind’s eye, with great intensity, some scene of the kind mentioned, in which I play the principal rôle. After thinking of such a situation for about half an hour, with a constantly resulting erection, I perform coitus with increased lustful pleasure and strong ejaculation. After the latter, the vision fades away. Ashamed, I depart as quickly as possible, and try not to think of the affair. Then, for about two weeks, I have no more such ideas; indeed, after a particularly satisfactory coitus, it may happen that, until the next attack, I have no sympathy whatever with masochistic ideas. But the next attack is sure to come sooner or later. I must, however, state that I also have coitus without being prepared by such ideas, especially, too, with women that are acquainted with me and my position, and in whose presence I abhor such fancies. Under the latter circumstances, however, I am not always potent, while, with masochistic ideas, my virility is perfect. It does not seem superfluous to add that otherwise, in my thought and feeling, I am very æsthetic, and despise anything like maltreatment of a human being. Finally, I will not leave unmentioned the fact that the form of address is of importance. In my fancies it is essential that the “mistress” address me in the second person (Du), while I must address her in the third (Sie). This circumstance of being thus familiarly addressed (Du) by a person so inclined, as the expression of absolute mastery, has, from my youth, given me lustful pleasure, and does to-day.

I had the fortune to find a wife who is in everything, but especially sexually, attractive to me; though, as I scarcely need say, she in no way resembles my masochistic ideal. She is gentle, but proud; for without the latter characteristic I cannot conceive such a thing as sexual charm. The first few months of married life were normal sexually; the masochistic attacks did not occur, and I had almost lost all thought of masochism. Then came the first confinement and the necessary abstinence. Punctually, then, with the occurrence of libido, came the masochistic fancies again, which, in spite of my great love for my wife, necessitated coitus with another, with the accompaniment of masochistic ideas. It is here worthy of note that coitus maritalis, which was later resumed, did not prove sufficient to banish the masochistic ideas, as masochistic coitus always does. As for the essential element in masochism, I am of the opinion that the ideas,—i.e., the mental element,—are the end and aim.

If the realization of the masochistic ideas (i.e., passive flagellation, etc.) be the desired end, then it is in opposition with the fact that the majority of masochists never attempt realization; or, when this is attempted, great disappointment occurs, or at least the desired satisfaction is not obtained.

Thus the reveling in imagination is the principal thing; and, in fact, this gives an unspeakable delight that takes its subject beyond external things, beyond all troubles and cares.

It is an astonishing fact that there is an author, who, instead of keeping them to himself, as others do, discloses his imaginary ideals to the world in novels and romances. In “Venus in Furs,” we find those that are like us in feeling,—word for word, line for line, are expressed the ideas so familiar to us, which we believe to be our own exclusive discovery.

Until then I did not think it possible that there could be, in any other brain than mine, the lustful thought of being harnessed to a plow and made to work like a draught-horse.

And the ill-temper of the mistress to be served at the toilet and bath; the imprisonment,—ah, how familiar such ideas are to us from childhood!

Therefore, perhaps by reason of this open disclosure of things that should be secret, the reading of this book shocks masochists, undeceives them, and exerts a curative influence.

Finally, I should mention that, according to my experience, the number of masochists, especially in large cities, seems to be quite large. The only sources of such information are—since men do not reveal these things—words of prostitutes; and, since they agree on the essential points, it may be concluded that certain facts are proved.

Thus there is the fact that every experienced prostitute is accustomed to keep some suitable instrument (usually a whip) for flagellation; but it must be remembered that there are men who have themselves whipped simply to increase their sexual pleasure; who, in contrast with masochists, regard flagellation as a means to an end.

On the other hand, almost all prostitutes agree that there are many men who like to play “slave,”—i.e., like to be so called, and have themselves scolded and trod upon and beaten. As has been said, the number of masochists is larger than has yet been dreamed.

As you can imagine, reading the “New Investigations”[62] made a great impression on me. I should like to have faith in a cure, in a logical cure, so to speak, in accordance with the motto: “Tout comprendre c’est tout guérir.” (To understand all is to cure all.)

Of course the word cure is to be taken with some limitation, and there must be a distinction made between general feelings and concrete ideas. The former can never be overcome; they come like a stroke of lightning, are there, and one does not know whence or how.

But this practice of masochism in imagination, by means of concrete, associated ideas, can be avoided, or at least restricted.

Now the thing is changed. I say to myself: What! you busy your mind with things which not only the æsthetic sense of others, but also your own, disapproves? You regard that as beautiful and desirable which, in your own judgment, is at once ugly, coarse, silly, and impossible? You long for a situation which in reality you can never obtain? This opposing idea has an immediate inhibitory and undeceiving effect, and takes the edge off the fancy. Too, since reading the “New Investigations” (early this year), I have actually not reveled in my fancy once, though the masochistic tendency has occurred with regularity.

I must also confess that, in spite of its marked pathological character, masochism is not only incapable of destroying my pleasure in life, but it does not in the least affect my outward life. When not in a masochistic state, as far as feeling and action are concerned, I am a perfectly normal man. During the activity of the masochistic tendencies there is, of course, a great revolution in my feeling, but my outward manner of life suffers no change; I have a calling that makes it necessary for me to move much in public, and I pursue it in the masochistic condition as well as ever.

The author of the foregoing lines also sends me the following notes:—

1. Masochism, according to my experience, is, under all circumstances, congenital, and never acquired by the individual. I know positively that I was never spanked; that my masochistic ideas were manifested from my earliest youth; and that, as long as I have been capable of thinking, I have had such thoughts. If the origin of them had been the result of a particular event, especially of a beating, I should certainly not have forgotten it. It is characteristic that the ideas were present before there was any libido. At that time the ideas were absolutely sexless. I remember that, when a boy, it affected (not to say excited) me intensely when an older boy addressed me in the second person (Du), while I spoke to him in the third (Sie). I would keep up a conversation with him, and have the exchange of address take place as often as possible. Later, when I had become more mature sexually, such things affected me only when they occurred with a married woman, and one relatively old.

2. Physically and mentally I am in all respects masculine. I have a superabundant growth of beard, and my whole body is very hairy. In my relations to the female sex that are not masochistic, the dominating position of the man is an indispensable condition, and any attempt to change it would meet with my energetic opposition. I am energetic, if not over-courageous; but the want of courage is not manifest when my pride is injured. I am not sensitive to events in nature (thunder-storms, storms at sea, etc.).[63]

Too, my masochistic tendencies have nothing feminine or effeminate about them (?). To be sure, in these the inclination to be sought and desired by the woman is dominant; but the general relation desired with her is not that in which a woman stands to a man, but that of the slave to the master, the domestic animal to its owner. If one regards the ultimate aim of masochism without prejudice, it must be acknowledged that its ideal is the position of a dog or horse. Both are owned by masters, and punished by them; and the masters are responsible to no one. Just this unlimited power of life and death, as exercised over slaves and domestic animals, is the end and aim of all masochistic ideas.

3. The foundation of all masochistic ideas is libido; and as this ebbs and flows, so do the masochistic fancies. On the other hand, as soon as the ideas are present, they greatly intensify the libido. I am by no means excessively sensual naturally. However, when the masochistic ideas occur, I am impelled to coitus at any cost (for the most part I am driven to the lowest women); and if these impulses are not soon obeyed, libido soon becomes almost satyriasis. One is almost justified in looking upon this as a circulus vitiosus.

Libido occurs either in the course of time, or as the result of especial excitement (also of a kind that is not masochistic,—e.g., kissing). In spite of its manner of origin, this libido, by virtue of the masochistic ideas it engenders, is soon transformed into a masochistic and impure libido.

Moreover, there is no doubt that external, accidental impressions, particularly loitering in the streets of a large city, greatly intensify the desire. The sight of beautiful and imposing female forms, in nature as well as in art, is exciting. For those subject to masochism,—at least during the attacks,—the whole external world becomes masochistic. The box on the ear administered by the teacher to the pupil and the crack of the driver’s whip make deep impressions on the masochist, while they leave him indifferent or annoy him when he is not in the masochistic state.

4. An example of masochistic ideas follows: “She” is a peasant woman,—a rough, tall, large-boned woman of forty or fifty years. She is the possessor of a small, remote farm, which she works with the help of her slave alone. The work begins before sunrise. At four o’clock in the morning she opens the shed where she has kept me shut up over night, and wakens me, as I lie on the ground, with a kick; then she leads me out and harnesses me to a milk-cart bound for town. She leads me by a halter, and urges me along. On the road she gets on the heavily-loaded wagon, and sleeps until the destination is reached. There, in the open market-place of the town, still harnessed to the wagon, I lie down on the bare ground to rest. Those passing knock against me or step on me, without giving me any attention. After the stock is sold, we start homeward. After a short rest the work begins again, always under the direction of the mistress, who holds me by the halter and urges me on. At seven or eight o’clock at night I am put up to rest, and sleep until the next morning, when the same thing begins again. Work and blows, blows and work; no pleasure, no recreation, day in and day out!

Another time I fancy myself in the rôle of a paid lover of an elderly female roué, who makes use of me, sexually, in the most reckless manner; and in this direction makes the most shameful demands on me. If I do not submit to these willingly, I am beaten and punished; and, at the same time, she despises me unspeakably; gives me the lowest housework to do; and on every occasion shows me how low an opinion she has of my manhood.

I cannot clothe the character of masochism in any better formula than the following: A real masochist, without reflection, prefers the kick of a low woman to the embrace of a Venus.

5. In reading Sacher-Masoch, it struck me that in masochists, now and then, there was also an undercurrent of sadistic feeling. Too, I have now and then discovered in myself sporadic feelings of sadism. I must remark, however, that the sadistic feelings are not so marked as the masochistic; and that, aside from the fact that they are infrequently accessory, the sadistic fancies never leave the sphere of abstract feeling, and, above all, never take the form of concrete, connected ideas (like those above mentioned). The effect on libido, however, is the same with both.

If this case is remarkable on account of the complete development of the psychical state that constitutes masochism, the following one is noteworthy because of the great extravagance of the acts resulting from the perversion. The case is also particularly suited to make clear the reason for the subjection and humiliation at the hands of the woman, and the peculiar sexual coloring of the resulting situations:—

Case 51. Masochism.—Mr. Z., official, aged 50; tall, muscular, healthy. He is said to come of healthy parentage, but his father was thirty years older than his mother. A sister, two years older than Z., suffers with delusions of persecution. There is nothing remarkable in Z.’s external appearance. Skeleton entirely masculine; abundant beard, but no hair on trunk. He characterizes himself as a man of sanguine temperament, whom no one can depress; though irascible and quick-tempered, he is quick to regret outbursts.

Z. says he has never masturbated. From his youth there have been nightly pollutions, in which girls play a part; but the sexual act, never. For example, he dreams that a pleasing woman lies heavily on him, or that, as he lies sleeping on the grass, she playfully walks up his back. Z. had always been averse to coitus with a woman. This act seemed animal to him. Nevertheless, he was drawn to women. It was only in the society of beautiful women and girls that he felt well and in his place. He was very gallant without being forward.

A voluptuous woman of beautiful form, and particularly with a pretty foot, when seated, had the power to throw him into intense excitement. He was impelled to offer himself as a chair, in order “to offer so much devotion.” A kick, a box on the ear from her, would be heaven to him. He had a horror at the thought of coitus with her. He felt the need to serve the woman. He thought how ladies liked to ride. He reveled in the thought of how fine it would be to be wearied by the burden of a beautiful woman, in order to give her pleasure. He painted the situation in all colors; thought of the beautiful foot armed with spurs, the beautiful legs, and the soft, full thighs. Every beautiful mature woman, every pretty female foot, always excited his imagination; but he never betrayed the peculiar feelings that seemed to him abnormal, and was able to control himself. But he felt no need to fight against them; on the contrary, it would have hurt him had he been compelled to give up the feelings that had become so dear to him.

At the age of thirty-two Z. happened to make the acquaintance of an attractive woman, aged twenty-seven, who had been separated from her husband, and whom he found in need. He took her, and worked for her, without any selfish motive, for months. One evening she impatiently demanded sexual satisfaction from him, and almost used violence. Coitus was successful. Z. took the woman, lived with her, and indulged in coitus moderately; but coitus was more a burden than a pleasure; erections became weak, and he could no longer satisfy the woman. She finally declared that she would not have intercourse with him, because he only excited without satisfying her. Though he loved the woman very much, he could not give up his peculiar fancies. After this he lived with her only in friendly relations, and deeply regretted that he could not serve her in the way she desired.

Fear of how she would receive his propositions, and a feeling of shame, kept him from confessing. He found a substitute in his dreams. Thus, for example, he dreamed that he was a proud, fiery steed, ridden by a beautiful lady. He, felt her weight, the bit he had to obey, the pressure of the thighs on his flanks; he heard her beautiful, joyous voice. The exertion threw him into a perspiration; the touch of the spurs did the rest, and always induced pollution with great lustful pleasure. At other times be dreamed that he was a small, weak horse. Then a large, heavy woman came and mounted the horse, and set off on a long journey in the mountains. Recklessly, and without mercy, she allowed the poor animal to feel her weight; she made herself comfortable on his back; while he threatened to give out under her, she had the greatest enjoyment, and with calm mind enjoyed the beautiful scenery. Under the influence of such dreams, seven years ago Z. overcame his reluctance, in order to experience such things in reality. He was successful in creating suitable opportunity. He speaks of it as follows: “I knew how to arrange it so that on an occasion she would, of her own will, seat herself on my back. Then I endeavored to make this situation as pleasant as possible, and easily made it so that on the next occasion she said, spontaneously: ‘Come, give me a little ride!’ Swelling with pride, and with both hands braced on a chair, I made my back horizontal, and she mounted astride, after the manner of a man. I then did the best I could to imitate the movements of a horse, and loved to have her treat me like a horse, without any thought of me. She could beat, prick, scold, or caress me, just as she felt inclined. I could carry on my back persons weighing from sixty to eighty kilos, for half or three-quarters of an hour, without interruption. At the end of this time I usually asked for a rest. During this the intercourse between the mistress and me was perfectly harmless and without any relation to what had preceded. After about a quarter of an hour I was always rested, and placed myself at the disposal of the mistress again. When time and circumstances allowed it, I did this three or four times in succession. It sometimes happened that I practiced it both in the morning and afternoon. After it I never felt weary or had any uncomfortable feeling; but on such days I had very little appetite. When possible, I liked best to bare my trunk, that I might feel the rider more perfectly. The mistress had to be decent. I liked her best in pretty shoes and stockings, with short, closed drawers, reaching to the knee; with the upper portion of her person completely dressed, and with hat and gloves.”

Mr. Z. further says that he has not performed coitus in seven years; but he thinks he is potent. The riding was a perfect substitute for that “animal act,” even when ejaculation was not induced.

For eight months Z. had determined to give up his masochistic play, and had kept his determination. But he thought that if a woman only half-way pretty were to address him directly, and say, “Come, I want to ride you,” he would not be strong enough to withstand the temptation. Z. wishes to know whether his abnormality is curable; whether he is unworthy as a vicious man, or an invalid deserving pity.

The following case seems very similar:—

Case 52. A man finds satisfaction in the following manner: Occasionally he goes to a puella publica. Here he has a porcelain ring, like those used in hanging curtains, put on his penis. Two cords are attached to the ring and drawn backward between his legs and attached to the bedstead. Then he tells the woman to beat him mercilessly with a whip and cry “whoa” to him constantly, and treat and abuse him as if he were an unruly horse. The more the woman spurs him on to pull, with shouts and blows, the greater his sexual excitement becomes. Erection occurs (probably mechanically favored by compression of the dorsal vein of the penis, which, when the cords are strained, must be closed by the pressure of the hard ring). With increasing erection, the whole member is compressed by the ring, and finally ejaculation occurs, with lustful feeling.

Even in the foregoing series of cases, with other things, the act of being walked upon has played a rôle as a means of expressing the masochistic situations of humiliation and pain. The exclusive and most extensive use of this means for perverse excitation and satisfaction is shown in the following classical case of masochism, which Hammond reports (op. cit., p. 28) from an observation by Dr. Cox,[64] of Colorado:—

Case 53. X., a model husband, very moral, the father of several children, has times—i.e., attacks—in which he visits brothels, chooses two or three of the largest girls, and shuts himself up with them. He bares the upper portion of his body, lies down on the floor, crosses his hands on his abdomen, closes his eyes, and then has the girls walk over his naked breast, neck, and face, urging them at every step to press hard on his flesh with the heels of their shoes. Sometimes he wants a heavier girl, or some other act still more cruel than this procedure. After two or three hours he has enough. He pays the girls with wine and money, rubs his blue bruises, dresses himself, pays his bill, and goes back to his business, only to give himself the same strange pleasure again after a few weeks.

Occasionally it happens that he has one of the girls stand on his breast; and the others then turn her around until his skin is torn and bleeding from the turning of the heels of her shoes. Frequently one of the girls has to stand on him in such a way that one shoe is over the eyes, with its heel pressing on one eye, while the other rests across his neck. In this position he endures the pressure of a person weighing about one hundred and fifty pounds for four or five minutes. The author speaks of dozens of similar cases that are known to him. Hammond presumes, with reason, that this man had become impotent for intercourse with women; that, in this strange procedure, he found an equivalent for coitus; and that, when the heels drew blood, he had pleasant sexual feelings, accompanied by ejaculation.

The ten cases of masochism thus far described, and the numerous analogous cases mentioned by those who report them, form a counterpart to the previously described group “c” of sadism. Just as in sadism men excite and satisfy themselves by maltreating women, so in masochism the same effect is sought in the passive reception of similar abuse. But group “a” of the sadists,—that of lust-murder,—strange as it may seem, is not without its counterpart in masochism. In its extreme consequences, masochism must lead to the desire to be killed by a person of the opposite sex, in the same way that sadism has its acme in active lust-murder. But the instinct of self-preservation opposes such a result; so that the extreme is not actually carried out. When, however, the whole structure of masochistic ideas is purely psychical, in the imagination of such individuals, even the extreme may be reached; as the following case shows:—

Case 54. A middle-aged man, married and the father of a family, who has always led a normal vita sexualis, but who says he comes of a very nervous family, makes the following communication: In his early youth he was powerfully excited sexually at the sight of a woman slaughtering an animal with a knife. From that time, for many years, he had reveled in the lustfully-colored idea of being stabbed and cut and even killed by women with knives. Later, after the beginning of normal sexual intercourse, these ideas lost completely their perverse stimulus for him.

This case should be compared with the statements made under Case 44, according to which men find sexual pleasure in being lightly pricked with knives in the hands of women, who, at the same time, threaten them with death.

Such fancies, perhaps, give the key to an understanding of the following strange case, for which I am indebted to a communication from Dr. Körber, of Rankau:—

Case 55. A lady makes me the following communication: While still a young and innocent girl, she was married to a man of about thirty years. On their wedding-night he forced a towel and soap into her hands, and, without any other expression of love, wanted her to lather his chin and neck (as if for shaving). The inexperienced young wife did it, and was not a little astonished, during the first weeks of married life, to learn its secrets in absolutely no other form. Her husband always told her that it gave him the greatest delight to have his face lathered by her. Later, after she had sought the advice of friends, she induced her husband to perform coitus, and had three children in the course of time (by him, she states with every assurance). The husband is industrious and reliable, but a moody man, with little perseverance; by occupation a merchant.

It may be inferred that this man conceived the act of being shaved (i.e., the lathering as a preparatory measure) as a rudimentary, symbolic realization of ideas of injury or death, or of fancies about knives; like those the man previously mentioned had had in his youth, and by means of which he had been sexually excited and satisfied. The perfect sadistic counterpart to this case, looked upon in this light, is offered by Case 35, which is a case of symbolic sadism.

At any rate, there is a whole group of masochists who satisfy themselves with the symbolic representations of situations corresponding with their perversion; a group that corresponds with group “e” of “symbolic” sadists, just as the previously mentioned cases of masochism correspond with the groups “c” and “a” of sadism. Thus, just as the perverse longings of the masochist may, on the one hand, advance to “passive lust-murder” (to be sure, only in imagination); so, on the other hand, they may be satisfied with simple symbolic representations of the desired situations, which otherwise are expressed in acts of cruelty (this, of course, taken objectively, goes much further than the idea of being murdered, but in fact not so far, owing to the determining subjective conditions).

With Case 55, other similar cases should be here described, in which the acts desired and planned by the masochist have a purely symbolic character, and, to a certain extent, serve to indicate the desired situation.

Case 56. (Pascal, “Igiene dell’ amore.”) Every three months a man of about forty-five years would visit a certain prostitute, and pay her ten francs for the following act. The puella had to undress him, tie his hands and feet, bandage his eyes, and draw the curtains of the windows. Then she would have her guest sit down on a sofa, and had to leave him there alone. After half an hour she had to come back and unbind him. Then the man would pay her and leave perfectly satisfied, to repeat his visit in about three months.

In the dark this man seems to have extended this situation, of being helpless in the hands of a woman, further in imagination. The following case, in which again a complicated comedy, in the sense of masochistic desires, is played, is still more peculiar:—

Case 57. (Dr. Pascal, ibid.) A gentleman in Paris was accustomed to call on certain evenings at a house where a woman, the owner, acceded to his peculiar desire. He entered the salon in full-dress, and she, likewise in evening toilette, had to receive him with a very haughty manner. He addressed her as “Marquise,” and she had to call him “dear Count.” Then he spoke of his good fortune in finding her alone, of his love for her, and of a lover’s rendezvous. At this the lady had to feel insulted. The pseudo-count grew bolder and bolder, and asked the pseudo-marquise for a kiss on her shoulder. There is an angry scene; the bell is rung; a servant, prepared for the occasion, appears, and throws the count out of the house. He departs well satisfied, and pays the actors in the farce handsomely.

In connection with this case of symbolic masochism, two more are here given, in which the psychical perversion was entirely confined to the sphere of thought and imagination, and no realization was attempted. The first is that of an individual, mentally and physically predisposed, bearing degenerative signs, in whom mental and physical impotence occurred early:—

Case 58. Mr. Z., aged 22, single, was brought to me by his father for medical advice, because he was very nervous and apparently abnormal sexually. Mother and maternal grandmother were insane. His father begat him at a time when he was suffering severely nervously.

Patient is said to have been a very lively and talented child. At the age of seven he was noticed to practice masturbation. After his ninth year he became inattentive, forgetful, and did not progress in his studies, constantly requiring help and protection. With difficulty he got through the Gymnasium, and during his time of freedom had attracted attention by his indolence, absent-mindedness, and various foolish acts.

Consultation was occasioned by an occurrence on the street, in which Z. had forced himself on a young girl in a very impetuous manner, and in great excitement had tried to have a conversation with her.

The patient gave as a reason, that, by conversing with a respectable girl, he wished to excite himself so that he could be potent in coitus with a prostitute!

His father characterizes him as a man of perfectly good disposition, moral, but lazy, and dissatisfied with himself; as one often in despair about his want of success in life; as indolent, and interested in nothing but music, for which he possesses great talent.

The patient’s exterior—his plagiocephalic head; his large, prominent ears; the deficient innervation of the right facialis about the mouth; the neuropathic expression of the eyes—indicates a degenerate, neuropathic individual.

Z. is tall, of powerful frame, and, in all respects, of masculine appearance. Pelvis masculine; testicles well developed; penis remarkably large; mons veneris with abundant hair. The right testicle hangs much lower than the left; the cremasteric reflex is weak on both sides. The patient is below the average intellectually. He feels his deficiency, complains of his indolence, and asks to have his will strengthened. His awkward, embarrassed manner, timid glances, and relaxed attitude, point to masturbation. The patient confesses that from his seventh year, until a year and a half ago, he practiced it, years at a time, from eight to ten times daily. Until a few years ago, when he became neurasthenic (cephalic pressure, loss of mental power, spinal irritation, etc.), he says he always found great sensual pleasure in it. Since then this had been lost, and the desire to masturbate had disappeared. He had constantly grown more bashful and indolent, less energetic, and more cowardly and apprehensive. He had lost interest in everything, and did his business only from a sense of duty, feeling very low-spirited. He had never thought of coitus, and, from his stand-point as an onanist, he could not understand how others could find pleasure in it.

Investigations in the direction of contrary sexual instinct gave a negative result. He says he never was drawn toward persons of his own sex; he rather thinks that he has now and then had a weak inclination for females. He asserts that he came to masturbate independently. In his thirteenth year he first noticed ejaculations as a result of masturbatic manipulations.

It was only after long persuasion that Z. consented to entirely unveil his vita sexualis. As his statements, which follow, show, he may be classified as a case of ideal masochism, with rudimentary sadism. The patient distinctly remembers that, at the age of six, without any cause, he had “ideas of violence.” He was compelled to imagine that a servant-girl spread his legs apart and showed his genitals to another; that she tried to throw him into cold or hot water, in order to cause him pain. These “ideas of violence” were attended with lustful feeling, and became the cause of masturbatic manipulations. Later the patient called them up voluntarily, in order to incite himself to masturbation. They also played a part in his dreams; but they never induced pollution, apparently because the patient masturbated excessively during the day.

In time, to these masochistic “ideas of violence,” others of a sadistic nature were added. At first they were scenes in which boys forcibly practiced onanism on one another, or cut off the genitals. He often imagined himself such a boy, now in an active, now in a passive, rôle. Later he busied himself with mental pictures of girls and women that exhibited themselves to one another. He reveled in the thought, for example, of a servant-girl spreading another girl’s legs apart and pulling the genital hair; or in the thought of boys treating girls cruelly, and pricking and pinching their genitals.

Such ideas also always induced sexual excitement, but he never experienced any impulse to carry them out actively or to have them performed on himself passive. It satisfied him to use them for masturbation. Since a year and a half ago, with diminishing sexual imagination and libido, these ideas and impulses had become infrequent, but their content remained unchanged. The masochistic “ideas of violence” predominated over the sadistic. Now, when he sees a lady, he has the thought that she has sexual ideas like his own. In this way, in part, he explains his embarrassment in social intercourse. Owing to the fact that he had heard that he would get rid of his burdensome sexual ideas, if he were to accustom himself to natural sexual indulgence, during the last year and a half he has twice attempted coitus though he only experienced repugnance, and was not confident of success. On both occasions the attempt was a fiasco. The second time he made the attempt, he felt such aversion that he pushed the girl away and fled.

The second case is the following one, placed at my disposal by a colleague. Even though it be aphoristic, it seems particularly suited to throw a clear light on the distinctive element of masochism,—the consciousness of subjection, in its peculiar psycho-sexual effect:—

Case 59. Masochism.—Z., aged 27, artist. He is powerfully built, of pleasing appearance, and is said to be free from hereditary taint. Healthy in youth, since his twenty-third year he has been nervous and inclined to be hypochondriacal. Though inclined to indulgence sexually, he is not very virile. In spite of associations with females, his relations with them are limited to innocent attentions. At the same time, his desire to devote himself to women that are cold toward him is remarkable. Since his twenty-fifth year he has noticed that females, no matter how ugly, always excite him sexually, whenever he discovers anything domineering in their character. An angry word from the lips of such a woman is sufficient to give him the most violent erections. Thus, one day, he sat in a café and heard the (ugly) female cashier scold the waiters in a loud voice. This threw him into the most intense sexual excitement, which soon induced ejaculation. Z. requires the women, with whom he is to have sexual intercourse, to repulse and annoy him in various ways. He thinks that only a woman like the heroines of Sacher-Masoch’s romances could charm him.

Cases like this, in which the whole perversion of the vita sexualis is confined to the sphere of imagination,—to the inner world of thought and instinct,—and only accidentally comes to the knowledge of others, do not seem to be infrequent. Their practical significance, like that of masochism in general (which has not the great forensic importance of sadism), is confined to the psychical impotence to which such individuals, as a rule, become subject; and to the intense impulse to solitary indulgence, with adequate imaginary ideas, and its results.

That masochism is a perversion of uncommonly frequent occurrence is sufficiently shown by the relatively large number of cases that have thus far been studied scientifically, as well as by the agreement of the various statements reported.

The works concerning prostitution in large cities also contain numerous statements concerning this matter.

Léo Taxil (op. cit., p. 228) describes masochistic scenes in Parisian brothels. The man affected with this perversion is there also called “slave.”

Coffignon (“La corruption à Paris”) has a chapter in his book entitled “Les Passionels,” which contains contributions to this subject.

It is interesting and worthy of mention, that one of the most celebrated of men was subject to this perversion, and describes it in his autobiography (though somewhat erroneously). From “Jean Jacques Rousseau’s Confessions” it is evident that he was affected with masochism.

Rousseau, with reference to whose life and malady Möbius (“J. J. Rousseau’s Krankengeschichte,” Leipzig, 1889) and Chatelain (“La folie de J. J. Rousseau,” Neuchatel, 1890) may be consulted, tells, in his “Confessions” (part i, book i), how Miss Lambercier, aged thirty, greatly impressed him when he was eight years old and lived with her brother as his pupil. Her solicitude, when he could not immediately answer a question, and her threats to punish him if he did not learn well, made the deepest impression on him. When, one day, he had blows at her hands, with the feeling of pain and shame, he also experienced sensual pleasure that incited a great desire to be whipped by her again. It was only for fear of disturbing the lady, that Rousseau failed to make other opportunities to experience this lustful, sensual feeling. One day, however, he unintentionally gave cause for a whipping at Miss Lambercier’s hands. This was the last; for Miss Lambercier must have noticed something of the peculiar effect of the punishment; and from this time on she did not allow the eight-year-old boy to sleep in her room. From this time Rousseau felt a desire to have himself punished by ladies pleasing to him, a la Lambercier; but he asserts that until his youth he knew nothing of the relation of the sexes to each other. As is known, Rousseau was first introduced to the real mysteries of love in his thirtieth year, and lost his innocence through Madame de Warrens. Until that time he had had only feelings and impulses attracting him to woman, in the nature of passive flagellation and other masochistic ideas.

Rousseau describes, in extenso, how he suffered, with his great sexual desires, by reason of his peculiar sensuality, which had undoubtedly been awakened by his whippings; for he reveled in desire, and could not disclose his longings. It would be erroneous, however, to suppose that Rousseau was concerned merely with flagellation. Flagellation only awakened ideas of a masochistic nature. At least, in these ideas lies the psychological nucleus of his interesting study of self. The essential element with Rousseau was the feeling of subjection to the woman. This is clearly shown by the “Confessions,” in which he expressly emphasizes that “Etre aux genoux d’une maitresse impérieuse, obéir à ses ordres, avoir des pardons à lui demander,—etaient pour moi de très douces jouissances.”[65]

This passage proves that the consciousness of subjection and humiliation before the woman was the most important element.

To be sure, Rousseau was himself in error in supposing that this impulse to be humiliated before a woman had arisen by association of ideas from the idea of flagellation:—

“N’osant jamais déclarer mon goût, je l’amusais du moins par des rapports qui m’en conservaient l’idée.”[66]

It is only in connection with the numerous cases of masochism, the existence of which has now been established, and among which there are so many that are in nowise connected with flagellation, showing the primary and pure psychical character of this instinct of subjection,—it is only in connection with these cases that a complete insight into Rousseau’s case is obtained, and the error detected into which he necessarily fell in the analysis of his own condition.

Binet (Revue Anthropologique, xxiv, p. 256), who analyzes Rousseau’s case in detail, also justly calls attention to its masochistic significance, when he says: “Ce qu’aime Rousseau dans les femmes, ce n’est pas seulement le sourcil froncé, la main levée, le regard sévère, l’attitude impérieuse, c’est aussi l’état émotionnel, dont ces faits sont la traduction extérieure; il aime la femme fière, dédaigneuse, l’écrasant à ses pieds du poids de sa royale colère.”[67]

The solution of this enigmatical psychological fact Binet finds in his assumption that it is an instance of fetichism, only with the difference that the object of the fetichism—i.e., the object of individual attraction (fetich)—is not a portion of the body, like a hand or foot, but a mental peculiarity. This enthusiasm he calls “amour spiritualiste,” in contrast with “amour plastique,” as manifested in ordinary fetichism.

This deduction is acute, but it gives only a word with which to designate a fact, not a solution of it. Whether an explanation is possible will later occupy our attention.

There were also elements of masochism (and sadism) in the celebrated, or notorious, French writer, C. P. Baudelaire, who died insane.

Baudelaire came of an insane and eccentric family. From his youth he was mentally abnormal. His vita sexualis was decidedly abnormal. He had love-affairs with ugly, repulsive women,—negresses, dwarfs, giantesses. About a very beautiful woman, he expressed the wish to see her hung up by her hands, and to kiss her feet. This enthusiasm for the naked foot also appears in one of his glowing poems as the equivalent of sexual indulgence. He said women were animals who had to be shut up, beaten, and fed well. The man displaying these masochistic and sadistic inclinations died of paretic dementia. (Lombroso, “The Man of Genius.”)

In scientific literature, the conditions that constitute masochism have not received attention until recently. All there is to mention is that Tarnowsky (“die Krankhaften Erscheinungen des Geschlechtssinns,” Berlin, 1886) relates that he has known happily married, intellectual men, who from time to time felt an irresistible impulse to subject themselves to the coarsest, cynical treatment,—to scoldings or blows from passive or active pederasts, or prostitutes. It is worthy of remark that, in Tarnowsky’s observation, in certain cases blows, even when they draw blood, do not bring the result desired (virility, or at least ejaculation during flagellation) by those given to passive flagellation. “The individual must then be undressed by force, his hands tied, fastened to a bench, etc., during which he fancies that he makes opposition, scolds, and pretends to resist. Only under such circumstances do the blows induce excitement that leads to ejaculation.”

O. Zimmermann’s work, “Die Wonne des Leids,” Leipzig, 1885, also contributes much to this subject,[68] taken from the history and literature.

Of late the subject has been given much attention.

A. Moll, in his work, “Die Conträre Sexualempfindung,” pp. 133 and 141 et seq., Berlin, 1891, gives a number of cases of complete masochism in individuals of contrary sexuality, and among them the case of a man suffering with contrary sexual instinct, who sent written instructions, containing twenty paragraphs, to a man engaged for his purpose, who was to treat and abuse him like a slave.

In June, 1891, Mr. Dimitri von Stefanowsky, Deputy Government Attorney in Jaroslaw, Russia, informed me that, about three years before, he had given his attention to the perversion of the vita sexualis, designated “masochism” by me, and called “passivism” by him; that a year and a half previously he had prepared a paper on the subject for Professor von Kowalewsky for the Russian Archives of Psychiatry; and that in November, 1888, he had read a paper on this subject, considered in its legal and psychological aspects, before the Legal Society of Moscow (printed in the Juridischen Boten, the organ of the society, in numbers 6 to 8).

In later fiction the psycho-sexual perversion which forms the subject of this study has been treated by Sacher-Masoch, whose writings, already frequently alluded to, afford typical pictures of the perverse mental life of men of this kind. Many affected with this perversion refer directly to the writings of Sacher-Masoch, as is seen from the foregoing cases, as typical descriptions of their own psychical condition.

In “Nana,” Zola has a masochistic scene, and likewise in “Eugène Rougon.” The latest “decadent” literature of France and Germany is also largely concerned with the themes of sadism and masochism. According to von Stefanowsky’s statement, the modern Russian novel frequently treats the subject; but the statements of the writer of travels, Johann Georg Forster (1754–1794), show that this subject also played a rôle in Russian folk-songs.

(b) Foot-and Shoe-Fetichists—Larvated Masochism.—Following the above-mentioned group of “symbolic” masochists, who do not exactly desire abuse by women as the means of expression of subjection, but all kinds of silly acts that can be understood only through an acquaintance with the masochistic circle of ideas, comes the very numerous class of foot- and shoe-fetichists.

By fetichists (v. infra, 3) I understand individuals whose sexual interest is confined exclusively to parts of the female body, or to certain portions of female attire. One of the most frequent forms of this fetichism is that in which the female foot or shoe is the fetich, and becomes the exclusive object of sexual feeling and desire. It is highly probable, and shown by a correct classification of the observed cases, that the majority—and perhaps all—of the cases of shoe-fetichism rest upon a basis of more or less conscious masochistic desire for self-humiliation.

In Hammond’s case (Case 53) the satisfaction of a masochist was found in being trod upon. In Cases 44 and 48, they also had themselves trod upon; in Case 51, equus eroticus, the person loved a woman’s foot, etc. In the majority of cases of masochism, the act of being trod upon with feet plays a part[69] as an easily accessible means of expressing the relation of subjection.

Of the numerous established cases of shoe-fetichism, the following one, reported by Dr. A. Moll, of Berlin, which corresponds in many respects with Hammond’s case, but which is described in more detail and more carefully observed, seems especially suited to show the connection between masochism and shoe-fetichism:—

Case 60. O. L., aged 31, book-keeper in a city of Wurtemburg; comes of a tainted family.

The patient is a large, powerful man, of ruddy appearance. In general he is of a quiet temperament, but may become very violent on occasion; he says himself that he is quarrelsome and inclined to assert himself. L. is of a kindly disposition and generous; easily made to weep. At school he passed for a talented pupil, with good powers of comprehension. The patient at times has congestion of the head, but is otherwise healthy, except that he is much depressed and melancholic as a result of his sexual perversion, here to be described.

But little can be learned of any hereditary taint.

The following facts concerning the development of his sexual life are gathered from the patient’s own statements:—

In very early youth—in fact, when he was eight or nine years old—L. had the desire to lick his teacher’s boots like a dog. L. thinks it possible that this thought was excited in him by his once seeing a dog actually do this, but he cannot state this with certainty; and it seems much more certain to the patient that the first ideas of this kind came in a waking state, not in dreams.

From his tenth to his fourteenth year he constantly sought to touch the shoes of his fellow-pupils, and also those of little girls; but for this purpose he always chose boys who had wealthy and prominent parents. One of these, the son of a rich landed proprietor, had riding-boots; in the boy’s absence L. took these in his hands, struck himself with them, and pressed them against his face. L. did the same thing with the elegant boots of an officer of dragoons.

After the beginning of puberty the desire was transferred exclusively to the boots of females. Thus, while skating, the patient’s attention was entirely occupied with putting on and taking off skates for ladies; but he always chose only such women as were rich and prominent socially, wearing elegant boots. In the street and everywhere L. constantly looked for elegant boots. His love for them went so far that he often put in his purse, and even in his mouth, the sand and mud that bore their imprints. As a boy of fourteen L. visited brothels; and he often visited a café chantant solely to excite himself with the sight of elegant boots (low shoes were less attractive). In his school-books and on the walls of closets, L. drew boots. In the theatre he saw nothing but the shoes of the ladies. For hours at a time, in the street and on board steam-boats, L. would run after ladies wearing elegant boots; and he thought with delight of how he might get a chance to touch the boots. This peculiar love for boots remains unchanged. The thought to have himself trod upon by ladies in their boots, or to kiss the boots, gives L. the most intense sensual delight. Before shoe-stores he will stand and stand, merely to look at the boots. He is particularly excited by their elegance.

The patient prefers high-buttoned or laced boots with high heels; but less elegant boots, even with low heels, also excite him, if their wearer is a wealthy, distinguished, and proud lady.

At the age of twenty L. attempted coitus; but, “in spite of the greatest efforts,” as he believes, he was not successful. During the attempt the patient had no thought of shoes; on the contrary, he had first sought to excite himself sexually with shoes, and he asserts that too great excitement was to blame for his want of success in coitus. Up to this time, being thirty-one years old, he has attempted coitus only four or five times, and always in vain.

On one occasion the patient, already much to be pitied on account of his disease, had the misfortune to contract syphilis. In reply to the question as to what he regarded as the most lustful act, the patient said: “It is my greatest delight to lie naked on the floor and have myself trod upon by girls wearing elegant boots; but, of course, this is possible only in brothels.” Moreover, according to the patient’s statements, these sexual perversions of men are well known in many houses of prostitution,—a proof that these are not so very infrequent. The prostitutes call these men “boot-lovers.” But the patient has only very infrequently had the lustful act actually performed, notwithstanding the fact that it is most beautiful and pleasant to him. The patient has no thoughts that impel to intercourse; at least, not in the sense of immissio penis in vagina,—an act that affords him no pleasure whatever. Indeed, he has gradually developed a fear of coitus, which may be sufficiently explained by his numerous unsuccessful attempts; for the patient says himself that his inability to complete coitus embarrassed him exceedingly. The patient has never practiced real onanism. With the exception of a few occasions on which the patient satisfied his sexual desire by onanism with boots or in a similar way, he is innocent of such satisfaction; for, in the excitement with boots, there is scarcely ever anything more than erection; at most, only a slight discharge of fluid takes place slowly, which the patient takes to be semen.

Simply a shoe, worn by no one, excites him when he sees it, but not nearly as intensely as when it is worn by a woman. New shoes that have not been worn excite him much less than those that have been used; but they must be free from wear and look as new as possible. Shoes of this kind excite him the most. As has been said, ladies’ boots excite him when they are not on the feet. Under such circumstances, in fancy, L. creates a lady for them; he presses them to his lips and on his penis. He would “die with delight” if a proud, respectable lady were to tread upon him with her shoes.

Aside from the previously mentioned characteristics of the women (pride, wealth, social prominence), which, in connection with the elegance of the boots, constitute an especial stimulus, the patient is by no means indifferent to the physical charms of the female sex. He is enthusiastic about beautiful women without thinking of boots, but this love is not directed to sexual satisfaction. The bodily charms play a part even in connection with the boots; a homely old woman, even wearing the most elegant boots, cannot affect the patient. The rest of the attire and other circumstances also play an essential rôle, as is shown by the fact that elegant boots worn by proud, distinguished women especially excite the patient. A common servant-girl, in her working-dress, even in the most elegant shoes, would not excite him. Men’s shoes and boots no longer affect the patient; and he never in the slightest degree feels himself attracted to men sexually.

Yet the patient has erections very easily. When he takes a child in his lap, when he pats a dog or horse for some time, when he travels on the cars, or when he rides,—erections occur. In the latter case he thinks it is due to the shaking. He has erections every morning; and he can induce erection in a very short time by thinking of the act with boots that is so pleasing to him. Pollutions formerly occurred frequently at night—about every three or four weeks; now they are more infrequent, occurring once about every three months.

In his erotic dreams the patient is almost always sexually excited by the same thoughts that excite him in the waking state. For some time he thinks he has felt ejaculation during erection; but he draws this conclusion only from feeling a little moisture at the end of the penis. Books touching the sphere of the patient’s sexual ideas especially excite him. Thus, in reading “Venus in Furs,”[70] by Sacher-Masoch, he is so excited “that the semen just runs away from him.” Moreover, with L., this kind of ejaculation, while reading, is a decided satisfaction of his sexual desire. My question, whether blows received from a woman’s hand would also excite him, the patient thinks he would have to answer in the affirmative. The patient has never made any such trial, but playful taps had, at any rate, always been very pleasing to him.

It would afford the patient a particularly intense pleasure if he were to be kicked by a woman, even without shoes, and with bare feet. He does not think that the blows, as such, would cause the excitement, but rather the thought of being maltreated by a woman; and this might follow scolding as well as actual blows. Besides, blows and cross words had an exciting effect only when they came from a proud and distinguished lady. In general it is the feeling of humiliation and slavish subjection that gives the patient lustful pleasure. “Were a lady,” the patient tells me, “to command me to wait on her, even with distant coldness, I should, nevertheless, feel sensual pleasure.”

To the question, whether with boots the feeling of humiliation came over him, the patient answers: “I think that this general passion for self-humiliation has been concentrated especially on ladies’ boots; for it is symbolic of one’s being ‘unworthy to loosen the latchet of another’s shoe’; and, besides, a subject kneels.”

Women’s stockings also have an exciting effect on the patient, but only to a slight extent, and perhaps only through awakening an idea of boots. The patient’s passion for ladies’ boots had constantly increased, but of late years he thought he had noticed a diminution of it. He seldom visits public women, and is also more capable of self-restraint. Yet this passion still rules him absolutely, and every other pleasure is spoiled by it. A pretty female boot could attract his glance from the most beautiful landscape. At the present time he often goes about at night in the corridors of hotels,[71] seeking elegant ladies’ shoes, which he kisses and presses against his face and neck, but principally against his penis.

The patient, who is very well-to-do, a short time ago went voluntarily to Italy, only with the thought of becoming the servant of a rich and distinguished lady unacquainted with him; but the plan failed. The patient, who came only for consultation, has not yet been treated medically.

The foregoing history reaches almost to the present time, and in the interval he has made me communications by letter concerning his condition. It does not require an extensive commentary. It seems to me to be one of the best cases to illustrate the relationship between shoe-fetichism and masochism, as set forth by von Krafft-Ebing.[72] The principal charm for the patient, as he, without leading questions, always emphasizes, is his subjection to a woman, who, in pride and position, must be as far above him as possible.

Such cases, in which, within a fully-developed circle of masochistic ideas, the foot and the shoe or boot of a woman, conceived as a means of humiliation, have become the objects of especial sexual interest, are numerous. Through numerous degrees that are easily discriminated, they form the demonstrable transition to other cases in which the masochistic inclinations retreat more and more to the background, and little by little pass beyond the threshold of consciousness; while the interest in women’s shoes, apparently absolutely inexplicable, alone remains in consciousness. The latter are the numerous cases of shoe-fetichism. These very frequent cases of shoe-lovers, which, like all cases of fetichism, possess forensic interest (theft of shoes), occupy a position midway between masochism and fetichism. The majority or all may be looked upon as instances of larvated masochism (the motive remaining unconscious) in which the female foot or shoe, as the masochist’s fetich, has acquired an independent significance.

Next come two cases in which the female shoe possesses a subordinate interest, but in which unmistakable masochistic desires play an important part (comp. Case 44):—

Case 61. Mr. X. aged 25, parents healthy, never sick before, places the following autobiography at my disposal: “I began to practice onanism at the age of ten, without ever having any lustful thoughts during the act. Yet at that time—I am sure of this—the sight and touch of girls’ elegant boots had a peculiar charm for me; my greatest desire was also to wear such shoes,—a wish that was occasionally fulfilled at masquerades. But I was also troubled by a very different thought: My ideal was to see myself in a position of humiliation; I would gladly have been a slave, and whipped; in short, I wished to receive the treatment that one finds described in many stories of slavery. I do not know whether the reading of such stories gave rise to my wish, or whether it arose spontaneously.

“Puberty began at the age of thirteen; with the occurrence of ejaculation lustful pleasure increased, and I masturbated more frequently, often two or three times a day. From my twelfth to my sixteenth year, during the act of onanism, I always had the idea that I was forced to wear girls’ boots. The sight of an elegant boot, on the foot of a girl at all pretty, intoxicated me; I inhaled the odor of the leather with avidity. In order to smell leather during the act of onanism, I bought a pair of leathern cuffs, which I smelled while I masturbated. My enthusiasm for ladies’ leathern shoes remains the same to-day; only, since my seventeenth year, it has been coupled with the wish to become a servant, to blacken shoes for distinguished ladies, to put on and take off their shoes for them, etc.

“My dreams at night are made up of shoe-scenes: either I stand before the show-window of a shoe-store regarding the elegant ladies’ shoes,—particularly buttoned shoes,—or I lie at a lady’s feet and smell and lick her shoes. For about a year I have given up onanism and go ad puellas; coitus takes place through intense thought of ladies’ buttoned shoes; or, if necessary, I take the shoe of the puella to bed with me. I have never suffered from my former onanism. I learn easily, have a good memory, and have never had headache in my life. This much concerning myself.

“A few words about my brother: I am thoroughly convinced that he is also a shoe-fetichist. Of the many facts that demonstrate this to me, it is only necessary to mention that it is a great pleasure for him to have a certain cousin (a very beautiful girl) tread upon him. As for the rest, I might undertake to tell whether a man who stands before a shoe-store, and regards the shoes on exhibition, is a “foot-lover” or not. This anomaly is uncommonly frequent. When in the circle of my acquaintance I turn the conversation to the question of what woman’s charm is, I very frequently hear it said that it is much more in attire than in nudity; but every one is careful not to reveal his especial fetich. I think an uncle of mine is also a shoe-fetichist.”

Case. 62. Reported by Mantegazza in his “Anthropological Studies,” 1886, p 110. X., American, of good family, mentally and morally well constituted; from the beginning of puberty capable of being excited sexually only by a woman’s shoe. Her body and naked or stockinged foot made no impression on him; but the foot, when covered with the shoe, or a shoe alone, induced erection and even ejaculation. Sight alone was sufficient for him in the case of elegant shoes,—i.e., shoes of black leather, buttoning up the side, and having very high heels. His sexual desire was powerfully excited by touching, kissing, or drawing on such shoes. His enjoyment was increased by driving nails through the soles so that their points would penetrate his feet while walking. This caused him terrible pain, but he had real lustful feeling at the same time. His greatest enjoyment was to kneel down before the elegantly-clad feet of ladies and have them step on him. If the wearer were an ugly woman, the shoes would not affect him, and his fancy would cool. If the patient had shoes alone at his disposal, his fancy would create a beautiful woman wearing them, and ejaculation would result. His nightly dreams were of the shoes of beautiful women. He considered the exposure of ladies’ shoes in show-windows immoral; while talk about the nature of woman seemed to him harmless, but in bad taste. X. attempted coitus several times without success; ejaculation never occurred.

In the following case the masochistic element is also plain enough, as is also the sadistic (comp. “Torture of Animals,” under “Sadism”):—

Case 63. A young, powerful man, aged 26. Nothing in the opposite sex excites his sensual feeling except elegant shoes on the feet of a handsome woman, especially when they are made of black leather and have high heels. The shoes without the wearer are sufficient. It gives him the greatest pleasure to see, touch, and kiss them. The feminine foot, when bare or covered with a stocking, has no effect on him. Since childhood he has had a weakness for ladies’ fine shoes.

X. is potent; during the sexual act the female must be elegantly dressed and, above all, have on pretty shoes. At the height of sensual excitement cruel thoughts about the shoes arise. He is forced to think with delight of the death-agonies of the animal from which the leather was taken. Sometimes he is impelled to take chickens and other animals with him to Phryne, in order to have her tread on them with her pretty shoes for his pleasure. He calls this “sacrificing to the feet of Venus.” At other times he has the woman walk on him with her shoes on, the harder the better.

Until the last year it was sufficient—since he did not take the slightest sensual pleasure in women—to caress ladies’ shoes that pleased him, thus attaining ejaculation and complete satisfaction. (Lombroso, Archiv di Psichiatria, ix, fascic. iii.)

The following case reminds one of the third of this series, on account of the interest in the nails of the shoes (as capable of inflicting pain); and of the fourth, on account of the slight accompanying sadistic element:—

Case 64. X., aged 34, married; of neuropathic parentage; suffered severely from convulsions as a child; remarkably precocious, but one-sided in development (could read at age of three); nervous from childhood. At the age of seven he manifested an inclination to handle shoes, especially the nails of women’s shoes. The mere sight, but still more the touching, of the shoe-nails and counting them, gave him indescribable pleasure.

At night he gave himself up to imagining how his cousins had their measures taken for shoes; how he nailed horse-shoes on to one of them or cut her feet off. In time the shoe-scenes came upon him during the day, and involuntarily induced erection and ejaculation. Frequently he took the shoes of female occupants of the house; and if he touched them with his penis he had an ejaculation. For a long time, when a student, it was possible for him to control his ideas and inclinations; but there came a time when he was compelled to listen to female footsteps on the pavements, which, like the sight of the nail-marks in ladies’ shoes, or the sight of shoes in the windows of the shoe-shops, always gave him a feeling of lustful pleasure. He married, and during the first months of his married life was free from these desires.

Gradually he became hysteropathic and neurasthenic. At this stage he began to have hysterical attacks when the shoemaker spoke to him of nails in ladies’ shoes or of driving nails in the same. The reaction was still greater if he chanced to see a pretty lady with shoes well beset with nails. In order to induce ejaculation it was only necessary for him to cut soles out of pasteboard and beset them with nails; or he would buy ladies’ shoes, have them beset with nails in the store, and at home scrape them on the ground, and finally touch the end of his penis with them. Moreover, lustful shoe-visions occurred spontaneously, in which he satisfied himself by masturbation.

X. is otherwise intelligent, skillful in his calling, but powerless in combating his perverse inclinations. He presents phimosis; penis short, expanded at the root, and incapable of complete erection. One day the patient allowed himself to masturbate when excited by the sight of ladies’ shoes beset with nails in the window of a shoe-shop, and thus became a criminal. (Blanche, Archiv. de Neurologie, 1882, Nr. 22.)

Reference may be made here to a case of contrary sexuality, to be described later, in which the principal sexual interest was in the boots of male servants. The desire was to be trod upon by them.

Case 65. (Dr. Pascal, “Igiene dell’ amore.”) X., merchant, from time to time (but particularly in bad weather) had the following desire: He would accost some prostitute and ask her to go to a shoe-shop with him, where he would buy her the handsomest pair of shoes of patent leather, under the condition that she would put them on immediately. After this took place, she had to go about in the street, walking in manure and mud as much as possible, in order to soil the shoes. After this, X. would lead the person to an hotel, and, almost before they had reached a room, he would cast himself on her feet, feeling an extraordinary pleasure in applying his lips to them. When he had cleansed the shoes in this manner, he paid her and went his way.

From these cases it may be plainly seen that the shoe is the fetich of the masochist, and apparently because of the relation of the dressed female foot to the idea of being trod upon and other acts of humiliation. When, therefore, in other cases of shoe-fetichism, the female shoe appears alone as the excitant of sexual desire, one is justified in presuming that masochistic motives have remained latent. The idea of being trod upon, etc., remains in the depths of unconscious life, and the idea of the shoe alone, the means for such acts, rises into consciousness. Cases that are otherwise wholly inexplicable are thus sufficiently explained. Here one has to do with larvated masochism; and this may always be assumed as the unconscious motive, when, as occurs not exceptionally, the origin of the fetichism, from an association of ideas on the occasion of some particular event, can be proved, as in Cases 87 and 88.

Such cases of desire for ladies’ shoes, without conscious motive and without demonstrable origin, are really innumerable.[73] Three cases are here given as examples:—

Case 66. Minister, aged 50. From time to time he goes to houses of prostitution and asks to rent a room. He enters it with a girl. Then he lustfully regards her shoes, takes one off and kisses and bites it. Finally, he puts it ad genitalia and ejaculat semen semineque ejaculato axillas pectusque terit; then he comes out of his sensual ecstasy. He begs the woman to allow him to keep the shoe for a few days, and always, at the appointed time, returns it with thanks (Cantarano, La Psichiatria, v, p. 205).

Case 67. Student, Z., aged 23; comes of a tainted family. Sister was insane; brother suffered with hysteria virilis. The patient, peculiar from childhood, has frequent attacks of hypochondriacal depression, tædium vitæ, and feels that he is persecuted. In a consultation on account of mental trouble, I find him a very perverse, hereditarily predisposed man, with neurasthenic and hypochondriacal symptoms. A suspicion of masturbation is confirmed. Patient makes interesting disclosures concerning his vita sexualis. At the age of ten he was powerfully attracted by the foot of one of his comrades. At twelve he became an enthusiast for ladies’ feet. It gave him a delightful sensation to revel in the sight of them. At fourteen he began to masturbate, thinking, at the same time, of the beautiful foot of a lady. From this time on he was taken with the feet of his three-year-old sister. The feet of other females that attracted him induced sexual excitement. Only women’s feet—no other part of them—interested him. The thought of sexual intercourse with women excited his disgust. He had never attempted coitus. After his twelfth year he had no interest in the feet of male individuals. The style of covering of the female foot is indifferent to him; it is only necessary that the person seem to be sympathetic. The thought of enjoying the feet of prostitutes was disgusting to him. For years he had been in love with his sister’s feet. If he could but obtain her shoes, the sight of them powerfully excited his sensuality. Kissing or embracing his sister did not have this effect. His greatest delight was to embrace and kiss the foot of a sympathetic woman, when ejaculation would result with a lively pleasurable sensation. Often he was impelled to touch his genitals with one of his sister’s shoes; but he had been able, thus far, to master this impulse, especially for the reason that for two years (owing to progressive irritable weakness of the genitals) the simple sight of the foot had induced ejaculation. From his relatives it is ascertained that the patient has a silly admiration for the feet of his sister; so that she avoids him and seeks to hide her feet from him. The patient looks upon his perverse sexual impulse as pathological, and is painfully affected by the fact that his vile fancy has for its object his sister’s foot. He avoided opportunity as much as he could, and sought to help the matter by masturbation when, as in dreams accompanied by pollution, ladies’ feet filled his imagination. However, when the impulse became too powerful he could not avoid gaining a partial sight of his sister’s foot. Immediately after ejaculation he would become angry with himself at having been weak again. His partiality for his sister’s foot had cost him many a sleepless night. He often wondered that he could still love his sister. Although it seemed right to him that she should conceal her feet from him, yet he was often irritated because the concealment caused him to have pollutions. The patient gives assurances of being moral in other respects, which are confirmed by his relatives.

Case 68. S., New York, is accused of being a street-thief. Numerous cases of insanity in his ancestry; father, brother, and sister mentally abnormal. At seven years, violent cerebral concussion twice. At thirteen, struck with a beam. At fourteen S. had violent attacks of headache. Accompanying these attacks, or immediately after them, peculiar impulse to take the shoes of female members of the family—as a rule, those belonging to one member—and hide them in some out-of-the-way corner. Taken to task, he would lie, or declare that he had no memory of the affair. The passion for shoes was unconquerable, and made its appearance every three or four months. On one occasion he attempted to take the shoe from the foot of one of the servants, and on another he stole his sister’s shoe from her sleeping-apartment. In the spring two ladies had their shoes torn from their feet in the open street. In August S. left his home early in the morning to go to his work as a printer. A moment afterward he tore the shoe from a girl’s foot in the open street, fled to his place of work, and there was arrested as a street-thief. He declared that he did not know much of his act; that it had come upon him like a stroke of lightning, at the sight of a shoe, that he must possess himself of it, but for what purpose he did not know. He had acted while in a state of unconsciousness. The shoe, as he correctly indicated, was found in his coat. In confinement he was so much excited mentally that an outbreak of insanity was feared. Discharged, he stole his wife’s shoes while she slept. His moral character and habits of life were blameless. He was an intelligent workman; but irregularity of employment, that soon followed, made him confused and incapable of work. Pardoned. (Nichols, Am. Journal of Insanity, 1859; Beck, “Med. Jurisprudence,” vol. i, p. 732, 1860.)

Dr. Pascal (op. cit.) has some similar cases, and many others have been mentioned to me by colleagues and patients.

(c) Disgusting Acts for the Purpose of Self-Humiliation and Sexual Gratification—Larvated Masochism.—There are numerous established cases in which perverted men are thrown into sexual excitement by the secretions, or even the excretions, of women, and try to see and touch them. Probably in these cases there is almost always an unconscious masochistic impulse,—pleasure in the most extreme humiliation of self, and desire to experience it.

This connection is made perfectly clear by the confessions of those affected with this repugnant perversion. Case 88 of the sixth edition—that of an individual affected with contrary sexuality, which is later described—is here instructive. The subject of this case not only revels in the thought of being the slave of the beloved man, and refers on this point to Sacher-Masoch’s “Venus in Furs,” sed etiam sibi fingit amatum poscere ut crepidas sudore diffluentes olfaciat ejusque stercore vescatur. Deinde narrat, quia non habeat, quæ confingat et exoptet, eorum loco suas crepidas sudore infectas olfacere suoque stercore vesci, inter quæ facta pene errecto se voluptate perturbari semenque ejaculari.

The masochistic significance of a disgusting act in the following case, communicated by a professional friend, is clear:—

Case 69. H. v. G., landed proprietor; major; died in his sixtieth year; came of a family in which irresponsibility, tendency to run in debt, and defect of morals are hereditary. In his youth he was given to most reckless dissipation (he was known as the leader of “naked balls”). He was always of a cynical and brutal nature, though punctilious and exact in his military service, which, on account of a disreputable affair that was not made known, he had to leave, and he lived in private life seventeen years. Untrammeled by the necessity to earn his living, he led everywhere the life of a man-of-the-town, and was everywhere avoided on account of his lascivious nature. His ostracism by the best society, which, in spite of his independence, he noticed, caused him to prefer the ordinary society of fakirs, artisans, and loafers. It cannot be ascertained that he had sexual intercourse with men, but it is certain that in his later years he arranged symposiums with mixed company and was known as a roué. In the last few years of his life he was accustomed to hang about new buildings in the evening, and of the women working there he would ask the dirtiest to accompany him. It is certain that he had the woman undress, and then he would suck her toes, his libido being excited and satisfied by the act.

Cantarano also reports a case in La Psichiatria, v year, p. 207, in which, preceding the act, apparently from a similar cause, there was biting and sucking of a woman’s toes in as filthy a state as possible.

Several cases have come to my knowledge in which, with other masochistic acts (maltreatment, humiliation), such disgusting desires were entertained; and the confessions of the individuals left no doubt of their significance.

Such cases prepare the way to an understanding of others which are absolutely incomprehensible without the connection with the masochistic desire for humiliation.[74] It is probable, however, that this impulse, in its actual significance, remains unknown to the perverted individual, and only the desire for disgusting things rises into consciousness,—again larvated masochism.

Other cases of Cantarano’s (loc. cit.) belong here: mictio even defæcatio puellæ ad linguam viri ante actum; consumption of confects smelling like fæces, in order to become potent; and also the following case, likewise communicated to me by a physician:—

Case 70. A Russian prince, who was very decrepit, was accustomed to have his mistress turn her back to him and defecate on his breast; this being the only way in which he could excite the remnant of libido.

Another supported a mistress in unusually brilliant style, with the condition that she eat marchpane exclusively. Ut libidinosus fiat et ejaculare possit excrementa feminæ ore excipit. A Brazilian physician tells me of several cases of defæcatio feminæ in os viri that have come to his knowledge. Such cases occur everywhere, and are not at all infrequent. All kinds of secretions—saliva, nasal mucus, and even aural cerumen—are used in this way and swallowed with pleasure; and oscula ad nates and even ad anum are indulged in. Dr. Moll (op. cit., p. 135) reports the same thing of a man affected with contrary sexuality. The perverse desire to practice cunnilingus, which is very wide-spread, probably frequently has its root in masochistic impulses.

Palanda (Archivio di Psichiatria. x, fascicolo 3, 4) relates the following case:—

Case 71. W., aged 45, predisposed, was given to masturbation at the age of eight. A decimo sexto anno libidines suas bibendo recentem feminarum urinam satiavit. Tanta erat voluptas urinam bibentis ut nec aliquid olfaceret nec saperet, hæc faciens. After drinking he always experienced disgust and ill-feeling, and made firm resolutions to do it no more in the future. Once he had the same pleasure in drinking the urine of a nine-year-old boy, with whom he once practiced fellatio. The patient suffers with epileptic insanity.

The cases described in this group form the complete counterpart to group “d” of the sadists.

Still other older cases belong here, which Tardieu (“Étude médico-légale sur les attentats aux mœurs,” p. 206) observed in senile individuals. He describes as “Renifleurs” persons “qui in secretos locos nimirum theatrorum pasticos convenientes quo complures feminæ ad micturiendum festinant, per nares urinali odore excitati, illico se invicem polluunt.” The “Stercoraires” that Taxil (“La prostitution contemporaine”) mentions are, in relation to this subject, unique.

Finally, space is here given to the following case, reported to me by a physician:—

Case 72. A notary, known from his youth to those about him as peculiar and misanthropic. During his school-days he was given to masturbation. According to his own story, he excited his sexual desire by spreading out on the cover of his bed pieces of toilet-paper that he had used, induced erection by regarding and smelling them, and then practiced masturbation. After his death, by the side of his bed, there was found a large basket of such papers, with the dates marked on them. Here there were probably fancies of the nature of the above-mentioned acts.

(d) Masochism in Women.—In woman voluntary subjection to the opposite sex is a physiological phenomenon. Owing to her passive rôle in procreation and long-existent social conditions, ideas of subjection are, in woman, normally connected with the idea of sexual relations. So to speak, they form the harmonics which determine the tone-quality of feminine feeling.

Any one conversant with the history of civilization knows in what a state of absolute subjection woman was always kept until a relatively high degree of civilization was reached;[75] and an attentive observer of life may still easily recognize how the custom of unnumbered generations, in connection with the passive rôle with which woman has been endowed by Nature, has given her an instinctive inclination to voluntary subordination to man; he will notice that exaggeration of customary gallantry is very distasteful to women, and that a deviation from it in the direction of masterful behavior, though loudly reprehended, is often accepted with secret satisfaction.[76] Under the veneer of polite society the instinct of feminine servitude is everywhere discernible.

Thus it is easy to regard masochism in general as a pathological growth of specific feminine mental elements,—as an abnormal intensification of certain features of the psycho-sexual character of woman,—and to seek its primary origin in that sex (v. infra, p. 145). It may, however, be held to be established that, in woman, an inclination to subordination to man (which may be regarded as an acquired, purposeful arrangement, a phenomenon of adaptation to social requirements) is to a certain extent a normal manifestation.

The reason that, under such circumstances, the “poetry” of the symbolic act of subjection is not reached, lies partly in the fact that man has not the vanity of that weakling who would use blows to display his power (as the love-serving knights did with the ladies of the Middle Ages), but prefers to demonstrate his real advantages. The barbarian has his wife plow for him, and the civilized lover speculates about her dowry; she willingly endures both.

Cases of pathological increase of this instinct of subjection, in the sense of feminine masochism, are probably frequent enough, but custom represses their manifestation. Many young women like nothing better than to kneel before their husbands or lovers. Among all Slavs of the lower classes it is said that the wives feel hurt if they are not beaten by their husbands. A Hungarian officer informs me that peasant women of the Somogy’er Comitates do not think they are loved by their husbands until they have received the first box on the ear as a sign of love.

It would probably be difficult for the physician to find cases of feminine masochism. Subjective and objective restraints—modesty and custom—naturally constitute, in women, insurmountable obstacles to the expression of perverse sexual instinct. Thus it happens that, up to the present time, but one case of masochism in a woman has been scientifically established; and this is accompanied by circumstances that obscure it.

Case 73. Miss v. X., Russian, aged 35; of greatly predisposed family. For some years she has been in the initial stage of paranoia persecutoria. This sprang from cerebro-spinal neurasthenia, the origin of which is found to be sexual hyper-excitation. Since her twenty-fourth year she has been given to masturbation. As a result of disappointment in an engagement and intense sexual excitement, she began to practice masturbation and psychical onanism. Inclination toward persons of her own sex never occurred. The patient says: “At the age of six or eight I conceived a desire to be whipped. Since I had never been whipped, and had never been present when others were thus punished, I cannot understand how I came to have this strange desire. I can only think that it is congenital. With these ideas of being whipped I had a feeling of actual delight, and pictured in my fancy how fine it would be to be whipped by one of my female friends. I never had any thought of being whipped by a man. I reveled in the idea, and never attempted any actual realization of my fancies. These disappeared after my tenth year. Only when I read “Rousseau’s Confessions,” at the age of thirty-four, did I understand what my longing for whippings meant, and that my abnormal ideas were like those of Rousseau. Since my tenth year I have never had any more such fancies.”

On account of its original character and the reference to Rousseau, this case may with certainty be called a case of masochism. The fact that it is a female friend that is conceived in imagination as whipping her, is explained by the circumstance that the masochistic desire was here present in the mind of a child before the psychical vita sexualis had developed and the instinct for the male had been awakened. Contrary sexual instinct is here expressly excluded.

An Attempt to Explain Masochism.

The facts of masochism are certainly among the most interesting in the domain of psychopathology. An attempt to explain them must first seek to distinguish in them the essential from the unessential. The distinguishing characteristic in masochism is certainly the unlimited subjection to the will of a person of the opposite sex (in sadism, on the contrary, the unlimited mastery of this person), with the awakening and accompaniment of lustful sexual feelings to the degree of orgasm. From all that has preceded it is clear that the particular manner in which this relation of subjection or domination is expressed (v. supra), whether in simply symbolic acts, or whether there is also a desire to suffer pain at the hands of a person of the opposite sex, is a subordinate matter.

While sadism may be looked upon as a pathological intensification of the masculine sexual character in its psychical peculiarities, masochism rather represents a pathological degeneration of the distinctive psychical peculiarities of woman. But masculine masochism is undoubtedly frequent; and it is this that most frequently comes under observation and almost exclusively makes up the series of observed cases. The reason for this has been previously stated (p. 139).

Two sources of masochism can be distinguished in the sphere of normal phenomena. The first is, that in the state of lustful excitement every impression made by the person giving rise to the sexual stimulus, independently of the nature of its action, is pleasing to the individual excited.

It is entirely physiological that playful taps and light blows should be taken for caresses,

“Like the lover’s pinch which hurts and is desired.”[77]

From here the step is not long to a state where the wish to experience a very intense impression at the hands of the consort leads to a desire for blows, etc., in cases of pathological intensification of lust; for pain is always a ready means for producing an intense bodily impression. Just as in sadism the sexual emotion leads to a state of exaltation in which the excessive motor excitement implicates neighboring nervous tracts; so in masochism an ecstatic state arises, in which the rising flood of a single emotion ravenously devours and covers with lust every impression coming from the beloved person.

The second and, indeed, the most important source of masochism is to be sought in a wide-spread phenomenon, which, though it is extraordinary and abnormal, by no means lies within the domain of sexual perversion.

I here refer to the very prevalent fact that in innumerable instances, which occur in all varieties, one individual becomes dependent on another of the opposite sex, in a very extraordinary and remarkable manner,—even to the loss of all independent will; a dependence which forces the party in subjection to acts and suffering which greatly prejudice personal interest, and often enough to offense against both morality and law.

This dependence, however, differs from the manifestations of normal life only in the intensity of the sexual feeling that here comes in play, and in the slight degree of will-power necessary for the maintenance of its equilibrium. The difference is one of intensity, not of quality, as in masochistic manifestations.

This dependence of one person upon another of the opposite sex, that is abnormal but not perverse,—a phenomena possessing great interest when regarded from a forensic stand-point,—I designate “sexual bondage;”[78] for the relations and circumstances attending it have in all respects the character of bondage. The will of the ruling individual dominates that of the person in subjection, just as a master’s does his bondsman’s.[79]

This “sexual bondage,” as has been said, is certainly an abnormal phenomenon. It begins with the first deviation from the normal. The degree of dependence of one person upon another, or of two upon each other, resulting from individual peculiarity in the intensity of motives that in themselves are normal, constitutes the normal standard established by law and custom. Sexual bondage is not a perverse manifestation, however; the instinctive activities at work here are the same as those that set in motion—even though it be with less violence—the psychical vita sexualis which moves entirely within normal limits.

Fear of losing the companion and the desire to keep him always satisfied, amiable, and inclined to sexual intercourse, are here the motives of the individual in subjection. An extraordinary degree of love—which, particularly in woman, does not always indicate an unusual degree of sensuality—and a weak character are the simple elements of this extraordinary process.[80]

The motive of the dominant individual is egoism, which finds unlimited room for action.

The manifestations of sexual bondage are various in form, and the cases are very numerous.[81] At every step in life we find men that have fallen into sexual bondage. Among married men, hen-pecked husbands belong to this category, particularly elderly men who marry young wives and try to overcome the disparity of years and physical defects by unconditional submission to the wife’s every whim; and unmarried men of ripe maturity, who seek to better their last chance of love by unlimited sacrifice, are also to be enumerated here. Here belong, also, men of any age, who, seized by hot passion for a woman, meet coldness and calculation, and have to capitulate on hard conditions; men of loving natures who allow themselves to be persuaded to marriage by notorious prostitutes; men who, to run after adventuresses, leave everything and jeopardise their future; husbands and fathers who leave wife and child, to lay the income of a family at the feet of a harlot.

But, numerous as the examples of masculine “bondage” are, every observer of life, who is at all unprejudiced, must allow that they are far from equalling, in number and importance, the cases of feminine “bondage.” This is easily explained. For a man, love is almost always only an episode, and he has many other and important interests; for a woman, on the other hand, love is the principal thing in life, and, until the birth of children, always her first interest. After this it is still often her first thought, but always, at least, takes the second place. But, what is still more important, the man ruled by this impulse easily satisfies it in embraces for which he finds unlimited opportunities. A woman in the upper classes of society, if she have a husband, is bound to him alone; and even in the lower classes there are still great obstacles to polyandry. Therefore, a woman’s husband means for her the whole sex, and his importance to her becomes very great. It must also be considered that the normal relation established by law and custom between husband and wife is far from being one of equality. In itself it expresses a sufficient predominance of woman’s dependence. The concessions she makes to her lover, to retain the love which it would be almost impossible for her to replace, only plunge her deeper in bondage; and this increases the insatiable demands of husbands resolved to use their advantage and traffic in woman’s readiness to sacrifice herself.

Here may be placed the fortune-hunter, who for money allows himself to be enveloped in the easily created illusions of a maiden; the seducer, and the man who compromises wives, calculating on blackmail; the gilded army officer and the musician with the lion’s mane, who know so well how to stammer “Thee or death!” as a means to pay debts and provide a life of ease. Here, too, belong the kitchen-soldier, whose love the cook returns with love plus means to satisfy a different appetite; the drinker, who consumes the savings of the mistress he marries; and the man who with blows compels the prostitute on whom he lives to earn a certain sum for him daily. These are only a few of the innumerable forms of bondage into which woman is forced by her greater need of love and the difficulties of her position.

The subject of “sexual bondage” must here receive brief consideration; for in it may be clearly seen the soil from which the main root of masochism springs. The relationship of these two phenomena of psychical sexual life is immediately apparent. Bondage and masochism both consist of the unconditional subjection of the individual affected with the abnormality to a person of the opposite sex, and of domination of the former by the latter.[82] The two phenomena, however, must be strictly differentiated; they are not different in degree, but in quality.

Sexual bondage is not a perversion and not pathological; the elements from which it arises—love and weakness of will—are not perverse; it is only their simultaneous activity that produces the abnormal result which is so opposed to self-interest, and often to custom and law. The motive, in obedience to which the subordinated individual acts and endures tyranny, is the normal instinct toward woman (or man); the satisfaction of which is the price of bondage. The acts of the person in subjection, by means of which the bondage is expressed, are performed at the command of the ruling individual, to satisfy selfishness, etc. For the subordinated individual they have no independent purpose; they are only the means to an end,—to obtain or retain possession of the ruling individual. Finally, bondage is a result of love for a particular person; it first appears when this love is awakened.

In masochism, which is decidedly abnormal and a perversion, this is all very different. The motive of the acts and suffering of the person in subjection is here the charm afforded by the tyranny in itself. There may, at the same time, be a desire for coitus with the dominant person; but the impulse is directed to the acts which serve to express the tyranny, as the immediate objects of gratification. These acts in which masochism is expressed are, for the individual in subjection, not means to an end, as in bondage, but the end in themselves. Finally, in masochism the longing for subjection occurs a priori, before the occurrence of an inclination to any particular object of love.

The connection between bondage and masochism may be assumed by reason of the correspondence of the two phenomena in the objective condition of dependence, notwithstanding the difference in their motives; and the transformation of the abnormality into the perversion probably takes place in the following manner: Any one living for a long time in sexual bondage becomes disposed to acquire a slight degree of masochism. Love that willingly bears the tyranny of the loved one then becomes an immediate love of tyranny. When the idea of being tyrannized over is long closely associated with the lustful thought of the beloved person, the lustful emotion is finally connected with the tyranny itself, and the transformation to perversion is completed. This is the manner in which masochism may be acquired by cultivation.[83]

Thus a mild degree of masochism may arise from “bondage,”—become acquired; but genuine, complete, deep-rooted masochism, with its feverish longing for subjection from the time of earliest youth, is congenital.

The explanation of the origin of the infrequent perversion of fully developed masochism is most probably to be found in the assumption that it arises from the very frequent abnormality of “sexual bondage”; in that now and then this abnormality is hereditarily transferred to a psychopathic individual in such a way that it becomes transformed into a perversion. It has been previously shown how a slight displacement of the psychical element under consideration may effect this transition.

This transformation of the abnormality into the perversion, through hereditary transference, would take place very easily where the psychopathic constitution of the descendant presented the other factor of masochism,—i.e., what has been previously called its main root,—the tendency of sexually hyperæsthetic natures to assimilate all impressions coming from the beloved person with the sexual impression.

From these two elements,—from “sexual bondage” on the one hand, and from the above-mentioned disposition to sexual ecstasy, which apperceives even maltreatment with lustful emotion, on the other,—the roots of which may be traced back to the field of physiological facts, masochism arises on the basis of psychopathic predisposition; in that its sexual hyperæsthesia intensifies first all the physiological accessories of the vita sexualis and, finally, only its abnormal accompaniments, to the pathological degree of perversion.[84]

At any rate, masochism, as a congenital sexual perversion, constitutes a functional sign of degeneration in (almost exclusively) hereditary taint; and this clinical deduction is confirmed in my cases of masochism and sadism. It is easy to demonstrate that the peculiar, psychically-anomalous direction of the vita sexualis which masochism represents, is an original abnormality, and not, so to speak, cultivated in a predisposed individual by passive flagellation, through association of ideas, as Rousseau and Binet suppose. This is shown by the numerous cases of masochism—in fact, the majority—in which flagellation never appears; in which the perverse impulse is directed exclusively to purely symbolic acts expressing subjection without any actual infliction of pain. This is demonstrated by the whole series of cases, from Case 53, given here.

The same result—namely, that passive flagellation is not the nucleus around which all the rest is gathered—is reached when closer study is given to the cases in which passive flagellation plays a rôle, as in Case 44 and Case 50. Case 51 is particularly instructive in relation to this; for in this instance there can be no thought of a sexually-stimulating effect of punishment received in youth. Moreover, in this case, connection with an early experience is not possible; for the situation constituting the object of principal sexual interest is absolutely incapable of being carried out by a child.

Finally, the origin of masochism in purely psychical elements, on confronting it with sadism (v. infra), is convincingly demonstrated. That passive flagellation occurs so frequently in masochism is explained simply by the fact that it is the most extreme means of expressing the relation of subjection.

I repeat that the decisive points, in the differentiation of simple passive flagellation from flagellation dependent upon masochistic desire, are that, in the former, the act is a means to make coitus, or at least ejaculation, possible; and that, in the latter, it is a means of gratification of masochistic desires.

As we have already seen, masochists subject themselves to all other kinds of maltreatment and suffering in which there can be no question of reflex excitation of lust. Since such cases are numerous, in such acts (and in flagellation in masochists, having like significance) we must seek to ascertain in what relation pain and lust stand to each other. From the statement of a masochist it is as follows:—

The relation is not of such a nature that that which causes physical pain is here simply perceived as physical pleasure; but the person in a state of masochistic ecstasy feels no pain; either because, by reason of his emotional state (like that of the soldier in battle), the physical effect on his cutaneous nerves is not apperceived; or because (as with religious martyrs and enthusiasts), with the preoccupation of consciousness with lustful emotion, the idea of maltreatment remains merely a symbol, without its quality of pain.

To a certain extent there is over-compensation of physical pain in psychical pleasure; and only the excess remains in consciousness as psychical lust. This also undergoes an increase; since, either through reflex spinal influence or through a peculiar coloring in the sensorium of sensory impressions, a kind of hallucination of bodily pleasure takes place, with a vague localization of the objectively projected sensation.

In the self-torture of religious enthusiasts (fakirs, howling dervishes, religious flagellants) there is an analogous state, only with a difference in the quality of pleasurable feeling. Here the conception of martyrdom is also apperceived without its pain; for consciousness is filled with the pleasurably colored idea of serving God, atoning for sins, deserving heaven, etc., through martyrdom.

Masochism and Sadism.

The perfect counterpart of masochism is sadism. While in the former there is a desire to suffer and be subjected to violence, in the latter the wish is to inflict pain and use violence.

The parallelism is perfect. All the acts and situations used by the sadist in the active rôle become the object of the desire of the masochist in the passive rôle. In both perversions these acts advance from purely symbolic acts to severe maltreatment. Even murder, in which sadism reaches its acme, finds, as is shown by Case 54,—of course, only in fancy,—its passive counterpart. Under favoring conditions, both perversions may occur with a normal vita sexualis; in both, the acts in which they express themselves are preparatory for coitus or substitutes for it.[85]

But the analogy does not exist simply in external manifestation; it also extends to the subjective character of both perversions. Both are to be regarded as original psychopathies in mentally abnormal individuals, who, in particular, are affected with psychical hyperæsthesia sexualis, and, as a rule, also with other abnormalities; and for each of these perversions two constituent elements may be demonstrated, which have their roots in psychical facts lying within physiological limits. For masochism, as shown above, these elements lie in the fact (1) that in the state of sexual emotion every impression produced by the consort, independently of the manner of its production, is, per se, attended with lustful pleasure, which, where there is hyperæsthesia sexualis, may go so far as to over-compensate all painful sensation; and in the fact (2) that “sexual bondage,” dependent on mental factors that are in themselves not perverse, may, under pathological conditions, become a perverse, pleasurable desire for subjection to the opposite sex, which—even if it be quite unnecessary to assume its inheritance from the female side—represents a pathological degeneration of the character belonging to woman,—of the instinct of subordination, physiological in woman.

In harmony with this, there are, likewise, two constituent elements explanatory of sadism, the origin of which may also be traced back within physiological limits. These are: the fact (1) that in sexual emotion, to a certain extent, as an accompanying psychical excitation, an impulse may arise to influence the object of desire in every possible way and with the greatest possible intensity, which, in individuals sexually hyperæsthetic, may become an impulse to inflict pain; and the fact (2) that, under pathological conditions, the man’s active rôle of winning woman may become an unlimited desire for subjugation.

Thus masochism and sadism represent perfect counterparts. It is also in harmony with this that the individuals affected with these perversions regard the opposite perversion in the other sex as their ideal, as shown by Case 44 and Case 50, and also by “Rousseau’s Confessions.”

But the contrast of masochism and sadism may also be used to invalidate the assumption that the former has its origin in the reflex effect of passive flagellation; and that all the rest is the product of associations of related ideas, as Binet, in explanation of Rousseau’s case, thinks, and as Rousseau himself believed.

In the active maltreatment forming the object of the sadist’s sexual desire there is, in fact, no irritation of his own sensory nerves by the act of maltreatment; so that there can be no doubt of the purely psychical character of the origin of this perversion. Sadism and masochism, however, are so related to each other, and so correspond in all points with each other, that the one allows, by analogy, a conclusion for the other; and this is alone sufficient to establish the purely psychical character of masochism.

According to the above-detailed contrast of all the elements and phenomena of masochism and sadism, and as a résumé of all observed cases, lust in the infliction of pain and lust in inflicted pain appear but as two different sides of the same psychical process, of which the primary and essential thing is the consciousness of active or passive subjection, in which the combination of cruelty and lustful pleasure has only a secondary psychological significance. Acts of cruelty serve to express this subjection; first, because they are the most extreme means for the expression of this relation; and, again, because they represent the most intense effect that one person, either with or without coitus, can exert on another.

The cases in which sadism and masochism occur simultaneously in one individual are interesting, but they present some difficulties of explanation. Cases 49, 50, 58, etc., are of this kind, and also particularly Case 30. From the latter it is evident that it is especially the idea of subjection that, both actively and passively, forms the nucleus of the perverse desires. Traces of the same thing are also to be observed, with more or less clearness, in many other cases. At any rate, one of the two perversions is always markedly predominant.

Owing to this marked predominance of one perversion, and the later appearance of the other, in such cases it may well be assumed that the predominating perversion is original, and that the other has been acquired in the course of time. The ideas of subjection and maltreatment, colored with lustful pleasure, either in an active or passive sense, have become deeply impressed in such an individual.

Occasionally the imagination is tempted to try the same ideas in an inverted rôle. There may even be realization of this inversion. Such attempts in imagination and in acts, however, are usually soon abandoned as inadequate for the original inclination.

Masochism and sadism also occur in combination with contrary sexual instinct, and, too, in association with all forms and degrees of this perversion. The individual of contrary sexuality may be a sadist as well as masochist (comp. Cases 48 and 49 and numerous cases in the following series of cases of contrary sexual instinct).

Wherever a sexual perversion has developed on the basis of a neuropathic individuality, sexual hyperæsthesia, which may always be assumed to be present, may induce the phenomena of masochism and sadism—now of the one, now of both combined, one arising from the other. Thus masochism and sadism appear as the fundamental forms of psycho-sexual perversion, which may make their appearance at any point in the domain of sexual aberration.[86]

3. The Association of Lust with the Idea of Certain Portions of the Female Person, or with Certain Articles of Female Attire—Fetichism.—In the considerations concerning the psychology of the normal sexual life in the introduction to this work (vide p. 17), it was shown that, within physiological limits, the pronounced preference for a certain portion of the body of persons of the opposite sex, particularly for a certain form of this part, may attain great psycho-sexual importance. Indeed, the especial power of attraction possessed by certain forms and peculiarities for many men—in fact, the majority—may be regarded as the real principle of individualization in love.

This preference for certain particular physical characteristics in persons of the opposite sex,—by the side of which, likewise, a marked preference for certain psychical characteristics may be demonstrated,—following Binet (“du Fetischisme dans l’amour,” Revue philosophique, 1887) and Lombroso (Introduction to the Italian edition of the second edition of this work), I have called “fetichism”; because this enthusiasm for certain portions of the body (or even articles of attire) and the worship of them, in obedience to sexual impulses, frequently call to mind the reverence for relics, holy objects, etc., in religious cults. This physiological fetichism has already been described in detail on page 17 et seq.

By the side of this physiological fetichism, however, there is, in the psycho-sexual sphere, an undoubted pathological, erotic fetichism, of which there is already a numerous series of cases presenting phenomena having great clinical and psychiatric interest, and, under certain circumstances, forensic importance. This pathological fetichism does not confine itself to certain parts of the body alone, but it is even extended to inanimate objects, which, however, are almost always articles of female wearing-apparel, and thus stand in close relation with the female person.

This pathological fetichism is connected, through gradual transitions, with physiological fetichism; so that (at least in body-fetichism) it is almost impossible to sharply define the beginning of the perversion. Moreover, the whole field of body-fetichism does not really extend beyond the limits of things which normally stimulate the sexual instinct. Here the abnormality consists only in the fact that the whole sexual interest is concentrated on the impression made by a part of the person of the opposite sex, so that all other impressions fade and become more or less indifferent. Therefore, the body-fetichist is not to be regarded as a monstrum per excessum, like the sadist or masochist, but rather as a monstrum per defectum. What stimulates him is not abnormal, but rather what does not affect him,—the limitation of sexual interest that has taken place in him. Of course, this limited sexual interest, within its narrower limits, is usually expressed with a correspondingly greater and abnormal intensity.

It would seem reasonable to assume, as the distinguishing mark of pathological fetichism, the necessity for the presence of the fetich as a conditio sine qua non for the possibility of performance of coitus. But when the facts are more carefully studied, it is seen that this limitation is really only indefinite. There are numerous cases in which, even in the absence of the fetich, coitus is possible, but it is incomplete and forced (often with the help of fancies relating to the fetich), and particularly unsatisfying and exhausting; and, too, closer study of the distinctive subjective psychical conditions in these cases shows that there are transitional states, passing, on the one hand, to mere physiological preferences, and, on the other, to psychical impotence in the absence of the fetich. It is therefore better, perhaps, to seek the pathological criterion of body-fetichism in purely subjective psychical states. The concentration of the sexual interest on a certain portion of the body that has no direct relation to sex (as have the mammæ and external genitals)—a peculiarity to be emphasized—often leads body-fetichists to such a condition that they do not regard coitus as the real means of sexual gratification, but rather some form of manipulation of that portion of the body that is effectual as a fetich. This perverse instinct of body-fetichists may be taken as the pathological criterion, no matter whether actual coitus is also possible or not.

Fetichism of inanimate objects or articles of dress, however, in all cases, may well be regarded as a pathological phenomenon; since its objects fall without the circle of normal sexual stimuli. But even here, in the phenomena, there is a certain outward correspondence with processes of the normal psychical vita sexualis; the inner connection and meaning of pathological fetichism, however, are entirely different. In the ecstatic love of a man mentally normal, a handkerchief or shoe, a glove or letter, the flower “she gave,” or a lock of hair, etc., may become the object of worship, but only because they represent a mnemonic symbol of the beloved person—absent or dead—whose whole personality is reproduced by them. The pathological fetichist has no such relations. The fetich constitutes the entire content of his idea. When he is possessed by it, sexual excitement occurs, and the fetich makes itself felt.[87]

According to all observations thus far made, pathological fetichism seems to arise only on the basis of a psychopathic constitution that is for the most part hereditary, or on the basis of existent mental disease.

Thus it happens that it not infrequently appears combined with the other (original) sexual perversions that arise on the same basis. Not infrequently fetichism occurs in the most various forms in combination with contrary sexuality, sadism, and masochism. Indeed, certain forms of body-fetichism (hand- and foot-fetichism) probably have a more or less distinct connection with the latter two perversions (v. infra).

But if fetichism also rests upon a congenital general psychopathic disposition, yet this perversion is not, like those previously considered, essentially of an original nature; it is not congenitally perfect, as we may well assume sadism and masochism to be. While in the sexual perversions thus far described we have met only cases of a congenital nature, here we meet only acquired cases. Aside from the fact that in fetichism the causative circumstance of its acquirement is often demonstrable, here the physiological conditions are wanting, which in sadism and masochism, by means of sexual hyperæsthesia, are intensified to perversions, and justify the assumption of congenital origin. In fetichism, every case requires an event which affords the subject of perversion. As has been said, it is, of course, physiological in sexual life to be partial to one or another of woman’s peculiarities, and to be enthusiastic about it; but concentration of the entire sexual interest on such partial impressions is here the essential thing; and for this concentration there must be a particular reason in every individual affected. Therefore, we may accept Binet’s conclusion that in the life of every fetichist there may be assumed to have been some event which determined the association of lustful feeling with the single impression. This event is to be referred to the time of early youth, and, as a rule, occurs in connection with the first awakening of the vita sexualis. This first awakening is associated with some partial sexual impression (since it is always something standing in some relation to woman), and stamps it for life as the principal object of sexual interest. The circumstances under which the association arises are usually forgotten. It is only the result of the association that is retained. The general predisposition to psychopathic states and the sexual hyperæsthesia of such individuals are all that is original here.[88]

Like the other perversions thus far considered, erotic (pathological) fetichism may also express itself in strange, unnatural, and even criminal acts: gratification with the female person loco indebito, theft and robbery of objects of fetichism, pollution of such objects, etc. Here, too, it only depends upon the intensity of the perverse impulse and the relative power of opposing ethical motives, whether and to what extent such acts are performed. These perverse acts of fetichists, like those of other sexually perverse individuals, may either alone constitute the entire external vita sexualis, or occur together with the normal sexual act. This depends upon the condition of physical and psychical sexual power, and the degree of excitability to normal stimuli that has been retained. Where excitability is diminished, not infrequently the sight or touch of the fetich serves as a necessary preparatory act.

The great practical importance which attaches to the facts of fetichism, in accordance with what has been said, lies in two factors. First, pathological fetichism is not infrequently a cause of psychical impotence.[89] Since the object upon which the sexual interest of the fetichist is concentrated stands, in itself, in no immediate relation to the normal sexual act, it often happens that the fetichist diminishes his excitability to normal stimuli by his perversion, or, at least is capable of coitus only by means of concentration of his fancy upon his fetich. In this perversion, and in the difficulty of its adequate satisfaction, just as in the other perversions of the sexual instinct, lie conditions favoring psychical and physical onanism, which again reacts deleteriously on the constitution and sexual power. This is especially true in the case of youthful individuals, and particularly in the case of those who, on account of opposing ethical and æsthetic motives, shrink from the realization of their perverse desires. Secondly, fetichism is of great forensic importance. Just as sadism may extend to murder and the infliction of bodily injury, fetichism may lead to theft and even to robbery for the possession of the desired articles.

Erotic fetichism has for its object either a certain portion of the body of a person of the opposite sex, or a certain article or material of wearing-apparel of the opposite sex. (Only cases of pathological fetichism in men have thus far been observed, and therefore only portions of the female person and attire are spoken of here.) In accordance with this, fetichists fall into three groups.

(a) The Fetich is a Part of the Female Body.—Just as, in physiological fetichism, the eyes, the hand, the foot, and the hair of woman very frequently become fetiches, so, in the pathological domain, the same portions of the body become the sole objects of sexual interest. This exclusive concentration of interest on these parts, by the side of which everything else feminine fades, and all other sexual value of woman may sink to nil, so that, instead of coitus, strange manipulations of the fetich become the object of desire,—this it is that makes these cases pathological.

Case 74. (Binet, op. cit.) X., aged 34, teacher in a Gymnasium. In childhood he suffered with convulsions. At the age of ten he began to masturbate, with lustful feelings, which were connected with very strange ideas. He was particularly partial to women’s eyes; but since he wished to imagine some form of coitus, and was absolutely innocent in sexual matters, to avoid too great a separation from the eyes, he evolved the idea of making the nostrils the seat of the female sexual organs. Then his lively sexual desires were connected with this idea. He sketched drawings representing correct Greek profiles of female heads, but the nostrils were so large that immissio penis would have been possible.

One day, in an omnibus, he saw a girl in whom he thought he recognized his ideal. He followed her to her home and immediately proposed to her. Shown the door, he returned again and again, until arrested. X. never had sexual intercourse.

Hand-fetichists are very numerous. The following case is not really pathological. It is given here as a transitional case:—

Case 75. B., of neuropathic family, very sensual, mentally intact. At the sight of the hand of a beautiful young lady he is always charmed and feels sexual excitement to the extent of ejaculation. It is his delight to kiss and press such hands. As long as they are covered with gloves he feels unhappy. By pretexts he tries to get hold of such hands. He is indifferent to the foot. If the beautiful hands are ornamented with rings, his lust is increased. Only the living hand, not its image, causes him this lustful excitement. It is only when he is exhausted sexually by frequent coitus that the hand loses its sexual charm. At first the memory-picture of female hands disturbed him even while at work. (Binet, op. cit.)

Binet states that such cases of enthusiasm for the female hand are numerous. Here it may be recalled that, according to Case 24, a man may be partial to the female hand as a result of sadistic impulses; and that, according to Case 46, the same thing may be due to masochistic desires. Thus such cases have more than one meaning. But this is by no means to say that all, or even a majority, of the cases of hand-fetichism allow or require a sadistic or masochistic explanation.

The following interesting case, that has been studied in detail, shows that, in spite of the fact that at first a sadistic or masochistic element seems to have exercised an influence, at the time of the individual’s maturity and the complete development of the perversion, the latter contained nothing of these elements. Of course, it is possible that, in the course of time, these disappeared; but here the assumption of the origin of the fetichism in an accidental association meets every requirement:—

Case 76. A case of hand-fetichism, communicated by Albert Moll. P. L., aged 28, a merchant of Westphalia. Aside from the fact that the patient’s father was remarkably moody and somewhat quick-tempered, nothing of an hereditary nature could be proved in the family. At school the patient was not very diligent; he was never able to concentrate his attention on any one subject for any length of time; on the other hand, from childhood he had a great inclination for music. His temperament was always nervous.

In August, 1890, he came to me complaining of headache and abdominal pain, which in every way gave the impression of being neurasthenic. The patient also said he was destitute of energy. Only after accurately directed questions did the patient make the following statements concerning his sexual life. As far as he could remember, the beginnings of sexual excitement occurred in his seventh year. Whenever he saw a boy of his own age urinate and caught sight of his genitals, he became lustfully excited. L. states with certainty that this excitement was associated with very evident erections. Led astray by another boy, L. learned to masturbate at the age of seven or eight. “Being of a very excitable nature,” said L., “I practiced masturbation very frequently until my eighteenth year, without gaining any clear idea of the evil results or the meaning of the practice.” He was particularly fond of practicing mutual onanism with some of his school-friends, but it was by no means an indifferent matter who the other boy was; on the contrary, only a few of his companions could satisfy him in this respect. To the question as to what particularly caused him to prefer this or that boy, L. replied that a white, beautifully-formed hand in his school-fellows impelled him to practice mutual onanism with them. L. further remembered that frequently, at the beginning of the gymnastic lesson, he would exercise by himself on a bar standing apart. He did this for the purpose of exciting himself as much as possible; and he was so successful that, without using his hand and without ejaculation,—L. was still too young,—he had lustful pleasure. Another early event which L. remembers is interesting. One day his favorite companion, N., who practiced mutual onanism with him, proposed that L. should try to get hold of his (N.’s) penis, and he would do all he could to prevent it. L. acquiesced. In this way the onanism way directly combined with a struggle between both parties, in which N. was always overcome. The struggle always finally ended in N.’s being compelled to allow L. to practice onanism on him. L. assured me that this kind of masturbation had given him, as well as N., especial pleasure.[90] In this way L. continued to practice masturbation very frequently until his eighteenth year. Warned by a friend, he then began to struggle with all his might against his evil habit. He became more and more successful, and finally, after the first performance of coitus, he stopped the practice of onanism entirely. But this was only accomplished in his twenty-second year. It now seems incomprehensible to the patient—and he says he is filled with disgust at the thought of it—how he could ever have found pleasure in performing masturbation with other boys. Now, nothing could induce him to touch another man’s genitals, the sight of which is even unpleasant to him. He has lost all inclination for men, and feels attracted by women exclusively.

It must be mentioned, however, that, though L. has a decided inclination for the female sex, he presents an abnormal phenomenon.

The essential thing in woman that excites him is the sight of her beautiful hands; L. is by far more impressed when he touches a beautiful female hand than he would be were he to see its possessor in a state of complete nudity. The extent to which L.’s preference for beautiful female hands goes is shown by the following incident:—

L. knew a beautiful young lady possessed of every charm, but her hands were quite large and not beautifully formed, and often they were not as clean as L. could wish. For this reason it was not only impossible for L. to conceive a deeper interest in the lady, but he was not able even to touch her. L. believes that there is nothing more disgusting to him than dirty finger-nails; this alone would make it impossible for him to touch a woman who in all other respects was most beautiful. L. formerly, as a substitute for coitus, had the puella perform genital manipulation with her hand until ejaculation took place.

To the question as to what there was about a woman’s hand that attracted him in particular, whether he saw in it a symbol of power, and whether it gave him pleasure to be directly humiliated by a woman, the patient answered that only the beautiful form of the hand charmed him; that it afforded him no gratification to be humiliated by a woman; and that he had never had any thought to regard the hand as the symbol or instrument of a woman’s power. The preference for the hand is still so great that the patient has greater pleasure when his genitals are touched by it than when he performs coitus in vaginam. Yet, the patient prefers to perform the latter, because it seems to him to be natural, while the former seems abnormal. The touch of a beautiful female hand on his body immediately causes him to have erection; he thinks that kissing and other contacts do not exert nearly so strong an influence. It is only of late years that the patient has performed coitus frequently, but it has always been very difficult for him to determine to do it. Too, in coitus, he did not find the complete satisfaction he sought. However, when he finds himself near a woman whom he would like to possess, sometimes, at mere sight of her, his sexual excitement becomes so intense that ejaculation results. L. says expressly that during this he does not intentionally touch or press his genitals; ejaculation under such circumstances affords him much more pleasure than he experiences in actual coitus.[91]

To go back, the patient’s dreams were never about coitus. When he had pollutions at night, they were almost always associated with other thoughts than those that occur in the normal man. The patient’s dreams are of events of his school-days. During his school-days, besides the mutual onanism described, he had ejaculations whenever he became anxiously excited. When, for example, the teacher dictated an extemporaneous exercise, and L. was unable to follow in translation, ejaculation often occurred.[92] The pollutions that now occur occasionally, at night, are only accompanied by dreams that have the same or a similar subject,—the events at school just mentioned. On account of his unnatural feeling and sensibility, the patient thinks he is incapable of loving a woman long.

Treatment of the patient’s perversion has not yet been possible.

This case of hand-fetichism certainly does not depend on masochism or sadism, but is to be explained simply by early indulgence in mutual onanism. There is here, also, quite as little of contrary sexual instinct. Before the sexual appetite was clearly conscious of its object, the hands of school-fellows were used. As soon as the instinct for the opposite sex became evident, the interest for the hand was transferred to woman.

In hand-fetichists, who, according to Binet, are so numerous, it is possible that other associations lead to the same result.

Next to the hand-fetichists, naturally come the foot-fetichists. While glove-fetichism, which belongs to the next group of object-fetichism, seldom takes the place of hand-fetichism, we find shoe- and boot-fetichism, of which there are innumerable cases occurring everywhere, taking the place of enthusiasm for the naked female foot. There are only here and there traces of the latter enthusiasm, and these are scarcely pathological. It is easy to see the reason for this. The female hand is usually seen uncovered; the foot, covered. Thus the early associations which determine the direction of the vita sexualis are naturally connected with the naked hand, but with the covered foot.

Shoe-fetichism also finds its place in the following group of dress-fetichism; however, on account of its demonstrable masochistic character in the majority of cases, it has been, for the most part, described already (p. 123 et seq.).

Besides the eyes, hand, and foot, the mouth and ears often play the rôle of a fetich. Among others, Moll (op. cit.) mentions such cases. (Comp. also Belot’s romance, “La Bouche de Madame X.,” which, B. states, rests upon actual observation.)

The following remarkable case came under my personal observation:—

Case 77. A gentleman of very bad heredity consulted me concerning impotence that was driving him almost to despair. While he was young, his fetich was women of plump form. He married such a lady, and was happy and potent with her. After a few months the lady fell very ill, and lost much flesh. When, one day, he tried to resume his marital duty, he was absolutely impotent, and remained so. If, however, he attempted coitus with plump women, he was perfectly potent.

Even bodily defects may become fetiches.

Descartes, who himself (“Traité des Passions,” cxxxvi) expresses some opinions concerning the origin of peculiar affections in associations of ideas, was always partial to cross-eyed women, because the object of his first love had such a defect. (Binet, op. cit.)

Lydston (“A Lecture on Sexual Perversion,” Chicago, 1890[93]) reports the case of a man who had a love-affair with a woman whose right lower extremity had been amputated. After separation from her, he searched for other women with a like defect.[94]—A negative fetich.

When the part of the female body forming the fetich is capable of removal, like the hair, the most extravagant acts may be performed. Therefore, hair-fetichists form an interesting and forensically-important category. While such admirers of female hair are probably not infrequent within physiological limits, and possibly various senses (sight, smell, and hearing, through crepitant sounds,—and certainly touch, just as with velvet- and silk-fetichists, v. infra) are thus excited with an accompaniment of lustful feeling; yet, a series of similar pathological cases has also been observed, in which the hair-fetichism had become an overpowering impulse, and driven the individuals to commit crimes.[95],[96] These form the group of hair-despoilers.

Case 78. A hair-despoiler. P., aged 40, artistic locksmith, single. His father was temporarily insane, and his mother was very nervous. He developed well, and was intelligent; but he was early affected with tics and imperative ideas. He had never masturbated. He loved platonically, and often busied himself with matrimonial plans. He had coitus infrequently with prostitutes, but never felt satisfied with such intercourse—rather, disgusted. Three years ago he was overtaken by misfortune (financial ruin), and, besides, he had a febrile disease, with delirium. These things had a very bad effect on his hereditarily-predisposed nervous system. On August 28, 1889, P. was arrested at the Trocadero, in Paris, in flagranti, as he forcibly cut off a young girl’s hair. He was arrested with the hair in his hand and a pair of shears in his pocket. He excused himself on the ground of momentary mental confusion and an unfortunate, irresistible passion; he confessed that he had ten times cut off hair, which he took great delight in keeping at home. On searching his home, sixty-five switches and tresses of hair were found, assorted in packets. P. had already been once arrested, on December 15, 1886, under similar circumstances, but was released for lack of evidence.

P. states that, for the last three years, when he is alone in his room at night, he feels ill, anxious, excited, and dizzy, and then is troubled by the impulse to touch female hair. When it happened that he could actually take a young girl’s hair in his hand, he felt intensely excited sexually, and had erection and ejaculation without touching the girl in any other way. On reaching home, he would feel ashamed of what had taken place; but the wish to possess hair, always accompanied by great sensual pleasure, became more and more powerful in him. He wondered that previously, even in the most intimate intercourse with women, he had experienced no such feeling. One evening he could not resist the impulse to cut off a girl’s hair. With the hair in his hand, at home, the sensual process was repeated. He was forced to rub his body with the hair and envelop his genitals in it. Finally, quite exhausted, he grew ashamed, and could not trust himself to go out for several days. After months of rest he was again impelled to possess himself of female hair, indifferent as to whose it might be. If he attained his end, he felt himself possessed by a supernatural power and unable to give up his booty. If he could not attain the object of his desire, he became greatly depressed, hurried home, and there reveled in his collection of hair. He combed and fondled it, and thus had intense orgasm, satisfying himself by masturbation. Hair exposed in the cases of hair-dressers made no impression on him; it required hair hanging down from a female head.

At the height of his act, he states, he is in such a state of excitement that he has only imperfect apperception and subsequent memory of what he does. When he touches the hair with the shears he has erection, and, at the instant of cutting it off, ejaculation. Since his misfortune, about three years ago, he states that he has had weakness of memory, is easily exhausted mentally, and has been troubled by sleeplessness and night-terrors. P. deeply regrets his crime.

Not only hair, but a number of hair-pins, ribbons, and other articles of the feminine toilet, were found in his possession, which he had had presented to him. He had always had an actual mania for collecting such things, as well as newspapers, pieces of wood, and other worthless trash, which he would never give up. He also had a strange and, to him, inexplicable fear of passing a certain street; if he ever tried it, it made him ill.

The opinion (medico-legal) showed him to be hereditarily predisposed, and proved the imperative, impulsive, and decidedly involuntary character of the criminal acts, which had the significance of an imperative act, induced by an imperative idea, with an accompaniment of overpowering abnormal sexual feeling. Pardon; asylum for insane. (Voisin, Socquet, Motet, Annales d’hygiène, April, 1890.)

Following this case, is a similar one which also deserves attention; for it has been well studied, and may be called almost classical; and, too, it places the fetich, as well as the original associative awakening of the idea, in a clear light:—

Case 79. A hair-despoiler. E., aged 25. Maternal aunt, epileptic; brother had convulsions. E. says he was fairly healthy as a child, and learned quite easily. At the age of fifteen he had a sensual feeling of pleasure, with erection, at the sight of one of the village beauties combing her hair. Until that time persons of the opposite sex had made no impression on him. Two months later, in Paris, the sight of young girls with their hair flowing down over their shoulders always excited him intensely. One day he could not resist an opportunity to twist a young girl’s hair in his fingers. For this he was arrested and sentenced to imprisonment for three months. After that he served five years as a soldier. During this time hair was not dangerous for him, though also not very accessible; but he dreamed sometimes of female heads with the hair braided or flowing. Occasional coitus with women, but without having their hair effective as a fetich. Once more in Paris, he again dreamed as before, and became greatly excited by female hair. He never dreamed about the whole form of a woman, only of heads with braids of hair. His sexual excitement due to this fetich had become so intense of late that he had resorted to masturbation. The idea of touching female hair, or, better, of possessing it to masturbate while handling it, grew more and more powerful. Of late, when he had female hair in his fingers, ejaculation was induced. One day he succeeded in cutting hair, about 25 centimetres long, from three little girls in the street, and keeping it in his possession, when he was arrested in a fourth attempt. Deep regret and shame. He was not sentenced. Since spending some time in the asylum, he has so far improved that female hair no longer excites him. Set at liberty, he thought of going to his native place, where the women wear their hair done up. (Magnan, Archiv. de l’anthropol. criminelle, v, Nr. 28.)

A third case is the following, which is likewise suited to illustrate the psychopathic nature of such phenomena; and the remarkable means which induced a cure are worthy of note:—

Case 80. Hair-fetichism. Mr. X., between thirty and forty years old; from the higher class of society; single. He says that he comes of a healthy family, but from childhood has been nervous, vacillating, and peculiar; that since his eighth year he has been powerfully attracted by female hair. This was particularly true in the case of young girls. When he was nine years old, a girl of thirteen seduced him. He did not understand it, and was not at all excited. A twelve-year-old sister of this girl also courted, kissed, and hugged him. He allowed this quietly, because this girl’s hair pleased him so well. When about ten years old, he began to have sensual feelings at the sight of female hair that pleased him. Gradually these feelings occurred spontaneously, and memory-pictures of girls’ hair were always immediately associated with them. At the age of eleven he was taught to masturbate by school-mates. The associative connection of sexual feelings and a fetichistic idea was already established, and always appeared when the patient indulged in evil practices with his companions. With advancing years, the fetich grew more and more powerful. Even false hair began to excite him, but he always preferred natural hair. When he could touch or kiss it, he was perfectly happy. He wrote essays and poems on the beauty of female hair; he sketched heads of hair and masturbated. After his fourteenth year he became so powerfully excited by his fetich that he had violent erections. In contrast with his early taste while a boy, he was now charmed only by luxuriant, thick black hair. He experienced intense desire to kiss such hair, particularly to suck it. To touch such hair afforded him but little satisfaction; he obtained much more pleasure in looking at it, but particularly in kissing and sucking it. If this were impossible, he would become unhappy, even to the extent of tædium vitæ. Then he would attempt to relieve himself, imagining fantastic “hair-adventures” and masturbating. Not infrequently, in the street and in crowds, he could not keep from imprinting a kiss on ladies’ heads. He would then hurry home to masturbate. Sometimes he could resist this impulse; but it was then necessary for him, filled with feelings of fear, to run away as quickly as possible, in order to escape the domination of his fetich. He was only once impelled to cut off a girl’s hair in a crowd. In the act he was seized with fear, and was not successful with his pocket-knife; and, by flight, he narrowly escaped detection.

When he became mature, he attempted to satisfy himself in coitus with puellis. He induced powerful erection by kissing the hair, but could not induce ejaculation. Therefore, he was unsatisfied by coitus. At the same time, his favorite idea was coitus with kissing of hair; but even this did not satisfy him, because it did not induce ejaculation. Faute de mieux, he once stole the combings of a lady’s hair, put it in his mouth, and masturbated while calling its owner up in imagination. In the dark a woman could not interest him, because he could not then see her hair. Flowing hair also had no charm for him; nor did the hair about the genitals. His erotic dreams were all about hair. Of late the patient had become so excited that he had a kind of satyriasis. He was incapable of business, and felt so unhappy that he sought to drown his sorrow in alcohol. He drank large quantities, had alcoholic delirium, an attack of alcoholic epilepsy, and required hospital treatment. After the intoxication had passed away, under appropriate treatment, the sexual excitement soon disappeared; and when the patient was discharged, he was freed from his fetichistic idea, save for its occasional occurrence in dreams. The physical examination showed normal genitals and no degenerative signs whatever.

Such cases of hair-fetichism, which lead to attacks on female hair, seem to occur everywhere, from time to time. In November, 1890, according to reports in American newspapers, several cities in the United States were troubled by such hair-despoilers.

(b) The Fetich is an Article of Female Attire.—The great importance of adornment, ornament, and dress, in the normal vita sexualis of man, is very generally recognized. Culture and fashion[97] have, to a certain extent, endowed woman with artificial sexual characteristics, the removal of which, when woman is seen unattired, in spite of the normal sensual effect of this sight, may exert an opposite influence.[98] It should not be overlooked that female dress often shows a tendency to emphasize and exaggerate certain sexual peculiarities,—secondary sexual characteristics (bosom, waist, hips). In most individuals the sexual instinct awakes long before there is any possibility or opportunity of intimate intercourse, and the early desires of youth are concerned with the ordinary appearance of the attired female form. Thus it happens that not infrequently, at the beginning of the vita sexualis, ideas of the persons exerting sexual charms and ideas of their attire become associated. This association may be lasting—the attired woman may be always preferred—if the individuals dominated by this perversion do not in other respects attain to a normal vita sexualis, and find gratification in natural charms.

In psychopathic individuals, sexually hyperæsthetic, as a result of this, it actually happens that the dressed woman is always preferred to the nude female form. It may be recalled that in Case 48 the woman was not to take off a garment, and that in Case 51, equus eroticus, the woman was preferred dressed. In Case 89, of the sixth edition,—that of a man manifesting contrary sexuality,—the same preference is expressed.

Dr. Moll (op. cit.) mentions a patient who could not perform coitus with puella nuda; the woman had to have on a chemise, at least. The same author (op. cit., p. 129) mentions a man affected with contrary sexuality, who was subject to the same dress-fetichism.

The reason for this phenomenon is apparently to be found in the mental onanism of such individuals. In seeing innumerable clothed forms, they have cultivated desires before seeing nudity.[99]

A more marked form of dress-fetichism is that in which, instead of the dressed woman, a certain kind of attire becomes a fetich. One can understand how, with an intense and early sexual impression, combined with the idea of a particular garment on the woman, in hyperæsthetic individuals, a very intense interest in this garment might be developed.

Hammond (op. cit.) reports the following case, taken from Roubaud (“Traité de l’impuissance,” Paris):—

Case 81. X., son of a general. He was raised in the country. At the age of fourteen he was initiated into the joys of love by a young lady. This lady was a blonde, and wore her hair in ringlets; and, in order to avoid detection in sexual intercourse with her young lover, she always wore her usual clothing,—gaiters, a corset, and a silk dress.

When his studies were completed, and he was sent to a garrison where he could enjoy freedom, he found that his sexual desire could be excited only under certain conditions. A brunette could not excite him in the least, and a woman in night-clothes could stifle every bit of love in him. In order to awaken his desire, a woman had to be a blonde, and wear gaiters, a corset, and a silk dress,—in short, she had to be dressed like the lady who had first awakened his sexual desire. He was always compelled to give up thoughts of matrimony, because he knew he would be unable to fulfill his marital duty with a woman in night-clothes.

Hammond reports another case where coitus maritalis could be performed only by the help of a certain costume; and Dr. Moll mentions several similar cases in individuals of hetero- and homo-sexuality. The cause may often be shown to be an early association, and such may always be assumed. It is only in this way that one can explain why a certain costume cannot be resisted by such individuals, no matter what person wears the fetich. Thus one can understand why, as Coffignon (op. cit.) relates, men at brothels demand that the women with whom they are concerned put on certain costumes, such as that of a ballet-dancer, or nun, etc.; and why these houses are furnished with a complete wardrobe for such purposes.

Binet (op. cit.) relates the case of a judge who was exclusively in love with Italian girls who came to Paris as artists’ models, and their peculiar costume. The cause was here demonstrably an impression made at the time of the awakening of the sexual instinct.

A third form of dress-fetichism, having a much higher degree of pathological significance, is by far the most frequent. In this form it is no longer the woman herself, dressed, or even dressed in a particular fashion, that constitutes the principal sexual stimulus, but the sexual interest is so concentrated on some certain article of female attire that the lustful idea of this object is entirely separated from the idea of woman, and thus obtains an independent value. This is the real domain of dress-fetichism, where an inanimate object—an isolated article of wearing-apparel—is alone used for the excitation and satisfaction of the sexual instinct. This third form of dress-fetichism is also the one that is important forensically.

In a large number of these cases the fetiches are articles of female underwear, which, owing to their private use, are suited to occasion such associations.

Case 82. K., aged 45, shoemaker, is reported to be without hereditary taint. He is peculiar, and has small mental endowment. He is of masculine habitus and without signs of degeneration. Previously blameless in conduct, on the evening of July 5, 1876, he was detected taking stolen female under-garments from a place of concealment. There were found with him about three hundred articles of the female toilet, among them, besides chemises and drawers, night-caps, garters, and a female doll. When arrested he was wearing a chemise. Since his thirteenth year he had been a slave to an impulse to steal women’s linen; but, after his first punishment for it, he had become very careful, and stolen with refinement and success. When this longing came over him, he would grow anxious, and his head would become heavy. Then he could not resist the impulse, cost what it might. He was indifferent to the source of the articles. At night, on going to bed, he would put on the stolen clothing and create beautiful women in imagination, thus inducing pleasurable feeling and ejaculation. This was apparently the motive of his thefts; at least, he had never disposed of any of the articles, but had hidden them here and there.

He declared that, earlier in his life, he had indulged in normal sexual intercourse with women. He denied onanism, pederasty, and other sexual acts. He said he was engaged at twenty-five, but the engagement was broken through no fault of his. He was incapable of insight into the abnormality of his condition and the wrong of his acts. (Passow, Vierteljahrsschrift f. ger. Medic., N. F. xxviii, p. 61; Krauss, “Psychologie des Verbrechens,” 1884, p. 190.)

Hammond (op. cit.) reports a case of passionate interest in single articles of female wearing-apparel. Here, also, the patient’s pleasure consisted in wearing a corset and other female garments (without any traces of contrary sexual instinct). The pain of tight lacing, experienced by himself or induced in women, is a delight to him,—sadistic-masochistic element.

A case probably belonging here is one reported by Diez (“Der Selbstmord,” 1838, p. 24), where a young man could not resist the impulse to tear female linen. While tearing it, he always had ejaculation.

A combination of fetichism with an impulse to destroy the fetich (in a certain sense, sadism with inanimate objects) seems to occur quite frequently (comp. Case 93).

An article of dress, which, though it has not really a private character, by its material and color, as well as by the place where it is worn, recalls under-garments, and hence has sexual relations, is the apron (comp. also the metonymic use of the word “apron” for “petticoat” in the saying, “To chase every apron,” etc.). This explains the following case:—

Case 83. C., aged 37; of a badly tainted family; of small mental endowment; plagiocephalic. At fifteen his attention was attracted by aprons hung out to dry. He bound them about himself and masturbated behind the fence. From that time he could not see aprons without repeating the act. If any one—no matter whether man or woman—with an apron on came near him, he was compelled to run after the person. In order to free him from this constant stealing of aprons, he was sent as a marine in his sixteenth year. In this calling he saw no aprons, and had continual rest. When, at nineteen, he returned home, he was again compelled to steal aprons, and, as a result, got into serious complications, and was several times locked up. He sought to free himself of his weakness by a sojourn of several years in a cloister. When he came out, he was just as bad as before. As a result of a new theft, he underwent a medico-legal examination, and was committed to an asylum. He never stole anything but aprons. It was a pleasure to him to revel in the memory of the first apron he ever stole. His dreams were filled with aprons. He occasionally used the memory of his thefts to make coitus possible, or for masturbation. (Charcot and Magnan, Arch. de neurolog., 1882, Nr. 12.)

In a case reported by Lombroso (“Amori anomali precoci nei pazzi,” Arch. di psich., 1883, p. 17), analogous to those of this series, a boy of very bad heredity, at the age of four, had erections and great sexual excitement at the sight of white garments, particularly underclothing. He was lustfully excited by handling and crumpling them. At the age of ten he began to masturbate at the sight of white, starched linen. He seems to have been affected with moral insanity, and was executed for murder.

The following case of petticoat-fetichism is combined with peculiar circumstances:—

Case 84. Z., aged 35; official; the only child of a nervous mother and healthy father. From childhood he was “nervous,” and at the consultation his neuropathic eyes, delicate, slender body, fine features, very thin voice, and sparse growth of beard attracted attention. The patient presents nothing abnormal except symptoms of slight neurasthenia. Genitals and sexual functions normal. Patient states that he has only masturbated four or five times, and that when he was very young. As early as at the age of thirteen, the patient was powerfully excited sexually by the sight of wet female dresses; while the same dresses, when dry, had no effect upon him. His greatest delight was to look at women with wet garments in the rain. If he met a woman having a pleasing face under such circumstances, he experienced an intense feeling of lustful pleasure, had erection, and felt impelled to perform coitus. He states that he has never had any desire to wet female dresses or to throw water on women. He can give no explanation of the origin of his peculiarity.

It is possible that, in this case, the sexual instinct was first awakened by the sight of a woman as she exposed her charms by raising her skirts in wet weather. The obscure instinct, not yet conscious of its object, then became directed to the wet garments, as in other cases.

Lovers of female handkerchiefs are frequent, and, therefore, important forensically. As to the frequency of handkerchief-fetichism, it may be remarked that the handkerchief is the one article of feminine attire which, outside of intimate association, is most frequently displayed, and which, with its warmth from the person and specific odors, may by accident fall into the hands of others. The frequency of early association of lustful feelings with the idea of a handkerchief, which may always be presumed to have occurred in such cases of fetichism, probably is due to this.

Case 85. A baker’s assistant, aged 32, single, previously of good repute, was discovered stealing a handkerchief from a lady. In sincere remorse, he confessed that he had stolen from eighty to ninety such handkerchiefs. He had cared only for handkerchiefs, and, indeed, only for those belonging to young women attractive to him. In his outward appearance the culprit presents nothing peculiar. He dresses himself with much taste. His conduct is peculiar, anxious, depressed, and unmanly, and he often lapses into whining and tears. Lack of self-reliance, weakness of comprehension, and slowness of perception and reflection, are noticeable. One of his sisters is epileptic. He lives in good circumstances; was never severely sick; developed well. In relating his history, he shows weakness of memory and lack of clearness; calculation is hard for him, though when young he learned and comprehended easily. His anxious, uncertain state of mind gives rise to a suspicion of onanism. The culprit confessed that he had been given to this practice excessively since his nineteenth year. For some years, as a result of his vice, he had suffered with depression, lassitude, trembling of the limbs, pain in the back, and disinclination for work. Frequently a depressed, anxious state of mind came over him, in which he avoided people. He had exaggerated, fantastic notions about the results of sexual intercourse with women, and could not bring himself to indulge in it. Of late, however, he had thought of marriage. With great remorse and in a weak-minded way, X. now confessed that six months before, while in a crowd, he became violently excited sexually at the sight of a pretty young girl, and was compelled to crowd up against her. He felt an impulse to compensate himself for the want of a more complete satisfaction of his sexual excitement, by stealing her handkerchief. Thereafter, as soon as he came near attractive females, with violent sexual excitement, palpitation of the heart, erection and impetus coeundi, the impulse would seize him to crowd up against them and, faute de mieux, steal their handkerchiefs. Although the consciousness of his criminal act never left him for a moment, he was unable to make any resistance to the impulse. During the act he felt an anxiety which was in part due to his inordinate sexual impulse, and partly to the fear of detection. The medico-legal opinion rightly gave weight to the congenital mental enfeeblement and the pernicious influence of masturbation, and referred the abnormal impulses to a perverse sexual impulse, calling attention to the presence of an interesting and well-known physiological connection between the olfactory and sexual senses. The inability to resist the pathological impulse was recognized. X. was not punished. (Zippe, Wiener Med. Wochenschrift, 1879, Nr. 23.)

I am indebted to the kindness of Dr. Fritsch, of Vienna, for further facts concerning this handkerchief-fetichist, who was again arrested in August, 1890, in the act of taking a handkerchief from a lady’s pocket:—

On searching his house, four hundred and forty-six ladies’ handkerchiefs were found. He stated that he had burned besides two bundles of them. In the course of the examination, it was further shown that X. had been punished with imprisonment for fourteen days, in 1883, for stealing twenty-seven handkerchiefs, and again with imprisonment for three weeks, in 1886, for a similar crime. Concerning his relatives, nothing more could be learned than that his father was subject to congestions, and that a brother’s daughter was weak-minded and constitutionally neuropathic. X. had married in 1879, and embarked in an independent business, and in 1881 he made an assignment. Soon after that, his wife, who could not live with him, and with whom he did not perform his marital duty (denied by X.), demanded a divorce. Thereafter he lived as assistant baker to his brother. He complained bitterly of an impulse for ladies’ handkerchiefs, but when opportunity offered, unfortunately, he could not resist it. In the act he experienced a feeling of delight, and felt as if some one were forcing him to it. Sometimes he could restrain himself, but, when the lady was pleasing to him, he yielded to the first impulse. He would be wet with sweat, partly from fear of detection, and partly on account of the impulse to perform the act. He says he has been sensually excited, by the sight of handkerchiefs belonging to women, since puberty. He cannot recall the exact circumstances of this fetichistic association. The sensual excitement, occasioned by the sight of a lady with a handkerchief hanging out of her pocket, had constantly increased. This had repeatedly caused erection, but never ejaculation. After his twenty-first year, he says, he had inclination to normal sexual indulgence, and had coitus without difficulty without ideas of handkerchiefs. With increasing fetichism, the appropriation of handkerchiefs had afforded him much more satisfaction than coitus. The appropriation of the handkerchief of a lady attractive to him was the same to him as intercourse with her would have been. In the act he had true orgasm.

If he could not gain possession of the handkerchief he desired, he would become painfully excited, tremble, and sweat all over. He kept separate the handkerchiefs of ladies particularly pleasing to him, and reveled in the sight of them, taking great pleasure in it. The odor of them also gave him great delight, though he states that it was really the odor peculiar to the linen, and not the perfume, which excited him sensually. He had masturbated but very seldom.

X. complained of no physical ailments except occasional headache and vertigo. He greatly regretted his misfortune, his abnormal impulse,—the evil spirit that impelled him to such criminal acts. He had but one wish: that some one might help him. Objectively there are mild neurasthenic symptoms, anomalies of the distribution of blood, and unequal pupils.

It was proved that X. had committed his crimes in obedience to an abnormal, irresistible impulse. Pardon.

Such cases of handkerchief-fetichism, where an abnormal individual is driven to theft, are very numerous. They also occur in combination with contrary sexuality, as is proved by the following case, which I borrow from page 125 of Dr. Moll’s frequently-cited work[100]:—

Case 86. Handkerchief-fetichism in a Case of Contrary Sexual Instinct.—K., aged 38; mechanic; a powerfully built man. He makes numerous complaints,—weakness of the legs, pain in the back, headache, want of pleasure in work, etc. The complaints give the decided impression of neurasthenia with tendency to hypochondria. Only after the patient had been under my treatment several months did he state that he was also abnormal sexually.

K. had never had any inclination whatever for women; but handsome men, on the other hand, had a peculiar charm for him. Patient had masturbated frequently until he came to me. He had never practiced mutual onanism or pederasty. He did not think that he would have found satisfaction in this, because, in spite of his preference for men, an article of white linen was his chief charm, though the beauty of its owner played a rôle. The handkerchiefs of handsome men particularly excite him sexually. His greatest delight is to masturbate in men’s handkerchiefs. For this reason he often took his friend’s handkerchiefs. In order to save himself from detection, he always left one of his own handkerchiefs with his friend in place of the one he stole. In this way he sought to escape the suspicion of theft, by creating the appearance of a mistake. Other articles of men’s linen also excited K. sexually, but not to the extent handkerchiefs did.

K. had often performed coitus with women, having erection and ejaculation, but without lustful pleasure. There was also nothing which could stimulate the patient to the performance of coitus. Erection and ejaculation occurred only when, during the act, he thought of a man’s handkerchief; and this was easier for the patient when he took a friend’s handkerchief with him, and had it in his hand during coitus. In accordance with his sexual perversion, in his nightly pollutions with lustful ideas, men’s linen played the principal rôle.

It is possible that, in this interest in (used) handkerchiefs, elements of feeling in the sense of masochism, group “c,” are also often at work.

Still far more frequent than the fetichism of linen garments is that of women’s shoes. These cases are, in fact, almost innumerable, and a great many of them have been scientifically studied; but I have but a few reports at second hand of the similar glove-fetichism (concerning the reason for the relative infrequency of glove-fetichism, vide p. 161).

In shoe-fetichism the close relationship of the object to the feminine person, which explains linen-fetichism, is absolutely wanting. For this reason, and because there is a large number of well-observed cases at hand, in which the fetichistic enthusiasm for the female shoe or boot consciously and undoubtedly arises from masochistic ideas, an origin of a masochistic nature, even when it is concealed, may always be assumed in shoe-fetichism, when, in the concrete case, no other manner of origin is demonstrable. For this reason the majority of the cases of shoe- or foot-fetichism have been given under “Masochism.” There the constant masochistic character of this form of erotic fetichism has been sufficiently demonstrated by means of transitional conditions. This presumption of the masochistic character of shoe-fetichism is weakened and removed only where another accidental cause for an association between sexual excitation and the idea of women’s shoes—the occurrence of which is quite improbable a priori—is demonstrable. In the two following cases, however, there is such a demonstrable connection:—

Case 87. Shoe-fetichism. Mr. v. P., of an old and honorable family, Pole, aged 32, consulted me, in 1890, on account of “unnaturalness” of his vita sexualis. He gave the assurance that he came of a perfectly healthy family. He had been nervous from childhood, and had suffered with chorea minor at the age of eleven. For ten years he had suffered with sleeplessness and various neurasthenic ailments. From his fifteenth year he had recognized the difference of the sexes and been capable of sexual excitation. At the age of seventeen he had been seduced by a French governess, but coitus was not permitted; so that intense mutual sensual excitement (mutual masturbation) was all that was possible. In this situation his attention was attracted by her very elegant boots. They made a very deep impression. His intercourse with this lewd person lasted four months. During this association her shoes became a fetich for the unfortunate boy. He began to have an interest in ladies’ shoes in general, and actually went about trying to catch sight of ladies wearing pretty boots. The shoe-fetichism gained great power over his mind. He had the governess touch his penis with her shoes, and thus ejaculation with great lustful feeling was immediately induced. After separation from the governess, he went to puellis, whom he had perform the same manipulation. This was usually sufficient for satisfaction. Only seldom did he resort to coitus as an auxiliary, and inclination for it grew less and less. His vita sexualis consisted of dream-pollutions, in which women’s shoes played the exclusive rôle; and of gratification with women’s shoes apposita ad mentulam, but this had to be done by the puella. In the society of the opposite sex the only thing that interested him was the shoe, and that only when it was elegant, of the French style, with heels, and of a brilliant black, like the original.

In the course of time the following conditions have become accessory: A prostitute’s shoe that is elegant and chic; starched petticoats, and black hose, if possible. Nothing else in woman interests him. He is absolutely indifferent to the naked foot. Women have not the slightest mental charm for him. He had never had masochistic desires, in the sense of being trod upon. In the course of years his fetichism had gained such power that when he saw a lady on the street, of a certain appearance and with certain shoes, he was so intensely excited that he had to masturbate. Slight pressure on the penis sufficed to induce ejaculation, in his state of severe neurasthenia. Shoes displayed in shops, and, of late, even advertisements of shoes, sufficed to excite him intensely. In states of intense libido he made use of onanism, if shoes were not at his immediate command. The patient quite early recognized the pain and danger of his condition, and, even when he was free from neurasthenic ailments, he was morally very much depressed. He sought help of various physicians. Cold-water cures and hypnotism were unsuccessful. The most celebrated physicians advised him to marry, and assured him that, as soon as he once really loved a girl, he would be free from his fetichism. The patient had no confidence in his future, but he followed the advice of the physicians. He was cruelly disappointed in the hope which the authority of the physicians had aroused in him, though he led to the altar a lady distinguished by both mental and physical charms. The wedding-night was terrible; he felt like a criminal, and did not approach his wife. The next day he saw a prostitute with the required chic. He was weak enough to have intercourse with her in his way. Then he bought a pair of elegant ladies’ boots, and hid them in bed, and, by touching them, while in marital embrace, after a few days, he was able to perform his marital duty. He ejaculated tardily, for he had to force himself to coitus; and, after a few weeks, this artifice failed, because his imagination failed. He felt unspeakably miserable, and would have preferred to make an end of himself. He could no longer satisfy his wife, who was sensual, and much excited by their previous intercourse; and he saw her suffering severely, both mentally and morally. He could not, and would not, disclose his secret. He experienced disgust in marital intercourse; he felt afraid of his wife, and feared the coming of night and being alone with her. He could no longer induce erection.

He again made attempts with prostitutes, and satisfied himself by touching their shoes. Then the puella had to touch his penis, when he would have ejaculation; but, if this did not take place, he would attempt coitus with the lewd woman; without success, however, for ejaculation would occur immediately. In absolute despair, the patient comes for consultation. He deeply regretted that, against his inner conviction, he had followed the unfortunate advice of the physicians, and made a virtuous wife unhappy, having deeply injured her, both mentally and morally. Could he answer God for continuing such a marriage? Even if he were to discover himself to his wife, and she were to do everything for him, it would not help him; for the familiar perfume of the demi-monde was also necessary.

Aside from his mental pain, this unfortunate man presented no remarkable symptoms. Genitals perfectly normal. Prostate somewhat enlarged. He complained that he was so under the domination of his boot-ideas that he would even blush when boots were talked about. His whole imagination was given up to such ideas. When he was on his estate, he often suddenly had to go a distance of ten miles to the city, to satisfy his fetichism with shoe-stores or with puellis.

This pitiable man could not bring himself to take treatment; for his faith in physicians had been greatly shaken. An attempt to ascertain whether hypnosis and a removal of the fetichistic association by this means, were possible, increased the mental excitement of the unfortunate man, who was exclusively controlled by the thought that he had made his wife unhappy.

Case 88. X., aged 24, from a badly-tainted family (mother’s brother and grandfather insane, one sister epileptic, another sister subject to migraine, parents of excitable temperament). During dentition he had had convulsions. At the age of seven he was taught to masturbate by a servant-girl. X. first experienced pleasure in these manipulations when this girl occasionally stroked his penis with her foot with her shoe on. Thus, in the predisposed boy, an association was established, as a result of which, from that time on, merely the sight of women’s shoes, and, finally, merely the idea of them, sufficed to induce sexual excitement and erection. He now masturbated while looking at women’s shoes, or while calling them up in imagination. At school the teacher’s shoes excited him intensely, and in general he was affected by shoes that were partly concealed by female garments. One day he could not keep from grasping the teacher’s shoes,—an act that caused him great sexual excitement. In spite of punishment he could not keep from performing this act repeatedly. Finally, it was recognized that there must be an abnormal motive in play, and he was sent to a male teacher. He then reveled in the memory of shoe-scenes with his former school-mistress, and thus had erections, orgasm, and, after his fourteenth year, ejaculation. At the same time, he masturbated while thinking of a woman’s shoe. One day the thought came to him to increase his pleasure by using such a shoe for masturbation. Thereafter he frequently took shoes secretly, and used them for that purpose.

Nothing else in a woman could excite him; the thought of coitus filled him with horror. Men did not interest him in any way. At the age of eighteen he opened a general store, and, among other things handled ladies’ shoes. He was excited sexually by fitting shoes for his female patrons, or by manipulating shoes that they had worn. One day, while doing this, he had an epileptic attack, and, soon after, another, while practicing onanism in his customary way. Then he recognized, for the first time, the injury to health caused by his sexual practices. He tried to overcome his onanism, sold no more shoes, and strove to free himself from the abnormal association between women’s shoes and the sexual function. Then frequent pollutions, with erotic dreams about shoes, occurred, and the epileptic attacks continued. Though devoid of the slightest feeling for the female sex, he determined on marriage, which seemed to him to be the only remedy.

He married a pretty young lady. In spite of lively erections when he thought of his wife’s shoes, in attempts at cohabitation he was absolutely impotent; for his distaste for coitus, and for close intercourse in general, was far more powerful than the influence of the shoe-idea, which induced sexual excitement. On account of his impotence, the patient applied to Dr. Hammond, who treated his epilepsy with bromides, and advised him to hang a shoe up over his bed, and look at it fixedly during coitus, at the same time imagining his wife to be a shoe. The patient became free from epileptic attacks, and potent so that he could have coitus about once a week. Too, his sexual excitation by women’s shoes grew less and less. (Hammond, “Sexual Impotence.”)

Following these two cases of shoe-fetichism, which apparently depend merely upon accidental association, and are not favored by any inner relation between the things themselves, is given the very strange case of a fetichist who was excited sexually only by the idea of a night-cap on the head of an ugly old woman; also a case arising apparently from merely accidental association:—

Case 89. L., aged 37, clerk, from tainted family, had his first erection at five years, when he saw his bed-fellow—an aged relative—put on a night-cap. The same thing occurred later, when he saw an old servant put on her night-cap. Later, simply the idea of an old, ugly woman’s head, covered with a night-cap, was sufficient to cause an erection. Simply the sight of a cap, or of a naked woman or man, made no impression, but the mere touch of a night-cap induced erection, and sometimes even ejaculation. L. was not a masturbator, and had never been sexually active until his thirty-second year, when he married a young girl with whom he had fallen in love. On his marriage-night he remained cold until, from necessity, he brought to his aid the memory-picture of an ugly woman’s head with a night-cap. Coitus was immediately successful. Thereafter it was always necessary for him to use this means. Since childhood he had been subject to occasional attacks of depression, with tendency to suicide, and now and then to frightful hallucinations at night. When looking out of windows, he became dizzy and anxious. He was a perverse, peculiar, and easily embarrassed man, of bad mental constitution. (Charcot and Magnan, Arch. de neurol., 1882, No. 12.)

In this very peculiar case, the simultaneous coincidence of the first sexual excitation and an absolutely heterogeneous impression seems to have determined the association.

Hammond (op. cit.) also mentions a case of accidental associative fetichism that is quite as peculiar. A married man, aged 30, who, in other respects, was healthy, physically and mentally, is said to have suddenly lost his sexual power, after moving to another house, and to have regained it as soon as the furniture of the sleeping-room had been arranged as it was before.

(c) The Fetich is Some Special Material.—There is a third principal group of fetichists who have as a fetich neither a portion of the female body nor a part of female attire, but some particular material which is so used, not because it is a material for female garments, but because in itself it can arouse or increase sexual feelings. In many cases of this kind, the act of feeling of such material during the sexual act seems indispensable, in order to make the latter possible, or at least satisfactory. Such materials are furs, velvet, and silk.

These cases differ from the foregoing instances of erotic dress-fetichism, in that these materials, unlike female linen, do not have any close relation to the female body; and, unlike shoes and gloves, they are not related to certain parts of the person which have peculiar symbolic significance. Moreover, this fetichism cannot be due to an accidental association, like that in the cases of the night-caps and the arrangement of the sleeping-room; for these cases form an entire group having the same object. It must be presumed that certain tactile sensations (a kind of tickling which stands in some distant relation to lustful sensations?), in hyperæsthetic individuals, furnish the occasion for the origin of this fetichism.

The following is a personal observation of a man affected with this peculiar fetichism:—

Case 90. N. N., aged 37; of a neuropathic family; neuropathic constitution. He makes the following statement: “From my earliest youth I have always had a deeply-rooted partiality for furs and velvet, in that these materials cause me sexual excitement, and the sight and touch of them give me lustful pleasure. I can recall no event that caused this peculiarity (such as the simultaneous occurrence of the first sexual excitation and an impression of these materials,—i.e., first excitation by a woman dressed in them); in fact, I cannot remember when this enthusiasm began. However, by this I would not exclude the possibility of such an event,—of an accidental connection in a first impression and consequent association; but I think it very improbable that such a thing took place, because I believe such an occurrence would have deeply impressed me. All I know is, that even when a small child I had a lively desire to see and stroke furs, and thus had an obscure sensual pleasure. With the first occurrence of definite sexual ideas,—i.e., the direction of sexual thoughts to woman,—the peculiar preference for women dressed in such materials was present. Since then, up to mature manhood, it has remained unchanged. A woman wearing furs or velvet, or, better, both, excites me much more quickly and intensely than one devoid of these auxiliaries. To be sure, these materials are not a conditio sine qua non of excitation; the desire occurs also without them, in response to the usual stimuli; but the sight and, particularly, the touch of these fetich-materials form for me a powerful aid to other normal stimuli, and intensify erotic pleasure. Often merely the sight of only a passably pretty girl, dressed in these materials, causes me lively excitement, and overcomes me completely. Even the sight of my fetich-materials gives me pleasure, but the touch of them much more. (To the penetrating odor of furs I am indifferent—rather, it is unpleasant—and it is endurable only by reason of the association with pleasing visual and tactile impressions.) I have an intense longing to touch these materials while on a woman’s person, to stroke and kiss them, and bury my face in them. My greatest pleasure is, inter actum, to see and feel my fetich on the woman’s shoulder.

“Fur, or velvet alone, exerts on me the effect described, the former much more intensely than the latter. The combination of the two has the most intense effect. Too, female garments of velvet and fur, seen and touched without the wearer, cause me sexual excitement; indeed, though to a less extent, the same effect is exerted by furs or robes having no relation to female attire, and also by the velvet and plush of furniture and drapery. Merely pictures of costumes of furs and velvet are objects of erotic interest to me; indeed, simply the word “fur” has a magic charm for me, and immediately calls up erotic ideas.

“Fur is such an object of sexual interest for me that a man wearing fur that is effective (v. infra) makes a very unpleasant, repugnant, and disgusting impression on me; such as would be made on a normal person by a man in the costume and attire of a ballet-dancer. Similarly repugnant to me is the sight of an old or ugly woman clad in beautiful furs; because opposing feelings are thus aroused.

“This erotic delight in furs and velvet is something entirely different from simple æsthetic pleasure. I have a very lively appreciation of beautiful female attire, and, at the same time, a particular partiality for point-lace; but it is purely of an æsthetic nature. A woman dressed in a point-lace toilette (or in other elegant, elaborate attire) is more beautiful than another; but one dressed in my fetich-material is more charming.

“But furs exercise on me the effect described only when the fur has very thick, fine, smooth, and rather long hair, that stands out like that of the so-called bearded furs. I have noticed that the effect depends upon this. I am entirely indifferent not only to the common coarse, bushy furs, but also to those that are commonly regarded as beautiful and precious, from which the long hair has been removed (seal, beaver), or of which the hair is naturally short (ermine); and likewise to those of which the hair is over-long and lies down (monkey, bear). The specific effect is exerted only by the standing long hair of the sable, marten, skunk, etc. But velvet is made of thick, fine, standing hairs (fibres); and its effect may be due to this. The effect seems to depend upon a very definite impression of the points of thick, fine hair upon the end-organs of the sensory nerves.

“But how this peculiar impression on the tactile nerves is related to sexual instinct is a perfect enigma to me. The fact is, that this is the case with many men. I would also state expressly that beautiful female hair pleases me, but plays no more important part than the other charm; and that while touching fur I have no thought of female hair. The tactile sensation, also, has not the least resemblance to that imparted by female hair. There is never association of any other idea. Fur, per se, arouses sensuality in me,—how, I cannot explain.

“The mere æsthetic effect, the beauty of costly furs, to which every one is more or less susceptible; which, since Raphael’s Fornarina and Reuben’s Helene Fourment, has been used as the foil and frame of female beauty by innumerable painters; and which plays so important a rôle in fashion,—the art and science of female dress,—this æsthetic effect, as has been remarked, explains nothing here. Beautiful furs have the same æsthetic effect on me as on normal individuals, and affect me in the same way that flowers, ribbons, precious stones, and other ornaments affect every one. Such things, when skillfully used, enhance female beauty, and thus, under certain circumstances, may have an indirect sensual effect. They never have a direct, powerful, sensual effect on me, as do the fetich-materials mentioned.

“Though in me, and, in fact, in all ‘fetichists,’ the sensual and æsthetic effect must be strictly differentiated, nevertheless, that does not prevent me from demanding in my fetich a whole series of æsthetic qualities in form, style, color, etc. I could give a very lengthy description of these qualities that my taste demands; but I omit it as not being essential to the real subject in hand. I would only call attention to the fact that erotic fetichism is complicated with purely æsthetic tastes.

“The specific erotic effect of my fetich-materials can be explained no better by the association with the idea of the person of the female wearing them, than by their æsthetic impression. For, in the first place, as has been said, these materials, as such, affect me when entirely isolated from the body; and, in the second place, articles of clothing of a much more private nature, and which undoubtedly call up associations, exert a much weaker influence over me. Thus the fetich-materials have an independent sensual value for me; why, is an enigma to me.

“Feathers in women’s hats, fans, etc., have the same erotic fetichistic effect on me as furs and velvet (similar tactile sensation of airy, peculiar tickling). Finally, the fetichistic effect, with much less intensity, is exerted by other smooth materials (satin and silk); but rough goods (cloth, flannel) have a repelling effect.

“In conclusion, I will mention that somewhere I read an article by Carl Vogt on microcephalic men, according to which these creatures, at the sight of furs, rushed for them and stroked them with every manifestation of delight. I am far from any thought, on this ground, to see in wide-spread fur-fetichism an atavistic retrogression to the taste of our hairy ancestors. Every cretin, with that simplicity belonging to his condition, touches anything that pleases him; and the act is not necessarily of a sexual nature; just as many normal men like to stroke a cat and the like, or even velvet and furs, and are not thus excited sexually.”

In the literature of this subject, there are a few cases belonging here:—

Case 91. A boy, aged 12, became powerfully excited sexually when he chanced to put on a fox-skin. From that time there was masturbation with the employment of furs, or by means of taking a furry dog to bed. Ejaculation would result, sometimes followed by an hysterical attack. His nocturnal pollutions were induced by dreaming that he lay entirely covered up in a white skin. He was absolutely insusceptible to stimuli coming from men or women. He was neurasthenic, suffered with delusions of being watched, and thought that every one noticed his sexual anomaly. He had tædium vitæ on account of this, and finally became insane. He had marked taint; his genitals were imperfectly formed, and he presented other signs of degeneration. (Tarnowsky, op. cit., p. 22.)

Case 92. C. is an especial lover of velvet. He is attracted in a normal way by beautiful women, but it particularly excites him to have the person with whom he has sexual intercourse dressed in velvet. In this, it is remarkable that it is not so much the sight as the touch of the velvet that causes the excitation. C. told me that stroking a woman’s velvet jacket would excite him sexually to an extent scarcely possible in any other way. (Dr. Moll, op. cit., p. 127.)

The following is a very peculiar case of material-fetichism. It is combined with the impulse to injure the fetich, which, in this case, represents an element of sadism toward the woman wearing the fetich, or impersonal sadism toward objects, which is of frequent occurrence in fetichists (comp. p. 170). This impulse to injure made this a remarkable criminal case:—

Case 93. In July, 1891, Alfred Bachmann, aged 25, locksmith, was brought before Judge I., in the second term of the criminal court, in Berlin. In April, 1891, the police had had numerous complaints, according to which some evil hand had cut women’s dresses with a very sharp instrument. On April 25, they were successful in arresting the perpetrator in the person of the accused. A policeman noticed how the accused pressed, in a remarkable manner, against a lady in the company of a gentleman, while they were going through a passage. The officer requested the lady to examine her dress, while he held the man under suspicion. It was ascertained that the dress had received quite a long slit. The accused was taken to the station, where he was examined. Besides a sharp knife, which he confessed he used for cutting dresses, two silk sashes, such as ladies wear on their dresses, were found on him; he also confessed that he had taken these from dresses in crowds. Finally, the examination of his person brought to light a lady’s silk neck-cloth. The accused said he had found this. Since his statement in this case could not be refuted, complaint was therefore made to rest on the result of the search; in two instances in which complaint was made by the injured parties his acts were designated as injury to property, and in two other instances as theft. The accused, a man who had been often punished before, with a pale, expressionless face, before the judge, gave a strange explanation of his enigmatical action. A major’s cook had once thrown him down-stairs when he was begging of her, and since that time he had entertained great hatred of the whole female sex. There was a doubt about his responsibility, and he was therefore examined by a physician. The medical expert gave the opinion, at the final trial, that there was no reason to regard the accused as insane, though he was of low intelligence. The culprit defended himself in a peculiar manner. An irresistible impulse forced him to approach women wearing silk dresses. The touch of silk material gave him a feeling of delight, and this went so far that, while in prison for examination, he had been excited if a silk thread happened to pass through his fingers while raveling rags. Judge Müller considered the accused to be simply a dangerous, vicious man, who should be made harmless for a long time. He advised imprisonment for one year. The court sentenced him to six months’ imprisonment, with loss of honor for a year.

The following case was communicated to me by a physician:—

In a brothel a certain man was known by the name of “Velvet.” He dressed a puella pleasing to him in a black velvet dress, and excited and satisfied his sexual appetite simply by stroking his face with a part of the velvet skirt, touching the woman in no other way.

I am assured by an officer that, among masochists, a partiality for furs, velvet, and feathers, is very frequent (comp. Case 44). In the novels of Sacher-Masoch, fur plays an important part; indeed, it furnishes a title to some of them. The explanation given there seems far-fetched and unsatisfactory,—that fur (ermine) is the symbol of royalty, and therefore the fetich of the men described in the novels.

II. Great Diminution or Complete Absence of Sexual Feeling for the Opposite Sex, with Substitution of Sexual Feeling and Instinct for the Same Sex. (Homo-sexuality, or Contrary Sexual Instinct).

After the attainment of complete sexual development, among the most constant elements of self-consciousness in the individual, are the knowledge of representing a definite sexual personality and the consciousness of desire, during the period of physiological activity of the reproductive organs (production of semen and ova), to perform sexual acts corresponding with that sexual personality,—acts which, consciously or unconsciously, have a procreative purpose.

The sexual instinct and desire, save for indistinct feelings and impulses, remain latent until the period of development of the sexual organs. The child is generis neutrius; and though, during this latent period,—when sexuality has not yet risen into clear consciousness, is but virtually present, and unconnected with powerful organic sensations,—too early excitation of the genitals may occur, either spontaneously or as a result of external influence, and find satisfaction in masturbation; yet, notwithstanding this, the psychical relation to persons of the opposite sex is still absolutely wanting, and the sexual acts during this period partake more or less of a reflex spinal nature.

The fact of innocence, or of sexual neutrality, is the more remarkable, since very early, in education, employment, dress, etc., the child undergoes a differentiation from children of the opposite sex. These impressions, however, remain destitute of mental meaning, because they apparently are without sexual coloring; for the central organ (cortex) of sexual emotions and ideas is not yet capable of activity, owing to its undeveloped condition.

With the inception of anatomical and functional development of the generative organs, and the differentiation of form belonging to each sex, which goes hand in hand with it in the boy or girl, rudiments of a mental feeling corresponding with the sex are developed; and in this, of course, education and external influences in general have a powerful effect upon the individual, who is now all attention.

If the sexual development is normal and undisturbed, a definite character, corresponding with the sex, is developed. Certain definite inclinations and reactions in intercourse with persons of the opposite sex arise; and it is psychologically worthy of note with what relative rapidity the definite mental type corresponding with the sex is evolved.

While modesty, for example, during childhood, is essentially but an uncomprehended and incomprehensible exaction of education and imitation, and in the innocence and näiveté of the child but imperfectly expressed; in the youth and maiden it becomes an imperative requirement of self-respect; and, if in any way it is offended, intense vasomotor reaction (blushing) and psychical emotion are induced.

If the original constitution is favorable and normal, and factors injurious to the psycho-sexual development exercise no influence, then a psycho-sexual personality is developed that is so unchangeable, and corresponds so completely and harmoniously with the sex the individual represents, that subsequent loss of the generative organs (as by castration), or the climacteric or senility, cannot essentially alter it. But this, of course, is not to declare that the castrated man or woman, the youth and the aged man, the maiden and matron, the impotent and the potent man, do not differ essentially from one another mentally.

An interesting and important question for what follows is, whether the peripheral influences of the generative glands (testes and ovaries), or central cerebral conditions, are the determining factors in psycho-sexual development. The fact that congenital deficiency of the generative glands, or removal of them before puberty, has a great influence on physical and psycho-sexual development, so that the latter is distorted and assumes a type more closely resembling the opposite sex (eunuchs, certain viragoes, etc.), betokens their great importance in this respect.

But that the physical processes taking place in the genital organs are only co-operative, and not the exclusive factors in the process of development of the psycho-sexual character, is shown by the fact that, notwithstanding a normal anatomical and physiological state of these organs, a sexual instinct may be developed which is the exact opposite of that characteristic of the sex to which the individual belongs.

In this case, the cause is to be sought only in an anomaly of central conditions,—in an abnormal psycho-sexual constitution. This constitution, as far as its anatomical and functional foundation is concerned, is absolutely unknown. Since, in almost all such cases, the individual subject to the perverse sexual instinct displays a neuropathic predisposition in several directions, and the latter may be brought into relation with hereditary degenerate conditions, this anomaly of psycho-sexual feeling may be called, clinically, a functional sign of degeneration. This perverse sexuality appears spontaneously, without external cause, with the development of sexual life, as an individual manifestation of an abnormal form of the vita sexualis, and then has the force of a congenital phenomenon; or it develops upon a sexuality the beginning of which was normal, as a result of very definite injurious influences, and thus appears as an acquired anomaly. Upon what this enigmatical phenomenon of acquired homo-sexual instinct depends is still inexplicable, and only a matter for hypothesis. Careful examination of the so-called acquired cases makes it probable that the predisposition also present here consists of a latent homo-sexuality, or, at least, bi-sexuality, which, for its manifestation, requires the influence of accidental exciting causes to rouse it from its slumber.

In so-called contrary sexual instinct there are degrees of the phenomenon which quite correspond with the degrees of predisposition of the individuals. Thus, in the milder cases, there is simple hermaphroditism; in more pronounced cases, only homo-sexual feeling and instinct, but limited to the vita sexualis; in still more complete cases, the whole psychical personality, and even the bodily sensations, are transformed to correspond with the sexual perversion; and, in the complete cases, the physical form is correspondingly altered.

The following division of the various phenomena of this psycho-sexual anomaly is made, therefore, in accordance with these clinical facts:—

A. Homo-sexual Feeling as an Acquired Manifestation.—The determining condition here is the demonstration of perverse feeling for the same sex; not the proof of sexual acts with the same sex. These two phenomena must not be confounded with each other; perversity must not be taken for perversion.

Perverse sexual acts, not dependent upon perversion, often come under observation. This is especially true with reference to sexual acts between persons of the same sex, particularly pederasty. Here paræsthesia sexualis is not necessarily at work; but hyperæsthesia, with physical or mental impossibility of natural sexual satisfaction. Thus we find homo-sexual intercourse in impotent masturbators or debauchees, or faute de mieux in sensual men and women in imprisonment, on ship-board, in garrisons, bagnios, boarding-schools, etc.

There is an immediate return to normal sexual intercourse as soon as obstacles to it are removed. Very frequently the cause of such temporary aberration is masturbation and its results in youthful individuals.

Nothing is so prone to contaminate—under certain circumstances, even to exhaust—the source of all noble and ideal sentiments, which arise of themselves from a normally developing sexual instinct, as the practice of masturbation in early years. It despoils the unfolding bud of perfume and beauty, and leaves behind only the coarse, animal desire for sexual satisfaction. If an individual, spoiled in this manner, reaches an age of maturity, there is wanting in him that æsthetic, ideal, pure, and free impulse which draws one toward the opposite sex. Thus the glow of sensual sensibility wanes, and the inclination toward the opposite sex becomes weakened. This defect influences the morals, character, fancy, feeling, and instinct of the youthful masturbator, male or female, in an unfavorable way, and, under certain circumstances, allows the desire for the opposite sex to sink to nil; so that masturbation is preferred to the natural mode of satisfaction.

Sometimes the development of higher sexual feelings toward the opposite sex suffers, on account of hypochondriacal fear of infection in sexual intercourse; or on account of an actual infection; or they suffer as a result of a faulty education which points out such dangers and exaggerates them. Again (especially in females), fear of the result of coitus (pregnancy), or abhorrence of men, by reason of mental or moral weakness, may direct into perverse channels an instinct that makes itself felt with abnormal intensity. But too early and perverse sexual satisfaction injures not merely the mind, but also the body; inasmuch as it induces neuroses of the sexual apparatus (irritable weakness of the centres governing erection and ejaculation; defective pleasurable feeling in coitus), while, at the same time, it maintains the imagination and libido in continuous excitement.

Almost every masturbator at last reaches a point where, frightened on learning the results of the vice, or on experiencing them (neurasthenia), or led by example or seduction to the opposite sex, he wishes to free himself of the vice and re-instate his vita sexualis. The moral and mental conditions are the most unfavorable possible. The pure glow of sexual feeling is destroyed; the fire of sexual instinct is wanting, and self-confidence, no less; for every masturbator is more or less timid and cowardly. If the youthful sinner at last comes to make an attempt at coitus, he is either disappointed because enjoyment is wanting, on account of defective sensual feeling, or he is lacking in the mental strength necessary to accomplish the act. The fiasco has a fatal effect, and leads to absolute psychical impotence. A bad conscience and the memory of past failures prevent success in any further attempts. The constant libido sexualis, however, demands satisfaction; but this moral and mental perversion separates him further and further from women. For various reasons, however (neurasthenic complaints, hypochondriacal fear of the results, etc.), the individual is kept from masturbation. Occasionally, under such circumstances, there may be bestiality. Intercourse with the same sex is then near at hand,—as a result of occasional seduction or of the feelings of friendship which, on the level of pathological sexuality, easily associate themselves with sexual feelings. Passive and mutual onanism then becomes the equivalent of the avoided act. If there is a seducer,—which, unfortunately, is so frequent,—then the cultivated pederast is produced,—i.e., a man who performs quasi acts of onanism with persons of his own sex, and, at the same time, feels and prefers himself in an active rôle corresponding with his real sex; who is mentally indifferent not only to persons of the opposite sex, but also to those of his own sex.

Sexual aberration in the normally constituted, untainted, mentally healthy individual, reaches this degree. No case has been demonstrated in which perversity has been transformed into perversion,—into a reversal of the sexual instinct.[101]

With tainted individuals, the matter is quite different. The latent perverse sexuality is developed under the influence of neurasthenia induced by masturbation, abstinence, or otherwise.

Gradually, in contact with persons of the same sex, sexual excitation by them is induced. Related ideas are colored with lustful feelings, and awaken corresponding desires. This decidedly degenerate reaction is the beginning of a process of physical and mental transformation, a description of which is attempted in what follows, and which is one of the most interesting psychological phenomena that has been observed. This metamorphosis presents different stages, or degrees.

I. Degree: Simple Reversal of Sexual Feeling.—This degree is attained when persons of the same sex have an aphrodisiac effect, and the individual has a sexual feeling for them. Character and feeling, however, still correspond with the sex of the individual presenting the reversal of sexual feeling. He feels himself in the active rôle; he recognizes his impulse toward his own sex as an aberration, and finally seeks aid. With episodical improvement of the neurosis, at first even normal sexual feelings may re-appear and assert themselves. The following case seems well suited to exemplify this stage of the psycho-sexual degeneration:—

Case 94. Acquired Contrary Sexual Instinct.—“I am an official, and, as far as I know, come of an untainted family. My father died of an acute disease; my mother is living and is quite nervous. A sister has been very intensely religious for some years.

“I myself am tall, and, in speech, gait, and manner, give a perfectly masculine impression. Measles is the only disease I have had; but since my thirteenth year I have suffered with so-called nervous headache. My sexual life began in my thirteenth year, when I became acquainted with a boy somewhat older than myself, with whom I took pleasure in mutual fondling of the genitals. I had the first ejaculation in my fourteenth year. Seduced to onanism by two older school-mates, I practiced it partly with others and partly alone; in the latter case, however, always with the thought of persons of the female sex. My libido sexualis was very great, as it is to-day. Later, I tried to win a pretty, stout servant-girl who had very large mammæ; id solum assecutus sum, ut me praesente superiorem corporis sui partem enudaret mihique concederet os mammasque osculari, dum ipsa penem meum valde erectum in manum suam recepit eumque trivit.

“Notwithstanding my urgent demand for coitus, she would not allow it; but she finally permitted me to touch her genitals.

“After going to the University, I visited a brothel and succeeded without especial effort.

“There an event occurred which brought a change in me. One evening I accompanied a friend home, and in a mild state of intoxication I grasped him ad genitalia. He made but slight opposition. I then went up to his room with him, and we practiced mutual masturbation. From that time we indulged in it quite frequently; in fact, it came to immissio penis in os, with resultant ejaculations. But it is strange that I was not at all in love with this person, but passionately in love with another friend, near whom I never felt the slightest sexual excitement, and whom I never connected with sexual matters, even in thought. My visits to brothels, where I was gladly received, became more infrequent; in my friend I found a substitute, and did not desire sexual intercourse with women.

“We never practiced pederasty, and that word was not even known between us. From the beginning of this relation with my friend, I again masturbated more frequently, and naturally the thought of females receded more and more into the background, and I thought more and more about young, handsome, strong men with the largest genitals. I preferred young fellows, from sixteen to twenty-five years old, without beards, but they had to be handsome and clean. Young laborers dressed in trousers of Manchester cloth or English leather, particularly masons, especially excited me.

“Persons in my own position had hardly any effect on me; but, at the sight of one of those strapping fellows of the lower class, I experienced marked sexual excitement. It seems to me that the touch of such trousers, the opening of them, and the grasping of the penis, as well as kissing the fellow, would be the greatest delight. My sensibility to female charms is somewhat dulled; yet in sexual intercourse with a woman, particularly when she has well-developed mammæ, I am always potent without the help of imagination. I have never attempted to make use of a young laborer, or the like, for the satisfaction of my evil desires, and never shall; but I often feel the longing to do it. I often impress on myself the mental image of such a man, and then masturbate at home.

“I am absolutely devoid of taste for female work. I rather like to move in female society, but dancing is repugnant to me. I have a lively interest in the fine arts. That my sexual sense is partly reversed is, I believe, in part due to greater convenience, which keeps me from entering into a relation with a girl; as the latter is a matter of too much trouble. To be constantly visiting houses of prostitution is, for æsthetic reasons, repugnant to me; and thus I am always returning to solitary onanism, which is very difficult for me to avoid.

“Hundreds of times I have said to myself that, in order to have a normal sexual sense, it would be necessary for me, first of all, to overcome my irresistible passion for onanism,—a practice so repugnant to my æsthetic feeling. Again and again I have resolved with all my might to fight this passion; but I am still unsuccessful. When I felt the sexual impulse gaining strength, instead of seeking satisfaction in the natural manner, I preferred to masturbate, because I felt that I would thus have more enjoyment.

“And yet experience has taught me that I am always potent with girls, and that, too, without trouble and without the help of imagining masculine genitals. In one case, however, I did not attain ejaculation because the woman—it was in a brothel—was devoid of every charm. I cannot avoid the thought and severe self-accusation that, to a certain extent, my contrary sexuality is the result of excessive onanism; and this especially depresses me, because I am compelled to acknowledge that I scarcely feel strong enough to overcome this vice by the force of my own will.

“As a result of my relations with my fellow-student and school-mate for years, mentioned in this communication,—which, however, began while we were at the University, and after we had been friends for seven years,—the impulse to unnatural satisfaction of libido has grown much stronger. I trust you will permit the description of an incident which occupied me for months:—

“In the summer of 1882, I made the acquaintance of a companion six years younger than myself, who, with several others, had been introduced to me and my acquaintances. I very soon felt a deep interest in this handsome man, who was unusually well proportioned, slim, and full of health. After a few weeks of association, this feeling became friendship, and at last passionate love, with feelings of the most intense jealousy. I very soon noticed that, in this, sexual excitation was also very marked; and, notwithstanding my determination, aside from all others, to keep myself in check in relation to this man, whom I respected so highly for his superior character, one night, after free indulgence in beer, as we were enjoying a bottle of champagne in my room and drinking to good, true, and lasting friendship, I yielded to the irresistible impulse to embrace him, etc.

“When I saw him, next day, I was so ashamed that I could not look him in the face. I felt the deepest regret for my action, and accused myself bitterly for having thus sullied this friendship, which was to be and remain so pure and precious. In order to prove to him that I had lost control of myself only momentarily, at the end of the semester I urged him to make an excursion with me; and after some reluctance, the reason of which was only too clear to me, he consented. Several nights we slept in the same room without any attempt on my part to repeat my action. I wished to talk with him about the event of that night, but I could not bring myself to it; even when, during the next semester, we were separated, I could not induce myself to write to him on the subject; and when I visited him, in March, at X., it was the same. And yet I felt a great desire to clear up this dark point by an open statement. In October of the same year, I was again in X., and this time found courage to speak without reserve; indeed, I asked him why he had not resisted me. He answered that, in part, it was because he wished to please me, and, in part, owing to the fact that he was somewhat apathetic as a result of being a little intoxicated. I explained to him my condition, and also gave him “Psychopathia Sexualis” to read, expressing the hope that by the force of my own will I should become fully and lastingly master of my unnatural impulse. Since this confession, the relation between this friend and me has been the most delightful and happy possible; there are the most friendly feelings on both sides, which are heart-felt and true; and it is to be hoped that they will endure.

“If I should not improve my abnormal condition, I am determined to put myself under your treatment; the more because, after a careful study of your work, I cannot count myself as belonging to the category of so-called urnings; and, too, because I have the firm conviction, or hope, at least, that a strong will, assisted and combined with skillful treatment, could transform me into a man of normal feeling.”

Case 95. Ilma S.,[102] aged 29; single; merchant’s daughter. She comes of a family having bad nervous taint. Father was a drinker and died by suicide, as also did the patient’s brother and sister. A sister suffers with convulsive hysteria. Mother’s father shot himself while insane. Mother was sickly, and died paralyzed after apoplexy. The patient never had any severe illness. She is bright, enthusiastic, and dreamy. Menses at the age of eighteen without difficulty; but thereafter they were very irregular. At fourteen, chlorosis and catalepsy from fright. Later, hysteria gravis and an attack of hysterical insanity. At eighteen, relations with a young man which were not platonic. This man’s love was passionately returned. From statements of the patient, it seems that she was very sensual, and after separation from her lover practiced masturbation. After this she led a romantic life. In order to earn a living, she put on male clothing, and became a tutor; but she gave up her place because her mistress, not knowing her sex, fell in love with her and courted her. Then she became a railway-employé. In the company of her companions, in order to conceal her sex, she was compelled to visit brothels with them, and hear the most vulgar stories. This became so distasteful to her that she gave up her place, resumed the garments of a female, and again sought to earn her living. She was arrested for a theft, and on account of severe hystero-epilepsy was sent to the hospital. There, inclination and impulse toward the same sex were discovered. The patient became troublesome on account of passionate love for female nurses and patients.

Her sexual perversion was considered congenital. With regard to this the patient made some interesting statements:—

“I am judged incorrectly, if it is thought that I feel myself a man toward the female sex. In my whole thought and feeling I am much more a woman. I loved my cousin as only a woman can love a man.

“The change of my feeling originated in this, that, in Pesth, dressed as a man, I had an opportunity to observe my cousin. I saw that I had wholly deceived myself in him. That gave me terrible heart-pangs. I knew that I could never love another man; that I belonged to those who love but once. Of similar effect was the fact that, in the society of my companions at the railway, I was compelled to hear the most offensive language and visit the most disreputable houses. As a result of the insight into men’s motives, gained in this way, I took an unconquerable dislike to them. However, since I am of a very passionate nature and need to have some loving person on whom to depend, and to whom I can wholly surrender myself, I felt myself more and more powerfully drawn toward intelligent women and girls who were in sympathy with me.”

The contrary sexual instinct of this patient, which was clearly acquired, expressed itself in a stormy and decidedly sensual way, and was further augmented by masturbation; because constant oversight in hospitals made sexual satisfaction with the same sex impossible. Character and occupation remained feminine. There were no manifestations of viraginity. According to information lately received by the author, this patient, after two years of treatment in an asylum, was entirely freed from her neurosis and sexual perversion, and discharged cured.

Case 96. X., aged 19; mother nervous; two sisters of mother’s father were insane. Patient of nervous temperament; well endowed mentally; well developed; normally formed. When he was twelve years old, he was seduced into mutual onanism by an elder brother.

After this, the patient continued the vice alone. In the last three years, during the act of masturbation, he had had peculiar fancies in the sense of “contrary sexual instinct.”

He fancies himself a female; as, for example, a ballet-dancer in the act of coitus with an officer or circus rider. These perverse fancies have accompanied the act of masturbation since the patient became neurasthenic. He understands the harm of masturbation, fights desperately against it, but always gives up to the impulse.

If he is able to withstand the impulse for a few days, a normal desire for sexual intercourse with females is awakened; but a certain fear of infection holds these desires in check, and always drives him again to masturbation.

It is worthy of remark that this unfortunate’s lascivious dreams concerned only females.

In the course of the last few months, the patient had become very neurasthenic and hypochondriacal. He feared tabes.

I advised treatment of the neurasthenia, suppression of masturbation, and marital cohabitation, if possible, after improvement of the neurasthenia.

Case 97. Mr. X, aged 35, single, official; mother insane, brother hypochondriacal.

Patient was healthy, strong, of lively sensual temperament. He had manifested powerful sexual instinct abnormally early, and masturbated while yet a small boy. He had coitus the first time at the age of fourteen, he says, with enjoyment and complete power. When fifteen years old, a man sought to seduce him, and performed manustupration on him. X. experienced a feeling of repulsion, and freed himself from the disgusting situation. At maturity he committed excesses in libido, with coitus; in 1880 he became neurasthenic, being afflicted with weakness of erection and ejaculatio præcox. He thus became less and less potent, and no longer experienced pleasure in the sexual act. At this time of sexual decadence, for a long time, he still had what was previously foreign to him, and is still incomprehensible to him,—an inclination for sexual intercourse with immature girls of the age of twelve or thirteen. His libido increased as virility diminished.

Gradually he developed inclination for boys of thirteen or fourteen. He was impelled to approach them.

Quodsi ei occasio data est ut tangere posset pueros qui ei placuere, penis vehementer se erexit tum maxime quum crura puerorum tangere potuisset. Abhinc feminas non cupivit. Nonnunquam feminas ad coitum coëgit sed erectio debilis, ejaculatio præmatura erat sine ulla voluptate.

Now only youths interested him. He dreamed about them and had pollutions. After 1882 he now and then had opportunity concumbere cum juvenibus. This led to powerful sexual excitement, which he satisfied by masturbation. It was only exceptional for him to venture to touch his bed-fellow and indulge in mutual masturbation. He shunned pederasty. For the most part, he was compelled to satisfy his sexual needs by means of solitary masturbation. In the act he called up the vision of pleasing boys. After sexual intercourse with such boys, he always felt strengthened and refreshed, but morally depressed; because there was consciousness of having performed a perverse, indecent, and punishable act. He found it painful that his disgusting impulse was more powerful than his will.

X. thinks that his love for his own sex has resulted from great excess in natural sexual intercourse, and bemoans his situation. On the occasion of a consultation, in December, 1889, he asked whether there were any means to bring him back to a normal sexual condition, since he had no real horror feminæ, and would very gladly marry.

This intelligent patient, free from degenerative signs, presented no abnormal symptoms except those of sexual and spinal neurasthenia of moderate degree.

II. Degree: Eviration and Defemination.—If, in cases of contrary sexual instinct thus developed, no restoration occurs, then deep and lasting transformations of the psychical personality may occur. The process completing itself in this way may be briefly designated eviration. The patient undergoes a deep change of character, particularly in his feelings and inclinations, which become those of a female. After this, he also feels himself to be a woman during the sexual act, has desire only for passive sexual indulgence, and, under certain circumstances, sinks to the level of a prostitute. In this condition of deep and more lasting psycho-sexual transformation, the individual is like the (congenital) urning of high grade. The possibility of a restoration of the previous mental and sexual personality seems, in such a case, excluded.

The following case is a classical example of this variety of lasting acquired contrary sexual instinct:—

Case 98. Sch., aged 30, physician, one day told me the story of his life and malady, asking explanation, and advice concerning certain anomalies of his vita sexualis. The following description gives, for the most part verbatim, the details of the autobiography; only in some portions is it shortened:—

“My parents were healthy. As a child I was sickly; but with good care I thrived, and got on well in school. When eleven years old, I was taught to masturbate by my playmates, and gave myself up to it passionately. Until I was fifteen, I learned easily. On account of frequent pollutions, I became less capable, did not get on easily in school, and was uncertain and embarrassed when called on by the teacher. Frightened by my loss of capability, and recognizing that the loss of semen was responsible for it, I gave up masturbation; but the pollutions became even more frequent, so that I often had two or three in a night. In despair, I now consulted one physician after another. None were able to help me.

“Since I grew weaker and weaker, by reason of the loss of semen, with the impulse to sexual satisfaction growing more and more powerful, I sought houses of prostitution. But I was there unable to find satisfaction; for, even though the sight of a naked female pleased me, neither orgasm nor erection occurred; and even manustupration by the puella was not capable of inducing erection. Scarcely would I leave the house, when the impulse would seize me again, and I would have violent erections. I grew ashamed before the girls, and ceased to visit such houses. Thus a couple of years passed. My sexual life consisted of pollutions. My inclination toward the opposite sex grew less and less. At nineteen I went to the University. The theatre had more attractions for me. I wished to become an actor. My parents were not willing. At the Capital I was compelled now and then to visit girls with my comrades. I feared such a situation; because I knew that coitus was impossible for me, and because my friends might discover my impotence. Therefore, I avoided, as far as possible, the danger of becoming the butt of jokes and ridicule.

“One evening, in the opera-house, an old gentleman sat near me. He courted me. I laughed heartily at the foolish old man, and entered into his joke. Exinapinato genitalia mea prehendit, quo facto statim penis meus se erexit. Frightened, I demanded of him what he meant. He said that he was in love with me. Having heard of hermaphrodites in the clinics, I thought I had one before me, and became curious to see his genitals. The old man was very willing, and went with me to the water-closet. Sicuti penem maximum ejus erectum adspexi, perterritus effugi.

“This man followed me, and made strange proposals which I did not understand, and repelled. He did not give me any rest. I learned the secrets of male love for males, and felt that my sexuality was excited by it. But I resisted the shameful passion (as I then regarded it), and, for the next three years, I remained free from it. During this time I repeatedly attempted coitus with girls in vain. My attempts to free myself of my impotence by means of medical treatment were also vain. Once, when my libido sexualis was troubling me again, I recalled what the old man had told me: that male-loving men were accustomed to meet on the E. Promenade.

“After a hard struggle, and with beating heart, I went there, made the acquaintance of a blonde man, and allowed myself to be seduced. The first step was taken. This kind of sexual love was satisfactory to me. I always preferred to be in the arms of a strong man. The satisfaction consisted of mutual manustupration; occasionally in osculum ad penem alterius. I was then twenty-three years old. Sitting, together with my comrades, on the beds of patients in the clinic during the lectures, excited me so intensely that I could scarcely listen to the lectures. In the same year I entered into a formal love-relation with a merchant of thirty-four. We lived as man and wife. X. played the man, and fell more and more in love. I gave up to him, but now and then I had to play the man. After a time I grew tired of him, became unfaithful, and he became jealous. There were terrible scenes, which led to temporary separation, and finally to actual rupture. (The merchant afterward became insane, and died by suicide.)

“I made many acquaintances, and loved the most ordinary people. I preferred those having a full beard, and who were tall and of middle age, and able to play the active rôle well. I developed a proctitis. The professor thought it was the result of sitting too much while preparing for examinations. I developed a fistula, and had to undergo an operation; but this did not cure me of my desire to allow myself to be used passively. I became a physician, and went to a provincial city, where I had to live like a nun. I developed a desire to move in ladies’ society, and was gladly welcomed there; because it was found that I was not so one-sided as most men, and was interested in toilettes and such feminine things. However, I felt very unhappy and lonesome. Fortunately, in this town, I made the acquaintance of a man, a ‘sister,’ who felt like me. For some time I was taken care of by him. When he had to leave, I had an attack of despair, with depression, which was accompanied by thoughts of suicide.

“When it became impossible for me to longer endure the town, I became a military surgeon in the Capital. There I began to live again, and often made two or three acquaintances in one day. I had never loved boys or young people; only fully-developed men. The thought of falling into the hands of the police was frightful. Thus I have escaped the clutches of the blackmailer. At the same time, I could not keep myself from the satisfaction of my impulse. After some months I fell in love with an official of forty. I remained true to him for a year, and we lived like a pair of lovers. I was the wife, and was formally courted by the lover. One day I was transferred to a small town. We were in despair. The last night was spent in continually kissing and caressing one another.

“In T. I was unspeakably unhappy, in spite of some ‘sisters’ whom I found. I could not forget my lover. In order to satisfy my sexual desire, which cried for satisfaction, I chose soldiers. Money obtained men; but they remained cold, and I had no enjoyment with them. I was successful in being re-transferred to the Capital. There, there was a new love-relation, but much jealousy; because my lover liked to go into the society of ‘sisters,’ and was proud and coquettish. There was a rupture. I was very unhappy and very glad to be transferred from the Capital. I now stayed in C., alone and in despair. Two infantry privates were brought into service, but with the same unsatisfactory result. When shall I ever find true love again?

“I am over medium height, well developed, and look somewhat aged; and, therefore, when I wish to make conquests I use the arts of the toilet. My manner, movements, and face are masculine. Physically I feel as youthful as a boy of twenty. I love the theatre, and especially art. My interest in the stage is in the actresses, whose every movement and gesture I notice and criticise.

“In the society of gentlemen I am silent and embarrassed, while in the society of those like myself I am free, witty, and as fawning as a cat, if a man is sympathetic. If I am without love, I become deeply melancholic; but the favors of the first handsome man dispel my depression. In other ways I am frivolous; anything but ambitious. My profession is nothing to me. Masculine pursuits do not interest me. I prefer novels and going to the theatre. I am effeminate, sensitive, easily moved, easily injured, and nervous. A sudden noise makes my whole body tremble, and I have to collect myself in order to keep from crying out.”

Remarks: The foregoing case is certainly one of acquired contrary sexual instinct, since the sexual instinct and impulse were originally directed toward the female sex. Sch. became neurasthenic through masturbation.

As an accompanying manifestation of the neurasthenic neurosis, lessened impressionability of the erection-centre and consequent relative impotence came on. As a result of this, sexual sensibility toward the opposite sex was lessened, with simultaneous persistence of libido sexualis. The acquired contrary sexual instinct must be abnormal, since the first touch by a person of the same sex is an adequate stimulus for the erection-centre. The perverse sexual feeling became complete. At first Sch. felt like a man in the sexual act; but more and more, as the change progressed, the feeling and desire of satisfaction changed to the form which, as a rule, characterizes the (congenital) urning.

This eviration induces a desire for the passive rôle, and, further, for (passive) pederasty. It makes a deeper impress on the character. The character becomes feminine, inasmuch as Sch. now prefers to move in the society of actual females, has an increasing desire for feminine occupations, and, indeed, makes use of the arts of the toilet in order to improve his fading charms and make “conquests.”

The foregoing facts, concerning acquired contrary sexual instinct and effemination, find an interesting confirmation in the following ethnological data:—

Even Herodotus describes a peculiar disease which frequently affected the Scythians. The disease consisted in this: that men became effeminate in character, put on female garments, did the work of women, and even became effeminate in appearance. As an explanation of this insanity of the Scythians,[103] Herodotus relates the myth that the goddess Venus, angered by the plundering of the temple at Ascalon by the Scythians, had made women of these plunderers and their posterity.

Hippocrates, not believing in supernatural diseases, recognized that impotence was here a causative factor, and explained it, though incorrectly, as due to the custom of the Scythians, by attributing it to disease of the jugular veins induced by excessive riding. He thought that these veins were of great importance in the preservation of the sexual powers, and that when they were severed, impotence was induced. Since the Scythians considered their impotence due to divine punishment, and incurable, they put on the clothing of females, and lived as women among women.

It is worthy of note that, according to Klaproth (“Reise in den Kaukasus,” Berlin, 1812, v, p. 285) and Chotomski, even at the present time impotence is very frequent among the Tartars, as a result of riding unsaddled horses. The same is observed among the Apaches and Navajos of the Western Continent, who ride excessively, scarcely ever going on foot, and are remarkable for small genitals and mild libido and virility. Sprengel, Lallemand, and Nysten recognized the fact that excessive riding may be injurious to the sexual organs.

Hammond reports analogous observations of great interest concerning the Pueblo Indians of New Mexico. These descendants of the Aztecs cultivate so-called “mujerados,” of which every Pueblo tribe requires one in the religious ceremonies (actual orgies in the spring), in which pederasty plays an important part. In order to cultivate a “mujerado,” a very powerful man is chosen, and he is made to masturbate excessively and ride constantly. Gradually such irritable weakness of the genital organs is engendered that, in riding, great loss of semen is induced. This condition of irritability passes into paralytic impotence. Then the testicles and penis atrophy, the hair of the beard falls out, the voice loses its depth and compass, and physical strength and energy decrease. Inclinations and disposition become feminine. The “mujerado” loses his position in society as a man. He takes on feminine manners and customs, and associates with women. Yet, for religious reasons, he is held in honor. It is probable that, at other times than during the festivals, he is used by the chiefs for pederasty. Hammond had an opportunity to examine two “mujerados.” One had become such seven years before, and was thirty-five years old at the time. Seven years before, he was entirely masculine and potent. He had noticed gradual atrophy of the testicles and penis. At the same time he lost libido and the power of erection. He differed in nowise, in dress and manner, from the women among whom Hammond found him. The genital hair was wanting, the penis was shrunken, the scrotum lax and pendulous, and the testicles were very much atrophied and no longer sensitive to pressure. The “mujerado” had large mammæ like a pregnant woman, and asserted that he had nursed several children whose mothers had died. A second “mujerado,” aged thirty-six, after he had been ten years in the condition, presented the same peculiarities, though with less development of mammæ. Like the first, the voice was high and thin. The body was plump.[104]

III. Degree: Stage of Transition to Metamorphosis Sexualis Paranoica.

A further degree of development is represented by those cases in which bodily sensation is also transformed in the sense of a transmutatio sexus. In this respect the following case is unique:—

Case 99. Autobiography. “Born in Hungary in 1844, for many years I was the only child of my parents; for the other children died for the most part of general weakness. A brother came late, who is still living.

“I come of a family in which nervous and mental diseases have been numerous. It is said that I was very pretty as a little child, with blonde locks and transparent skin; very obedient, quiet, and modest, so that I was taken everywhere in the society of ladies without any offense on my part.

“With a very active imagination—my enemy through life—my talents developed rapidly. I could read and write at the age of four; my memory reaches back to my third year. I played with everything that fell into my hands,—with leaden soldiers, or stones, or ribbons from a children’s store; but a machine for working in wood, that was given to me as a present, I did not like. I liked best to be at home with my mother, who was everything to me. I had two or three friends, with whom I got on good-naturedly; but I liked to play with their sisters quite as well, who always treated me like a girl, which at first did not embarrass me. I must have already been on the road to become just like a girl; at least, I can still well remember how it was always said: ‘He is not intended for a boy.’ At this I tried to play the boy,—imitated my companions in everything, and tried to surpass them in wildness. In this I succeeded. There was no tree or building too high for me to reach its top. I took great delight in soldiers. I avoided girls more, because I did not wish to play with their play-things; and it always annoyed me that they treated me so much like one of themselves.

“In the society of mature people, however, I was always modest, and, also, always regarded with favor. Fantastic dreams about wild animals—which once drove me out of bed without waking me—frequently troubled me. I was always very simply, but very elegantly, dressed, and thus developed a taste for beautiful clothing. It seems peculiar to me that, from the time of my school-days, I had a partiality for ladies’ gloves, which I put on secretly as often as I could. Thus, when once my mother was about to give away a pair of gloves, I made great opposition to it, and told her, when she asked why I acted so, that I wanted them myself. I was laughed at; and from that time I took good care not to display my preference for female things. Yet my delight in them was very great. I took especial pleasure in masquerade costumes,—i.e., only in female attire. If I saw them, I envied their owners. What seemed to me the prettiest sight was: two young men, beautifully dressed as white ladies, with masks on; and yet I would not have shown myself to others as a girl for anything; I was so afraid of being ridiculed. At school I worked very hard, and was always among the first. From childhood my parents taught me that duty came first; and they always set me an example. It was also a pleasure for me to attend school; for the teachers were kind, and the elder scholars did not plague the younger ones. We left my first home; for my father was compelled, on account of his business,—which was dear to him,—to separate from his family for a year. We moved to Germany. Here there was a stricter, rougher manner, partly in teachers and partly in scholars; and I was again ridiculed on account of my girlishness. My school-mates went so far as to give a girl, who had exactly my features, my name, and me hers; so that I hated the girl. But I later came to be on terms of friendship with her after her marriage. My mother tried to dress me elegantly; but this was repugnant to me, because it made me the object of joke. So, finally, I was delighted when I had correct trousers and coats. But with these came a new annoyance. They irritated my genitals, particularly when the cloth was rough; and the touch of tailors while measuring me, on account of their tickling, which almost convulsed me, was unendurable, particularly about the genitals. Then I had to practice gymnastics; and I simply could do nothing at all, or only indifferently the things that girls cannot do easily. While bathing I was troubled by feeling ashamed to undress; but I liked to bathe. Until my twelfth year I had a great weakness in my back. I learned to swim late, but ultimately so well that I took long swims. At thirteen I had pubic hair, and was about six feet tall; but my face was feminine until my eighteenth year, when my beard came in abundance and gave me rest from resemblance to woman. An inguinal hernia that was acquired in my twelfth year, and cured when I was twenty, gave me much trouble, particularly in gymnastics. Besides, from my twelfth year on, I had, after sitting long, and particularly while working at night, an itching, burning, and twitching, extending from the penis to my back, which the acts of sitting and standing increased, and which was made worse by catching cold. But I had no suspicion whatever that this could be connected with the genitals. Since none of my friends suffered in this way, it seemed strange to me; and it required the greatest patience to endure it; the more owing to the fact that my abdomen troubled me.

“In sexualibus I was still perfectly innocent; but now, as at the age of twelve or thirteen, I had a definite feeling of preferring to be a young lady. A young lady’s form was more pleasing to me; her quiet manner, her deportment, but particularly her attire, attracted me. But I was careful not to allow this to be noticed; and yet, I am sure that I should not have shrunk from the castration-knife, could I have thus attained my desire. If I had been asked to say why I preferred female attire, I could have said nothing more than that it attracted me powerfully; perhaps, too, I seemed to myself, on account of my uncommonly white skin, more like a girl. The skin of my face and hands, particularly, was very sensitive. Girls liked my society; and, though I should have preferred to have been with them constantly, I avoided them when I could; for I had to exaggerate in order not to appear feminine. In my heart I always envied them. I was particularly envious when one of my young girl friends got long dresses and wore gloves and veils. When, at the age of fifteen, I was on a journey, a young lady, with whom I was boarding, proposed that I mask as a lady and go out with her; but, owing to the fact that she was not alone, I did not acquiesce, much as I should have liked it. Others stood on very little ceremony with me. While on this journey, I was pleased at seeing boys in one city wearing blouses with short sleeves, and the arms bare. A lady elaborately dressed was like a goddess to me; and if even her hand touched me coldly I was happy and envious, and only too gladly would have put myself in her place in the beautiful garments and lovely form. Nevertheless, I studied assiduously, and passed through the Realschule and the Gymnasium in nine years, passing a good final examination. I remember, when fifteen, to have first expressed to a friend the wish to be a girl. In answer to his question, I could not give the reason why. At seventeen I got into fast society; I drank beer, smoked, and tried to joke with waiter-girls. The latter liked my society, but they always treated me as if I wore petticoats. I could not take dancing lessons, they repelled me so; but if I could have gone as a mask, it would have been different. My friends loved me dearly; I hated only one, who seduced me into onanism. Shame on those days, which injured me for life! I practiced it quite frequently, but in it seemed to myself like a double man. I cannot describe the feeling; I think it was masculine, but mixed with feminine elements. I could not approach girls; I feared them, but they were not strange to me. They impressed me as being more like myself; I envied them. I would have denied myself all pleasures if, after my classes, at home I could have been a girl and thus have gone out. Crinoline and a smoothly-fitting glove were my ideals. With every lady’s gown I saw I fancied how I should feel in it,—i.e., as a lady. I had no inclination toward men. But I remember that I was somewhat lovingly attached to a very handsome friend with a girl’s face and dark hair, though I think I had no other wish than that we both might be girls.

“At the high-school I finally once had coitus; hoc modo sensi, me libentius sub puella concubuisse et penem meum cum cunno mutatum maluisse. To my astonishment, too, the girl had to treat me as a girl, and did it willingly; but she treated me as if I were she (she was still quite inexperienced, and, therefore, did not laugh at me).

“When a student, at times I was wild, but I always felt that I assumed this wildness as a mask. I drank and duelled, but I could not take lessons in dancing, because I was afraid of betraying myself. My friendships were close, but without other thoughts. It pleased me most to have a friend masked as a lady, or to study the ladies’ costumes at a ball. I understood such things perfectly. Gradually I began to feel like a girl.

“On account of unhappy circumstances, I twice attempted suicide. Without any cause I once slept fourteen days, had many hallucinations (visual and auditory at the same time), and was with both the living and the dead. The latter habit of thought remains. I also had a friend (a lady) who knew my hobby and put on my gloves for me; but she always looked upon me as a girl. Thus I understood women better than other men did, and in what they differed from men; so I was always treated more feminarum,—as if they had found in me a female friend. On the whole, I could not endure obscenity, and indulged in it myself only out of braggadocio when it was necessary. I soon overcame my aversion to foul odors and blood, and even liked them. I was wanting in only one respect: I could not understand my own condition. I knew that I had feminine inclinations, but believed that I was a man. Yet I doubt whether, with the exception of the attempts at coitus, which never gave me pleasure (which I ascribe to onanism), I ever admired a woman without wishing I were she; or without asking myself whether I should not like to be the woman, or be in her attire. Obstetrics I learned with difficulty (I was ashamed for the exposed girls, and had a feeling of pity for them); and even now I have to overcome a feeling of fright in obstetrical cases; indeed, it has happened that I thought I felt the traction myself. After filling several positions successfully as a physician, I went through a military campaign as a volunteer surgeon. Riding, which, while a student, was painful to me, because in it the genitals had more of a feminine feeling, was difficult for me (it would have been easier in the female style).

“Still, I always thought I was a man with obscure masculine feeling; and whenever I associated with ladies, I was still soon treated as an inexperienced lady. When I wore a uniform for the first time, I should have much preferred to have slipped into a lady’s costume, with a veil; I was disturbed when the stately uniform attracted attention. In private practice I was successful in the three principal branches. Then I made another military campaign; and during this I came to understand my nature; for I think that, since the first ass, no beast of burden has ever had to endure with so much patience as I have. Decorations were not wanting, but I was indifferent to them.

“Thus I went through life, such as it was, never satisfied with myself, full of dissatisfaction with the world, and vacillating between sentimentality and a wildness that was for the most part affected.

“My experience as a candidate for matrimony was very peculiar. I should have preferred not to marry, but family circumstances and practice forced me to it. I married an energetic, amiable lady, of a family in which female government was rampant. I was in love with her as much as one of us can be in love,—i.e., what we love we love with our whole hearts, and live in it, even though we do not show it as much as a genuine man does. We love our brides with all the love of a woman, almost as a woman might love her bridegroom. But I cannot say this for myself; for I still believed that I was but a depressed man, who would come to himself, and find himself out by marriage. But, even on my marriage-night, I felt that I was only a woman in man’s form; sub femina locum meum esse mihi visum est. On the whole, we lived contented and happy, and for two years were childless. After a difficult pregnancy, during which I was in mortal fear of death, the first boy was born in a difficult labor,—a boy on whom a melancholy nature still hangs; who is still of melancholy disposition. Then came a second, who is very quiet; a third, full of peculiarities; a fourth, a fifth; and all have predisposition to neurasthenia. Since I always felt out of my own place, I went much in gay society; but I always worked as much as human strength would allow. I studied and operated; and I experimented with many drugs and methods of cure, always on myself. I left the regulation of the house to my wife, as she understood house-keeping very well. My marital duties I performed as well as I could, but without personal satisfaction. Since the first coitus, the masculine position in it has been repugnant, and, too, difficult for me. I should have much preferred to have the other rôle. When I had to deliver my wife, it almost broke my heart; for I knew how to appreciate her pain. Thus we lived long together, until severe gout drove me to various baths, and made me neurasthenic. At the same time, I became so anæmic that every few months I had to take iron for some time; otherwise I would be almost chlorotic or hysterical, or both. Stenocardia often troubled me; then came unilateral cramps of chin, nose, neck, and larynx; hemicrania and cramps of the diaphragm and chest-muscles. For about three years I had a feeling as if the prostate were enlarged,—a bearing-down feeling, as if giving birth to something; and, also, pain in the hips, constant pain in the back, and the like. Yet, with the strength of despair, I fought against these complaints, which impressed me as being female or effeminate, until three years ago, when a severe attack of arthritis completely broke me down.

“But before this terrible attack of gout occurred, in despair, to lessen the pain of gout, I had taken hot baths, as near the temperature of the body as possible. On one of these occasions it happened that I suddenly changed, and seemed to be near death. I sprang with all my remaining strength out of the bath: I had felt exactly like a woman with libido. Too, at the time when the extract of Indian hemp came into vogue, and was highly prized, in a state of fear of a threatened attack of gout (feeling perfectly indifferent about life), I took three or four times the usual dose of it, and almost died of haschisch poisoning. Convulsive laughter, a feeling of unheard of strength and swiftness, a peculiar feeling in brain and eyes, millions of sparks streaming from the brain through the skin,—all these feelings occurred. But I could not force myself to speak. All at once I saw myself a woman from my toes to my breast; I felt, as before while in the bath, that the genitals had shrunken, the pelvis broadened, the breasts swollen out; a feeling of unspeakable delight came over me. I closed my eyes, so that at least I did not see the face changed. My physician looked as if he had a gigantic potatoe instead of a head; my wife had the full moon on her nates. And yet I was strong enough to briefly record my will in my note-book when both left the room for a short time.

“But who could describe my fright, when, on the next morning, I awoke and found myself feeling as if completely changed into a woman; and when, on standing and walking, I felt vulva and mammæ! When at last I raised myself out of bed, I felt that a complete transformation had taken place in me. During my sickness a visitor said: ‘He is too patient for a man.’ And the visitor gave me a plant in bloom, which seemed strange, but pleased me. From that time I was patient, and would do nothing in a hurry; but I became tenacious, like a cat, though, at the same time, mild, forgiving, and no longer bearing enmity,—in short, I had a woman’s disposition. During the last sickness I had many visual and auditory hallucinations,—spoke with the dead, etc.; saw and heard familiar spirits; felt like a double person; but, while lying ill, I did not notice that the man in me had been extinguished. The change in my disposition was a piece of good fortune which came over me like lightning, and which, had it come with me feeling as I formerly did, would have killed me; but now I gave myself up to it, and no longer recognized myself. Owing to the fact that I still often confounded neurasthenic symptoms with the gout, I took many baths, until an itching of the skin with the feeling of scabies, instead of being diminished, was so increased that I gave up all external treatment (I was made more and more anæmic by the baths), and hardened myself as best I could. But the imperative female feeling remained, and became so strong that I wear only the mask of a man, and in everything else feel like a woman; and gradually I have lost memory of the former individuality. What was left of me from the gout, the influenza ruined entirely.

“Present Condition: I am tall, slightly bald, and the beard is growing gray. I begin to stoop. Since having the influenza, I have lost about a quarter of my strength. Owing to a valvular lesion, my face looks somewhat red; full beard; chronic conjunctivitis; more muscular than fat. The left foot seems to be developing varicose veins, and it often goes to sleep; but it is not really thickened, though it seems to be.

“The mammary region, though small, swells out perceptibly. The abdomen is feminine in form; the feet are placed like a woman’s, and the calves, etc., are feminine; and it is the same with arms and hands. I can wear ladies’ hose, and gloves, 7½ to 7¾ in size. I also wear a corset without annoyance. My weight varies between 168 and 184 pounds. Urine without albumen or sugar, but it contains an excess of uric acid. But if there is not too much uric acid in it, it is clear, and almost as clear as water after any excitement. Bowels usually regular; but should they not be, then come all the symptoms of female obstipation. Sleep is poor,—for weeks at a time only two or three hours long. Appetite quite good; but, on the whole, my stomach will not bear more than that of a strong woman, and reacts to irritating food with cutaneous eruption and burning in the urethra. The skin is white, and, for the most part, feels quite smooth; there has been unbearable cutaneous itching for the last two years; but during the last few weeks it has diminished, and is now present only in the popliteal spaces and on the scrotum.

“Tendency to perspire. Perspiration was previously as good as wanting, but now there are all the odious peculiarities of the female perspiration, particularly about the lower part of the body; so that I have to keep myself cleaner than a woman. (I perfume my handkerchief, and use perfumed soap and eau-de-Cologne.)

“General Feeling: I feel like a woman in a man’s form; and even though I often am sensible of the man’s form, yet it is always in a feminine sense. Thus, for example, I feel the penis as clitoris; the urethra as urethra and vaginal orifice, which always feels a little wet, even when it is actually dry; the scrotum as labia majora; in short, I always feel the vulva. And all that that means one alone can know who feels or has felt so. But the skin all over my body feels feminine; it receives all impressions, whether of touch, of warmth, or whether unfriendly, as feminine, and I have the sensations of a woman. I cannot go with bare hands, as both heat and cold trouble me. When the time is past when we men are permitted to carry sun-umbrellas, I have to endure great sensitiveness of the skin of my face, until sun-umbrellas can again be used. On awaking in the morning, I am confused for a few moments, as if I were seeking for myself; then the imperative feeling of being a woman awakens. I feel the sense of the vulva (that one is there), and always greet the day with a soft or loud sigh; for I have fear again of the play that must be carried on throughout the day. I had to learn everything anew; the knife—apparatus, everything—has felt different for the last three years; and with the change of muscular sense I had to learn everything over again. I have been successful, and only the use of the saw and bone-chisel are difficult; it is almost as if my strength were not quite sufficient. On the other hand, I have a keener sense of touch in working with the curette in the soft parts. It is unpleasant that, in examining ladies, I often feel their sensations; but this, indeed, does not repel them. The most unpleasant thing I experience is fœtal movement. For a long time—several months—I was troubled by reading the thoughts of both sexes, and I still have to fight against it. I can endure it better with women; with men it is repugnant. Three years ago I had not yet consciously seen the world with a woman’s eyes; this change in the relation of the eyes to the brain came almost suddenly, with violent headache. I was with a lady whose sexual feeling was reversed, when suddenly I saw her changed in the sense I now feel myself,—viz., she as man,—and I felt myself a woman in contrast with her; so that I left her with ill-concealed vexation. At that time she had not yet come to understand her own condition perfectly.

“Since then, all my sensory impressions are as if they were feminine in form and relation. The cerebral system almost immediately adjusted itself to the vegetative; so that all my ailments were manifested in a feminine way. The sensitiveness of all nerves, particularly that of the auditory and olfactory and trigeminal, increased to a condition of nervousness. If only a window slammed, I was frightened inwardly; for a man dare not tremble at such things. If food is not absolutely fresh, I perceive a cadaverous odor. I could never depend on the trigeminus; for the pain would jump whimsically from one branch of it to another; from a tooth to an eye. But, since my transformation, I bear toothache and migraine more easily, and have less feeling of fear with stenocardia. It seems to me a strange fact that I feel myself to be a fearful, weak being, and yet, when danger threatens, I am much rather cool and collected; and this is true in dangerous operations. The stomach rebels against the slightest indiscretion (in female diet) that is committed without thought of the female nature, either by ructus or other symptoms; but particularly against abuse of alcoholics. The indisposition after intoxication that a man who feels like a woman experiences is much worse than any a student could get up. It seems to me almost as if one feeling like a woman were entirely controlled by the vegetative system.

“Small as my nipples are, they demand room, and I feel them as mammæ; just as during the beginning of puberty, the nipples swelled and pained. On this account, the white shirt, the waistcoat, and the coat trouble me. I feel as though the pelvis were female; and it is the same with the anus and nates. At first the sense of a female abdomen was troublesome to me; for it cannot bear trousers, and it always possesses or induces the feminine feeling. I also have the imperative feeling of a waist. It is as if I were robbed of my own skin, and put in a woman’s skin that fitted me perfectly, but which felt everything as if it covered a woman; and whose sensations passed through the man’s body, and exterminated the masculine element. The testes, even though not atrophied or degenerated, are still no longer testes, and often cause me pain, with the feeling that they belong in the abdomen, and should be fastened there; and their mobility often bothers me.

“Every four weeks, at the time of the full moon, I have the molimen of a woman for five days, physically and mentally, only I do not bleed; but I have the feeling of a loss of fluid; a feeling that the genitals and abdomen are (internally) swollen. A very pleasant period comes when, afterward and later in the interval for a day or two, the physiological desire for procreation comes, which with all power permeates the woman. My whole body is then filled with this sensation, as an immersed piece of sugar is filled with water, or as full as a soaked sponge. It is like this: first, a woman longing for love, and then, for a man; and, in fact, the desire, as it seems to me, is more a longing to be possessed than a wish for coitus. The intense natural instinct or the feminine concupiscence overcomes the feeling of modesty, so that indirectly coitus is desired. I have never felt coitus in a masculine way more than three times in my life; and even if it were so in general, I was always indifferent about it. But, during the last three years, I have experienced it passively, like a woman; in fact, oftentimes with the feeling of feminine ejaculation; and I always feel that I am impregnated. I am always fatigued as a woman is after it, and often feel ill, as a man never does. Sometimes it caused me so great pleasure that there is nothing with which I can compare it; it is the most blissful and powerful feeling in the world; at that moment the woman is simply a vulva that has devoured the whole person.

“During the last three years I have never lost for an instant the feeling of being a woman, and now, owing to habit, this is no longer annoying to me, though during this period I have felt debased; for a man could endure to feel like a woman without a desire for enjoyment; but when desires come! The happiness ceases; then come the burning, the heat, the feeling of turgor of the genitals (when the penis is not in a state of erection the genitals do not play any part). In case of intense desire, the feeling of sucking in the vagina and vulva is really terrible—a hellish pain of lust hardly to be endured. If I then have opportunity to perform coitus, it is better; but, owing to defective sense of being possessed by the other, it does not afford complete satisfaction; the feeling of sterility comes with its weight of shame, added to the feeling of passive copulation and injured modesty. I seem almost like a prostitute. Reason does not give any help; the imperative feeling of femininity dominates and rules everything. The difficulty in carrying on one’s occupation, under such circumstances, is easily appreciated; but it is possible to force one’s self to it. Of course, it is almost impossible to sit, walk, or lie down; at least, any one of these cannot be endured long; and with the constant touch of the trousers, etc., it is unendurable.

“Marriage then, except during coitus, where the man has to feel himself a woman, is like two women living together, one of whom regards herself as in the mask of a man. If the periodical molimen fail to occur, then come the feelings of pregnancy or of sexual satiety, which a man never experiences, but which take possession of the whole being, just as the feeling of femininity does, and are repugnant in themselves; and, therefore, I gladly welcome the regular molimen again. When erotic dreams or ideas occur, I see myself in the form I have as a woman, and see erected organs presenting. Since the anus feels feminine, it would not be hard to become a passive pederast; only positive religious command prevents it, as all other deterrent ideas would be overcome. Since such conditions are repugnant, as they would be to any one, I have a desire to be sexless, or to make myself sexless. If I had been single, I should long ago have taken leave of testes, scrotum, and penis.

“Of what use is female pleasure, when one does not conceive? What good comes from excitation of female love, when one has only a wife for gratification, even though copulation is felt as though it were with a man? What a terrible feeling of shame is caused by the feminine perspiration! How the feeling for dress and ornament lowers a man! Even in his changed form, even when he can no longer recall the masculine sexual feeling, he would not wish to be forced to feel like a woman. He still knows very well that, before, he did not constantly feel sexually; that he was merely a human being uninfluenced by sex. Now, suddenly, he has to regard his former individuality as a mask, and constantly feel like a woman, only having a change when, every four weeks, he has his periodical sickness, and in the intervals his insatiable female desire. If he could but awake without immediately being forced to feel like a woman! At last he longs for a moment in which he might raise his mask; but that moment does not come. He can only find amelioration of his misery when he can put on some bit of female attire or finery, an under-garment, etc.; for he dare not go about as a woman. To be compelled to fulfill all the duties of a calling with the feeling of being a woman costumed as a man, and to see no end of it, is no trifle. Religion alone saves from a great lapse; but it does not prevent the pain when temptation affects the man who feels as a woman; and so it must be felt and endured! When a respectable man who enjoys an unusual degree of public confidence, and possesses authority, must go about with his vulva—imaginary though it be; when one, leaving his arduous daily task, is compelled to examine the toilette of the first lady he meets, and criticise her with feminine eyes, and read her thoughts in her face; when a journal of fashions possesses an interest equal to that of a scientific work (I felt this as a child); when one must conceal his condition from his wife, whose thoughts, the moment he feels like a woman, he can read in her face, while it becomes perfectly clear to her that he has changed in body and soul,—what must all this be? The misery caused by the feminine gentleness that must be overcome! Oftentimes, of course, when I am away alone, it is possible to live for a time more like a woman; for example, to wear female attire, especially at night, to keep gloves on, or to wear a veil or a mask in my room, so that thus there is rest from excessive libido. But when the feminine feeling has once gained an entrance, it imperatively demands recognition. It is often satisfied with a moderate concession, such as the wearing of a bracelet above the cuff; but it imperatively demands some concession. My only happiness is to see myself dressed as a woman without a feeling of shame; indeed, when my face is veiled or masked, I prefer it so, and thus think of myself. Like every one of Fashion’s fools, I have a taste for the prevailing mode; so greatly am I transformed. To become accustomed to the thought of feeling only like a woman, and only to remember the previous manner of thought to a certain extent in contrast with it; and, at the same time, to express one’s self as a man,—it requires a long time and an infinite amount of persistence.

“Nevertheless, in spite of everything, it will happen that I betray myself by some expression of feminine feeling, either in sexualibus, when I say that I feel so and so, expressing what a man without the female feeling cannot know; or when I accidentally betray that female attire is my talent. Before women, of course, this does not amount to anything; for a woman is greatly flattered when a man understands something of her matters; but this must not be displayed to my own wife. How frightened I once was when my wife said to a friend that I had great taste in ladies’ dress! How a haughty, stylish lady was astonished when, as she was about to make a great error in the education of her little daughter, I described to her in writing and verbally all the feminine feelings! To be sure, I lied to her, saying that my knowledge had been gleaned from letters. But her confidence in me is as great as ever; and the child, who was on the road to insanity, is rational and happy. She had confessed all the feminine inclinations as sins; now she knows what, as a girl, she must bear and control by will and religion; and she feels that she is human. Both ladies would laugh heartily, if they knew that I had only drawn on my own sad experience. I must also add that I now have a finer sense of temperature and, besides, a sense of the elasticity of the skin and tension of the intestines, etc., in patients, that was unknown to me before; that in operations and autopsies, poisonous fluids more readily penetrate my (uninjured) skin. Every autopsy causes me pain; examination of a prostitute, or a woman having a discharge, a cancerous odor, or the like, is actually repugnant to me. In all respects I am now under the influence of antipathy and sympathy, from the sense of color to my judgment of a person. Women usually see in each other the periodical sexual disposition; and, therefore, a lady wears a veil, if she is not always accustomed to wear one, and usually she perfumes herself, even though it be only with handkerchief or gloves; for her olfactory sense in relation to her own sex is intense. Odors have an incredible effect on the female organism; thus, for example, the odors of violets and roses quiet me, while others disgust me; and with ihlang-ihlang I cannot contain myself for sexual excitement. Contact with a woman seems homogeneous to me; coitus with my wife seems possible to me because she is somewhat masculine, and has a firm skin; and yet it is more an amor lesbicus.

“Besides, I always feel passive. Often at night, when I cannot sleep for excitement, it is finally accomplished, si femora mea distensa habeo, sicut mulier cum viro concumbens, or if I lie on my side; but an arm or the bed-clothing must not touch the mammæ, or there is no sleep; and there must be no pressure on the abdomen. I sleep best in a chemise and night-robe, and with gloves on; for my hands easily get cold. I am also comfortable in female drawers and petticoats, because they do not touch the genitals. I liked female dresses best when crinoline was worn. Female dresses do not annoy the feminine-feeling man; for he, like every woman, feels them as belonging to his person, and not as something foreign.

“My dearest associate is a lady suffering with neurasthenia, who, since her last confinement, feels like a man, but who, since I explained these feelings to her, coitu abstinet as much as possible, a thing I, as a husband, dare not do. She, by her example, helps me to endure my condition. She has a more perfect memory of the female feelings, and has often given me good advice. Were she a man and I a young girl, I should seek to win her; for her I should be glad to endure the fate of a woman. But her present appearance is quite different from what it formerly was. She is a very elegantly dressed gentleman, notwithstanding bosom and hair; she also speaks quickly and concisely, and no longer takes pleasure in the things that please me. She has a kind of melancholy dissatisfaction with the world, but she bears her fate worthily and with resignation, finding her comfort only in religion and the fulfillment of duty. At the time of the menses, she almost dies. She no longer likes female society and conversation, and has no liking for delicacies.

“A youthful friend felt like a girl from the very first, but he had inclinations toward the male sex. His sister had the opposite condition; and when the uterus demanded its right, and she saw herself as a loving woman, in spite of her masculinity, she cut the matter short, and committed suicide by drowning.

“Since complete effemination, the principal changes I have observed in myself are:—

“1. The constant feeling of being a woman from top to toe.

“2. The constant feeling of having female genitals.

“3. The periodicity of the monthly molimen.

“4. The regular occurrence of female desire, though not directed to any particular man.

“5. The passive female feeling in coitus.

“6. After that, the feeling of impregnation.

“7. The female feeling in thought of coitus.

“8. At the sight of women, the feeling of being of their kind, and the feminine interest in them.

“9. At the sight of men, the feminine interest in them.

“10. At the sight of children, the same feeling.

“11. The changed disposition and much greater patience.

“12. The final resignation to my fate, for which I have nothing to thank but positive religion; without it I should have long ago committed suicide.

“To be a man and to be compelled to feel that chaque femme est futuée ou elle désire d’être, is hardly to be endured.”

The foregoing autobiography, scientifically so important, was accompanied by the following no less interesting letter:—

“Sir: I must next beg your indulgence for troubling you with my communication. I lost all control, and thought of myself only as a monster before which I myself shuddered. Then your work gave me courage again; and I determined to go to the bottom of the matter, and examine my past life, let the result be what it might. It seemed a duty of gratitude to you to tell you the result of my recollection and observation, since I had not seen any description by you of an analogous case; and, finally, I also thought it might perhaps interest you to learn, from the pen of a physician, how such a worthless human, or masculine, being thinks and feels under the weight of the imperative idea of being a woman.

“It is not perfect; but I no longer have the strength to reflect more upon it, and have no desire to go into the matter more deeply. Much is repeated; but I beg you to remember that any mask may be allowed to fall off, particularly when it is not voluntarily worn, but enforced.

“After reading your work, I hope that, if I fulfill my duties as physician, citizen, father, and husband, I may still count myself among human beings who do not deserve merely to be despised.

“Finally, I wished to lay the result of my recollection and reflection before you, in order to show that one thinking and feeling like a woman can still be a physician. I consider it a great injustice to debar woman from Medicine. A woman, through her feeling, gets on the track of many ailments which, in spite of all skill in diagnosis, remain obscure to a man; at least, in the diseases of women and children. If I could have my way, I should have every physician live the life of a woman for three months; then he would have a better understanding and more consideration in matters affecting the half of humanity from which he comes; then he would learn to value the greatness of women, and appreciate the difficulty of their lot.”

Remarks: The badly-tainted patient is originally psycho-sexually abnormal, in that, in character and in the sexual act, he feels as a female. This abnormal feeling remained purely a psychical anomaly until three years ago, when, owing to severe neurasthenia, it received overmastering support in imperative bodily sensations of a transmutatio sexus, which now dominate consciousness. Then, to the patient’s horror, he felt bodily like a woman; and, under the impulse of his imperative feminine sensations, he experienced a complete transformation of his former masculine feeling, thought, and will; in fact, of his whole vita sexualis, in the sense of eviration. At the same time, his ego is able to control these abnormal psycho-physical manifestations, and prevent descent to paranoia,—a remarkable example of imperative feelings and ideas on the basis of neurotic taint, which is of great value for a comprehension of the way in which the psycho-sexual transformation may be accomplished.

IV. Degree: Metamorphosis Sexualis Paranoica.—A final possible stage in this disease-process is the delusion of a transformation of sex. It arises on the basis of sexual neurasthenia that has developed into neurasthenia universalis, resulting in a mental disease,—paranoia.

The following cases show the development of the interesting neuro-psychological process to its height:—

Case 100. K., aged 36, single, servant, received at the clinic on February 26, 1889, is a typical case of paranoia persecutoria, resulting from neurasthenia sexualis, with olfactory hallucinations, sensations, etc. He comes of a predisposed family. Several brothers and sisters were psychopathic. Patient has an hydrocephalic skull, depressed in the region of the right fontanelle; eyes neuropathic. He has always been very sensual; began to masturbate at nineteen; had coitus at twenty-three; begat three illegitimate children. He gave up further sexual intercourse, on account of fear of begetting more children, and of being unable to provide for them. Abstinence proved very painful to him. He also gave up masturbation, and was then troubled with pollutions. A year and a half ago he became sexually neurasthenic, had diurnal pollutions, became thereafter ill and miserable, and, after a time, generally neurasthenic, finally developing paranoia. A year ago he began to have paræsthetic sensations,—as if there were a great coil in the place of his genitals; and then he felt that his scrotum and penis were gone, and that his genitals were changed into those of a female. He felt the growth of his breasts; that his hair was that of a woman; and that feminine garments were on his body. He thought himself a woman. The people in the street gave utterance to corresponding remarks: “Look at the woman! The old blowhard!” In a half dreamy state, he had the feeling as if he played the part of a woman in coitus with a man. During it he had the most lively feelings of pleasure. During his stay at the clinic, a remission of the paranoia occurred, and, at the same time, a marked improvement of the neurasthenia. Then the feelings and ideas due to a developing metamorphosis sexualis disappeared.

A more advanced case of eviration, on the way to a transformatio sexus paranoica, is the following:—

Case 101. Franz St., aged 33; school-teacher; single; probably of tainted family; always neuropathic; emotional, timid, intolerant of alcohol; began to masturbate at eighteen. At thirty there were manifestations of neurasthenia sexualis (pollutions with consequent fatigue, which at last began to occur during the day; pain in the region of the sacral plexus, etc.). Gradually, spinal irritation, pressure in the head, and cerebral neurasthenia were added. Since the beginning of 1885 the patient had given up coitus, in which he no longer experienced pleasurable feeling. He masturbated frequently.

In 1888 he began to have delusions of suspicion. He noticed that he was avoided, and that he had unpleasant odors about him (olfactory hallucinations). In this way he explained the altered attitude of people, and their sneezing, coughing, etc. He smelled corpses and foul urine. He recognized the cause of his bad smells in inward pollutions. He recognized these in a feeling he had as if a fluid flowed up from the symphysis toward the breast. Patient soon left the clinic.

In 1889 he was again received in an advanced stage of paranoia masturbatoria persecutoria (delusions of physical persecution).

In the beginning of May, 1889, the patient attracted notice, in that he was cross when he was addressed as “mister.” He protested against it, because he was a woman. Voices told him this. He noticed that his breasts were growing. Some weeks before, others had touched him in a sensual manner. He heard it said that he was a whore. Of late, dreams of pregnancy. He dreamed that, as a woman, he indulged in coitus. He felt the immissio penis, and, during the hallucinatory act, also a feeling of ejaculation.

Head straight; facial form long and narrow; parietal eminences prominent; genitals normally developed.

The following case, observed in the asylum at Illenau, is a pertinent example of lasting delusional alteration of sexual consciousness:—

Case 102. Metamorphosis Sexualis Paranoica.—N., aged 23, single, pianist, was received in the asylum at Illenau in the last part of October, 1865. He came of a family in which there was said to be no hereditary taint; but it was tuberculous (father and brother died of pulmonary tuberculosis). Patient, as a child, was weakly and dull, though especially talented in music. He was always of abnormal character; silent, retiring, unsocial, and sullen. He practiced masturbation after fifteen. After a few years neurasthenic symptoms (palpitation of the heart, lassitude, occasional pressure in the head, etc.), and also hypochondriacal symptoms, were manifested. During the last year he had worked with great difficulty. For about six months neurasthenia had increased. He complained of palpitation of the heart, pressure in the head, and sleeplessness; was very irritable, and seemed to be sexually excited. He declared that he must marry for his health. He fell in love with an artist, but almost at the same time (September, 1865) he fell ill with paranoia persecutoria (ideas of enemies, derision in the street, poison in food; obstacles were placed on the bridges to keep him from going to his inamorata). On account of increasing excitement and conflicts with those about him that he considered inimical to him, he was taken to the asylum. At first he presented the picture of a typical paranoia persecutoria with symptoms of sexual, and later general, neurasthenia, though the delusions of persecution did not rest upon this neurotic foundation. It was only occasionally that the patient heard such sentences as this: “Now the semen will be drawn out of him. Now the bladder will be cut out.”

In the course of the years 1866–68, the delusions of persecution became less and less apparent, and were for the most part replaced by erotic ideas. The somatic and mental basis was a lasting and powerful excitation of the sexual sphere. The patient fell in love with every woman he saw, heard voices which told him to approach her, and begged to be allowed to marry, declaring that, if he was not given a wife, he would waste away. With continuance of masturbation, in 1869, signs of future effemination made themselves manifest. “He would, if he should get a wife, love her only platonically.” The patient grows more and more peculiar, lives in a circle of erotic ideas, sees prostitution practiced in the asylum, and now and then hears voices which impute immoral conduct with women to him. For this reason he avoids the society of women, and only associates with them for the sake of music when two witnesses are with him.

In the course of the year 1872, the neurasthenic condition became markedly increased. Now paranoia persecutoria again comes into the foreground, and takes on a clinical coloring from the neurotic basis. Olfactory hallucinations occur. Magnetic influences are at work on him (false interpretation of sensations due to spinal asthenia). With continued and intense sexual excitement and excess in masturbation, the process of effemination constantly progresses. Only episodically is he a man and inclined toward a woman, complaining that the shameless prostitution of the men in the house makes it impossible for a lady to come to him. He is dying of magnetically poisoned air and unsatisfied love. Without love he cannot live. He is poisoned by lewd poison that affects his sexual desire. The lady that he loves is sunk in the lowest vice. The prostitutes in the house have fortune-chains; that is, chains in which, without moving, a man can indulge in lustful pleasure. He is ready now to satisfy himself with prostitutes. He is possessed of a wonderful ray of thought that emanates from his eyes, which is worth twenty millions. His compositions are worth 500,000 francs. With these indications of delusions of grandeur, there are also those of persecution—the food is poisoned by venereal excrement; he tastes and smells poison, hears infamous accusations, and asks for instruments to close his ears. From August, 1872, however, the signs of effemination become more and more frequent. He acts somewhat affected, declaring that he can no longer live among men that drink and smoke. He thinks and feels like a woman. He must thenceforth be treated like a woman and transferred to a female ward. He asks for confections and delicate desserts. Occasionally, on account of tenesmus and cystospasm, he asks to be transferred to a lying-in hospital and treated as a woman very ill in pregnancy. The abnormal magnetism of masculine attendants has an unfavorable effect on him. At times he still feels himself to be a man, but in a way which indicates his abnormally altered sexual feeling. He pleads only for satisfaction by means of masturbation, or for marriage without coitus. Marriage is a sensual institution. The girl that he would take for a wife must be a masturbator. About the end of December, 1872, his personality became completely feminine. From that time he remained a woman. He had always been a woman, but in his babyhood a French Quaker, an artist, had put masculine genitals on him, and by rubbing and distorting his thorax had prevented the development of his breasts. After this he demanded to be transferred to the female department, protection from men that wished to violate him, and asked for female clothing. Eventually he also desired to be given employment in a toy-shop, with crocheting and embroidery work to do, or a place in a dress-making establishment with female work. From the time of the transformatio sexus, the patient begins a new reckoning of time. He conceives his previous personality in memory as that of a cousin.

He always speaks of himself in the third person, and calls himself the Countess V., the dearest friend of the Empress Eugenie; asks for perfumes, corsets, etc. He takes the other men of the ward for girls, tries to raise a head of hair, and demands “Oriental Hair-Remover,” in order that no one may doubt his gender. He takes delight in praising onanism, for “she had been an onanist from fifteen, and had never desired any other kind of sexual satisfaction.” Occasionally neurasthenic symptoms, olfactory hallucinations, and persecutory delusions are observed. All the events up to the time of December, 1872, belong to the personality of the cousin.

The patient’s delusion that he is the Countess V. can no longer be corrected. She proves her identity by the fact that the nurse has examined her, and finds her to be a lady. The countess will not marry, because she hates men. Since he is not provided with female clothing and shoes, he spends the greatest part of the day in bed, acts like an invalid lady of position, affectedly and modestly, and asks for bon-bons and the like. His hair is done, up in a knot as well as it allows, and the beard is pulled out. Breasts are made out of biscuits.

In 1874 caries began in the left knee-joint, to which pulmonary tuberculosis was soon added. Death on December 2, 1874. Skull normal. Frontal lobes atrophic. Brain anæmic. Microscopical (Dr. Schüle): In the superior layer of the frontal lobe, ganglion cells somewhat shrunken; in the adventitia of the vessels, numerous fat-corpuscles; glia unchanged; isolated pigment particles and colloid bodies. The lower layers of the cortex normal. Genitals very large; testicles small, lax, and show no change macroscopically on section.

The delusion of sexual transformation, displayed, in its conditions and phases of development, in the foregoing case, is a manifestation remarkably infrequent in the pathology of the human mind. Besides the foregoing cases, personally observed, I have seen such a case, as an episodical phenomenon, in a lady having contrary sexuality (Case 92 of the sixth edition of this work), one in a girl affected with original paranoia, and another in a lady suffering with original paranoia.

Save for a case briefly reported by Arndt, in his text-book (p. 172), and one quite superficially described by Sérieux (“Recherches Clinique,” p. 33), and the two cases known to Esquirol, I cannot recall any cases of delusion of sexual transformation in literature. Arndt’s case may be briefly given here, though, like Esquirol’s cases, it gives nothing concerning the genesis of the delusion:—

Case 103. A middle-aged woman in the asylum at Greifswald thought she was a man, and acted out her belief. She cut her hair short, and parted it on one side in the military fashion. A sharply-cut profile, a nose somewhat large, and a certain heaviness of all the features gave the face something characteristic, and, in combination with the short hair combed smoothly over the ears, gave the whole head a decidedly masculine appearance. She was tall and lean; her voice low and rough; the larynx angularly prominent; her attitude erect; her gait, like all her movements, heavy, but not awkward. She looked like a man in female dress. Asked how she had come to think she was a man, she would almost always cry excitedly: “Just look at me! Don’t I look like a man? I feel like a man, too. I have always felt so, but I only gradually came to understand it clearly. The man who should be my husband is not a real man. I raised my children myself. I always felt somewhat like this, but I came to understand later. Did I not always work like a man? The man who passed for my husband only helped. He did what I planned. From my youth I have been more masculine than feminine. I have always had more liking for the garden and farm than for work in the house and kitchen. But I never understood the reason. Now I know I am a man, and I shall bear myself like one. It is a shame to make me always wear women’s clothes.”

Case 104. X., aged 26, tall, and of handsome appearance. Since his earliest youth he has loved to wear female attire. As he grew up, he managed it so that, when he was a participant in theatricals, he always had a female part. After an attack of mental excitement, he imagined that he was actually a woman, and tried to convince others of it.

He liked to undress himself, and dress his hair and put on female clothing. In this state he wished to go out on the street. In other respects he was perfectly reasonable. He would spend the whole day arranging his hair and looking at himself in the glass, costuming himself in a night-dress as much like a woman as possible. In walking he imitated women. One day, when Esquirol acted as if about to lift up his dress, he flew into a passion and upbraided him for his want of modesty (Esquirol).

Case 105. Mrs. X., widow. Owing to the death of her husband and loss of fortune, she had been greatly troubled in mind. She became disturbed mentally, and was admitted to the Salpêtrière after attempting suicide.

Mrs. X., lean, thin; constantly maniacal; she believes herself a man, and flies angry if she is addressed as “madam.” Once, when male clothing was placed at her disposal, she was beside herself with joy. She died, in 1802, of a consumptive malady; and she expressed her delusion of being a man until shortly before her death (Esquirol).

I have already mentioned the interesting relations existing between the facts of delusional transformation of sex and the so-called insanity of the Scythians.

Marandon (“Annales médico-psychologiques,” 1877, p. 161), like others, has erroneously presumed that with the ancient Scythians there was an actual delusion, and that the condition was not merely that of eviration. According to the law of empirical actuality, the delusion, so infrequent to-day, must also have been very infrequent in ancient times. Since it can only be conceived as arising on the basis of a paranoia, there can be no thought of its endemic occurrence; it can only be regarded as a superstitious manifestation of eviration (the result of anger of the goddess), as is also evident from the statements of Hippocrates.

The facts of the so-called Scythian insanity, as well as the facts lately learned about the Pueblo Indians, are also noteworthy anthropologically, in that atrophy of the testes and genitals in general, and approximation to the female type, physically and mentally, were observed. This is the more remarkable, since, in men who have lost their procreative organs, such a reversal of instinct is quite as unusual as in women, mutatis mutandis, after the natural or artificial climacteric.

B. Homo-Sexual Feeling as an Abnormal Congenital Manifestation.[105]—The essential feature of this strange manifestation of the sexual life is the want of sexual sensibility for the opposite sex, even to the extent of horror, while sexual inclination and impulse toward the same sex are present. At the same time, the genitals are normally developed, the sexual glands perform their functions properly, and the sexual type is completely differentiated.

Feeling, thought, will, and the whole character, in cases of the complete development of the anomaly, correspond with the peculiar sexual instinct, but not with the sex which the individual represents anatomically and physiologically. This abnormal mode of feeling may not infrequently be recognized in the manner, dress, and calling of the individuals, who may go so far as to yield to an impulse to don the distinctive clothing corresponding with the sexual rôle in which they feel themselves to be.

Anthropologically and clinically, this abnormal manifestation presents various degrees of development:—

1. Traces of hetero-sexual, with predominating homo-sexual, instinct (psycho-sexual hermaphroditism).

2. There exists inclination only toward the same sex (homo-sexuality).

3. The entire mental existence is altered to correspond with the abnormal sexual instinct (effemination and viraginity).

4. The form of the body approaches that which corresponds to the abnormal sexual instinct. However, actual transitions to hermaphrodites never occur, but, on the contrary, completely differentiated genitals; so that, just as in all pathological perversions of the sexual life, the cause must be sought in the brain (androgyny and gynandry).

The first definite communications[106] concerning this enigmatical phenomenon of Nature are made by Caspar (“Ueber Nothzucht und Päderastie,” Caspar’s Vierteljahrsschrift, 1852, i), who, it is true, classes it with pederasty, but makes the pertinent remark that this anomaly is, in most cases, congenital, and, at the same time, to be regarded as a mental hermaphroditism. There exists here an actual disgust of sexual contact with women, while the imagination is filled with beautiful young men, and with statues and pictures of them. It did not escape Casper that in such cases emissio penis in anum (pederasty) is not the rule, but that, by means of other sexual acts (mutual onanism), sexual satisfaction is sought and obtained.

In his “Clinical Novels” (1863, p. 33) Casper gives the interesting confession of a man showing this perversion of the sexual instinct, and does not hesitate to assert that, aside from vicious imagination and vice, as a result of over-indulgence in normal sexual intercourse, there are numerous cases in which pederasty has its origin in a remarkable, obscure impulse, which is congenital and inexplicable. About the middle of the “sixties,” a certain assessor, Ulrichs, himself subject to this perverse instinct, came out and declared, in numerous articles,[107] that the sexual mental life was not connected with the bodily sex; that there were male individuals that felt like women toward men (“anima muliebris in corpore virili inclusa”). He called these people “urnings,” and demanded nothing less than the legal and social recognition of this sexual love of the urnings as congenital and, therefore, as right; and the permission of marriage among them. Ulrichs failed, however, to prove that this certainly congenital and paradoxical sexual feeling was physiological, and not pathological.

Griesinger (Archiv f. Psychiatrie, i, p. 651) threw the first ray of light on these facts, anthropologically and clinically, by pointing out the marked hereditary taint of the individual, in a case which came under his own observation.

We have Westphal (Archiv f. Psychiatrie, ii, p. 73) to thank for the first systematic consideration of the manifestation in question, which he defined as “congenital reversal of the sexual feeling, with consciousness of the abnormality of the manifestation,” and designated with the name, since generally accepted, of contrary sexual instinct. At the same time, he began a series of cases,[108] which, up to this time, has reached ninety-three, those reported in this monograph not being included.

Westphal leaves it undecided as to whether contrary sexual feeling is a symptom of a neuropathic or of a psychopathic condition, or whether it may occur as an isolated manifestation. He holds fast to the opinion that the condition is congenital.

From the cases published up to 1877, I have designated this peculiar sexual feeling as a functional sign of degeneration, and as a partial manifestation of a neuro-psychopathic state, in most cases hereditary,—a supposition which has found renewed confirmation in a consideration of additional cases. The following peculiarities may be given as the signs of this neuro-psychopathic taint:—

1. The sexual life of individuals thus organized manifests itself, as a rule, abnormally early, and thereafter with abnormal power. Not infrequently still other perverse manifestations are presented besides the abnormal method of sexual satisfaction, which in itself is conditioned by the peculiar sexual feeling.

2. The psychical love manifest in these men is, for the most part, exaggerated and exalted in the same way as their sexual instinct is manifested in consciousness, with a strange and even compelling force.

3. By the side of the functional signs of degeneration attending contrary sexual feeling are found other functional, and in many cases anatomical, evidences of degeneration.

4. Neuroses (hysteria, neurasthenia, epileptoid states, etc.) co-exist. Almost always the existence of temporary or lasting neurasthenia may be proved. As a rule, this is constitutional, having its root in congenital conditions. It is awakened and maintained by masturbation or enforced abstinence.

In male individuals, owing to these practices or to congenital disposition, there is finally neurasthenia sexualis, which manifests itself essentially in irritable weakness of the ejaculation centre. Thus it is explained that, in most of the cases, simply embracing and kissing, or even only the sight of the loved person, induce the act of ejaculation. Frequently this is accompanied by an abnormally powerful feeling of lustful pleasure, which may be so intense as to suggest a feeling of magnetic currents passing through the body.

5. In the majority of cases, psychical anomalies (brilliant endowment in art, especially music, poetry, etc., by the side of bad intellectual powers or original eccentricity) are present, which may even go so far as pronounced conditions of mental degeneration (dementia, moral insanity).

In many urnings, either temporarily or permanently, insanity of a degenerative character (pathological emotional states, periodical insanity, paranoia, etc.) makes its appearance.

6. In almost all cases where an examination of the physical and mental peculiarities of the ancestors and blood-relations has been possible, neuroses, psychoses, degenerative signs, etc., have been found in the families.[109]

The depth of congenital contrary feeling is shown by the fact that the lustful dream of the male-loving urning has for its content only male individuals; that of the female-loving woman, only female individuals, with corresponding situations.

The observation of Westphal, that the consciousness of one congenitally defective in sexual desires toward the opposite sex is painfully affected by the impulse toward the same sex, is true in only a number of cases. Indeed, in many instances, the consciousness of the abnormality of the condition is wanting. The majority of urnings are happy in their perverse sexual feeling and impulse, and unhappy only in so far as social and legal barriers stand in the way of the satisfaction of their instinct toward their own sex.

The study of contrary sexual feeling points directly to anomalies of the cerebral organization of the affected individuals. Gley (Revue philosoph., January, 1884) believes that he is able to solve the riddle by the theory that the individuals have a female brain and male sexual glands; and, further, that pathological brain conditions determine the sexual life, while normally the sexual organs determine the sexual functions of the brain.

One of my patients offered me an interesting theory in explanation of original contrary sexual instinct. He started with the actual bi-sexuality shown by the fœtus anatomically up to a certain age. While normally the organs which attain complete development exclusively condition and determine the sexual type, and the influence of the opposite organs, which remain rudimentary, is nil, it is conceivable that, under the influence of a factor inimical to the normal development of the brain (hereditary taint, etc.), these rudimentary organs likewise exercise an influence which, under certain circumstances, may be even greater than that of the fully developed organs which determine the external sexual type.

In a similar manner, Kiernan (Medical Standard, 1888) and G. Frank Lydston (Phila. Med. and Surg. Reporter, 1888) attempt to explain a part of the cases of congenital sexual paranoia. Magnan, too (Ann. méd. psychol., 1885, p. 458), writes, in all earnestness, of the brain of a woman in the body of a man, and vice versâ.[110]

The attempted explanations of congenital urnings are not less superficial; for instance, that of Ulrichs, who, in his “Memnon,” 1868, speaks of an “anima muliebris virili corpore inclusa (virili corpori innata),” and thus tries to explain the congenital origin and the female character of his abnormal sexual instinct. The idea of the patient, the subject of Case 124, is original. He supposes that when his father begat him he thought to beget a girl, but, instead of a girl, a boy resulted. One of the strangest explanations of congenital contrary sexual feeling is made by Mantegazza (op. cit., p. 106, 1886).

According to this author, in such individuals there exist anatomical anomalies which, by an error of Nature, consist in a distribution to the rectum of the nerves intended for the genitals; so that only in this situation the lustful sensation is aroused which otherwise results from stimulation of the genitals. But how does this author, in other ways so acute, explain the great majority of cases, where pederasty is abhorred by those affected with contrary sexual feeling? Besides, Nature never makes such leaps. Mantegazza rests his hypothesis upon the statements of an acquaintance, a celebrated writer, who assured him that he was not sure that he took a greater pleasure in coitus than in defecation! Allowing the correctness of his experience, still it would only prove that the man was sexually abnormal, and that his pleasure in coitus was reduced to a minimum.

An explanation of congenital contrary sexual feeling may perhaps be found in the fact that it represents a peculiarity bred in descendants, but arising in ancestry. The hereditary factor might be an acquired abnormal inclination for the same sex in the ancestors (v. infra), found fixed as a congenital abnormal manifestation in the descendants. Since, according to experience, acquired physical and mental peculiarities, not simply improvements, but essentially defects, are transmitted, this hypothesis becomes tenable. Since individuals affected with contrary sexual feeling not infrequently beget children,—at least, they are not absolutely impotent (women never are),—a transmission to descendants is possible.

This supposition is decidedly favored by Case 124, in which the eight-year-old daughter of an individual affected with contrary sexual feeling, practiced mutual masturbation—a sexual act—at an age which permits the presumption of contrary sexual feeling. No less significant is the communication made to me by a young man of twenty-six, who belongs to the third group of contrary sexuality. He knew with certainty that his father, who had died some years before, was also subject to contrary sexuality. An informant assured me, at least, that he knew many other men with whom his father had sustained “relations.” Whether, in the case of the father, it was an acquired or a congenital contrary sexual instinct, and to what group he belonged, could not be ascertained.

The foregoing hypothesis seems the more plausible, when it is considered that the first three degrees of congenital contrary sexual instinct correspond exactly with the developmental stages which are discoverable in the development of the acquired anomaly. One, therefore, feels inclined to designate the various degrees of congenital contrary sexual instinct as various degrees of an hereditarily-induced sexual anomaly, acquired from the progenitors or otherwise developed. Here, too, the law of progressive heredity must be taken into consideration.

The sexual acts, by means of which male urnings seek and find satisfaction, are multifarious. There are individuals, of fine feeling and strength of will, who sometimes satisfy themselves with platonic love, with the risk, however, of becoming nervous (neurasthenic) and insane, as a result of this enforced abstinence. In other instances, for the same reasons which may lead normal individuals to avoid coitus, onanism, faut de mieux, is indulged in.

In urnings with nervous systems congenitally irritable, or injured by onanism (irritable weakness of the ejaculation centre), simple embraces or caresses, with or without contact of the genitals, are sufficient to induce ejaculation and consequent satisfaction. In less irritable individuals, the sexual act consists of manustupration by the loved person, or mutual onanism, or imitation of coitus between the thighs. In urnings morally perverse and potent, quoad erectionem, the sexual desire is satisfied by pederasty,—an act, however, which is repugnant to perverted individuals that are not defective morally, much in the same way as it is to normal men. The statement of urnings is remarkable, that the sexual act with persons of the same sex, which is adequate for them, gives them a feeling of great satisfaction and accession of strength, while satisfaction by solitary onanism, or by enforced coitus with a woman, affects them in an unfavorable way, making them miserable and increasing their neurasthenic symptoms. The manner of satisfaction of the female urning is little known. In one of my cases, the girl masturbated, and during the act felt herself to be a man; and her fancy created a beloved female person. In another case, the act consisted of practicing onanism on the person loved, and fondling her genitals.

Amor lesbicus is presumably not infrequent here, for which an enlarged clitoris or an artificial priapus may be used.

As to the frequency[111] of the occurrence of the anomaly, it is difficult to reach a just conclusion, since those affected with it break from their reserve only very infrequently; and in criminal cases the urning with perversion of sexual instinct is usually classed with the person given to pederasty for simply vicious reasons. According to Casper’s and Tardieu’s, as well as my own, experience, this anomaly is much more frequent than reported cases would lead us to presume.

Ulrichs (“Kritische Pfeile,” p. 2, 1880) declares that, on an average, there is one person affected with contrary sexual instinct to every two hundred mature men, or to every eight hundred of the population; and that the percentage among the Magyars and South Slavs is still greater,—statements which may be regarded as untrustworthy. The subject of one of my cases knows personally, at his home (13,000 inhabitants), fourteen urnings. He further declares that he is acquainted with at least eighty in a city of 60,000 inhabitants. It is to be presumed that this man, otherwise worthy of belief, makes no distinction between the congenital and the acquired anomaly.

1. Psychical Hermaphroditism.[112]—The characteristic mark of this degree of inversion of the sexual instinct is that, by the side of the pronounced sexual instinct and desire for the same sex, a desire toward the opposite sex is present; but the latter is much weaker and is manifested episodically only, while the homo-sexuality is primary, and, in time and intensity, forms the most striking feature of the vita sexualis.

The hetero-sexual instinct may be but rudimentary, manifesting itself simply in unconscious (dream) life; or (episodically, at least) it may be powerfully exhibited.

The sexual instinct toward the opposite sex may be strengthened by the exercise of will and self-control; by moral treatment, and possibly by hypnotic suggestion; by improvement of the constitution and the removal of neuroses (neurasthenia); but especially by abstinence from masturbation. However, there is always the danger that homo-sexual feelings, in that they are the most powerful, may become permanent, and lead to enduring and exclusive contrary sexual instinct. This is especially to be feared as a result of the influences of masturbation (just as in acquired inversion of the sexual instinct) and its neurasthenia and consequent exacerbations; and, further, it is to be found as a consequence of unfavorable experiences in sexual intercourse with persons of the opposite sex (defective feeling of pleasure in coitus, failure in coitus on account of weakness of erection and premature ejaculation, infection). On the other hand, it is possible that æsthetic and ethical sympathy with persons of the opposite sex may favor the development of hetero-sexual desires. Thus it happens that the individual, according to the predominance of favorable or unfavorable influences, experiences now hetero-sexual, now homo-sexual, feeling.

It seems to me probable that such hermaphrodites from constitutional taint are not infrequent.[113] Since they attract very little attention socially, and since such secrets of married life are only exceptionally brought to the knowledge of the physician, it is at once apparent why this interesting and practically important transitional group to the group of absolute contrary sexuality, has thus far escaped scientific investigation. Many cases of frigiditas uxoris and mariti may possibly depend upon this anomaly. Sexual intercourse with the opposite sex is, in itself, possible. At any rate, in cases of this degree, no horror sexus alterius exists. Here is a fertile field for the application of medical and moral therapeutics (v. infra). The differential diagnosis from acquired contrary sexual instinct may present difficulties; for in such cases, as long as the vestiges of a normal sexual instinct are not absolutely lost, the actual symptoms are the same (v. infra). In the first degree, the sexual satisfaction of homo-sexual impulses consists in passive and mutual onanism and coitus inter femora.

Case 106. Psychical Hermaphroditism in a Lady.—Mrs. M., aged 44, exemplifies the fact that an inverted and a normal sexual instinct may be united in one person, be it in man or woman. The father of this lady was very musical, and very talented as an artist. He took life easily; and to his extraordinary beauty was added a great admiration for the opposite sex. After several apoplectic attacks, he died demented in an asylum. Father’s brother was neuro-psychopathic, and when a child was a somnambulist; and all his life he was afflicted with hyperæsthesia sexualis. Thus, although married and the father of married sons, he tried to seduce his niece, Mrs. M., with whom he was wildly in love, when she was eighteen years old. Father’s father was very eccentric and a distinguished actor. He first studied theology, but, as a result of partiality for the dramatic muse, he became an actor and singer. He committed excesses in baccho et venere; was a spendthrift and luxurious. He died at forty-nine, of apoplexia cerebri. Mother’s father and mother died of tuberculosis of the lungs.

Mrs. M. was one of eleven children, of whom six are still living. Two brothers, who resembled the mother physically, died, at sixteen and twenty, of tuberculosis. A brother suffers with laryngeal phthisis. Four living sisters and Mrs. M. resemble the father physically, and the eldest is unmarried, very nervous, and shy of people. Two younger sisters are married, healthy, and have healthy children. The other is unmarried, and suffers with nervous complaints. Mrs. M. has four children, several of whom are delicate and neuropathic.

The patient can tell nothing of importance concerning her childhood. She learned easily, and was æsthetically and poetically inclined. She was considered a little high-strung, and too much given to novel-reading and sentimentality. Her constitution was neuropathic, and she was extremely sensitive to changes of temperature, sometimes having annoying cutis anserina as a result of slight draughts. It is remarkable that one day, when she was about ten years old, she thought that her mother no longer loved her; and she put matches in her coffee to make herself really sick, that she might thus excite her mother’s love for her.

Puberty began, without difficulty, at the age of eleven. Thereafter the menses were regular. Before the time of puberty sexuality manifested itself, and, according to the opinion of the patient, its promptings have been abnormally intense all her life. The first feelings and impulses were decidedly inverted. She conceived a passionate but platonic love for a young lady. She wrote verses and sonnets to her, and was perfectly happy if she could admire “the entrancing charms” of her goddess in the bath, or steal a glimpse of her neck, shoulders, and breast while she was dressing. The wild impulse to touch these physical charms was always overcome. While a young girl, she had actually been in love with Madonnas of Raphael and Guido Reni. In all kinds of weather she would run after pretty girls and ladies for hours at a time, admiring their beauty, losing no opportunity to please them, offering them bouquets, etc. The patient asserted that, until the age of nineteen, she was absolutely without a suspicion of a difference of sex; because she had been educated as in a cloister by a very prudish aunt, who was an old maid. As a result of this great ignorance, the patient became the victim of a man who was passionately in love with her, and who had coitus with her by means of stratagem. She became the wife of this man, bore one child, and lived an “eccentric” sexual life with him. She felt perfectly satisfied with married intercourse. After a few years she became a widow. Since then, women have again been the object of her love, primarily, as the patient thinks, from fear of the results of sexual intercourse with a man.

At twenty-seven, second marriage, without love, to a phthisical husband. Patient was three times confined, and fulfilled her maternal duties. Her physical health failed, and in the later years of this married life she had an increasing aversion for her husband, partly due to a sense of his disease, though, at the same time, there was constantly present an intense desire for sexual indulgence.

Three years after the death of her second husband, the patient discovered the fact that her nine-year-old daughter, by her first husband, was given to masturbation, and that she was failing in physical health. The patient read of this vice, and could not overcome the impulse to indulge in the practice, becoming, in consequence, an onanist. She is unable to bring herself to give the details of this period of her life. She says that she was frightfully excited sexually, and had to send her daughters from home to save them from terrible consequences; but the two boys she was able to keep at home.

Patient became neurasthenic ex masturbatione (spinal irritation, feeling of pressure in head, weariness, lack of mental control), and, at times, had dysthymia and painful tædium vitæ. Her sexual feeling would be directed at one time to women, at another to men. She was able to restrain herself, and suffered much from abstinence, especially because, on account of her neurasthenic troubles, she sought to obtain relief in masturbation, though only in case of great necessity. At the present time, though forty-four years old, and menstruating regularly, she suffers intensely with a passion for a young man whose presence she cannot avoid on account of the exigencies of occupation.

Patient presents nothing remarkable in external appearance. She is gracefully formed, but the muscular system is not strongly developed. Pelvis is, in all respects, that of a female, but the arms and legs are decidedly large and of masculine form. Ladies’ shoes do not fit her, but, being opposed to exciting attention, she forces her feet into female shoes, and they are, therefore, much deformed. Genitals normally developed, and present no other abnormality than descent of the uterus, with hypertrophy of the vaginal portion. On thorough examination it is seen that the patient is essentially homo-sexual, and that the desire for the opposite sex is but episodical and sensual. Thus, at present, she suffers intensely with sexual desires for every man with whom she comes in contact, but it is a more refined and higher pleasure for her to imprint a kiss on the soft, round cheek of a maiden. This pleasure is one she often enjoys, because she is much beloved as the “dear aunt” by all the “sweet creatures”; for she voluntarily does them the most various chivalrous favors, always feeling herself at such times as a man.

Case 107. Contrary Sexual Instinct with Sexual Satisfaction in Hetero-Sexual Intercourse.—Mr. Z., aged 36, Hollander, consulted me, in 1888, on account of an anomaly of his sexual feelings, which had become a matter of anxiety to him in connection with an intended marriage. Patient’s father was neuropathic, and suffered with nightmare and night-terrors. Grandfather was mentally unsound; father’s brother an idiot. Patient’s mother and her family were healthy and normal mentally. The patient had four sisters and one brother, the latter being subject to moral insanity. Three sisters are healthy, and living happy married lives.

As a child, the patient was weak, nervous, and subject to night-terrors, like his father; but he never had any severe sickness except coxitis, as a result of which he limps slightly. Sexual impulses were manifested early. At eight, without any teaching, he began to masturbate. From his fourteenth year, ejaculation. He was mentally well endowed, and his principal interest was in art and literature. He was always weak muscularly, and had no inclination for boyish sports and later for manly occupations. He had a certain interest for female toilettes, ornaments, and occupations. From the time of puberty the patient noticed in himself an inexplicable inclination toward male persons. Youths of the lowest classes were especially attractive to him. Cavalrymen especially excited his interest. He experienced a lustful desire to press himself against such individuals from behind. Occasionally, in crowds, it was possible for him to do this; and in such an event an intense feeling of pleasure passed over him. After his twenty-second year, on such occasions, he now and then had an ejaculation. From that time ejaculation occurred when a sympathetic man laid his hand on the patient’s thigh. He was now in great anxiety lest he might sometime assault a man sexually. People of the lower classes, wearing tight, brown trousers, were especially dangerous for him. His greatest pleasure would be: to embrace such a man and press himself on him; but, unfortunately, the morality of his country did not allow such a thing. Pederasty seemed disgusting to him.

It gave him great pleasure to gain a sight of the genitals of males. He was always compelled to look at the genitals of every man he met. In circuses, theatres, etc., only male performers interested him. Patient has never noticed any inclination for women. He does not avoid them, even dances with them on occasion, but he never feels the slightest sensual excitation under such circumstances.

At the age of twenty-eight the patient was neurasthenic as a result of his excessive masturbation.

Then frequent pollutions in sleep occurred, which weakened him very much. It was only occasionally that he dreamed of men when he had pollutions; and never of women. A lascivious dream-picture (pederasty) had occurred but once. He dreamed of dying-scenes, of being attacked by dogs, etc. After these, as before, he suffered with great libido sexualis. Often there came up before him such lascivious thoughts as gloating over the death of animals in the slaughter-house, or allowing himself to be whipped by boys; but he always overcame such desires, and also the impulse to dress in a military uniform.

In order to cure himself of masturbation, and to thoroughly satisfy his libido, he determined to frequent brothels. He first attempted sexual intercourse with a woman when twenty-one, after over-indulgence in wine. The beauty of the female form, and female nudity in general, made no impression on him. However, he was able to enjoy the act of coitus, and thereafter he visited brothels regularly for “purposes of health.”

From this time he took great pleasure in hearing men tell stories of their sexual relations with the opposite sex.

Ideas of flagellation would also come to him while in a brothel, but the retention of such fancies was not essential for the performance of coitus. He considered sexual intercourse with prostitutes only a remedy against the desire for masturbation and men,—a kind of safety-valve to prevent compromising himself with some man.

The patient now wishes to marry, but fears not only that he could have no love for a decent woman, but also that he might be impotent for intercourse with one. Hence his thought and need of medical advice.

The patient is very intelligent, and is, in all respects, of masculine appearance. In dress and manner he presents nothing that would attract attention. Gait, voice, and skeleton,—the pelvis especially,—masculine in character. Genitals of normal development. The normal growth of hair for a male is abundant. The patient’s relatives and friends have not the slightest suspicion of his sexual anomalies. In his inverted sexual fancies, he has never felt himself in the rôle of a woman toward a man. For some years he has been entirely free from neurasthenic troubles.

The question as to whether he considered himself a subject of congenital inversion of sexual instinct he could not answer. It seems probable that there was a congenital weak inclination for the opposite sex, with a greater one for the same sex, which, as a result of early masturbation in consequence of the homo-sexual instinct, was still more weakened, but not reduced to nil. With the cessation of masturbation, the feeling for women became in a measure more natural, but only in a coarsely sensual way.

Since the patient explained that, for reasons of family and business, it was necessary for him to marry, it was impossible to avoid this delicate question.

Fortunately, the patient limited his inquiries to the question as to his virility as a husband; and it was necessary to reply that he was virile, and that he would probably be so in conjugal intercourse with the wife of his choice,—at least, if she were to be in mental sympathy with him; besides, that he could at all times improve his power by exercising his imagination in the right direction.

The main thing was to strengthen the sexual inclination for the opposite sex, which was defective, but not absolutely wanting. This could be done by avoiding and opposing all homo-sexual feelings and impulses, possibly with the help of the artificial inhibitory influences of hypnotic suggestion (removal of homo-sexual desires by suggestion); by the excitation and exercise of normal sexual desires and impulses; by complete abstinence from masturbation, and eradication of the remnants of the neurasthenic condition of the nervous system by means of hydrotherapy, and possibly general faradization.

I am indebted to a physician, aged thirty, for the following autobiography, which in another respect is noteworthy:—

Case 108. Mental Hermaphroditism; Abortive Contrary Sexual Instinct.—“In my ancestry I am somewhat predisposed hereditarily. My grandfather on my father’s side was a high-liver and a speculator. My father was a man of character, but for more than thirty years he has suffered with folie circulaire, without, however, being much hindered by it in business. My mother, like her father before her, suffers with stenocardiac attacks. My mother’s father and brother are said to have been sexually hyperæsthetic. My only sister, about nine years older than myself, was twice subject to attacks of eclampsia, and during puberty was religiously exalted, and probably also sexually hyperæsthetic. During many years she had to suffer with a severe hysterical neurosis, but she is now completely well.

“As an only son, and born late, I was the apple of my mother’s eye; and I have her indefatigable care to thank that I survived childhood, after having passed through all the possible diseases of children (hydrocephalus, measles, croup, small-pox, and, at thirteen, chronic intestinal catarrh that lasted a year). My mother, being herself very religious, raised me, without spoiling me, in a religious way, and implanted in me, as the guiding moral principle, an unyielding devotion to duty, which was further carried to an extreme in me by a teacher whom I still call a friend. Owing to my delicate health, my childhood, in greater part, was spent in bed; and I was thus given to quiet occupations, especially reading; and thus as a boy I came to be—if not blasé—premature at least. As early as eight or nine the parts of books that excited me most were those where injuries or operations that had to be endured by beautiful girls or ladies, were described. Thus I was thrown into great excitement by a story in which was pictured a maiden that had run a thorn into her foot, with a boy taking it out for her. Indeed, every time that I looked upon this picture, which was in nowise lascivious, I had an erection. Whenever possible, I went to see chickens killed; and if I had missed that, I looked at the spots of blood, and stroked the warm bodies of the birds, with pleasurable shudders. I would emphasize the fact that I have always been a great lover of animals, and have felt disgust and pity while killing larger animals, and even in the vivisection of frogs.

“The killing of chickens is still a great sexual stimulus for me, and especially holding them, during which I have palpitation of the heart and precordial oppression. It is of interest that my father had a passion for binding together the hands of girls and young women.

“I think that another of my sexual abnormalities is attributable to this strain of cruelty. As I shall clearly describe later, one of my favorite games was that of an improvised doll-theatre, where I prescribed the parts of my companions. Almost always it was a young girl who, at the command of her papa, whom I represented, had to have a painful operation done on her foot. The more the girl cried, the more satisfaction I had. How I came to hit upon the foot as the constant object of operation will be seen from the following: When a very young boy, I happened to see my eldest sister change her stockings. When she hastily hid her feet, my attention was attracted, and immediately the sight of her bare feet to the ankles came to be the ideal of my longing. Naturally, this made my sister very careful; and thus there was occasioned a constant quarrel, which, on my part, was kept up with all the wiles of cunning and flattery, and with even explosions of anger, until my seventeenth year. In other respects my sister was very indifferent. Indeed, her kiss is repugnant to me. Faute de mieux, I made use of the feet of servants; masculine feet had no effect on me. My greatest desire would have been to cut the nails, or, sit venia verbo, the corns, on the beautiful foot of a woman. My lustful dreams were concerned with these things. Indeed, I applied myself to the study of medicine really in the expectation of gaining an opportunity to satisfy my desires, or cure them. Thank God, I attained the latter. After undertaking the first dissection of the lower extremity of a female, this unhappy desire was removed from me. I was unhappy because I was always deeply ashamed of this impulse. I think I may spare further details concerning it, since this peculiar enthusiasm, which even inspired me to write verses, has been sufficiently described by others.

“Now, concerning the last phase of my sexual errors: I was about thirteen, and had just begun to mature, when a school-mate, who happened to be our guest, teased me one night by kicking me with his bare feet under the covers. I seized his foot, and immediately became greatly excited, and had a pollution after it,—the first that I had. The boy was peculiarly girlish in form, and was also mentally effeminate. Too, another comrade who had very small and delicate hands and feet, whom I once saw in a bath, caused unusual excitement in me. I thought it a great piece of good fortune to be in bed with either of these, though any nearer sexual intercourse than embracing them never came into my mind. Moreover, I always thrust such thoughts aside with aversion. Some years later, when about sixteen or eighteen, I made the acquaintance of two other boys that awakened my sexual feeling. When I played with either of these, I immediately had an erection. Both were very energetic and lively, but delicately formed and child-like. At the occurrence of puberty I lost interest in both of them, though a warm friendship was preserved. I should never have allowed myself to have indulged in vicious practices with them.

“When I went to the University, I forgot completely these errors of my libido sexualis, and from principle I kept from sexual intercourse until I was twenty-four, in spite of the contempt of my companions. When pollutions became too frequent, and I began to fear cerebral neurasthenia ex abstinentia, I gave myself up to normal sexual indulgence, though somewhat mechanically; and it was, of course, very beneficial to me.

“The especial field of work to which I have devoted myself is responsible for the fact that I am almost impotent with puellis publicis, and also for the fact that the naked form of a woman disgusts rather than excites me. The act always satisfies me the most, if, during it, I can keep the vision of the face before me; but since, on the other hand, the idea that the girl near me is enjoyed by another is unbearable, for years I have found it absolutely necessary for my mental comfort, in spite of the pecuniary sacrifice, to keep a mistress, and, indeed, a virgin. Otherwise the most terrible jealousy made me absolutely incapable of work. I must also mention that, at thirteen, I fell in love platonically for the first time; and since then I have often pined in chaste love. What distinguishes my case from all others is the fact that I have never once masturbated in my life.

“Some weeks ago, in sleep, I was frightened by a dream of a naked boy, from which I awoke with an erection. In conclusion, I venture to undertake the difficult task of describing my present condition: Medium height, gracefully formed. Skull dolichocephalic, with prominence in the occipital region; circumference, 59 centimetres; frontal prominence marked; glance somewhat neuropathic; pupils medium; teeth very defective; musculature strong and tense; abundant hair, blonde. Varicocele on the left side; frenulum too short, which hindered me in coitus. I severed it myself three years ago. Since then ejaculation is retarded, and pleasurable feeling much diminished. Temperament choleric. Quick of comprehension; good at drawing conclusions; energetic; for one hereditarily predisposed, very persevering. I learn languages easily, and have a good ear for music, but otherwise I have no talent for the arts. I am always ambitious to do my duty, but I am constantly troubled with tædium vitæ, and only kept from attempts at suicide by my religion and the thought of my mother. Otherwise I am a typical candidate for suicide. I am ambitious, jealous, have a fear of paralysis; left-handed. I am filled with socialistic ideas. I like adventures, and I am courageous. I have decided never to marry.”

Case 109. Psychical Hermaphroditism. Autobiography.—“I was born in 1868. The families of both my parents are healthy; at any rate, mental disease has never occurred in them. My father was a merchant; he is now sixty-five years old, and for years has been nervous and especially inclined to be melancholic. Before his marriage, my father is said to have lived fast. My mother is healthy, though not very strong. There are two other healthy children.

“I was very early developed sexually, and in my fourteenth year was so much troubled by pollutions that I was frightened. Under what circumstances they occurred, particularly the nature of the dreams that were connected with them, I am no longer able to state. The fact is, that for years I have only felt myself drawn toward men sexually; and, with every effort and a terrible struggle, I am still unable to overcome this unnatural impulse that is so repugnant to me. It is said that I had many severe illnesses in my childhood, and that my life was often despaired of. To this was probably due the fact that I was spoiled and made very delicate. I was always much in the house, preferred to play with dolls rather than with soldiers, and I liked to play quietly in the house better than to play noisily in the streets. I entered the Gymnasium at the age of ten. Though I was lazy, I was among the best scholars; for I learned very easily, and was the favorite of my teacher. From my earliest childhood (seventh year), I took pleasure in little girls. I remember that, even until my thirteenth year, I had formal love-affairs with them, and was jealous of those who associated with them; that I took pleasure in looking under the petticoats of my sister’s friends and the servants; and that I had erections when touching the persons of my female playmates. I can, however, recall with certainty that boys attracted and excited me sexually just as early and powerfully. I always took great delight in reading and in the theatre. I had a doll-theatre, with which I played by preference. I knew whole pieces by heart, and copied the actors I saw, taking especially the female parts, in which I was delighted to put on female attire.

“As my sexual life became more pronounced, my inclination for boys won the upper hand. I fell completely in love with my companions, and had lustful feeling if one of them who pleased me touched my body. I became very shy, and refused to take gymnastic and swimming lessons. I thought I was different from my comrades, and did not like to undress before them. I liked to look at the penes of my companions, and easily had erections. I masturbated but once, and that in my youth. When a friend told me that one could have pleasure without women, I likewise tried it; but I found no pleasure in it. At that time, also, a book fell in my hands which warned against the effects of onanism. After that one trial I never did it again. In my fourteenth or fifteenth year, I made the acquaintance of two younger boys who excited me sexually to the highest degree. I was especially in love with one of them. I became sexually excited in his presence, and was restless when I did not have him near me. I was jealous of those who associated with him, and embarrassed in his presence. He had no suspicion of my condition. I felt very unhappy, and often wept gladly, feeling then relieved. Yet I could not understand this feeling, and always felt its irregularity. I was also especially unhappy because my ability to work disappeared all at once. I, who before had learned with ease, suddenly had difficulty; my thoughts were never on the subject. Only by straining every nerve could I get anything through my head. I always had to study aloud, in order to keep my attention on the matter in hand. My memory, which was previously excellent, often left me in the lurch. Nevertheless, I continued to be a good scholar, and I still pass for a talented man; but I have terrible difficulty in learning anything. I exerted all my energy to free myself from this sad condition. Daily I went swimming; I practiced turning, rode much, and practiced fencing, in all of which I enjoyed myself very much. I still like to be on a horse’s back, though I know nothing about horses, and have no particular talent for physical exercises. I was never absent from a drinking-party, and I smoked. I was much liked. In cafés I associated much with waitresses, and liked to amuse myself with them, without, however, being sexually excited by them. Among my friends and teachers, I passed for a man who was much with women, and spoiled by them. Unfortunately, this was not true.

“At the age of nineteen I went to the University. My first semester was spent at the University of B., and it is still terrible to recall it. My sexual appetite powerfully excited me, and at night, for hours at a time, I ran about looking for men, especially when I was intoxicated. The next morning I would be crazy about myself. Fortunately, I found no one. In the second semester, I went to M. This was my happiest time. I had pleasant friends, and, for a wonder, took pleasure in women, and was very happy about it. I had a love-affair with a young girl of spoiled character, with whom I spent wild nights. I was extraordinarily virile. I, who had formerly been chaste, also associated with other women, as never before. I felt fresh and well after coitus. I was not charmed so much by the female figure, which was never beautiful to me, as by—I know not what. In short, I knew women whose touch immediately induced erection. This joy and state of delight did not last long. I was so foolish as to take rooms with a friend. We had one sleeping-room. My friend was very talented and amiable, and a favorite with women; and it was by these characteristics that he at first so strongly attracted me. In fact, I love only highly-educated men; uneducated, powerful persons are able to excite me intensely only for the moment, and cannot retain my affections. I soon fell in love with my friend. Then came the terrible time that destroyed my health. I slept in the same room with my friend, and had to see him undress daily; so that it required all my strength to keep from betraying myself. I became nervous, cried easily, and was jealous of those who associated with my friend. I still associated with women; but it was only with difficulty that I could perform coitus, which, like woman, was repugnant to me. The same women who had excited me intensely, no longer had any effect on me. I followed my friend to W., where he met an earlier friend, with whom he associated. I became jealous and sick with love and longing. At the same time, I associated with women again, but seldom, and only with difficulty, indulged in coitus. I became terribly depressed and almost insane. Work was out of the question. I led a foolish, wild life, and spent a great amount of money, almost throwing it away. Then, after six weeks of it, I broke down, and had to visit a water-cure, where I spent many months. There I came to myself again, and soon became much liked; for I can be very gay, and I take great pleasure in the society of educated ladies. In conversation, I prefer married women to younger girls; I am also very gay in the society of gentlemen at the beer-table and bowling-alley.

“At this sanitarium I met a man of twenty-nine, who was apparently constituted like myself. The fellow forced himself upon me, and wanted to embrace and kiss me; but he was very repugnant to me, though he excited me, and his touch caused erection, and even ejaculation. One evening he got me to perform mutual onanism. After it I spent a most frightful, sleepless night; I was terribly disgusted with the whole affair, and thought I should never do such a thing with a man again. All day long I could get no rest. It was terrible to me that, in spite of this, and against my will, this man so excited me sexually; yet, on the other hand, it gave me satisfaction that he was in love with me, and apparently had to go through struggles similar to my earlier ones. From that time I was successful in keeping him away from me.

“I again went to various Universities, and also visited many water-cures, with temporary, but never permanent, benefit. I fell in love, too, with many friends, but never so deeply as with the friend at M. I no longer had sexual intercourse, neither with women—I was incapable of it—nor with men; for I had no opportunity for it with the latter, and I forced myself to avoid it. I still often met my friend of M.; we are as good friends as ever, and, much to my delight, he no longer excites me. It is usually so; when for a long time I have not seen a person who excites me, the sexual influence disappears.

“I passed my examinations with distinction. During the last year before they took place,—when I was twenty-three,—I began to practice masturbation; for I could find no other way in which to gratify my burdensome sexual appetite. Still, I did it very infrequently; for after it I was always disgusted, and spent a sleepless night. But when I have drunk much, I lose all strength; and then I run about for hours, seeking men, and finally come to onanism, to awake the next day with a dull head and a horror of myself, and go about all day in a melancholy state. As long as I have control of myself, I use all my strength to combat my nature. It is terrible when one can have no pleasure in associating with friends, and every erect soldier or butcher-boy makes one tremble and throb. It is frightful when night comes, and I watch at the window for some one to urinate against a wall across the way, and give me an opportunity to see his genitals. These thoughts are terrible; and besides, there is the consciousness of the immorality and criminality of my state of mind and my longing. I have a repugnance for myself that I cannot describe. I consider my condition abnormal; I cannot think that it is congenital, but I believe that the impulse was bred in me by faulty education. My suffering makes me reckless and egotistical; it takes away all kindness of disposition, and makes me careless about my family. I am moody, and often almost insane; often I am so depressed that I know not what to do, and then am easily moved to tears. And yet I have a horror of sexual intercourse with men. One evening when I came from a drinking-party, drunk and excited and in a half-conscious state, and, full of desire, was wandering about, I met a young man, who got me to perform mutual masturbation. Though he excited me, after the act I was beside myself. To-day, when I go by the place, I am overcome with horror; and lately, when riding by it, without any cause, I fell from my gentle horse, that I know so well,—I was so overcome by the memory of my unworthy deed.

“I love family life and children, and social intercourse; and, with my position in society, I am suited to have a family. But I must give up all that; and yet, I cannot abandon hope of cure. And so I vacillate between hopeful gaiety and frightful hopelessness, and neglect business and family. Indeed, I do not ask that I may marry and found a family; I wish only to overcome the terrible inclination for the male sex; only to associate quietly with my friends, and to learn to respect myself again.

“No one has any suspicion of my condition; I pass rather for a great roué,—a reputation I try to maintain. I often try to have relations with girls, for which I often have opportunity. I have known many who loved me, and who would have sacrificed their honor for me; but I have no love to offer them, and nothing sexual to give. And yet I can love a man. I am excited only by young men,—i.e., aged from seventeen to twenty-five, without full beards, and preferably with no beards at all. I can love only those that are educated, respectable, and amiable. I am, in short, very proud, and quick; I am also enthusiastic, and easily led by persons who please me. These I try to imitate, but I am very sensitive with them, and easily hurt. I put much value on appearances, love beautiful furniture and dress, and assume a distinguished manner and elegant address. I am unhappy in that my neurasthenic condition keeps me from doing and learning what I should like.”

Last fall I made the patient’s acquaintance. He is destitute of degenerative signs, and of perfectly masculine appearance, even though he is delicately formed and slender. Genitals perfectly normal. Appearance distinguished, with nothing striking. He is much troubled about his sexual perversion, and wishes to be freed from it at any price. In spite of the greatest effort on the part of both physician and patient, only a slight degree of hypnosis, insufficient for suggestive treatment, could be induced.

Case 110. Psychical Hermaphroditism—Mouth-fetichism.—“I am thirty-one years old, and an official in a manufactory. My parents are healthy, and have nothing abnormal about them. My paternal grandfather is said to have had brain disease; my maternal grandmother died melancholic; a cousin of my mother was given to drink; several other blood-relations are abnormal mentally.

“I was four years old when my sexual appetite awoke. A man between twenty and thirty years old, who played with us children, and took us in his arms, excited in me the desire to embrace and kiss him passionately. This desire for sensual kissing on the mouth is characteristic of me, and it still forms the chief charm of my sexual gratification.

“I experienced a similar excitation in about my ninth year. A man who was ugly and dirty, and had a red beard, likewise excited in me this desire for him. Here was manifested, for the first time, a characteristic peculiar to me, which is still present,—i.e., the peculiar stimulus which coarseness—the filthiness of a person in dress and conduct—is to my senses at times.

“While in the Gymnasium, from my eleventh to my fifteenth year, I was affected with a passion for a comrade. In this case, it was also my greatest pleasure to embrace him, and kiss him on the mouth. I was often seized with a desire for him as intense as that I now have for persons I love. I think, however, that I first had erections in my thirteenth year. During these years, as I have said, I had only the desire to embrace and kiss; cupiditas videndi vel tangendi aliorum genitalia mihi plane deerat. I was a perfectly innocent, näive boy, and, until my fifteenth year, did not know the meaning of an erection; indeed, I never once ventured to kiss the beloved person; for I felt that it would be doing something strange. I felt no desire to masturbate, and also had the good fortune not to be seduced to it by older comrades. I have never yet masturbated; I feel a certain repugnance for it.

“In my fourteenth and fifteenth years I was seized with a passion for several young persons, some of whom still attract me. Thus I was very much in love with a boy with whom I had never spoken. It was even a delight to meet him on the street.

“That my passions were of a sensual nature is shown by the fact that, when I pressed and caressed the hands of those I loved, I had powerful erections. But it has always been my greatest pleasure amplecti et os osculari; I desired nothing else.

“I did not know that what I experienced was sexual love; I only said to myself that it was impossible that I alone felt such stimuli.

“Until my fifteenth year a woman had never excited me; but one evening, when I was alone with our servant-girl in a room, I experienced the same desire that I had for many boys. At first I played with her; and, when I found that she liked to be kissed, I covered her with kisses. I felt such sensual pleasure in it as I now seldom experience. Mouth to mouth, we kissed each other, and after about ten minutes ejaculation occurred. Thus I gratified myself two or three times a week. I soon began a similar relation with our cook, and with other servant-girls. Ejaculation always took place after kissing for about ten minutes.

“In the meantime, I had taken dancing-lessons. There I was first charmed by a nice girl; but this love soon disappeared, and I fell in love with another girl, with whom I never became acquainted, but at the sight of whom I felt an attraction like that of boys, and unlike the purely brutal passion I felt for other girls. At this time my impulse for girls was at its acme; I was pleased by about an equal number of girls and boys. As mentioned above, I gratified my sensuality by kissing the servant-girl and inducing ejaculation. Thus I spent the time from my sixteenth to my eighteenth year. The departure of the servant deprived me of opportunity.

“Then came two or three years during which I had to give up sexual pleasure. In general, girls pleased me less; and, too, now that I had grown older, I was ashamed to surrender myself to the servant-girls.

“It was not possible for me to obtain a mistress; for, notwithstanding my years, I was carefully watched by my parents, and associated but little with young men, and thus had but little independence. With the diminution in the desire for women, the attractiveness of youths increased.

“Since I had had, since my sixteenth year, frequent pollutions at night with dreams,—in part of women and in part of men,—which weakened and depressed me exceedingly, I desired to make an end of them by means of normal coitus. But scruples and the belief that prostitutes would have no effect on me, kept me from the brothel until my twenty-first year. For two or three years I went through a daily struggle (if there had been male houses of prostitution, no scruples would have hindered me). Finally I visited a brothel. I could not even induce erection; for one reason because the girl, though she was unusually fresh and pretty for a prostitute, did not affect me; but really because she would not kiss me on the mouth. I was very much depressed, and thought I was impotent. Three weeks afterward I visited another prostitute, and she immediately induced erection by her kiss. She was erect and had thick lips, and was much more sensual than the first one. After only three minutes of simple kissing, mouth to mouth, ejaculation was induced,—of course, ante portam. Thus it was only after I had visited prostitutes about seven times that I was successful in coitus.

“At one time I would have no erection at all, because the girl made no impression on me; again I would ejaculate prematurely. The first times I was reluctant penem introducere; and, too, even after I was successful in normal coitus, I found no pleasure in it. Sensual satisfaction comes with kissing on the mouth; for me this is the principal thing, coitus serving only as something secondary to embracing. Coitus, no matter how much the woman might charm me, would be an indifferent matter without kissing; indeed, erection disappears, or does not occur at all, when the woman will not kiss on the mouth. Yet, I cannot kiss every woman, but only such as have faces pleasing to me; a prostitute, the sight of whom is repugnant to me, with any amount of kissing, which then only disgusts me, cannot excite me.

“Thus, during the last four years, I have visited brothels about every ten days or two weeks. Only seldom does coitus fail; for I have learned my peculiarities, and in the choice of a prostitute know immediately whether she will excite me or have no effect. Of late, however, it has again happened that I thought the woman would stimulate me, and yet no erection occurred. This happened when, the day before, I had to repress too forcibly the desire for men.

“At first, when I went to brothels, the sensual pleasure was very slight; only a very few times did I have true lustful feeling (as in kissing previously). Now, on the contrary, for the most part I experience sensual pleasure. The lower houses have a particular charm for me; for of late the coarseness of the women, the dark entrance, the yellow light of the lamps, and all the surroundings, have a peculiar charm for me; probably because my sensuality is unconsciously excited by meeting soldiers, who frequent such places, and who at the same time lend a certain charm to the women. If I but find a woman whose face attracts me, I can have intense lustful pleasure. Besides by prostitutes, my desire can be excited by peasant-girls, servant-girls, working-women, and girls of the lower classes,—in general, by those in common dress. Red cheeks, thick lips, and erect forms please me particularly. I am absolutely indifferent to respectable women and young ladies.

“My pollutions are usually without lustful pleasure, and often occur with dreams of men, but very seldom—almost never—with dreams of women. As is shown by the last circumstance, in spite of regular coitus, my desire is still for young men. Indeed, I may say that it has only increased, and that very markedly. Though immediately after coitus the girls have no charm for me, yet the kiss of a pleasing woman could immediately induce erection again. For the first few days after coitus, young men seem the most attractive to me.

“Sexual congress with women does not satisfy all my sensual desire. I have days when I frequently have erections with an intense desire for young men; then come quieter days, with moments of complete indifference for women and latent desire for men. On the other hand, too great sensual rest makes me melancholy; viz., when such rest follows moments of repressed excitement. Only, then, when the thought of beloved youths again causes erection, do I feel light-hearted again. Then the rest changes to intense nervousness; I feel depressed, and sometimes have headache (after repressed erection). This nervousness often increases to ungovernable restlessness, which I then seek to overcome by coitus.

“Last year an essential change took place in my sexual life, when I dared to enjoy male love for the first time. In spite of pleasurable coitus with women (more correctly, pleasurable kissing with resultant ejaculation), my desire for young men gave me no peace. I determined to go to a brothel much frequented by soldiers, and, in extremity, to buy a soldier for myself. I had the good luck to meet immediately one like myself, who, notwithstanding his much lower station, in character and behavior was not unworthy of me. What I experienced (and still experience) with this young man is something different from what I feel with women. The sensual pleasure is not greater than with prostitutes, whose kisses and embraces excite me extraordinarily; but I can experience lustful pleasure with him at any time, and for him I have a feeling that is wanting for women. Unfortunately, I have been able to embrace and kiss him only about eight times.

“Though we have been separated many months, he having been sent to a garrison in Hungary, we have not forgotten each other, and keep up a regular correspondence. In order to possess him, I dared to go to a brothel and there embrace him, being in danger of being betrayed.

“Early in our acquaintance there came a time when I heard nothing more of him; for he did not think he could trust me. During these weeks I endured anxiety and pain that brought me into a state of depression and anxious restlessness, such as I had never before experienced. Scarcely to have found a lover and then to be compelled to lose him, seemed the greatest misfortune to me. When, thanks to my efforts, we met again, my joy was unbounded; indeed, I was so excited that, in his embrace again for the first time, in spite of my sensual lust, I could not induce ejaculation.

“Usus sexualis in osculis et amplexionibus solis constitit, pene meo ludere ei licebat (while the touch on it of a woman’s hand is unendurable to me, and I never allow it). It is also to be noted that, in the company of my lover, I immediately have an erection; the pressure of his hand, or even his look, is sufficient. Evenings, for hours at a time, I have gone about with him, never tiring of his society for a moment, despite his inferior station. With him I feel happy, and the sexual satisfaction is merely the crowning of our love. Although I had finally found the man like myself, whom I had so long sought, and I could at last enjoy male love, yet I have not become insensitive to women; and I visit brothels when I am too sorely troubled by desire. I had hoped to be able to spend this winter in the city where my lover is; but this is, unfortunately, impossible, and I am now forced to be separated from him for an indefinite period. Nevertheless, we shall try to see each other, if only for a short time, and only once or twice a year; at least, I hope that in the future we may again be together for a longer time. Thus, for this winter, I am again compelled to be without a friend like myself. I had, indeed, resolved, on account of the danger of discovery, never to try to find another urning; but this is impossible. Sexual intercourse with women does not satisfy me, and my desire for young men constantly increases. I am often afraid of myself; afraid that, in asking all prostitutes, as I do, whether they know others like me, I might be discovered. Yet I cannot keep from seeking a youth like myself; indeed, I know that in case of necessity I shall buy a soldier, though I know perfectly well the penalty meted out to one caught in such circumstances.

“I can no longer do without male love; without it I should always be out of harmony with myself. My ideal would be to be associated with a number like myself; but I should be satisfied if I could have unrestrained intercourse with one lover. I could easily dispense with women, if I had regular male satisfaction; but I think that at long intervals I should embrace a woman for the sake of variety, as my nature is absolutely hermaphroditic in a psycho-sexual sense (women I can only desire sensually, but I can love and sensually desire young men). If there were marriage between men, I think I should not avoid a life-long union; while marriage with a woman seems to me something impossible. For, in the first place, though the woman charmed me, the charm would soon be lost in regular intercourse, and then all sexual indulgence, if not impossible, would certainly be devoid of pleasure for me; and, in the second place, true love for the wife would be wanting—the attraction that I feel with young men I love, and which makes the intercourse that is not simply sensual seem desirable to me. The constant association with a youth physically pleasing and in mental harmony with me, and who could understand all my feelings and share my intellectual opinions and desires, would, it seems to me, be the greatest happiness.

“The young men who please me must be between eighteen and twenty-eight. As I have grown older, the limit of age in those pleasing to me has increased; otherwise, I am pleased with the most various forms. The principal rôle, if not the exclusive one, is played by the face. Blondes excite me more than dark persons; they must have no beard, but merely a small moustache that is not too thick, or none at all. As for the rest, the only thing I can say is, that certain kinds of faces please me. Faces with large, straight noses are excluded, as are also pale cheeks; but there are exceptions. I regard soldiers with favor, and many please me when in uniform who do not affect me when in civil dress. Just as in women certain ordinary articles of dress (like light-colored jackets) please me, so the military costume attracts me. To go to dance-halls—usually beer-halls—where there are many soldiers, and mix with the crowd of soldiers and boys that please me, and try to get a kiss and embrace,—this mingling with them would, of course, be an excitant only of sensuality; intellectually and socially, everything common in speech and conduct is repugnant to me.

“With young men of higher position, my sensual desire is less prominent.

“What I have said of the attractiveness of certain kinds of dress is not to be understood in the sense that they attract me in themselves. This charm only means that the dress may help to strengthen or make prominent the attraction exerted by the face, when, perhaps, the same face in itself would not attract me to the same extent. I may say the same thing, though with a different meaning, of the odor of lighted cigars. In indifferent persons the odor of cigars is rather repugnant than pleasing to me, but exciting in those sexually attractive. The kiss of a prostitute smelling of cigar-smoke, affords greater pleasure (because, even though in part unconsciously, I am reminded of the kiss of a man). Therefore, I took pleasure in kissing my lover just after he had smoked. (It is to be noted that I myself have never smoked a cigar or cigarette, and have never even tried to smoke.) I am tall and thin; my face is masculine; my eyes are restless; and in my whole form I often have something girlish. My health leaves much to be desired. It is much influenced by my sexual anomaly. As previously mentioned, I am very nervous, and I often have paroxysms of onomatomania. At times, I also have terrible depression and melancholia, when I see the difficulty of gratification corresponding with my male-loving nature; and when I am greatly excited sexually, and have overcome the desire, owing to impossibility of male gratification. In such conditions, often the depression is associated with absolute lack of sexual desire. In work I am industrious, but often too quick; for I am inclined to work too rapidly and violently. I have a lively interest in art and literature. Among poets and writers of fiction, I prefer, for the most part, those who describe refined feelings, peculiar passions, and far-fetched impressions; an artificial or hyper-artificial style pleases me. Likewise in music, it is the nervous, exciting music of a Chopin, a Schumann, a Schubert, or a Wagner, etc., that is in most perfect harmony with me. Everything in art that is not only original, but bizarre, attracts me.

“I do not like physical exercise, and do not practice it.

“In character I am kind and compassionate; and, though I have much to suffer with my anomaly, I am not unhappy because I love young men, but because the satisfaction of such love is considered improper, and because I cannot gratify it without restraint. I cannot regard male love as a vice, though I can well understand why it is considered vicious. But, since this love is regarded as criminal, in gratifying it I am in harmony with myself, but not with our age of the world; and, therefore, I must, necessarily, be somewhat depressed; the more, since I have a frank character that hates a lie. The pain of having always to hide it all in myself has induced me to confess my anomaly to a few friends, of whose silence and appreciation I am confident. Nevertheless, my situation often seems sad. On account of the difficulty of gratification and the general abhorrence of male love, I am often a little proud that I have such anomalous feelings. Of course, I shall never marry. This does not seem any misfortune, even though I love family life, and have thus far lived only with my parents. I live in the hope that later I shall have a lover; I must have one; without one, the future seems dark and barren, and all the ambitions usually cherished—honor, position, etc.—seem empty and unattractive. If I should not have this hope fulfilled, I know I shall be unable to long devote myself to my business with pleasure, and I shall soon be in a condition to sacrifice everything to obtain male love. I no longer have any moral scruples on account of my anomalous inclination; I have, in fact, never been troubled because I felt attracted to boys. I am much more inclined to judge morality and immorality in accordance with my feelings than in accordance with fixed principles; for I have always been given to skepticism, and have never yet studied out a fixed belief for myself. As yet, only what injures others seems to me to be evil and immoral, and that that I would not have inflicted on myself; and, in this direction, I may say that I try to infringe on the rights of others as little as possible, and that I am capable of great indignation at injustice inflicted on another. But, why love of men should be something immoral, I cannot understand; purposeless activity of the sexual instinct (if the immoral is to be seen in all that is useless and unnatural) is also found in intercourse with prostitutes, and even in marriage where means to prevent conception are used; and it seems to me that the sexual intercourse of men must be placed on the same level with all sexual congress that has not procreation as an end. But that only sexual gratification that has this purpose is moral, seems to me to be questionable. Certainly, sexual satisfaction that is not directed to procreation is not contrary to nature; and, whether it has not other purposes unknown to us, is uncertain; and, even if it were purposeless, it would not necessarily be despicable (it is not certain that the measure of a moral act is its usefulness).

“I am very certain that present prejudice will disappear, and that when once such individuals experience male-love, the right of unrestricted love will be acknowledged. For the possibility of such recognition one need but recall the Greeks and their friendships, which were nothing but sexual love; and one has only to think that, despite such unnatural vice, practiced by their greatest men in intellectual and æsthetic matters, the Greeks are still regarded as an unattainable example, and held up for imitation.

“I have already thought of having my anomaly cured by hypnotism. If it were to be of any use, which I doubt, yet I should certainly desire to be assured of a lasting love for women. For even though I cannot satisfy myself with men, yet I prefer to feel this capability of inordinate lust and love, even ungratified, to being absolutely without feeling. Thus I still have the hope that I shall find opportunity to satisfy the love I desire, the love that would make me happy; and I should not prefer the suggestive removal of homo-sexual feelings, without the simultaneous substitution of a hetero-sexual equivalent, to my present condition. Finally, I should like to add, in contrast with the statements of urnings in the published biographies, that I, at least, find it very difficult to recognize those like myself. Though I have described my sexual anomaly somewhat in detail, it seems to me that the following notes are important for a better understanding of my condition:—

“Of late I have given up immissio penis, and confined myself to coitus inter femoræ puellæ. Ejaculation occurs earlier than with conjunctio membrorum, and I experience a certain lustful feeling in the penis itself. If this manner of sexual intercourse is quite pleasant to me, it is, perhaps, in part to be referred to the fact that in this kind of sexual indulgence the sex is quite indifferent, and I am, perhaps, unconsciously reminded of masculine embrace. But this memory is absolutely unconscious, and but obscurely felt; for I am not indebted to my imagination for my pleasure, but it is due immediately to kissing the woman’s mouth. I feel that the charm which the brothel and prostitutes have for me also begins to fade; but I am sure certain women will always be able to excite me by their kisses. Still, no woman is, or ever will be, so attractive as to induce me to overcome obstacles in winning her; but even the danger of discovery and disgrace could only with difficulty restrain me from seeking a man’s embraces.

“Thus I lately allowed myself to be induced to buy a soldier at a prostitute’s house. The lustful pleasure was very great, but the subsequent feeling of satisfaction was especially very exhilarating. The next day I felt similarly strengthened (capable of erection at any moment); and though I have not yet been able to meet the soldier again, the thought that I shall venture to purchase another gives me peace. But I could be perfectly satisfied only in finding one feeling like myself, of my own position and education.

“I have not yet mentioned that the female form (with the exception of the face) and genitals have no attraction for me (to touch the latter with my hand would be disgusting to me); but membrum virile me tangere dum os meum os ejus osculatur, mihi exoptatum esse; indeed, to kiss that of a very pleasing man would not be disgusting to me. Onanism, as has been said, would be quite impossible for me.”

Case 111. Psychical Hermaphroditism.-Hetero-sexual feeling early interfered with by masturbation, but episodically very intense. Homo-sexual feeling ab origine perverse (sexual excitation by men’s boots).

Mr. X., of high social position, Russian, aged 28, came to me in September, 1887, in a despairing mood, to consult me on account of a perversion of his vita sexualis, which made life seem almost unbearable to him, and which had repeatedly brought him near to suicide. The patient comes of a family in which neuroses and psychoses have been of frequent occurrence. In the father’s family there had been consanguineous marriages for three generations. The father is said to have been a healthy man, and to have lived morally in marriage. However, his father’s preference for fine-looking servants seems remarkable to the son. The mother’s family is described as eccentric. The mother’s grandfather and great-grandfather died melancholic; her sister was insane; a daughter of the grandfather’s brother was hysterical, and had nymphomania. Only three of the mother’s twelve brothers and sisters married. Of these, one brother was homo-sexual, and always nervous as a result of excessive masturbation.

The patient’s mother is said to be a bigot, and of small mental endowment, nervous, irritable, and inclined to melancholia. Patient has a sister and a brother. The brother is frequently melancholy, and, though mature, has never shown the slightest trace of sexual inclinations. The sister is an acknowledged beauty, and much sought by gentlemen. This lady is married, but childless, as reported, owing to the impotence of her husband. She has always been indifferent to the attentions shown her by men, but is charmed by female beauty, and actually in love with some of her female friends.

With respect of himself, the patient asserts that, when four years old, he dreamed of handsome jockeys wearing shining boots. Too, he never dreamed of women when he grew older. His nightly pollutions were always induced by “boot-dreams.” From his fourth year he had a peculiar partiality for men, or, more correctly, for lackeys wearing shining boots. At first they only excited his interest, but, with development of his sexual functions, the sight of them caused powerful erections and lustful pleasure. It was only servants’ boots that affected him; the same kind of boots on persons of like social station were without effect on him. In a homo-sexual sense, there was no sexual impulse connected with these situations. Even the thought of such a possibility was disgusting to him. At times, however, he had sensually-colored ideas,—like being his servant’s servant, and drawing off his boots; but the idea of being stepped on by him, or of having to blacken his boots, was most pleasing. The pride of the aristocrat rose up against such thoughts. In general, these notions about boots were disgusting and painful to him.

Sexual instinct was early and powerfully developed. It first found expression in indulgence in sensual thoughts about boots, and, after puberty, in dreams accompanied by pollutions; otherwise, the mental and physical development was undisturbed. Patient was well endowed mentally,—learned easily, finished his studies, and became an officer. On account of his distinguished, manly appearance and his high position, he was much sought in society.

He characterizes himself as a clever, quiet, strong-willed, but superficial man. He asserts that he is a passionate hunter and rider, and that he has never had any inclination for feminine pursuits. In the society of ladies he has always been reserved; dancing always tired him. He had never had any interest in a lady of high social position. As for women, only the buxom peasant girls, such as are the models of painters in Rome, had interested him. He had, however, never felt any sexual interest in such representatives of the female sex. In the theatre and circus only male performers had excited his interest; but, at the same time, they had caused him no sensual feelings. As for men, only their boots excited him, and, indeed, only when the wearers belonged to the servant class and were handsome men. Men of his own position, wearing never so fine boots, were absolutely indifferent to him.

With reference to his sexual inclinations, the patient is still uncertain whether he feels more inclination toward the opposite sex or toward his own sex. He is inclined to think that originally he had more inclination for women, but that this sympathy was, in any case, very weak. He states with certainty that the sight of a naked man made no impression on him, and that the sight of male genitals was even repugnant to him. In the case of women, this was not exactly the case, but he was not excited sexually even by the most beautiful feminine form. When a young officer, he was now and then compelled to accompany his comrades to brothels. He was the more easily persuaded to this, since he hoped by this means to be rid of his vile partiality for boots; but he was impotent unless he brought the thought of boots to his aid. Under such circumstances, the act of cohabitation was normally performed, but without pleasurable feeling. Patient felt no impulse to intercourse with women, always requiring some external cause,—i.e., persuasion. Left to himself, his vita sexualis consisted in reveling in ideas about boots, and in corresponding dreams with pollutions. Since more and more there became connected with them the impulse to kiss his servant’s boots, to draw them off, etc., the patient determined to use every means to rid himself of this disgusting desire, which deeply wounded his pride. At that time, being in his twentieth year, and in Paris, he recalled a very beautiful peasant girl, who lived in his distant home. He hoped, with her assistance, to free himself of his perverse sexual inclination. He went directly home, and tried to win the girl’s favor. It seems that the patient was not naturally homo-sexual. He asserts that at that time he was actually in love with this person, and that her glance, or the touch of her dress, gave him sensual pleasure; and, when she once kissed him, he had a powerful erection. After about a year and a half, the patient succeeded in gaining his desires with this person.

He was potent, but ejaculated tardily (ten to twenty minutes), and never had a pleasurable feeling in the act.

After about a year and a half of sexual intercourse with this girl, his love for her grew cold, because he did not find her so “fine and pure” as he wished. From this time it was necessary for him to call upon ideas about boots for help, which had been latent, in order to be potent in sexual intercourse with her. In proportion as his power failed, these ideas arose spontaneously. Thereafter he had coitus with other women. Now and then, especially when the woman was in sympathy with him, the act took place without any assistance of imagination. It once happened that the patient committed a rape. It is remarkable that on this single occasion he had a pleasurable feeling in the (forced) act. Immediately after the deed he had a feeling of disgust. When, an hour after the forced indulgence, he had coitus with the same woman, with her consent, he experienced no feeling of pleasure.

With decrease of virility,—i.e., when it was preserved only in connection with ideas about boots,—libido for the opposite sex decreased. The patient’s slight libido and weak inclination for women are evidenced by the fact that, while he still sustained sexual relations with the peasant girl, he began to masturbate. He learned the vice from “Rousseau’s Confessions,” the book accidentally falling into his hands. The boot-fancies immediately linked themselves with corresponding impulses. He then had violent erections, masturbated, and ejaculation afforded him a lively feeling of pleasure, which was denied to him in coitus; and at first he felt himself fresher and brighter, as a result of the masturbation.

In time, however, symptoms of sexual, and, later, of general, neurasthenia, with spinal irritation, appeared. He then at first gave up masturbation, and sought his first love; but she was now more than ever indifferent to him. Since he finally became impotent, even when he called ideas of boots to his assistance, he gave up women entirely, and again practiced masturbation; by which he felt himself protected from the impulse to kiss and blacken servants’ boots. At the same time, he continued to feel that his sexual position was a painful one. He again occasionally attempted coitus, and was successful in it as soon as he thought of blackened boots. Too, after continued abstinence from masturbation, he was sometimes successful in coitus without any artificial aid.

The patient says that his sexual needs are intense. If he has not had an ejaculation in a long time, he becomes congestive and psychically much excited, and tormented by repugnant images of boots, so that he is forced to have coitus, or, preferably, to masturbate.

For some time his moral position has been complicated most painfully by the fact that, as the last of a wealthy line of high position, and at the importunate desire of his parents, he must marry. The bride is of rare beauty, and mentally in perfect sympathy with him; but, as a woman, she is as indifferent to him as any other. Æsthetically she satisfies him “as a work of art;” in his eyes, she is an ideal. To honor her in a platonic way would be happiness worth striving for; but to possess her as a wife is a painful thought. He is certain beforehand that with her he will be impotent, save with the help of ideas of boots. To use such means, however, is in opposition to his respect and his moral and æsthetic feeling for the lady. Were he to soil her with such thoughts, she would lose, in his eyes, all her æsthetic value; and then he would become impotent for her, and she would become repugnant to him. The patient considers his position one of despair, and confesses that he has lately been repeatedly near suicide.

He is a man of much intelligence, and decidedly of masculine appearance, with abundant growth of beard, deep voice, and normal genitals. The eye has a neuropathic expression. No signs of degeneration. Symptoms of spinal neurasthenia. It was possible to reassure the patient, and give him hope of his future.

The medical advice consisted in means for combating the neurasthenia, and the interdiction of masturbation and indulgence of the fancy in images of boots, in the hope that, with the removal of the neurasthenia, cohabitation without ideas of boots would become possible; and that, in time, the patient would become morally and physically capable of marriage.

In the latter part of October, 1888, the patient wrote me that he had resolutely resisted masturbation and his imagination. In the interval he had had but one dream about boots, and scarcely a pollution. He had been free from homo-sexual inclinations, but, in spite of this, there was often considerable sexual excitement, without anything like adequate libido for women. In this deplorable situation, he was compelled, by circumstances, to marry in three months.

2. Homo-Sexual Individuals, or Urnings.—In distinction from the preceding group of psycho-sexual hermaphrodites, there are here, ab origine, sexual desires and inclinations for persons of the same sex exclusively; but, in contrast with the following group, the anomaly is limited to the vita sexualis, and does not more deeply and seriously affect the character and mental personality.

The vita sexualis of these urnings, mutatis mutandis, is entirely like that in normal hetero-sexual love; but, since it is the exact opposite of the natural feeling, it becomes a caricature, and this the more, since these individuals, at the same time, as a rule, are subject to hyperæsthesia sexualis, and, therefore, their love for their own sex is emotional and passionate.

The urning loves and deifies the male object of his affections, just as a man idealizes the woman he loves. He is capable of the greatest sacrifice for him, and experiences the pangs of unfortunate, often unrequited, love; suffers from the unfaithfulness of the beloved object, and is subject to jealousy, etc.

The attention of the male-loving man is given only to male dancers, actors, athletes, statues, etc. The sight of female charms is indifferent to him, if not repulsive. A naked woman is disgusting to him, while the sight of male genitals, hips, etc., affords him infinite pleasure.

The bodily contact of a sympathetic man induces a thrill of delight; and, since such individuals are mostly sexually neurasthenic, congenitally or from onanism or enforced abstinence from sexual intercourse, under such circumstances ejaculation is very easily induced, which, in the most intimate intercourse with women, cannot be induced at all, or only by mechanical means. The sexual act with a man, in many instances, affords pleasure, and leaves behind a feeling of well-being. Should the urning be able to force himself to coitus, in which, as a rule, disgust has the effect of an inhibitory concept, and makes the act impossible, then his feeling is something like that of a man compelled to take disgusting food or drink. However, experience teaches that not infrequently urnings falling in this group marry, either out of ethical or social considerations.

Such unfortunates are relatively potent, in that in marital intercourse they incite their imagination, and, instead of thinking of their wives, they call up the image of some loved male person. But for them coitus is a great sacrifice, and no pleasure; and it makes them, for days after, nervous and miserable. If such urnings, by means of powerful excitation of their imagination, or under the influence of alcoholic drinks, or by erections induced by an overfilled bladder, etc., are enabled to overcome the inhibitory feelings and ideas, then they are still entirely impotent; while simply the touch of a man may induce powerful erection, and even ejaculation.

Dancing with a woman is unpleasant to an urning, but to dance with a man, especially one with an attractive form, seems to him the greatest of pleasures. The male urning, in so far as he possesses higher culture, is not opposed to non-sexual intercourse with women, when by mind and refinement they make conversation pleasant. It is only of woman in her sexual rôle that he has a horror. The homo-sexual woman offers the same manifestations, mutatis mutandis. In this degree of sexual degeneration, character and occupation correspond with the sex which the individual represents. The sexual perversion remains isolated, but an anomaly of the mental being of the individual which deeply affects the social existence. In accordance with this, many of these individuals, in the sexual act, feel themselves in the rôle which would naturally belong to them in hetero-sexual intercourse.

However, transitions to group 3 occur, in as much as sometimes the passive rôle which corresponds with the homo-sexual manner of feeling, is thought of or desired, or at least forms the subject of dreams. Moreover, inclinations for occupations and tendencies of taste are manifested, which do not correspond with the sex of the individual. In many cases, one gets the impression that such symptoms are artificial, the result of educational influences; in other cases, that they represent deeper acquired degenerations of the original anomaly, induced by the perverse sexual activity (masturbation), analogous to the signs of progressive degeneration observed in acquired inversion of the sexual instinct.

With regard to the manner of sexual satisfaction, it must be stated that with many male urnings simple embraces are sufficient to induce ejaculation, since they are subject to irritable weakness of the sexual apparatus. In case of sexual hyperæsthesia, and where there is paræsthesia of the moral sense, great pleasure is afforded by intercourse with persons of the lowest condition. On the same basis, desires to commit pederasty (active, of course) and other similar acts occur, though it is but seldom, and apparently only in cases of moral defect, and by reason of libido nimia in individuals especially passionate, that pederasty is indulged in. The sensual desire of mature urnings, in contradistinction from old and decrepit debauchees, who prefer boys (and indulge in pederasty by preference), seems never to be directed to immature males. Only for want of better material, and in case of violent passion, does the urning become dangerous to boys. The manner of sexual satisfaction in female urnings may be mutual and passive masturbation. To them coitus is quite as disgusting, wearisome, and inadequate as it is to the male urning.

Case 112. The following is an extract from a very circumstantial autobiography which a physician affected with contrary sexual instinct has put at my disposal:—

“I am now forty years old, of healthy family,[114] and have always been healthy and considered a model of physical and mental strength and energy. I am of powerful build, but have only a moderate beard, and, with the exception of hair in the axillæ and on the mons veneris, my body is hairless. The penis, even soon after birth unusually large, measures, in statu erectionis, 24 centimetres long by 11 centimetres in circumference. I am a skillful rider, athlete, and swimmer, and have passed through two great campaigns as a military surgeon. I never experienced any taste for female attire and vocation. Up to the time of puberty I was shy toward the female sex, and I am yet shy with new acquaintances.

“I have always had a distaste for dancing. In my eighth year an inclination for my own sex made its appearance. I next experienced pleasure in regarding my brother’s genitals. I induced my brother to indulge with me in mutual fondling of the genitals, as a result of which I had an erection. Later, in bathing with the school-children, the boys excited a lively interest in me; the girls, none at all. I had so little interest in them that, as late as my fifteenth year, I believed that they also had a penis. In company with boys like myself, I took pleasure in mutual manustupration. At eleven and a half years I was given a strict tutor, and thereafter could steal to my friends but seldom. I learned very easily, but could not get along with my teacher; and when one day he made it too hard for me, I became furious and struck at him with a knife, and would have gladly stabbed him, if he had not fallen into my arms. In my thirteenth year, for a similar cause, I escaped from the teacher, and wandered about for six weeks in the neighboring country.

“I now entered the Gymnasium. At that time I was already sexually developed, and amused myself while bathing with my comrades in the way above mentioned, and later by imitatio coitus between the thighs. I was then thirteen years old. I took absolutely no pleasure with girls. Violent erections caused me to play with my genitals, and I came to take my penis in my mouth, which I succeeded in doing by bending over. This induced ejaculation. I thus learned masturbation. I was much frightened, looked upon myself as a criminal, and confessed to a companion of sixteen. He encouraged and quieted me, and entered into a love-bond with me. We were happy, and satisfied ourselves by mutual onanism. At the same time, I masturbated. After two years the bond was broken; but to this day, when we occasionally meet,—my friend is a high official,—the old fire lights up anew.

“That time with my friend H. was a happy one, the return of which I would gladly buy with my heart’s blood. Then life was a pleasure, learning was mere play, and I had a feeling for everything beautiful.

“During this time a physician, a friend of my father’s, seduced me by caressing me and practicing masturbation on me on the occasion of a visit, and by explaining the sexual act to me. He advised me never to practice manustupration, since it was injurious to health. He then practiced mutual onanism with me, and explained that this was the only way in which he could perform the sexual function. He had a horror of women, and, therefore, had lived unhappily with his deceased wife. He gave me a pressing invitation to visit him as often as possible. The physician was a pompous man, and the father of two sons aged fourteen and fifteen respectively, with whom in the following year I entered into love-relations similar to those I had with my friend H.

“I was ashamed of my unfaithfulness to him, but at the same time continued my relations with the physician. He practiced mutual masturbation with me, showed me our spermatozoa under the microscope, and pornographic works and pictures, which, however, did not please me, because I had interest only for male forms. On the occasion of later visits, he asked me to do him a favor which he had never yet enjoyed, and which he very much desired. Since I loved him, I acquiesced in everything. He dilated my anus with instruments, and practiced pederasty on me, and at the same time performed masturbation, so that I experienced pleasure and pain at once. After this discovery I went immediately to my friend H., with the thought that this beloved man would be able to give me still greater pleasure. We practiced pederasty on each other, but were both deceived, and did not repeat it; for passively I had only pain, and actively no pleasure, while mutual onanism gave us both the greatest enjoyment. Thereafter, out of gratitude, I was still frequently at the disposal of the physician only. Up to my fifteenth year I practiced passive or mutual onanism with my friend. Now I was quite grown, and had all kinds of signs made to me by women and girls; but I fled from them as Joseph did from Potiphar’s wife. At fifteen I came to the Capital. I had but infrequent opportunity for the satisfaction of my sexual inclination. I reveled in the sight of pictures and statues of male forms, and could not keep from kissing the beloved statues. The fig-leaves on the genitals were my principal annoyance.

“At seventeen I went to the University. There, again, I lived two years with my friend H.

“When I was in my eighteenth year, while in a state of mild intoxication, I was set on to have coitus with a woman. I forced myself to it, but immediately afterward I fled the house, overcome with disgust. Just as after the first active manustupration, I had a feeling as if I had committed a crime. On the occasion of another attempt, while in a sober condition, in spite of every effort of a beautiful naked girl, I could not get an erection; though the mere sight of a boy or the touch of a man’s hand on my thigh, would always throw my penis into violent erection. A short time before, my friend H. had had a similar experience. In vain we racked our brains to discover the reason for it. Now I let women alone, and found enjoyment with friends in passive and mutual onanism, among others with both the sons of the physician, who had used them for pederasty after my departure.

“When nineteen years old, I made the acquaintance of two genuine urnings:—

“A., aged 56, of effeminate appearance, beardless, of small endowment mentally, possessing a powerful sexual desire that had been manifested abnormally early, had indulged in urnings’ love since his sixth year. Once a month he visited the Capital. I had to sleep with him. He was insatiable in mutual onanism, and made me take part in active and passive pederasty, which was an unpleasant part of the bargain for me.”

“B., a merchant, aged 36, of masculine appearance, was as passionate as I was. He knew how to make his manipulations on me such a stimulus that I had to serve him passively in pederasty. He was the only one with whom I ever had any pleasure in passive pederasty. He confessed to me that when he but knew that I was near, he had the most painful erections; and that when I could not serve him, he was compelled to satisfy himself by masturbation.

“While pursuing these love-affairs, I was clinical assistant in hospital, and was considered ambitious and skillful in my work. I naturally sought throughout literature for an explanation of my sexual peculiarity. I found it in part as a crime deserving punishment, while for myself I could only recognize in it the natural satisfaction of my sexual desire. I was aware that this was congenital with me. But feeling myself in opposition to the whole world, often near insanity and suicide, I again sought to satisfy my powerful sexual desire with women. The result was always the same,—either want of sufficient erection, or, when it became possible, to force myself to the act, disgust and horror of its repetition. As a military surgeon, I suffered terribly from the sight and touch of thousands of naked male forms. Fortunately, I formed a love-bond with a lieutenant affected similarly, and passed again a time of happiness. For love of him I consented to pederasty, for which he longed. We loved each other until he lost his life at Sedan. From that time I never gave myself to active or passive pederasty, although I had many love-affairs, and was a person much sought.

“At twenty-three I went to the country as a physician, and was sought and esteemed. I satisfied myself with boys over fourteen. I interested myself in political affairs, and made an enemy of the clergyman, and, being betrayed by one of my lovers, was denounced and compelled to flee. The legal investigation, fortunately, did me no harm. I was able to return, but I was greatly shaken; and I went to the war (1870) as a soldier, in the hope of meeting my death. I returned, however, with many distinctions, much matured; and I found still more pleasure in earnest work in my profession. I hoped that the extinction of my excessive sexual desire was near at hand, exhausted by the great hardships of the campaign.

“Scarcely had I recovered, when the old unbounded desire again appeared, and led to new unbridled satisfaction. Of course, I often thought of it; but my inclination, so revolting to the world, did not seem so to me.

“For a year, by means of the greatest exercise of my will, I abstained; then I went to the Capital to force myself to cohabit with a woman. I, who at the sight of the dirtiest ragamuffin had painful erections, could scarcely induce one with the most beautiful woman. Overcome, I returned home and obtained a young man-servant for my personal service and satisfaction.

“The solitude of life as a country physician, and the longing for children, drove me to marriage; besides, I wished to make an end to gossip, and I hoped finally to triumph over my fatal desire.

“I knew a young girl, of whose respect and love for me I was convinced. Through my esteem and honor for my wife, I was enabled to perform the conjugal duties, and begat four boys. The boyish appearance of my wife was of effectual assistance. I called her my ‘Raphael.’ I forced into my fancy images of boys, in order to induce erection. If my fancy ceased for a moment, the erection failed. I was unable to sleep with my wife. Within the last few years coitus has become constantly more difficult to attain, and for two years we have given up all attempts. My wife knows my mental condition, and her esteem and love for me may become estranged.

“My sexual inclination for my own sex is unchanged, and, unfortunately, too often forces me to become untrue to my wife. To this day, the sight of a youth of sixteen puts me into violent sexual excitement with painful erections, so that occasionally I am compelled to help myself with manustupration of him and onanism on myself.

“The sufferings I endure are indescribable. Faute de mieux, I have my wife practice manustupration on me; but what my wife’s hand accomplishes with great effort in half an hour is produced by the hand of a boy in a few seconds. Thus I live, miserable, a slave of the law and of my duty to my wife! I never had pleasure in active or passive pederasty. If I ever practiced or suffered it, it was only from gratitude or desire to please.”

The physician to whom I owe the preceding autobiography assures me that he, up to this time, has had sexual intercourse with at least six hundred urnings. There were, indeed, many among them who to-day occupy high and respected positions. Only about ten per cent. of them came later to love women. Another portion did not avoid women, but were more inclined to their own sex; the remainder were exclusively and lastingly urnings.

This physician asserted that among the six hundred he never found abnormal formation of the genitals; but there were, however, frequent approaches to the female form, as well as incomplete growth of hair, delicate complexion, and higher voice. Development of the mammæ was not infrequent. He asserted that from his thirteenth to his fifteenth year he had milk in his mammæ, which his friend H. sucked out. Only about ten per cent. of this number showed inclination for female occupations, etc. All his acquaintances were affected with a sexual desire that was abnormally powerful, and made its appearance abnormally early. The vast majority felt themselves as the man in their relations with the other, and satisfied themselves by mutual onanism, or by manustupration on the person of the lover, or by masturbation at his hands. The majority were inclined to active pederasty; but very frequently the law and æsthetic feeling were reasons for the non-performance of the act. Those feeling themselves toward the others as women were few, and the inclination to passive pederasty was very infrequent.

In the beginning of 1887, this physician was arrested for having commuted acts of indecency on the persons of two boys under fourteen years. The crime consisted in his having first rubbed mentulam propriam inter femora viri until ejaculatio, and the same procedure cum mentula propria inter femora pueri. At the examination it was recognized that an abnormal instinct was in play, though, at the same time, it was shown that the culprit was not mentally unsound, and not deprived of free will; at least, he had not acted in obedience to an uncontrollable impulse. Therefore, he was sentenced to prison for one year, the mildest possible punishment.

Case 113. Mr. X., Hungarian, merchant, consulted me on account of neurasthenia and sleeplessness, which had existed for years. The investigation of the cause of his trouble led the patient to confess that he had an abnormal sexual instinct for his own sex, that he was very passionate, and that his nervous trouble might well come from that. The following, taken from the history of this intelligent patient, possesses scientific interest:—

“My abnormal sexual instinct reaches back to my childhood. When three years old, I got hold of a journal of fashions. The beautiful pictures of the men I kissed until the paper was torn to tatters, but I paid no attention to the female figures. I did not like to play with boys. I preferred to play with girls, because they always had dolls. I especially liked to cut out dolls’ clothes; and to-day, in spite of my thirty-three years, dolls still possess an interest for me. When a boy, for hours I would lurk about available places, in order to get a sight of male genitals. When I succeeded, a strange, dizzy feeling came over me. Weak, unattractive men or boys made no impression on me. At thirteen I began to masturbate. From my thirteenth till my fifteenth year, I slept with a handsome young man. That was happiness. Hours at a time at night, with erections, I would wait for his return. If in bed he chanced to touch my genitals, it gave me delight. At fourteen I had a school-mate whose instincts were like my own. For hours at a time, during school-hours, we held each other’s genitals. Ah, those were happy hours! As often as I could, I lingered in bath-houses. That was always a feast for me. The sight of male genitals induced violent erections. At sixteen I came to the metropolis. Seeing so many handsome men charmed me. In my eighteenth year I attempted coitus with a prostitute, but disgust and fear made it impossible. Other attempts were failures, until my nineteenth year, when I tried again with success; but the act afforded me no pleasure, rather inducing a feeling of disgust. I conquered myself, and was proud of my success at being a man, which I had gradually begun to doubt.

“Subsequent attempts were no longer successful. The disgust was too great. When the woman was undressing, it became necessary, on account of my feeling of repugnance, to put out the light. I now considered myself impotent, consulted physicians, and visited baths and sanitariums to cure my supposed impotence; for I still did not know what to think of it. I took pleasure in the society of ladies, perhaps out of conceit; for I impressed most ladies as being sympathetic and amiable; but I valued in them nothing more than mental and æsthetic qualities. I liked to dance with them; but if one pressed against me in dancing, I experienced a feeling of repugnance, and even disgust, and felt like striking her. If in joke I happened to dance with a gentleman, I always took the part of the lady. I would press and rub against him, and take a perfect delight in it. When I was eighteen, a gentleman who came into the office, said, ‘That is a fine youth; in the East he would bring a pound sterling every time!’ I puzzled my head over that. Another gentleman liked to joke with me, and steal kisses of me as he was going away, which I would have given him only too gladly. He afterward became my lover. These circumstances excited my attention, and I waited for an opportunity.

“When I was twenty-five years old, it happened that a man who was formerly a Capucine monk became attracted to me. For me he was like a Mephistopheles. Finally he spoke to me. To this day I can almost feel the beating of my heart that he caused me; I almost fainted. He made a rendezvous for that evening at a public house. I went, but at the threshold I turned back, afraid. On the next evening he met me again. He overcame my scruples, and took me to his room. I was scarcely able to walk for excitement. My seducer made me sit on his sofa, and, smiling at me, he fixed his wonderful black eyes on me, and I lost consciousness. This delight, this ideal, divine sense of pleasure that filled my whole being,—I could write too much about it. I think only an innocent youth, over head and ears in love, who for the first time has his love’s longing fulfilled, could be as happy as I was that night. My seducer demanded my life, in joke; but I at first thought him in earnest. I begged him to let me be happy for a time, and then, united to him, I would end my life. It would have been entirely in accordance with the high-flown ideas I entertained at that time. For five years after that, I kept up a relation with the man, who is still so dear to me. Oh, how happy, and yet, often, how unhappy, I was during those years! If I but saw him speak to a handsome young man, I became wildly jealous.

“When twenty-seven, I became engaged to a young lady. Her mind and æsthetic feeling, as well as financial considerations, induced me to think of marriage. At the same time, I am very fond of children, and, whenever I meet even the commonest day-laborer and his wife and a pretty child, I envy the man his good fortune. Thus I made a fool of myself. I managed to get through the time of courtship; when kissing my bride I felt more anxiety and fear than pleasure. On one or two occasions, however, after luxurious dinners, while kissing her passionately, I had erections. How happy I was at that! I saw myself already a father. I twice came near breaking off the engagement. On my marriage-day, when all the guests had assembled, I locked myself in a room, cried like a child, and felt that I could not proceed with the ceremony. At the persuasion of all the relatives, to whom I made the best excuses that occurred to me, I allowed myself to be taken, in ordinary street-costume, to the altar.

“As great good fortune would have it, at the time of the marriage, my wife was menstruating. Oh, how thankful I was for this excuse! I am now convinced that this circumstance is all that made later cohabitation possible. How it later became possible for me to cohabit with my wife, and have a lovely boy, I do not know. He is the comfort of my ruined life. I can only thank God for the happiness of having a child. I was a cheat, so to speak, in the marriage-bed. My wife, whom I respect for her high qualities of character, has no suspicion of my condition, but she often complains of my coldness. With her goodness of heart and simplicity, it was possible for me to make her think that the conjugal duty should be performed but once a month. Since she is in nowise sensual, and I can find excuse in my nervousness, I am successful in keeping up the swindle. Cohabitation is the greatest sacrifice for me. By taking considerable wine, and by making use of the erections which occur in the morning, as the result of an overfilled bladder, it is possible for me to perform coitus once a month; but it affords me no pleasurable feeling, and I am worried and experience an increase of my nervous difficulties all day long after it. The consciousness of having fulfilled my duty toward my wife, whom in all other respects I love, affords me moral consolation and satisfaction. With a man, it is otherwise. With him I can perform the act several times in a night, always taking the sexual rôle of a man. In this, I experience the greatest pleasure, the purest happiness. I feel myself refreshed and invigorated by it. Of late, my desire for men has somewhat decreased; in fact, I have courage even to avoid a handsome young man that approaches me. Will it last? I fear not. I am absolutely unable to do without male love; if I am compelled to forego it, I become depressed, feel weary and miserable, and have pain and pressure in my head. I have always regarded my pitiable peculiarity as something congenital, and I would feel happy if I had only not married. I pity my good wife. Often the fear seizes me that I cannot endure it with her longer; then thoughts about divorce, suicide, and flight to America come to me.”

No one seeing the patient to whom I owe this communication would suspect his condition. His outward appearance is, in all respects, masculine; he has a well-developed, full beard, strong and deep voice, and normal genitals. The cranium is normally formed; signs of degeneration are absolutely wanting, and only an exquisitely nervous eye makes one suspect a neuropathic condition. The vegetative organs perform their functions normally. The patient presents the usual symptoms of a neurasthenia, which may, in all essentials, be ascribed to sexual excesses with persons of his own sex, in a man abnormally passionate; and to the injurious influences of forced, though infrequent, coitus with the wife where horror feminæ exists.

The patient declares that he comes from healthy parents, and that he knows of no neuroses or mental disease in his ancestry. His elder brother was married three years. There was a separation, because the husband never had sexual intercourse with his wife. He married a second time. The second wife also complained of neglect on the part of the husband; but she had four children, concerning whose legitimacy no doubt was ever raised. A sister is hysteropathic.

The patient says that, when a young man, he suffered with momentary attacks of dizziness, during which it seemed to him as if he were about to die. He says that he has always been very excitable and emotional, and an enthusiast for the arts, especially poetry and music. He himself designates his character as enigmatical, abnormal, nervous, restless, extravagant, and undecided. He is often exalted without real reason, and then again depressed, even to thoughts of suicide. He may pass through quick and sudden changes,—“religious and frivolous, optimistic and cynical, cowardly and brave, credulous, amiable, and suspicious; inclined to do others harm, and sorrowful to tears over the misfortunes of others; and with this, generous to excess, and then again miserly à la Harpagon.” The patient is certainly a tainted individual. He seems to be very well endowed intellectually, and, as he says, to have learned easily, and been among the first at school.

The marriage of this man was not happy. Notwithstanding the fact that it was but very infrequently that he performed the inadequate and injurious sexual act with his wife, and that he sought and found a substitute in male lovers, he remained neurasthenic. His disease, at times, presents marked exacerbations, even manifesting itself in despairing depression about his matrimonial, sexual, and mental condition, which even extends to violent tædium vitæ.

His wife became hysteropathic and anæmic, and the patient attributed this to sexual abstinence. Try as he would to force himself, of late years he has not been able to perform coitus, erection failing completely; while, in intercourse with male lovers, he is very potent.

The son of these unfortunate parents, who is now over nine years old, develops well. The patient adds that formerly, in coitus with his wife, he was potent only when he thought of a beloved man. (From the author’s “Lehrb. der Psychiatrie.”)

Case 114. Autobiography. “The writer of this is a congenital urning. If I have not consorted with other urnings, nevertheless, I am fully informed of my condition; for it has been my lot to see almost all literature on the subject. A short time ago, your work, ‘Psychopathia Sexualis,’ was sent to me. I saw in it that you were working and studying without prejudice in the interest of science and humanity.

“If I cannot tell you much that is new, yet I will speak of a few things which I trust you will receive as one more stone to be used by you in your work; which, I am confident, will, in your hands, aid in saving us.

“When you presume that there is often an hereditary tainted condition, perhaps you are right. My father was subject to spinal disease before my birth; later, he became mentally unsound, and took his own life.

“Another point, which I am inclined to doubt, is the one mentioned by you in another place,—i.e., that onanism practiced from youth may lead to perverse instinct.

“I (merchant, owner of a small business, unmarried) am in the beginning of my thirtieth year. I am apparently healthy, and show scarcely a deviation from the normal masculine type. The first sexual impulses were immediately and exclusively directed to the male sex, and I experienced them from my tenth year. I have masturbated since my twelfth year. Since, in spite of all attempts, coitus with women was always absolutely impossible for me; and since I have never had desire for women—on the contrary, rather aversion; and since my attempts have never resulted in the slightest erection, I have been compelled to satisfy myself by onanism.

“If now I am to confess the manner of my sexual satisfaction, I may say that in my earlier years my fellow-pupils and companions excited me sexually. Now my impulse consists in a desire for boys of about ten, but mostly for youths of from fifteen to twenty years.

“For a long time, strong and healthy cadets, of fine form, have had a particular charm for me; and by their handsome uniforms and fine presence they especially excite my desire. I have no opportunity to approach them, or even to enter into distant social intercourse with them; but I am compelled to satisfy myself with following them in the streets and squares; or in restaurants, horse-cars or railways, by sitting near them, and, when it is possible to do it unnoticed, under such circumstances, by practicing onanism. My most ardent wish has often been to become the friend, servant, or slave of such a young man.

“I have never even dreamed of direct pederasty; my desire has always been bodily contact, embrace, manustupration of my genitals by my lover, and, on my part, a kiss on his genitals or podex.

“I often have the desire, however, to represent Sacher-Masoch in his ‘Venus in Furs.’ There a man makes himself the voluntary slave of a woman, and feels an intense thrill of lustful pleasure, if he is only chastised and humiliated by her. But I naturally feel that I could, under no circumstances, become the slave of a woman, but only of a man; more correctly, of a young man; one, however, for whom I should have such an infinite love that I could give myself up entirely to his mercy or cruelty.

“The lustful images that float before my mind in masturbation are those of this or that young man that I have just seen. As a sad and incomplete substitute, I practice this onanism constantly.

“I pass into a lustful dream in this way (and I say all here, because I wish to write only the truth and the whole truth): I choose a young man that pleases me by his form, and in imagination give myself up to involuntary obedience to him. I imagine that he wishes to humiliate me, and that he commands me, for example, to kiss his feet; or compels me to smell his socks. For want of the desired actuality, I take my own socks, smell of them, take them into my mouth, rub them over my genitals, and immediately erection and ejaculation, with sensual pleasure, take place.

“Yes, I am so dominated by this mental imagery that I imagine that the young man is my confessor, and, in order to humiliate me, orders me to eat of his excrement. Here again, in want of actuality, I eat of my own excrement, but only in small quantity. Then, with an imperfect feeling of disgust and violent palpitation of the heart, erection and ejaculation take place.

“However, I come to this vile, feverish imagery and the performance of these acts, only when it has not been possible for me for a long time to satisfy myself by onanism in the immediate vicinity of a young man.

“This is for me more natural, because I then have more pleasure, and experience a more perfect physical and mental benefit, even though my ideal of actual and direct satisfaction in mutual understanding were never to be accorded me.

“I almost believe that the above-mentioned disgusting imagery is only the evil result of constant want of normal satisfaction,—i.e., of my normal satisfaction as an urning; and that with a regular satisfaction, body to body, the imagery that becomes almost insane would be less intense, and certainly would not go to such extravagance. Or it is the ultimate result of an attempt at abstinence; for these idiotic, sensual images only come after a long period of it.

“I believe, indeed, that, under other social conditions, I should be capable of great and noble love and self-sacrifice. My thoughts are in no way exclusively carnal or diseased. How often, at the sight of a handsome young man, a deep feeling of impatience seizes me, and I breathe at once the sweet words of Heine:—

“‘Du bist wie eine Blume, so hold, so schön, so rein,’ etc.[115]

“And once, when I was compelled to part with a young man who had honored and valued me as his friend and protector, though my love had remained unknown to him, those fine verses by Scheffel kept passing through my mind, especially the last,—mutatis mutandis:—

“‘Grau wie der Himmel, steht vor mir die Welt,

Doch wend’ es sich zum Guten oder Bösen,
Du, lieber Freund, in Treuen denk’ ich Dein!
Behüt Dich Gott! es wär’ zu schön gewesen,

Behüt Dich Gott, es hat nicht sollen sein!’[116]

“I have never independently revealed my love to a young man, and have never spoiled or injured one morally; but I have, now and then, made the way easy for many. Under such circumstances, nothing is too much trouble, and I obtain victims as only I can.

“When I have an opportunity to have such a beloved friend about me, to educate, protect, and help, if my recognized love find a (natural, unsexual) return, then all my disgusting mental imagery grows less and less intense; then my love becomes almost platonic and ennobled, to sink again into the mire when this worthy satisfaction is removed.

“As for the rest, and without over-estimating myself, I may say that I am not one of the worst of men. Brighter mentally than the average man, I take interest in all that moves humanity. I am amiable, and easily moved to pity, and am incapable of doing any animal, much less a man, an injury; but, on the contrary, do good wherever I can.

“When I have nothing to reproach myself with in my own conscience, and must, at the same time, set myself in opposition to the judgment of the world, I suffer very much. Indeed, I have done no one harm, and I consider my love, in its noblest activity, to be quite as holy as that of a normal man; but, with the unhappy lot which impatience and ignorance cast upon us, I suffer even to the extent of tædium vitæ.

“No pen, no tongue can describe all the misery, all the unhappy situations, the constant fear of having this peculiarity recognized, and of being cast from society. The one thought that, as soon as recognized, one’s existence would be lost, and he would be cast away from all, is as terrible as any thought can be. Then all the good that one had ever done would be forgotten; then, in the pride of his great morality, every normal man would be moved to scorn, even though he himself had been never so frivolous in his own love.

“Then what does our misery amount to? We may, cursing man, end our unhappy lives. Truly, I often long for the quiet of an asylum. My life may end when it will, the quicker the better; I am ready.

“To refer to one more point: I also believe, like the others that have written to you, that our nervousness is first acquired as a result of our unhappy, unspeakably miserable life among our fellow-creatures.

“And still another: You write, at the conclusion of your work, concerning the repeal of the legal enactments concerned. Indeed, humanity would not be destroyed if they were repealed. In Italy there is no such law, as far as I know; and Italy is not a wilderness, but a cultivated nation.

“As for myself, compelled as I am to undermine my life by onanism, the law could not touch me; for I have never sinned against it in a letter. But, at the same time, I suffer under the accursed scorn to which we are subjected. How can the ideas of society be changed, so long as there is a law which strengthens it in its immorality? The law must, of course, correspond with public opinion; but it should not be in harmony with the erroneous opinion of ignorance, but only in accord with the ideas of the best and most scientific thinkers,—not with the wish and prejudice of the vulgar. True thinking minds cannot much longer be satisfied with the old idea.

“Pardon me, Professor, if I close without a signature. Do not try to find me. I could tell you nothing more. I give you these lines in the interest of future sufferers. Publish from them, in the interest of science, truth, and justice, what seems to you to be necessary.”

Case 115. On a summer evening, at twilight, X. Y., a physician of a city in North Germany, was detected by a watchman while committing a misdemeanor with a countryman in a field. He was practicing masturbation on him, and then mentulam alius in os suum immisit. X. escaped legal prosecution by flight. The authorities dismissed the complaint, because there had been no publicity, and because immissio membri in anum had not taken place. Among X.’s effects was found an extensive correspondence of a perverse sexual character, which showed that he had had perverse intercourse for years with all classes of people.

X. came of a neurotic family. His paternal grandfather died by suicide while insane. His father was a weak, peculiar man. One brother masturbated at the age of two. A cousin was sexually perverse, and practiced perverse acts, similar to those of X., while a youth; he became weak-minded, and died of spinal disease. A paternal great-uncle was an hermaphrodite. His mother’s sister was insane. His mother is said to have been healthy. X.’s brother is nervous and irascible.

X., likewise, was nervous as a child. The mewing of a cat would create great fear in him; and if one but imitated the voice of a cat, he would cry bitterly, and run to others for protection. Slight physical disturbance caused violent fever. He was a quiet, dreamy child, of excitable imagination, but of slight mental capabilities. He did not indulge much in boyish games; he preferred feminine pursuits. It gave him especial pleasure to curl the hair of the house-maid or of his brother.

At thirteen X. went to an Institute. There he practiced mutual masturbation, seduced his comrades, and, by his cynical conduct, made them unmanageable; so that he had to be taken home. At that time the parents found love-letters with lascivious contents, showing perverse sexuality. From the age of seventeen he studied under the strict surveillance of a professor in a Gymnasium. He made but sad progress in learning. He had only a talent for music.

After finishing his studies, the patient entered the University, at the age of nineteen. There he attracted attention by his cynical character and his association with young persons who were thought to be given to masculine love. He began to be dandified; wore striking cravats, and shirts that were low cut; he forced his feet into narrow shoes, and curled his hair in a remarkable way. This peculiarity disappeared when he left the school, and had returned home.

At the age of twenty-four he was for a long time neurasthenic. From that time until his twenty-ninth year, he was earnest and skillful in his profession; but he avoided the society of the opposite sex, and constantly associated with men of doubtful character.

The patient would not allow a personal examination. In writing, he made the excuse for this that it would be of no use, because his impulse to his own sex had existed from his earliest childhood, and was congenital. He had always had horror feminæ, and had never been inclined to avail himself of the charms of women. Toward men he felt himself in the rôle of a man. He recognized his impulse toward his own sex as abnormal, and excused his sexual indulgence as being the result of an abnormal natural condition.

Since his flight X. lives out of Germany, in Southern Italy, and, as I learned from a letter, now, as before, he indulges in perverse love. X. is an earnest, stately man, of masculine features, well-grown beard, and normally developed genitals. Dr. X. furnished me, a short time ago, with his autobiography, of which the following is worthy of mention:—

“When, at the age of seven, I entered the private school, I felt very uncomfortable, and found very little sympathy with my companions. Only toward one of them, who was a very handsome child, did I feel attracted, and I loved him wildly. In childish games I always knew how to arrange it so that I could appear in feminine attire; and my greatest pleasure was to form intricate coiffures for our servant-girls. I often regretted that I was not a girl.

“My sexual instinct awakened when I was thirteen, and from the moment of its appearance was directed toward youthful, strong men. At first I was not really certain that this was abnormal, but consciousness of it came when I saw and heard how my companions were characterized sexually. I began to masturbate at the age of thirteen. At seventeen I left home and went to the Gymnasium of a large Capital, where I was put to board with a married professor of the Gymnasium, with whose son I afterward had sexual relations. It was with him that I first had sexual satisfaction. Thereafter I made the acquaintance of a young artist, who very soon noticed that I was abnormal, and confessed to me that he was in the same condition. I learned from him that this abnormality was very frequent; and this knowledge overcame the trouble that I had had in supposing that I was alone in my abnormality. This young man had an extensive acquaintance with persons in like condition, to which he introduced me. There I became the object of general attention, for on all sides I was declared to be very attractive physically. I soon became insanely loved by an old gentleman; but, not finding him to my taste, I endured him but a short time, and then gave ear to a young and handsome officer who lay at my feet. He was really my first love.

“After passing my final examination, at the age of nineteen, free from the discipline of school, I made the acquaintance of a great number of people like myself, and among them Karl Ulrichs (Numa Numantinus).

“When, later, I took up the study of medicine, and associated with many normal youths, I was often in a position where I was compelled to visit public prostitutes. After having consorted to no purpose with various prostitutes, some of whom were very beautiful, the opinion was spread among my acquaintances that I was impotent, and I strengthened this by telling of previous sexual excesses. At that time I had numerous external relations with persons who prized my physical peculiarities, which were considered very beautiful. The result of this was, that I was exciting somebody all the time; and I received such a mass of love-letters that I was often in embarrassment. The acme of this was reached later, when, as a physician, I lived in the hospital. There I moved about like a celebrated person, and the scenes of jealousy that took place, on my account, almost led to the discovery of the whole thing. Shortly after this, I fell ill with an inflammation of my shoulder-joint, from which I recovered after three months. During this illness I received subcutaneous injections of morphine several times daily, which were suddenly discontinued, and which I practiced thereafter secretly after my recovery. For the purpose of special study, I spent some months in Vienna, before entering into private practice, and there, by means of some recommendations, I gained entrance to various circles of people like myself. I there learned that the abnormality in question, in its various forms, is spread through the lower classes as well as the higher, and that those who are approachable for money are not infrequently met among the higher classes.

“When I established myself in the country, I hoped to cure myself of the morphine habit by means of cocaine; and then I became a victim of cocaine, which, only after three relapses, I was able to rid myself of (about two years ago). In my position, it was impossible for me to find sexual satisfaction, and I noticed with pleasure that the use of cocaine had overcome my desire. When, on the first occasion, at the urgent request of my aunt, I had emancipated myself from cocaine, I traveled for a few weeks, in order to improve my health, the perverse impulses were again awakened in their old strength, and, one evening, while out in the fields by the city amusing myself with a man, I noticed that I had been detected by the authorities and advertised; but that the act of which I was accused was not punishable, in accordance with the opinion expressed by the highest court of the German kingdom. I had, therefore, to be careful; for already the announcement of the crime had been heralded on all sides. I saw that, after this, I would be compelled to leave Germany, and find a new home where neither the law nor public opinion would be opposed to that impulse, which, like all abnormal instincts, could not be overcome by the will. Since I was never deceived for a moment about the matter, in recognizing my impulses as opposed to social usages, I repeatedly attempted to become master of them; but by these efforts they were increased in power. This same observation has been communicated to me by acquaintances. Since I was exclusively drawn toward strong, youthful, and masculine individuals, and they were very seldom inclined to yield to my wishes, I was compelled to buy them. Since my desire was limited to persons of the lower classes, I was always able to find such as were purchasable with money. I hope that the following statements will not awaken your repugnance. At first I intended to omit them; but, for the completeness of this communication, I may include them, since they serve to enrich the clinical material. I am compelled to perform the sexual act in the following way:—

“Pene juvenis in os recepto, ita ut commovendo ore meo effecerim, ut is quem cupio, semen ejaculaverit, sperma in perinæum exspuo, femora comprimi jubeo et penem meum ad versus et intra femora compressa immitto. Dum hæc fiunt, necesse est, ut juvenis me, quantum potest, amplectatur. Quæ prius me fecisse narravi, eandem mihi afferunt voluptatem, acsi ipse ejaculo. Ejaculationem pene in anum immittendo vel manu terendo assequi, mihi nequaquam amœnum est.

“Sed inveni, qui penem meum receperint atque ea facientes, quæ supra exposui, effecerint, ut libidines meæ plane sint saturatæ.

“Concerning my person, I must still mention the following: I am 186 centimetres tall, of masculine appearance, and, with the exception of abnormal irritability of the skin, healthy. My hair and beard are black and thick. My genitals are of medium size and normally formed. I am able, without any trace of fatigue, to perform the sexual act from four to six times in twenty-four hours. My life is very regular. I use alcohol and tobacco very sparingly. I play the piano quite well, and some of my unpretentious compositions have been much applauded. I have lately finished a novel, which, as my first work, has been very favorably criticised by my friends. The story has several problems taken from the life of urnings in the subject-matter.

“Among the large number of fellow-sufferers that are personally known to me, I have naturally been in a position to make observations concerning the condition and the degrees of abnormality; and, perhaps, the following communications may be of service to you:—

“The most abnormal thing that I am acquainted with, was the impulse of a gentleman who lived in Berlin. He preferred, above all others, young fellows with unwashed feet, which he would lick passionately. A gentleman in Leipzig was similar to him; who, where it was possible, would linguam in anum immittere, preferring the parts to be uncleaned. Several have assured me that the sight of riding-boots or of parts of military uniforms, induced such excitement in them that ejaculation resulted. A man in Paris compelled a friend ut in os ei mingat.

“With reference to the degree in which many feel themselves as women, which is with me not the case, two persons in Vienna are examples. They bore feminine names. One is a barber who calls himself ‘French Laura’; the other was formerly a butcher, who calls himself ‘Selcher-Fanny.’ Both of them never missed an opportunity, during the carnival time, to show themselves in very fantastic feminine masks. In Hamburg there is a person that many people believe to be a woman, because he always goes about the house in feminine attire, and only occasionally leaves the house, and always in such clothing. This man wished to stand as godmother at a christening, and, as a result of it, gave rise to great scandal.

“Feminine timidity, frivolity, obstinacy, and weakness of character, are the rule in such individuals.

“Several cases of perverse sexuality are known to me where epilepsy and psychoses are present. Hernias are remarkably frequent. In practice many persons come to me to be treated for diseases of the anus, because of recommendation by friends. I saw two syphilitic and one local chancre, and several fissures; and at present I am treating a gentleman for condylomata of the anus, which form a rounded tumor as large as a fist. One case of primary affection of the soft palate I saw in Vienna, in a young man who was accustomed to frequent mask-balls dressed as a girl, and entice young men; he would then pretend that he was menstruating, and thus induce the others to use him per os. The assertion was made that in this way he had deceived fourteen men in one evening. Since, in none of the publications concerning contrary sexuality that I have seen, I have found anything concerning the intercourse of pederasts among themselves, I venture to communicate something concerning it in conclusion:—

“As soon as individuals that are affected with contrary sexuality become acquainted, there is a detailed narration of their experiences, loves, and seductions, as far as the social difference between them allows such entertainment. Only in very few cases is this amusement uncommon with new acquaintances. Among themselves, they call themselves ‘aunts’; in Vienna, ‘sisters’; and two very masculine public prostitutes in Vienna, whom I accidentally became acquainted with, and who lived in a perverse sexual relation with each other, told me that for the corresponding condition in women the name ‘uncle’ was used. Since becoming conscious of my abnormal instinct, I have met thousands of such individuals.

“Almost every large city has some meeting-place, as well as a so-called promenade. In smaller cities there are relatively few ‘aunts,’ though in a small town of 2300 inhabitants I found eight, and in one of 7000 eighteen of whom I was absolutely sure,—to say nothing of those whom I suspected. In my own town of 30,000 inhabitants, I personally know about one hundred and twenty ‘aunts.’ The greater number of them, and I especially, possess the capability of judging another immediately as to whether they are alike or not, which, in the language of the ‘aunts,’ is called ‘reasonable’ or ‘unreasonable.’ My acquaintances are often astounded at the certainty of my judgment. Individuals that are apparently absolutely masculine I recognize as ‘aunts’ at the first sight. On the other hand, I am able to behave myself in such a masculine way that, in circles to which I have been introduced by acquaintances, there is a doubt as to my genuineness. When I am in the mood, I can act exactly like a girl.

“Since the majority of ‘aunts,’ like myself, in no way regret their abnormality, but would be sorry if the condition were to be changed; and, moreover, since the congenital condition, according to my own and all other experience, cannot be influenced; therefore, all our hope rests upon the possibility of a change of the laws with reference to it, so that only rape or the commission of public offense, when this can be proved at the same time, shall be punishable.”

Case 116. Contrary Sexual Instinct in a Woman.—S. J., aged 38, governess, came to me for advice about a nervous trouble. Her father was temporarily insane, and died of a brain disease. The patient is an only child, and even when quite young she suffered with feelings of anxiety and painful ideas. She thought, for example, that she would awake in her coffin after it had been closed; that at confession she might forget something, and make a sinful confession. She suffered much with headache. She was always very much excited and apprehensive, but yet she had to see horrible things, like corpses, etc.

Even in her earliest childhood, the patient was excited sexually, and began to masturbate without any teaching. The menses began at fourteen, and were always accompanied by colicky pains, violent sexual excitement, migraine, and depression. After her eighteenth year she learned to repress her impulse to masturbate.

The patient has never felt any inclination toward persons of the opposite sex. If she thought of marriage, it was only because she sought in matrimony a means of being supported. On the other hand, she felt powerfully attracted by girls. At first she regarded this inclination as friendship; but in the depth of her attachment to female friends, and in the longing she constantly felt for them, she recognized that the feeling was something more than friendship.

The patient cannot understand how a girl can love a man, but she can easily see how a man might love a girl. She always has a lively interest in beautiful women and girls, and is powerfully excited at sight of them. Her longing had always been to kiss and embrace such dear creatures. She had never dreamed of a man, but only of girls. Her delight had been to revel in the sight of them. Separation from such female friends had always made her desperate.

The patient, whose appearance is perfectly feminine and very respectable, states that she has never felt herself in any particular rôle with her friends, not even in dreams. Female pelvis; large mammæ; no sign of beard.

Case 117. Mrs. R., Russian, aged 35, of high social position, was brought to me, in 1886, by her husband for advice.

Father was a physician, and very neuropathic. Paternal grandfather was healthy and normal, and reached the age of ninety-six. Facts concerning paternal grandmother are wanting. All the children of father’s family are said to have been nervous. The patient’s mother was nervous, and suffered with asthma. The mother’s parents were healthy. One of the mother’s sisters had melancholia.

From her tenth year patient has been subject to habitual headache. With the exception of measles, she has had no illness. She was capable, and enjoyed the best of training, having especial talent for music and languages. It became necessary for her to prepare herself for the work of a governess, and during her earlier years she was mentally overworked. She passed through an attack of melancholia sine delirio, of some months’ duration, at seventeen. The patient asserts that she has always had sympathy only for her own sex, and found only an æsthetic interest in men. She never had any taste for female work. As a little girl, she preferred to play with boys.

She says she remained well until her twenty-seventh year. Then, without external cause, she became depressed and considered herself a bad, sinful person, had no pleasure in anything, and was sleepless. During this time of illness she was also troubled with imperative conceptions: that she must think of the death of herself and her relatives. Recovery after about five months. She then became a governess, was overworked, but remained well, except for occasional neurasthenic symptoms and spinal irritation.

At twenty-eight she made the acquaintance of a lady five years younger than herself. She fell in love with her, and her love was returned. The love was very sensual, and satisfied by mutual masturbation. “I loved her as a god; her’s is a noble soul,” she said, when she mentioned this love-bond. It lasted four years, and was ended by the (unfortunate) marriage of her friend.

In 1885, after much emotional strain, the patient became ill with symptoms of hystero-neurasthenia (dyspepsia, spinal irritation, and tonic spasmodic attacks; attacks of hemiopia with migraine and transitory aphasia; pruritus pudendi et ani). In February, 1886, these symptoms disappeared.

In March she became acquainted with her present husband, and married him without taking much time for reflection; for he was rich, much in love with her, and his character was in sympathy with her own.

On April 6th, she read the sentence, “Death misses no one.” Like a flash of lightning in a clear sky, the former imperative conceptions of death returned. She was forced to meditate on the most horrible manner of death for herself and those about her, and constantly imagine death-scenes. She lost rest and sleep, and took no pleasure in anything. Her condition improved. Late in May, 1886, she was married, but was still troubled by painful thoughts at that time: that she would bring misfortune on her husband and those about her.

First coitus on June 6, 1886. She was deeply depressed morally by it. She had had no such conception of matrimony. The husband, who really loved his wife, did all he could to quiet her. He consulted physicians, who thought all would be well after pregnancy. The husband was unable to explain the peculiar behavior of his wife. She was friendly toward him, and suffered his caresses. In coitus, which was actually carried out, she was entirely passive, and after the act she was tired, exhausted all day long, nervous, and troubled with spinal irritation.

A bridal tour brought about a meeting with her old friend, who had lived in an unhappy marriage for three years. The two ladies trembled with joy and excitement as they sank into each other’s arms, and became inseparable. The husband saw that this friendly relation was a peculiar one, and hastened their departure. He had an opportunity to ascertain, through the correspondence of his wife with this friend, that the letters interchanged were like those of two lovers.

Mrs. R. became pregnant. During pregnancy the remains of depression and imperative ideas disappeared. In September, during about the ninth week of pregnancy, abortion took place. After that, renewed symptoms of hystero-neurasthenia. In addition to this, there were anteflexio et latero-positio dextra uteri, anæmia, and atonia ventriculi.

At the consultation the patient gave the impression of a very neuropathic, tainted person. The neuropathic expression of the eyes cannot be described. Appearance entirely feminine. With the exception of a very narrow, arched palate, there was no skeletal abnormality. With difficulty the patient could be brought to give the details of her sexual abnormality. She complained that she had married without knowing what marriage between men and women was. She loved her husband dearly for his mental qualities, but marital intercourse was a pain to her; she did it unwillingly, without ever finding any satisfaction in it. Post actum, all day long she was weary and exhausted. Since the abortion and the interdiction of sexual intercourse by the physicians, she had been better; but she thought of the future with horror. She esteemed her husband, and loved him mentally; but she would do anything for him, if he would but avoid her sexually in the future. She hoped to have sensual feeling for him in time. When he played the violin, she seemed to feel the beginning of an inclination for him that was something more than friendship; but it was only transitory, and she could get no assurance for the future in it. Her greatest happiness was in correspondence with her former lover. She felt that this was wrong, but she could not give it up; for to do so made her miserable.

It is remarkable that the anomaly may be long limited to mere perversion of the sexual instinct, and that the impulse to perverse indulgence may make its appearance after some accidental cause,—e.g., seduction, or some neurosis. Such cases might easily be mistaken for acquired contrary sexual instinct (v. supra), if, with reference to the sexual feeling, they should not be demonstrated by the history to be original and congenital.

Case 118. Mrs. C., aged 32, wife of an official, a large, not uncomely woman, feminine in appearance, comes of a neuropathic and emotional mother. A brother was psychopathic, and died of drink. Patient was always peculiar, obstinate, silent, quick-tempered, and eccentric. The brothers and sisters are excitable people. Pulmonary phthisis has been frequent in her family. When only a girl of thirteen, with signs of great sexual excitement, she attracted attention by enthusiastic love for a female friend of her own age. Her education was strict, though the patient secretly read many novels, and wrote innumerable poems. She married at eighteen to free herself from unpleasant circumstances at home.

She says she has always been indifferent toward men. In fact, she avoided balls. Female statues pleased her. Her greatest happiness was to think of marriage with a beloved woman. She was not aware of her sexual peculiarity until marriage, and the thing had remained inexplicable to her. Patient did her marital duty, and bore three children, two of whom were subject to convulsions. She lived pleasantly with her husband, but she esteemed him only for his moral qualities. She gladly avoided coitus. “I should have preferred intercourse with a woman.”

Until 1878 she had been neurasthenic. On the occasion of a sojourn at a watering-place, she made the acquaintance of a female urning, whose history I have reported as Case 6, in the Irrenfreund, No. 1, 1884.

The patient came home a changed person. Her husband says: “She was no longer a woman, no longer had any love for me and the children, and would have no more of marital approaches. She was inflamed with passionate love for her female friend, and had taste for nothing else.” After the husband forbade her lover the house, there was interchange of letters with such expressions in them as “My dove! I live only for you, my soul.” There were meetings and frightful excitement when an expected letter did not come. The relation was in nowise platonic. From certain indications it is presumable that mutual masturbation was the means of sensual satisfaction. This relation lasted until 1882, and made the patient decidedly neurasthenic.

She absolutely neglected the house, and her husband hired a woman of sixty years as a house-keeper, and also a governess for the children. The patient fell in love with both, who, at least, allowed caresses, and profited materially through the love of their mistress.

In the latter part of 1883, on account of developing pulmonary tuberculosis, she had to go south. There she became acquainted with a Russian lady of forty years, and fell passionately in love with her; but she did not meet with a return of love in her sense. One day insanity became manifest. She thought the Russian lady a nihilist; that she was magnetized by her; and she presented formal persecutory delusions. She fled, and was caught in an Italian city, and placed in a hospital, where she soon became quiet. Again she followed the lady with her love, felt herself very unhappy, and planned suicide.

When she returned home, she was greatly depressed because she did not have the lady, and was contrary toward her family. A delusive, erotic state of excitement came on about the end of May, 1884. She danced, shouted, and called herself a man; demanded her former lovers, and said she was of royal blood. She escaped from the house in male attire, and was taken to the asylum in a state of eroto-maniacal excitement. After a few days the exaltation disappeared. The patient became quiet, and made a despairing attempt at suicide; and after it she was in great anguish of mind with tædium vitæ. The perverse sexual feeling grew less and less noticeable, and the tuberculosis progressed. The patient died of phthisis in the beginning of 1885.

The examination of the brain presented nothing unusual as far as architecture and arrangement of convolutions were concerned. Weight of brain 1150 grammes. Skull slightly asymmetrical. No anatomical signs of degeneration. External and internal genitals without anomaly.

3. Effemination and Viraginity.—There are various transitions from the foregoing cases to those making up this category, characterized by the degree in which the psychical personality, especially in general manner of feeling and inclinations, is influenced by the abnormal sexual feeling. In this group, fully-developed cases in men are females in feeling; in women, males. This abnormality of feeling and of development of the character is often apparent in childhood. The boy likes to spend his time with girls, play with dolls, and help his mother about the house; he likes to cook, sew, knit, and develops taste in female toilettes, so that he may even become the adviser of his sisters. As he grows older he eschews smoking, drinking, and manly sports, and, on the contrary, finds pleasure in adornment of person, art, belles-lettres, etc., even to the extent of giving himself entirely to the cultivation of the beautiful. Since women possess corresponding inclinations, he prefers to move in the society of women.

If he can assume the rôle of a female at a masquerade, it is his greatest delight. He seeks to please his lover, so to speak, by studiously trying to represent what pleases the female-loving man in the opposite sex,—sweetness, sympathy, taste for æsthetics, poetry, etc. Efforts to approach the female appearance in gait, attitude, and style of dress are frequently seen.

The female urning, even when a little girl, presents the reverse. Her favorite place is the play-ground of boys. She seeks to rival them in their games. The girl will have nothing to do with dolls; her passion is for playing horse, soldier, and robber. For female employments there is manifested not merely a lack of taste, but often unskillfulness in them. The toilette is neglected, and pleasure found in a coarse, boyish life. Instead of an inclination for the arts, there is manifested an inclination and taste for the sciences. Occasionally there may be attempts to smoke and drink. Perfumes and cosmetics are abhorred. The consciousness of being born a woman, and, therefore, of being compelled to renounce the University, with its gay life, and the army, induces painful reflections.

In the inclinations of the amazon for manly sports, the masculine soul in the female bosom manifests itself; and not less in the show of courage and manly feeling. The female urning loves to wear her hair and have her clothing in the fashion of men; and it is her greatest pleasure, when opportunity offers, to appear in male attire. Her ideals are historical and contemporary feminine personalities distinguished for mind and energy.

With reference to the sexual feeling and instinct of these urnings, so thoroughly permeated in all their mental being, the men, without exception, feel themselves to be females; the women feel themselves to be males. Thus they feel themselves to be antagonistic to persons of their own sex constituted like themselves; for, of course, they are like them in form. But, on the other hand, they are drawn toward those of their own sex that are homo-sexual or sexually normal. The same jealousy which occurs in normal sexual life also occurs here, when rivalry is threatened; and, indeed, since they are, as a rule, hyperæsthetic sexually, this jealousy is often boundless.

In cases of completely-developed contrary sexuality, hetero-sexual love is looked upon as a thing absolutely incomprehensible; sexual intercourse with a person of the opposite sex is unthinkable, impossible. Such an attempt brings on the inhibitory concept of disgust or even horror, which makes erection impossible. Only two of my transitional cases to the third category were able, with the help of their imagination, by thinking of themselves as men with reference to the woman, to have cohabitation; but the act, which was inadequate for them, was a great sacrifice, and afforded them no pleasure.

In homo-sexual intercourse the man always feels himself, in the act, as a woman; the woman, as a man. The means of indulgence, in the case of a man, where there is irritable weakness of the ejaculation centre, are simply succubus, or passive coitus inter femora; in other cases, passive masturbation, or ejaculatio viri dilecti in ore proprio. Many have a desire for passive pederasty; occasionally a desire for active pederasty occurs. In one attempt of this kind, the man desisted because of the disgust which seized him when the act reminded him of coitus.

There was never inclination for immature persons (boy-love). Not infrequently there were only platonic desires. The sexual satisfaction of the female probably consists of amor lesbicus, or active masturbation.

Case 119. Autobiography. “1. Descent: I am now in my twenty third year. I have chosen the study of the technical arts as an occupation, and am completely satisfied with it. I had but the mild diseases of children, while the other children, who are now healthy, had to pass through severe illnesses. My parents are both living, and my father is an advocate. He, like my mother, is, as we say, nervously hyper-sensitive. In my father’s family there were two other children, who died early.

“2. My person: As for my physical peculiarities, I am of robust figure, without being of especially handsome form; eyes, gray; hair, blonde; hair and beard correspond with my sex and years. The mammæ and genitals are normally developed. My gait is firm and almost heavy; my bearing, careless. It is remarkable that the breadth of the pelvis is exactly equal to that of the shoulders.

“I am naturally well endowed mentally. In one of my certificates my talents are, in fact, called ‘excellent.’ Without any particular desire to excel in them, I passed my examinations with distinction. I have an interest in everything that concerns the well-being of humanity, and in science, art, and industry. With my energy it is comparatively easy to postpone for a time the satisfaction of my desires, which will be described hereafter. Intentionally and consciously, I curse the morality of to-day, which forces those who are abnormal sexually to break laws that are voluntarily established, and regards sexual congress of two persons of the same sex as a matter depending on the choice of the individual, and a matter in which law-makers have a right to interfere. From my studies I have found the most earnest incentives to construct, on the basis of the Darwinian theory, after Carneri’s method, a system of morals, which, to be sure, does not harmonize with the prevailing system, but which seeks to elevate and improve mankind in accordance with natural law.

“I think that there are not many marks of hereditary taint in me. There is a certain hyper-sensitiveness. A very intense dream-life is perhaps important. In general, it is occupied with indifferent matters, and never has so-called sensual images as a subject; at most, in this direction, it is concerned only with female attire and putting it on, which for me is a lustful thought. At the same time, until my sixteenth year, it often went to the extent of somnambulism, or, very frequently, as is still often the case, to loud talking in sleep.

“3. My inclinations: The above-mentioned abnormal proclivity is the fundamental factor in my sexual feeling. When I am dressed like a woman, I feel perfectly satisfied. A peculiar feeling of peace and comfort comes over me, which allows me to work mentally with greater ease. My libido for indulgence in sexual intercourse is extremely slight. Too, I have much love and taste for female handiwork, and, without assistance, I learned to crochet and embroider, and I like to do these things in secret. I also like other female employments, like sewing, etc.; so that at home, where I keep my proclivity perfectly concealed, and guard against indulging it by involuntary activity, I have often won the praise of being as good as a servant-girl; which did not make me ashamed, but, on the contrary, filled me with secret pride. I can make nothing out of dancing with women; I liked to dance only with my school-fellows, for which the manner of our instruction in dancing gave opportunity. But in this it gave me pleasure only when I could dance as a lady. A multitude of other desires and dreams, which seem to have something typical about them, I pass over, because they seem exactly similar to those described in ‘Psychopathia Sexualis.’ .... In other respects my inclinations are not different from those of my sex. I smoke and drink moderately, love delicacies, and have no pleasure in physical exercises.

“4. Development: After this brief description of my personality, I may pass on to an analysis of the developmental history of my abnormality. As soon as I was able, to some extent, to think independently, and I understood the difference between the sexes, it was my secret and fixed desire to be a girl. In fact, I believed I was one. But when in the bath I saw the same genitals on other boys, the impossibility of my thought became apparent. I reduced my wish, and hoped that I was at least an hermaphrodite. And, owing to the fact that I had a certain shyness about looking closely at pictures or descriptions of the genitals, this hope was entertained, notwithstanding the fact that I had abundant opportunity to read writings on the subject, until my studies compelled me to make a closer acquaintance with the matter. During this time I read everything I could get about hermaphroditism, and longed to be in the place of the female who, as the newspapers often reported, had been raised as a male and been restored to her sex by accident. The recognition of my masculinity made an end of this dreaming, and did not fill me with any especial delight. I tried to destroy my sexual glands by gradual pressure, but pain soon caused me to desist. My longing is still for the external characteristics of the female sex,—for a pretty coiffure, a rounded breast, a slim waist.

“At the age of twelve I first had an opportunity to put on female attire; and I soon came to drape myself, by means of bed-clothes, bed-linen, etc., with female petticoats. When I grew older, it was my greatest delight to put on my sister’s dresses secretly, even if it could be but for a few moments, and with constant danger of detection. Later, much to my delight, I had an opportunity to play a female rôle in a love-scene; and it is said that I was not at all bad in the part. When I began to lead an independent life as a student, I immediately obtained female dresses and linen, which I kept in order myself. When at night, safe from discovery, I can put on one article after another, from corset to apron and bracelet, I am perfectly satisfied, and devote myself to some quiet employment, inwardly happy and full of delight in doing it. While dressing, an erection usually occurs, but it is never followed by an ejaculation, and soon disappears. I also try to approximate the female appearance in externals, by arranging my hair appropriately and removing the beard, which I should have preferred to tear out.

“5. Sexual inclinations: In passing to the description of my sexual proclivities, I desire, first, to note, in general, that puberty occurred normally, as I judge from the pollutions that occurred, the change of voice, etc. Pollutions still occur regularly once every three weeks, seldom more frequently. With them I never experience any lustful feeling. I have never practiced onanism; until lately I knew nothing more of it than its name, and I had to seek direct information about it, in order to understand it. Any touch on the erect penis is disturbing and painful to me, and without lustful feeling.

“Previously I behaved very shyly toward women, but I now act quietly, and associate with them as with my kind. Direct excitation, in a sexual sense, by a woman, sometimes occurred; but when I try to analyze this, it seems to me that it was never her person, but rather her attire alone, that was effectual. I fell in love with her dress, and the thought of wearing one like it was heavenly. Thus sexual excitation never took place, not even in brothels where I was led by friends, in spite of the sight of the greatest voluptuousness and beauty. But friendly feelings for the female sex were in my heart. I imagined how, dressed as a woman and unrecognized, I could stay with them, associate with them, and take pleasure with them. I prefer the impression made on me by girls whose breasts have not yet fully developed, particularly those wearing the hair short; for such girls are more nearly like me and my aspect. Once I was so fortunate as to find a girl who felt unhappy in her sex. We formed a firm bond of friendship with one another, and we often took delight in the idea of exchanging places. Perhaps it is not inappropriate or unimportant for the characterization, to record the following: Some months ago, when the story was running through the newspapers of an Hungarian countess who, dressed as a man, had married, and felt like a man, in all earnestness, I thought of offering myself to her, in order to contract an inverted marriage,—she as husband, I as wife.... I have never attempted coitus, and have never felt any desire for it. But since I foresaw that the erection necessary with a woman would be wanting, I thought of putting on some of her clothing; and I think that then the expected result would occur.

“As for my behavior toward male persons, first of all, it is to be emphasized that I had the warmest friendships during my school-days. My heart was full of happiness, if I could do some small service for the object of my devotion. I really worshiped him passionately. But, on the slightest occasion, I evinced terrible jealousy; and while my anger lasted I felt as if I could neither live nor die. When reconciliation occurred, for a short time I was the happiest of creatures. I also tried to make friends of boys, whom I bribed with sweetmeats, and whom I should gladly have kissed. Though my love always remained platonic, yet it is abnormal. An expression that I unconsciously made at that time about an elder friend, whom I worshiped, shows that. I said I loved him so that I should have liked to marry him. And even now, when I indulge but little in intercourse, I am easily taken with a handsome man with a fine beard and refined features. Yet I have never met a being feeling like myself, whom I could confide in, and with whom I could live as a female friend. I never attempted to exercise my inclinations directly, and never committed any foolish act of this kind. Finally I ceased to visit museums where nude male figures were displayed; for the erections, which were sure to occur, were exceedingly annoying. I had often secretly wished to sleep with a man, and often found opportunity. I was asked by a rather unattractive elderly man to sleep with him. Cum eo concubui, ille genitalia mea tetigit; and though his person was unattractive to me, I was filled with an intense feeling of lust. I felt as if completely surrendered to him; in a word, I felt like a woman.

“If I may be permitted to add a concluding word to what I have already said, I wish to state expressely that, though I am conscious of the abnormality of my inclinations, I have no desire to change them; I long only for a time when, more easily and with less danger of discovery, I can give rein to my desires and experience a delight that will harm no one.”

Case 120. Miss Z., aged 31, artist, comes for consultation on account of neurasthenic symptoms. She is remarkable for coarse, masculine features, a deep voice, short hair, a masculine style of dress, masculine gait, and self-consciousness. In other respects she is feminine, with well-developed mammæ and a female pelvis, and without any indication of beard.

Examination with reference to contrary sexual instinct gives a positive result:—

The patient states that even when a little girl she preferred to play with boys, and particularly “soldier,” “merchant,” and “robber.” She was very wild and unrestrained in these games with boys, but never had any proclivity for dolls or female employment, of which she learned only the most ordinary things (knitting, sewing).

In school she made good progress, being especially interested in mathematics and chemistry. She early had a desire for sculpture, and showed talent for it. Her greatest ambition was to become a real artist. In her dreams of the future, she never thought of marriage. As an artist, she was interested in handsome men, but she was really attracted only by female forms; she saw male forms only “in the distance.” She could never endure “trumpery”; “manly dress” was all that pleased her. The ordinary society of girls was repugnant to her, because their talk about toilettes, ornaments, and love-affairs with men, seemed stale and tiresome to her. On the other hand, since her childhood she had had enthusiastic friendships with certain girls; at the age of ten she was in love with a girl companion, and wrote her name everywhere. Since then she had had numerous female friends, with whom she had indulged in passionate kissing. She pleased the girls, as a rule, because of her masculine bearing. She wrote poems to her female friends, and could have done anything out of love for them. To her it was very remarkable that she was embarrassed before girls, especially when they were friends. She could not undress before them. The more she loved a friend, the more modest she was before her.

At the present time she has such a relation. She kisses and embraces her Laura, walks by her window, and suffers all the pangs of jealousy, particularly when she sees her conversing with men. Her only wish is to live always with this female friend.

The patient states, however, that twice in her life men have made an impression on her. She thinks that if she had been really sought, there would have been a marriage; for she is very fond of family life and children. If a man wished to possess her, it would be necessary for him to win her; she herself would prefer to win a female friend. She thinks woman is more beautiful and ideal than man. In her infrequent erotic dreams, the subject had always been a female. She had never dreamed of men. She does not think that she could now love a man; for men are false, and she herself is nervous and anæmic.

She considers herself a woman in all respects, but regrets that she is not a man. Even at the age of four it had been her greatest pleasure to put on boys’ clothes. She certainly had a masculine character, and, too, had never wept. Her greatest passion was for riding, gymnastics, fencing, and driving. She suffered much because no one about her understood her. It seemed silly to her to talk about feminine things. Many of her acquaintances had thought that she should really have been a man.

The patient says that she was never sensual. In embracing female friends, she had often experienced a peculiar lustful feeling. Embracing and kissing had been her only manner of expressing her friendship.

The patient states that she comes of a nervous father, and an insane mother who, as a young girl, had been passionately in love with her own brother, and had tried to induce him to flee with her to America. The patient’s brother is a very eccentric, peculiar man.

The patient presents no external degenerative signs; head regular. She says the menses began at fourteen, and that they have been regular, but always painful.

Case 121. “In order to designate at once my unhappy diseased condition with its correct name, I will state at the beginning that it bears all the marks of what, in your work, ‘Psychopathia Sexualis,’ you have named effemination.

“I am now thirty-eight years old, and, thanks to my abnormality, I look back on a life that has been full of indescribable suffering; so that I am often astonished to think what capacity for suffering a man has. Of late consciousness of the suffering I have endured has become the source of a kind of self-respect, which, in itself, makes my life, in a measure, endurable.

“But I shall now endeavor to describe my condition with all truth. I am physically healthy, and, as far as I can remember, have never had any severe illness. I come of a healthy family. But my parents are both of a very excitable nature, my father being of the so-called choleric, and my mother of the sanguine, temperament; she has a strong tendency to mild melancholia. She is a lively woman, loved for her good-heartedness and active benevolence; but she is still very dependent and deficient in self-confidence. All these peculiarities were marked in her father. I mention this fact, because I am told that I resemble them both; and as far as the last two peculiarities are concerned, I can myself acknowledge the resemblance. But when I made attempts, by means of my inner strength and by thinking of my own power, to rend the bond that, with magic force, draws me to men, there was always a residuum left that I could not eradicate. As far as I can remember, I have always had this elementary longing for a male lover. To be sure, its first expressions were of a coarse, sensual nature. I do not know whether I was yet ten years old, when, while lying in bed in the day-time, I suddenly discovered how, by pressure on my genitals, I induced a new and intoxicating feeling, while fancying that a man of my acquaintance performed sensual manipulations on me. It was only many years afterward that I learned that this was onanism. At first I was so frightened and so depressed by the inexplicableness of my longing, that I then made my first attempt at suicide. If I had only put it into execution! For since then there has been such frequent violent agitation of mind and body that my heart has been bound as with a chain, and made cold. I may say at once that, up to the present time, onanism has not loosened me from its clutches; it has overcome all attempts and efforts to escape, and my desire to resist it is almost destroyed. Three or four times I have given it up for a month at a time, usually under the influence of mental excitement.

“When about thirteen, I had my first love. To-day it seems as if my greatest wish then was to kiss my school-fellow’s fresh, rosy lips. It was a passion full of romantic dreams. At the age of fifteen or sixteen it became more violent, when I first experienced the insane pangs of a jealousy which is more terrible than that of natural love can be. This second period of my life lasted for years, though I spent but a few days with the object of my passion; and then we did not see each other for fifteen years. Gradually my feeling cooled, and I then fell passionately in love several times with other men, who, with the exception of one, were about my own age.

“My love—if you will kindly allow this expression for a feeling condemned by the majority of mankind—has never been returned; I have never had intercourse with a man in any way that would not bear the light of day; never has any one shown even extraordinary interest in me, though one of my friends discovered my secret longing; and yet I have had a burning desire for masculine love. In this longing my feelings seem to me to be entirely those of a loving woman; and I notice, with horror, that my sensual ideas grow more and more like those of a woman. During the periods when I am free from any particular love, my longing degenerates so that, in my onanistic manipulations, I conjure up only coarse, sensual ideas. But I am still finally able to overcome these. My efforts to repress the love, however, are absolutely vain. At the present time I am again suffering with such an exaggerated state of feeling that has existed for months; and I have pondered so much over its peculiarities that I think I can describe my feelings truthfully. In this way I have made the peculiar observation that I have never loved a bearded man. From this it might easily be presumed that I am given to so-called boy-love; but that is not the case. For, to the sensual charm, on closer association, a mental interest is added. With this begins the mental pain. I am seized with such a passionate longing that I am willing to sacrifice myself, in a way. I excite confidence in myself; and from this mutual feeling a heart-felt friendship might be engendered, if deep down in my soul were not sleeping the demon which impels me to the closest of relationships, which is allowed only between human beings of opposite sex. My whole being, every fibre of my body, longs for it, and I am consumed by a hot, glowing passion. I wonder that here I can again describe in unfeeling words the feelings that coursed through my whole being. Of course, by the struggle of years, I have been forced to learn to conceal my inclination, and smile when torn by pain. For, in never having my love returned, I have learned to know all the sufferings of love. Jealousy—insane, blinding jealousy—of any and every body who casts but a friendly glance at the object of my secret love!

“I have emphasized the mental element, in order to show how deeply rooted my abnormal impulse is. I have never felt the slightest touch of sensual love for the opposite sex. The idea of being forced to associate sensually with women is repugnant to me. At times I have suffered enough on being assured of the love of young girls. Like every young man, I have had abundant opportunity to enjoy the modern social pleasures, dancing among them. I like to dance; but if I could dance with men, as a girl, I should be really happy.

“I wish once more to remark that my love is entirely sensual. How could I otherwise explain the fact that the pressure of my lover’s hand, often merely his glance, causes palpitation and erection! I have done everything to eradicate this love from my—let us say ‘heart.’ I have tried to still it by means of onanism; to drag it in the mire, in order to raise myself above it. (About ten years ago, during such a time of love, I avoided onanism, and felt that my feeling of love elevated me.) I still entertain the delusion that if the object of my love were to tell me he loved me, that he loved me, and only me, I should willingly give up sensual gratification to repose in faithful arms. But that is certainly a self-deception.

“Honored sir, I have a responsible occupation, and I think I can give the assurance that my abnormal inclination has never, even in a hair’s breadth, caused me to deviate from the duty imposed on me. Aside from this abnormality, I am not insane, and I might ultimately become contented; but I have, particularly of late years, suffered too much not to look on the future with painful feeling. For the future will certainly not bring fulfillment of the desire which constantly glows under the ashes,—the desire to possess a lover who understands and returns my love. Such a relation would make me truly happy. I have thought much about the origin of my abnormality, particularly because I think I am forced to assume that it was not inherited. I believe that onanism has changed the inborn feeling into a burning passion. I might long ago have put an end to my misery, since I have no fear of death, and since in religion—which, strange to say, has not departed from my impure heart—I find no warning against suicide. But the consciousness that I am not alone responsible, and that a worm has nipped my whole life in the bud,—a certain comfort that has sprung up of late out of indescribable suffering,—leads me to see whether comparative happiness in life cannot be obtained on an entirely new basis: something which fills the whole heart. I think I could be happy under the influence of quiet family life. But I dare not conceal from you the fact that the thought of married life with a wife is terrible to me, and that I make the attempt of a change of life with a bleeding heart; for thus I absolutely abandon the hope that is always awake; namely, the delusion that fate may yet bring me the desired happiness.

“This delusion is so deeply rooted in me that I think nothing but hypnotic suggestion could help me. If you could advise me, you would make me unspeakably happy. Of course, your strictest injunction would be to abandon onanism. How gladly I would follow it! But if I were not to have direct physical, some mechanical, means at hand to help me, I should certainly be unable to free myself from this vice; and this the more, because I fear that, by long years of habit, my nature has become accustomed to it. Of course, I have not escaped the effects of it, even though they are not so terrible as they are often pictured. I suffer with mild nervousness, am, indeed, weakened, and have periodical disturbance of digestion; but I can still endure hard work, and take a certain pleasure in it, when it is not too great. I am depressed, but I can be happy, and, fortunately, I take pleasure in my calling, and am interested in various things, particularly music, art, and belles-lettres. I have never indulged in female pursuits.

“As may be seen from the foregoing, I like to associate with men, especially with those who are handsome; but I have never had intimate relations with them. A wide gulf separates me from them!

“Postscript: I feared that in the foregoing I had not described my sexual life with sufficient exactness. It consists only in onanism; but in it I abandon myself to almost all the repugnant acts that are comprehended under coitus inter femora, ejaculatio in ore, etc.

“My rôle is passive. When I am seized by a passion, the ideas change, and become entirely a desire to be impregnated. The struggle against such a passion is so terrible, because my mind is also implicated. I long for the closest, the most complete union that can be conceived as existing between two men,—always together, common interests, unlimited confidence, sexual union. I think that natural love is different from this only in its degree of warmth; it does not reach the boiling-point of our passion. Just now I am fighting the battle over again; with force I stifle the insane passion that has so long enthralled me. All night long I walk about, followed by the image of him I love; for love of whom I would give up all I possess. How sad it is that the noblest feeling given to man—friendship—is sullied by common sensual feeling!

“I wish once more to state that I cannot come to the determination to transform my sexual life by means of sexual intercourse with the opposite sex. The thought of such intercourse fills me with repugnance and disgust.”

Case 122. “I write, as well as I can, the history of my suffering, actuated only by the desire, by this autobiography, to clear up to some extent the misunderstanding and errors concerning ‘contrary sexual instinct’ which are still so widely prevalent.

“I am thirty-seven years old, and come of healthy parents, both of whom were very nervous. I only mention this, because I have often had the thought that my contrary sexual instinct came by way of inheritance; but this is nothing more than vague. Of my grandparents, whom I did not know, the only remarkable thing I can mention is, that my maternal grandfather was known as a great Don Juan.

“I was rather a weak child, and during my first two years suffered severely with fits, as a result of which my understanding and memory may have suffered; for I learn but slowly things which do not particularly interest me, and easily forget them. I may also mention that, during the time before I was born, my mother was subject to violent mental excitement, and was often frightened. From my third year I have been perfectly well, and have escaped severe illness. Only when a boy, from the age of twelve to sixteen, I had peculiar, indescribable nervous sensations, which made themselves felt in my head and finger-tips, and in which it seemed to me as if my whole being were about to cease. For many years, however, these attacks have ceased to occur. I am rather a powerful man, with abundant growth of hair, and in all respects masculine.

“Even when a boy of six years, I came independently to masturbate, and, until my nineteenth year, I practiced the vice quite persistently; and even now, faute de mieux, I quite frequently resort to it, notwithstanding the fact that I understand the vileness of the passion, and always feel somewhat weakened after it. But sexual intercourse with a man does not affect me in the least; on the contrary, it gives me a feeling of being strengthened. I began school at the age of seven, and soon experienced an intense feeling of sympathy for my companions, which, however, made no other impression on me. In the Gymnasium, at the age of fourteen, my companions explained to me the sexual life of man, which, up to that time, was absolutely unknown to me; but I was not much interested in the matter. At this time I also practiced mutual onanism with two or three friends who had seduced me into it; and it had an extraordinary charm for me. I was still perfectly unconscious of the perversity of my sexual instinct, and considered my vices as sins of youth, like those committed by all boys of the same age. Interest in the female sex I thought would come in time. Thus I became nineteen years old. During the following years I fell insanely in love three times,—once with a very handsome actor, then with a bank employé, and with one of my friends, the last two being men who were nothing less than beautiful, and calculated to excite sensual feeling. But this love was merely platonic, and occasionally found expression in glowing poetry. It was, perhaps, the most perfect period of my life; for I regarded everything with pure, innocent eyes. In my twenty-first year

I gradually began to notice that I was not constituted exactly like my comrades; for I found no pleasure in masculine pursuits. I had but little liking for smoking, drinking, and card-playing, and I was frightened to death by a brothel. I have never been in one; I was always able to avoid visiting one on some pretext or other. But I now began to think about myself; I often felt terribly lonesome, miserable, and unhappy, and longed for a friend constituted like myself, without, however, ever thinking that there could be other men like me. At twenty-two I made the acquaintance of a young man who finally explained to me contrary sexual instinct and the individuals affected with it. He, being also an urning, was in love with me. It was as if scales had fallen from my eyes; and I bless the day this explanation came to me. From that time I saw the world with different eyes; I saw that many others were given the same fate; and I began to learn to content myself with this lot as well as I could. Unfortunately, I did not succeed very well, and I am still often seized with bitterness and a deep hatred of the modern ideas which treat us poor urnings with such terrible harshness. For what is our fate? In most cases we are not understood, and are derided and despised; and even when all goes well, and we are understood, we are still pitied like invalids or the insane,—and pity was always sickening to me. I now began to play a part, in order to deceive my fellow-men as to my state of mind; and it always gave me great satisfaction to succeed in this. I made the acquaintance of several men like myself, with whom I established relations, which, however, never lasted long; for I was very fearful and cautious; but, at the same time, I was very particular and easily wearied.

“I have always absolutely despised pederasty as something unworthy a man, and I only wish that all those like me would do the same; but, unfortunately, with many this is not the case. If all like me thought as I do, then the contempt and scoffing of men that feel differently would be a still greater injustice to us than it now is.

“Toward the man I love I feel completely like a woman, and, therefore, in the sexual act I am quite passive. In general, my whole sensibility and feeling are feminine. I am vain, coquettish, fond of ornament, and like to please others. I love to dress myself beautifully, and, in cases where I wish to please, I even make use of the arts of the toilet, in which I am quite skilled.

“While I have but little interest in politics, I am passionately fond of music and an inspired follower of Richard Wagner. I have noticed this preference in the majority of us; I find that this music is perfectly in accord with our nature.

“I play the violin quite well; I like reading, and read much, but I have little interest in anything else. Everything else in life is quite indifferent to me, owing to the deep resignation that more and more takes possession of me.

“Even though I should have reason to be satisfied with my fate, in that I have an assured position in a technical employment in a large city of Germany, still I take no pleasure in my calling. I should be best suited if, independent and free, I could travel about with a handsome lover, and live for music and literature, particularly for the theatre, which seems to me to be one of the greatest pleasures. A connection with a court theatre I think of as being very acceptable.

“The only position or calling that seems really desirable to me is that of a great artist,—singer, actor, painter, or sculptor; and it seems to me that it would be even finer to be born to the throne of a king,—a wish that is in harmony with my pronounced desire for power. (If there is really such a thing as transmigration of souls, a subject I have studied much, and which seems to me to clear up much, I must have lived at one time as an emperor, or ruler of some kind.) But a man must be born to all this; and since I am not, I am without ambition for so-called social honors and distinctions.

“As to my tastes, I must mention a painful dissension there is in them. Handsome, intellectual young men of at least twenty years, who must be of my own social station, seem to me to be suited rather for platonic love; but with them I satisfy myself completely with a straightforward, though ideal, friendship, which seldom goes beyond a few kisses. But I can be excited sensually only by coarse, powerful men that are at least of my own age, and mentally and socially beneath me. The reason for this strange phenomenon may be that my pronounced feeling of shame and my innate apprehensiveness, with my cautious disposition, have the effect of an inhibitory idea with men of my own social position; so that with them it is with difficulty and seldom that I can induce sexual excitement in myself. That this diversity is painful to me is owing to the fact that I am always afraid to discover myself to these simple men, below me in station, who may often be bought with money. But I cannot imagine anything worse than a scandal, which would at once drive me to suicide. For I can think of nothing more terrible than, through some slight act of carelessness or the enmity of any man, suddenly to be branded before the world, and to be powerless to avert it. But what is it that we do that is so different from what normally constituted men can do, at least, quite as frequently without embarrassment, and without shame? That we do not feel as the crowd feels is not our fault, but a cruel trick of Nature.

“Innumerable times I have puzzled my brain to know whether science, or any of her free and unprejudiced devotees, could think of any way in which to give us step-children of Nature a more endurable position before the law and mankind. But I have always reached the same sad conclusion, that when one enters the lists in behalf of anything, he must first know thoroughly, and be able to explain, that for which he contends. And who is to-day able to perfectly explain and define contrary sexual instinct? Yet there must be some correct explanation of it; there must be some way in which the mass of mankind can be brought to a milder and more reasonable judgment of it; and, first of all, there must be some way to show that contrary sexual instinct should not be regarded as meaning the same as pederasty, as the majority of men—I may say all—regard it. By such an act a man might erect for himself an immortal monument in the gratitude of thousands of men of present and future generations; for there have been, are, and will ever be, urnings, and in greater number than perhaps has been suspected.

“In Wilbrand’s work, ‘Fridolin’s Secret Marriage,’ I find a very plausible theory given in explanation of this matter; for I myself have repeatedly had opportunity to observe that all urnings do not love men with the same intensity, but that there are innumerable sub-varieties,—from the most feminine man to the man of contrary sexuality who is equally sensitive to female charms. This may also account for the so-called difference between congenital and acquired contrary sexual instinct, which, in my inadequate opinion, does not exist. Yet, in all the fifty-five individuals I have become acquainted with in the three years since I came to understand this matter, I have met the same peculiarities of temperament, disposition, and character. Almost all of them are more or less idealists: they smoke but little, or not at all; they are bigoted, vain, desirous of admiration, and superstitious; and, unfortunately, I must confess that they combine more the defects and the reverse sides of both sexes than their good qualities. For woman in a sexual rôle I experience a feeling of true horror, which I could never overcome, even with the help of my extremely lively imagination. I have never attempted it, because I am thoroughly convinced of the fruitlessness of such an attempt, that seems to me unnatural and sinful.

“In purely social and friendly relations, I like to associate with ladies and girls, and I am gladly welcomed in ladies’ society; for I am much interested in the fashions for ladies, and know how to talk of such things with great skill. When I wish to, I can be very gay and amiable; but my faculty for conversation is, for the most part, only assumed, and it always tires me. I have always had great skill in female work, and shown interest in it. As a child, and up to my thirteenth year, I was passionately fond of playing with dolls, whose clothes I made myself; and it still affords me much pleasure to work at beautiful embroidery, which, unfortunately, I can do only in secret. I have the same preference for knick-knacks, photographs, flowers, sweetmeats, toilet-articles, and such feminine things; and my room, which I arranged and decorated myself, is like the over-crowded boudoir of a lady.

“As particularly remarkable, I wish still to mention that I have never suffered with pollutions. I dream very much, and intensely, almost every night; occasionally I have lascivious dreams, which have only men as subjects, but I always wake out of them before it comes to ejaculation. In reality I am not very passionate sexually, and I have periods lasting from four to six weeks, in which I have almost no sexual desire. Unfortunately, these periods are infrequent, and they are usually followed by an awakening of my intense sexual desire that is only the more violent; which, when it is unsatisfied, causes intense physical and mental suffering. I then become moody, depressed, sensitive, irritable, and retiring; peculiarities, however, which, with the first opportunity I have for sexual gratification, again disappear. I must mention, also, that often, on the slightest occasion, my mood may change several times during the day; it is like April weather.

“I dance well, and like to; but I love dancing only for its rhythmical movement, and because of my partiality for music.

“In conclusion, I wish to speak of something that always arouses repugnance in me. We are usually considered diseased, and that is absolutely incorrect. For in every disease there is a means of cure or amelioration; but no power in the world can take from an urning his perverse natural constitution. Even suggestion, which has been used with so much apparent success, cannot induce any enduring change in the mental life of an urning. In us, effect is mistaken for cause. We are considered diseased, because in time the majority of us really become ill. I am almost convinced that two-thirds of us, in later life, when we really live so long, have a mental defect of one kind or another; and this is only too easily explained. For, what strength of will and nerves is required for one to constantly dissimulate, lie, and play the hypocrite all his life! How often in the society of normal men, when the conversation turns to contrary sexual instinct, must one agree with the words of abuse and contempt, while every one of them wounds the heart. On the other hand, there are always the tiresome and indecent jokes and talk about women, etc., that must be heard; and which to-day, in so-called ‘good society,’ are popular—and to show interest and give attention to them! Daily and hourly to see so many handsome men to whom one cannot reveal himself; to be compelled to go without a friend, intercourse with whom we desire so much; and besides, constantly the fearful anxiety of betraying one’s self before the eyes of the world, and then standing covered with ignominy and shame! It is really no wonder that the majority of us are incapable of real work; for we need all our strength of will and power of endurance for the struggle with our own fate. How injurious it is to our nerves constantly to be compelled to shut up all these thoughts and feelings in our hearts; where our lively fancy, feeding on it all, plays all the more intensely, so that we go about with a burning fire within us that only too often threatens to consume us! Happy are those of us that are never denied the strength to lead such a life; but those, too, are happy that have passed beyond it.”

Case 123. Autobiography. “In what follows, you will find the description of the character, as well as the mental and sexual disposition, of an urning,—i.e., of an individual who, in spite of his masculine form, feels as a woman, whose senses women do not excite, and whose sexual desires are constantly directed toward men.

“Convinced that the enigma of our existence can be solved, or, at least, illuminated, only by the unprejudiced thought of scientific men, I describe my life only with the aim of perhaps clearing up this cruel error of Nature, and possibly doing a kindness to people like me to come in later generations; for there will be urnings as long as men are born, just as it is a fact that they have existed in every age. With the progress of science in our epoch, men will see in me and those like me not objects of hatred, but objects of pity, which deserve not the odium, but the compassion, of their more fortunate brothers. I shall be as brief as possible in my communication, and also objective; and, with reference to my caustic, often cynical, style, I may note that, above all, I shall be honest, and, therefore, not avoid strong expressions; for they are most happily suited to the subject in hand.

“I am in my thirty-fifth year; a merchant, with a fair income; somewhat above average height, slim, weak of muscle, with full beard, and quite ordinary face, and, at first sight, in nowise different from ordinary men. On the other hand, my gait is feminine, and particularly mincing in fast walking; the movements are awkward and displeasing, indicative of a want of manly feeling. The voice is neither feminine nor shrill, but rather a baritone.

“This is my external appearance.

“I do not smoke or drink, and can neither whistle, ride, do gymnastic feats, fence, nor shoot. I have absolutely no interest in horses or dogs, and have never had a gun or sword in my hand. In inner feeling and sexual desire, I am completely a woman. Without thorough education,—I passed through but few classes in the Gymnasium,—I am yet intelligent, like to read well-written, improving books, and have good judgment; but I allow myself to be carried away by the feelings of the moment, and I am easily influenced by any one who knows my weakness and how to make use of it. Constantly making resolves, I have never the energy to carry them out; like a woman, I am moody and nervous, often irritated without reason, and sometimes mean. Toward persons that do not please me, I am arrogant, unjust, and often shamefully insulting.

“In all my conduct I am superficial, and often frivolous, and I have no deep moral feeling. I have little consideration for parents and brothers and sisters. I am not egotistic, but, on occasion, self-sacrificing. I cannot withstand tears, and can—like a woman—be won by amiability and entreaty.

“In my earliest years I avoided playing soldier, gymnastics, or the rough games of my manly comrades, and ran about with little girls, with whom I was much more in sympathy than with boys. I was retiring, bashful, and often blushing. When no more than twelve or thirteen years old, the close-fitting uniform of a handsome soldier gave me the most peculiar feeling; and while, during the next few years, my comrades were always talking about girls, and even engaged in love-affairs, I could, for hours at a time, run after a well-built man with well-rounded hips, and feast my eyes on the sight.

“Without thinking much of these impressions, so different from the feelings of my comrades, I began to masturbate, always during the act thinking of a heroic, handsome form; and this continued until my seventeenth year, when I learned from a companion constituted like myself a true explanation of my condition. Since that time I have been with girls eight or ten times; but, in order to have an erection, it was always necessary to think of a handsome man of my acquaintance. And I am thoroughly convinced that to-day, even with the help of imagination, I should be unable to have intercourse with a girl.

“Shortly after my discovery I preferred to associate with mature, powerful urnings; for at this time I had neither mind nor opportunity to associate with real men. Since this my taste has changed entirely, and men, real men, of twenty-five or thirty-five years, with supple, powerful forms, are the only ones that ravish my senses, and charm me as if I were a woman. Circumstances have allowed me, during these years, to make about a dozen male acquaintances that would serve my purpose for a gulden or two a visit. If I am alone in a room with a handsome youth, my greatest pleasure is membrum ejus vel maxime si magnum atque crassum est, manibus capere et apprehendere et premere, turgentes nates femoraque tangere atque totum corpus manibus contrectare et, si conceditur, os faciem atque totum corpus, immovero nates, ardentibus osculis obtegere. Quodsi membrum magnum purumque est, dominusque ejus mihi placet, ardente libidine mentulam ejus in os meum receptam complures horas sugere possum, neque autem delector, si semen in os meum ejaculatur, cum maxima eorum qui “urnings” nominantur pars hac re non modo delectatur, sed etiam semen nonnunquam devorat.

“The most intense delight, however, is experienced when I find a real man, qui membrum meum in os recepit et erectionem in ore suo concedit.

“Improbable as it sounds, I am yet able to find some coarse fellows who will allow themselves to be used for this purpose. They learn the thing while in military service, for urnings know that under such circumstances they can be made to do the most for money; and when the fellows are once trained, circumstances often compel them, in spite of their passion for the opposite sex, to continue the practice.

“With certain exceptions, urnings make no impression on me, because everything feminine is repugnant to me. At the same time, there are some that know how to give me the most intense pleasure, just as a real man can; and I prefer to consort with them, for the reason that sometimes they return my passionate caresses. In tête-à-tête with such a person, I throw all check from my excited senses, and give my animal passions free rein, osculor, premo, amplector eum, linguam meam in os ejus immitto; ore cupiditate tremente ejus labrum superius sugo, faciem meam ad ejus nates adpono et odore voluptari e natibus emanente voluptate obstupescor. Real men, in close-fitting uniform, make the deepest impression on me; and if I have an opportunity to embrace and kiss such a ravishing fellow, ejaculation takes place at once,—a weakness which I attribute to my frequent masturbation. In my earlier years I practiced it very frequently, almost every time I saw a man pleasing to me, whose image I kept before my eye during the act. For this my taste is in nowise difficult to please—like that a servant-girl might have in finding her ideal in a dragoon guard. A handsome face is a pleasant supplement, inflaming my sensual desire, but in no respect an essential. The requisite remains: vir inferiore corporis parte robusta et bene formosa, turgidis femoribus durisque natibus, while the upper portion of the body may be slim. Corpulence disgusts me. A sensual mouth with pretty teeth affects me more intensely; and if the person has also a membrum pulchrum magnum et æqualiter formatum, all my demands—the most far-reaching—are fulfilled.

“When I was younger, with men that pleased me and excited my passions intensely, ejaculation took place from five to eight times in a night, and now it occurs from four to six times; for I am unusually strong sensually, and, as an example, even the clinking of a hussar’s sword may excite me. At the same time, I have a very lively fancy, and spend most of my leisure hours thinking of handsome men with strong limbs; and I would be delighted to look on when a powerful fellow, using force, magna mentula præditus me præsente puellam futuat; mihi persuasum est, fore ut hoc aspectu sensus mei vehementissima perturbatione afficiantur et dum futuit corpus adolescentis pulchri tangam et, si liceat, ascendam in eum dum cum puella concumbit atque idem cum eo faciam et membrum meum in ejus anum immittam. The accomplishment of these cynical ideas—with which my mind is often filled—is hindered only by my limited means; otherwise, I should long ago have had the reality.

“Soldiers have the greatest charm for me, but I have also a weakness for butchers, fakirs, drivers, circus-riders, and boat-captains; and all these must be supple and powerfully built. Urnings I hate in intimate relation, and for the majority of them I have an inexplicable and unjust aversion. I have never had but one urning for an intimate friend. On the other hand, the most affectionate and enduring ties bind me to men of my own age, in whose company I delight, but with whom I have no sexual relations, and who have no idea of my condition.

“Talk on politics and economics, like every other earnest subject, I hate; though I gossip with considerable sense and peculiar pleasure about the theatre. At operas I see myself on the stage, feel myself applauded by the public, and would prefer to sing as a passive heroine, or in the dramatic rôle of a woman.

“The most interesting subject of conversation for me, and those like me, is, however, always—men; for us this is inexhaustible. Their secret charms are described in the most minute details, mentulæ æstimantur, quanta sint magnitudine, quanta, crassitudine; de forma earum atque rigiditate conferimus, alter ab altero cognoscit cujus semen celerius, cujus tardius ejaculetur. I may add that, of my four brothers, one gave himself to the service of urnings, without himself being one; and all four are ladies’ men, and indulge in sexual excesses. The genitals of the men of our family are, without exception, unusually developed.

“In conclusion, I repeat the words with which I began these lines. I could not choose my expressions, because my object in the foregoing has been to afford material for the study of the urning’s existence, and absolute truth was essential. I beg the numerous cynics to keep this circumstance in mind.”

In October, 1890, the writer of the foregoing lines presented himself to me. In all essentials his appearance corresponded with his description. Genitals large, with abundant growth of hair. His parents had been well nervously. One brother had shot himself on account of nervous trouble; three others were intensely nervous. The patient came to me in a state of despair. He could not endure such a life any longer; for he had been admonished about intercourse with men that could be bought; and with his extreme sensual nature he was unable to abstain. Too, he could not understand how he could be made to love women, and enjoy the nobler joys of life. He had had love for men since his thirteenth year.

He felt in all respects like a woman, and longed to be won by men that were not urnings. When he was with an urning, it was just as if two girls were together. He would prefer being sexless to living longer as he was. Would not castration help him?

An attempt at hypnosis with the highly excited patient induced only a very slight degree of lethargy.

Case 124. B., waiter, aged 42, single, was sent to me by his physician, with whom he was in love, as one who was suffering from contrary sexual feeling. B. very willingly, and in a decent manner, gave a history of his past life, especially of his sexual life, and was glad at least to have an authoritative opinion concerning his sexual condition, which had always appeared to him abnormal.

B. knew nothing to report of his grandparents. His father had been a passionate, excitable man, a drinker, and always very sensual. After he had begotten twenty-four children by one wife, he was divorced from her; and after that his landlady became three times pregnant by him. His mother was healthy.

Of the twenty-three children, but six were living; several were nervous, but not sexually abnormal, with the exception of one sister, who always sought men.

B. asserts that from childhood he was sickly. At eight his sexual life began. He masturbated, and became possessed of the idea penem aliorum puerorum in os arrigere, which gave him the greatest pleasure. At twelve he began to fall in love with men, usually with those between thirty and forty, with moustaches. Even at that time his sexual desire was greatly developed, and he had erections and pollutions. From that time, indeed, he masturbated daily, and during the act thought of a beloved man. Yet his greatest delight had been penem viri in os arrigere. During the act he had ejaculation, with an intense feeling of pleasure. Only about twelve times had he had this pleasure. He had never felt disgust with the penis of another sympathetic man; quite the contrary. He had never accepted proffers of pederasty; actively or passively, it was very disgusting to him. In the perverse sexual act he had always thought of himself in the rôle of a woman. His passion for men in sympathy with him had been unbounded. He would have done everything for a lover; even at the sight of him he would tremble with excitement and joy.

At nineteen he often allowed himself to be taken by his comrades to houses of prostitution. He never had pleasure in coitus, and only in the moment of ejaculation felt satisfaction. In order to get an erection with a woman, it was always necessary, in the act, for him to think of a beloved man. He would always have preferred to have the woman allow immissio penis in os, which, however, was always denied him. Faute de mieux, he had practiced coitus, and, indeed, twice became a father. The last child, a girl of eight, had already begun to practice masturbation and mutual onanism, which troubled him very much as a father. He wished to know whether there was any remedy for it.

The patient asserted that he always felt himself toward men in a feminine rôle (also in sexual intercourse). He had always thought that his sexual perversion had resulted from his father’s wishing to beget a girl when he begat him. His brothers and sisters had always joked him on account of his feminine manners. Sweeping and house-cleaning had always been pleasant occupations for him. His activities in this direction had often been wondered at, and he was considered more skillful than a girl. Whenever he could, he dressed like a woman. At the carnival he appeared at the dances masked as a female. He was very successful at coquetry on such occasions, because he had a feminine nature.

He had never had real pleasure in drinking, smoking, or in masculine occupations or pleasures; but, on the other hand, he loved to sew, and as a child had often been scolded for his playing with dolls. His interest at the circus or theatre was confined to men. Frequently he could not overcome the impulse to hang around water-closets, in order to get sight of male genitals.

Feminine charms had never pleased him. Coitus had been possible only when he thought of a beloved man. Nocturnal pollutions were always induced by lascivious dreams of men.

In spite of much sexual excess, B. had never suffered from neurasthenia sexualis, and, besides, there was not a symptom of neurasthenia discoverable in him.

Patient is delicate, and his whiskers and moustache, which made their appearance in his twenty-eighth year, are thin. Externally, with the exception of a weaving gait, he presents nothing which would point to his feminine nature. He asserts that he has often been joked about his feminine gait. His conduct is in all respects decent. His genitals are large, well developed, and normal in all respects, and the growth of genital hair is abundant; the pelvis is masculine. The head is rachitic, somewhat hydrocephalic, with prominence of the parietal bones. The face is remarkably small. The patient says that he is irritable and easily angered.

Case 125. On May 1, 1880, G., Ph.D., and a writer, was brought to the clinic for mental diseases, at Graz, by the public authorities. While on his return from Italy, G. found a soldier in Graz who gave himself up to him for hire, but ultimately denounced G. to the police, because G. had openly confessed his love for men. The authorities considered his mental condition doubtful, and sent him to alienists for examination. To the physicians G. related, with cynical openness, that years before, in M., he had had just such an affair with the police, and was in prison fourteen days. In the South there was no danger from such people; it was only in Germany and Austria that the thing was regarded as an evil.

G. is fifty years old, tall, powerful, and has a humerous expression, and a cynical, coquettish manner; the eye has a neuropathic, swimming expression; the teeth of the under jaw stand far back from those of the upper jaw. The cranium is normal, the voice masculine, and the beard abundant. The genitals are well formed, though the testicles are somewhat small. With the exception of slight emphysema of the lungs and external fistula in ano, there are no remarkable anomalies of the vegetative organs. G.’s father was subject to periodical insanity. His mother was a high-strung person, and she had an insane sister. Of the children, four died in childhood.

With the exception of scrofulosis, G. asserts that he was healthy. He obtained the degree of Doctor of Philosophy; at twenty-five, he had hæmoptysis, and went to Italy, where he has since lived, with slight interruption, by writing and by giving private lessons. G. says that he often has congestions, and also some spinal irritation,—i.e., pain in his back,—but otherwise he has a genial disposition; only he is not much of a financier; and at the same time, like all old prostitutes, he has a very good appetite. Further, he states, with great satisfaction and remarkable cynicism, that he has congenital contrary sexual instinct. When only five years old, it was his greatest pleasure to get sight of a penis, and he hung about appropriate places, in order to enjoy that pleasure. Even before puberty he practiced masturbation. At the time of puberty he noticed an inward feeling for friends. An obscure impulse pointed out to him the way his love would take. He was actually impelled to kiss young men, and now and then to caress their genitals. When twenty-six years old, he first began to have sexual intercourse with men, toward whom he felt like a woman. Even as a child, it was his greatest delight to put on female attire. He was often chastised by his father because, in the effort to satisfy this impulse, he put on his sister’s clothing. If he happened to see a ballet, only the male dancers interested him. Since he could remember, he had had a horror feminæ. If he happened to visit a brothel, it was only to see young men. He was, indeed, a rival of prostitutes. If he saw a young man, he just looked at his eyes; in case these pleased him, then came the mouth—whether it was well formed for kissing; then he would look at the genitals—whether they were well developed. G. pointed, with great feeling of self-satisfaction, to his poetical works, and tried to make it appear that persons with natures like his were poetically endowed. He gave as examples Voltaire, Frederick the Great, Eugene of Savoy, and Plato, as well as numerous distinguished men of the present, who, according to his opinion, were urnings. His greatest pleasure was to have a sympathetic young man read his verses to him. During the last summer he had had such a lover. When he had to part with him, he was quite undone, and he did not eat or sleep until gradually he had regained his former condition. He said that the love of urnings was a passionate, inner fire. According to his statement, in Naples the effeminelli lived in a quarter together, just as in Paris the grisettes live with their lovers. They sacrifice themselves for their lovers, and care for the household, just as the grisettes do. On the other hand, an urning repels an urning, “just as one prostitute does another—that is the curse.”

The need of intercourse with males occurs about once a week with G. He is happy in his peculiar sexuality, which he, it is true, considers peculiar, but which he will not regard as abnormal or wrong. He thinks that nothing remains for him and those like him but to raise what is unnatural in themselves to the supernatural. He looks upon the love of urnings as the higher, the ideal, as godlike, an abstract love. When shown that such a love is far from the purpose of Nature and the preservation of the race, he expresses the pessimistic thought that the world should die out, and the earth turn round its axis without men, who were on it only for trouble. As reason and explanation of his unnatural sexual feeling, G. refers to Plato, “who certainly was no beast.” Plato expressed allegorically the idea that men were originally balls. The gods had divided these into two hemispheres. For the most part, man is suited to woman, but sometimes man to man. In the latter case, the impulse to union is quite as powerful as in the former, and they strengthen each other in the same way. G. further relates that his dreams, when they were erotic, never had women, but only men, for their subjects. Male-love was the only kind that could satisfy him. He considered it disgusting for one human being to be prodding about in the abdomen of another with his penis, since he had heard that in this disgusting fashion coitus was usually carried out. He had never had the curiosity to inform himself concerning the female genitals; the subject was disgusting to him. The indulgence of his sexual appetite he did not consider a vice, but the result of a natural impulse which compelled him to it. It conduced to self-preservation. Onanism was a poor substitute, and, moreover, injurious, while urning-love was morally elevating and conducive to physical well-being.

With moral indignation, which in contrast with his cynicism in other directions appeared ridiculous, he protested against the classification of urnings with those who indulged in pederasty. He looked on the podex with disgust, as it was a secreting organ. The intercourse of urnings always took place in front, and was combined onanism.

This was the extent of G.’s disclosures, whose mental condition was certainly congenitally abnormal. As proof of this, may be cited his cynicism; his incredible frivolity in his application of his vices to religion, in which direction we cannot follow him without overstepping the bounds set by scientific inquiry; his perverse philosophical ideas with reference to his sexual perversion; his perverse manner of looking at the world; his ethical defect in all directions; his vagabondage; and his perverse mind and exterior. G. makes the impression of an original paranoiac. (Personal case. Zeitschrift für Psychiatrie.)

Case 126. Taylor had occasion to examine a certain Eliza Edwards, aged 24. It was discovered that she was of masculine sex. E. had worn female clothing from her fourteenth year, and also been an actress. The hair was worn long after the manner of females, and parted in the middle. The form of the face was feminine, but otherwise the body was masculine. The beard was carefully pulled out. The masculine, well-developed genitals were fixed in an upward position by an artful bandage. The condition of the anus indicated passive pederasty.

Case 127. An official of middle age, who for some years had been happy in family life, and was married to a virtuous woman, presented a peculiar manifestation of contrary sexual feeling.

One day, through the indiscretion of a prostitute, the following scandal became public: About once a week X. would appear in a house of prostitution, and there dress himself up as a woman, always requiring, as a part of his costume, a coiffure. When his toilet was completed, he would lie down on the bed, and have the prostitute perform manustupration. But he very much preferred to have a male person (a servant of the house). This man’s father was hereditarily tainted, had been insane several times, and was afflicted with hyperæsthesia and paræsthesia sexualis.

Case 128. C. R., maid-servant, aged 26, suffered from the time of her development with original paranoia and hysteria. As a result of her delusions, her life had been somewhat romantic, and in 1884, in Switzerland, where she had gone as a result of delusions of persecution, she came under the observation of the authorities. On this occasion, it was ascertained that R. was affected with contrary sexual instinct.

Concerning her parents and relatives there is no information at hand. R. asserted that, with the exception of an inflammation of the lungs at the age of sixteen, she had never been severely ill.

First menstruation at fifteen, without any difficulties; thereafter it was very often irregular and abnormally excessive. The patient declared that she never had had inclinations toward the opposite sex, and had never allowed the approach of a man. She never could understand how her friends could describe the beauty and amiability of men. But it was charming and inspiring for her to imprint a kiss on the lips of a beloved female friend. She had a love for girls that was incomprehensible to her. She had passionately loved and kissed some of her female friends, and she would have given up her life for them. Her greatest delight would have been to have constantly lived with such a friend and absolutely possessed her.

In this she felt toward the beloved girl like a man. Even as a little child, she had an inclination only for the play of boys, and she loved to hear shooting and military music, was always much excited by them, and would gladly have gone as a soldier. The chase and war have been her ideals. In the theatre only feminine performers interested her. She knew very well that the whole of this inclination was unwomanly, but she could not help it. It had always been a great pleasure for her to go about in male clothing, and in the same way she had always preferred masculine work, and had shown unusual skill in it; while with reference to feminine occupations, especially handiwork, she had to say the contrary. The patient had also a weakness for smoking and spirits. On account of persecutory delusions, in order to rid herself of her persecutions, the patient had often gone about in male attire, and played the part of a man. She did this with such (congenital) skill that, as a rule, she was able to deceive people concerning her sex.

It is authoritatively established that in 1884, for a long time, the patient went about in male attire, now in the garments of a civilian, now in the uniform of a lieutenant; and in August of the same year, dressed as a male servant, she fled to Switzerland as a result of delusions of persecution. There she found service in a merchant’s family, and fell in love with the daughter of the house, “the beautiful Anna,” who, on her side, not recognizing the sex of R., fell in love with the handsome young man.

Concerning this episode the patient makes the following characteristic statement: “I was madly in love with Anna. I don’t know how it came about, and I cannot put myself right concerning this impulse. In this fatal love lies the reason why I played the rôle of a man so long. I have never yet felt any love for a man, and I believe that my love is for the female and not the male sex. I can in nowise understand my condition.”

From Switzerland R. wrote letters home to her friend, Amelia, which were produced at the examination. They are letters showing passionate love, which goes beyond the bounds of friendship. She apostrophizes her friend, “My flower, sun of my heart, longing of my soul.” She was her greatest happiness on earth; her heart was hers. And in her letters to her friend’s parents she wrote: “You, too, should watch your flower, for, if she should die, you also would be unable to endure life.”

For the purpose of investigating her mental condition, R. remained for some time in an asylum. On one occasion, when Anna was allowed to pay R. a visit, there was no end of passionate embraces and kisses. The visitor acknowledged freely that they had before secretly embraced and kissed in the same way.

R. is a tall, slim, stately person, of feminine form in all respects, but with masculine features. Cranium regular; no anatomical signs of degeneration. Genitals normal and indicative of virginity. All the circumstances indicate that she has only indulged in platonic love. Glance and appearance are indicative of a neuropathic person. Severe hysteria, occasional cataleptoid attacks, with visionary and delirious states. The patient is very easily brought into a state of somnambulism by hypnotic influence, and in this condition is susceptible to all possible suggestions. (Personal case. Friedreich’s Blätter, 1886, Heft 1.)

4. Androgyny and Gynandry.—Forming direct transitions from the foregoing groups are those individuals of contrary sexuality in whom not only the character and all the feelings are in accord with the abnormal sexual instinct, but also the skeletal form, the features, voice, etc.; so that the individual approaches the opposite sex anthropologically, and in more than a psychical and psycho-sexual way. This anthropological form of the cerebral anomaly apparently represents a very high degree of degeneration; but that this variation is based on an entirely different ground than the teratological manifestation of hermaphroditism, in an anatomical sense, is clearly shown by the fact that thus far, in the domain of contrary sexuality, no transitions to hermaphroditic malformation of the genitals have been observed. The genitals of these persons always prove to be fully differentiated sexually, though not infrequently there are present anatomical signs of degeneration (epispadiasis, etc.), in the sense of arrests of development in organs that are otherwise well differentiated.

There is yet wanting a sufficient record of cases belonging to this interesting group of women in masculine attire with masculine genitals, and men in feminine dress with the sexual organs of the female. Every experienced observer of his fellow-men remembers masculine persons that were very remarkable for their womanish character and type (wide hips, form rounded by abundant development of adipose tissue, absence or insufficient development of beard, feminine features, delicate complexion, falsetto voice, etc.); and, on the other hand, women that, by reason of build, pelvis, gait, attitude, heavy and decidedly masculine features, rough and deep voice, etc., had little to remind one of femininity.

We have already met some indications of such an anthropological transformation in foregoing groups, as in Case 106, where the woman had the feet of a man; and in Case 112, where there was development of mammæ and production of milk during puberty.

In persons belonging to the fourth group, and in certain ones in the third, forming transitions to the fourth, there seems to be a feeling of shame (sexual) toward persons of the same sex, and not toward those of the opposite sex.

Case 129. Androgyny. Mr. v. H., aged 30, single; of neuropathic mother. Nervous and mental diseases are said not to have occurred in the patient’s family, and his only brother is said to be mentally and physically completely normal. The patient developed tardily physically, and, therefore, spent much of his time at the sea-shore and climatic resorts. From childhood he was of neuropathic constitution, and, according to the statements of his relatives, unlike other boys. His disinclination for masculine pursuits and his preference for feminine amusements were early remarked. Thus he avoided all boyish games and gymnastic exercises, while doll-play and feminine occupations were particularly pleasing to him. Thereafter he developed well physically, and escaped severe illnesses, but he remained mentally abnormal, incapable of an earnest aim in life, and decidedly feminine in thought and feeling.

In his seventeenth year pollutions occurred, became more frequent, and finally took place during the day; so that the patient grew weak, and manifested various nervous disturbances. Symptoms of neurasthenia spinalis made their appearance, and have lasted up to the last few years, but they have become milder with the decrease in the number of pollutions. Onanism is denied, but is very probable. An indolent, effeminate, dreamy habit of thought has become more and more noticeable ever since puberty. All efforts to induce the patient to take up an earnest pursuit in life were vain. His intellectual functions, though formally quite undisturbed, were never equal to the motive of an independent character, and the higher ideals of life. He remained dependent, an overgrown child; and nothing more clearly indicated his original abnormal condition than an actual incapability to take care of money, and his own confession that he had no ability to use money reasonably; that as soon as he had money he wasted it for curios, toilet-articles, and the like.

Incapable as he was of a reasonable use of money, the patient was no more capable of leading a social existence; indeed, he was incapable of gaining an insight into its significance and value.

He learned very poorly, spending his time in toilettes and artistic nothings, particularly in painting, for which he evinced a certain capability; but in this direction he accomplished nothing, since he was wanting in perseverence. He could not be brought to take up any earnest thought; he had a mind only for externals, was always distracted, and serious things quickly wearied him. Preposterous acts, senseless journeys, waste of money, and debts repeatedly occur throughout the course of his later life; and even for these positive faults in his life he was wanting in understanding. He was self-willed and intractable, and never did well as soon as an attempt was made to put him on his feet and point out to him his own interests.

With these manifestations of an original abnormal and defective mind, there were notable indications of perverse sexual feeling, which were also indicated in the somatic habitus of the patient. Sexually, the patient felt like a woman toward men, and had inclinations toward people of his own sex, with indifference, if not actual disinclination, for females.

In his twenty-second year it is asserted that he had sexual intercourse with women, and was able to perform the act of cohabitation normally; but, partly on account of increase of neurasthenic symptoms which was occasional after coitus, and partly on account of fear of infection,—but really by reason of a want of satisfaction,—he soon ceased to indulge in such intercourse. Concerning his abnormal sexual condition, he is not quite clear; he is conscious of an inclination toward the male sex, but confesses, only in a shame-faced way, that he has certain pleasurable feelings of friendship for masculine individuals, which, however, are not accompanied by any sensual feelings. The female sex he does not exactly abhor; he could even bring himself to marry a woman who could have an attraction for him, by means of similarity in artistic tastes, if he could but be freed from conjugal duties, which were unpleasant to him, and the performance of which made him tired and weak. He denied having had sexual intercourse with men, but his blushing and embarrassment, and, still more, an occurrence in N., where the patient, some time before, provoked a scandal by attempting to have sexual intercourse with youths, gave him the lie.

Too, his external appearance, habitus, form, gestures, manners, and dress are remarkable, and decidedly recall the feminine form and characteristics. The patient, however, is over middle height, but thorax and pelvis are decidedly of feminine form. The body is rich in fat; the skin is well cared for, delicate, and soft. This impression of a woman in masculine dress is further increased by a thin growth of hair on the face, which is shaven, with the exception of a small moustache; by the mincing gait; the shy, effeminate manner; the feminine features; the swimming, neuropathic expression of the eyes; the traces of powder and paint; the curtailed cut of the clothing, with the bosom-like prominence of the upper garments; the fringed, feminine cravat; and the hair brushed down smoothly from the brow to the temples. The physical examination makes undoubted the feminine form of the body. The external genitals are well developed, though the left testicle has remained in the canal; the growth of hair on the mons veneris is thin, and the latter is unusually rich in fat and prominent. The voice is high, and without masculine timbre.

Too, the occupation and manner of thought of v. H. are decidedly feminine. He has a boudoir and a well-supplied toilet-table, with which he spends many hours in all kinds of arts for beautifying himself. He abhors the chase, practice with arms, and such masculine pursuits, and calls himself an æsthete; speaks with preference of his paintings and attempts at poetry. He is interested in feminine occupations, which—e.g., embroidery—he engages in, and calls his greatest pleasure. He could spend his life in an artistic and æsthetic circle of ladies and gentlemen, in conversation, music, and æsthetics. His conversation is preferably about feminine things,—fashions, needlework, cooking, and household work.

The patient is well nourished, but anæmic. He is of neuropathic constitution, and presents symptoms of neurasthenia, which are maintained by a bad manner of life, lying abed, living in-doors, and effeminateness. He complains of occasional pain and pressure in the head, and habitual obstipation. He is easily frightened; complains of occasional lassitude and fatigue, and drawing pains in the extremities, in the direction of the lumbo-abdominal nerves. After pollutions, and regularly after eating, he feels tired and relaxed; he is sensitive to pressure over the spinous processes of the dorsal vertebræ, as also to pressure along accessible nerves. He feels peculiar sympathies and antipathies for certain persons, and, when he meets people for whom he has an antipathy, he falls into a condition of peculiar fear and confusion. His pollutions, though now they occur but seldom, are pathological, in that they occur by day, and are unaccompanied by any sensual excitement.

Opinion: 1. Mr. v. H., according to all observations and reports, is mentally an abnormal and defective person, and that, in fact, ab origine. His contrary sexual instinct represents a part of his abnormal physical and mental condition.

2. This condition, in that it is congenital, is incurable. There exists defective organization of the highest cerebral centres, which renders him incapable of leading an independent life, and of obtaining a position in life. His perverse sexual instinct prevents him from exercising normal sexual functions; and this is attended by all the social consequences of such an anomaly, and the danger of satisfaction of perverse impulses arising out of his abnormal organization, with consequent social and legal conflicts. Fear of the latter, however, cannot be great, since the (perverse) sexual impulse of the patient is weak.

3. Mr. v. H., in the legal sense of the word, is not irresponsible, and neither fit for, or in need of, treatment in a hospital for the insane. It is possible for him—though but an overgrown child, and incapable of personal independence—to live in society, though under the care and guidance of normal individuals. Too, to a certain extent, it is possible for him to respect the laws and restrictions of society, and to judge his own acts; but, with respect of possible sexual errors and conflicts with criminal laws, it must be emphasized that his sexual instinct is abnormal, having its origin in organic pathological conditions; and this circumstance should eventually be used in his favor. On account of his notorious lack of independence, he cannot be discharged from parental care or guardianship, inasmuch as otherwise he would be ruined financially.

4. Mr. v. H. is also physically ill. He presents signs of slight anæmia and of neurasthenia spinalis. A rational regulation of his manner of life and a tonic regimen, and, if possible, hydro-therapeutic treatment, seem necessary. The suspicion that this trouble has its origin in early masturbation should be entertained, and the possibility of the existence of spermatorrhœa, that is of importance etiologically and therapeutically, lies near. (Personal case. Zeitschr. f. Psychiatrie.)

Case 130. Miss X., aged 38, consulted me, late in the fall of 1881, on account of severe spinal irritation and obstinate sleeplessness, in combating which she had become addicted to morphine and chloral. Her mother and sister were nervous sufferers, but the rest of the family were healthy. The trouble dated from a fall on her back in 1872, at which time the patient was terribly frightened, though, when a girl, she had been subject to muscular cramps and hysterical symptoms. Following this shock, a neurasthenic and hysterical neurosis developed, with predominating spinal irritation and sleeplessness. Episodically, hysterical paraplegia, lasting as long as eight months, and hysterical hallucinatory delirium, with convulsive attacks, occurred. In the course of this, symptoms of morphinism were added. A stay of some months in the hospital relieved the latter, and considerably improved the neurasthenic neurosis, in the treatment of which general faradization exerted a remarkably favorable influence.

Even at the first meeting, the patient produced a remarkable impression by reason of her attire, features, and conduct. She wore a gentleman’s hat, her hair closely cut, eye-glasses, a gentleman’s cravat, a coat-like outer garment of masculine cut that reached well down over her gown, and boots with high heels. She had coarse, somewhat masculine features; a harsh, deep voice; and made rather the impression of a man in female attire than that of a lady, if one but overlooked the bosom and the decidedly feminine form of the pelvis. During the long time that she was observed, there were never signs of erotocism. When questioned concerning her attire, she would only respond that the style she chose suited her better. Gradually it was ascertained from her that, even when she was a small girl, she had had a preference for horses and masculine pursuits, and never any interest in feminine occupations. Later she developed a particular pleasure in reading, and prepared herself to be a teacher. Dancing had never pleased her; it had always seemed silly to her. Too, the ballet had never interested her. Her greatest pleasure had always been in the circus. Until her sickness, in 1872, she had neither had inclination for persons of the opposite nor for those of her own sex. From that time she had, what was remarkable to herself, a peculiar friendship for females, particularly for young ladies; and she had a desire, and satisfied it, to wear hats and coats of masculine style. Since 1869, besides, she had worn her hair short, and parted it on the side, as men do. She asserts that she was never sensually excited in the company of men, but that her friendship and self-sacrifice for sympathetic ladies was unbounded; while from that time she also experienced repugnance for gentlemen and their society.

Her relatives report that, before 1872, the patient had a proposal of marriage, which she refused; and that when she returned from a sojourn at a watering-place, in 1874, she was sexually changed, and occasionally showed that she did not regard herself as a female.

Since that time she would associate only with ladies, and has had a kind of love-relation with one or another, and made remarks which indicated that she looked upon herself as a man. This predilection for women was decidedly more than mere friendship, since it expressed itself in tears, jealousy, etc.

When, in 1874, she was stopping at a watering-place, a young lady, who took her for a man in disguise, fell in love with her. When this lady married, later, the patient was for a long time depressed, and spoke of unfaithfulness. Moreover, since her sickness, her relatives were struck by her desire for masculine attire, her masculine conduct, and disinclination for feminine pursuits; while previously, at least sexually, she had presented nothing unusual.

Further investigations showed that the patient had a love-relation, which was not purely platonic, with the lady described in Case 118; and that she wrote her affectionate letters like those of a lover to his beloved. In 1887 I again saw the patient in a sanitarium, where she had been placed on account of hystero-epileptic attacks, spinal irritation, and morphinism. The contrary sexual feeling existed unchanged, and only by the most careful watching was the patient kept from improper advances toward her fellow-patients.

Her condition remained quite unchanged until 1889. Then the patient began to fail, and she died of “exhaustion,” in August, 1889. The autopsy showed, in the vegetative organs, amyloid degeneration of the kidneys, fibroma of the uterus, and cyst of the left ovary. The frontal bone was much thickened, uneven on the inner surface, with numerous exostoses; dura adherent to vault of cranium. Long diameter of skull, 175 millimetres; lateral diameter, 148 millimetres; weight of the œdematous, but not atrophied, brain, 1175 grammes. The meninges delicate, easily removed. Cortex pale. Convolutions broad, not numerous, regularly arranged. Nothing abnormal in cerebellum and great ganglia.

Case 131. Gynandry.[117] History: On November 4, 1889, the step-father of a certain Count Sandor V. complained that the latter had swindled him out of 800f., under the pretense of requiring a bond as secretary of a stock company. It was ascertained that Sandor had entered into matrimonial contracts and escaped from the nuptials in the spring of 1889; and, more than this, that this ostensible Count Sandor was no man at all, but a woman in male attire,—Sarolta (Charlotte), Countess V.

S. was arrested, and, on account of deception and forgery of public documents, brought to examination. At the first hearing S. confessed that she was born on Sept. 6, 1866; that she was a female, Catholic, single, and worked as an authoress under the name of Count Sandor V.

From the autobiography of this man-woman I have gleaned the following remarkable facts that have been independently confirmed:—

S. comes of an ancient, noble, and highly-respected family of Hungary, in which there have been eccentricity and family peculiarities. A sister of the maternal grandmother was hysterical, a somnambulist, and lay seventeen years in bed, on account of fancied paralysis. A second great-aunt spent seven years in bed, on account of a fancied fatal illness, and at the same time gave balls. A third had the whim that a certain table in her salon was bewitched. If anything were laid on this table, she would become greatly excited and cry, “Bewitched! bewitched!” and run with the object into a room which she called the “Black Chamber,” and the key of which she never let out of her hands. After the death of this lady, there were found in this chamber a number of shawls, ornaments, bank-notes, etc. A fourth great-aunt, during two years, did not leave her room, and neither washed herself nor combed her hair; then she again made her appearance. All these ladies were, nevertheless, intellectual, finely educated, and amiable.

S.’s mother was nervous, and could not bear the light of the moon.

From her father’s family it is said she had a trace too much. One line of the family gave itself up almost entirely to spiritualism. Two blood-relations on the father’s side shot themselves. The majority of her male relatives are unusually talented; the females are decidedly narrow and domestic. S.’s father had a high position, which, however, on account of his eccentricity and extravagance (he wasted over a million and a half), he lost.

Among many foolish things that her father encouraged in her was the fact that he brought her up as a boy, called her Sandor, allowed her to ride, drive, and hunt, admiring her muscular energy.

On the other hand, this foolish father allowed his second son to go about in female attire, and had him brought up as a girl. This farce ceased in his fifteenth year, when the son was sent to a higher school.

Sarolta-Sandor remained under her father’s influence till her twelfth year, and then came under the care of her eccentric maternal grandmother, in Dresden, by whom, when the masculine play became too obvious, she was placed in an Institute, and made to wear female attire.

At thirteen she had a love-relation with an English girl, to whom she represented herself as a boy, and ran away with her.

Sarolta returned to her mother, who, however, could do nothing, and was compelled to allow her daughter to again become Sandor, wear male clothes, and, at least once a year, to fall in love with persons of her own sex.

At the same time, S. received a careful education, and made long journeys with her father,—of course, always as a young gentleman. She early became independent, and visited cafés, even those of doubtful character, and, indeed, boasted one day that in a brothel she had had a girl sitting on each knee. S. was often intoxicated, had a passion for masculine sports, and was a very skillful fencer.

She felt herself drawn particularly toward actresses, or others of similar position, and, if possible, toward those who were not very young. She asserts that she never had any inclination for a young man, and that she has felt, from year to year, an increasing dislike for young men.

“I preferred to go into the society of ladies with ugly, ill-favored men, so that none of them could put me in the shade. If I noticed that any of the men awakened the sympathies of the ladies, I felt jealous. I preferred ladies who were bright and pretty; I could not endure them if they were fat or much inclined toward men. It delighted me if the passion of a lady was disclosed under a poetic veil. All immodesty in a woman was disgusting to me. I had an indescribable aversion for female attire,—indeed, for everything feminine,—but only in as far as it concerned me; for, on the other hand, I was all enthusiasm for the beautiful sex.”

During the last ten years S. had lived almost constantly away from her relatives, in the guise of a man. She had had many liaisons with ladies, traveled much, spent much, and made debts.

At the same time, she carried on literary work, and was a valued collaborator on two noted journals of the Capital.

Her passion for ladies was very changeable; constancy in love was entirely wanting.

Only once did such a liaison last three years. It was years before that S., at Castle G., made the acquaintance of Emma E., who was ten years older than herself. She fell in love with her, made a marriage-contract with her, and they lived together, as man and wife, for three years at the Capital.

A new love, which S. regarded as a fate, caused her to sever her matrimonial relations with E. The latter would not have it so. Only with the greatest sacrifice was S. able to purchase her freedom from E., who, it is reported, still looks upon herself as a divorced wife, and regards herself as the Countess V.! That S. also had the power to excite passion in other women is shown by the fact that when she (before her marriage with E.) had grown tired of a Miss D., after having spent thousands of guldens on her, she was threatened with shooting by D. if she should become untrue.

It was in the summer of 1887, while at a watering-place, that S. made the acquaintance of a distinguished official’s family. Immediately she fell in love with the daughter, Marie, and her love was returned.

Her mother and cousin tried in vain to break up this affair. During the winter, the lovers corresponded zealously. In April, 1888, Count S. paid her a visit, and in May, 1889, attained her wish; in that Marie—who, in the meantime, had given up a position as teacher—became her bride in the presence of a friend of her lover, the ceremony being performed in an arbor, by a false priest, in Hungary. S., with her friend, forged the marriage-certificate. The pair lived happily, and, without the interference of the step-father, this false marriage, probably, would have lasted much longer. It is remarkable that, during the comparatively long existence of the relation, S. was able to deceive completely the family of her bride with regard to her true sex.

S. was a passionate smoker, and in all respects her tastes and passions were masculine. Her letters and even legal documents reached her under the address of “Count S.” She often spoke of having to drill. From remarks of the father-in-law, it seems that S. (and she afterward confessed it) knew how to imitate a scrotum with handkerchiefs or gloves stuffed in the trousers. The father-in-law also, on one occasion, noticed something like an erected member on his future son-in-law (probably a priapus). She also occasionally remarked that she was obliged to wear a suspensory bandage while riding. The fact is, S. wore a bandage around the body, possibly as a means of retaining a priapus.

Though S. often had herself shaved pro forma, the servants in the hotel where she lived were convinced that she was a woman, because the chambermaids found traces of menstrual blood on her linen (which S. explained, however, as hæmorrhoidal); and, on the occasion of a bath which S. was accustomed to take, they claimed to have convinced themselves of her real sex by looking through the key-hole.

The family of Marie make it seem probable that she for a long time was deceived with regard to the true sex of her false bridegroom. The following passage in a letter from Marie to S., August 26, 1889, speaks in favor of the incredible simplicity and innocence of this unfortunate girl: “I don’t like children any more, but if I had a little Bezerl or Patscherl by my Sandi,—ah, what happiness, Sandi mine!”

A large number of manuscripts allow conclusions to be drawn concerning S.’s mental individuality. The chirography possesses the character of firmness and certainty. The characters are genuinely masculine. The same peculiarities repeat themselves everywhere in their contents,—wild, unbridled passion; hatred and resistance to all that opposes the heart thirsting for love; poetical love, which is not marred by one ignoble blot; enthusiasm for the beautiful and noble; appreciation of science and the arts.

Her writings betray a wonderfully wide range of reading in classics of all languages, in citations from poets and prose writers of all lands. The evidence of those qualified to judge literary work shows that S.’s poetical and literary ability is by no means small. The letters and writings concerning the relation with Marie are psychologically worthy of notice.

S. speaks of the happiness there was for her when by M.’s side, and expresses boundless longing to see her beloved, if only for a moment. After such a happiness, she could have but one wish,—to exchange her cell for the grave. The bitterest thing was the knowledge that now Marie, too, hated her. Hot tears, enough to drown herself in, she had shed over her lost happiness. Whole quires of paper are given up to the apotheosis of this love, and reminiscences of the time of the first love and acquaintance.

S. complained of her heart, that would allow no reason to direct it; she expressed emotions which were such as only could be felt,—not simulated. Then, again, there were outbreaks of most silly passion, with the declaration that she could not live without Marie. “Thy dear, sweet voice; the voice whose tone perchance would raise me from the dead; that has been for me like the warm breath of Paradise! Thy presence alone were enough to alleviate my mental and moral anguish. It was a magnetic stream; it was a peculiar power your being exercised over mine, which I cannot quite define; and, therefore, I cling to that ever-true definition: I love you because I love you. In the night of sorrow I had but one star,—the star of Marie’s love. That star has lost its light; now there remains but its shimmer,—the sweet, sad memory which even lights with its soft ray the deepening night of death,—a ray of hope.”

This writing ends with the apostrophe: “Gentlemen, you learned in the law, psychologists and pathologists, do me justice! Love led me to take the step I took; all my deeds were conditioned by it. God put it in my heart.

“If He created me so, and not otherwise, am I then guilty; or is it the eternal, incomprehensible way of fate? I relied on God, that one day my emancipation would come; for my thought was only love itself, which is the foundation, the guiding principle, of His teaching and His kingdom.

“O God, Thou All-pitying, Almighty One! Thou seest my distress; Thou knowest how I suffer. Incline Thyself to me; extend Thy helping hand to me, deserted by all the world. Only God is just. How beautifully does Victor Hugo describe this in his ‘Legendes du Siècle’! How sad do Mendelssohn’s words sound to me: ‘Nightly in dreams I see thee’!”

Though S. knew that none of her writings reached her lover, she did not grow tired writing of her pain and delight in love, in page after page of deification of Marie. And to induce one more pure flood of tears, on one still, clear summer evening, when the lake was aglow with the setting sun like molten gold, and the bells of St. Anna and Maria-Wörth, blending in harmonious melancholy, gave tidings of rest and peace, she wrote: “For that poor soul, for this poor heart that beat for thee till the last breath.”

Personal Examination: The first meeting which the experts had with S. was, in a measure, a time of embarrassment to both sides; for them, because perhaps S.’s somewhat dazzling and forced masculine carriage impressed them; for her, because she thought she was to be marked with the stigma of moral insanity. She had a pleasant and intelligent face, which, in spite of a certain delicacy of features and diminutiveness of all its parts, gave a decidedly masculine impression, had it not been for the absence of a moustache. It was even difficult for the experts to realize that they were concerned with a woman, despite the fact of female attire and constant association; while, on the other hand, intercourse with the man Sandor was much more free, natural, and apparently correct. The culprit also felt this. She immediately became more open, more communicative, more free, as soon as she was treated like a man.

In spite of her inclination for the female sex, which had been present from her earliest years, she asserts that in her thirteenth year she first felt a trace of sexual feeling, which expressed itself in kisses, embraces, and caresses, with sensual pleasure, and this on the occasion of her elopement with the red-haired English girl from the Dresden Institute. At that time feminine forms exclusively appeared to her in dream-pictures, and ever since, in sensual dreams, she has felt herself in the situation of a man, and occasionally, also, at such times, experienced ejaculation.

She knows nothing of solitary or mutual onanism. Such a thing seemed very disgusting to her, and not conducive to manliness. She had, also, never allowed herself to be touched ad genitalia by others, because it would have revealed her great secret. The menses began at seventeen, but were always scanty, and without pain. It was plain to be seen that S. had a horror of speaking of menstruation; that it was a thing repugnant to her masculine consciousness and feeling. She recognized the abnormality of her sexual inclinations, but had no desire to have them changed, since in this perverse feeling she felt both well and happy. The idea of sexual intercourse with men disgusted her, and she also thought it would be impossible.

Her modesty was so great that she would prefer to sleep among men rather than among women. Thus, when it was necessary for her to answer the calls of nature or to change her linen, it was necessary for her to ask her companion in the cell to turn her face to the window, that she might not see her.

When occasionally S. came in contact with this companion,—a woman from the lower walks of life,—she experienced a sexual excitement that made her blush. Indeed, without being asked, S. related that she was overcome with actual fear when, in her cell, she was compelled to force herself into the unusual female attire. Her only comfort was, that she was at least allowed to keep a shirt. Remarkable, and what also speaks for the significance of olfactory sensations in her vita sexualis, is her statement that, on the occasions of Marie’s absence, she had sought those places on which Marie’s head was accustomed to repose, and smelled of them, in order to experience the delight of inhaling the odor of her hair. Among women, those who are beautiful, or voluptuous, or quite young do not particularly interest her. The physical charms of women she makes subordinate. As by magnetic attraction, she feels herself drawn to those between twenty-four and thirty. She found her sexual satisfaction exclusively in corpora feminæ (never in her own person), in the form of manustupration of the beloved woman, or cunnilingus. Occasionally she availed herself of a stocking stuffed with oakum as a priapus. These admissions were made only unwillingly by S., and with apparent shame; just as in her writings, immodesty or cynicism are never found.

She is religious, has a lively interest in all that is noble and beautiful,—men excepted,—and is very sensitive to the opinion others may entertain of her morality.

She deeply regrets that in her passion she made Marie unhappy, and regards her sexual feelings as perverse, and such a love of one woman for another, among normal individuals, as morally reprehensible. She has great literary talent and an extraordinary memory. Her only weakness is her great frivolity and her incapability to manage money and property reasonably. But she is conscious of this weakness, and does not care to talk about it.

She is 153 centimetres tall, of delicate skeleton, thin, but remarkably muscular on the breast and thighs. Her gait in female attire is awkward. Her movements are powerful, not unpleasing, though they are somewhat masculine, and lacking in grace. She greets one with a firm pressure of the hand. Her whole carriage is decided, firm, and somewhat self-conscious. Her glance is intelligent; mien somewhat diffident. Feet and hands remarkably small, having remained in an infantile stage of development. Extensor surfaces of the extremities remarkably well covered with hair, while there is not the slightest trace of beard, in spite of all shaving experiments. The hips do not correspond in any way with those of a female. Waist is wanting. The pelvis is so slim, and so little prominent, that a line drawn from the axilla to the corresponding knee is straight,—not curved inward by a waist, or outward by the pelvis. The skull is slightly oxycephalic, and in all its measurements falls below the average of the female skull by at least one centimetre.

The circumference of the head is 52 centimetres; the occipital half-circumference, 24 centimetres; the line from ear to ear, over the vertex, 23 centimetres; the anterior half-circumference, 28.5 centimetres; the line from glabella to occiput, 30 centimetres; the ear-chin line, 26.5 centimetres; long diameter, 17 centimetres; greatest lateral diameter, 13 centimetres; diameter at auditory meati, 12 centimetres; zygomatic diameter, 11.2 centimetres. The upper jaw projects strikingly, its alveolar process projecting beyond the under jaw about 0.5 centimetre. The position of the teeth is not fully normal; the right upper canine has not developed. Mouth remarkably small. Ears prominent; lobes not differentiated, passing over into the skin of the cheek. Hard palate narrow and high; voice rough and deep; mammæ fairly developed, soft, and without secretion. Mons veneris covered with thick, dark hair. Genitals completely feminine, without trace of hermaphroditic appearance, but at the stage of development of those of a ten-year-old girl. The labia majora touch each other almost completely; labia minora have a cock’s-comb-like form, and project under the labia majora. The clitoris is small, and very sensitive. Frenulum delicate; perineum very narrow; introitus vaginæ narrow; mucous membrane normal. Hymen wanting (probably congenitally); likewise, the carunculæ myrtiformes. Vagina so narrow that the insertion of a membrum virile would be impossible, and it is also very sensitive; certainly coitus had not taken place. Uterus is felt, through the rectum, to be about the size of a walnut, immovable, and retroflected.

The pelvis appears generally narrowed (dwarf-pelvis), and of decidedly masculine type. The distance between anterior superior spines is 22.5 centimetres (instead of 26.3 centimetres). Distance between the crests of the ilii, 26.5 centimetres (instead of 29.3 centimetres); between the trochanters, 27.7 centimetres (31); the external conjugate diameter, 17.2 centimetres (19 to 20); therefore, presumably, the internal conjugate would be 7.7 centimetres (10.8). On account of narrowness of the pelvis, the direction of the thighs is not convergent, as in a woman, but straight.

The opinion given showed that in S. there was a congenitally abnormal inversion of the sexual instinct, which, indeed, expressed itself, anthropologically, in anomalies of development of the body, depending upon great hereditary taint; further, that the criminal acts of S. had their foundation in her abnormal and irresistible sexuality.

S.’s characteristic expressions—“God put love in my heart. If He created me so, and not otherwise, am I, then, guilty; or is it the eternal, incomprehensible way of fate?”—are really justified.

The court granted pardon. The “countess in male attire,” as she was called in the newspapers, returned to her home, and again gave herself out as Count Sandor. Her only distress is her lost happiness with her beloved Marie.

A married woman, in Brandon, Wisconsin, whose case is reported by Dr. Kiernan (The Medical Standard, 1888, November and December), was more fortunate. She eloped, in 1883, with a young girl, married her, and lived with her as husband undisturbed.

An interesting “historical” example of androgyny is a case reported by Spitzka (Chicago Medical Review, August 20, 1881). It was that of Lord Cornbury, Governor of New York, who lived in the reign of Queen Anne. He was apparently affected with moral insanity; was terribly licentious, and, in spite of his high position, could not keep himself from going about in the streets in female attire, coquetting with all the allurements of a prostitute.

In a picture of him that has been preserved, his narrow brow, asymmetrical face, feminine features, and sensual mouth at once attract attention. It is certain that he never actually regarded himself as a woman.

Moreover, in individuals afflicted with contrary sexual instinct, in themselves, the perverse sexual feeling and inclination may be complicated with other perverse manifestations. Thus here, with reference to the activity of the instinct, there may be acts quite analogous to acts indulged in by individuals in perverse satisfaction of the instinct, but who, at the same time, have a natural inclination toward persons of the opposite sex.

Owing to the circumstance that abnormally increased sexuality is almost a regular accompaniment of contrary sexual feeling, acts of lustful cruelty in the satisfaction of libido are easily possible. A remarkable example of this is the case of Zastrow (Casper-Liman, 7. Auflage, Bd. i, p. 190; ii, p. 487), who bit one of his victims (a boy), tore his prepuce, slit the anus, and strangled the child.

Z. came of a psychopathic grandfather and melancholic mother. His brother indulged in abnormal sexual pleasures, and committed suicide.

Z. was a congenital urning, and in habitus and occupation masculine. There was phimosis. Mentally, he was a weak, perverse, unsocial man. He had horror feminæ, and, in his dreams, he felt himself like a woman toward a man. He was painfully conscious of his want of normal sexual feeling and his perverse instinct, and sought satisfaction in mutual onanism, with frequent desire for pederasty.

Similar sadistic feelings of this kind, in those afflicted with contrary sexual instinct, are found in some of the foregoing histories (comp. Cases 107 and 108 of this edition, and Case 96 of the sixth edition). But masochism also occurs (comp. Case 43, sixth edition; Cases 111 and 114 of this edition; and Case 3, in the first edition of “Neue Forschungen”).

As examples of perverse sexual satisfaction dependent on contrary sexual instinct, may be mentioned the Greek, who, as Athenäus reports, was in love with a statue of Cupid, and defiled it, in the temple of Delphi; and besides the monstrous cases reported by Tardieu (“Attentats,” p. 272), the terrible one reported by Lombroso (“L’uomo delinquente,” p. 200), of a certain Artusio, who wounded a boy in the abdomen, and abused him sexually by means of the incisions.

Cases 86, 110, and 111, also, show that fetichism may also occur with contrary sexual instinct.

DIAGNOSIS, PROGNOSIS, AND THERAPY OF CONTRARY SEXUAL INSTINCT.

While up to this time contrary sexual instinct has had but an anthropological, clinical, and forensic interest for science, now, as a result of the latest investigations, there is some thought of therapy in this incurable condition, which so heavily burdens its victims, socially, morally, and mentally.

A preparatory step for the application of therapeutic measures is the exact differentiation of the acquired from the congenital cases; and among the latter, again, the assignment of the concrete case to its proper position in the categories that have been established empirically.

The diagnostic differentiation of the acquired from the congenital condition is made without difficulty in the early stages of the anomaly.

If sexual inversion has already taken place, then the history of the development of the case will throw light upon it.

The important decision, prognostically, as to whether the contrary sexual instinct is congenital or acquired, can only be made in such cases by means of the most minute details of the history.

The establishment of the fact that contrary sexual instinct existed before indulgence in masturbation is of great importance with reference to deciding whether the anomaly is congenital or not. In this, however, a difficulty arises, owing to the possibility of imperfect localization of past events (illusions of memory).

For the presumption of acquired contrary sexual instinct, it is important to prove the existence of hetero-sexual instinct before the beginning of solitary or mutual onanism.

In general, the acquired cases are characterized in that:—

1. The homo-sexual instinct appears secondarily, and always may be referred to influences (masturbatic neurasthenia, mental) which disturbed normal sexual satisfaction. It is, however, probable that here, in spite of powerful sensual libido, the feeling and inclination for the opposite sex are weak ab origine, especially in a spiritual and æsthetic sense.

2. The homo-sexual instinct, as long as inversio sexualis has not taken place, is looked upon, by the individual affected, as vicious and abnormal, and yielded to only faute de mieux.

3. The hetero-sexual instinct long remains predominant, and the impossibility of its satisfaction gives pain. It weakens in proportion as the homo-sexual feeling gains in strength.

On the other hand, in congenital cases (a) the homo-sexual instinct is the one that occurs primarily, and becomes dominant in the vita sexualis. It appears as the natural manner of satisfaction, and also dominates the dream-life of the individual. (b) The hetero-sexual instinct fails completely, or, if it should make its appearance during the life of the individual (psycho-sexual hermaphroditism), it is still but an episodical phenomenon which has no root in the mental constitution of the individual, and is essentially but a means of satisfaction of sexual desire.

The differentiation of the above groups of congenital contrary sexuality from one another, and from the cases in which the anomaly is acquired, will, after the foregoing, present no difficulties.

The prognosis of the cases of acquired contrary sexual instinct is, at all events, much more favorable than that of the congenital cases. In the former, the occurrence of effemination—the mental inversion of the individual, in the sense of perverse sexual feeling—is the limit beyond which there is no longer hope of benefit from therapy. In the congenital cases, the various categories established in this book form as many stages of psycho-sexual taint, and benefit is probable only within the category of the psychical hermaphrodites, though possible (vide the case of Schrenk-Notzing) in that of the urnings.

The prophylaxis of these conditions becomes thus the more important,—for the congenital cases, prohibition of the reproduction of such unfortunates; for the acquired cases, protection from the injurious influences which experience teaches may lead to the fatal inversion of the sexual instinct.

Numerous predisposed individuals meet this sad fate, because parents and teachers have no suspicion of the danger which masturbation brings in its train to such children.

In many schools and academies masturbation and vice are actually cultivated. At present much too little attention is given to the mental and moral peculiarities of the pupils. If only the tasks are done, nothing more is asked. That many pupils are thus ruined in body and soul is never considered. In obedience to affected prudery, the vita sexualis is veiled from the developing youth, and not the slightest attention given to the excitations of his sexual instinct. How few family physicians are ever called in, during the years of development of children, to give advice to their patients that are often so greatly predisposed!

It is thought that all must be left to Nature; in the meantime, Nature rises in her power, and leads the helpless, unprotected innocent into dangerous by-paths.

A more detailed treatment of this prophylactic side of the subject is impossible here.[118]

To parents and teachers, the experiences detailed in this work, and numerous scientific works on masturbation, give suggestions.

The lines of treatment, when contrary sexual instinct exists, are the following:—

1. Prevention of onanism, and removal of other influences injurious to the vita sexualis.

2. Cure of the neurosis (neurasthenia sexualis and universalis) arising out of the unhygienic conditions of the vita sexualis.

3. Mental treatment, in the sense of combating homo-sexual, and encouraging hetero-sexual, feelings and impulses.

The most important part of the treatment lies in fulfilling the third indication, particularly with reference to onanism.

Only in very few cases, where acquired contrary sexual instinct has not progressed far, can the fulfillment of 1 and 2 be sufficient, as the following case, fully reported by the author in the Irrenfreund, 1884, No. 1, proves:—

Case 132. Count Z., aged 51, of psychopathic mother, was early sent to a military school, and there was taught onanism. He developed well, and had normal sexual feelings, but, as a result of masturbation, he became somewhat neurasthenic in his seventeenth year. He enjoyed intercourse with women, was married at twenty-five, but after a year more became neurasthenic, and absolutely lost his inclination for women. In its place came contrary sexual instinct. Involved in an accusation for high treason, he was sent to prison for two years, and then to Siberia for five years. In these seven years, under the influence of continued masturbation, neurasthenia and contrary sexual instinct constantly increased. With his freedom restored at the age of thirty-five, the patient began to visit all kinds of health-resorts on account of his great neurasthenia; and this has since been his occupation. In all these years his abnormal sexual feeling has not changed in any way. For the most part, he lived away from his wife, whom, it is true, he esteemed for her mental qualities; though he avoided her, as he did every other woman. His contrary sexual feeling is purely platonic. “Friendship,” sweet embraces, and kisses sufficed him. Pollutions, which occasionally occurred, were induced by lascivious dreams which had for subject persons of his own sex. Also, during the day, the most beautiful woman had no charm for him, while simply the sight of handsome men induced erection and ejaculation. Only athletes and male dancers in the circus and ballet interested him. At times of greater excitability, even masculine statues gave him erections. Now and again he resumed his old vice of masturbation. This man of æsthetic culture had a horror of pederasty.

He felt, always, that his perverse sexual feeling was something abnormal, without, however, in his apparently much weakened libido and virility, feeling unhappy.

The examination gave the usual findings of neurasthenia. Development, manner, and attire presented nothing remarkable. Electrical massage was unusually successful. After a few sittings the patient was mentally and physically much better. After twenty sittings libido was again awakened, not in the same way, but normally, as the patient had felt until his twenty-fifth year. Lascivious dreams were concerned only with women; and one day the patient joyfully gave the information that he had had coitus, and that he had had the same natural feeling in it that he had had twenty-six years before. He then began to live with his wife again, and hoped that he was lastingly freed from neurasthenia and contrary sexual instinct. His hope was fulfilled for the six years during which I was able to keep the patient under observation.

As a rule, physical treatment, even though it be re-inforced morally by good advice with reference to the avoidance of masturbation, the repression of homo-sexual feelings and impulses, and the encouragement of hetero-sexual desires, will not prove sufficient, even in cases of acquired contrary sexual instinct.

Here a method of mental treatment—hypnotic suggestion—is all that can bring benefit.

The following case is interesting; and it is an example of successful auto-suggestion that gives encouragement for the milder forms of the anomaly:—

Case 133. Autobiography of a Psychical Hermaphrodite. Successful Struggle against Homo-sexual Inclinations made by the Patient himself.—“My father once had a stroke, but has recovered save for paralysis of the face. My mother was very anæmic and melancholic. Both suffered severely with hæmorrhoids, and my father ascribed to this trouble the lumbar pain with which he suffered from time to time after his marriage.

“I am, if I may so express myself, a passive character. When a child, I indulged in all kinds of fancies, religious as well as others. I suffered with incontinence of urine, and it is said that in sleep I handled my genitals, so that my father fastened my hands to the bed! (I was then a mere child, and had not masturbated.) I was always very shy and embarrassed in social intercourse. When about fourteen or fifteen years old, I was seduced into onanism. The impulse and desire for women, occurring in connection with the awakening sexual feeling, were, in reality, only of a platonic nature; I was also without the society of ladies. When about eighteen, I attempted to satisfy my sexual desire in the natural way, more in obedience to a feeling of curiosity than from inner longing. Since that time, without having experienced any real inclination for women, as often as possible I have satisfied my desire by means of sexual intercourse.

“Soon after puberty I became very anæmic, and appeared much older than I really was. Then came melancholic and peculiar ideas. It was a delight to me to fancy myself humiliated in the extreme. It may be of interest to add that, at that time, I was troubled with religious doubts, and only later found the courage to rise above religions. I fell in love with young men. At first I opposed these ideas; later they became so powerful that I became a genuine urning. Women seemed to me to be human beings of the second class. I was in a state of despair. My sickened soul was filled with tædium vitæ and thoughts inimical to humanity. One day I read: ‘What will it come to?’ And ere I knew it, I was a socialist; but an ideal one. Life again had value for me, for I had an ideal,—the joyous struggle for the social elevation of the proletariat. This caused a powerful revolution in me. As in my best years (from the age of sixteen to seventeen), I took interest in art, particularly in dramatic art. I am, at the present time, writing a play and a story, and I am occupied with the grandest thoughts. I read a remark of Schlegel’s concerning Sophocles, who was indebted to his physical exercise for his energy and creative power, and to music for his artistic proportions. In another place I read: ‘The dramatist must, above all things, be mentally intact.’ This depressed me; for my contrary sexual feelings could not arise in a perfectly normal mind.

“I thought of having myself treated hypnotically; but shame held me back. Then I said to myself that I was a weakling, indeed, to have so little confidence in myself, and began in earnest to combat my abnormal desires. At the same time, I struggled against my nervousness by leading the proper kind of a life. I rowed, fenced, and was much in the open air; and I was delighted when, at last, I awoke and seemed to be an entirely different man. When I thought of the time from my twentieth to my twenty-sixth year, it seemed to me that, during those years, a strange and depressive being had been dwelling within me.

“I was astonished that the handsomest rider or the trimmest waiter excited in me almost no interest; even the muscular masons had no effect on me. I was disgusted when I thought that, at one time, such men had seemed handsome to me. My self-respect increased; I am good-natured, but my character is entirely active. Since my twentieth year my appearance has steadily improved. My appearance now corresponds perfectly with my years. There were recurrences of my abnormal inclinations, to be sure; but I struggled against them energetically. I satisfy my libido only by means of natural intercourse, and I hope that, by continuing to lead a proper life, my pleasure in natural coitus will increase.”

As a rule, only suggestion coming from a second person, and that by means of hypnosis, promises any success. In such cases, the object of post-hypnotic suggestion is to remove the impulse to masturbation and homo-sexual feelings and impulses, and to encourage hetero-sexual feelings with a sense of virility. A prerequisite is, of course, the possibility to induce hypnosis of sufficient intensity. It is, unfortunately, in these very cases of neurasthenia that this is impossible, since they are often excited, embarrassed, and in no condition to concentrate their thoughts.

Thus, in a case reported by me in the International. Centralblatt für die Physiologie und Pathologie der Harn- und Sexualorgane, Bd. i, Heft 2, p. 58, it was impossible for me to induce hypnosis, though the patient desired it, and did everything to make it successful. By reason of the great benefit that can be given to such unfortunates, and with Ladame’s case in view (v. infra), in the future, in all such cases, everything should be done to bring about hypnosis,—the only means of salvation. The result, in the three following cases, was satisfactory:—

Case 134. Contrary Sexual Instinct Acquired through Masturbation.—Mr. X., merchant, aged 29. Father’s parents healthy. Nothing nervous in father’s family. Father was an irritable, peevish old man. One brother of the father was a man-about-town, and died unmarried. Mother died in third confinement, when the patient was six years old; she had a deep, rough, masculine voice, and coarse appearance. Of the children, one brother is irritable, “melancholic,” and indifferent to women.

When a child patient had scarlet fever with delirium. Until his fourteenth year he was light-hearted and social, but, after that, quiet, solitary, and “melancholic.” The first trace of sexual feeling appeared in his tenth or eleventh year, and at that time he learned masturbation from other boys, and practiced mutual onanism with them. At the age of thirteen or fourteen, ejaculation for the first time. Patient has felt no evil results of onanism until the last three months.

In school he learned easily, but was troubled with headaches. After the age of twenty, pollutions, in spite of daily practice of onanism. With pollutions, “procreative” dreams, as man and wife might perform the act, occurred. In his seventeenth year he was seduced into mutual onanism by a man having a love for men. He found satisfaction in this, inasmuch as he was always very passionate sexually. It was a long time before the patient again sought new opportunities for intercourse with males. He did it simply to rid himself of semen. He felt no friendship or love for the person with whom he had intercourse. He felt satisfaction only when he played the passive rôle,—when manustupration was practiced on him. When the act was once completed, he had no respect for the individual. If it happened that, later, he came to respect the man, then he ceased to indulge in the act with him. Later it became indifferent to him whether he masturbated or had masturbation practiced on him. When he himself practiced onanism, he always thought of pleasing men practicing onanism on him during the act. He preferred a hard, rough hand.

The patient thought that, had he not been led astray, he would have arrived at a natural mode of satisfaction of his sexual desires. He never felt love for his own sex, though he had pleased himself with the thought of loving men. At first he had had sensual inclinations toward the opposite sex. He had taken pleasure in dancing, and he had been pleased with women, but he had taken more pleasure in the figure than the face. Too, he had had erections at the sight of women that pleased him. He had never attempted coitus, for fear of infection; whether he was potent or not with women, he did not know. He thought he could be so no longer, because his feeling for women had grown cold, especially during late years.

While previously, in his sensual dreams, he had had ideas of both men and women, of late years he had dreamed only of approaches to men; he could not remember that he had dreamed, in late years, of sensual relations with a woman. At the theatre, as well as in the circus and ballet, the feminine figure had always interested him. In museums masculine and feminine statues had affected him equally.

Patient is a great smoker, a beer-drinker, loves male society, and is a gymnast and skater. Anything dandified was repugnant to him, and he had never felt any desire to please men; he would even have preferred to please women.

He now felt his position to be painful, because onanism had obtained the upper hand. Masturbation, that had previously been practiced without evil effects, now began to disclose its bad results.

Since July, 1889, he had suffered with neuralgia of the testicles. The pain occurred particularly at night; and at night there was also trembling (increased reflex excitability).

Sleep was not refreshing, and he would wake up with pain in the testicles. He was inclined, now, to indulge more frequently in onanism. He was afraid of the consequences of the habit. He hoped that his sexual life might still be turned into normal channels. Now, he thought of the future; he had a relation with a girl, who was attractive to him, and the thought to possess her as a wife was pleasing.

For five days he had abstained from onanism, but he could scarcely believe that he would be able, with his own strength, to overcome the habit. Of late he had been very much depressed, having lost all desire for work, and become tired of life.

Patient is tall, powerful, well nourished, and has a thick growth of beard. Skull and skeleton normal. Knee-jerks very prompt; deep reflexes in upper extremities much increased. Pupils dilated, equal, and act promptly. Carotids of equal calibre; hyperæsthesia urethræ; cords and testicles not sensitive; genitals normal.

The patient was calmed, and given hope for the future, provided that he give up onanism and attempt to transfer his sexual desires from persons of his own sex to females.

Hip-baths (24° to 20° R.); ext. secal. conut. aquos., 0.5; antipyrin, 1.0 (pro die); pot. brom., 4.0 (evenings), were ordered.

December 13th. To-day the patient came, in a disturbed condition of mind, complaining that, unaided, he was unable to resist the impulse to masturbate, and he asked for help.

A trial of hypnosis induced a condition of deep lethargy in the patient.

He was given the following suggestions:—

1. I can not, must not, and will not masturbate again.

2. I abhor the love for my own sex, and shall never again think men handsome.

3. I shall and will become well again, fall in love with a virtuous woman, be happy, and make her happy.

December 14th. While out walking to-day, patient saw a handsome man, and felt himself powerfully drawn toward him.

From this time there were hypnotic sittings every second day, with the above suggestions.

December 18th (fourth sitting), somnambulism occurred; the impulse to onanism and interest in men disappear.

At the eighth sitting “complete virility” was added to the above suggestions. The patient feels himself morally elevated and physically strengthened. The neuralgia of the testicles has disappeared. He now found that he was without sexual feeling.

He now believed himself free from masturbation and contrary. sexual inclination.

After the eleventh sitting he thought that further help was unnecessary. He wished to go home, and marry. He felt well and potent. Early in January, 1890, treatment ceased.

In March, 1890, the patient wrote: “I have since had several occasions on which it has been necessary for me to use all my moral strength in order to overcome my habit, and, thank God, I have been successful in freeing myself from this vice. Several times I have had opportunity for sexual intercourse, and I have found pleasure in it. I look calmly on my happy future.”

Case 135. Acquired Contrary Sexual Instinct. Marked Improvement under Hypnotic Treatment.—Mr. P., born in 1863, official in a manufactory. He comes of a highly respected patrician family of Middle Germany, in which nervousness and insanity have been of frequent occurrence.

His great-grandfather on the father’s side and his sister died insane; the grandmother died of apoplexy; father’s brother died insane, and a daughter of the latter died of cerebral tuberculosis. The maternal grandmother was melancholic for years; maternal grandfather, insane. A maternal uncle took his life in an attack of insanity. The patient’s father is very nervous. An elder brother is very neurasthenic, and has anomalies of the vita sexualis; another is the subject of Case 155; a third is eccentric in conduct, and is said to be subject to fixed ideas. A sister suffers with convulsions, and another died of them when a little child.

The patient is constitutionally predisposed; for he was early very peculiar, irritable, irascible, and impressed those around him as being abnormal.

His vita sexualis appeared very early and in great intensity, and was satisfied, without any seductions, in onanism. From his sixteenth year the prematurely developed boy visited brothels of the Capital, using his permissions to go out on Sundays and holidays for that purpose. He took pleasure in coitus, but during the week he satisfied himself with onanism. After his twentieth year, when he became independent, the patient indulged with prostitutes excessively, and fell ill with neurasthenia sexualis, becoming relatively impotent and unsatisfied in coitus, owing to weakness of erection and premature ejaculation. His sexual libido became more powerful than ever, and was satisfied in onanism. Early in 1888 the patient made the acquaintance of a young man. “By his pleasing face, his attractive manner, and his beautiful form, he conquered me entirely. I wished to speak to him, and was happy at mere sight of him. I was completely in love with him. With this, my love for women was extinguished. Any man could excite me to such an extent that, for some moments, I would feel my memory fail, and I would stammer.

“Soon after this I made the acquaintance of a gentleman who was likewise very attractive, and who had a decided influence on my future life. He was male-loving. I confessed to him that I no longer felt anything but aversion for the female sex, and that I was attracted to men.

“When I once asked my companion how he brought it about that soldiers would surrender themselves to him, he answered that the principal thing was skill; almost any of them could be brought to it. Late in 1888, thinking of these words, I was attracted by an officer’s servant, and was intensely excited by him, but ejaculation never occurred. Since I saw that the soldier would surrender himself without trouble, I approached him. Alium quondam militem in cubiculum allectum rogavi ut veste exuta mecum in lectum concumberet. Rogatus fecit quæ volui et alter alterius penem trivit.

“Though after this success I misused many persons, I was never really in love, so to speak, with but one. He was a very handsome young fellow of seventeen. His voice was so attractive to me, and his manner was so delicately proper, that I cannot forget him. In my dreams I thought only of handsome young men, and often for whole nights I could not sleep, owing to sensual feeling.”

Early in 1889 the patient’s conduct awakened a suspicion of male-love. A threatening communication frightened him, and plunged him in deep depression, so that he contemplated suicide. At the advice of the family physician, he came to the Capital. Since the patient was unable to overcome his habitual desires by his own will, hypnotic treatment was undertaken. It induced but mild lethargy, and, in opposition to the seduction of former lovers, it had but little effect.

At that time the patient was wanting in earnest desire. There was some improvement in matters, in the face of the disgrace to relatives and the prospect of a legal examination that was actually threatening. The patient determined to attempt a cure with the author.

I found him to be a delicate, pale, very neurasthenic man, much depressed, and despairing about the future. He was without degenerative signs. He realized his perverted situation, and seemed to be willing to do anything in order to become again a decent, moral man.

He regretted exceedingly his sexual perversion, which he regarded as abnormal, but also as having been acquired. He made no attempt to conceal the fact that he could not control himself with young men, and likewise he would not say that he could abstain from onanism, to which, faute de mieux, he was driven. Only a powerful, imperious will could keep him from it.

Thus far his male-love had consisted exclusively of mutual onanism. Erections occurred only when touching men he loved; ejaculation resulted early, but simple embrace was not sufficient. He had never felt himself in any particular sexual rôle toward a man. Genitals and vegetative organs normal.

In addition to treatment directed to his neurasthenia, on April 8, 1890, hypnotic suggestion was begun. Hypnosis was easily induced by simply looking at him, with verbal suggestion. After a half-minute the patient passed into deep lethargy, with a cataleptiform state of the muscles. The awakening was brought about by suggesting it at counting three. Post-hypnotic suggestions were always successful. The intra-hypnotic suggestions were:—

1. The interdiction of onanism.

2. The command that male-love should be felt to be disgraceful and despicable, and that it should be impossible.

3. The command to regard only women as beautiful; to approach them, to dream of them, and to have libido and erection at sight of them.

The sittings occurred daily. On April 14th, the patient announced, with thankfulness and a kind of moral satisfaction, that he had had pleasure in coitus, and had ejaculated tardily. On April 16th, he felt free from inclination to masturbate, attracted to women, and perfectly indifferent to men. He dreamed of female charms and coitus with women. May 1st, the patient seemed and felt himself to be normal sexually. He has become a different man mentally, full of courage and self-confidence. He has coitus with complete satisfaction, and thinks that he is insured against relapse.

In a later letter Mr. P. writes: “As was only to be expected, I find myself lastingly freed from my errors. All that remains to remind me of my unhappy time are the dreams, which, though they are infrequent, come from my past, which I have no power to banish, and which sometimes, indeed, pleasantly occupy my thoughts. But by my own will I yet hope soon to succeed in freeing myself absolutely from them. Should I ever become weak again, the ideas you have impressed on me would, I am sure, make an energetic resistance, and I should not succumb.”

On October 20, 1890, P. wrote me: “I am completely cured of onanism, and I have no pleasure in male-love. Yet complete virility does not seem to have been re-established, notwithstanding the fact that I lead a virtuous life. Nevertheless, I feel satisfied.”

Case 136. Acquired Contrary Sexual Instinct.—Mr. Z., aged 32, divorced. He comes of a hysteropathic mother. Maternal grandmother suffered with hysteria, and her brothers and sisters were neurotic. One brother is an urning. Z. was but poorly endowed mentally, and did not learn easily. No sickness besides scarlatina. When thirteen, he was taught to masturbate by companions in a school. Sexually, he was hyperæsthetic, and, at seventeen, began to indulge in coitus, with full pleasure and power. For reasons of position and money, he married at twenty-six. The marriage was very unhappy. After a year Mrs. Z. became incapable of coitus, by reason of uterine disease. Z. satisfied his inordinate desires with other women, faute de mieux, by masturbation. Besides, he gave himself up to play, led an absolutely dissolute life, became exceedingly neurasthenic, and sought to strengthen his weakened nerves by drinking great quantities of wine and brandy. To his essential cerebral asthenia were added peripheral alcoholic cramps and globus, and he became very emotional. His libido nimia continued unabated. On account of his disgust of prostitutes and fear of infection, satisfaction by coitus was exceptional. For the most part, the patient helped himself with onanism.

Four years ago he noticed weakening of erection and decrease of libido for women. He began to feel himself drawn toward men, and his lascivious dreams were no longer concerned with women, but with men.

Three years ago, while being rubbed by a bath-attendant, he became powerfully excited sexually (the attendant also had an erection, to patient’s surprise). He could not keep from embracing and kissing the attendant, and allowing him to perform masturbation on him, the attendant doing it most willingly. From this time this mode of sexual indulgence was all that he cared for. Women became a matter of entire indifference to him; he devoted himself exclusively to men. With them he practiced mutual masturbation, and had a longing to sleep with them. He abhorred pederasty. He was entirely satisfied until (August, 1890) an anonymous letter, warning him to be careful, brought him to his senses. He was much frightened, had hysterical attacks, and became much depressed. He was embarrassed before men, seemed like a pariah in society, contemplated suicide, and finally confessed to a priest, who comforted him. He now fell into a religious state (equivalent), and, out of remorse and to cure himself of his abnormal sexual inclinations, wished to go into a cloister. While in this state, my “Psychopathia Sexualis” fell into his hands. He was frightened and filled with shame, but found a comfort in it, inasmuch as he concluded that he must have some malady. His first thought was to rehabilitate himself sexually in his own eyes. He overcame all disinclination, and visited a brothel. At first he was not successful, on account of great excitement, but he finally succeeded.

Since, however, his contrary sexual inclinations were not overcome, in spite of all his efforts to put them down, he finally came to me, asking for assistance. He felt himself to be terribly unfortunate, and very near to despair and suicide. He saw destruction before him, and would be saved at any price.

His confession was interrupted by numerous hysterical attacks. Comforting and encouraging words about his future had a calming influence.

Physically, patient presented a slightly retreating brow, with no other anatomical signs of degeneration. Spinal irritation, exaggerated deep reflexes, and a sense of pressure in the head pointed to a neurasthenic condition. No genital anomalies, though there was hyperæsthesia urethræ. Mien distressed; attitude relaxed; mind distracted and vacillating.

Hip baths, massage, ergot with antipyrin and pot. brom., ordered, with interdiction of onanism, intercourse with men, and lascivious thoughts of them.

After a few days the patient came complaining that he was not equal to the task. He said his will was too weak. In this precarious situation, it seemed that nothing but hypnotic treatment could bring improvement.

September 11, 1889. First sitting. Bernheim’s method used, in order to induce lethargy as quickly as possible.

Suggestions:—

1. I abhor onanism, and will not masturbate again.

2. I regard the inclination for men disgusting,—horrible; and I shall never think men handsome and enticing.

3. Women alone I find enticing. Once a week I shall cohabit, with full pleasure and power.

The patient received these suggestions, and repeated them in a drawling tone.

The sittings took place every second day. After the fifteenth, it was possible to induce the somnambulic stage of hypnosis with any post-hypnotic suggestions desired.

The patient improved morally and mentally, but symptoms of cerebral neurasthenia troubled him still, and, now and then, dreams of men occurred; and there were, also, in the waking state, inclinations toward men, which depressed him exceedingly.

Treatment until September 24th. Result: Free from onanism; no longer excitable to men, though impressionable to women. Normal coitus once in eight days. Hysterical symptoms absent; neurasthenic symptoms much ameliorated.

On October 6th the patient reported by letter that he was feeling well, and expressed his gratitude for his salvation; he felt as if given a new life.

December 9, 1889, patient again came for treatment. Of late he had had lascivious dreams of men twice, but had experienced no inclination toward men in the waking state. He had also resisted the impulse to masturbate, though, while living alone in the country, he had had no opportunity for coitus. He had inclinations only for the opposite sex, and, as a rule, dreamed only of females. Returned to the city, he had indulged in coitus with pleasure. The patient felt himself morally rehabilitated, being almost free from neurasthenic symptoms; and, after three more hypnotic sittings, he declared himself perfectly well, and confident that he would not relapse. Such a relapse occurred, however, in September, 1890, when, after over-exertion on an excursion into the mountains, and emotional strain with want of opportunity for coitus, he had again become neurasthenic.

Again he had dreams of men, and felt drawn toward attractive male forms; he masturbated many times, and, after returning to the city, found no real pleasure in coitus. By means of anti-neurasthenic treatment and hypnosis, it was possible soon to restore the previous condition.

In the course of the years 1890 and 1891 the patient now and then had contrary sexual feelings and dreams, but only when, as a result of emotional strain or excesses, his neurosis re-appeared. At such times satisfaction in coitus was wanting. He would then find it necessary to undergo a few hypnotic sittings, in order to restore his equilibrium—always with success.

At the end of 1891 the patient pointed with satisfaction to the fact that, since treatment, he had been able to avoid masturbation and male-intercourse, and had regained his self-confidence and self-respect.

The foregoing details of the successful results of hypnotic suggestion, in cases of acquired contrary sexual feeling, make it seem possible that those unfortunates that are afflicted with the congenital perversion may be helped in some degree by the same means.

To be sure, here the condition is entirely different, since a congenital condition must be combated, an abnormal psycho-sexual life annihilated, and a new one created. A priori this task seems impossible; at least, in the perfect urning. That the apparently impossible is artificially possible may be seen from the case of Schrenk-Notzing, which follows below. It far surpasses the case reported by me (v. infra), in which at least the homo-sexual feelings and impulses were removed by means of hypnotic suggestion.

The case of Ladame (v. infra) is an analogous one. The conditions are more favorable in psycho-sexual hermaphrodites, where at least there are rudiments of hetero-sexual feelings that may be strengthened and made operative by suggestion.

Case 137. “I was born in 1858, out of wedlock. It was only late that I was able to trace my obscure origin, and obtain knowledge of my parents; and this knowledge is, unfortunately, very obscure and imperfect. My father and mother were cousins. My father died three years ago. He had later married, and, as far as I know, had several healthy children.

“I do not think that my father had contrary sexual feelings. Without knowing him as my father, I often saw him when I was a child. He was a powerful, masculine man. As for the rest, it is said that, at the time of my birth, or before, he was sexually ill.

“I have often seen my mother on the street, but I did not then know that she was my mother. At the time of my birth she may have been about twenty-four years old. She was tall, and quick and energetic of movement, and her character was decided. At the time of my birth she is reported to have gone about much in male attire, to have worn short hair, to have smoked a long pipe, and in general to have been remarkable for her eccentric character. She was exceedingly well educated, and is said to have been beautiful in her youth. She left a fortune,—considerable even when measured by our present ideas,—but she died unmarried.

“In any case, all this would point to homo-sexual inclinations, or, at least, to abnormalities. On the other hand, several years before my birth, my mother took care of a little girl. This step-sister, whom I never knew, married young, but early in her married life, for reasons unknown to me, she poisoned herself.

“I am 1.7 metres tall, measure 92 centimetres around the waist, and 102 centimetres around hips, and, therefore, I think my pelvis is somewhat over-developed. The subcutaneous fat has always been abundant. Skeletal form is strong. The muscular system is well formed, but, from lack of exercise, perhaps owing to the influence of early, long-continued, and frequent indulgence in onanism, it is not well developed; so that I appear stronger than I really am. Hair of head and face is normal; genital hair, somewhat thin. The upper portion of the body is as good as without hair. In all other ways my appearance is fully masculine. Gait, attitude, and voice are those of a fully developed man, and other urnings have often told me that they would never have suspected my passion. I served in the army, and always found pleasure in all knightly exercises,—riding, fencing, swimming, etc.

“My early training was under a priest. I had but few real playmates. The family life of my foster-parents was faultless. In October, 1861, I entered the Institute. Here I indulged in my first perverse acts, which I shall describe more fully when I come to the development of my sexual life.

“I finished the Gymnasium, served my voluntary years in the army, and then studied forestry, being now a director of estates. During my early years my mental development was very slow. I first learned to speak in my third year, and thus the supposition that I had hydrocephalus was strengthened. From the time of beginning school, my mental development was abnormal; indeed, I learned easily, but I have never been able to concentrate my activity on any particular subject. I have a great interest in art and æsthetics, but almost none in music. In early years my character was the worst possible. Without being able to give any reason for it, during the last twelve years there has been an entire transformation. Now, there is nothing I hate more than a lie, and I never speak untruth even in jest. In financial matters, without being avaricious, I have become an economical manager.

“It is enough that, with a deep feeling of shame, I look back on my past; and, if I could be freed from my unhappy sexual perversion, or perversity, I should justly regard myself as a true gentleman. I am kind, and always ready to be charitable to the extent of my means; I am gay-spirited, and regarded with favor socially. I have no trace of that nervous irritability which is so often noticeable in others like me. Too, I am not wanting in personal courage. There is nothing in the early period of my development that points to abnormality. To be sure, as a child, I liked to lie in bed on my abdomen, and, of a morning, I often took delight in rolling about on my abdomen, much to the amusement of my foster-parents; but I cannot recall that, at such times, I ever had sensual feeling. I never sought much to play with girls, and I never played with dolls. I early heard talk about sexual matters; but I never thought anything about it. In my dreams, too, at that time, there was nothing sexual; and, in my association with boys of my own age, there was nothing of that kind. I think I may say that my vita sexualis was really first awakened after I had been seduced into mutual masturbation, in my thirteenth year, by a room-mate at the Institute. At that time ejaculation did not take place, but first about a year later. Nevertheless, I gave myself up to the vice of onanism passionately. At this time, however, the first signs of homo-sexual inclination were manifested. Youthful, powerful men, market-helpers, workmen, and soldiers took possession of my dreams, and played an important rôle in my fancy while masturbating. At this time was also first shown the tendency to pederasty, especially passive. Up to my fourteenth year I frequently made mutual attempts at pederasty with my seducer, but neither of us were successful in bringing about immissio. At the same time, there was also a weak inclination for the female sex. About a year after the first indulgence in onanism, I was once with a puella publica, but I had neither ejaculation nor any especial feeling of sensual pleasure. Thereafter, and up to my nineteenth year, I performed coitus in public houses about six times. Erection and ejaculation occurred promptly, but without marked sensual pleasure. At least onanism, particularly mutual onanism, I liked quite as much. I have never had any love for athletes. About ten years ago, while at H., a watering-place, I thought I was in love with a beautiful lady of a highly respectable family; I was happy in her presence, and thought myself happy in finding my love returned. For a time this affair kept me from masturbating; I was only afraid that, weakened by onanism that had been practiced for years, I should be incapable of performing my marital duty. When we became widely separated, my feeling quickly cooled; I found that I had deceived myself; and, after about two years, without jealousy, I was able to hear that the lady had married. My inclination for women—if, in reality, I have ever had any—grew colder and colder. Two and a half years ago, when I visited a public house with very virile friends, I last performed coitus. There was erection, but no ejaculation. Women have become indifferent to me. A prostitute who acts coarsely excites my repugnance. With intellectual women, particularly when they are elderly, I like to converse, but in their society I am often unskillful and awkward, often devoid of tact. I have never been able to find any charm in woman’s physical form.

“But, to return to the perverse inclinations. When, at the age of fourteen, I went to H., I lost sight of my lover and seducer. He was some years older than I, and was an official; and, in this capacity, when I was nineteen, I again met him once on the railway. We immediately cut the journey short, and lodged together, attempting mutual pederasty; but, on account of pain, immissio was not successful. We amused ourselves in mutual onanism. In H. I had sexual intercourse with two fellow-students, but this intercourse was confined to frequent mutual onanism, owing to the fact that they were not inclined to pederasty. During the last year of my stay (when I was nineteen), I had intercourse with another person, which likewise consisted of onanism; but our intercourse was more intimate, and we always retired, and practiced mutual onanism in bed. From Easter, 1869, until July, 1870, I had no lover. I practiced onanism alone. When the war broke out, I offered myself as a volunteer, but was not accepted. At the same time a former school-mate offered himself. He had developed into a remarkably handsome man. I had to spend one night with him in an over-crowded hotel. Though as students we had never associated sexually, he was not averse to my desire, and attempted pederasty. In this instance pain prevented success; but, in the attempt, ejaculatio ante anum meum occurred. Even now I can recall the pleasurable feeling I had in it,—a feeling previously unknown. After the war I frequently met this friend, but our intercourse was later limited to onanism. During the following eighteen years I had but two opportunities for homo-sexual intercourse. The first was in the winter of 1879, on the occasion of meeting a handsome hussar in a railway carriage. I induced him to sleep with me at an hotel. Later he confessed to me that he had previously practiced mutual masturbation with the son of a landed proprietor of his town. I could not bring him to pederasty. On the other hand, I induced ejaculation in him by receptio penis ejus in os meum. This caused me no satisfaction, but rather disgust. I have never tried it again; and, too, I have never allowed receptio penis mei in os alterius. In 1887, likewise on the railway, I made the acquaintance of a sailor, and induced him to stay with me at an hotel. He said he had never practiced pederasty, but he was ready for it. He was apparently sensually excited; he had an erection immediately, and performed the act with evident passion. It was the first time that pederasty was successfully performed. I had terrible pain, but also indescribable pleasure.

“With my sojourn here, my vita sexualis has undergone a complete change. I have learned how easy it is to find persons who, partly for money and partly from desire, yield to our inclinations. I have also not been spared annoying experiences with cheats. Until the end of the last year (since then, owing to fear of venereal infection, I have not gone beyond mutual masturbation), I enjoyed male-love to the full extent, particularly in passive pederasty. I have never practiced active pederasty, because I have found no one able to endure the pain.

“Generally, I seek my lovers among cavalrymen and sailors, and, eventually, among workmen, especially butchers and smiths. Robust forms, with healthy facial complexions, attract me especially. Leathern riding-trousers have a particular charm for me. I have no partiality for kissing and the like. I also love large, hard, and calloused hands.

“I do not wish to leave unmentioned that, under certain circumstances, I have great control of myself.

“As director of an estate, I lived in a large house. My personal servant was a very handsome young man who had served in the hussars. After once having spoken with him, in general terms, on the subject, and found that he could not be approached, for years I lived in close intimacy with him, and enjoyed his beauty, but never touched him. I think that, to this day, he knows nothing of my passion. Likewise, two and a half years ago, in C., I made the acquaintance of a sailor, who is still regarded by me and my acquaintances as one of the handsomest men we know. After an absence of more than two years, on invitation, he visited me a few weeks ago. I knew how to arrange matters so that we slept in the same room, and I burned with desire to be nearer to him. As a preliminary, however, I sounded him in confidential talk; and, when I found that he despised everything connected with male-love, I had not the heart to approach him more closely. For weeks we slept in the same room, and I took constant delight in his divine form (at first, was sexually excited, in fact); I bathed with him, in the Roman manner, in order to see his beautiful form naked,—but he never learned anything of my passion. I still have an ideal, platonic relation with this young man, who, for one of his position, has an unusual education and fine talent for poetry.

“Until my thirty-eighth year I had not a clear understanding of my condition. I always thought that, by early and frequent masturbation, I had become averse to women, and hoped always that, when the right woman came, I should be able to abandon onanism and find pleasure in her. Here it was that I first came to fully understand my condition, after making the acquaintance of others suffering and feeling like myself. At first I was frightened; later I came to look upon my fate as something not dependent on myself. Too, I made no further effort to resist temptation.

“Two or three weeks ago ‘Psychopathia Sexualis’ fell into my hands. The work has made an unexpectedly deep impression on me. At first I read the work with an interest that was undoubtedly lascivious. The description of the cultivation of mujerados, for example, excited me uncommonly. The thought of a young, powerful man being emasculated in this manner, in order, later, to be used for pederasty by a whole tribe of wild, powerful, and sensual Indians, so excited me that I masturbated five times during the next two days, fancying myself such a presumptive mujerado. The farther I read in the book, however, the more I saw its moral earnestness; the more I felt disgust with my condition; and the more I saw that I must do everything, if it were possible, to bring about a change in my condition. When I had finished the book, I was determined to seek assistance from its author.

“The reading of this work had an undoubted effect. Since then I have masturbated only twice, and have practiced onanism with cavalrymen only twice. In every instance I have had really less pleasure and satisfaction than before, and I always have the feeling: ‘Ah, if I could only be free from it!’ Nevertheless, I confess that, even now, in the society of handsome soldiers, I immediately have erection.

“In conclusion, I may add that, in spite of, or, perhaps, on account of, onanism, I have never had pollutions. The ejaculation of semen, which usually consists of only a few drops, and it has always been so, takes place only after prolonged friction. If, for any reason, I have not masturbated for a long time, the ejaculation takes place quickly, and is more abundant. About twelve years ago Hansen tried in vain to hypnotize me.”

In the spring of 1891 the writer of the foregoing autobiography visited me, with the declaration that he could live no longer in his condition; that he looked to hypnotic treatment as the only hope of salvation, for he had not strength enough to resist his impulse to masturbation and satisfaction with persons of his own sex. He felt like a pariah; like an unnatural man; like one outside the laws of nature and society, and in danger of criminal prosecution. He felt moral repugnance when he performed the act with a man, but yet the sight of any handsome soldier actually electrified him. For years he had not had the slightest sympathy with women, not even mentally.

The patient looked to be exactly the person, physically and mentally, described by himself in his autobiography. His head was exquisitely hydrocephalic, and also plagiocephalic. At first attempts at hypnosis met with difficulties. Only by Braid’s method, with the help of a little chloroform, was deep lethargy attained at the third sitting. From that time simply looking at a shining object was sufficient. The suggestions consisted of the command to avoid masturbation, the removal of homo-sexual feelings, and the assurance that the patient would have inclination for women and be virile, and have pleasure only in hetero-sexual intercourse. Masturbation was indulged in but once; after the eighth sitting the patient dreamed of a woman.

When, after the fourteenth sitting, the patient had to return, on account of pressing business, he declared that he was quite free from any inclination to masturbate or to indulge in male-love, but that he was by no means absolutely free from his partiality for men. He felt a returning interest in the female sex, and hoped to be freed finally from his unhappy condition by continuance of the treatment.

Case 138. Psychical Hermaphroditism.—Mr. von P., aged 25, single, comes of a neuropathic family. As a child he had convulsions. He recovered, but remained weak, emotional, and irritable. No severe illnesses. Before his tenth year sexuality was manifested. His earliest remembrance concerning it was that of lascivious feelings in company with the servants of the house. When older, he had sensual dreams which were of intercourse with men. In circuses the male performers alone interested him.

Youthful, powerful men were most enticing to him. Often, he could scarcely resist the longing to fall on their necks and kiss them. Of late simply the touching of such persons had become sufficient to give him pleasure and induce ejaculation. The impulse to engage in “affairs” with men he had, thus far, fortunately resisted. The patient is a psychical hermaphrodite, in so far as he is not insensitive to the charms of women, and finds men more pleasing than women. In fact, feminine nudity had never pleased him, and he can remember only to have dreamed once of coitus with a woman.

On account of his great sexual desire, and because he was ashamed to give himself up to men, after his twentieth year he began to have sexual intercourse with women. Since then, he has very seldom indulged in manual onanism, but often in mental masturbation, during which the forms of handsome men float through his fancy.

He had coitus with success, but without pleasure or sensual feeling. On account of circumstances, he was forced to abstain from his twenty-second until his twenty-fourth year. This abstinence was painful, and he relieved himself, now and then, by mental onanism.

When, a year ago, he had opportunity again for coitus, he noticed failure of libido for women, imperfect erection, and premature ejaculation. Finally he gave up coitus; then libido for men was manifested.

In the condition of irritable weakness of the ejaculatory centre, mere touching of sympathetic men was sufficient to induce ejaculation.

Patient is an only child. The circumstances of his family demand that he marry. He justly hesitates to do this, thinks he is mentally impotent, and asks for advice and help.

He points out that his feeling for men must be eradicated in order to help him.

Patient’s appearance is, in all respects, masculine. His head is slightly hydrocephalic and rhombic. Abundant growth of beard. Genitals normal; cremasteric reflex cannot be excited. No manifestations of neurasthenia. Neuropathic eyes. Pollutions infrequent. Erections occur only as a result of contact with men.

July 16, 1889, hypnotic suggestion, after Bernheim’s method, was begun. It was first at the third sitting that deep lethargy was induced.

Suggestions: “You have no longer any desire for men. Only woman is beautiful and desirable. You will love a woman, marry, be happy, and make her happy. You are fully potent; you feel that already.”

In daily hypnosis, which never goes beyond lethargy, the patient accepts the suggestions. On July 24th, he announces that he has had pleasure in coitus; and the male servants no longer interest him. At the same time, he still finds men more beautiful than women. On August 1, 1889, it was necessary to discontinue treatment. Result: Completely potent; entire indifference for men, but also for women.

The same treatment met with decided success in a case of psycho-sexual hermaphroditism, reported by me in vol. i of the Internat. Centralblatt für die Physiol. u. Path. der Harn- und Sexualorgane.

Case 139. Mr. von X., aged 25, landed proprietor. He comes of a neuropathic, passionate father. Father is said to have been normal sexually. His mother was nervous, as were her two sisters. Maternal grandmother was nervous, and his maternal grandfather was a roué, much given to venery. Patient is like his mother, and an only child. From birth he was weak, suffered much with migraine, and was nervous. He passed through several illnesses. At fifteen he began masturbation, without having been taught it.

Until his seventeenth year he says he never had feeling for men, or, in fact, any sexual inclination; but at this time desire for men arose. He fell in love with a comrade. His friend returned his love. They embraced and kissed and indulged in mutual onanism. Occasionally patient practiced coitus inter femora viri. He abhorred pederasty. Lascivious dreams were concerned only with men. In the circus and theatre males alone interested him. The inclination was for those of about twenty years. Handsome, tall forms were enticing to him. Given these conditions, he was quite indifferent to other characteristics of the men. In his sexual affairs with men his part was always that of a man.

After his eighteenth year the patient was always a source of anxiety to his highly respected parents, for he then began a love-affair with a male waiter, who fleeced him and made him an object of remark and ridicule. He was taken home. He consorted with servants and hostlers. He caused a scandal. He was sent away for travel. In London he got into a “blackmailing scrape,” but succeeded in escaping to his home.

He profited in no way by this bitter experience, and again showed disgraceful inclinations toward men. Patient was sent to me to be cured of his fatal peculiarity (December 12, 1888). Patient is a tall, stately, robust, well-nourished young man, of masculine build; large, well-formed genitals. Gait, voice, and attitude are masculine. He has no pronounced masculine passions. He smokes but little, and only cigarettes; drinks little, and is fond of confectionery. He loves music, arts, æsthetics, flowers, and moves in ladies’ society by preference. He wears a moustache, the face being otherwise cleanly shaved. His garments are in nowise remarkable. He is a soft, blasé fellow, and a do-nothing. He lies abed mornings, and can scarcely be made to rise before noon. He says he has never regarded his inclination toward his own sex as abnormal. He looks upon it as congenital; but, taught by his evil experiences, he wishes to be cured of his perversion. He has little faith in his own will. He has tried to help himself, but always begins to masturbate. This he finds injurious, inasmuch as it causes slight neurasthenic symptoms. There is no moral defect. The intelligence is a little below the average. Careful education and aristocratic manners are apparent. The exquisite neuropathic eye betrays the nervous constitution. The patient is not a complete and hopeless urning. He has hetero-sexual feelings, but his sensual inclinations toward the opposite sex are manifested weakly and infrequently. When nineteen, he was first taken to a brothel by friends. He experienced no horror feminæ, had efficient erections, and some pleasure in coitus, but not the instinctive delight he experienced while embracing men.

Since then, patient asserts that he has had coitus six times, twice sua sponte. He gives the assurance that he is always capable of it, but he does it only faute de mieux, as he does masturbation, when the sexual impulse troubles him, as a substitute for intercourse with men. He has thought of the possibility of finding a sympathetic lady and marrying her. He would regard marital cohabitation and abstinence from intercourse with men as hard duties.

Since there were rudiments of hetero-sexual feelings present, and the case could not be looked upon as hopeless, it seemed that treatment was indicated. The indications were clear enough, but there was no support for them in the will of the indolent patient, so unconscious of his own position. It lay near to seek support for the moral influence in hypnosis. The fulfillment of this hope seemed doubtful, because the famous Hansen had tried several times, in vain, to hypnotize him.

At the same time, by reason of the most important social interests of the patient, it was necessary to make another attempt. To my great surprise, Bernheim’s procedure induced immediately a condition of deep lethargy, with possibility of post-hypnotic suggestion.

At the second sitting somnambulism was induced by merely looking at him. The patient is obnoxious to suggestions of all kinds; indeed, contractures are induced by stroking him. He is awakened by counting three. Awakened, patient has amnesia for all the events of the hypnotic state. Hypnosis is induced every second or third day for the communication of hypnotic suggestions. At the same time, moral and hydro=therapeutic measures are employed.

The hypnotic suggestions were as follow:—

1. I abhor onanism, because it makes me sick and miserable.

2. I no longer have inclination toward men; for love of men is against religion, nature, and law.

3. I feel an inclination toward women; for woman is lovely and desirable, and created for man.

During the sittings the patient always repeats these suggestions. After the fourth sitting it was noticeable that, when taken into society, he paid court to ladies. Shortly after that, when a famous prima-donna sang, he was all enthusiasm for her. Some days later the patient sought the address of a brothel.

At the same time, he preferred the society of young gentlemen; but the most careful watching failed to reveal anything suspicious.

February 17th. Patient asks to be allowed to indulge in coitus, and is very well satisfied with his experience with one of the demi-monde.

March 16th. Up to this time, hypnosis twice a week. The patient always passes into deep somnambulism by simply being looked at, and, at request, repeats the suggestions. He is obnoxious to all kinds of post-hypnotic suggestion, and, in the waking state, knows not the least of the influences exerted on him in the hypnotic state. In the hypnotic condition he always gives the assurance that he is free from onanism and sexual feeling for men. Since he gives the same answers in hypnosis,—e.g., that on such and such a date he practiced onanism for the last time, and that he is too much under the will of the physician to be able to lie,—his assertions deserve belief; the more, since he looks well and is free from all neurasthenic symptoms, and, in the society of men, not the slightest suspicion rests on him. An open, free, and manly bearing is developed.

Moreover, since, of his own will, he now and then indulges in coitus with pleasure, and occasional pollutions are induced by lascivious dreams which concern women, there can be no doubt of the favorable change of his vita sexualis; and it is presumable that the hypnotic suggestions have developed into auto-suggestive inclinations, which direct his feelings, thoughts, and will. Probably the patient will always remain a natura frigida; but he more often speaks of marriage, and of his intention to win a wife as soon as he has become acquainted with a sympathetic lady.

In July, 1889, I received a letter from his father, which told me of his good health and conduct.

On May 24, 1890, by chance, I met my former patient, while on a journey. His bright, healthful appearance allowed the most favorable opinion of his condition. He told me that he still had sympathetic feeling for some men, but never anything like love. He occasionally had pleasurable coitus with women, and now thought of marriage.

I hypnotized him, in the former manner, to try him, and asked for the commands I had given him. In a deep condition of somnambulism, and in the same tone of voice as formerly, the patient repeated the suggestions he had received in December, 1888,—an excellent example of the possible duration and power of post-hypnotic suggestion.

Case 140. Psychical Hermaphroditism; Improvement with Hypnotic Treatment.—Mr. von K., aged 23; of distinguished family; well endowed mentally; scrofulous as a child. His father is said to have been dissipated. His father’s brother is said to have been subject to contrary sexuality.

The patient states that, when only seven years old, he had a peculiar inclination for male persons. It was particularly coachmen and servants having moustaches for whom he showed partiality at that time. He experienced a peculiar delightful sensation when he pressed himself against such persons.

The patient entered the cadet corps early, and there he was seduced into mutual onanism, and also learned imitatio coitus inter femora viri. At the age of seventeen he had coitus with a prostitute for the first time. He performed the act perfectly, but had not the slightest pleasure in it; and he learned that this kind of gratification amounted to nothing, or that he must be different from other young men.

Nevertheless, he often had coitus, and contracted gonorrhœa. After this he experienced an increasing aversion for the female sex, and indulged in coitus less and less frequently; in fact, only when, with intense libido, he could not gain opportunity for intercourse with men. His inclination for men predominated more and more, and he was attracted exclusively by those handsomely formed, and having as little beard as possible. He descended to the most revolting practices,—coitus buccalis, active and passive pederasty.

The patient was deeply ashamed of such depravity, and was constantly endeavoring to get into better ways by means of coitus with women. But he came to the despairing conclusion that his moral strength was insufficient, that he was indifferent about intercourse with women, or that it was repugnant to him; and that he was created for sexual intercourse with persons of his own sex. In fact, he had never dreamed of women, but always of men; and that at a time, too, when he had no suspicion of the difference between the sexes.

The patient comes for consultation, because he sees that he is jeopardizing the happiness of his whole life, and recognizes the unnaturalness and immorality of his sexual life. He does not regard his condition as hopeless; for he has no horror of women, and three weeks ago he had successful coitus with one, though it was devoid of all pleasure and mental satisfaction. He has no doubt that he was really created to love men; but, owing to acquired neurasthenia, in the sexual act with a man he experiences no such pleasure as formerly. He had given up his position as an officer, because the soldiers excited him so sexually that he feared he might compromise himself.

The patient is devoid of degenerative signs. His appearance is perfectly masculine, and his genitals are normal. Examination of the semen revealed abundance of spermatozoa. The penis is large and well developed; the growth of hair ad genitalia, as well as on the rest of the body, is abundant. The patient has masculine tastes, but has never been partial to drinking and smoking. A neuropathic eye is all that points to a nervous constitution.

In his sexual acts with men, he states that, as a rule, he has felt as a man, only now and then as a woman.

An attempt at hypnosis leads to lethargy, with cataleptic condition of the muscles, and the opportunity is used to impart suitable suggestions.

After the fourth sitting he expressed himself as satisfied, and wondered that men made no impression on him. He wished to try his fortune with women, but was afraid that he was impotent.

After the sixth sitting, without advice, he attempted coitus cum muliere. His libido was very great, but inter actum this and erection left him.

After the ninth sitting the patient was forced to discontinue treatment, owing to business that called him home. He was satisfied, in that he felt indifferent and capable of resistance to men. He felt sure that he would not relapse into his former vices. At the same time, he had not the slightest interest in the female sex.

Case 141. Mr. X., aged 31, chemist, comes of a neuropathic family, and from childhood has been nervous, emotional, and apprehensive, and afflicted with migraine. He remembers distinctly that, when a very small boy, he had a lustful feeling at the sight of the half-naked persons in the work-shop at his father’s house, and felt drawn to them. When he began school, he felt in the same way toward his companions. At the age of eleven, without teaching, he began to masturbate, during which he thought of his comrades. Later there were enthusiastic friendships. His vita sexualis gained the upper hand. As he grew up, women also interested him, but his chief interest was in men of the higher circles of society. He felt that this inclination was abnormal, and sought the acquaintance of puellis; he often had coitus, but never with any real pleasure. Thus he became more and more given to contrary sexuality, practiced mutual masturbation and coitus inter femora viri, and occasionally gave himself up to passive pederasty; but he soon abandoned this, on account of the pain it caused him.

He asserts that he feels perfectly masculine, and has never had female inclinations. Skeleton and attitude perfectly masculine; strabismus; abundant beard; genitals entirely normal. No aversion to the female sex. Occasional coitus with puellis, but without satisfaction. The patient feels exceedingly unhappy, and clearly recognizes his abnormal position; at any price, he wishes to be freed from his homo-sexual inclination, and made capable of marriage. “It is terrible to have to act a farce constantly.” At the first attempt at hypnosis, after Bernheim’s method, the patient passes into a state of deep lethargy. He proves to be very susceptible to suggestion, and suitable suggestions are imparted. After the fourth sitting, he states, with gratitude, that men become indifferent, and he begins to have pleasure in coitus; but he did not feel mentally satisfied, owing to the fact that he was limited to puellæ publicæ. After the fourteenth sitting he declared that he required no more treatment. He was in love with a young lady, and thought of marrying her. He asked for her hand, and was refused. Soon after, while he was on a journey in Italy, men interested him again. He had a relapse, and asked for further treatment. A few sittings re-established the status quo ante.

Case 142. Psychical Hermaphroditism; Successful Treatment by Hypnotic Suggestion.—Mr. von Z., aged 29. He asserts that he comes of healthy grandparents; of a healthy father, but of a nervous mother. He is an only child, and was petted by his mother. At the age of eight he was powerfully excited sexually by a male servant, who showed him pornographic pictures and his penis.

When twelve years old, Z. fell in love with his tutor. On going to sleep, the naked form of this man appeared before him. He thought of himself as in a female rôle in relation to him, and thought to marry him some time.

At the age of thirteen, at a private ball, his fancy was excited by a young governess, and, at fifteen, he fell in love with a young lady. He remained very excitable sensually; but, thereafter, exclusively so to men pleasing to him. Masturbation was not practiced.

At the age of twenty the patient became neurasthenic (ex abstinentia?). He now attempted coitus, but was not successful. On the other hand, he had intense desire on an occasion when he saw a naked man in a steam-bath. The latter noticed his excitement, approached him, and performed masturbation on him, giving the patient intense delight. He felt powerfully attracted to this man, and, thereafter, allowed him to repeat the act. In the meantime, there were attempts at coitus with females, which always ended in a fiasco. The patient was much troubled by this, and consulted physicians, who explained his impotence as due to nervousness, and thought that it would soon pass off.

Until his twenty-fifth year his sexual indulgence consisted of masturbation by the beloved man about once a month. At this time he last felt attracted to a woman. It was to a young peasant-girl. She would not accede to his wishes. Since his lover was also unattainable, the patient began to masturbate alone. With this, his neurasthenia increased. For this reason he was unable to finish his studies; he became shy, dysthymic, abulic, and now vainly tried cures at various hydropathic establishments. On account of continued severe (cerebro-spinal) neurasthenia, the patient came to me for advice, in the latter part of February, 1890.

A tall, slim man, of aristocratic and decidedly masculine manners. Neuropathic appearance; large ears, the lobes of which run into and lose themselves in the skin of the cheeks. Genitals perfectly normal. The usual picture of cerebro-spinal neurasthenia of moderate degree. Great depression; complaint of being dissatisfied with life, even to tædium vitæ; he is pained by his sexual anomaly, especially because he is urged by his family to marry.

He is interested in women only mentally, not physically. Sexually, his only interest is in men of distinction. His dreams have never been about persons of the opposite sex, but of those of his own sex. In these lascivious dreams he has always seen himself in the rôle of a woman.

The most refined woman has never been able to induce erection or even libido in him.

His sexual intercourse with men has consisted of passive or mutual masturbation. He had practiced solitary onanism only infrequently and faute de mieux. During the last five months he had abstained, and had had no male intercourse since August, 1889.

An attempt at hypnosis, after Bernheim’s method, failed; prolonged stroking of the brow induced deep lethargy, with catalepsy.

This method is used, in order to carry out suggestive treatment of this patient, who is so worthy of compassion. The hypnotic state is always the same; he cannot be brought into a state of somnambulism.

At the third sitting the patient is given the suggestions: ever despise onanism and male love; find women beautiful, and dream of them.

After the sixth sitting (March 10th) a moral transformation takes place in his mind. The patient becomes quieter, feels more free, and dreams now and then of women, and no longer of men, finding that the latter have become indifferent to him. He gratefully states that he has no more inclination to masturbation. He approaches women, but he notices that they have not the least attraction for him.

On March 19th, business called the patient home; so that the treatment had to be discontinued.

On May 17, 1890, the patient returned for treatment. He asserted that he had not masturbated in the interval, and that he had resisted his inclination to men. Too, he had not dreamed of men, but twice of women, though only platonically. His cerebral asthenia (ex abstinentia?) had increased. He apparently suffers for the want of mental and sensual satisfaction of his vita sexualis; for homo-sexual love and masturbation have become impossible for him, and intercourse with women is denied him. The patient is thus painfully depressed to the extent of tædium vitæ.

He is now subjected to anti-neurasthenic treatment (hydro-therapeutic and electro-therapeutic), and the treatment by hypnosis is resumed. Only after ten weeks of painstaking treatment did the neurasthenic symptoms disappear. Progressing parallel with this, there was a change of his mental personality.

The patient was gratified to note that he grew stronger; that his sexual life no longer played a dominating part. Though he felt more drawn toward men than women, yet he easily resisted homo-sexual desires. His former boudoir became a work-room; instead of to adornment and frivolous reading, he gave himself to walks in the mountains and forests. On account of the danger of a fiasco, the initiative in hetero-sexual attempts was left to the patient.

It was not until the fourteenth week of treatment that the patient made an attempt. It was perfectly successful. The patient became happy, and sound in body and mind, and expressed the best hope of his future, even having thoughts of marriage.

He experienced increasing pleasure in normal sexual intercourse; he occasionally had lascivious dreams of women, and no longer dreamed of men.

The patient stopped treatment at the end of September. He felt perfectly normal in hetero-sexual intercourse, devoid of neurasthenia, and had thoughts of marriage. Yet he freely confessed that he still always had erections at the sight of a naked, handsome man; though he could easily resist the desires that arose, and in dreams had exclusively “relations avec la femme.”

In April, 1891, I again saw the patient, and he was in the best of health. He regarded his vita sexualis as perfectly normal; for he had coitus regularly with pleasure and full virility, dreamed only of women, and had no inclination to masturbation. Yet he made the interesting confession that frequently, post coitum, he still had a temporary “gout pour l’homme,” which he could easily control. He thought he was lastingly cured, and was occupied with thoughts of marriage.

Case 143. Congenital Contrary Sexual Feeling. Successful Removal of Homo-Sexual Feelings by Suggestions.—L., doctor of philosophy, aged 34, German, consulted me, in the spring of 1888, on account of perversion of his vita sexualis, and asked whether he could not be freed from it by means of hypnotic treatment.

Patient came of a healthy mother, in whose family, for generations, there had been neither insanity nor nervous disease. He, like his only brother, is much like his father mentally. His brother is very sensual, and also psychically abnormal, and given to over-indulgence in drink.

His father was a neuropathic, eccentric man. Nothing is known of any abnormal sexual manifestations in him, though, like all his brothers, he had a tendency to over-indulgence in alcohol.

This vice seems to have been inherited from his mother (grandmother of patient), who was a notorious drinker. The father of this woman (great-grandfather of patient) was also a great drinker. No other ancestral history was obtainable.

Patient states that from childhood he was nervous and easily excited. He learned very easily, and had a talent for languages. He was always interested in art, particularly in music and poetry. His education was excellent, and given at home. When he was thirteen, his father told him that he should never touch his genitals, for it was wrong to do so, and to do it might bring unhappiness.

Occasionally his father showed him pictures of syphilitic diseased conditions, etc., in an anatomical museum, and the patient was disgusted and frightened. He believed that his later fear of sexual intercourse with women was partly nourished by this early erroneous teaching.

However, the patient seeks the principal cause of his sexual perversion in a defect of organization. When a small boy, he had a silly enthusiasm for companions. He also remembers that, at that time, he had a desire only for girlish games, and preferred the society of girls. When a boy, he had a passion for crocheting and embroidering. At fourteen he was still without any sexual knowledge, and fell into the hands of a pederast. He ran away, frightened, when he learned what was to be done with him. When fifteen, a sympathetic companion was accustomed to lay his head in the patient’s lap. This gave the patient a peculiar pleasurable feeling, but he knew no explanation of it. At sixteen he had the first erections—at the sight of men.

At twenty he first learned that his sexual condition was perverse, and recognized the fact that what he had taken for friendship was love. He was much frightened at the discovery, and much pained. His sympathies were directed toward young men of the upper class that were handsomely formed and of pleasing appearance.

The society of ladies had no effect on him. He was never attracted by the charms of the opposite sex. In his fifteenth year he had a sensual dream, in which he thought a girl of elegant figure sat opposite him, on a sofa.

In the theatre it was only the art of the actresses that he admired; the actors excited his real interest.

Drinking and smoking had always been very repugnant to him. Hunting and gymnastics, and other masculine occupations, had no interest for him. He did not enter the army, because his general physical weakness precluded it.

The patient has but little sexual desire. He has never had any impulse to satisfy himself with persons of his own sex. Some years ago, when he first tried to embrace a man lovingly, he had powerful erection and became greatly excited; but he was able to control himself and to repel his lover. Thereafter he always avoided such attempts. It was only seldom that he became powerfully excited sexually, and even then he was not driven to satisfy himself. He was never given to onanism. During the establishment of puberty, the patient had frequent dreams with pollutions, but these were not induced by erotic fancies of any kind.

Some years ago, for a long time, ejaculation was always induced by the embrace of a sympathetic man, but this condition of irritable weakness disappeared. As years passed, the patient, who had always had a desire for marriage and a family, became anxious on account of the conviction that the inclination toward females, for which he had hoped, would never come. It became more and more clear to him that he was abnormal, and he began to have fears about his virility and his future happiness in life.

In order to test the matter, he sought a brothel. He found a prostitute of beautiful form; he had the best will to satisfy himself that he was virile; the woman did all she could, but in vain. There was no erection, and he withdrew, ashamed. New attempts, under the most favorable circumstances, were likewise failures, though the patient brought his imagination to his aid, and thought himself to be embracing a man instead of a woman.

He now realized that his ideal—to consummate marriage—was impossible. He felt himself very unfortunate, and dissatisfied with life. Besides, it forced itself upon him that morally he was lowered, because he could not overcome his inclination for his own sex, and his friendship for respectable men of his circle was degraded by sexual feelings. In his consultation with me, the patient was unending in the description of his painful situation. His ideal was marriage. He longed for it, for purely ethical reasons. He thought of it as something holy; but the begetting of children, the sexual act, was very repugnant to him. At the same time, he saw that he could not really marry without being potent. Would not hypnotic suggestion exercise a favorable influence on his sexual life? He had not the energy of a man of normal sexual condition. He seemed to himself to be all wrong. He would endure all—to be poor and miserable—if he could but have a normal sexual inclination.

When the patient was gently told of the congenital and deep constitutional significance of his sexual anomaly, and shown that, therefore, the creation of a normal sexual condition was doubtful, he thought that he would be satisfied to remain in his condition. But he wished to know whether it were not possible to eradicate his inclination for men, without attempting to create an equivalent for women; and if, in hypnosis, it could not be suggested to him that, in the future, men be a matter of indifference to him, and that, in intercourse with his friends, he no longer be excited sexually. Such a result would elevate very much his moral feeling, and make him satisfied and unembarrassed in social relations with his friends.

The possibility of such suggestive removal of feelings by hypnosis could not be gainsaid, though he was in doubt as to whether he could be hypnotized or not, since the hypnoscope had proved to have no effect upon him.

Out of pity and scientific interest, I decided to make an immediate attempt at hypnosis, after Bernheim’s method.

The patient passed easily into a condition of deep lethargy, and, in a drawling voice, repeated the following suggestion: “I feel that, from this time, I am sexually indifferent to men; and, that a man is as sexually indifferent to me as a woman.”

When I counted three,—having suggested previously that he awake at three,—the patient came to himself, as if out of a deep sleep, and performed immediately the post-hypnotic suggestion to open the door of the stove. He said that he had not lost consciousness entirely, that he had felt as one paralyzed and without will, and that he had felt a peculiar creeping sensation in all his limbs.

After five days the patient came again. In manner he was a different person, and he said, joyfully, that he felt like another man. Energy and will-power—the loss of which he had felt so keenly—had returned. He felt, now, entirely unembarrassed toward men, and had a new joy in living.

The following seven days he was hypnotized. Hypnosis is no longer as deep as at first, though the suggestion is always accepted and repeated. However, he is quite profoundly influenced; for, the suggestion given, he sleeps on, in a state of lethargy, for ten minutes, and has to be awakened by suggestion. This always occurs as if from a deep sleep,—slowly, and through a stage of somnolence.

After the eighth sitting the patient found himself well and happy, and in possession of full self-confidence. He had the feeling and the evidence that men had no influence on him.

He thought he could dispense with hypnotic treatment, and gratefully took his leave, with the promise that, should the influence of the suggestion fade, he would come again. Since then, I have heard nothing more of this interesting patient, and I have reason to hope that he remains improved.

The patient is, in all respects, of masculine appearance; beard abundant. Physically, with the exception of slight neurasthenic symptoms, he presents nothing remarkable. Genitals normal. (Personal case. Internat. Centralblatt, etc., Bd. i, Heft 1.)

Case 144. X., aged 33; single; tall. Mentally, of small endowment; comes of tainted family. Paternal grandfather died at thirty-four with a mental disease, which is said to have developed as a result of onanism and spermatorrhœa. His father and brother suffered with disturbances of the sexual functions. There was insanity in the mother’s family; other branches of the family were noted for their irritable and eccentric character.

The patient has too small a head, a retreating brow, abnormal ears, sparse growth of hair, and a hernia, which is probably congenital. Genitals large, and normally developed.

Great impressionability; neuropathic constitution; occasional tædium vitæ. For several years, peculiar, imperative ideas: that he is a locomotive; a horse; a velocipede; and, that he must act accordingly. From his earliest youth, contrary sexual feeling (congenital). Horror feminæ; sexual inclination toward boys; satisfaction by sensual contact, and, faute de mieux, masturbation. One day he had an affair with a boy dressed in gray, which made a deep impression on him. Since then, while masturbating, the image of the boy comes into his mind; and he cannot see gray clothes without having powerful erections. On the advice of physicians whom he consulted, he attempted coitus with women, but was cold and impotent, notwithstanding the assistance of memory-pictures of the boy dressed in gray; and he finally gave up the efforts.

March 27th, first hypnotic sitting. Small result. He resists, and says his fancy keeps him from going to sleep.

In a further series of sittings he declares that he experiences unfavorable effects,—is more excited, and troubled by imperative ideas and the desire to masturbate. He makes fun of the physician and hypnotism, and offers much resistance, with the expression that hypnotism is good for nothing, and only makes people crazy.

However, gradually it became possible to induce somnambulism. After twenty-five sittings the patient confessed that he was better, and that he was less troubled with imperative ideas and onanism. The sittings were repeated every week or two. The patient felt mentally and morally well, ceased to masturbate, but, at the end of treatment, was indifferent toward the opposite sex (Dr. Ladame, Revue de l’hypnotisme, September 1, 1889).

In the two foregoing cases there was successful suggestive removal of homo-sexual feelings,—a result which, as Case 143 shows, means a great improvement for such unfortunate individuals, in that it protects them from shame and the law. An entirely different and phenomenal result is presented by the following case, reported by Dr. v. Schrenk-Notzing in the Wiener internat. klin. Rundschau, October 6, 1889, No. 40, which is a case of effemination. It discloses a new method of treatment of urnings; but it is necessary to guard against illusions. Only where hypnosis can be deepened to somnambulism, are decided and lasting results to be expected:—

Case 145. Congenital Contrary Sexual Instinct Improved by Hypnotic Suggestion.—R., official, aged 28. January 20, 1888, he sought medical advice. He is the brother of the patient who is the subject of Case 135, and, therefore, of a badly tainted family (v. supra). Toward the end of treatment, he confessed that he was the author of the autobiography which was published as Case 83 in the fifth edition of this work, and it is here reproduced:—

“In brief, my abnormality consists of this, that in sexual relations I feel myself to be completely feminine. Since my earliest youth, in my sexual acts and fancies, I have always had before my eyes only images of masculine beings and masculine genitals.

“Until I went to the University, I found nothing in this (I had never spoken with others about my fancies, but rather, while at the Gymnasium, lived a silent and retired life).

“While at the University, it struck me that female persons made not the slightest impression on me. Since then, in houses of prostitution, etc., I have attempted coitus, or only to obtain an erection, with women, but always in vain.

“Erection ceased immediately, as soon as I was in a room alone with a woman. At first I considered it impotence, though, at the same time, I was so excited sexually that I had to masturbate several times during the day in order to sleep.

“Quite different, however, has been the development of my feelings toward the masculine sex, and it has grown stronger every year. At first they expressed themselves in extraordinary, enthusiastic friendship for certain persons, under whose windows at night I would wait for hours; whom in all possible ways I would try to meet on the streets, and with whom I sought to come in contact. I wrote such persons the most passionate letters, in which, however, I was shy in expressing my feelings too plainly. Later, after my twentieth year, I came to understand the essential nature of my inclinations, particularly from the sensual pleasure I experienced as soon as I came in direct contact with any of these friends. These persons were all finely built men, with dark hair and eyes. I have never had my feelings excited by boys. Real pederasty is absolutely incomprehensible to me. About this time (twenty-second to twenty-third year) the circle of my beloved friends grew more and more extensive. Now I can scarcely see a handsome man on the street without having the wish to possess him excited in me. The fact is, I especially love persons of the lower classes, whose powerful forms attract me,—soldiers, policemen, car-drivers, etc.,—i.e., all that wear uniforms. If one of these returns my look, I feel a kind of thrill go through my whole body. I am especially excitable in the evening, and merely the heavy tread of a soldier is alone sufficient to induce the most powerful erections. I take a very peculiar pleasure in following such persons and looking at them. As soon as I learn that they are married, or that they consort with girls, my excitement very frequently ceases.

“A few months ago I became able to control my inclinations to such an extent that they were not directly noticeable. About this time I followed a soldier who seemed likely to acquiesce in my desire, and spoke to him. For money he was ready for anything. At once I was filled with a most violent longing to embrace and kiss him, and the danger of being noticed did not deter me from doing it. He had scarcely grasped my genitals when ejaculation followed. With this meeting, I had finally attained the long-desired goal of my life. I knew that my whole nature would find its happiness and satisfaction in it, and from this time I gave myself up entirely to the effort to find a person whom I could love, and from whom I should never part. For my acts I do not experience the slightest twinge of conscience.

“To be sure, in quiet moments, I very well appreciate the difference between my way of thinking and the way of the world; as a lawyer, too, I naturally recognize the dangers of a relation of the kind I desire; but, as long as my entire nature does not change, I shall not be able to give up the opportunities offered me. Nevertheless, I should be willing to undergo any cure to be freed from my abnormal condition.

“I recognize my feminine feeling, among other things, in the fact that any sensual idea in connection with a woman must be forced, and seems unnatural to me. I am also sure that my respect for a woman—I move much in the society of ladies, and enjoy it—would change immediately to repugnance, were I to notice any sensual inclination in her toward me. In my dreams and sensual fancies of men, I always think of myself in such positions with them that their faces are always toward mine. My greatest delight would be to have a powerful man, undressed, take me in his arms with a force I could not resist. In such situations I always think of myself in a passive rôle, and have to force my feelings, in order to think of myself in any other position. In this, I am truly feminine. Great as my desire may be to approach certain persons, my struggle is as great not to allow this to be noticed. Moustaches, abundance of hair, and even dirt, seem to be especially enticing. It is hardly necessary to say that, to me, my condition, with reference to society, is absolutely desperate; and, if I had not the hope of finding a being that would understand me, life would be scarcely endurable. I feel that sexual commerce with a man is the only means of successfully combating my impulse to onanism. Though this has a very bad effect on me, I cannot keep myself from it constantly, because, as I have often found, I will be even more weakened by pollutions at night and persistent erections during the day.

“Up to this time I have truly loved but two men. Both were officers, remarkably endowed mentally, handsomely and gracefully formed, and of dark skin and eyes. I became acquainted with the first at the University. I was madly in love with him, and suffered unspeakably on account of his indifference. I spent nights under his window, simply to be near him. When he was officially transferred, I was in despair.

“Soon after, I became acquainted with an officer that resembled him, who likewise enchained me at first sight. I sought every opportunity to meet him, spent the day in the streets, and at places where I hoped to get a sight of him. I knew how the blood came into my face when, unsuspected, I saw him. When I saw him friendly with others, I could scarcely contain myself for jealousy. When I sat near him, I was impelled to touch him. I could scarcely conceal my excitement when I touched his knee or thigh. I never ventured, however, to express my feelings to him; for, from his conduct, I was convinced that he would not understand them or share them.

“I am twenty-seven years old, of medium height, and well-developed, and would be considered handsome. My chest is somewhat narrow, hands and feet small, and voice weak. Mentally, I think I am well endowed; for I passed the State examination with distinction, speak several languages, and am a good painter.

“In my calling I pass for one that is industrious and conscientious. My acquaintances think me cold and peculiar. I do not smoke, do not play games, and cannot sing or whistle. My gait, like my voice, is somewhat affected. I have much taste for elegance, love adornment, sweetmeats, and perfumes, and prefer the society of ladies.”

From Dr. von Schrenk’s notes of the case, it is learned, further, that social and criminal deterrents, on the one hand, and uncontrollable desire for his own sex, on the other, caused violent mental struggles, and made life unendurable. For this reason the patient confided in the physician. January 22, 1889, hypnotic treatment, with suggestion, after the method of Nancy, was begun with the patient. Gradually it became possible to induce somnambulism.

The suggestions were made with reference to indifference to men, and ability to resist them, and to increase of interest in women; masturbation was thus forbidden, and women substituted for men in lascivious dreams. After a few sittings pleasure at sight of women was induced. At the seventh sitting successful coitus was suggested; this was fulfilled.

During the next three months the patient remained, under the influence of occasional hypnotic suggestions, in the full possession of normal sexual functions. April 22, 1889, there was a relapse, induced by a companion. At the next sitting, remorse and shame. As expiation, coitus with a woman in the presence of his seducer.

The patient complained that coitus with women below him in station did not satisfy his æsthetic feelings. He hoped to find satisfaction in a happy marriage. After forty-five sittings (May 2, 1889) the patient considered himself cured. Treatment ceased. He became engaged to a young lady some weeks later, and presented himself again, after six months, as a happy bridegroom. He thought that, in his happiness with his wife, he had a sure preventive against relapse.

The author emphasizes the fact that the hypnotic treatment had no injurious collateral effect, and leaves undecided the question as to whether the cure is permanent or not, with R.’s very bad heredity. But he expresses the conviction that, in case of relapse, renewed hypnotic treatment would not be contra-indicated.

Since the incredible result of this case interested me exceedingly, as did its further course, I wrote to the author, requesting information concerning his patient.

Dr. v. Schrenk very kindly placed at my disposal the following letter, which he had received from the patient in January, 1890:—

“By means of suggestive treatment given me by Baron Schrenk, for the first time I became possessed of the psychical condition that permitted me to have intercourse with a woman, which, up to that time, in spite of repeated efforts, I had been unable to do successfully.

“Since my æsthetic needs were unsatisfied by intercourse with prostitutes, I thought to find my real salvation in matrimony. The earlier friendly inclination toward a lady known in my youth offered me the opportunity, the more because I believed that she, of all others, would be in a position to awaken feelings for the opposite sex which were absolutely foreign to me. Her character,—i.e., our harmony,—is in such accord with my inclinations that I am fully convinced that I shall also find complete psychical satisfaction. This conviction has not changed during the eight months of my engagement.

“I intend to be married in about four weeks.

“As far as my position with respect of my own sex is concerned, my power of resistance—and this is the lasting positive result of this treatment—is absolutely changed in degree. While previously it was impossible for me to overcome an intense sexual excitation when I saw a finely formed car-driver, to-day, in the company of my former lovers, I am without sexual excitement. At the same time, I must add that now, as formerly, their society has a certain attraction for me, though it is not to be compared with my earlier passion.

“On the other hand, I have refused repeated persuasions to indulge in sexual intercourse with men, without expending much force in resistance,—persuasions which formerly I should have been unable to resist. I may say, indeed, that it is a feeling of compassion for my former lovers, that have proved their passionate devotion to me, which keeps me from directly repulsing them. My action seems to be due to a feeling of duty, rather than to inner need.

“Since the conclusion of treatment, I have not consorted with prostitutes. This circumstance, and the numerous letters and persuasions from my former lover, may well be the reason why, in the eight months that have elapsed, I have allowed him to persuade me to sexual intercourse on three or four occasions. At these times I have always been conscious of being completely master of myself, as compared with my earlier passionate condition in like situations, as the violent reproaches of my friend convinced me. I always feel a certain unconquerable repugnance, which cannot be based on moral grounds, but which, I believe, must be attributed to the treatment. I no longer feel a love for him in the former sense. Besides, since the treatment, I have sought no opportunities for sexual intercourse with men, and I feel no need of it. But, formerly, not a day passed on which I did not feel impelled to it, so that at times I was unable to think of anything else. Awake or dreaming, ideas of sexual content are very infrequent.

“I may express the belief that my marriage, that is to take place in a few weeks, and the much desired change of place that is bound to it, will entirely remove the residuum of my earlier condition. I conclude these lines with the honest assurance that, subjectively, I am another man, and that this change has restored the mental equilibrium that was previously wanting.”

The foregoing words, which Dr. v. Schrenk completes with the verbal statement of the patient that he had not practiced onanism again, are a brilliant proof of the lasting effect of post-hypnotic suggestion. I consider the hetero-sexual instinct of the patient to be the artificial creation of his excellent physician; and the patient himself seems to recognize this, in that he speaks of a repugnance which “does not rest on moral grounds, but which depends on the treatment.”

The further fate of this interesting patient may be learned from the following letter, kindly submitted by Dr. v. Schrenk:—

“Honored Sir: Having been home some days from my wedding-journey, I wish to send you a short report of my present condition. During the week before my wedding I was in great excitement, because I feared that I should be unable to perform certain duties. The impelling thoughts of my friend, who wished another meeting with me, at any price, had no effect on me. We had not seen each other since I heard from you last. [Receipt of the professor’s letter.] However, I was much troubled with the thought that my marriage must be unhappy. Now, however, I have no anxiety. To be sure, on the first night, success was difficult,—to induce sexual excitation in myself,—but on the following night, and since, the influences needed for a normal man, I believe, would have been sufficient for me. I am also convinced that the harmony between us, which, of course, is mentally of long standing, will become more and more complete. A relapse to the former condition seems impossible. It is, perhaps, significant for my present condition, that I one night dreamed of my former lover, and that the dream was not sensual, and did not excite me sensually.

“I am satisfied with my present circumstances. I am, of course, well aware that my present inclinations are far from being of a degree equal to what they formerly were. I believe, however, that they will daily grow stronger. Already my former life is incomprehensible, and I cannot understand why I did not earlier think to overcome the abnormal sexual instinct by normal sexual indulgence. A relapse would now be possible only with an entire change of my mental life; and, in a word, it seems impossible.

“Your obedient servant, ——d.”

From a letter of Dr. v. Schrenk’s, of December 7th, I extract the following:—

“In this case the cure seems to be of longer duration than I expected; for, on speaking with the patient, some months ago, he said that he was perfectly happy in marriage, and, as I hear, he expects soon the happiness of a father.”

Dr. v. Schrenk has reported in the Wiener internationalen klinischen Rundschau, 1891, No. 26, later and very interesting facts concerning his patient, which, therapeutically, are very satisfactory.

IV. SPECIAL PATHOLOGY.

THE MANIFESTATIONS OF ABNORMAL SEXUAL LIFE IN THE VARIOUS FORMS AND STATES OF MENTAL DISTURBANCE.

Arrest of Mental Development.

Sexual life in idiots is, in general, but slightly developed. It is wanting entirely in idiots of high grade. In such instances the genitals are frequently small and deformed, and menstruation is late or does not occur at all. There is impotence, or sterility, as the case may be. Even in idiots of low grade, sexuality is not prominent. In infrequent cases it is manifested with a certain periodicity, and then with greater intensity. It may then be expressed impulsively, and be violently satisfied. Perversions of the sexual instinct do not occur at the lowest levels of mental development.

When the desire for sexual satisfaction is opposed in these cases, great passion is excited, with danger of murderous assault on the persons attacked. It is to be expected that idiots should not exercise choice, and they attempt to satisfy the sexual instinct on their nearest relatives.

Thus Marc-Ideler reports the case of an idiot who attempted to rape his sister, and had almost strangled her when he was discovered.

Friedreich reports an analogous case (Friedreich’s Blätter, 1858, p. 50).

I have repeatedly had occasion to give opinions in cases of attempts to rape little girls.

Giraud (Annal. méd. psych., 1885, Nr. 1) also reports a case of this kind. Consciousness of the significance of the act is always wanting; an instinctive knowledge that such obscene acts are not publicly permitted is often present, and causes the attempted sexual act to be undertaken in a deserted place.

In imbeciles the sexual instinct is usually developed as in normal individuals. The moral inhibitory ideas are cloudy, and, therefore, the sexual impulse is more or less openly manifested. For this reason imbeciles are sources of disturbance in society. Abnormal intensity and perversion of the sexual instinct are infrequent.

The most frequent manner of satisfaction of the sexual desire is onanism. The weak-minded seldom make sexual attacks on adults of the opposite sex.

Sexual satisfaction with animals is frequently attempted. The great majority of cases of injury (sexual) to animals must be attributed to imbeciles. Children are quite often their victims.

Emminghaus (Maschka’s Handb. iv., p. 234) draws attention to the frequency of open manifestation of sexual instinct, which comprises open masturbation, exhibition of the genitals, attacks on children and those of the same sex, and sodomy.

Giraud (Annal. méd. psychol., 1855, Nr. 1) has reported a whole series of immoral attacks on children:—

1. H., aged 17, imbecile, enticed a little girl into a barn, by giving her nuts. There he exposed her genitals and showed his own, making movements of coitus on the child’s abdomen. He had no idea of the moral significance of the act.

2. L., aged 21; imbecile; degenerate. While he was watching cattle, his sister of eleven years, with a playmate of eight years, came and told him how some unknown man had attempted to do them violence. L. led the children to a deserted house and attempted coitus with the younger child, but let her go because no emission occurred, and because the child cried out. On the way home he promised to marry her if she would not say anything. At the trial he thought that by marriage he could right the wrong he had done.[119]

3. G., aged 21, microcephalic, imbecile, has masturbated since his sixth year, and practiced active and passive pederasty. He has repeatedly tried to perform pederasty with boys, and attacked little girls. He was absolutely without an understanding of his acts. His sexual desire was manifested periodically and intensely, as in animals.[120]

4. B., aged 21; imbecile. While alone in a forest with his sister of nineteen, he demanded that she allow coitus. She refused. He threatened to strangle her, and stabbed her with a knife. The frightened girl fondled his penis, and he then left her and quietly went on with his work. B. has a deformed, microcephalic skull, and has no sense of the significance of his act.

Emminghaus (op. cit., p. 234) reports the case of an exhibitionist:—

Case 146. A man, aged 40, married, had for sixteen years been accustomed to exhibit himself in parks, at dusk, to little girls and servants, and drew their attention to himself by whistling. After having been frequently punished for it, he avoided the places, but he carried on his practice elsewhere. Hydrocephalus. Mental weakness of slight degree. Mild sentence passed.

Case 147. X., of tainted family; imbecile; defective and perverted in intellect, feeling, and will. For help and protection he was brought before an officer. It was complained that he had repeatedly exposed his genitals to servant-girls, and had shown himself at windows with the upper portion of his body naked. No other manifestations of sexual instinct. No onanism reported. (Sander, Archiv f. Psych., i, p. 655.)

Case 148. Pederasty with a Child.—On April 8, 1884, at ten o’clock A.M., while X. was sitting on the street, holding a boy of eighteen months on her lap, a certain Vallario approached and took the child from X., saying he was going to take it for a walk. He went the distance of half a kilometre, and returned, saying that the child had fallen from his arms, and thus injured its anus. The anus was torn, and blood was pouring from it. At the place where the deed was done, traces of semen were found. V. confessed his horrible crime, and, at his final trial, he acted so strangely that an examination of his mental condition was made. He had impressed the prison attendants as being an imbecile. V., aged 45, mason, defective morally and intellectually, is dolicho-microcephalic; has narrow, deformed facial bones, and the halves of the face and the ears are asymmetrical; the brow is low and retreating; genitals normal. V. shows general diminution of cutaneous sensibility, is imbecile, and has no ideas. He lives in the present, has no ambition, and does nothing of his own will. He has no desires and no emotional feeling. He has never had coitus. Nothing more could be ascertained about his vita sexualis. Proofs of intellectual and moral idiocy, due to microcephaly; the crime is referred to a perverse, uncontrollable sexual impulse. Sent to an asylum. (Virgilio, il Manicomio, V. year, No. 3.)

A case mentioned by L. Meyer (Arch. f. Psych., Bd. i, p. 103) shows how female imbeciles may indulge in shameless prostitution and immorality.[121]

States of Acquired Mental Weakness.

The numerous anomalies of the vita sexualis in senile dementia have been described in the section on “General Pathology.” In other conditions of acquired mental weakness,—those due to apoplexy; trauma capitis; to the secondary stages of psychoses; or to inflammatory processes in the cortex (lues, paretic dementia),—perversions of the sexual instinct seem to be infrequent; and here the immoral sexual acts seem to depend on abnormally increased or uninhibited sexual feeling, which, in itself, is not abnormal.

(1) Dementia Consecutive to Psychoses.

Casper (Klin. Novellen, Fall 31) reports a case that belongs here. It is that of a physician, aged 33, who attempted rape on a child. He was weakened mentally, as a result of hypochondriacal melancholia. He excused his deed in a very silly way, and had no appreciation of the moral and criminal meaning of the act, which was apparently the result of a sexual impulse that could not be controlled on account of his mental weakness.

Case 21, in Liman’s Zweifelhafte Geisteszuständen, is an analogous case (dementia after melancholia; offense against morals by exhibition).

(2) Dementia After Apoplexy.

Case 149. B., aged 52. He passed through a cerebral attack, and was no longer able to carry on his business as a merchant.

One day, in the absence of his wife, he locked two girls in the house, gave them liquors to drink, and then carried out sexual acts with the children. He commanded them to say nothing, and went to his business. The medical expert established mental weakness, resulting from repeated apoplexies. B., who, up to this time, had been wellbehaved, says he committed the criminal act because of an uncontrollable and incomprehensible impulse; and that, when he came to himself, he was ashamed, and sent the girls away. Since his apoplectic attack, B. had been weak-minded, incapable of business, and hemiplegic; but, soon after arrest, he made an unskillful attempt at suicide. He often cried childishly. His moral and intellectual energy in opposing his sensual impulses was certainly much weakened. No sentence. (Giraud, Ann. méd. Psychol. March, 1881.)

(3) Dementia After Injury of Head.

Case 150. K., when fourteen years old, was injured on the head by a horse. The skull was fractured in several places, and several pieces of bone required removal.

From that time K. was weak mentally, passionate, and ill-tempered. Gradually he developed an inordinate and truly beastly sensuality, which drove him to the most immoral acts. One day he raped a girl of twelve, and strangled her for fear of discovery. Arrested, he confessed. The medical experts declared him responsible, and he was executed.

The autopsy revealed ossification of almost all the sutures, remarkable asymmetry of the halves of the skull, and evidences of healed fractures. The affected hemisphere had bands of cicatricial tissue running through it, and was one-third smaller than the other. (Friedreich’s Blätter, 1885, Heft 6.)

(4) Acquired Mental Weakness, Probably Resulting from Lues.

Case 151. X., officer, had repeatedly committed immoral acts with little girls; among other things, he had induced them to perform manustupration on him, had exposed his genitals, and handled theirs.

X., formerly healthy, and of blameless life, was infected with syphilis in 1867. In 1879 paralysis of the left abducens occurred. Thereafter mental weakness was noticed, with a change of his disposition and character. Headache, occasional incoherence of speech, failure of power of thought and logic, occasional inequality of pupils, and paresis of the right facial muscles, were observed.

X., aged 37, shows no trace of lues when examined. The paralysis of the left abducens is still present. The left eye is amblyopic. He is mentally weak. Concerning the trial that was before him, he said it was nothing but a harmless misunderstanding. Indications of aphasia. Weakness of memory, particularly for recent events. Superficial emotional reaction; rapid exhaustion of memory and ability to speak. Proved: that the ethical defect and the perverse sexual impulse are the symptoms of an abnormal condition of brain induced by lues.

Suspension of criminal proceedings. (Personal case. Jahrbücher für Psychiatrie.)

(5) Paretic Dementia.

Here the sexual life is usually abnormally affected; in the incipient stages of the disease, as well as in episodical states of excitement, it is intensified, and sometimes perverse. In the final stages libido and sexual power usually become nil.

Just as in the prodromal stage of the senile forms, one sees here, in connection with more or less evident losses in the moral and intellectual spheres, expressions of an apparently intensified sexual instinct (obscene talk, openness in intercourse with the opposite sex, thoughts of marriage, frequenting of brothels, etc.), which is characteristic of the clouding of consciousness.

Seduction, abduction, and public scandal are here the order of the day. At first there is still some appreciation of the circumstances, though the cynicism of the acts is striking enough. As the mental weakness increases, such patients become criminal by reason of exhibition, masturbation in the streets, and attempts at immoral acts with children.

If conditions of mental excitement come on, attempts at rape are committed, or, at least, grossly immoral acts,—the patient attacks women on the street, appears in public in very imperfect dress; or, half-clothed, tries to force his way into strange houses, to cohabit with the wife of an acquaintance, or to marry the daughter on the spot.

Numerous cases belonging to this category are cited by Tardieu (“Attentats aux moeurs”); Mendel (“Progressive Paralyse der Irren,” 1880, p. 123); Westphal (Arch. f. Psych., vii, p. 622); and a case by Petrucci (Annal. méd. Psychol., 1875) shows that bigamy may also occur here.

The brutal disregard of consequences with which the patients in the advanced stages attempt to satisfy their sexual instinct, is characteristic.

In a case reported by Legrand (“La folie,” p. 519), the father of a family was found masturbating in the open street. After the act he consumed his semen.

A patient seen by me, an officer, of a prominent family, in broad daylight, made attacks on little girls at a watering-place.

A similar case is reported by Dr. Régis (“De la dynamie ou exaltation fonctionnelle au début de la paral. gén.,” 1878).

Cases reported by Tarnowsky (op. cit., p. 82) show that also pederasty and bestiality may occur in the prodromal stages and course of this malady.

Epilepsy.—Epilepsy is allied to the acquired states of mental weakness because it often leads to them, and then all the possibilities of reckless satisfaction of the sexual impulse that have been mentioned may occur. Moreover, in many epileptics the sexual instinct is very intense. For the most part, it is satisfied by masturbation, now and then by attacks on children, and by pederasty. Perversion of the instinct with perverse sexual acts seems to be infrequent.

Much more important are the numerous cases in literature in which epileptics, who, during intervals, present no signs of active sexual impulse, but manifest it in connection with epileptic attacks, or during the time of equivalent or post-epileptic exceptional mental states. These cases have scarcely yet been studied clinically, and forensically not at all; but they deserve careful study. In this way certain cases of violence and rape would be understood, and legal murders prevented.

From the following facts, it will certainly be clear that the cerebral changes which accompany the epileptic outbreak may induce an abnormal excitation of the sexual instinct. Besides, in the exceptional mental states of epileptics, they are unable to resist their impulses, by reason of the disturbance of consciousness.

For years I have known a young epileptic, of bad heredity, who, always after frequent epileptic seizures, attacks his mother, and tries to violate her.[122] After a time he comes to himself, and has no memory of his acts. In the intervals he is very strict in morals, and has but slight sexual inclination.

Some years ago I became acquainted with a young peasant, who, during epileptic attacks, masturbated shamelessly, but during the intervals was above reproach.

Simon (“Crimes et délits,” p. 220) mentions an epileptic girl of twenty-three, well educated, and of the best morals, who, in attacks of vertigo, would shout out obscene words, then raise her dress, make lascivious movements, and try to tear open her under-garments.

Kiernan (Alienist and Neurologist, January, 1884) reports the case of an epileptic who always had, as an aura, the vision of a beautiful woman in lascivious attitudes, which induced ejaculation. After some years, with treatment with potassium bromide, the vision was changed to that of a devil attacking him with a pitchfork. The instant this reached him, he became unconscious.

The same author speaks of a very respectable man who had, two or three times a year, epileptic attacks of furor and dysthymia, with impulses to pederasty, which lasted a week or two; and of a lady who, with epilepsy that came on during the climacterium, had sexual desire for boys.

Case 152. W., of good heredity, previously healthy; before and after, sound mentally, quiet, kind, temperate. On April 18, 1877, he had no appetite. On the 14th, in the presence of his wife and children, he demanded coitus, first of his wife’s friend, who was present, then of his wife. Taken away, he had an epileptoid attack; after this he became wildly maniacal and destructive, threw hot water on those that tried to approach him, and threw a child in the stove. Then he soon became quiet, but for some days remained confused, and finally came to himself with no memory of the events of his attack. (Kowalewsky, Jahrbücher f. Psych., 1879.)

Another case, examined by Casper (Klin. Novellen, p. 267), may be attributed to epilepsy (larvated). A respectable man attacked four women, one after another, in the open street (once before two witnesses), and violated one of them, “notwithstanding that his young, pretty, and healthy wife” lived hard by.

The epileptic significance of the sexual acts in the following cases is unequivocal:—

Case 153. L., official, aged 40; a kind husband and father. During four years he has offended public morals twenty-five times, for which he has had to endure long imprisonment.

In the first seven complaints he was accused of exposing his genitals to girls from eleven to thirteen years old, while riding by them, and calling their attention by obscene words. While in confinement, he had exposed his genitals at a window which opened on a popular street.

L.’s father was insane; his brother was once met on the street wearing only a shirt. During his military service L. had had two attacks of severe fainting. Since 1859 he had suffered with peculiar attacks of vertigo, at such times becoming weak, tremulous, and deathly pale; it grew dark before his eyes, and he saw bright stars, and was forced to get support in order to keep upright. After violent attacks, great weakness, profuse sweating.

Since 1861 he had been very irritable, which, respected though he was as an official, caused him much trouble in his work. His wife noticed the change in him. He had days when he would run about the house as if insane, holding his head between his hands, striking the wall, and complaining of headache. In 1864 he fell to the ground four times, lying there stiff, with eyes open. Confused states of consciousness were also proved to have occurred.

L. declared that he had not the slightest remembrance of the crime of which he was accused. Observation showed further and more violent attacks of epileptic vertigo. L. was not sentenced. In 1875 paretic dementia developed with a rapidly fatal result. (Westphal, Arch. f. Psych., vii, p. 113.)

Case 154. A rich man of twenty-six had lived for a year with a girl with whom he was very much in love. He cohabited infrequently, and was never perverse.

Twice during the year, after excessive indulgence in alcohol, he had had epileptic attacks. One evening after dinner, where he had taken much wine, he hurried to the house of his mistress, and into her sleeping-apartment, although the servant told him she was not at home. From there he hastened into a room where a boy of fourteen was sleeping, and began to violate him. At the cry of the child, whose prepuce and hand he had injured, the servant hurried to them. He left the boy and attacked the maid; after that he went to bed and slept twelve hours. When he awoke, he had an indistinct remembrance of intoxication and coitus. Thereafter there were repeated epileptic attacks. (Tarnowsky, op. cit., p. 52.)

Case 155. X., of high social position, led a dissolute life for some time, and had epileptic attacks. He became engaged. On his wedding-day, shortly before the ceremony, he appeared, on his brother’s arm, before the assembled guests. When he came before his bride, he exposed his genitals and began to masturbate. He was at once taken to an expert in mental disease. On the way he constantly masturbated, and for some days was actuated by this impulse, which gradually decreased in intensity. After this paroxysm the patient had only a confused memory of the events, and could give no explanation of his acts. (Tarnowsky, op. cit., p. 53.)

Case 156. Z., aged 27; very bad heredity; epileptic. He violated a girl of eleven, and then killed her. He lied about the deed. Absence of memory, i.e., mental confusion at the time of the crime, was not proved. (Pugliese, Arch. di Psich., viii, p. 622.)

Case 157. V., aged 60, physician, violated children. Sentenced to imprisonment for two years. Dr. Marandon later proved the existence of epileptoid attacks of apprehensiveness, dementia, erotic and hypochondriacal delusions, and occasional attacks of fear. (Lacassagne, Lyon. méd., 1887, No. 51.)

Case 158. On August 4, 1878, H., aged 15, was picking gooseberries with several little girls and boys as her companions. Suddenly she threw L., aged 10, to the ground and exposed her, and ordered A., aged 8, and O., aged 5, to bring about conjunctio membrorum with the girl; and they obeyed.

H. had a good character. For five years she had been subject to irritability, headache, vertigo, and epileptic attacks. Her mental and physical development had been arrested. She had not menstruated, but she manifested menstrual molimena. Her mother is suspected to be epileptic. For three months H., after seizures, had frequently done strange things, and afterward had no memory of them.

H. seems to have been deflowered. Mental defect is not apparent. She said she had no memory of the act of which she was accused. According to her mother’s testimony, she had an epileptic attack on the morning of August 4th, and she had been, on that account, told by her mother not to leave the house. (Pürkauer, Friedreich’s Blätter f. ger. Med., 1879.)

Case 159. Immoral Acts of an Epileptic in States of Abnormal Unconsciousness.—T., revenue-collector; aged 52; married. He is accused of having practiced immorality with boys for about seventeen years, by practicing masturbation on them, and by inducing them to carry out the act on himself. The accused, a respected officer, is overcome by the terrible crime attributed to him, and declares that he knows nothing of the deeds of which he is accused. His mental integrity is questionable. His family physician, who has known him twenty years, emphasizes his peculiar, retiring disposition and his mercurial moods. His wife asserts that T. once tried to throw her in the water, and that he sometimes had outbreaks in which he tore off his clothing, and tried to throw himself out of windows. T. knew nothing of these attacks. Other witnesses testified to strange changes of mood and peculiarities of character. A physician reports the observation of occasional attacks of vertigo and convulsions in him.

T.’s grandmother was insane; his father was affected with chronic alcoholism, and of late years had had epileptiform attacks. The father’s brother was insane, and had killed a relative while in a delirious state. Another uncle of T. had killed himself. Of T.’s three children, one was weak-minded, another cross-eyed, and the third was subject to convulsions. The accused asserted that he had occasional attacks in which consciousness was so reduced that he did not know what he was about. These attacks were ushered in by an aura-like pain in the back of his neck. He was then impelled to go out in the air. He did not know where he went. His wife had perfectly satisfied him sexually. For eighteen years he had had chronic eczema (actual) of the scrotum, which had often caused him to have extraordinary sexual excitement. The opinions of the six experts were contradictory (sane,—attacks of larvated epilepsy); the jury disagreed, so that he was dismissed. Dr. Legrand du Saulle, who was called as an expert witness, found that, until his twenty-second year, T. had urinated in bed from ten to eighteen times a year. After that time the enuresis nocturna had ceased; but, from that time, states of mental confusion, lasting from an hour to a day, had occurred occasionally, and they left the patient without any memory of them. Soon again T. was arrested for public immorality, and sentenced to imprisonment for fifteen months. In prison he grew sick, and apparently much weaker mentally. For this reason he was pardoned, but the mental weakness increased. T. was noticed to have repeated epileptoid convulsions (tonic convulsion with tremor and loss of consciousness). (Auzouy, Annal. méd. psychol., 1874, Nov.; Legrand du Saulle, “Étude méd. légale,” etc., p. 99.)

The following case of immoral acts with children, observed by the author and reported in Friedreich’s Blätter, will serve to conclude this group,[123] so important in its legal bearings. It is the more important, in that a state of unconsciousness was established at the time of the act, and because, for allied reasons, the facts related in Latin show how a complicated and refined act becomes possible in such a state of unconsciousness.

Case 160. P., aged 49; married; hospital beneficiary. He was accused of having committed the following terrible acts with two girls—D., aged ten, and G., aged nine,—whom he had taken to his work-shop on May 25, 1883.

D. testifies: “I was in the meadow with G. and my sister J., aged three. P. called us into his shop and fastened the door. Tum nos exosculabatur, linguam in os meum demittere tentabat faciemque mihi lambebat; sustulit me in gremium, bracas aperuit, vestes meas sublevavit, digitis me in genitalibus titillabat et membro femina mea fricabat ita ut humida fierem. When I cried, he gave me twelve kreuzers, and threatened to shoot me if I told on him. At last he tried to persuade me to come again the next day.”

G. testified: “P. nates et genitalia D. æ exosculatus, iisdem me conatibus aggressus est. Deinde filiolum quoque tres annos natum in manus acceptum osculatus est nudatumque parti suæ virili appressit. Postea quæ nobis essent nomina interrogavit ac censuit, genitalia D. æ meis multo esse majora. Quin etiam nos impulit, ut membrum suum intueremur, manibus comprehenderemus et videremus, quantopere id esset erectum.”

At his examination, May 29th, P. said he had but an indistinct recollection of having fondled, caressed, and made presents to a little girl a short time before. If he had done anything more, it must have been in an irresponsible condition. Besides, he had suffered for years with weakness in his head, as result of an injury. On June 22d he knew nothing of the events of May 25th, and nothing of his examination on May 29th. This amnesia was shown, also, on cross-examination.

P. comes of a family affected with cerebral disease; a brother was epileptic. P. was formerly a drinker. Years before, he had actually suffered an injury to his head. Since then, from time to time, he has had attacks of mental disturbance, introduced by moroseness, irritability, tendency to alcoholic excesses, apprehension, and delusions of persecution sufficient to induce threats and deeds of violence. At the same time, he would have auditory hyperæsthesia, vertigo, headache, and cerebral congestion,—all this, with great mental confusion and amnesia for the whole period of the attack, which would sometimes last for weeks.

During the intervals he was subject to headache, which started from the seat of injury on the head (a small scar in the skin over the right temple), which was painful on pressure. With exacerbation of the headache, he became very irritable, morose to an extent that inclined him to suicide, and mentally like one drunk. In 1879, while in such a state, he made an impulsive attempt at suicide, of which he afterward had no memory. Soon after this, being sent to hospital, he gave the impression of being epileptic, and, for a long time, was treated with pot. bromide. At the end of 1879 he was taken to the infirmary, no actual epileptic attack having been observed.

During his lucid intervals he was a virtuous, industrious, good-natured man, and had never shown any sexual excitement; and, until this time, never sexual inclinations, even during his mental confusion. Moreover, until lately, he had lived with his wife. At the time of the criminal act, he had shown signs of an approaching attack, and had asked the physician to prescribe pot. bromide.

P. asserted that, since the injury to his head, he had been intolerant of heat and alcohol, which immediately brought on headache and confusion. The medical examination proved the truth of his assertions about mental weakness, irritability, and poor sleep.

If pressure were made at the seat of the trauma, P. became congested, irritable, confused, and trembled all over; he appeared excited; consciousness was disturbed, and remained so for hours.

At times, when he is free from the sensations that start from the scar, he seems kind, free, willing, and open, though he is mentally weak and cloudy. P. was not sentenced. (Vide Friedreich’s Blätter for full report.)

Periodical Insanity.

Just as in cases of non-periodical mania, an abnormal intensity or a noticeable prominence of the sexual sphere is very often manifested in the periodical attacks (v. infra, “Mania”).

The following case, reported by Servaes (Arch. f. Psych.), shows that it then may also be perverted:—

Case 161. Catharine W., aged 16; she has not yet menstruated; previously healthy.

Seven weeks before admission (December 3, 1872), melancholic depression and irritability. November 27th, maniacal outbreak, lasting two days; thereafter, melancholic. December 6th, normal condition.

December 24th (twenty-eight days after the first maniacal attack), silent, shy, depressed. December 27th, exaltation (jolly, laughing, etc.), with violent love for an attendant (female). December 31st, suddenly melancholic catalepsy, which disappeared after two hours. January 20, 1873, new attack like the previous one. A similar one on February 18th, with traces of menses. The patient had no memory whatever for what occurred in the paroxysms, and blushed scarlet with astonishment and shame when told about them.

Thereafter there were abortive attacks, which entirely disappeared, to give place to the normal mental condition in June.

In a case reported by Gock (Arch. f. Psych., v), which was probably circular insanity, in a man of very bad heredity, during the stage of exaltation there was manifestation of sexual feeling for men. In this case, however, the patient thought himself a girl, and it is questionable whether the sexual inclination was induced by the delusion or by a contrary sexual instinct.

In connection with these cases of abnormal manifestation of the sexual instinct are those which, as a symptom of mania, manifest an abnormal and frequently a perverse sexual instinct in an impulsive way, analogous to dipsomania, which forms the nucleus of the psychical disturbance, while in the intervals the sexual instinct is neither intense nor perverse.

Quite a pure case of such periodical psychopathia sexualis, connected with the process of menstruation, is the following, reported by Anjel (Arch. f. Psych., xv, H. 2):—

Case 162. A quiet lady, near the climacteric. Very bad heredity. In her youth, attacks of petit mal. Always eccentric, quick-tempered; very moral; childless marriage.

Several years ago, after a violent emotional disturbance, a hystero-epileptic attack, with post-epileptic insanity of several weeks’ duration. Thereafter there was sleeplessness for several months. Following this, there was always menstrual insomnia, and the impulse to embrace and kiss boys of ten, and fondle their genitals. During this excitement there was no desire for coitus; certainly not for intercourse with adults.

The patient often speaks openly of this impulse, and asks to be watched, as she is not to be trusted. In the intervals she anxiously avoids all talk of it, is very modest, and in nowise passionate sexually.

With reference to the still imperfectly-known cases of periodical psychopathia sexualis of this kind, Tarnowsky (op. cit., p. 38) has made valuable contributions, though his cases were not all of a periodic nature; and one of the cases, taken from a work of the author’s, is not rightly understood (Case 8, p. 37), since sodomy was only subsidiary, and the abnormal intense libido sexualis was not periodic.

Tarnowsky reports cases where married, cultured men, the fathers of families, were, from time to time, compelled to perform the most terrible sexual acts, while during the intervals they were sexually normal, abhorred their paroxysmal sexual acts, and shuddered before the expectation of their repetition.

If a new paroxysm came on, the normal sexual instinct disappeared; a state of mental excitement arose with insomnia, and thoughts and impulses to commit the perverse sexual acts, with anxious confusion and an increasing impulse to the abhorred indulgence. In this state the act was a relief, because it ended the condition. The analogy with dipsomania is complete.

For other cases (of periodical pederasty), vide Tarnowsky, op. cit., p. 41. The case there reported, on page 46, belongs in the category of epilepsy.

The following case, reported by Anjel (Arch. f. Psych., xv, H. 2), is one of the most typical of the convulsive-like occurrence of sexual excitement:—

Case 163. A gentleman of high social position, aged 45; generally respected and beloved; heredity good; very moral; married fifteen years. Previously normal sexually; the father of several healthy children, and living in happy matrimony. Eight years ago he suffered a violent fright. For some weeks thereafter he had a feeling of apprehension and cardiac attacks. Then came attacks, at intervals of several months or a year, of what the patient called his “moral catarrh.” He became sleepless. After three days, loss of appetite, increasing irritability, strange appearance; fixed stare, staring into space; paleness, changing with redness; tremor of the fingers; red, shining eyes, with peculiar glassy expression; and violent, quick manner of speech. There was a desire for girls of from five to ten years, even for his own daughters. He would beg his wife to guard the children. For days at a time, while in this state, he would shut himself in his room. Previously he was compelled to pass school-girls on the street, and he found a peculiar pleasure in exposing his genitals before them, by acting as if about to urinate.

For fear of exposure, he shuts himself in his room, full of desire, incapable of movement, and torn by feelings of fear. Consciousness seems to be undisturbed. The attacks last from eight to fourteen days. The cause of their return is not clear. Improvement is sudden; there is great desire for sleep, and, after this is satisfied, he is again well. In the interval there is nothing abnormal. The author assumes an epileptic foundation, and considers the attacks to be the psychical equivalents of epileptic convulsions (!).

Mania.—With the general excitation that here exists in the psychical organ, the sexual sphere is likewise often implicated. In maniacal individuals of the female sex, this is the rule. In certain cases, it may be questionable whether the instinct, which, in itself, is not intensified, is simply recklessly manifested, or whether it is present in actual abnormal intensity. For the most part, the latter is the true assumption,—certainly so where sexual delusions and their religious equivalents are constantly expressed. In accordance with the degrees of intensity of the disease, the intensified instinct is expressed in different forms.

In simple maniacal exaltation in men, courting, frivolity, and lasciviousness in speech, and frequenting of brothels, are observed; in women, inclination for the society of men, personal adornment, perfumes, talk of marriage and scandals, suspicion of the virtue of other women; or there is manifested the religious equivalent,—pilgrimages, missionary work, desire to go into a cloister or to become the servant of a priest; and in this case there is much talk about innocence and virginity.

At the height of mania there may be seen invitations to coitus, exhibition, obscenity, great excitation at sight of women, tendency to smear the person with saliva, urine, and even fæces; religio-sexual delusions,—to be under the protection of the Holy Ghost, to have given birth to Christ, etc.; open onanism, and pelvic movements of coitus.

In maniacal men care must be taken to prevent shameless masturbation and sexual attacks on women.

Satyriasis and Nymphomania.

States of mental excitement, in which an abnormal intense sexual impulse is prominent, are called satyriasis (in males) and nymphomania (in women), or uteromania.

Moreau considers these cases peculiar to themselves, but he is certainly in error. The sexual complexus of symptoms is always but the partial manifestation of a general psychosis (mania, hallucinatory insanity?).

The essential element of the state of sexual excitement is a condition of psychical hyperæsthesia with involvement of the sexual sphere. The imagination calls up only sexual images, which may lead to hallucinations, illusions, and true hallucinatory delirium.

The most indifferent ideas excite sensual association, and the lustful coloring of the ideas and apperceptions is very much intensified.

The abnormal state of consciousness implicates the whole course of feeling and desire, and is accompanied by general physical excitement like that that accompanies coitus (v. “Physiology”). Often the genitals are in a constant state of turgor (priapism in males).

The man affected with this sexual passion seeks to satisfy his desire at any price, and, therefore, becomes very dangerous to women. Faute de mieux, he practices onanism or sodomy. The nymphomaniacal woman seeks men by exhibition, or to attract them by her sensual conduct; at the sight of men she is intensely excited sexually, and satisfies herself by masturbation, or by pelvic movements of coitus.

Satyriasis is infrequent. Nymphomania is more frequently observed, and not seldom in the climacteric. It may occur in senility. Abstinence,[124] with constant excitation of the sexual sphere as a result of psychical or peripheral irritation (pruritus pudendi, oxyuris, etc.), may cause these conditions, but probably only in those predisposed.

The assertion that it may also result from poisoning by cantharides seems to depend upon confounding it with priapism. The primary lustful feeling that accompanies priapism due to cantharides soon becomes painful. Satyriasis and nymphomania are acute abnormal psycho-sexual states.

There are also cases that, not without reason, might be called chronic satyriasis or nymphomania. To these belong the men who, for the most part as a result of abusus veneris, or more particularly of masturbation, suffer with neurasthenia sexualis, and at the same time have intense libido sexualis. The imagination, as in acute cases, is in a state of excitement, and the mind full of obscene images; so that the most elevated ideas are besmirched with the most cynical images and thoughts.

The thought and desire of such men are solely directed to the sexual sphere; and since their flesh is weak, led on by their fancy, they come to indulge in the grossest perversions of the sexual act.

Analogous cases in women may be called chronic nymphomania. They naturally lead to prostitution. Legrand du Saulle (“La folie,” p. 510) reports interesting cases which apparently are pure.

Melancholia.—The thoughts and feelings of melancholiacs are not favorable for the excitation of sexual desires. At the same time, these patients sometimes masturbate. In my experience such cases have always been hereditarily predisposed and previously given to onanism. The act did not seem to be so much due to a lustful desire as to be induced by habit, ennui, anxiety, and the impulse to change temporarily the painful mental condition.

Hysteria.—In this neurosis the sexual life is very frequently abnormal; indeed, always in predisposed individuals. All the possible anomalies of the sexual function may occur here, with sudden changes and peculiar activity; and, on an hereditary degenerate basis and in moral imbecility, they may appear in the most perverse forms. The abnormal change and inversion of the sexual feeling are never without effect upon the patient’s disposition.

The following case, reported by Giraud, is one of this nature worthy of repetition:—

Case 164. Marian L., of Bordeaux. At night, while the household was asleep under the influence of narcotics she had administered, she had given the children of the house to her lover for sexual enjoyment, and had looked on at the immoral acts. It was found that L. was hysterical (hemianæsthesia and convulsive attacks), but before her illness she had been a moral, trustworthy person. Since her illness she had become a shameless prostitute, and lost all moral sense.

In the hysterical the sexual sphere is often abnormally excited. This excitement may be intermittent (menstrual?). Shameless prostitution, even in married women, may result. In a milder form the sexual impulse expresses itself in onanism, going about in a room naked, smearing the person with urine and other things, or wearing male attire, etc.

Schüle (Klin. Psychiatrie, 1886, p. 237) finds very frequently an abnormally intense sexual impulse “which disposes girls, and even women living in happy marriage, to become Messalinas.”

The author cited knows cases in which, on the wedding-journey, attempts at flight with men, who had been accidentally met, were made; and respected wives who entered into liaisons, and sacrificed everything to their insatiable impulse.

In hysterical insanity the abnormally intense sexual impulse may express itself in delusions of jealousy, unfounded accusations against men for immoral acts,[125] hallucinations of coitus,[126] etc.

Occasionally frigidity may occur, with absence of lustful feeling,—due, for the most part, to genital anæsthesia.

Paranoia.—Abnormal manifestations in the sexual sphere, in the various forms of paranoia, are not infrequent. Many of these cases are developed on sexual abuse (masturbatic paranoia) or sexual excitement; and, according to experience, in individuals psychically degenerate, with other functional signs of degeneracy, the sexual sphere is, for the most part, deeply implicated.

In paranoia religiosa and erotica the abnormally intense and, under certain circumstances, perverse sexual instinct is most clearly manifested. In the first variety, however, the condition of sexual excitation is expressed not so much in a direct method of satisfaction of the sexual desires as (there are exceptions) in platonic love,—in enthusiastic admiration of a person of the opposite sex who is pleasing æsthetically. Under certain circumstances, the enthusiasm is for a fanciful person, a portrait, or a statue.

A love for the opposite sex that is weak and purely mental, too, often has its basis in weakness of the genitals due to long-continued masturbation; and, under the guise of virtuous admiration of a beloved person, great lasciviousness and sexual perversion are often concealed. Episodically, especially in women, violent sexual excitement may occur as a nymphomania.

For the most part, paranoia religiosa rests upon sexuality which manifests itself in a sexual impulse that is abnormally early and intense. The libido finds satisfaction in masturbation or religious enthusiasm, the object of which may be a certain minister, saint, etc.

The psycho-pathological relations between the sexual and religious domains have been described in detail on p. 8 et seq.

Apart from masturbation, sexual crimes are relatively frequent in religious paranoia.

Marc’s work (p. 160) contains a remarkable example of religious insanity.

Giraud (Annal. méd. psychol.) has reported a case of rape of a little girl by a religious paranoiac, aged 43, who was temporarily erotic. Here, also, belongs a case of incest (Liman, Vierteljahrsschr. f. ger. Med.).

Case 165. M. impregnated his daughter. His wife, mother of eighteen children, and herself pregnant by her husband, lodged the complaint. M. had had religious paranoia for two years. “It was revealed to me that I should beget the Eternal Son with my daughter. Then a man of flesh and blood would arise by my faith, who would be eighteen hundred years old. He would be a bridge between the Old and New Testaments.” This command, which he deemed divine, was the cause of his insane act.

Sexual acts that have a pathological motive sometimes occur in persecutory paranoia.

Case 166. A married woman of thirty had, by means of money and sweetmeats, enticed a boy of five, who played near her, handled his genitals, and then attempted coitus. She was a teacher, who had been betrayed and then cast off. Previously moral, for some time she had given herself to prostitution. The explanation of her immoral change was given, when it was found that she had various delusions of persecution, and thought she was under the secret influence of her seducer, who impelled her to sexual acts. She also believed that the boy had been put in her way by her seducer. Coarse sensuality as a motive for her crime came less into consideration, as it would have been easy for her to satisfy sexual desire in a natural way. (Küssner, Berl. klin. Wochenschrift.)

Cullerre (“Perversions sexuelles chez les persécutés,” in Annal. médico-psychol., March, 1886) has reported similar cases,—the case of a patient who, suffering with paranoia sexualis persecutoria, tried to violate his sister, giving as a reason that the impulse was given him by Bonapartists.

In another case a captain, suffering with delusions of persecution by electro-magnetism, was driven to pederasty,—a thing he abhorred. In a similar case the persecutor impelled to onanism and pederasty.

V. PATHOLOGICAL SEXUALITY IN ITS LEGAL ASPECTS.

The laws of all civilized nations punish those who commit perverse sexual acts. Inasmuch as the preservation of chastity and morals is one of the most important reasons for the existence of the commonwealth, the state cannot be too careful, as a protector of morality, in the struggle against sensuality. This contest is unequal; because only a certain number of the sexual crimes can be legally combated, and the infractions of the laws by so powerful a natural instinct can be but little influenced by punishment. It also lies in the nature of the sexual crimes, that but a part of them ever reach the knowledge of the authorities. Public sentiment, in that it looks upon them as disgraceful, lends much aid.

Criminal statistics prove the sad fact that sexual crimes are progressively increasing in our modern civilization.[127] This is particularly the case with immoral acts with children under the age of fourteen. The moralist sees in these sad facts nothing but the decay of general morality, and in some instances comes to the conclusion that the present mildness of the laws punishing sexual crimes, in comparison with their severity in past centuries, is in part responsible for this.

The medical investigator is driven to the conclusion that this manifestation of modern social life stands in relation to the predominating nervousness of later generations, in that it begets defective individuals, excites the sexual instinct, leads to sexual abuse, and, with continuance of lasciviousness associated with diminished sexual power, induces perverse sexual acts.

It will be clearly seen, from what follows, how such an opinion is justified, especially with respect of the increasing number of sexual crimes committed on children. It is at once evident, from what has gone before, that neuropathic, and even psychopathic, states are largely determinate for the commission of sexual crimes. Here nothing less than the responsibility of many of the men who commit such crimes is called in question.

Psychiatry cannot be denied the credit of having recognized and proved the psycho-pathological significance of numerous monstrous, paradoxical sexual acts. Law and Jurisprudence have thus far given but little attention to the facts resulting from investigations in psychopathology. Law is, in this, opposed to Medicine, and is constantly in danger of passing judgment on individuals who, in the light of science, are not responsible for their acts.

Owing to this superficial treatment of acts that deeply concern the interests and welfare of society, it becomes very easy for justice to treat a delinquent, who is as dangerous to society as a murderer or a wild beast, as a criminal, and, after punishment, release him to prey on society again; on the other hand, scientific investigation shows that a man mentally and sexually degenerate ab origine, and therefore irresponsible, must be removed from society for life, but not as a punishment.

A judge who considers only the crime, and not its perpetrator, is always in danger of injuring not only important interests of society (general morality and safety), but also those of the individual (honor).

In no domain of criminal law is co-operation of judge and medical expert so much to be desired as in that of sexual delinquencies; and here only anthropological and clinical investigation can afford light and knowledge. The nature of the act can never, in itself, determine a decision as to whether it lies within the limits of mental pathology, or within the bounds of mental physiology. The perverse act does not indicate perversion of instinct. At any rate, the most monstrous and perverse sexual acts have been committed by persons of sound mind. The perversion of feeling must be shown to be pathological. This proof is to be obtained by learning the conditions attending its development, and by proving the existence of a general neuropathic or psychopathic condition.

The species facti is important; but it allows, however, only presumptions, since the same sexual act, according as it is committed by an epileptic, paralytic, or a man of sound mind, takes on other features and peculiarities, in accordance with the manner in which it is done.

Periodical recurrence of the act under identical circumstances, and an impulsive manner in carrying it out, give rise to weighty presumptions that it is of pathological significance. The decision, however, must follow after referring the act to its psychological motive (abnormalities of thought and feeling), and after showing this elementary anomaly to be but one symptom of a general neuropathic condition,—either an arrest of mental development, or a condition of psychical degeneration, or a psychosis.

The cases discussed in the portion of this work devoted to general and special pathology will certainly be useful to the medical expert, in assisting him to discover the motive of the act. To obtain the facts necessary to allow a decision of the question whether immorality or abnormality occasioned the act, a medico-legal examination is required,—an examination which is made according to the rules of science; which takes account of both the past history of the individual and the present condition,—the anthropological and clinical data.

The proof of the existence of an original, congenital anomaly of the sexual sphere is important, and points to the need of an examination in the direction of a condition of psychical degeneration. An acquired perversity, to be pathological, must be found to depend upon a neuropathic or psychopathic state.

Practically, paretic dementia and epilepsy must first come to mind. The decision concerning responsibility will depend on the demonstration of the existence of a psychopathic state in the individual convicted of a sexual crime.

This is indispensable, to avoid the danger of covering simple immorality with the cloak of disease.

Psychopathic states may lead to crimes against morality, and at the same time remove the conditions necessary to the existence of responsibility, under the following circumstances:—

1. To oppose the normal or intensified sexual desire, there may be no moral or legal notions, owing to (a) the fact that they may never have been developed (states of congenital mental weakness); or to (b) the fact that they have been lost (states of acquired mental weakness).

2. When the sexual desire is increased (states of psychical exaltation) and consciousness simultaneously clouded, the mental mechanism is too much disturbed to allow the opposing ideas, virtually present, to exert their influence.

3. When the sexual instinct is perverse (states of psychical degeneration). It may, at the same time, be intensified.

Cases of sexual delinquency that occur outside of states of mental defect, degeneration, or disease, can never be excused on the ground of irresponsibility.

In many cases, instead of an abnormal psychical condition, a neurosis (local or general) is found. Inasmuch as the transitions from a neurosis to a psychosis are easy, and elementary psychical disturbances are frequent in the former, and constant in profound perversion of the sexual life, the neurotic affection—e.g., impotence, irritable weakness, etc.—exerts an influence on the motive of the incriminating act; and a just judge, notwithstanding the lack of legal irresponsibility due to mental defect or disease, will recognize the circumstances which ameliorate the heinousness of the crime.

For various reasons the practical jurist will, in all cases of sexual crimes, call medical experts to make a psychiatric examination.

To be sure, his own conscience and judgment must be the guides when necessity makes them his only reliance. Under the following circumstances indices are given which point to a pathological condition:—

The accused is senile. The sexual crime is committed openly, with remarkable cynicism. The manner of obtaining sexual satisfaction is silly (exhibition), or cruel (mutilation or murder), or perverse (necrophilia, etc.).

From what experience teaches, it may be said that, among the sexual acts that occur, rape, mutilation, pederasty, amor lesbicus, and bestiality may have a psycho-pathological basis.

In case of lust-murder,—in as far as it goes beyond murder itself,—and likewise in case of mutilation of corpses, psychopathic conditions are probable.

Exhibition and mutual masturbation make pathological states seem very probable. Masturbation of another and passive onanism may occur in connection with senile dementia and contrary sexual feeling, but also with mere sensuality.

Cunnilingus and fellare (penem in os mulieris arrigere) have not thus far been shown to depend upon psycho-pathological conditions.

These horrible sexual acts seem to be committed only by sensual men who have become satiated or impotent from excessive indulgence in a normal way. Pædicatio mulierum does not seem to be psychopathic, but rather a practice of married men of low morality, who wish to prevent pregnancy; and of satiated cynics in non-marital sexual indulgence.

The practical importance of the subject makes it necessary that the sexual acts threatened with punishment as sexual crimes be considered by jurists from the stand-point of the medico-legal expert. Thus there is an advantage gained, in that the psycho-pathological acts, according to circumstances, are placed in the right light by comparison with analogous acts that fall within the domain of physiological psychology.

1. Offense Against Morality in the Form of Exhibition.

(Austrian Statutes, § 516; Abridgment, § 195. German Statutes, § 183.)

In man’s present condition of civilization, modesty is a characteristic and motive so firmly fixed by centuries of education that presumption of a psycho-pathological element necessarily arises when public decency is coarsely offended.

The presumption is justifiable that an individual who in this way has offended public decency and his own self-respect was incapable of moral feeling (idiots); or that it has been lost (states of acquired mental weakness); or that he has acted while in a clouded state of consciousness (transitory insanity, states of partial consciousness).

A very distinctive act which belongs here is that of exhibition (exposure). The cases thus far recorded are exclusively those of men who ostentatiously expose their genitals to persons of the opposite sex, in some instances following them, without, however, becoming aggressive.

The silly manner of this sexual activity, or really sexual demonstration, points to intellectual and moral weakness; or, at least, to temporary inhibition of the intellectual and moral functions, with excitation of libido dependent upon a decided disturbance of consciousness (abnormal unconsciousness, mental confusion); and, at the same time, the virility of these individuals is called in question. Thus there are various categories of exhibitionists.

The first category includes states of mental weakness in which, owing to the causative cerebral (or spinal) disease, consciousness is clouded, and the ethical and intellectual functions are interfered with; and in which there can be no opposition made to a sexual desire that has either always been intense, or that has been intensified by the disease-process. At the same time, impotence exists, and no longer permits expression of the sexual instinct in violent acts (rape), but only in acts that are silly.

The majority of reported cases[128] fall in this category. They are those of individuals afflicted with senile dementia, paretic dementia, or mental defects due to alcoholism, epilepsy, etc.

Case 167. Z., high official, aged 60; widower; father of a family. He had excited offense in that, during fourteen days, he had repeatedly exposed his genitals at his window, to a girl of eight years who lived opposite him. After a few months, under like circumstances, this man repeated his indecent act. At his examination he acknowledged the depravity of his action, and could give no excuse for it. Death, a year later, due to cerebral disease. (Lasègue, op. cit.)

Case 168. Z., aged 78; seaman. He had repeatedly exhibited his genitals on children’s play-grounds, and in the neighborhood of girls’ schools. This was the only way in which he was active sexually. He was married, and the father of ten children. Twelve years before, he had suffered a severe head-injury, since which he had had a deep scar, which indented the bone. Pressure on this scar caused pain; at the same time his face would flush, his expression become fixed, and he would grow somnolent, with convulsive movements in the right upper extremity (apparently epileptoid state in connection with cortical disease). Besides, there was senile dementia and advanced senium. It is not reported whether the exhibition coincided with epileptoid attacks or not. Senile dementia proved; pardoned. (Dr. Schuchardt, op. cit.)

Pelanda (op. cit.) has reported a number of cases of this kind:—

1. Paralytic, aged 60. At the age of fifty-eight he began to exhibit himself to women and children. In the asylum at Verona, for a long time thereafter, he was lascivious and also attempted fellatio.

2. A drinker, aged 66, suffering with folie circulaire. His exhibition was first noticed in church during divine service. His brother was likewise an exhibitionist.

3. A drinker, predisposed, aged 49. He was always very excitable sexually; in an asylum on account of chronic alcoholism. He exhibited himself whenever he saw a woman.

4. A man, aged 64; married; father of fourteen children. Great predisposition. Rachitic, microcephalic head. For years he had been an exhibitionist, in spite of repeated punishment.

Case 169. X., merchant, born in 1833; single. He had repeatedly exhibited himself to children, or even urinated at the same time; once, under these circumstances, he had kissed a little girl, driving her away. Twenty years previously X. had had a severe attack of mental disease, lasting two years, in which he is said to have had an apoplectic attack. Later, after loss of his fortune, he gave himself to drink, and of late years had often appeared absent-minded. His condition was that of alcoholism, senium præcox, and mental weakness. Penis small; phimosis; testicles atrophic. Proof of mental disease; pardoned. (Dr. Schuchardt, op. cit.)

Such cases recall the lasciviousness of youthful, sexuallyexcited persons that are still more or less boyish; but also that of many mature cynics of low morality, who find pleasure in defiling the walls of public closets, etc., with drawings of male and female genitals,—a kind of ideal exhibition which, however, is still widely separated from actual exhibition.

Another category of exhibitionists is made up of epileptics. This category is essentially to be distinguished from the foregoing, in that a conscious motive for the exhibition is wanting; and it appears much more like an impulsive act which, without any consideration of external circumstances, is performed as if it were an abnormal organic necessity.

At the time of the act there is always a state of imperfect consciousness; and thus is explained the fact that the unfortunate individual, without consciousness of the meaning of his act, or, at least, without cynicism, does it in obedience to a blind impulse. On regaining consciousness, he regrets and abhors it if there is not permanent mental weakness.

The prime motive in this state of imperfect consciousness, as with other impulsive acts, is a feeling of apprehensive oppression. If a sexual feeling become associated with it, then the ideas are given a certain direction in the sense of a corresponding (sexual) act.

How sexual ideas very easily arise temporarily in epileptics may be understood from the discussion under “Epilepsy.”

If, however, such an association has once been formed; if a particular act has taken place in an attack,—it is the more easily repeated in every subsequent attack; for, so to speak, a known tract has been established in the path of motivity.

The feeling of anxiety, with the state of imperfect consciousness, causes the associated sexual impulse to appear as a command,—an inner force, which is acted upon in a purely impulsive manner and in a state of absolute irresponsibility.

Case 170. K., a subordinate official, aged 29; of neuropathic family; living in happy marriage, and the father of one child. He has repeatedly, especially at dusk, exhibited himself to servant-girls. K. is tall, slim, pale, nervous, and hasty in manner. There is imperfect memory of the crimes. Since childhood there have been frequent severe congestive attacks, with intense flushing of the face, a rapid, tense pulse, and a fixed, absent stare. At the same time there were, now and then, confusion and vertigo. In this (epileptic) exceptional state K. would answer only after repeated questioning, and then it was as if he were waking from a dream. K. states that he has always felt excited and restless for some hours before his criminal acts, and experienced a feeling of fear, with oppression, and congestion of the head. In this condition he had often been giddy, and experienced an indistinct feeling of sexual excitement. At the height of such states he had left the house, without any purpose in view, and exposed his genitals anywhere. When he had reached home again, he had had but a dreamy remembrance of what had occurred, and felt very weak and depressed. It is also remarkable that, while exhibiting his genitals, he had used lighted matches to make them visible. The opinion was to the effect that the criminal acts depended upon epilepsy, and were imperative impulses; but he was, nevertheless, sentenced, with the assumption of extenuating circumstances. (Dr. Schuchardt, op. cit.).

Case 171. L., aged 39; single; tailor. His father was probably a drinker; he had two epileptic brothers, one of whom was insane. The patient himself has slight epileptic attacks, and from time to time states of imperfect consciousness, in which he runs about aimlessly, and thereafter does not know where he has been. He was considered a moral man, but he is now accused of having exhibited and played with his genitals in a strange house five or six times. His memory of these acts was very imperfect.

On account of repeated desertion from the army (probably likewise in epileptic states of imperfect consciousness), L. had been severely punished. In imprisonment he became insane with “epileptic insanity,” was sent to the Charité, and from there discharged “cured.” As far as the criminal acts were concerned, cynicism and wantonness could be excluded. That they were committed in a state of imperfect consciousness is probable from the fact, among other things, that to the policeman who arrested him, the “imbecile,” who was then in a cloudy state of consciousness, was in a remarkable mental state. (Liman, Vierteljahrsschrift f. ger. Med., N. F. xxxviii, H. 2.)

Case 172. L., aged 37. From October 15th to November 2d, he had many times given offense, by exhibiting himself to girls in daylight on the open street, and even in schools, into which he forced himself. It happened occasionally that he wanted the girls to perform manustupration or allow coitus, and, when refused, he performed masturbation before them. In G., in a public-house, he rapped on the window, with his penis exposed, so that the children and servant-girl in the kitchen were forced to see it.

After his arrest it was ascertained that since 1876 L. had very frequently caused trouble by exhibitions, but had always escaped punishment, owing to the demonstration of mental disease by physicians. On the other hand, he had been punished for desertion and theft in the army, and, later, once, as a civilian, for stealing cigars. L. had repeatedly been in asylums on account of insanity (attacks of insanity). Besides, he was often remarkable on account of his changeable, quarrelsome character, occasional excitement, and inconstancy.

L.’s brother died of paralysis. He himself presents no degenerative signs; no epileptic antecedents. During the time of observation he is neither insane nor mentally weakened. He behaves himself very well, and expresses great regret for his sexual crimes. About himself he states that, though no drinker, he occasionally has an impulse to drink. Soon after beginning, congestion of the head, vertigo, restlessness, anxiety, and oppression come on. He then passes into a dreamy state. An irresistible impulse now forces him to expose himself; and he then experiences a feeling of relief and breathes more easily. When he has once exposed himself, he knows nothing more of what he does. As precursors of such attacks, he had often, a short time before, had flames before the eyes, and vertigo. For the time of his clouded state of consciousness, he had but a clouded, dreamy memory.

It was only after a time that sexual ideas and impulses had become associated with these apprehensive, cloudy states of consciousness. Years ago, in such states, without motive and with great danger, he had deserted; once he had jumped from a third-story window; on another occasion he had left a good position to wander about aimlessly in a neighboring country, where he was at once arrested for exhibition.

When, outside of his abnormal periods, L. once became intoxicated, there was no exhibition. In the lucid state his sexual feeling and intercourse are perfectly normal. (Dr. Hotzen, Friedreich’s Blätter, 1890, H. 6). For other instances, vide Cases 153, 155.

A clinical group that very nearly approaches the epileptic exhibitionists is made up of certain neurasthenic individuals, in whom, likewise, there may occur attacks (epileptoid?) of imperfect consciousness[129] in connection with a feeling of apprehensive oppression; and with this sexual impulses may be associated, resulting in acts of exhibition having an impulsive character.

Case 173. Dr. S., academic teacher, had aroused public indignation by being seen repeatedly running about in the Zoological Garden at Berlin, before ladies and children, with his genitals hanging out. S. admitted this, but denied all thought or consciousness of causing public offense, and excused himself by saying that his running about with exposed genitals afforded him relief from nervous excitement. Mother’s father was insane, and died by suicide; his mother was constitutionally neuropathic, a somnambulist, and had been temporarily insane. The culprit was neuropathic, had been a somnambulist, and had had continuous aversion to sexual intercourse with females. In his youth he practiced onanism. He was a neurasthenic man, shy, torpid, and easily became embarrassed and confused. He was sexually always much excited. Frequently he dreamed that he was running about with exposed genitals, or that, dressed only in a shirt, he hung from a fence with his head downward, so that the shirt fell down, exposing his erected penis. His dreams would induce pollution, and he would then have rest for a few days or an entire week.

Also, in his waking state, the impulse would often come upon him, just as in his dreams, to run about with exposed genitals. As he was about to expose himself, he would become very hot, and then he would run aimlessly about. The member would become moist with secretion, but pollution was never induced. Finally, when it had become flaccid, he would put it up, and then come to himself, glad if no one had seen him. In such conditions of excitement he seemed to be in a dream; as if intoxicated. He had never had the intention to offend women. S. was not epileptic. His declarations had the impress of truth. He had actually never followed or spoken to women while in this condition. Frivolity and coarseness were excluded. In agreement with Westphal, the author regards S. as belonging “to a class of individuals of peculiar hypochondriacal tendencies, in whom the attention is constantly directed, in an abnormal way, to certain bodily sensations and processes; who brood over these, connecting all kinds of peculiar conceptions with them, at last making use of quite as strange means to combat the bodily sensations and ideas.” At least, S.’s act was due to pathological sensation and idea, and S. was in a condition of pathological disturbance of mental action at the time of the commission of his acts. In the case of this exhibitionist, the manner of satisfaction of the sexual instinct may be considered as peculiar to the individual. (Liman, Vierteljahrsschrift für gerichtel. Med., N. F. xxxviii, Heft 2.)

Case 174. X., aged 38; married; father of one child. Always sullen and silent. Suffers frequently with headache. Very neurasthenic, though not insane. He is troubled much at night by pollutions. He has repeatedly followed shop-girls, for whom he had lain in wait, exposing and handling his genitals. In one case he even followed a girl into a shop. (Trochon, Arch. de l’anthropologie criminelle, iii, p. 256.)

In the following case the exhibition seems subsidiary to the impulsive desire to satisfy sudden, intense libido, by means of masturbation:—

Case 175. R., coachman, aged 49, Vienna; married since 1866; childless. Father neuropathic and given to sexual excesses; died of cerebral disease. He presents no degenerative signs.

At the age of twenty-nine he suffered a severe concussion by falling from a height. Up to that time the vita sexualis had been normal. Since that time, every three or four months, he has been seized with very painful sexual excitement, accompanied by an intense desire to masturbate. A feeling of weariness and discomfort, with a desire for alcoholic indulgence, precedes this. In the intervals he is sexually cold, and has but very infrequent desire for his wife, who, moreover, for five years has been sick, and incapable of cohabitation. He gives the assurance that, as a young man, he never masturbated, and that, in the intervals between his attacks, he has never thought of satisfying himself sexually in this way.

The impulse to masturbation during the attack is always excited by certain feminine charms,—short cloak, pretty foot and ankle, elegant appearance. Age makes no difference; even little girls excite him. The impulse is sudden and unconquerable. R. describes the situation and act as characteristically impulsive. He had often tried to resist it; but then he would grow hot, terribly frightened, his head would burn, and he would seem to be in a fog; but he never lost consciousness. At the same time he would have violent, darting pain in the testicles and spermatic cords. He regretted it, but had to confess that the impulse was stronger than his will. In such a situation it forced him to masturbate, no matter where he might be. After ejaculation he would become calm, and regain his self-control. He regarded it as a terrible affliction. Defense shows that R. has been punished six times for similar offenses—exhibition and masturbation in the open street.

On November 4, 1889, R., while in his worst condition, happened to be in the street as a crowd of school-girls went by. This awakened his unconquerable impulse. There was not time to run to a closet, he was so excited. There was immediate exhibition, masturbation in front of a house,—great scandal and immediate arrest. R. is not weak-minded, and has no ethical defect. He bemoans his fate, deeply regrets his act, and fears new attacks. He regards his condition as abnormal,—as a fate against which he is powerless.

He thinks himself still virile. Penis abnormally large. Cremasteric reflex present; patellar reflex increased. Weakness of the sphincter of the bladder, that has existed for some years. Various neurasthenic difficulties.

The opinion showed that R. was subject to the influence of abnormal conditions, and had acted impulsively. Patient was sent to an asylum, from which he was discharged after a few months.

In the foregoing case the important point, clinically, lies not in the neurosis that is present, but rather in the impulsive character of the act (exhibition dependent on masturbation).

With the enumeration of the categories of imbeciles, of mentally weakened individuals, and of the exhibitionists that are in a neurotic (epileptic or neurasthenic) state of imperfect consciousness, apparently the clinical and forensic side of this phenomenon is still unexhausted; in addition to these, there is another class, the representatives of which, owing to deep hereditary taint (hereditary degenerative neurosis?), are impelled to periodical and very impulsive exhibition.

With reference to these conditions of psychopathia sexualis periodica (comp. “Periodical Insanity”), in which the accidentally-awakened impulse to exhibition is but a partial manifestation of a clinical whole, like dipsomania periodica, Magnan, from whom I borrow the following instructive cases, justly lays the greatest stress upon the impulsive, periodical feature of these abnormal impulses; and no less upon the fact that they are often accompanied by terrible anxiety, which, after the realization of the impulse, gives place to a feeling of relief.

These facts, and no less, the clinical picture of degeneracy that, for the most part, is referable to injurious conditions that are hereditary, or that exercise an injurious effect on the development of brain in early years (rachitis, etc.), are, medicolegally, of decisive importance [with reference to the question of responsibility].

Case 176. G., aged 29, waiter in a café. In 1888, while standing under a church-door, he exhibited himself to several girls working opposite. He confessed the act, and also that, many times, in the same place and at the same time of day, he had been guilty of the same crime, having been punished for it, the year before, with imprisonment for one month.

G. has very nervous parents. His father is mentally unstable and very irascible. His mother is at times insane, and suffers with severe nervous disease.

G. has always had nervous twitching of the face, and constant alternation of causeless depression, with tædium vitæ, and periods of elation. At the ages of ten and fifteen, for slight cause, he wished to commit suicide. When excited, he has similar twitching of the extremities. He presents constant general analgesia. In prison he was at first beside himself with shame about the disgrace he had brought on his family, and said he was the worst of men, deserving the severest punishment.

Until his nineteenth year G. had satisfied himself with solitary and mutual masturbation, and, on one occasion, he had practiced onanism with a girl. From that time, working in a café, the female customers had excited him so intensely that ejaculation was often induced. He suffered with almost constant priapism, and, as his wife stated, in spite of coitus, it often disturbed his rest at night. For seven years he had repeatedly exhibited himself at his window, and also exposed himself naked to female neighbors living opposite.

In 1883 he married out of desire. Marital intercourse did not satisfy his needs. At times his sexual excitement was so intense that he had headache, and seemed confused, like one drunk, strange, and incapable of work.

Case 177. B., aged 27; of neuropathic mother and alcoholic father. He has one brother who is a drinker; and an hysterical sister.

After his eleventh year, onanism, solitary or mutual. After his fifteenth year, impulses to exhibition. He attempted it at a street-urinal; he felt pleasure in it, but also immediately twinges of conscience. If he attempted to oppose his impulse thereafter, he became apprehensive, and had a feeling of oppression in his chest. When a soldier, he was often impelled to expose himself, under various pretexts, to his comrades.

After his seventeenth year he had sexual congress with women. It gave him great pleasure to show himself naked before them. He continued his exhibition on the street. Since he could but infrequently count on female spectators at urinals, he changed his place to churches. In order to exhibit himself at such places, he always had to strengthen his courage by drinking. Under the influence of spirits, the impulse, at other times controllable with difficulty, became irresistible. He was not sentenced. He lost his position, and then drank more. Not long after, he was again arrested for exhibition and masturbation in a church.

Case 178. X., aged 35; barber’s assistant. Repeatedly punished for offense against decency, he is again arrested; for, during three weeks, he had been hanging around girls’ schools, trying to attract the attention of the pupils, and, when he had succeeded in this, had exhibited himself. Occasionally he had promised them money, with the words, “Habeo mentulam pulcherrimam, venite ad me ut eam lambatis.” At his examination X. confessed everything, but did not know how it had come about. He was the most reasonable of men in other respects, but had the impulse to commit this crime, and could not overcome it.

In 1879, when in the army, he was once out on leave, and had run around exhibiting himself to children: imprisonment for a year. The same crime in 1881. He chased the crying children, and “stared” at them: imprisonment of one year and three months. Two days after his discharge, he said to two little girls: “If you want to see my tail, come with me to this (market) booth.” He denied these words, and claimed drunkenness: imprisonment for three months.

In 1883, renewed exhibition; during the act he said nothing. At his examination he stated that, since a severe illness, eight years previously, he had suffered with such excitations: imprisonment for one month.

In 1884, exhibition before girls in a church-yard; again in 1885. He declared: “I understand my crime, but it is like a disease. When it comes over me, I cannot keep from such acts. It sometimes happens that, for quite a long time, I am free from these inclinations.” Imprisonment for six months.

Discharged on August 12, 1885, he had a relapse on August 15. The same excuse was given. This time he underwent medical examination. The examination revealed no mental disturbance. Sentenced to three years. After discharge, a series of new exhibitions. On this occasion, examination revealed the following:—

His father suffered with chronic alcoholism, and is said to have been guilty of the same crime. Mother and sister nervously ill, and the whole family of excitable temperament.

From his seventh to his eighteenth year X. suffered with epileptic convulsions. First cohabitation at sixteen; later, gonorrhœa and, it is stated, syphilis. After that, normal sexual intercourse until his twenty-first year. At that time he often had to pass a play-ground, and he occasionally had to urinate there; and it happened that the children looked at him, out of curiosity.

He noticed, occasionally, that this looking at him caused him sexual excitement, and induced erection, and even ejaculation. He now found more pleasure in this kind of sexual gratification, and became indifferent about coitus, satisfying himself only in this manner. He felt that all his thought was ruled by this, and he dreamed only of exhibitions, with pollutions. His attempts to control his impulse became more and more ineffectual. It came over him with such force that he noticed nothing around him, and saw and heard nothing, and was like one “devoid of reason,”—like “a bull trying to butt his head through a wall.”

X. has an abnormally broad head. Small penis; the left testicle deformed. Patellar reflex absent. Symptoms of neurasthenia, especially cerebral. Frequent pollutions. For the most part, his dreams are about normal coitus, only infrequently about exhibition before little girls.

With reference to his sexual acts, he states that the impulse to seek and approach little girls is primary; only when he has succeeded in attracting their attention to his exposed genitals do erection and ejaculation occur. He does not lose consciousness in the act. After it he is troubled about his deed, and, if undiscovered, says to himself, “Once more I have escaped the authorities.”

In prison he did not have the impulse; there, he was troubled only with dreams and pollutions. In freedom he had daily sought opportunity to satisfy himself with exhibition. He would give ten years of his life to be free from the thing; “this life of constant anxiety, this alternation between freedom and imprisonment, is unendurable.”

The opinion assumed a congenital (?) perversity of the sexual instinct, with unmistakable hereditary taint, neuropathic constitution, asymmetry of cranium, and defective development of the genitals.

It is also worthy of remark that the exhibition began when the epilepsy ceased; so that one might think of a vicarious phenomenon.

The sexual perversity developed, with predisposition, through accidental association of ideas of sexual content (children looking at him while urinating) with an act that, in itself, was purposeless.

The patient was not sentenced, but sent to an asylum. (Dr. Freyer, Zeitschr. f. Medicinalbeamte, 3 Jahrg., No. 8.)

Case 179. At 9 o’clock at night, in the spring of 1891, a lady, in great trepidation, came to the policeman in the city park of X., with the statement that a man, absolutely naked in front, had approached her from the bushes, and she had run away, frightened. The officer went at once to the place indicated, and found a man, who exposed ventrem et genitalia nuda. He attempted to escape, but was overtaken and arrested. He stated that he had been sexually excited by alcohol, and had been on the point of going to a prostitute. On his way through the park, however, he recalled the fact that exhibition gave him much greater pleasure than was afforded him by coitus, in which he seldom, and only faute de mieux, indulged. After drawing up his shirt, he posted himself in the bushes, and, when two women came up the path, he approached them with exposed genitals. In such exhibition he had a pleasurable feeling of warmth, and the blood mounted to his head.

The accused works in a manufactory, and his employer states that he is faithful, saving, sober, and intelligent.

In 1886 B. had been punished because he had twice exhibited himself publicly,—once in broad daylight, and once at night, under a lamp.

B., aged 37, single, makes a peculiar impression, owing to his dandified dress and affected manner. His eyes have a neuropathic, languishing expression; around his mouth plays a smile of self-satisfaction. He is said to come of healthy parents. A sister of his father, and one of his mother, were insane. Others of their relatives were thought religiously eccentric.

B. has never had any severe illness. From childhood he was eccentric and imaginative. He loved romances about knights and others, was entirely absorbed by them, and even went so far as to identify himself in fancy with the heroes. He always thought himself a little better than others, and thought much of elegant dress and ornament; and when he strutted about on Sundays, he imagined himself a high official.

B. has never had epileptic symptoms. In youth, moderate indulgence in masturbation; later, moderate indulgence in coitus. Previously, never any perverse sexual feelings or impulses. Retired manner of life; in leisure hours, reading (popular novels, heroic tales, Dumas, and others). B. was no drinker. Exceptionally he made himself a kind of punch, by which he was always excited sexually.

For some years, with marked decrease of libido, after such alcoholic indulgence, he had had “accursedly silly thoughts,” and developed the desire genitalia adspectui feminarum publice exhibere.

If he got into this state, he felt warm, his heart beat violently, blood rushed to his head, and he could then no longer resist his impulse. He heard and saw nothing more, and was absolutely absorbed in his lust. Afterward he had often pounded his crazy head with his fists, and firmly resolved never to do such a thing again; but the crazy ideas had always returned.

In his exhibition his penis became only half-erected, and ejaculation never occurred; even in coitus it was always tardy. In exhibition he was satisfied with genitalia sua adspicere, and he had the lustful thought that this sight must be very pleasant to women, since he liked so much to see genitalia feminarum. He was capable of coitus only when the puella showed herself very partial to him; without this, he preferred rather to pay and go without doing anything. In his dreams he exhibited himself to young, voluptuous women.

The medico-legal opinion recognized the hereditary psychopathic character of the culprit, and the perverse, impulsive desire to perform the incriminating acts; and pointed out, further, the remarkable fact that in B., who was otherwise sober and saving, the impulses to indulge in alcohol depended on abnormal conditions that recurred periodically, and forced him to indulge. That, during his attacks, B. was in an exceptional psychical state, in a kind of mental confusion, and absolutely absorbed in his perverse sexual fancy, is clearly shown by the species facti. Thus is explained the fact that he became aware of the approach of the police only when it was too late to try to escape. In this hereditary and degenerate impulsive exhibitionism, it is interesting to note how the perverse sexual impulse is awakened from its latency by the influence of alcohol.

A forensically important variety of exhibition, which, clinically, certainly rests upon a similar neurotic and degenerate foundation, and which expresses itself in a peculiar act, conditioned by violent libido (hyperæsthesia sexualis), associated with diminished virility, is made up of the so-called frotteurs.

The three following cases, borrowed from Magnan (op. cit.), are typical:—

Case 180. D., aged 44, hereditarily predisposed, drinker, and suffering with lead poisoning. Until the last year he had masturbated much, and often drawn pornographic pictures, and shown them to his acquaintances. He had repeatedly dressed himself as a woman in secret. For two years, since becoming impotent, he had felt desire, while in crowds at dusk, mentulam denudare eamque ad nates mulieris crassissimæ terere. Once, when discovered in the act, he had been sentenced to imprisonment for four months.

His wife kept a milk-shop. Iterum iterumque sibi temperare non potuit quin genitalia in ollam lacte completam mergeret. In the act he felt lustful pleasure, “as if touched with velvet.” He was cynical enough to use this milk for himself and the customers. During imprisonment alcoholic persecutory insanity developed in him.

Case 181. M., aged 31; married six years; father of four children; badly predisposed; subject to melancholia at times. Three years before, he was discovered by his wife with a silk dress on, masturbating. One day he was discovered, in a store, in the act of frottage on a lady. He was very repentant, and asked to be severely punished for his irresistible impulse.

Case 182. G., aged 33; badly predisposed hereditarily. At an omnibus-station he was discovered in the act of frottage with his penis on a lady. Deep repentance; but he stated that at the sight of a noticeable posteriora of a lady, he was irresistibly impelled to practice frottage, and that he became confused and knew not what he did. Sent to an asylum.

Case 183. A frotteur. Z., born in 1850; of blameless life previously; of good family; private official. He is well-to-do financially; untainted. After a short married life he became a widower, in 1873. For some time he had attracted attention in churches, because he crowded up behind women, both old and young indifferently, and toyed with their tournures. He was watched, and one day he was arrested in the act. Z. was terribly frightened, and in despair about his situation; and, in making a full confession, he begged for pardon, for nothing but suicide remained for him.

For two years he had been subject to the unhappy impulse to go in crowds of people,—in churches, at box-offices of theatres, etc,—and press up behind females and manipulate the prominent portion of their dresses, having orgasm and ejaculation during the act.

Z. states that he was never given to masturbation, and had never been in any way perverse sexually. Since the early death of his wife, he had gratified his great sexual desire in temporary love-affairs, having always had an aversion for prostitutes and brothels. The impulse to frottage had suddenly seized him, two years before, while he happened to be in church. Though he was conscious that it was wrong, he could not help yielding to it immediately. Since then he had been excitable to the posteriora of females, and had been actually impelled to seek opportunity for frottage. The only thing on women that excited him was the tournure; every other part of the body and attire was a matter of indifference to him; and it made no difference to him whether the woman was old or young, beautiful or ugly. Since this began, he had had no more inclination for natural gratification. Of late frottage scenes had appeared in his dreams. During his acts he was fully conscious of his situation and the act, and tried to perform it in such a way as to attract as little attention as possible. After his act he was always ashamed of what he had done.

The medical examination revealed no sign of mental disease or mental weakness, but symptoms of neurasthenia sexualis,—ex abstinentia libidinosi (?),—which was also proved by the circumstance that even simple touching of the fetich with the unexposed genitals sufficed to induce ejaculation. Apparently Z., weakened sexually and distrusting his virility, and yet libidinous, had come to practice frottage by having the sight of posteriora feminæ fall together accidentally with sexual excitement; and this associative combination of a perception with a feeling permitted the former to attain the significance of a fetich.

As an act which offends public morals, and which is, therefore, punishable, the violation of statues—a whole series of cases of which Moreau (op. cit.) has collected from ancient and modern times—may be enumerated here. They are, unfortunately, given too much like anecdotes to allow satisfactory judgment of them. They always give the impression of being pathological,—like the story of a young man (related by Lucianus and St. Clemens, of Alexandria) who made use of a Venus of Praxiteles for the gratification of his lust; and the case of Clisyphus, who violated the statue of a goddess in the Temple of Samos, after having placed a piece of meat on a certain part. In modern times, the Journal L’événement of March 4, 1877, relates the story of a gardener who fell in love with a statue of the Venus of Milo, and was discovered attempting coitus with it. At any rate, these cases stand in etiological relation with abnormally intense libido and defective virility or courage, or lack of opportunity for normal sexual gratification.

The same thing, must be assumed in the case of the so-called voyeurs,[130]—i.e., men who are so cynical that they seek to get sight of coitus, in order to assist their virility; or who seek to have orgasm and ejaculation at the sight of an excited woman. Concerning this moral aberration, which, for various reasons, cannot be further described here, it will suffice to refer to Coffignon’s book, “La Corruption à Paris.” The revelations, in the domain of sexual perversity, and also perversion, which this book makes, are horrible.

2. Rape and Lust-Murder.

(Austrian Statutes, § 125, 127; Austrian Abridgment, § 192; German Statutes, § 177.)

By the term rape, the jurist understands coitus, outside of the marriage relation, with an adult, enforced by means of threats or violence; or with an adult in a condition of defenselessness or unconsciousness; or with a girl under the age of fourteen years. Immissio penis, or, at least, conjunctio membrorum (Schütze), is necessary to establish the fact. To-day, rape on children is remarkably frequent. Hofmann (“Ger. Med.,” i, p. 155) and Tardieu (“Attentats”) report horrible cases.

The latter establishes the fact that, from 1851 to 1875 inclusive, 22,017 cases of rape came before the courts in France, and, of these, 17,657 were committed on children.

The crime of rape presumes a temporary, powerful excitation of sexual desire, induced by excess in alcohol, or by some other condition. It is highly improbable that a man morally intact would commit this most brutal crime. Lombroso (Goltdammer’s Arch.) considers the majority of men who commit rape to be degenerate, particularly when the crime is done on children or old women. He asserts that, in many such men, he has found actual signs of degeneracy.

It is a fact that rape is very often the act of degenerate male imbeciles,[131] where, under some circumstances, the bond of blood is not respected.

Cases as a result of mania, satyriasis, and epilepsy, have occurred, and are to be kept in mind.

The crime of rape may follow the murder of the victim.[132] There may be unintentional murder, murder to destroy the only witness of the crime, or murder out of lust (v. supra). Only for cases of the latter kind should the term lust-murder[133] be used.

The motives of lust-murder have been previously considered. The cases given in illustration are characteristic of the manner of the deed. The presumption of a murder out of lust is always given when injuries of the genitals are found, the character and extent of which are such as could not be explained by merely a brutal attempt at coitus; and, still more, when the body has been opened, or parts (intestines, genitals) torn out, and are wanting.[134]

Lust-murders dependent upon psychopathic conditions are never committed with accomplices.

Case 184. Weak-mindedness, Epilepsy. Attempt at Rape; Murder.—On the evening of May 27, 1888, an eight-year-old boy, Blasius, was playing with other children in the neighborhood of the village of S. An unknown man came along and enticed the boy into the woods. The next day the boy’s body was found in a ravine, with the abdomen slit open, an incised wound in the cardiac region, and two stab-wounds in the neck.

Since, on May 21st, a man, answering to the description given of the murderer by the children, had attempted to treat a six-year-old girl in a similar manner, and had only accidentally been detected, it was presumed to be a case of lust-murder. It was proved that the body was found in a heap, with only the shirt and jacket on; also, that there was a long incision in the scrotum.

Suspicion fell upon a peasant, E.; but, on confrontation with the children, it was not possible to identify him with the stranger who had enticed the boy into the woods. Besides, with the help of his sister, he proved an alibi. The untiring efforts of the officers brought new evidence to light, and finally E. confessed. He had enticed the girl into the woods, thrown her down, exposed her genitals, and was about to abuse her; but, as she had an eruption on her head, and was crying loudly, his desire cooled, and he fled.

After he enticed the boy into the woods, with the pretext of showing him a bird’s nest, he was taken with a desire to abuse him. Since the boy refused to take off his trousers, he did it for him; and when the boy began to cry out, he stabbed him twice in the neck. Then he made an incision, just above the pubes, in imitation of female genitals, in order to use it to satisfy his lust. But, since the body grew cold immediately, he lost his desire, and, cleaning his knife and hands near the body, he fled. When he saw the boy dead, he was filled with fear, and his limbs became weak.

During his examination E. looked apathetically at a garland. He had acted in a state of mental weakness. He could not understand how he came to do such a thing. He must have been beside himself; for he often became senseless, so that he would almost fall down. Previous employers report that he had periods when he was devoid of thought and confused, doing no work all day, and avoiding others. His father states that E. learned with difficulty, was unskillful at work, and often so obstinate that one did not think to punish him. At such times he would not eat, and occasionally ran away and remained all day. At such times he also seemed quite lost in thought, screwed his face up, and said senseless things. When quite a boy, he still sometimes wet the bed, and often came home from school with wet or soiled clothing. He was very restless in sleep, so that no one could sleep beside him. He had never had playmates. He had never been cruel, bad, or immoral.

His mother gave similar testimony; and further, that, in his fifth year, E. first had convulsions, and once lost the power of speech for seven days. Sometime about his seventh year he once had convulsions for forty days, and was also dropsical. Later, too, he was often seized in sleep, and he often then talked in his sleep; and mornings, after such nights, the bed was found wet.

At times it was impossible to do anything with him. Since his mother did not know whether it was due to viciousness or disease, she did not venture to punish him.

Since his convulsions, in his seventh year, he had failed so in mind that he could not learn even the common prayers; and he also became very irascible.

Neighbors, persons prominent in the community, and teachers, state that E. was peculiar, weak-minded, and irascible; that at times he was very strange, and apparently in an exceptional mental state.

The examinations of the medical experts gave the following results:—

E. is tall, slim, and poorly nourished. His head measures 53 centimetres in circumference. The cranium is rhombic, and in the occipital region flattened.

His expression is devoid of intelligence; his glance is fixed, expressionless; his attitude is careless, and his body is bent forward. Movements are slow and heavy. Genitals normally developed. E.’s whole appearance points to torpidity and mental weakness.

There are no signs of degenerative marks, no abnormality of the vegetative organs, and no disturbances of motility or sensibility. He comes of a perfectly healthy family. He knows nothing of convulsions or of wetting his bed at night, but he states that, of late years, he has had attacks of vertigo and loss of mind.

At first, in circumlocution, he denies the murder. Later, in great contrition, before the examining judge, he confessed all, and gave a clear motive for his crime. He had never had such a thought before.

He has been given to onanism for years; he even practiced it twice daily. He states that, for want of courage, he had never ventured to ask coitus of a woman, though in dreams such scenes exclusively passed before him. Neither in dreams nor in the waking state had he ever had perverse instincts; particularly no sadistic or contrary sexual feelings. Too, the sight of the slaughter of animals had never interested him. When he enticed the girl into the woods, his desire was to satisfy his lust with her; but how it happened that he tried such a thing with a boy, he could not explain. He thought he must have been out of his mind at that time. The night after the murder he could not sleep on account of fear; he had twice confessed already, to ease his conscience. He was only afraid of being hung. This should not be done, as he had done the deed in a weak-minded condition.

He could not tell why he had cut open the boy’s abdomen. It had not occurred to him to handle the intestines, smell them, etc. He stated that, after the attempt on the girl in the day-time, and in the night, after the murder of the boy, he had convulsions. At the time of his crime he was indeed conscious, but he had not thought at all of what he did.

He suffered much with headache; could not endure heat, thirst, or alcohol; there were times when he was perfectly confused. The test of his intelligence showed a high grade of weak-mindedness.

The opinion (Dr. Kautzner, of Graz) showed the imbecility and neurosis of the accused, and made it probable that his crime, for which he had only a general recollection, had been committed in an exceptional (præ-epileptic) mental state, conditioned by the neurosis. Under all circumstances, E. was considered dangerous, and probably would require commitment to an asylum for life.

3. Bodily Injury, Injury to Property, and Torture of Animals Dependent on Sadism.[135]

(Austrian, § 152, 411; German, § 223 [bodily injury]. Austrian, § 85, 468; German, § 303 [injury to property]. Austrian Police Regulations; German Statutes, § 360 [torture of animals].)

Aside from lust-murder, described in the foregoing section, as milder expressions of sadistic desires, impulses to stab, flagellate, or defile females, to flagellate boys, to maltreat animals, etc., also occur.

The deep degenerative significance of such cases is clearly demonstrated by the series of examples given under “General Pathology.” Such mentally degenerate individuals, should they be unable to control their perverse impulses, could only be objects of care in asylums.

4. Bodily Injury, Robbery, and Theft Dependent on Fetichism.

(Austrian, § 190; German, § 249 [robbery]. Austrian, § 171, 460; German, § 242 [theft].)

It is seen from the section on fetichism, under “General Pathology,” that pathological fetichism may become the cause of crimes. There are now recognized, as such, hair-despoiling (Cases 78, 79, 80); robbery or theft of female linen, handkerchiefs, aprons (Cases 82, 83, 85, 86), shoes (Cases 68, 87, 88), and silks (Case 93). It cannot be doubted that such individuals are subjects of deep mental taint. But, for the assumption of an absence of mental freedom and consequent irresponsibility, it must be proved that there was an irresistible impulse, which, either owing to the strength of the impulse itself, or to the existence of mental weakness, made control of the punishable, perverse impulsion impossible. Such crimes and the peculiar manner in which they are performed,—in which they differ very much from common robbery and theft,—always demand a medico-legal examination. But that the act per se does not, by any means, necessarily arise from psycho-pathological conditions is shown by the infrequent cases of hair-despoiling[136] simply for the purpose of gain.

5. Violation of Individuals Under the Age of Fourteen.

(Austrian Statutes, § 128, 132; Austrian Abridgment, § 189, 191^3; German Statutes, § 174, 176^3)

By violation of sexually immature individuals, the jurist understands all the possible immoral acts with persons under fourteen years of age that are not comprehended in the term rape. The term violation, in the legal sense of the word, comprehends the most horrible perversions and acts, which are possible only to a man who is controlled by lust and morally weak, and, as is usually the case, lacking in sexual power.

A common feature of these crimes, committed on persons that are more or less children, is that they are unmanly, childish, and often silly. It is a fact that such acts, with exceptions in pathological cases, like those of imbeciles, paretics, and senile dements, are almost exclusively committed by young men who lack courage or have no faith in their virility; or by roués who have, to some extent, lost their virility. It is psychologically incomprehensible that an adult of full virility, and mentally sound, should indulge in sexual abuses with children.

The imagination of debauchees, in actively or passively picturing the immoral acts, is exceedingly lively; and that the following enumeration of the sexual acts of this kind known to law exhausts all the possibilities is questionable. Most frequently the abuse consists of sexual handling (under some circumstances, flagellation[137]), active manustupration, or seducing children by inducing them to perform onanism, or lustful handling, on the seducer. Less frequent acts are cunnilingus, irrumare on boys or girls, pædicatio puellarum, coitus inter femora, and exhibition.

In a case which Maschka reports (“Handb.,” iii, p. 174), a young man had naked girls, from eight to twelve years old, dance about in his room, and urinate before him, until he ejaculated. Not infrequently boys are abused by sensual women, who undertake to bring about conjunctio membrorum with them, in order to satisfy themselves by means of friction or onanism.[138]

Tardieu saw one of the most disgusting examples. A servant, in company with her lover, masturbated children intrusted to them, performed cunnilingus with a girl of seven, and introduced parsnips and potatoes into her vagina, and put similar things into the rectum of a baby of two years!

Case 185. Z., aged 62; deeply tainted, masturbator. He states he has never had coitus, but has frequently practiced fellatio. He is in an asylum, on account of paranoia. It had been his greatest pleasure to entice girls, aged from ten to fourteen years, and practice cunnilingus and other vile acts with them. In these acts he had orgasm and ejaculation. Masturbation did not give him the same satisfaction, and induced ejaculation only with difficulty. Faute de mieux he also practiced fellatio with men; occasionally an exhibitionist. Phimosis; asymmetrical cranium. (Pelanda, Arch. di Psichiatria, x. fascic. 3, 4.)

Case 186. X., priest, aged 40. He was accused of enticing girls, aged from ten to thirteen, undressing and fondling them lustfully, and finally masturbating. He is tainted, and has been an onanist from childhood; morally imbecile; always very excitable sexually. Head somewhat small. Penis unusually large; indications of hypospadiasis. (Pelanda, loc. cit.)

Case 187. K., aged 23; laborer. He was accused and convicted of repeatedly enticing boys, and now and then girls, to an out-of-the-way place, and practicing abuses with them (mutual masturbation, fellatio puerorum, fondling of the genitals of the girls).

K. is an imbecile, and physically deformed, being scarcely 1.5 metres tall; cranium rachitic and hydrocephalic; teeth bad,—furrowed, defective, and irregular. Large lips, idiotic expression, stuttering speech, and an awkward attitude complete the picture of psycho-physical degeneration. K. behaves like a child discovered in some mischievous act. Scarcely any growth of beard. Genitals well and normally developed. He has a superficial consciousness of having done something improper, but he is unconscious of the moral, social, and legal significance of his crimes.

K. comes of a drunken father, and a mother who became insane from the abuse of her husband, and died in an asylum. In his babyhood the boy was almost blinded by corneal ulcers, and, after his sixth year, he grew up with an almoner, and later with difficulty earned his living as an organ-grinder. His brother is good for nothing, and the culprit himself was considered a surly, quarrelsome, evil, moody, irritable man. The opinion emphasized the intellectual, moral, and physical defect of the culprit.

Unfortunately it must be admitted that the most revolting of these crimes are done by sane individuals who, by reason of satiety in normal sexual indulgence, lasciviousness, and brutality, and not seldom during intoxication, forget that they are human beings.

A great number of these cases, however, certainly depend upon pathological states. This is particularly true where old men become the seducers of children.[139]

I agree with Kirn, who, under all circumstances, in cases of this kind, holds a mental examination to be always necessary; since, frequently enough, a re-awakened, perverse, abnormally intense, and uncontrollable sexual desire is shown to be one of the manifestations of a senile dementia.

6. Unnatural Abuse—Sodomy.[140]

(Austrian Statutes, § 129; Abridgment, § 190; German Statutes, § 175.)

(a) Violation of Animals—Bestiality.[141]

Violation of animals, monstrous and revolting as it seems to mankind, is by no means always due to psycho-pathological conditions. Low morality and great sexual desire, with lack of opportunity of natural indulgence, are the principal motives of this unnatural means of sexual satisfaction, which is resorted to by women as well as by men.

To Polak we owe the knowledge that in Persia bestiality is frequently practiced because of the delusion that it cures gonorrhœa; just as in Europe an idea is still prevalent that intercourse with children heals venereal disease.

Experience teaches that bestiality with cows and horses is none too infrequent. Occasionally the acts may be undertaken with goats, bitches, and, as a case of Tardieu’s and one by Schauenstein show (Lehrb., p. 125), with hens.

The action of Frederick the Great, in the case of a cavalryman who had committed bestiality with a mare, is well known: “The fellow is a beast, and shall be reduced to the infantry.”

The intercourse of females with beasts is limited to dogs. A monstrous example of the moral depravity in large cities is related by Maschka (“Handb.,” iii),—the case of a Parisian female who showed herself in the sexual act with a trained bull-dog, to a secret circle of roués, at 10 francs a head.

There has been, heretofore, but little legal consideration of the mental condition in those given to violation of animals. In several cases known to the writer, the individuals were weak-minded. In Schauenstein’s case there was insanity.

The following case of bestiality is one that was certainly conditioned by disease. He was an epileptic. In this case the desire for animals appeared as an equivalent of the normal sexual desire:—

Case 188. X., peasant, aged 40; Greek-Catholic. Father and mother were hard drinkers. Since his fifth year patient has had epileptic convulsions,—i.e., he falls down unconscious, lies still two or three minutes, and then gets up and runs wildly about with staring eyes. Sexuality was first manifested at seventeen. The patient had inclinations neither for women nor for men, but for animals (birds, horses, etc.). He had intercourse with hens and ducks, and later with horses and cows. Never any onanism.

The patient paints pictures of saints; is of very limited intelligence. For years, religious paranoia, with states of ecstasy. He has an “unspeakable” love for the Virgin, for whom he would sacrifice his life. Taken to hospital, he proves to be free from infirmity and signs of degeneration.

He had always had an aversion for women. In a single attempt at coitus with a woman he was impotent, but with animals he was always potent. He is ashamed before women; coitus with women he regards almost as a sin. (Kowalewsky, Jahrb. f. Psychiatrie, vii, Heft 3.)

Case 189. On the afternoon of September 23, 1889, W., aged 16, shoemaker’s apprentice, caught a goose in a neighbor’s garden, and committed bestiality on the fowl until the neighbor approached. On being accused by the neighbor, W. said, “Is there anything wrong with the goose?” and then went away. At his examination he confessed the act, but excused himself on the ground of temporary loss of mind. Since a severe illness, in his twelfth year, he several times a month had attacks, with heat in his head, in which he was intensely excited sexually, could not help himself, and did not know what he did. He had done the act in such an attack. He answered for himself in the same way at the trial, and stated that he knew nothing of the species facti except from the statements of the neighbor. His father states that W., who comes of a healthy family, has always been sickly since an attack of scarlatina in his fifth year, and that, at the age of twelve, he had a febrile cerebral disease. W. had a good reputation, learned well in school, and, later, helped his father in his work. He was not given to masturbation.

The medical examination revealed no intellectual or moral defect. The physical examination revealed normal genitals; penis relatively greatly developed; marked exaggeration of the patellar reflexes. In other respects, negative result.

The history of the condition at the time of the deed was not to be depended upon. There was no history of previous attacks of mental disturbance, and there were none during the six weeks of observation. There was no perversion of the vita sexualis. The medical opinion allowed the possibility that some organic cause (cerebral congestion), dependent upon cerebral disease, may have exercised an influence at the time of the commission of the criminal act. (From the opinion of Dr. Fritsch, of Vienna.)

Case 190. Impulsive Sodomy.—A., aged 16; gardener’s boy; born out of wedlock; father, unknown; mother, deeply tainted, hystero-epileptic. A. has a deformed, asymmetrical cranium, and deformity and asymmetry of the bones of the face; the whole skeleton is also deformed, asymmetrical, and small. From childhood he was a masturbator; always morose, apathetic, and fond of solitude; very irritable, and pathological in his emotional reaction. He is imbecile, probably much reduced physically by masturbation, and neurasthenic. Besides, he presents hysteropathic symptoms (limitation of the visual field, dyschromatopsia; diminution of the senses of smell, taste, and hearing on the right side; anæsthesia of the right testicle, clavus, etc.).

A. is convicted of having committed masturbation and sodomy on dogs and rabbits. When twelve years old he saw how boys masturbated a dog. He imitated it, and thereafter he could not keep from abusing dogs, cats, and rabbits in this vile manner. Much more frequently, however, he committed sodomy on female rabbits,—the only animal that had a charm for him. At dusk he was accustomed to repair to his master’s rabbit-pen, in order to gratify his vile desire. Rabbits with torn rectums were repeatedly found. The act of bestiality was always done in the same manner. There were actual attacks which came on every eight weeks, always in the evening, and always in the same way. A. would become very uncomfortable, and have a feeling as if some one were pounding his head. He felt as if losing his reason. He struggled against the imperative idea of committing sodomy with the rabbits, and thus had an increasing feeling of fear and intensification of headache, until it became unbearable. At the height of the attack there was sound of bells, cold perspiration, trembling of the knees, and, finally, loss of resistive power, and impulsive performance of the perverse act. As soon as this was done, he lost all anxiety; the nervous cycle was completed, and he was again master of himself, deeply ashamed of the deed, and fearful of the return of an attack. A. states that, in such a condition, if called upon to choose between a woman and a female rabbit, he could make choice only of the latter. In the intervals, of all domestic animals, he is partial only to rabbits. In his exceptional states simple caressing or kissing, etc., of the rabbit suffices, as a rule, to afford him sexual satisfaction; but sometimes he has, when doing this, such furor sexualis that he is forced to wildly perform sodomy on the animal.

The acts of bestiality mentioned are the only acts which afford him sexual satisfaction, and they constitute the only manner in which he is capable of sexual indulgence. A. states that, in the act, he never had a lustful feeling, but satisfaction, inasmuch as he was thus freed from the painful condition into which he was brought by the imperative impulse.

The medical evidence easily proved that this human monster was a psychically degenerate, irresponsible invalid, and not a criminal. (Boeteau, La France médicale, 38th year, No. 38.)

The following case seems to be devoid of a psychopathic basis:—

Case 191. Sodomy.—In a provincial town a man was caught in intercourse with a hen. He was thirty years old, and of high social position. The chickens had been dying one after another, and the man causing it had been searched for a long time. To the question of the judge, as to the reason for such an act, the accused said that his genitals were so small that coitus with women was impossible. Medical examination showed that the genitals were actually extremely small. The man was mentally entirely sound.

There were no statements concerning any abnormalities at the time of puberty, etc. (Gyurkovechky, “Männl. Impotenz,” 1889, p. 82.)

(b) With Persons of the Same Sex—Pederasty; Sodomy in its Strict Sense.

German law takes cognizance of unnatural sexual relations only between men; Austrian, between those of the same sex; and, therefore, unnatural relations between women are punishable.

Among the immoralities between men, pederasty (immissio penis in anum) claims the principal interest. Indeed, the jurist thought only of this perversity of sexual activity; and, according to the opinions of distinguished interpreters of the law (Oppenhoff, “Stgsb.,” Berlin, 1872, p. 324, and Rudolf and Stenglein, “D. Strafgesb. f. d. Deutsche Reich,” 1881, p. 423), immissio penis in corpus vivum belongs to the criminal act covered by § 175.

According to this interpretation, legal punishment would not follow other improper acts between male persons, so long as they were not complicated with offense to public decency, with force, or undertaken with boys under the age of fourteen. Of late this interpretation has again been abandoned, and the crime of unnatural abuse between men has been assumed when merely acts similar to cohabitation were performed.[142]

The study of contrary sexual instinct has placed male love of males in a very different light from that in which it, and particularly pederasty, stood at the time the statutes were framed. The fact that there is no doubt about the pathological basis of many cases of contrary sexual instinct shows that pederasty may also be the act of an irresponsible person, and makes it necessary, in court, to examine not merely the deed, but also the mental condition of the perpetrator.

The principles laid down previously must also be adhered to here. Not the deed, but only an anthropological and clinical judgment of the perpetrator can permit a decision as to whether we have to do with a perversity deserving punishment, or with an abnormal perversion of the mental and sexual life, which, under certain circumstances, excludes punishment. The next legal question to settle is whether the contrary sexual feeling is congenital or acquired; and, in the latter case, whether it is abnormal perversion or moral perversity.

Congenital contrary sexual instinct occurs only in predisposed (tainted) individuals, as a partial manifestation of a defect evidenced by anatomical or functional abnormalities, or both. The case becomes clearer, and the diagnosis more certain, if the individual, in character and disposition, seems to correspond entirely with his sexual peculiarity; and if the inclination toward persons of the opposite sex is entirely wanting, and horror of sexual intercourse with them is felt; and if the individual, in the impulses to satisfy the contrary sexual instinct, shows other anomalies of the sexual sphere, such as more pronounced degeneration in the form of periodicity of the impulse and impulsive conduct, and is a neuropathic and psychopathic person.

Another question concerns the mental condition of the urning. If this be such as to remove the possibility of moral responsibility, then the pederast is not a criminal, but an irresponsible insane person. This condition in congenital urnings is apparently less frequent than another. As a rule, these cases present elementary psychical disturbances, which do not remove responsibility. But this does not settle the question of the responsibility of the urning. The sexual instinct is one of the most powerful organic needs. There is no law that looks upon its satisfaction outside of marriage as punishable in itself; if the urning feels perversely, it is not his fault, but the fault of a condition natural to him. His sexual instinct may be æsthetically very repugnant, but, from his stand-point, it is natural. And, too, in the majority of these unfortunates, the perverse sexual instinct is abnormally intense, and their consciousness recognizes it as nothing unnatural. Thus they fail to have moral and æsthetic ideas to assist them in resisting the instinct. Innumerable normally constituted men are in a position to overcome the desire for satisfaction of their libido without suffering from it in health. Many neuropathic individuals,—and urnings are almost always neuropathic,—on the contrary, become nervously ill when they do not satisfy the sexual desire, either as Nature prompts or in a way that is for them perverse.

The majority of urnings are in a painful situation. On the one hand, there is an impulse toward persons of their own sex that is abnormally intense, the satisfaction of which has a good effect, and is natural to them; on the other, is public sentiment which stigmatizes their acts, and the law which threatens them with punishment. Before them lies mental despair,—even insanity and suicide,—at the very least, nervous disease; behind them, shame, loss of position, etc. It cannot be doubted that, under these circumstances, states of necessity and compulsion may be created by the unfortunate natural disposition and constitution. Society and the law should understand these facts. The former must pity, and not despise, such unfortunates; the latter must cease to punish them,—at least, while they remain within the limits which are set for the activity of their sexual instinct.

As a confirmation of these opinions and demands concerning these step-children of Nature, it is permissible to reproduce here the memorial of an urning to the author. The writer of the following lines is a man of high position in London:—

“You have no idea what a constant struggle we all—particularly those of us that have the most mind and finest feelings—have to endure, and how we suffer under the prevailing false ideas about us and our so-called immorality.

“Your opinion that the phenomenon under consideration is primarily due to a congenital ‘pathological’ disposition will, perhaps, make it possible to overcome existing prejudices, and awaken pity for poor, ‘abnormal’ men, instead of the present repugnance and contempt. Much as I believe that the opinion expressed by you is exceedingly beneficial to us, I am still compelled, in the interest of science, to repudiate the word ‘pathological’; and you will permit me to express a few thoughts with respect of it.

“Under all circumstances the phenomenon is anomalous; but the word ‘pathological’ conveys another meaning, which I cannot think suits this phenomenon; at least, as I have had occasion to observe it in very many cases. I will allow, a priori, that, among urnings, a far higher proportion of cases of insanity, of nervous exhaustion, etc., may be observed than in other normal men. Does this increased nervousness necessarily depend upon the character of urningism, or is it not, in the majority of cases, to be ascribed to the effect of the laws and the prejudices of society, which prohibit the indulgence of their sexual desires, depending on a congenital peculiarity, while others are not thus restrained?

“The youthful urning, when he feels the first sexual promptings and näively expresses them to his comrades, soon finds that he is not understood; he shrinks into himself. If he tell his parents or teacher what moves him, that which is as natural to him as swimming is to a fish is described as wrong and sinful, and he is told it must be fought and overcome at any price. Then an inner conflict begins, a powerful repression of sexual inclinations; and the more the natural satisfaction of desire is repressed, the more lively the fancy becomes, and paints the very pictures that the wish is to banish. The more energetic the character that carries on this inner conflict, the more the whole nervous system must suffer. Such a powerful repression of an instinct so deeply implanted in us, in my opinion, develops the abnormal symptoms which are observed in many urnings; but this does not necessarily follow from the urning’s disposition.

“Some continue the conflict for a longer or shorter time, and thus injure themselves; others at last come to the knowledge that the powerful instinct born in them cannot possibly be sinful, and, therefore, they cease to try to do the impossible,—the repression of the instinct. Then, however, begin constant suffering and excitement. When a normal man seeks satisfaction of sexual inclination, he knows how to find it easily; it is not so with the urning. He sees men that attract him, but he dares not say—nay, not even betray by a look—what his feelings are. He thinks that he alone of all the world has such abnormal feelings. Naturally he seeks the society of young men; but he does not venture to confide in them. Thus he comes to provide himself with a satisfaction that he cannot otherwise obtain. Onanism is practiced inordinately, and followed by all the evil results of that vice. When, after a time, the nervous system has been injured, the abnormality is again not the result of urningism, but it is produced by the onanism to which the urning resorts, as a result of the public sentiment that denies him opportunity to satisfy the sexual instinct that is natural to him.

“Or, let us suppose the urning has had the rare fortune to soon find a person like himself; or, that he has been introduced by an experienced friend to the events of the world of urnings. Then he is spared much of the inner conflict; but, at the same time, fearful cares and anxieties follow his footsteps. Now he knows that he is not the only one in the world that has such abnormal feelings; he opens his eyes and wonders that he meets so many of his kind in all social circles and in all callings; he also learns that, in the world of urnings, as in the other, there is prostitution, and that men as well as women can be bought. Thus there is no longer any want of opportunity for sexual satisfaction. But here how differently the experience is gained from that obtained in the normal manner of sexual indulgence!

“Let us consider the happiest case. After longing all one’s life, the friend of like feeling is found. But he cannot be approached openly, as a lover approaches the girl he loves. In constant fear, both must conceal their relations; nay, even intimacy that might easily excite suspicion—especially should they not be of like age, or should they belong to different classes—must be kept from the world. Thus, even in this relation, is forged a chain of anxiety and fear that the secret will be betrayed or discovered, which leaves them no joy in the indulgence. The slightest thing that would not affect others makes them tremble with fear that suspicion might be excited and the secret discovered, and destroy social position and business. Could this constant anxiety and care be endured without leaving a trace, without exerting an influence on the entire nervous system?

“Another less fortunate man does not find a friend of like feeling, but falls into the hands of a handsome man, who sought him until the secret was discovered. Now the most refined blackmail is extorted. The unfortunate, persecuted man, brought to the alternative of paying or of losing his social position, and bringing disgrace on himself and his family, pays; and the more he gives, the more voracious the vampire becomes; until at last there remains nothing but absolute financial ruin or dishonor. Who can wonder that nerves are not equal to such a terrible struggle!

“They give way; insanity comes on; and the miserable man at last finds the rest in an asylum that he could not find in the world. Another, in the same situation, driven to despair, finds relief in suicide. It cannot be known how many of the suicides of young men are to be attributed to this combination of circumstances.

“I do not think that I am in error when I declare that at least one-half of the suicides of young men are due to such conditions. Even in those cases where urnings are not persecuted by a heartless villain, but where a happy relation between two men exists, discovery, or even the fear of it, very often leads to suicide. How many officers, how many soldiers, having such relations with their subordinates or companions, in the moment when they have believed themselves discovered, have sought to escape the threatened disgrace by means of a bullet! And it is the same in all callings.

“Therefore, if it must be admitted that, among urnings, more mental abnormalities and more insanity are actually observed than among other men, yet this does not prove that the mental disturbance is a necessary accompaniment of the urning’s condition, and that the latter induces the former.

“According to my firm conviction, by far the greater number of cases of mental disturbance or abnormal disposition observed in urnings are not to be attributed to the sexual anomaly; but they are caused by the existing notions concerning urnings, and the resulting laws, and dominant public sentiment concerning the anomaly. Any one with an adequate idea of the mental and moral suffering, of the anxiety and care, that the urning must endure; of the constant hypocrisy and secrecy he must practice, in order to conceal his inner instinct; of the difficulties that meet him in satisfying his natural desire,—can only be surprised that more insanity and nervous disturbance does not occur in urnings. The greater part of these abnormal states would not be developed, if the urning, like another, could find a simple and easy way in which to satisfy his sexual desire,—if he were not forever troubled by these anxieties!”

De lege lata, as far as the urning is concerned, the paragraph with reference to pederasty must not be applied without the proof of actual pederasty; and psychical and somatic abnormalities must be examined by experts with respect of an estimate in the individual of the question of guilt.

De lege ferenda, the urnings wish a repeal of the paragraphs. The jurist could not consent to this, if he were to remember that pederasty is much more frequently a disgusting vice than the result of physical and mental infirmity; and that, moreover, many urnings, though driven to sexual acts with their own sex, are yet in nowise compelled to indulge in pederasty,—a sexual act which, under all circumstances, must stand as cynical, disgusting, and, when passive, as certainly injurious. Whether for reasons of expediency (difficulty of fixing the guilt, encouragement of blackmail, etc.), it would not be opportune to strike from the statutes the legal punishment of the male-loving man, and to protect youth by the use of the paragraphs concerning sexual abuses, is a future question for jurists.

What has been said concerning congenital contrary sexuality and its relation to the law is also applicable to the acquired abnormality. The accompanying neurosis or psychosis should have much diagnostic and forensic weight with reference to the question of guilt.

It only remains to describe acquired non-pathological pederasty,—one of the saddest pages in the history of human delinquencies:—

Cultivated Pederasty.[143]

The motives that bring to pederasty a man originally normal sexually and of sound mind are various. It is used temporarily as a means of sexual satisfaction faute de mieux,—as in infrequent cases of bestiality,—where abstinence from normal sexual indulgence is a necessity.[144] It thus occurs on ship-board during long voyages, in prisons, in baths, etc. It is highly probable that, among men subjected to such conditions, there are single individuals of low morals and great sensuality, or actual urnings, who seduce the others. Lust, imitation, and desire further their purpose.

The strength of the sexual instinct is most markedly shown by the fact that such circumstances are sufficient to overcome repugnance for the unnatural act.

Another category of pederasts is made up of old roues that have become supersatiated in normal sexual indulgence, and who find in pederasty a means of exciting sensual pleasure, the act being a new method of stimulation. Thus they temporarily renew their power, that has been psychically and physically reduced to so low a state. The new sexual situation makes them, so to speak, relatively potent, and makes pleasure possible that is no longer possible in normal intercourse. In time power to indulge in pederasty is also lost. The individual may thus finally be reduced to passive pederasty as a stimulus to make possible temporary active pederasty; just as, occasionally, flagellation or looking on at obscene acts (Maschka’s case of mutilation of animals) is resorted to for the same purpose.

The termination of sexual activity expresses itself in all kinds of abuse of children,—cunnilingus, fellare, and other enormities.

This kind of pederasts is the most dangerous, since they deal mostly with boys, and ruin them in body and soul.

In reference to this, the experiences of Tarnowsky (op. cit., p. 53 et seq.), gathered from the society of St. Petersburg, are terrible. The places where pederasty is cultivated are Institutes. Old roués and urnings play the rôle of seducers. At first it is difficult for the person to carry out the disgusting act. Fancy is made to assist by calling up the image of a woman. Gradually, with practice, the unnatural act becomes easy, and at last the individual, like one injured by masturbation, becomes relatively impotent for women, and lustful enough to find pleasure in the perverse act. Such individuals, under certain circumstances, give themselves for money.

As Tardieu, Hofmann, Simon, and Taylor show, such individuals are not infrequently found in large cities. From numerous statements made to me by urnings, it is learned that actual prostitution and houses of prostitution for male-loving men exist in large cities. The arts of coquetry used by these male prostitutes are noteworthy,—ornament, perfumes, feminine styles of dress, etc., to attract pederasts and urnings. This imitation of feminine peculiarities is spontaneous and unconscious in congenital cases, and in many acquired cases of (abnormal) contrary sexual instinct.

The following lines are of interest to the psychologist, and offer the officers of the law important facts concerning the social life and practice of pederasts:—

Coffignon, “La Corruption à Paris,” p. 327, divides active pederasts into “amateurs,” “entreteneurs,” and “souteneurs.”

The “amateurs” (“rivettes”) are debauched persons, but also frequently congenitally perverse sexually, of position and fortune, who are forced to guard themselves against detection in the gratification of their homo-sexual desires. For this purpose they visit brothels, lodging-houses, or the private houses of female prostitutes, who are usually on good terms with male prostitutes. Thus they escape blackmail.

Some of these “amateurs” are cunning enough to indulge their vile desires in public places. They thus run the risk of arrest, but, in a large city, little risk of blackmail. Danger is said to add to their secret pleasure.

The “entreteneurs” are old sinners who, even with the danger of falling into the hands of blackmailers, cannot deny themselves the pleasure of keeping a (male) mistress.

The “souteneurs” are pederasts that have been punished, who keep their “jesus,” whom they send out to entice customers (“faire chanter les rivettes”), and who then, at the right moment, if possible, appear for the purpose of plucking the victim.

Not infrequently they live together in bands, the members, in accordance with individual desire, living together as husbands and wives. In such bands there are formal marriages, betrothals, banquets, and introductions of brides and grooms into their apartments.

These “souteneurs” attach their “jesus” to themselves.

The passive pederasts are “petits jesus,” “jesus,” or “aunts.”

The “petits jesus” are lost, depraved children, whom accident places in the hands of active pederasts, who seduce them, and reveal to them the horrible means of earning a livelihood, either as “entretenus” or as male street-walkers, with or without “souteneurs.”

The most suitable and promising “petits jesus” are given into the hands of persons who instruct these children in the art of female dress and manner. Gradually they then seek to emancipate themselves from their teachers and masters, in order to become “femmes entretenues”; and not infrequently by means of anonymous denunciation of their “souteneurs” to the police.

It is the object of the “souteneur” and the “petit jesus” to make the latter appear young, as long as possible, by means of all the arts of the toilet.

The limit of age is about twenty-five years; then they all become “jesus” and “femmes entretenues” and are then sustained by several “souteneurs.” The “jesus” fall into three categories: “filles gallantes,” i.e., those that have fallen again into the hands of a “souteneur”; “pierreuses” (ordinary street-walkers, like their female colleagues); and “domestics.”

The “domestics” hire out to active pederasts, either to gratify their desires or to obtain “petits jesus” for them.

A sub-group of these “domestics” is formed by such of them as enter the service of “petits jesus” as “femmes de chambre.” The principal object of these “domestics” is to use their positions to obtain compromising knowledge, with which they later practice blackmail, and thus assure themselves ease in their old age.

The most horrible class of active pederasts is made up of the “aunts,”—i.e., the “souteneurs” of (male) prostitutes,—who, though normal sexually, are morally depraved, and practice pederasty (passive) only for gain, or for the purpose of blackmail.

The wealthy “amateurs” have their reunions and places of meeting, where the passive ones appear in female attire, and horrible orgies take place. The waiters, musicians, etc., at such gatherings, are all pederasts. The “filles gallantes” do not venture, except during the carnival, to show themselves on the street in female dress; but they know how to lend to their appearance something indicative of their calling, by means of style of dress, etc. They entice by means of gesture, peculiar movements of the hands, etc., and lead their victims to hotels, baths, or brothels.

What the author says of blackmail is generally known. There are cases where pederasts have allowed their entire fortune to be wrung from them.

The following notice from a Berlin (National?) newspaper, of February, 1884, which fell into my hands by accident, seems suited to show something of the life and customs of urnings:—

“The Woman-Haters’ Ball.—Almost every social element of Berlin has its social reunions,—the fat, the bald-headed, the young,—and why not the woman-haters? This species of men, so interesting psychologically and none too edifying, had a great ball to-day. ‘Grand Vienna Mask-Ball,’—so ran the notice. The sale of tickets was very rigorous; they wish to be very exclusive. Their rendezvous was a well-known dance-hall. We enter the hall about midnight. The graceful dancing is to the strains of a fine orchestra. Thick tobacco-smoke, veiling the gas-lights, does not allow the details of the moving mass to become obvious; only during the pause between the dances can we obtain a closer view. The masks are by far in the majority; black dress-coats and ball-gowns are seen only now and then.

“But what is that? The lady in rose-tarletan, that just now passed us, has a lighted cigar in the corner of her mouth, and puffs like a trooper; and she also wears a small, blonde beard, lightly painted out. And yet she is talking with a very décolleté ‘angel’ in tricots, who stands there, with bare arms folded behind her, likewise smoking. The two voices are masculine, and the conversation is likewise very masculine; it is about the ‘d— tobacco, that permits no air.’ Two men in female attire. A conventional clown stands there, against a pillar, in soft conversation with a ballet-dancer, with his arm around her faultless waist. She has a blonde ‘Titus-head,’ sharp-cut profile, and apparently a voluptuous form. The brilliant ear-rings, the necklace with a medallion, the full, round shoulders and arms, do not permit a doubt of her ‘genuineness,’ until, with a sudden movement, she disengages herself from the embracing arm, and, yawning, moves away, saying, in a deep bass, ‘Emile, you are too tiresome to-day!’ The ballet-dancer is also a male!

“Suspicious now, we look about further. We almost suspect that here the world is topsy-turvy; for here goes, or, rather, trips, a man—no, no man at all, even though he wears a carefully trained moustache. The well-curled hair; the powdered and painted face with the blackened eyebrows; the golden ear-rings; the bouquet of flowers reaching from the left shoulder to the breast, ornamenting the elegant black gown; the golden bracelets on the wrists; the elegant fan in the white-gloved hand,—all these things are anything but masculine. And how he toys with the fan! How he dances and turns, and trips and lisps! And yet kindly Nature made this doll a man. He is a salesman in a great millinery store, and the ballet-dancer mentioned is his ‘colleague.’

“At a little corner-table there seems to be a great social circle. Several elderly gentlemen press around a group of décolleté ladies, who sit over a glass of wine and—in the spirit of fun—make jokes that are none too delicate. Who are these three ladies? ‘Ladies!’ laughs my knowing friend. ‘Well, the one on the right, with the brown hair and the short, fancy dress, is called “Butterrieke,” and he is a hair-dresser; the second one—the blonde in a singer’s costume, with the necklace of pearls—is known here by the name of “Miss Ella of the tight-rope,” and he is a ladies’ tailor; and the third,—that is the widely-celebrated “Lottie.”

“But that person cannot possibly be a man? That waist, that bust, those classic arms, the whole air and person are markedly feminine!

“I am told that ‘Lottie’ was once a book-keeper. To-day she, or, rather, he, is exclusively ‘Lottie,’ and takes pleasure in deceiving men about his sex as long as possible. ‘Lottie’ is singing a song that would hardly do for a drawing-room, in a high voice, acquired by years of practice, which many a soprano might envy. ‘Lottie’ has also ‘worked’ as a female comedian. Now the quondam book-keeper has so entered into the female rôle that he appears on the street in female attire almost exclusively, and, as the people with whom he lodges state, uses an embroidered night-dress.

“On closer examination of the assembly, to my astonishment, I discover acquaintances on all hands: my shoemaker, whom I should have taken for anything but a woman-hater—he is a ‘troubadour,’ with sword and plume; and his ‘Leonora,’ in the costume of a bride, is accustomed to place my favorite brand of cigars before me in a certain cigar-store. ‘Leonora,’ who, during an intermission, removes her gloves, I recognize with certainty by her large, blue hands. Right! There is my haberdasher, also; he moves about in a questionable costume as Bacchus, and is the swain of a repugnantly bedecked Diana, who works as a waiter in a beer-restaurant. The real ‘ladies’ of the ball cannot be described here. They associate only with one another, and avoid the woman-hating men; and the latter are exclusive, and amuse themselves, absolutely ignoring the charms of the women.”

These facts deserve the careful attention of the police, who should be placed in a position to cope with male prostitution, as they now do with that of women.

Male prostitution is certainly much more dangerous to society than that of females; it is the darkest stain on the history of humanity.

From the statements of a high police official of Berlin, I learn that the police of Berlin are conversant with the male demi-monde of the German Capital, and do all they can to suppress blackmail among pederasts,—a practice which often does not stop short of murder.

The foregoing facts justify the wish that the law-maker of the future may, for reasons of utility, at least, abandon the prosecution of pederasty.

With reference to this point, it is worthy of note that the French Code does not punish it so long as it does not become an offense to public decency. Probably for politico-legal reasons, the new Italian Penal Code passes over the crime of unnatural abuse in silence, as do the statutes of Holland and, as far as I know, Belgium and Spain.

In how far such cultivated pederasts are to be regarded as mentally and morally sound may remain an open question. The majority of them suffer with genital neuroses. At least, in these cases, there are the stages of transition to acquired pathological contrary sexual instinct. The responsibility of these individuals, who are certainly much lower than the women who prostitute themselves, in general cannot be questioned.

The various categories of male-loving men, with respect of the manner of sexual indulgence, may be thus characterized in general:—

The congenital urning becomes a pederast only exceptionally, and eventually resorts to it after having practiced and exhausted all the possible immoral acts with males. Passive pederasty is for him the ideally and practically adequate form of the sexual act. He practices active pederasty only to please another. The most important point here is the congenital and unchangeable perversion of the sexual instinct.

It is otherwise with the pederast by cultivation. He has once acted normally sexually, or, at least, had normal inclinations, and occasionally has intercourse with the opposite sex. His sexual perversity is neither congenital nor unchangeable. He begins with pederasty and ends in other perverse sexual acts, induced by weakness of the centres for erection and ejaculation. At the height of his power, his sexual desire is not for passive, but for active pederasty. He yields himself to passive pederasty only to please another; for money, in the rôle of a male prostitute; or as a means, when virility is declining, to make active pederasty still occasionally possible.

A horrible act, that must be alluded to, in conclusion, is pædicatio mulierum,[145] and even uxorum. Sensual individuals sometimes do it with hardened prostitutes, or even with their wives. Tardieu gives examples where men, usually practicing coitus, sometimes indulged in pederasty with their wives. Occasionally fear of a repetition of pregnancy may induce the man to perform, and the woman to tolerate, the act.

Case 192. Imputation of pederasty that was not proved. Résumé from the legal proceedings:—

On May 30, 1888, Dr. S., chemist, of H., in an anonymous letter, was accused by his step-father of having immoral relations with G., aged 19, the son of a butcher. Dr. S. received the letter, and, astounded by its contents, hastened to his lawyer, who promised to proceed discreetly in the matter, and to ascertain from the authorities whether he would be publicly prosecuted.

On the next morning, G., who lived in the house of Dr. S., was arrested. At the time he was sick with gonorrhœa and orchitis. Dr. S. tried to induce the authorities to release G., and advised caution, but he was refused. In his statement to the judge, S. said that he became acquainted with G. on the street, three years previously, and then saw no more of him until the fall of 1887, when he met him in his father’s shop. After November G. supplied Dr. S.’s kitchen with meat,—coming in the evening to get the order, and bringing the meats the next morning. Thus S. gradually became well acquainted with G., and came to have a very friendly feeling for him. When S. fell ill and was, for the most part, confined to his bed until the middle of May, 1888, G. gave him so much attention that S. and his wife were much attracted to him on account of his harmless, child-like, and happy disposition. Dr. S. showed and explained to him his collection of curiosities, and they spent the evenings pleasantly together, the wife also being usually present; besides, S. and G. experimented in making sausages, jelly, etc. In February, 1888, G. fell ill with gonorrhœa. Dr. S., being his friend, and having studied medicine for several terms, took care of G., procured medicine for him, etc. In May, G. being still sick, and, for several reasons, inclined to leave home, S. and his wife took him into their own home to care for him. S. denied the truth of all the suspicions that had been raised by this relation, and defended himself by pointing to his life of previous respectability, his education, and to the fact that G., at the time, was suffering with a disgusting, contagious disease, and that he himself had a painful affection (nephritic calculus, with occasional attacks of colic).

Opposed to this statement of Dr. S.’s must be mentioned the facts that were brought out in court, and which led to conviction in the first trial.

The relation of S. to G. had, by reason of its obviousness, given cause for remark by private individuals, as well as by those in public houses. G. spent almost all his evenings with S.’s family, and, finally, came to be quite at home there. They took walks together. Once, while out on such a walk, S. said to G. that he was a pretty fellow, and that he (S.) was very fond of him. On the same occasion, there was also talk of sexual matters, and also of pederasty. S. said he touched on these subjects only to warn G. With reference to the intercourse at home, it was proved that occasionally S., while sitting on a sofa, embraced G., and kissed him. This happened in the presence of the wife, as well as of the servant-girls. When G. was ill with gonorrhœa, S. instructed him in the method of using a syringe, and, at the time, took the penis in his hand. G. testified that S., in answer to his question why he was so fond of him, said, “I don’t know, myself.” When, one day, G. remained away, S., with tears in his eyes, complained of it to him when he returned. S. also told him that his marriage was unhappy, and, in tears, begged G. not to leave him; that he must take the place of his wife.

From all this resulted the just accusation, that the relation between the culprits had a sexual direction. The fact that all was open and known to everybody, according to the complaint, did not speak for the harmlessness of the relation, but more for the intensity of the passion of S. The spotless life of the accused was allowed, as well as his honesty and gentleness. The probability of an unhappy marriage, and that S. was of a very sensual nature, was shown.

During the course of the trial, G. was repeatedly examined by the medical experts. He is scarcely of medium size, pale, and of powerful frame; penis and testicles are very perfectly developed (large).

In consonance with the accusation, it was found that the anus was pathologically changed, in that there were no wrinkles in the skin about it and the sphincter was relaxed; and it was presumed that these changes pointed to the probability of passive pederasty.

The conviction was based on these facts. The judgment passed recognized that the relation that existed between the culprits did not necessarily point to unnatural abuses, any more than did the physical conditions found on the person of G.

However, by reason of the combination of the two facts, the court was convinced of the guilt of both culprits, and held it proved: “That the abnormal condition of G.’s anus had been caused by the frequently repeated introduction of the penis of S., and that G. voluntarily permitted the performance of this immoral act on himself.”

Thus the conditions of § 175, R. St. G. B., seemed to be covered. In passing sentence, there was consideration of S.’s education, which made him appear to be G.’s seducer; in G.’s case, this fact and his youth were given weight; and the previous respectability of both was held in view. Thus Dr. S. was sentenced to imprisonment for eight months, and G. for four months.

The culprits appealed to the Supreme Court at Leipzig, and prepared themselves, in case the appeal should be denied, to collect evidence sufficient to call for a new trial.

They subjected themselves to examination and observation by distinguished experts. The latter declared that G.’s anus presented no signs of indulgence in passive pederasty.

Since it seemed of importance to those interested to make clear the psychological aspect of the case, which was not touched on at the trial, the author was intrusted with the examination and observation of Dr. S. and G.

Results of the Personal Examination, from December 11 to 13, 1888, in Graz.—Dr. S., aged 37; two years married, without children. Ex-Director of the City Laboratory of H. He comes of a father who is said to have been nervous, owing to great activity; who had an apoplectic attack in his fifty-seventh year, and died, at the age of sixty-seven, of another attack of apoplexy. His mother is living, and is described as a strong person, who has been nervous for years. Her mother reached quite an old age, and is said to have died of a cerebellar tumor. A brother of the mother’s father is said to have been a drinker. The paternal grandfather died early, of softening of the brain.

Dr. S. has two brothers, who are in perfect health.

He states that he is of nervous temperament, and has been of strong constitution. After articular rheumatism, which he had in his fourteenth year, he suffered with great nervousness for some months. Thereafter he often suffered with rheumatic pains, palpitation, and shortness of breath. These symptoms gradually disappeared with sea-bathing. Seven years ago he had gonorrhœa. This disease became chronic, and for a long time caused bladder-difficulty.

In 1887 he had his first attack of renal colic, and he had such attacks repeatedly during the winter of 1887 and 1888, until May 16, 1888, when quite a large renal calculus was passed. Since then his condition had been quite satisfactory. While suffering with stone, during coitus, at the moment of ejaculation, he felt severe pain in the urethra, and the same pain on urinating.

With reference to his life, S. states that he attended the Gymnasium until he was fourteen, but after that, owing to the results of his severe illness, he studied privately. He then spent four years in a drug-store, and then studied medicine for six semesters at the University, serving, in the war of 1870, as a voluntary hospital assistant. Since he had no certificate of graduation from the Gymnasium, he gave up the study of medicine, and obtained the degree of doctor of philosophy. Then he served in the Museum of Minerals in K., and later as assistant in the Mineralogical Institute of H. Thereafter he made special studies in the chemistry of food-stuffs, and five years ago became Director of the City Laboratory.

He makes all these statements in a prompt, precise manner, and does not think long about his answers; so that one is more and more led to think that he is a man who loves and speaks the truth,—the more, since, on the following day, his statements are identical. With reference to his vita sexualis, Dr. S., in a modest, delicate, and open way, states that, in his eleventh year, he began to have a knowledge of the difference of the sexes, and for some time, until his fourteenth year, was given to onanism. He first had coitus at eighteen, and thereafter indulged moderately. His sensual desire had never been very great, but, until lately, the sexual act had been normal in every way, and accompanied by gratifying pleasurable feeling and full virility. Since his marriage, two years ago, he had cohabited with his wife exclusively. He had married his wife out of love, and still loved her, having coitus with her at least several times a week. The wife, who was also at hand, confirmed these statements.

All cross-questioning with reference to a perversion of sexual feeling toward men Dr. S. answered repeatedly in the negative, to repeated examination, and that without contradiction or any thought of the answers. Even when, in order to trap him, he is told that the proof of a perverse sexual instinct would be of avail in the trial, he sticks to his statements. One gains the important impression that S. has not the slightest knowledge of the facts of male-love. Thus it is learned that his lascivious dreams have never been about men; that he is interested only in female nudity; that he liked to dance with ladies, etc. No traces of any kind of sexual inclination for his own sex can be discovered in S. With reference to his relations with G., Dr. S. expresses himself exactly as he did at his examination before the court. In explanation of his partiality for G., he can only say that he is nervous, and a man of feeling and great sensibility, and very sensitive to friendliness. During his illness he had felt very lonesome and depressed; his wife had frequently been with her parents; and thus it had happened that he had become friendly with G., who was so gentle and kind. He still had a weakness for him, and felt remarkably quiet and contented while in his society.

He had had two such close friendships previously: when he was yet a student, with a corps-brother, a Dr. A. whom he also embraced and kissed; later, with a Baron M. When it happened that he could not see him for a few days, he became depressed, and even cried.

He also had a similar feeling and attachment for animals. Thus he had a poodle that died a short time ago, mourned like a member of the family; and he had often kissed the animal. (On relating this, the tears came to his eyes.) His brother confirmed these statements, with the remark, with reference to his brother’s remarkable friendship for A. and M., that in these instances there was not the slightest suspicion of sexual coloring or relation. Too, the most careful and detailed examination of Dr. S. gave not the slightest reason for such a presumption.

He states that he never had the slightest sensual feeling for G., to say nothing of erection or sensual desire. His partiality for G., which bordered on jealousy, S. explained as due merely to his sentimental temperament and his inordinate friendship. G. was still as dear to him as if he were his son.

It is worthy of note that S. stated that when G. told him about his love-adventures with girls, it had hurt him only because G. was in danger of injuring himself and ruining his health by dissipation. He had never felt hurt himself by this. If he knew a good girl for G. he would be glad to rejoice with him, and do all he could to promote their marriage.

S. states that it was first in the course of his legal examination that he saw how he had been careless in his intercourse with G., by causing gossip. His openness he explained as due to the innocence of the friendship.

It is worthy of note that S.’s wife never noticed anything suspicious in the intercourse between her husband and G., though the most simple wife would instinctively notice anything of that nature. Mrs. S. had also made no opposition to receiving G. into the house. On this point she remarked that the guest-chamber in which G. lay ill, was on the second floor, while the living apartments were on the fourth; and, further, that S. never associated alone with G. as long as he was in the house. She states that she is convinced of her husband’s innocence, and that she loves him as before.

Dr. S. states freely that formerly he had often kissed G., and talked with him about sexual matters. G. was much given to women, and in friendship he had often warned him about sexual dissipation, particularly when G., as often happened, did not look well. He had once said that G. was a handsome fellow; it was in a perfectly harmless relation.

The kissing of G. had been due to inordinate friendship, when G. had shown him some particular attention, or pleased him especially. In the act he had never had any sexual feeling. Too, when he had now and then dreamed of G., it was in a perfectly harmless way.

It appeared of great importance to the author to form also an opinion of G.’s personality. On December 12th, the desired opportunity was given, and G. was carefully examined.

G. is a young man, aged 20, of delicate build, whose development corresponds with his years; and he appears to be neuropathic and sensual. The genitals are normal and well developed. The author thinks he may be permitted to pass over the condition of the anus, as he does not feel called upon to pass judgment upon it. With prolonged association with G., one gets the impression that he is a harmless, kind, and artless man, who is light-minded, but not morally depraved. Nothing in his dress or manner indicates perverse sexual feeling. There cannot be the slightest suspicion that he is a male courtesan.

When G. is introduced in medias res, he states that S. and he, feeling their innocence, had told the matter as it actually was, and on this the whole trial had been based.

At first, S.’s friendship, and especially the kissing, had seemed remarkable, even to him. Later he had convinced himself that it was merely friendship, and had then thought no more about it.

G. had looked upon S. as a father-like friend; for he was so unselfish, and loved him so.

The expression “handsome fellow” was made when G. had a love-affair, and when S. expressed his fears about a happy future for G. At that time S. had comforted him, and said that his (G.’s) appearance was pleasing, and that he would make an eligible match.

Once S. had complained to him (G.) that his wife was inclined to drink, and burst into tears. G. was touched by his friend’s unhappiness. On this occasion S. had kissed him, and begged for his friendship, and asked him to visit him frequently.

S. had never spontaneously directed the conversation to sexual matters. G. once asked what pederasty was, of which he had heard much while in England; and S. had explained it to him.

G. acknowledges that he is sensual. At the age of twelve he had been made acquainted with sexual matters by school-mates. He had never masturbated, had first had coitus at the age of eighteen, and had since visited brothels frequently. He had never felt any inclination for his own sex, and had never experienced any sexual excitement when S. kissed him. He had always had pleasure in coitus normally performed. His lascivious dreams had always been of women. With indignation, and pointing to his descent from a healthy and respectable family, he repels the insinuation of having been given to passive pederasty. Until the gossip about them came to his ears, he had been innocent and devoid of suspicion. The anal anomalies he tries to explain in the same way that he did at the trial. Auto-masturbation in ano he denies.

It should be noted that Mr. J. S. claims to be no less astonished by the charge against his brother of male-love than those more closely associated with him. Yet he could not understand what attached his brother to G.; and all the explanations which S. made to him concerning his relation to G. were vain.

The author took the trouble to observe Dr. S. and G., in a natural way, while they were dining, in company with S.’s brother and Mrs. S., in Graz. This observation revealed not the slightest sign of improper friendship.

The general impression which Dr. S. made on me was that of a nervous, sanguine, somewhat overstrained individual, but, at the same time, kind, open-hearted, and very emotional.

Dr. S. is physically strong, somewhat corpulent, with a symmetrical, brachycephalic cranium. The genitals are well developed; the penis somewhat bellied; the prepuce somewhat hypertrophied.

Opinion.—Pederasty is, unfortunately, not infrequent among mankind to-day; but still, occurring among the peoples of Europe, it is an unusual, perverse, and even monstrous manner of sexual gratification. It presumes a congenital or acquired perversion of the sexual instinct, and, at the same time, defect of moral sense that is either original or acquired, as a result of pathological influences.

Medico-legal science is thoroughly conversant with the physical and psychical conditions from which this aberration of the sexual instinct arises; and in the concrete and doubtful case it seems requisite to ascertain whether these empirical, subjective conditions necessary for pederasty are present. Too, it is essential to distinguish between active and passive pederasty.

Active pederasty occurs:—

I. As a non-pathological phenomenon:—

1. As a means of sexual gratification, in case of great sexual desire, with enforced abstinence from natural sexual intercourse.

2. In old debauchees, who have become satiated with normal sexual intercourse, and more or less impotent, and also morally depraved; and who resort to pederasty, in order to excite their lust with this new stimulus, and aid their virility, that has sunk so low psychically and physically.

3. Traditionally, among certain barbarous races that are devoid of morality.

II. As a pathological phenomenon:—

1. Upon the basis of congenital contrary sexual instinct, with repugnance for sexual intercourse with women, or even absolute incapability of it. But, as even Casper knew, pederasty, under such conditions, is very infrequent. The so-called urning satisfies himself with a man by means of passive or mutual onanism, or by means of coitus-like acts (e.g., coitus inter femora); and he resorts to pederasty only very exceptionally, as a result of intense sexual desire, or with a low or lowered moral sense, out of desire to please another.

2. On the basis of acquired contrary sexual instinct:—

(a) As a result of long years of onanism, which finally causes impotence for women with continuance of intense sexual desire.

(b) As a result of severe mental disease (senile dementia, brain-softening of the insane, etc.), in which, as experience teaches, an inversion of the sexual instinct may take place.

Passive pederasty occurs:—

I. As a non-pathological phenomenon:—

1. In individuals of the lowest class, who, having had the misfortune to be seduced in boyhood by debauchees, endured pain and disgust for the sake of money, and became depraved morally, so that, in more mature years, they have fallen so low that they take pleasure in being male prostitutes.

2. Under circumstances analogous to those of I, 1,—as a remuneration to another for having allowed active pederasty.

II. As a pathological phenomenon:—

1. In individuals affected with contrary sexual instinct, with endurance of pain and disgust, as a return to men for the bestowal of sexual favors.

2. In urnings who feel toward men like women, out of desire and lust. In such female-men there is horror feminæ and absolute incapability for sexual intercourse with women. Character and inclinations are feminine.

The empirical facts that have been gathered by legal medicine and psychiatry are all included in this classification. Before the court of medical science, it would be necessary to prove that a man belonged to one of the above categories in order to carry the conviction that he was a pederast.

In the life and character of Dr. S., one searches in vain for signs which place him in one of the categories of active pederasts which science has established. He is neither one forced to sexual abstinence, nor one made impotent for women by debauchery; neither is he congenitally male-loving, nor alienated from women by masturbation, and attracted to men through continuance of sexual desire; and, finally, he is not sexually perverse as a result of severe mental disease.

In fact, the general conditions necessary for the occurrence of pederasty are wanting in him,—moral imbecility or moral depravity, on the one hand, and inordinate sexual desire, on the other.

It is likewise impossible to classify the accomplice, G., in any of the empirical categories of passive pederasty; for he possesses neither the peculiarities of the male prostitute nor the clinical marks of effemination; and he has not the anthropological and clinical stigmata of the female-man. He is, in fact, the very opposite of all this.

In order to make a pederastic relation between the two plausible medico-scientifically, it would be requisite for Dr. S. to present the antecedents and marks of the active pederasts of I, 2, and G., those of the passive pederasts of II, 1 or 2.

The assumption lying at the basis of the verdict is, from a psychological stand-point, legally untenable.

With the same right, every man might be considered a pederast. It remains to consider whether the explanations given by Dr. S. and G. of their remarkable friendship are psychologically valid.

Psychologically it is not without parallel that so sentimental and eccentric a man as S.—without any sexual excitement whatever—should entertain a transcendental friendship. It suffices to recall the friendship of school-girls, the self-sacrificing friendship of sentimental young persons in general, and the partiality which this sensitive man sometimes showed even for domestic animals,—where no one would think of sodomy. With S.’s mental character, extraordinary friendship for the youth G. may be easily comprehended. The openness of this friendship permits the conclusion that it was innocent, much rather than that it depended upon sensual passion.

The defendants succeeded in obtaining a new trial. The new trial took place on March 7, 1890. There was much evidence presented in favor of the accused.

The previous moral life of S. was generally acknowledged. The Sister of Charity who cared for G. in S.’s house, never noticed anything suspicious in the intercourse between S. and G. S.’s former friends testified to his morality, his deep friendship, and his habit of kissing them on meeting or leaving them. The anal abnormalities previously found on G. were no longer present. Experts called by the court allowed the possibility that they had been due simply to digital manipulations; their diagnostic value in any case was contested by the experts called by the defense.

The court recognized that the imputed crime had not been proved, and exonerated the defendants.

Lesbian Love.[146]

Where the sexual intercourse is between adults, its legal importance is very slight; it could come into consideration only in Austria. In connection with urningism, this phenomenon is of anthropological and clinical value. The relation is the same, mutatis mutandis, as between men. Lesbian love does not seem to approach urningism in frequency. The majority of female urnings do not act in obedience to an innate impulse, but they are developed under conditions analogous to those which produce the urning by cultivation.

These “forbidden friendships” flourish especially in penal institutions for females.

Kraussold (op. cit.) reports: “The female prisoners often have such friendships, which, when possible, extend to mutual manustupration.

“But temporary manual gratification is not the only purpose of such friendships. They are made to be enduring,—entered into systematically, so to speak,—and intense jealousy and a passion for love are developed which could scarcely be surpassed between persons of opposite sex. When the friend of one prisoner is merely smiled at by another, there are often the most violent scenes of jealousy, and even beatings.

“When the violent prisoner has been put in irons, in accordance with the prison-regulations, she says ‘she has had a child by her friend.’”

We are indebted to Parent-Duchatelet (“De la prostitution,” 1857, vol. i, p. 159) for interesting communications concerning Lesbian love.

According to this experienced author, repugnance for the most disgusting and perverse acts (coitus in axilla, inter mammæ, etc.) which men perform on prostitutes is not infrequently responsible for driving these unfortunate creatures to Lesbian love. From his statements it is seen that it is essentially prostitutes of great sensuality who, unsatisfied with intercourse with impotent or perverse men, and impelled by their disgusting practices, come to indulge in it.

Besides these, there are prostitutes who let themselves be known as given to tribadism; persons who have been in prisons for years, and in these hot-beds of Lesbian love, ex abstinentia, acquired this vice.

It is interesting to know that prostitutes hate those who practice tribadism,—just as men abhor pederasts; but female prisoners do not regard the vice as indecent.

Parent mentions the case of a prostitute who, while intoxicated, tried to force another to Lesbian love. The latter became so enraged that she denounced the indecent woman to the police. Taxil (op. cit. p. 166, 170) reports similar instances.

Mantegazza (“Anthropol. culturhistorische Studien,” p. 97) also finds that sexual intercourse between women has especially the significance of a vice which arises on the basis of unsatisfied hyperæsthesia sexualis.

In many cases of this kind, however, aside from congenital contrary sexual instinct, one gains the impression that, just as in men (vide supra), the cultivated vice gradually leads to acquired contrary sexual instinct, with repugnance for sexual intercourse with the opposite sex.

At least Parent’s cases were probably of this nature. The correspondence with the lover was quite as sentimental and exaggerated in tone as it is between lovers of the opposite sex; unfaithfulness and separation broke the heart of the one abandoned; jealousy was unbridled, and led to bloody revenge. The following cases of Lesbian love, by Mantegazza, are certainly pathological, and possibly examples of congenital contrary sexual instinct:—

1. On July 5, 1777, a woman was brought before a court in London, who, dressed as a man, had been married to three different women. She was recognized as a woman, and sentenced to imprisonment for six months.

2. In 1773, another woman, dressed as a man, courted a girl, and asked for her hand; but the trick did not succeed.

3. Two women lived together as man and wife for thirty years. On her death-bed the “husband” confessed her secret to those about her.

Coffignon (op. cit., p. 301) makes later statements worthy of notice.

He reports that this vice is, of late, quite the fashion,—partly owing to novels on the subject, and partly as a result of excessive work on sewing-machines, the sleeping of female servants in the same bed, seduction in schools by depraved pupils, or seduction of daughters by perverse servants.

The author declares that this vice (“saphism”) is met more frequently among ladies of the aristocracy and prostitutes.

He does not differentiate physiological and pathological cases, nor, among the latter, the acquired and congenital cases. The details of a few cases, which are certainly pathological, correspond exactly with the facts that are known about men of contrary sexuality.

The saphists have their places of meeting, recognize each other by peculiar glances, carriage, etc. Saphistic pairs like to dress and ornament themselves alike, etc. They are then called “petites sœurs” (little sisters).

7. Necrophilia.[147]

(Austrian Statutes, § 306.)

This horrible kind of sexual indulgence is so monstrous that the presumption of a psychopathic state is, under all circumstances, justified; and Maschka’s recommendation, that the mental condition of the perpetrator should always be investigated, is well founded. In any case, an abnormal and decidedly perverse sensuality is required to overcome the natural repugnance which man has for a corpse, and permit a feeling of pleasure to be experienced in sexual congress with a cadaver.

Unfortunately, in the majority of the cases reported, the mental condition was not examined; so that the question whether necrophilia is compatible with mental soundness must remain open. But any one having knowledge of the horrible aberrations of the sexual instinct would not venture, without further consideration, to answer the question in the negative.

8. Incest.

(Austrian Statutes, § 132; Abridgment, § 189; German Statutes, § 174.)

The preservation of the moral purity of family life is a product of civilization;[148] and feelings of intense displeasure arise in an ethically intact man at thought of lustful feeling toward a member of the same family. Only great sensuality and defective ideas of laws and morals can lead to incest.

Both conditions may, in tainted families, be operative. Drinking and a state of intoxication in men; weak-mindedness which does not allow the development of the feeling of shame, and which, under certain circumstances, is associated with eroticism in females,—these facilitate the occurrence of incestuous acts. External conditions which facilitate their occurrence are due to defective separation of the sexes among the lower classes.

As a decidedly pathological phenomenon, the author has found incest in states of congenital and acquired mental weakness, and infrequently in cases of epilepsy and paranoia.

In many of the cases, probably a majority, it is not possible, however, to find a pathological basis for the act which so deeply wounds not only the tie of blood, but also the feeling of a civilized people. But in many of the cases reported in literature, to the honor of humanity, the presumption of a psychopathic basis is possible.

In the Feldtmann case (Marc-Ideler, vol. i, p. 18), where a father constantly made immoral attacks on his adult daughter, and finally killed her, the unnatural father was weak-minded and, besides, probably subject to periodical mental disease. In another case of incest between father and daughter (loc. cit., p. 247), the latter, at least, was weak-minded. Lombroso (Archiv. di Psichiatria, viii, p. 519) reports the case of a peasant, aged 42, who practiced incest with his daughters, aged, respectively, 22, 19, and 11; he even forced the youngest to prostitute herself, and then visited her in a brothel. The medico-legal examination showed predisposition, intellectual and moral imbecility, and alcoholism.

There was no mental examination in the case reported by Schürmeyer (Deutsche Zeitschr. für Staatsarzneikunde, xxii, H. 1), in which a mother laid her son of five and a half years on herself, and practiced abuse with him; and in that given by Lafarque (Journ. Méd. de Bordeaux, 1874), where a girl, aged 17, laid her brother, aged 13, upon herself, brought about membrorum conjunctionem, and performed masturbation on him.

The following cases are those of tainted individuals: Magnan (Ann. méd.-psych., 1885) mentions an unmarried woman, aged 29, who, though indifferent toward other children or even men, suffered frightfully in the presence of her nephew, and could scarcely control her impulse to cohabit with him. This sexual peculiarity continued only as long as the nephew was quite young.

Legrand (Ann. méd.-psych., May, 1876) mentions a girl, aged 15, who seduced her brother into all manner of sexual excesses on her person; and when, after two years of this incestuous practice, her brother died, she attempted to murder a relative. In the same article there is the case of a married woman, aged 36, who hung her open breast out of a window, and indulged in abuse with her brother, aged 18; and also the case of a mother, aged 39, who practiced incest with her son, with whom she was madly in love, became pregnant by him, and induced abortion.

Through Casper we know that depraved mothers in large cities sometimes treat their little daughters in a most horrible fashion, in order to prepare them for the sexual use of debauchees. This crime belongs elsewhere.

9. Immoral Acts with Persons in the Care of Others; Seduction (Austrian).

(Austrian Statutes, § 131; Abridgment, § 188; German Statutes, § 173).

Allied to incest, but still less repugnant to moral sensibility, are those cases in which persons seduce those entrusted to them for care or education, and who are more or less dependent upon them, to commit or suffer vicious practices. Such acts, which especially deserve legal punishment, seem only exceptionally to have psychopathic significance.

INDEX.

Abuse, unnatural, 404
Acts for self-humiliation, 134
Æsthetics and sexuality, 10
Amor lesbicus, 428

Anæsthesia sexualis, acquired, 47

- congenital, 42

Androgyny, 304
Areas, erogenous, 31
Attraction, sexual, 16
Baudelaire, 122
Binet, 18, 19, 21, 121
Bondage, sexual, 141
Bote, 202
Boys, whipping of (sadistic), 82
Brunn, 19
Cæsars, 58
Capitals as breeding-places of sensuality, 7

Christianity, influence of, 4, 6

- contrasted with Mohammedanism, 5

Cohabitation, 32

Contrary sexual instinct, 185

- causes of, 188

- degrees of, 187

Corpses, mutilation of, 67

Cruelty, passively endured, 89

- and love, 9
- and lust, 9
- sources of, 86

Decadence, moral, 6
Defemination, 197
Defilement of women, 79
Delirium acutum, 54

Dementia and psychopathia sexualis, 361

- paretic, and psychopathia sexualis, 363

Descartes, 162
Diagnosis of contrary sexuality, 319
Durga, 57
Effemination, 279

Ejaculation centre, 31

- affections of, 36

Epilepsy and psychopathia sexualis, 364

Equus eroticus, 111

Erection centre, 24

- affections of, 35

Esquirol, 220, 221
Eviration, 197
Exhibition, 382
Eyes, neuropathic, 21
Family life, 6

Fetichism, 17

- and crime, 401
- of apron, 170
- of feathers, 182
- of female attire, 167
- of female person, 157
- of foot and shoe, 123, 176
- of furs, 181
- of hair, 20
- of hand, 158
- of handkerchief, 171
- of glove, 175
- of material, 180
- of odors, 21
- of silk, 183
- of velvet, 180
- of voice, 22
- religious, 17

Fiction and sexual perversion, 123

Flagellation, 28, 152

- and masochism, 99
- differentiation of, 100
- for reflex effect, 99
- heroines of, 29

Flagellum salutis, 29
Friendship and love, 19
Frigiditas uxoris, 46
Frottage, 394
Gley, 226
Griesinger, 224
Gynandry, 304
Hair, as a fetich, 20
Hair-despoilers, 162, 164, 165
Herodotus, 200

Hermaphroditism, psychical, 230

- cases of, 232–255

Hippocrates, 201

Homo-sexuality, 185, 255

- acquired, 188
- causes of, 188
- congenital, 222

- degrees of, I, 191; II, 197; III, 202; IV, 216

- explanation of, 227

Holder, 202

Hyperæsthesia sexualis, 48

- cases of, 51–55

Hypnosis, therapeutics, 322–357
Hysteria, 375
Idiocy and psychopathia sexualis, 358
Imbecility and contrary sexuality, 359
Ink, throwing of, 80

Insanity, and contrary sexuality, 358

- periodical, 372

Incest, 431
Japanese women, 3
Juvenal, 31
Kiernan, 227
Kiernan’s explanation of sadism, 152
Kleist, 88
Ladame’s case, 344
Libido sexualis, 24–32

Love and cruelty, 9

- and friendship, 19
- and religion, 8
- fetichism of, 19
- Lesbian, 428
- of man and woman compared, 15
- platonic, 11, 12
- true, 11
- youthful, 11

Lust and cruelty, 10, 57

- and battle, 58, 60
- and murder, 62, 397
- and the passive endurance of cruelty, 90
- and plunder, 58

Lupercal, 31
Lydston, 162, 227
Magnan, 20, 227
Mania, 373
Mantegazza, 7, 227
Marschalls Gilles de Rays, 58
Maudsley, 1
Masoch, Sacher-, 89

Masochism, 89

- and flagellation, 99
- and sadism, 148
- explanation of, 139
- in women, 137
- larvated, 123
- rudimentary, 101
- symbolic, 115

Melancholia, 374

Messalinas, 88

Metamorphosis sexualis paranoica, 216

- transition to, 202

Modesty, origin of, 2, 15

- in women, 15

Mohammedan women, 5
Morality, progress in, 5
Morals, decadence of, and pathology, 6
Mujerados, 201
Necrophilia, 430
Nervi erigentes, 24

Neuroses, cerebral, 36

- sexual, 34

- spinal, 35

Nymphomania, 373

Olfactory fetichism, 21

- hallucinations and sexuality, 28

- sense and sexual sense, 26

Paradoxia sexualis, 37
Paræsthesia sexualis, 56
Paranoia, 376

Pathological sexuality in its legal aspects, 378

Pathology, general, 34

- special, 358

Pederasty, 408

- cultivated, 414

- false imputation of, 420

Penthesilia, 88
Perfumes as a fetich, 21, 26
Physiology, 23
Priapism, 35
Prognosis of contrary sexuality, 319
Psychology, sexual, 1
Psychopathia sexualis periodica, 371

Puberty, its psychological importance, 7

- relation to poetry, 7

- to religious feeling, 7

Pueblo Indians, 201
Rape, 397
Religion and sensuality, 8
Reversal of sexual feeling, 191
Robbery, 401
Rousseau, 119
Sacher-Masoch, 89
Sade, Marquis de, 57, 71

Sadism, 57, 401

- and masochism, 148
- atavistic, 152
- cases of, 62–67
- in women, 87
- physiological relations of, 59
- symbolic, 81
- with animals, 84
- with other objects, 82

Satyriasis, 373
Schema of sexual neuroses, 34
Schopenhauer, 41
Scythians, insanity of the, 200
Schrenk-Notzing’s case, 351
Senile libido, 40, 41

Sensuality, 5

- religious equivalent of, 8

Servants, immoral acts of, with children, 432

Sexuality, source of ethical feeling, 1

- and the social feeling, 1

- simple reversal of, 191

Sexual attraction, 16

- bondage, 141

- desire, physiology of, 23

- instinct in childhood, 37

- in old age, 38

- promptings, first, 7

- satisfaction in received cruelty and abuse, 91

- selection, 2

Shoe-fetichism, 123

- cases of, 124–134

Silk-fetichism, 183
Siva, 57
Sodomy, 404
Spanking, dangers of, 28
Stefanowsky, 123
Sterility, 13
Sulphuric acid, throwing of, 80
Suggestion, hypnotic, 322–357
Theft, 401
Torture of animals, 401
Therapy of contrary sexuality, 321
Ulrichs, 227
Urning, memorial of one, 410

Urnings, 255

- cases of, 257–279

- laws concerning, 413

Vampirism, 87
Vanity, 16
Velvet-fetichism, 180
Violation of children, 402
Viraginity, 279
Virility, loss of, 12
Voice as a fetich, 22
Westermarck, 15, 16, 20
Westphal, 224
Whitechapel murderer, 64

Woman, elevation of, 3

- in Old Testament and Gospels, 4

- position of, 2

- sexual appetite of, 15

- rôle of, 13

Woman-haters’ ball, 417

Women, defilement of, 79

- injury of, 70

- masochism in, 137

Zones, erogenous, 31

1. “Meanwhile, until Philosophy shall at last unite and maintain the world, Hunger and Love impel it onward.”

2. Hartmann’s philosophical view of love, in the “Philosophy of the Unconscious,” p. 583, Berlin, 1869, is the following: “Love causes more pain than pleasure. Pleasure is illusory. Reason would cause love to be avoided if it were not for the fatal sexual instinct; therefore, it would be best for a man to have himself castrated.” The same opinion, minus the consequence, is also expressed by Schopenhauer (“Die Welt als Wille und Vorstellung,” 3. Aufl., Bd. ii, p. 586 u. ff.).

3. “No physical or moral misery, no suffering, however corrupt it may be, should frighten him who has devoted himself to a knowledge of man and the sacred ministry of medicine; in that he is obliged to see all things, let him be permitted to say all things.”

4. The Latin is left untranslated.

5. The works of Moll and von Schrenck-Notzing have since appeared.—Trans.

6. Die Suggestions-Therapie, etc., F. Enke, Stuttgart, 1892.

7. Comp. Lombroso, “The Criminal.”

8. Comp. Westermarck, “History of Human Marriage.” McMillan & Co., 1891.

9. This generally entertained idea, also held by many historians, requires some limitation, in that the symbolic and sacramental character of marriage was first made clear and unequivocal by the Council of Trent, even though there was ever in the spirit of Christianity that which would free woman and raise her from the inferior position occupied by her in the ancient world and the Old Testament.

That this took place so late may well be due in part to the traditions of Genesis of the secondary creation of woman from the rib of man, and of her part in the Fall, and the consequent curse: “Thy will shall be to thy husband.” Since the Fall, for which the Old Testament made woman responsible, became the corner-stone of the fabric of churchteachings, the wife’s social position could but remain inferior until the spirit of Christianity had gained a victory over tradition and scholasticism.

It is remarkable that, with the exception of the interdiction of putting away a wife (Matt. xix, 9), the gospels contain nothing favoring woman. Gentleness toward the adulteress and the repentant Magdalene does not affect the position of the wife in itself. The Epistles of Paul specifically declare that the position of woman shall not be altered (II Corinth. xi, 3–12; Ephes. v, 22: “Wives, submit yourselves unto your husbands;” and 33, “And the wife see that she reverence her husband”).

Passages in Tertullian show how the Fathers of the Church were prejudiced against woman by Eve’s guilt: “Woman, thou shouldst forever go in sorrow and rags, thy eyes filled with tears! Thou hast brought man to the ground!” St. Hieronymus has nothing good to say of woman. He says, “Woman is a door for the devil, a way to evil, the sting of the scorpion.” (“De cultu feminarum,” i, 1.)

Canonical Law declares: “Only man was created in the image of God, not woman; therefore, woman should serve him and be his maid!”

The Provincial Council of Macon, in the sixth century, earnestly debated the question whether woman had a soul.

The effect of these ideas in the Church on the peoples embracing Christianity was direct. Among the Germans, after the acceptance of the new faith, for the foregoing reason, the weregild for a wife—the simple expression of her value—decreased (J. Falke, “Die ritterliche Gesellschaft,” p. 49. Berlin, 1862). Concerning the value of each sex among the Jews, vide Leviticus, xxvii, 3 and 4.

Moreover, polygamy, which is expressly recognized in the Old Testament (Deut. xxi, 15), is nowhere explicitly interdicted in the New Testament. Christian princes (e.g., the Marovingian kings, Clotar I, Childebert I, Pepin I, and many of the royal Franks) lived in polygamy; and at that time the Church made no opposition to it (Weinhold, “Die deutschen Frauen im Mittelalter,” ii, p. 15). Comp. also Unger, “Die Ehe,” etc., and the excellent work by Louis Bridel, “La femme et le droit,” Paris, 1884.

10. Comp. Friedländer “Sittengeschichte Roms.” Wiedemeister, “Der Cäsarenwahnsinn.” Suetonius. Moreau, “Des aberrations du sens génésique.”

11. These statements, however, are opposed to Friedreich (“Hdb. d. gerichtsärztl Praxis,” i, p. 271, 1843), and also Lombroso (op. cit., p. 42), according to whom pederasty is very frequent among the uncivilized Americans.

12. Comp. Friedreich, “gerichtl. Psychologie,” p. 389, who has collected numerous examples. Thus the nun Blanbekin was always troubled with the thought about what had become of the part lost at the circumcision of Christ. Veronica Juliani, canonized by Pope Pius II, in memory of the divine lion, took an actual lion in her bed and kissed it, and let it suck from her breast; and even secreted a few drops of milk for it. St. Catherine, of Genoa, often burned with such inward fire that, in order to cool herself, she would lie down on the ground and cry “Love, love, I can endure it no longer!” At the same time she felt a peculiar inclination for her confessor. One day she lifted his hand to her nose and smelled an odor which penetrated to her heart, “a heavenly perfume, so delightful that it would wake the dead.” St. Armelle and St. Elizabeth were troubled with a similar longing for the child Jesus. The temptations of St. Anthony, of Padua, are well known. An old prayer is significant: “O, that I had found thee, Holy Emanuel; O, that I had thee in my bed to bring delight to body and soul. Come and be mine, and my heart shall be thy resting-place.”

13. Comp. Friedreich, “Diagnostik der psych. Krankheiten,” p. 347 u. ff.; Neumann, “Lehrb. d. Psychiatrie,” p. 80.

14. The relation of this trio finds its expression not only in the events of real life, as above indicated, but also in romance, and even in the sculpture of degenerate eras. As an example we may point to the group of St. Theresa, by Bernini, who “sinks in an hysterical faint on a marble cloud, with an amorous angel plunging the arrow (of divine love) into her heart” (Lübke).

15. A Russian religious sect.

16. Westermarck (op. cit., p. 211), after a careful review of the evidence, says: “These facts appear to prove that the feeling of shame, far from being the original cause of man’s covering his body, is, on the contrary, a result of this custom; and that the covering, if not used as a protection from climate, owes its origin, at least in a great many cases, to the desire of men and women to make themselves attractive.”—Trans.

17. This is not literally the case. “It is expressly stated, of the women of several savage peoples, that they are less desirous of self-decoration than the men.”—Westermarck, op. cit., p. 184. And the same writer (p. 182) says that “it is a common notion that women are by nature vainer and more addicted to dressing and decorating themselves than men. This certainly does not hold good for savage and barbarous peoples in general.”—Trans.

18. Comp. Max Müller, who derives the word fetich etymologically from factitious (artificial, an insignificant thing).

19. Deutsches Montagsblatt, Berlin, August 20, 1888.

20. Magnan’s “spinal cérébral postérieur,” who finds pleasure in every woman, and on whom every woman looks with favor, has only desire to satisfy his lust. Purchased or forced love is not real love (Mantegazza). The one who originated the saying, “Sublata lucerna nullum discrimen inter feminas,” must have been a cynic indeed. Power in a man to perform love’s act is no proof that this makes possible the greatest pleasure of love. There are, indeed, urnings who are potent for women,—men who do not love their wives, but who are still able to perform the marital “duty.” In most cases of this kind, indeed, there is no lustful pleasure; it is essentially a kind of onanistic act, for the most part made possible by means of help of imagination that calls up another beloved person. By this deception sensual pleasure can be induced, but this rudimentary psychical satisfaction is the result of a mental trick, just as in solitary onanism, where fancy has to assist in order to induce sensual pleasure. As a rule, the degree of orgasm necessary as a means to the attainment of lustful pleasure seems attainable only when the imagination intervenes. Where mental impediments exist (indifference, repugnance, disgust, fear of infection or pregnancy, etc.), sensual pleasure seems usually wanting.

21. “The important part played by the hair of the head as a stimulant of sexual passion appears in a curious way from Mr. Sibree’s account of King Radàma’s attempt to introduce European customs among the Hovas of Madagascar. As soon as he had adopted the military tactics of the English, he ordered that all his officers and soldiers should have their hair cut, but this command produced so great a disturbance among the women of the capital that they assembled in great numbers to protest against the king’s order, and could not be quieted until they were surrounded by troops, and their leaders cruelly speared.”—Westermarck, op. cit.

Here male hair was a physiological fetich of females. It represents a relation of the sexes that civilization has gradually reversed. While in civilized society woman exercises her ingenuity to increase her attractiveness, among savages it is the men who are anxious to increase their physical charms. This reversal of the primitive relation is a very interesting fact, and is probably to be explained by the transference of the “liberty of choice” from woman to man which civilization has gradually induced. Westermarck (op. cit., p. 185) says: “It should be noted that it is, as a rule, the man only that runs the risk of being obliged to lead a single life. Hence it is obvious that, to the best of his ability, he must endeavor to be taken into favor by making himself as attractive as possible. In civilized Europe, on the other hand, the opposite occurs. Here it is the woman that has the greatest difficulty in getting married, and she is also the vainer of the two.”—Trans.

22. The olfactory centre is presumed by Ferrier (“Functions of the Brain”) to be in the region of the gyrus uncinatus. Zuckerkandl (“Ueber das Riechcentrum,” 1887), from researches in comparative anatomy, concludes that the olfactory centre has its seat in Ammon’s horn.

23. Comp. Laycock, who (“Nervous Diseases of Women,” 1840) found that in women the love for musk and similar perfumes was related to sexual excitement.

24. Also in the insanity of gestation.—Trans.

25. The following case, reported by Binet, seems to be in opposition to this idea. Unfortunately nothing is said concerning the mental characteristics of the person. In any event, it is certainly confirmatory of the relations existing between the olfactory and sexual senses:—

D., a medical student, was seated on a bench in a public park, reading a book (on pathology). Suddenly a violent erection disturbed him. He looked up and noticed that a lady, redolent with perfume, had taken a seat upon the other end of the bench. D. could attribute the erection to nothing but the unconscious olfactory impression made upon him.

26. Meibomius, “De flagiorum usu in re medica,” London, 1765; Boileau, “The History of the Flagellants,” London, 1783.

27. Comp. Roubaud, “Traité de l’impuissance et de la stérilité.” Paris, 1878.

28. Literature: Parent-Duchatelet, Prostitution dans la ville de Paris, 1837.—Rosenbaum, Entstehung der Syphilis, Halle, 1839; also, Die Lustseuche im Alterthum, Halle, 1839.—Descuret, La médecine des passions, Paris, 1860.—Casper, Klin. Novellen, 1863.—Bastian, Der Mensch in der Geschichte.—Friedländer, Sittengeschichte Roms.—Wiedemeister, Cäsarenwahnsinn.—Scherr, Deutsche Cultur- und Sittenge- schichte, Bd. i, Cap. 9.—Tardieu, Des attentats aux mœurs., 7 édit., 1878.—Emminghaus, Psychopathol., pp. 98, 225, 230, 232.—Schüle, Handbuch der Geisteskrankheiten, p. 114.—Marc, Die Geisteskrankheiten, übers v. Ideler, ii, p. 128.—v. Krafft, Lehrb. der Psychiatrie, 4 Aufl., i, p. 90; Lehrb. d. ger. Psychopathol., 2 Aufl., p. 234; Archiv f. Psychiatrie, vii, 2.—Moreau, Des aberrations du sens génésique, Paris, 1880.—Kirn, Allg. Zeitschr. f. Psychiatrie, xxxix, Heft 2 u. 3.—Lombroso, Geschlechtstrieb u. Verbrechen in ihren gegenseitigen Beziehungen (Goltdammer’s Archiv, Bd. xxx.).—Tarnowsky, Die krankhaften Erscheinungen des Geschlechtssinns, Berlin, 1886.—Ball, La Folie érotique, Paris, 1888.—Serieux, Recherches cliniques sur les anomalies de l’instinct sexuel, Paris, 1888.—Hammond, Sexual Impotence.

29. Vide Ultzmann, Genito-Urinary Neuroses in the Male (published by The F. A. Davis Co., Philadelphia), for discussion of peripheral neuroses.

30. An interesting example of how an imperative conception of non-sexual content can exert an influence is related by Magnan (Ann. méd. psych., 1885): Student, aged 21, strongly predisposed hereditarily, previously a masturbator, constantly struggles with the number 13 as an imperative conception. As soon as he attempts coitus the imperative idea inhibits erection and makes the act impossible.

31. Louyer-Villermay speaks of masturbation in a girl of 3 or 4 years, and Moreau (“Aberrations du sens génésique,” 2 édit., p. 209) of the same in one of 2 years. See, further, Maudsley, “Physiology and Pathology of Mind;” Hirschsprung (Kopenhagen), Berlin, klin. Wochenschr., 1866, Nr. 38; Lombroso, “The Criminal,” Cases 10, 19, and 21.

32. Comp. Kirn, Zeitschr. f. Psych., Bd. xxxix. Legrand du Saulle, Annal. d’hyg., 1868, Oct.

33. The translator has lately seen a case of this kind that illustrates the lack of care taken by our criminal courts. A very infirm man, aged 55 to 60, under favoring circumstances, made an unsuccessful sexual assault on a girl aged about 18. At his trial he made full confession, and explained his act as due to ordinary sinfulness. He was the father of a family and living with his wife, and up to that time blameless sexually. He was sentenced to five years of hard labor! He was incapable of almost the lightest work. Conversation with him while in jail showed at once that he was well advanced in senile dementia. Legal question concerning his mental condition was not raised,—because he confessed, probably!

34. Cases, vide Laségue: “Les exhibitionistes,” Union médicale, 1877, May 1st.

35. Legrand du Saulle, La folie devant les tribunaux, p. 530.

36. Kirn, Maschka’s Handb. d. ger. Med., pp. 373, 374; Allg. Zeitschrift f. Psychiatrie, Bd. xxxix, p. 220.

37. Die Welt als Wille und Vorstellung, 1859, B. ii, p. 461 et seq.

38. “Ueber männliche Sterilität,” Wiener med. Presse, 1878, Nr. 1. “Ueber Potentia generandi et coeundi,” Wiener Klinik, 1885, Heft 1, S. 5. Translated under the title of Genito-Urinary Neuroses, etc. The F. A. Davis Company, Philadelphia.

39. In individuals in whom intense sexual hyperæsthesia is associated with acquired irritable weakness of the sexual apparatus, it is possible that simply at the sight of a pleasing female figure, without peripheral irritation of the genitals, not only the mechanism of erection, but also that of ejaculation, may be excited to action from the psycho-sexual centre. For such individuals, all that is necessary to induce orgasm, or even ejaculation, is to imagine themselves in a sexual situation with a female that sits opposite them in railway-coupé or drawing-room. Hammond (op. cit., p. 40) describes several cases of this kind that came to him for treatment for impotence that followed; and he mentions that these individuals used the term “ideal coitus” for the act. Dr. Moll, of Berlin, told me of a similar case; and in this instance the same designation was chosen for the act.

40. So named from the notorious Marquis de Sade, whose obscene novels treated of lust and cruelty. In French literature the expression “Sadism” has been applied to this perversion.

41. U. A. Novalis, in his “Fragments”; Görres, “Christliche Mystik,” Bd. iii, p. 460.

42. Comp. also Alfred deMusset’s famous verses to the Andalusian girl:—

“Qu’elle est superbe en son désordre—quand elle tombe les seins nus—

Qu’on la voit, béante, se tordre—dans un baiser de rage et mordre—

En hurlant des mots inconnus!”

43. During the excitement of battle the idea of lust forces its way into consciousness. Comp. the description of a battle by a soldier, by Grillparzer:—

“And as the signal rang out, the armies met, breast to breast—lust of the gods!—here, there, the murderous steel slays enemy, friend. Given and taken—death and life—with wavering change—wildly raging in frenzy.”

44. Schulz (Wiener Med. Wochenschrift, No. 49, 1869) reports a remarkable case of a man, aged 28, who could perform coitus with his wife only after working himself into an artificial fit of anger.

45. Concerning analogous acts in rutting animals, vide Lombroso, “The Criminal.”

46. Among animals it is always the male who pursues the female with proffers of love. Playful or actual flight of the female is not infrequently observed; and then the relation is like that between the beast of prey and the victim.

47. The conquest of woman takes place to-day in the social form of courting, in seduction and deception. From the history of civilization and anthropology we know that there have been times, as there are savages to-day that practice it, where brutal force, robbery, or even blows that made a woman powerless, were made use of to obtain love’s desire. It is possible that tendencies to such outbreaks of sadism are atavistic.

48. In the Jahrbücher für Psychologie, ii, p. 128, Schäfer (Jena) refers to the reports of two cases by A. Payer. In the first case states of great sexual excitement were induced by the sight of battles or of paintings of them; in the second, by cruel torturing of small animals (vide Case 24). It is added: “The pleasure of battle and murder is so predominantly an attribute of the male sex throughout the animal kingdom, that there can be no question about the close relation existing between this side of the masculine character and male sexuality. I believe, too, that by unprejudiced observation I can show that, in men who are absolutely normal mentally and physically, the first indefinite and incomprehensible precursors of sexual excitement may be induced by reading exciting scenes of the chase and war,—i.e., they give rise to unconscious longings for a kind of satisfaction in warlike games (wrestling), in which, also, the fundamental sexual impulse to the most perfect and intense contact with a companion is expressed, with the more or less clearly defined secondary thought of conquest.”

49. It sometimes happens that an accidental sight of blood, etc., is what first excites the preformed psychical mechanism of the sadistic individual, and awakens the instinct.

50. Comp. Metzger’s ger. Arzneiw., herausgegeben von Remer, p. 539; Klein’s Annalen, x, p. 176, xviii, p. 311; Heinroth, System der psych, ger. Med., p. 270; Neuer Pitaval, 1855, 23, Th. (Fall Blaize Ferrage).

51. Comp. Spitzka, The Journal of Nervous and Mental Disease, December, 1888; Kiernan, The Medical Standard, November, December, 1888.

52. Simon (Crimes et Délits, p. 209) mentions an experience of Lacassagne’s, to whom a respectable man said that he was never intensely excited sexually except when a spectator at a funeral.

53. Taxil (op. cit.) gives more detailed accounts of this sexual monster, which must have been a case of habitual satyriasis, accompanied by perverse sexual instinct. Sade was so cynical that he actually sought to idealize his cruel lasciviousness, and become the apostle of a theory based upon it. He became so bad (among other things he made an invited company of ladies and gentlemen erotic by causing to be served to them chocolate bon-bons which contained cantharides) that he was committed to the insane asylum at Charenton. During the revolution of 1790, he escaped. Then he wrote obscene novels filled with lust, cruelty, and the most obscene scenes. When Bonaparte became Consul, Sade made him a present of his novels magnificently bound. The Consul had the works destroyed, and the author committed to Charenton again, where he died, at the age of sixty-four.

54. Comp. Krauss, Psychologie des Verbrechens, 1884, p. 188; Dr. Hofer, Annalen der Staatsarzneikunde, 6 Jahrgang, Heft 2; Schmidt’s Jahrbücher, Bd. lix, p. 94.

55. According to newspaper reports, in December, 1890, several similar attacks were made in Mainz. A young fellow between fourteen and sixteen years old pressed against women and girls and stabbed them in the legs with a sharp-pointed instrument. He was arrested, and seemed to be insane. Further details of the case are not known.

56. Leo Taxil (La Corruption, Paris, Noiret, p. 223) makes the same statements. There are also men who demand introductio linguæ meretricis in anum.

57. Leo Taxil (op. cit., p. 234) relates that in Parisian brothels instruments are kept ready which look like knouts, but which are merely tubes filled with air, such as clowns use in circuses. Sadistic men use them to create for themselves the illusion that they are whipping women.

58. The legend is especially spread throughout the Balkan peninsula. Among the Greeks it has its origin in the myth of the lamiæ and marmolykes,—blood-sucking women. Goethe made use of this in his “Bride of Corinth.” The verses referring to vampirism, “suck thy heart’s blood,” etc., can be thoroughly understood only when compared with their ancient sources.

59. In the latest literature we find the matter treated, but particularly in Sacher-Masoch’s novels, which are hereafter to be alluded to, and in Ernest von Wildenbruch’s “Brunhilde,” Rachilde’s “La Marquise de Sade,” etc.

60. So named from the writer, Sacher-Masoch, whose romances and novels have as their particular object the description of this perversion.

61. Comp., supra, Introduction, p. 28.

62. The author’s “Neue Forschungen auf d. Gebiet d. Psychopathia Sexualis,” Stuttgart, 1891, which is, for the most part, incorporated in this edition of “Psychopathia Sexualis.”

63. This difference of courage in the face of events in nature, on the one hand, and in the face of personal conflict, on the other, is certainly remarkable (comp. Case 44), even though it is the only indication of effemination mentioned in this case.

64. Transactions of the Colorado State Medical Society, quoted in the Alienist and Neurologist, 1883, p. 345.

65. “To be at the feet of an imperious mistress; to obey her orders; to be compelled to sue her for pardon,—these things are my most intense delight.”

66. “Never daring to express my desire, I at least gave it rein under circumstances that served to preserve in me the idea of it.”

67. “What Rousseau loves in women is not only the frowning brow, the threatening hand, the angry glance, the imperious attitude, but it is also the emotional state of which these are the objective translation; he loves the fierce, disdainful woman who crushes him at her feet with the weight of her royal displeasure.”

68. However, the domain of masochism must be sharply differentiated from the principal subject of that work, which is, that love contains an element of suffering. Unrequited love has always been described as “sweet, but sorrowful;” and poets have spoken of “blissful pain” or “painful bliss.” This must not, as it is by Z., be confounded with the manifestations of masochism, any more than the characterization of an unyielding lover as “cruel” should be. It is remarkable, however, that Hamerling (“Amor und Psyche,” iv, Gesang) uses perfect masochistic pictures, flagellation, etc., to express this feeling.

69. The desire to be trod upon also occurs in religious enthusiasts (comp. Turgenjew, “Sonderbare Geschichten”).

70. In this story the writer describes a man whose greatest pleasure lies in being treated like a slave by a beautiful woman, whom he loves. Besides numerous scenes in which the man is whipped by the woman, there are others in which he is trod upon by her. It is this act that forms the principal means of excitement in the case above described.

71. In Continental hotels the guests are accustomed to put their shoes in the corridors at night, to be cleaned.

72. However, against the theory that foot- and shoe-fetichism is a manifestation of (latent) masochism, Dr. Moll (op. cit., p. 136) raises the objection that it is still unexplained why the fetichist so often prefers boots with high heels, then boots and shoes of a particular kind—buttoned or laced. To this objection it may be remarked that, in the first place, the high heels characterize the shoes as feminine; and, in the second place, that in spite of the sexual character of his inclination, the fetichist demands all kinds of æsthetic qualities in his fetich (comp. Case 90).

73. There is apparently a connection between foot-fetichism and the fact that certain persons of this kind, whom coitus does not satisfy, or who are unable to perform it, find a substitute for it in tritus membri inter pedes mulieris.

74. Analogy with the excesses of religious enthusiasm is found even here. The religious enthusiast, Antoinette Bouvignon de la Porte, mixed her food with fæces to punish herself (Zimmermann, op. cit., p. 124). The beatified Marie Alacoque, to “mortify” herself, licked up with her tongue the dejections of patients, and sucked their toes covered with sores.

75. The laws of the early Middle Ages gave the husband the right to kill the wife; those of the later Middle Ages, the right to beat her. The latter right was used freely, even by those of high standing (comp. Schultze, Das höfische Leben zur Zeit des Minnesangs, Bd. i, p. 163 et seq.). Yet, by the side of this, the paradoxical chivalry of the Middle Ages stands unexplained.

76. Comp. Lady Milford’s words in Schiller’s “Kabale und Liebe”: “We women can only choose between ruling and serving; but the highest pleasure power affords is but a miserable substitute, if the greater joy of being the slaves of a man we love is denied us!”

77. Anthony and Cleopatra, v. 2.

78. Comp. the author’s article, “über geschlechtliche Hörigkeit und Masochismus,” in the Psychiatrischen Jahrbücher, Bd. x, p. 169 et seq., where this subject is treated in detail, and particularly from the forensic stand-point.

79. The expressions “slave” and “slavery,” though often used metaphorically under such circumstances, are avoided here because they are the favorite expressions of masochism, from which this “bondage” must be strictly differentiated.

The expression “bondage” is not to be construed to mean J. S. Mill’s “Bondage of Woman.” What Mill designates with this expression are laws and customs, social and historical facts. Here, however, we always speak of facts having peculiar individual motives that even conflict with prevalent customs and laws.

80. Perhaps the most important element is, that by the habit of submission a kind of mechanical obedience, without consciousness of its motives, which operates with automatic certainty, may be established, having no opposing motives to contend with, because it lies beyond the threshold of consciousness; and it may be used by the dominant individual like an inanimate instrument.

81. Sexual bondage, of course, plays a rôle in all literatures. Indeed, for the poet, the extraordinary manifestations of the sexual life that are not perverse form a rich and open field. The most celebrated description of masculine “bondage” is that by Abbé Prévost, “Mano Lescault.” An excellent description of feminine “bondage” is that of “Leone Leoni,” by George Sand. But first of all comes Kleist’s “Käthchen von Heilbronn,” who himself called it the counterpart of (sadistic) “Penthesilea.” Halm’s “Griseldis” and many other similar poems also belong here.

82. Cases may occur in which the sexual bondage is expressed in the same acts that are common in masochism. When rough men whip their wives, and the latter suffer for love, without, however, having a desire for blows, we have a pseudo form of bondage that may simulate masochism.

83. It is very interesting, and dependent upon the nature of bondage and masochism, which essentially correspond in external effects, that to illustrate the former certain playful, metaphorical expressions are in general use; such as “slavery,” “to bear chains,” “bound,” “to hold the whip over,” “to harness to the triumphal car,” “to lie at the feet,” “hen-pecked,” etc.,—all things which, literally carried out, form the objects of the masochist’s desire. Such similes are frequently used in daily life and have become trite. They are derived from the language of poetry. Poetry has always recognized, within the general idea of the passion of love, the element of dependence in the lover, who practices self-sacrifice spontaneously or of necessity. The facts of “bondage” have also always presented themselves to the poetical imagination. When the poet chooses such expressions as those mentioned, to picture the dependence of the lover in striking similes, he proceeds exactly as does the masochist, who, to intensify the idea of his dependence (his ultimate aim), creates such situations in reality. In ancient poetry, the expression “domina” is used to signify the loved one, with a preference for the simile of “casting in chains” (e.g., Horace, Od. iv, 11). From antiquity through all the centuries to our own times (comp. Grillparzer, “Ottokar,” Act v: “To rule is sweet, almost as sweet as to obey”), the poetry of love is filled with similar phrases and similes. The history of the word “mistress” is also interesting. But poetry reacts on life. It is probable that the courtly chivalry of the Middle Ages arose in this way. In its reverence for women as “mistresses” in society and in individual love-relations; its transference of the relations of feudalism and vassalage to the relation between the knight and his lady; its submission to all feminine whims; its love-tests and vows; its duty of obedience to every command of the lady,—in all this, chivalry appears as a systematic, poetical development of the “bondage” of love. Certain extreme manifestations, like the deeds and suffering of Ulrich von Lichtenstein or Pierre Vidal in the service of their ladies; or the practice of the fraternity of the “Galois” in France, whose members sought martyrdom in love and subjected themselves to all kinds of suffering,—these clearly have a masochistic character, and demonstrate the natural transformation of one phenomenon into the other.

84. If it be considered that, as shown above, “sexual bondage” is a phenomenon observed much more frequently and in a more pronounced degree in the female sex than in the male, the thought arises that masochism (if not always, at least as a rule) is an inheritance of the “bondage” of feminine experience. Thus it comes into a relation—though distant—with contrary sexual instinct, as a transference to the male of a perversion really belonging to the female. This conception of masochism as a rudimentary contrary sexual instinct, as a partial effemination, here affecting only the secondary sexual character of the vita sexualis (a theory still more unconditionally expressed in the sixth edition of this work) finds its support in the statements of the subjects of Case 44 and Case 50, who present other features of effemination, and give as their ideal a relatively old woman who seeks and wins them; and, further, in the fact that the (potent) masochist prefers the rôle of succubus, as shown by statements referring to this.

It must, however, be emphasized that “bondage” also plays no unimportant rôle in the masculine vita sexualis, and that masochism in man may also be explained without any such transference of feminine elements. It must also be remembered here that masochism, as well as its counterpart, sadism, occurs in irregular combination with contrary sexual instinct.

85. Of course, both have to contend with opposing ethical and æsthetic motives in foro interno. After these have been overcome and sadism appears, it immediately comes in conflict with the law. This is not the case with masochism; which accounts for the greater frequency of masochistic acts. But the instinct of self-preservation and fear of pain oppose the realization of the latter. The practical significance of masochism lies only in its relations to psychical impotence; while that of sadism lies beyond that, and is principally forensic.

86. Every attempt to explain the facts of either sadism or masochism, owing to the close connection of the two phenomena demonstrated here, must also be suited to explain the other perversion. An attempt to offer an explanation of sadism, by J. G. Kiernan (Chicago) (vide “Psychological Aspects of the Sexual Appetite,” Alienist and Neurologist, St. Louis, April, 1891) meets this requirement, and for this reason may be briefly mentioned here. Kiernan, who has several authorities in Anglo-American literature for his theory, starts from the assumption of several naturalists (Dallinger, Drysdale, Rolph, Cleukowsky) which conceives the so-called conjugation, a sexual act in certain low forms of animal life, to be cannibalism, a devouring of the partner in the act. He brings into immediate connection with this the well-known facts that at the time of sexual union crabs tear limbs from their bodies and spiders bite off the heads of the males, and other sadistic acts performed by rutting animals with their consorts. From this he passes to lust-murder and other lustful acts of cruelty in man, and assumes that hunger and the sexual appetite are, in their origin, identical; that the sexual cannibalism of lower forms of animal life has an influence in higher forms and in man, and that sadism is an example of atavism.

This explanation of sadism would, of course, also explain masochism; for if the origin of sexual intercourse is to be sought in cannibalistic processes, then both the survival of one sex and the destruction of the other would fulfill the purpose of nature, and thus the instinctive desire to be the victim would be explained. But it must be stated in objection that the basis of this reasoning is insufficient. The extremely complicated process of conjugation in lower organisms, into which science has really penetrated only during the last few years, is by no means to be regarded as simply a devouring of one individual by another (comp. Weismann, Die Bedeutung der Sexuellen Fortpflanzung für die Selectionstheorie, p. 51, Jena, 1886).

87. In Zola’s “Therese Raquin,” where the lover repeatedly kisses his mistress’s boot, the case is quite different from that of shoe- and boot-fetichists, who, at the sight of every boot worn by a lady, or even alone, are thrown into sexual excitement, even to the extent of ejaculation.

88. Though Binet (op. cit.) declares that every sexual perversion, without exception, depends upon such an “accident acting on a predisposed subject” (where, under predisposition, only hyperæsthesia in general is understood), yet such an assumption for other perversions than fetichism is neither necessary nor satisfactory. For example, it is not clear how the sight of another’s punishment could excite sexually even a very excitable individual, if the physiological relationship of lust and cruelty had not been developed into original sadism in an abnormally excitable individual.

89. When young husbands who have associated much with prostitutes feel impotent in the face of the chastity of their young wives—a thing that frequently occurs—the condition may be regarded as a kind of (psychical) fetichism in a wider sense. One of my patients was never potent with his beautiful and chaste young wife, because he was accustomed to the lascivious methods of prostitutes. When he now and then attempted coitus with puellis he was perfectly potent. Hammond (op. cit.) reports a very similar interesting case. Of course, in such cases, a bad conscience and hypochondriacal fear of impotence play an important part.

90. A kind of rudimentary sadism in L. and masochism in N.

91. Great sexual hyperæsthesia. Comp. note on p. 50.

92. This is also sexual hyperæsthesia. Any intense excitement affects the sexual sphere (Binet’s “dynamogénie générale”). Concerning this, Dr. Moll communicates the following case: “A similar thing is described by Mr. E., aged 27; merchant. While at school, and afterward, he often had ejaculation with pleasurable feeling when he was seized with a feeling of intense anxiety. Besides, almost every other physical or mental pain exerted a similar influence. E., as he states, has a normal sexual instinct, but suffers with nervous impotence.”

93. Phila. Med. and Surg. Rep., Sept. 7, 1889.

94. This case was originally reported by Dr. A. R. Reynolds, Chicago (Western Med. Reporter, Nov., 1888).

95. Moll (op. cit. p. 131) reports: “A man, X., becomes intensely excited sexually whenever he sees a woman with the hair in a braid; loose hair, no matter how beautiful, cannot produce this effect.”

Of course, it is not justifiable to consider all hair-despoilers fetichists, for in a few cases such acts are done for the purpose of gain,—i.e., the stolen hair is not a fetich.

96. Magnan (Arch, de Neurologie, vol. xxxiii, No. 69, 1892) gives the details of a case of sexual perversion in a degenerate individual, where the elements of fetichism and sadism were combined, and faute de mieux the sadistic impulse found satisfaction in self-mutilation. The perverse impulse began at the age of six; the sight of a boy or girl with a delicate, white skin awakened in him sexual appetite, with a desire to bite and eat a piece of the skin. While caressing a horse, the impulse to bite the soft skin of its nostrils arose, and afterward the memory of this became associated with the act of onanism. Later, he began to prick himself with pins, knives, etc., while masturbating. The desire to bite and eat skin was also provoked by the sight of shining blades, like those of scissors. He was always able to resist the impulse to attack young girls; but the struggle was hard, and for eight months he hesitated before venting his passion on his own person. He was finally arrested in the act of cutting a large piece of skin from his arm with scissors. Asked the motive of his self-mutilation, he stated that for several hours he had been following a young girl who had a fine, white skin, and was burning with desire to cut out a piece of it and eat it. On his person there were many scars of previous mutilations. The impulse was devoid of natural sexual desire. Chewing the piece of skin provoked ejaculation.—Trans.

97. The frequent changes of style of dress which fashion dictates may be referred to a physiological law. The reaction of the nervous system to a constant stimulus diminishes in proportion to the duration of the action of the stimulus. Constant association with nudity removes its power to excite sexually. Owing to this, the savage endeavors to attract attention by changing his physical peculiarities; he dresses his hair in some remarkable way, or paints his body; then he tattooes his skin, or performs striking self-mutilation, such as half-castration and circumcision (comp. Westermarck, op. cit., p. 205). Finally, mutilation is replaced by movable appendages, upon which ornaments are worn; and thus there is afforded opportunity for change, in obedience to the unconscious physiological requirement, which is called a “taste for change.” Undoubtedly, woman’s desire for changes of fashion is primarily dependent upon man’s desire to be pleased; and her function in this direction has certainly been transferred from him to her by civilization (comp. p. 16).—Trans.

98. Comp: Goethe’s remarks about his adventure in Geneva (“Briefe aus der Schweiz,” 1. Abtheil., Schluss).

99. The fact that the partly-veiled form is often more charming than when it is perfectly nude, is, as far as object goes, similar, but quite different psychically. This depends upon the effect of contrast and expectation, which are common phenomena, and in no sense pathological.

100. On page 124 (op. cit.) Dr. Moll writes concerning this impulse in hetero-sexual individuals: “The passion for handkerchiefs may go so far that the man is entirely under their control. A woman tells me: ‘I know a certain gentleman, and when I see him at a distance I only need to draw out my handkerchief so that it peeps out of my pocket, and I am certain that he will follow me as a dog follows its master. Go where I please, this gentleman will follow me. He may be riding in a carriage or engaged in important business, and yet, when he sees my handkerchief he drops everything in order to follow me,—i.e., my handkerchief.’”

101. Garnier (Anomalies Sexuelles, Paris, pp. 508, 509) reports two cases (Cases 222 and 223) that are apparently opposed to this assumption, particularly the first, in which despair about the unfaithfulness of a lover led the individual to submit to the seductions of men. But the case itself clearly shows that this individual never found pleasure in homo-sexual acts. In Case 223, the individual was effeminated ab origine, or was at least a psychical hermaphrodite.

Those who hold to the opinion that the origin of homo-sexual feelings and instinct is found to be exclusively in defective education and other psychological influences are entirely in error.

An untainted male may be raised never so much like a female, and a female like a male, but they will not become homo-sexual. The natural disposition is the determining condition; not education and other accidental circumstances, like seduction. There can be no thought of contrary sexual instinct save when the person of the same sex exerts a psycho-sexual influence on the individual, and thus brings about libido and orgasm,—i.e., has a psychical attraction. Those cases are quite different in which, faute de mieux, with great sensuality and a defective æsthetic sense, the body of a person of the same sex is used for an onanistic act (not for coitus in a psychical sense).

In his excellent monograph, Moll shows very clearly and convincingly the importance of original predisposition in contrast with exciting causes (comp. op. cit., pp. 156–175). He knows “many cases where early sexual intercourse with men was not capable of inducing perversion.” Moll significantly says, further: “I know of such an epidemic (of mutual onanism) in a Berlin school, where a person who is now an actor shamelessly introduced mutual onanism. Though I now know the names of very many urnings in Berlin, yet I could not ascertain, even with anything like probability, that among all the scholars of that school at that time there was one that had become an urning; but, on the other hand, I have quite certain knowledge that many of those scholars are now normal sexually, in feeling and intercourse.”

102. Comp, author’s Experimental Study in the Domain of Hypnotism, 1889. G. P. Putnam’s Sons, New York.

103. Comp. Sprengel, “Apologie des Hippokrates,” Leipzig, 1792, p. 611; Friedreich, “Literärgeschichte der psych. Krankheiten,” 1830, p. 31; Lallemand, “Des pertes séminales,” Paris, 1836, i, p. 581; Nysten, “Dictionn. de médecine,” xi édit., Paris, 1858, Art. “éviration et Maladie des Scythes”; Marandon, “De la maladie des Scythes”; “Annal. médico-psychol.,” 1877, Mars, p. 161; Hammond, American Journal of Neurology and Psychiatry, August, 1882.

104. The following description of the “bote” is taken from Dr. J. G. Kiernan’s article on “Responsibility in Sexual Perversion,” read before the Chicago Medical Society, March 7, 1892: “In accordance with the well-known physiological law, that too frequent excitation of a nerve exhausts the reaction of that nerve to that excitant, sexual excess exhausts the normal reaction, whence it occurs that abnormal stimulus is required and the vice type of sexual perversion results. Such vice types crop up among savages. Dr. A. B. Holder (N. Y. Med. Jour., 1889) describes a sexual pervert called the ‘bote’ by the Montana and the ‘burdach’ by the Washington Indians. Such a pervert is found among all the tribes of the Northwest. Like all other sexual perverts, these ‘botes’ can recognize each other. Dr. Holder has found that the ‘bote’ wears the squaw dress, parts his hair like a squaw, and assumes feminine speech and manners. Their features are often masculine. In childhood feminine dress and manners are assumed, but not until puberty do ‘bote’ practices result. These consist in taking the male organ of the active party in the lips of the ‘bote,’ who experiences the sexual orgasm at the same time. A ‘bote’ examined by Dr. Holder was a splendidly formed fellow, of prepossessing face, in perfect health, active in movement, and happy in disposition. By offering payment, he induced him to submit himself, though with considerable reluctance, to a thorough examination. He was five feet eight inches high, weighed one hundred and fifty-eight pounds, and had a frank, intelligent face,—being an Indian, of course beardless. He was thirty-three years of age, and had worn woman’s dress for twenty-eight years. His dress was the usual dress of the Indian female, consisting of four articles,—a single dress or gown of half a dozen yards of cloth, made loose with wide sleeves, and skirt reaching to the ankles, the skirt and body of one piece, very much like the ‘Mother Hubbard’ negligée worn by ladies; a beaded belt loosely confining this at the waist; stockings from government annuity goods, and buckskin moccasins extending above the ankles. The hair, twenty-four or twenty-six inches long, was parted in the centre and allowed to hang loose in two masses behind the shoulders. Since among the Sioux and some other tribes it is usual for men to wear their hair in this way, it is well to observe that in this tribe (Absaroke) the men usually wear the hair in long braids, and always part it on the side and ‘roach’ the front. His skin was smooth and free from hair, there being absolutely none on the legs, arms, or breast, or in the arm-pits. This is of no special significance, as male and female Indians are both free from hair on these parts of the body. The mammæ were as rudimentary as those of the male. When he removed his dress he threw his thighs together so as to completely conceal the organs, whether male or female; such a movement is made by timid women under examination,—a movement usually successful in the female, owing to the non-projecting character of the genitals and to the rotundity of the thighs; but not usually easy, for the reverse reasons, in the male. In this the ‘bote’—either from the conformation of the thighs, which had the feminine rotundity, or from skill acquired by habit—succeeded completely. When he separated his thighs, male organs came into view, in size perhaps not quite so large as the physique of the man would indicate, but in position and shape altogether normal. The penis was flaccid. The ‘bote’ in habits very closely resembles a class described by Hippocrates among the Scythians of Caucasus, called by the Greeks anandreis, a word strikingly similar in meaning to ‘bote.’”—Trans.

105. Bibliography (besides works mentioned hereafter): Tardieu, Des attentats aux moeurs, 7 édit., 1878, p. 210.—Hofmann, Lehrb. d. ger. Med., 3 Aufl., pp. 172, 850.—Gley, Revue philosophique, 1884, Nr. 1.—Magnan, Annal. med.-psychol., 1885, p. 458.—Shaw and Ferris, Journal of Nervous and Mental Disease, 1883, April.—Bernhardi, Der Uranismus, Berlin (Volksbuchhandlung), 1882.—Chevalier, De l’inversion de l’instinct sexual, Paris, 1885.—Ritti, Gaz. hebdom. de médecine et de chirurg., 1878, 4. Januar.—Tamassia, Rivista sperim, 1878, pp. 97–117.—Lombroso, Archiv. di Psichiatr., 1881.—Charcot et Magnan, Archiv. de neurologie, 1882, Nr. 7, 12.—Moll, Die conträre Sexualempfindung, Berlin, 1891 (numerous bibliographic references).—Chevalier, Archives de l’anthropologie criminelle, vol. v, No 27; vol. vi, No. 31.—Reuss, “Aberrations du sens générique,” Annales d’hygiène publique, 1886.—Saury, Étude clinique sur la folie héréditaire, 1886.—Brouardel, Gaz. des hôpiteaux, 1886 and 1887.—Tilier, L’instinct sexuel chez l’homme et chez les animaux, 1889.—Carlier, Les deux prostitutions, 1887.—Lacassagne, art. “Pédérastie,” in the Diction. encyclopédique.—Vibert, art. “Pédérastie,” in the Diction. méd. et de chirurgie.

106. Dr. Moll, of Berlin, called my attention to the fact that in Moritz’s Magazin f. Erfahrungsseelenkunde, vol. viii, Berlin, 1791, there are references to contrary sexual instinct in man. In fact, there two biographies of men are reported who manifested an enthusiastic love for persons of their own sex. In the second case, which is particularly noteworthy, the patient himself explains his aberration by the fact that, as a child, he was caressed only by grown persons, and, as a boy of ten or twelve years, only by his school-fellows. “This, and the want of association with persons of the opposite sex, in me, caused the natural inclination toward the female sex to be entirely diverted to the male sex. I am still quite indifferent to women.”

It cannot be determined whether such a case is one of congenital (psycho-sexual hermaphroditism?) or acquired contrary sexual instinct. The oldest case of contrary sexual instinct, that has thus far been proved in Germany, is that of a woman who was married to another, and gratified herself sexually with a leathern priapus. A case of viraginity, historically and legally interesting, derived from the legal proceedings, which took place early in the eighteenth century, is reported by Dr. Müller (Alexandersbad), in Friedrich’s Blätter f. ger. Medicin, 1891, part iv.

107. “Vindex, Inclusa, Vindicta, Formatrix, Ara spei, Gladius furens, kritische Pfeile,” Leipzig (Otto u. Kadler), 1864–1880.

108. In male individuals: (1) Casper, Klin. Novellen, p. 36 (Lehrb. d. ger. Med., 7 Aufl., p. 176); (2) Westphal, Archiv f. Psych., ii. p. 73; (3) Schminke, id., iii, p. 225; (4) Scholz, Vierteljahrsschr. f. ger. Med., xix; (5) Gock, Arch. f. Psych., v., p. 564; (6) Servaes, id., vi, p. 484; (7) Westphal, id., vi, 620; (8, 9, 10) Stark, Zeitsch. f. Psychiatrie, Bd. 31; (11) Liman (Casper’s Lehrb. der ger. Med., 6 Aufl., p. 509), p. 291; (12) Legrand du Saulle, Annal. méd.-psychol., 1876, May; (13) Sterz, Jahrb. f. Psychiatrie, iii, Heft 3; (14) Krueg, Brain, 1884, Oct.; (15) Charcot et Magnan, Arch. de neurolog., 1882, Nr. 9; (16, 17, 18) Kirn, Zeitschr. f. Psych., Bd. 39, p. 216; (19) Rabow, Erlenmeyer’s Centralb., 1883, Nr. 8; (20) Blumer, Americ. Journ. of Insanity, 1882, July; (21) Savage, Journal of Mental Science, 1884, October; (22) Scholz, Vierteljahrsschr. f. ger. Med., N. F. Bd. 43, Heft. 7; (23) Magnan, Ann. méd. psychol., 1885, p. 461; (24) Chevalier, De l’inversion de l’instinct sexuel, Paris, 1885, p. 129; (25) Morselli, La Riforma medica, iv, March; (26) Leonpacher, Friedreich’s Blätter, 1888, H. 4; (27) Holländer, Allg. Wiener Med. Zeitg., 1882; (28) Kreise, Erlenmeyer’s Centralblatt, 1888, Nr. 19; (29, 30, 31, 32) v. Krafft, Psychopathia sexualis, 3 Aufl., Beob. 32, 36, 42, 43; (33) Golenko, Russ. Archiv f. Psychiatrie, Bd. ix, H. 3 (v. Rothe, Zeitschr. f. Psychiatrie); (34) v. Krafft, Internationales Centralblatt f. d. Physiol, u. Pathologie der Harn-u. Sexualorgane, Bd. 1, H. 1; (35) Cantarano, La Psichiatria, 1887, v., p. 195; (36) Sérieux, Recherches cliniques sur les anomalies de l’instinct sexuel, Paris, 1888, obs. 13; (37–42) Kiernan, The Medical Standard, 1888, 7 cases; (43–46) Rabow, Zeitschr. f. klin. Medicin, Bd. xvii, Suppl.; (47–51) v. Krafft, Neue Forschungen, Beob. (1, 3, 4, 5, 8); (52–61) v. Krafft, Psychopath. Sexualis, 5 Aufl., Beob. 53, 61, 64, 66, 73, 75, 78, 84, 85, 87; (62–65) v. Krafft, Neue Forschungen, 2 Aufl., Beob. 3, 4, 5,6; (66, 67) Hammond, Sexual Impotence; (68–71) Garnier, Anomalies sexuelles, 1889, Obs. 227, 228, 229, 230; (72) Müller, Friedreich’s Blätter, 1891; (73–87) v. Krafft, Psychopathia Sexualis, 6 Aufl., Beob. 78, 81, 82, 84, 85, 86, 87, 89, 93, 94,96, 97, 98, 101, 102.

In female individuals: (1) Westphal, Arch. f. Psych., ii, p. 73; Gock, op. cit., Nr. 1; (3) Wise, The Alienist and Neurologist, 1883, January; (4) Cantarano, La Psichiatria, 1883, p. 201; (5) Sérieux, op. cit., obs. 14; (6) Kiernan, op. cit.

109. Tarnowsky (op. cit., p. 34) records a case which shows that contrary sexual feeling, as a concomitant manifestation with neurotic degeneration, may also affect the descendants of parents having no neurotic taint. In this instance, lues of the parents played a part, as in a similar case of Scholz (Vierteljahrsschr. f. ger. Med.), in which the perversion of the sexual desires stood in causal relation with an arrest of psychical development, caused by traumatism.

110. This supposition is overthrown by the result of the post-mortem of my case (118), where the brain-weight was 1150 grammes, and of Case 130, where it was 1175 grammes.

111. That inversion of the sexual instinct is not infrequent is proved, among other things, by the circumstance that it is frequently a subject in novels. Chevalier (op. cit.) points out in French literature, besides the novels of Balzac, like “La Passion au Desert” (treating of bestiality) and “Sarrazine” (treating of the love of a woman for a eunuch), Diderot’s “La Religieuse” (a story of one given to amor lesbicus); Balzac’s “La Fille aux Yeux d’Or” (amor lesbicus); Th. Gautier’s “Mademoiselle de Maupin”; Feydeau’s “La Comtesse de Chalis”; Flaubert’s “Salammbo,” etc. Belot’s “Mademoiselle Giraud, Ma Femme” may also be mentioned (now translated into English). It is interesting that the heroines of these (Lesbian) novels appear in the character and rôle of the husband of a lover of the same sex, and that their love is extremely passionate. Moreover, the neuropathic foundation of this sexual perversion does not escape the writers. This theme is treated, in German literature, in “Fridolin’s heimliche Ehe,” by Wilbrand; in “Brick and Brack Oder Licht in Schatten,” by Emerich Graf Stadion. The oldest urning’s romance is probably that published by Petronius at Rome, under the Empire, under the title Satyricon.

112. Comp. author’s work, “Ueber psychosexuales Zwitterthum,” in the internationalen Centralblatt f. d. Physiologie u. Pathologie der Harn und Sexualorgane, Bd. i, Heft 2.

113. This idea is supported by the statements of an unmarried urning which Dr. Moll, of Berlin, kindly communicated to me. He could report a number of cases of his acquaintance, in which married men at the same time had “relations” with men.

114. Later it became known that a near relative died insane, and, further, that eight of his parent’s children had died of acute or chronic hydrocephalus at ages ranging from one to fifteen.

115. .sp 1

“Thou art like any flower, so sweet, so beautiful, so pure,” etc.

116. .sp 1

“Lowering like the heavens, frowns the world on me,

Yet blest or cursed will be the fate I meet.

With trusting heart, dear friend, I think of thee!

God keep thee, dear! it would have been too sweet!

God keep thee, dear! such happiness was not to be!”

117. Comp. the expert medical opinion of this case, by Dr. Birnbacher, in Friedreich’s Blätter f. ger. Med., 1891, H. 1.

118. With reference to prophylaxis, the following words, which were written to me by the subject of Case 88 of the sixth edition, are noteworthy: “If it were only possible that—not as among the Spartans, where the weaklings were allowed to perish for the sake of perfect selection, in accordance with the Darwinian idea—our contrary sexual instincts might be recognized early in youth; and if it were only possible that, at this time of life, the worst of all diseases could be cured by suggestion! Probably cure could be more easily effected in youth than later.”

119. For numerous cases, v. Henke’s Zeitschr., xxiii.—Ergänzungsheft, p. 147.—Combes, Annal. méd. psychol., 1866.—Liman, Zweifelh. Geisteszustände, p. 389.—Casper-Liman, Lehrb., 7. Auflage, Fall 295.—Bartels, Friedreich’s Blätter f. gerichtl. Med., 1890, Heft 1.

120. Other cases of pederasty, v. Casper, Klin. Novellen, Fall 5; Combes, Annal. méd. psychol.

121. V. Sander, Vierteljahrsschr. f. ger. M., xviii, p. 31.—Casper, Klin. Novellen, Fall 27.

122. Arndt (Lehrb. d. Psych., p. 410) especially emphasizes the passionate element in epileptics: “I have known epilepsy that expressed itself in a most sensual way toward the mother, and that that rested under a suspicion on the part of fathers, concerning sexual intercourse with the mothers.” But when Arndt declares that, wherever there is a peculiarity of the sexual life, thought of an epileptic element should come into consideration, he is in error.

123. Comp. also Liman, Zweifelhafte Geisteszustände, Fall 6.—Lasègue, Exhibitionists, Union méd., 1877.—Ball and Chambert, Art. Somnambulisme (Dict. des scienc. méd., 1881).

124. Comp. the interesting cases of Marc-Ideler, ii, p. 137.—Ideler, “Grundriss der Seelenheilkunde,” ii, pp. 488–492.

125. Vide Fall Merlac, in the author’s Lehrb. d. ger. Psychopathol., 2 Aufl., p. 322.—Morel, Traité des malad. mentales, p. 687.—Legrand, La folie, p. 337.—Process La Roncière, in Annal. d’hyg., 1. Serie, iv; 3. Serie, xxii.

126. The incubus in the witch-trials of the Middle Ages depended on them.

127. Comp. Casper, Klin. Novellen.—Lombroso, Goltdammer’s Archiv, Bd. xxx.—Oettingen, Moralstatistik, p. 494.

128. Lasègue, Union Médicale, 1877, May.—Laugier, Annal d’hygiène publ., 1878, No. 106.—Pelanda, “Pornopaths,” Archivio di Psichiatria, viii.—Schuchardt, Zeitschr. f. Medicinalbeamte, 1890, Heft 6.

129. Comp. v. Krafft, “Ueber transitorisches Irresein bei Neurasthenischen,” Irrenfreund, 1883, No. 8.

130. Dr. Moll calls this perversion (?) mixoscopia (from μιξις, cohabitation; and σκεπτειν, to look). His assumption that it is related to masochism, in that there is a stimulus for the voyeur in suffering at seeing a woman in the possession of another, does not seem to me to be justified. For further details, vide Moll, “Die conträre Sexualempfindung,” p. 137.

131. Annal. médico-psychol., 1849, p. 515; 1863, p. 57; 1864, p. 215; 1866, p. 253.

132. Comp. the cases of Tardieu, Attentats, p. 182–192.

133. Comp. Haltzendorff, Psychologie des Mords.

134. Tardieu, Attentats, Case 51, p. 188.

135. Masochism may, under certain circumstances, attain forensic importance. Modern criminal law no longer recognizes the principle, “volenti non fit injuria”; and the present Austrian statute, in § 4, says expressly: “Crimes may also be committed on persons who demand their commission on themselves.”

As Herbst (Handb. d. österr. Strafrechts., Wien, 1878, p. 72) remarks, there are, nevertheless, crimes conditioned by the absence of assent on the part of the injured individual, which cease to be such as soon as the injured individual has given consent,—e.g., theft, rape.

But Herbst also enumerates here the limitation of personal freedom (?).

Of late a decided change of views on this point has taken place. The German criminal law regards the consent of a man to his own death of such importance that a very different and much milder punishment is inflicted under such circumstances (§ 216); and it is the same in Austrian law (Austrian Abridgment, § 222). The so-called double suicide of lovers was the act considered. In bodily injury and deprivation of freedom, the consent of the victim must also receive consideration at the hands of the judge. Certainly a knowledge of masochism is of importance in making a judgment of the probability of asserted consent.

136. According to Austrian law, this crime should fall under § 411, as slight bodily injury; according to the German criminal law, it is bodily injury (comp. Liszt, p. 325).

137. Cases, vide Friedreich’s Blätter f. ger. Anthropologie, iii, p. 77.

138. Cases, Maschka, Handb., iii, p. 175.—Casper, Vierteljahrsschr., 1852, Bd. i.—Tardieu, Attentats.

139. Comp. Kirn, Allg. Zeitschr. f. Psych., 39, p. 217.

140. I follow the usual terminology in describing bestiality and pederasty under the general term sodomy. In Genesis (chap. xix), whence this word comes, it signifies exclusively the vice of pederasty. Later, sodomy was often used synonymously with bestiality. The moral theologians, like St. Alphons of Liguori, Gury, and others, have always distinguished correctly, i.e., in the sense of Genesis, between sodomia, i.e., concubitus cum persona ejusdem sexus, and bestialitas, i.e., concubitus cum bestia (comp. Olfus, Pastoralmedicin, p. 78).

The jurists brought confusion into the terminology by establishing a “Sodomia ratione sexus” and a “S. ratione generis.” Science, however, should assert itself as ansilla theologiæ, and return to the correct usage.

141. For interesting histories, vide Krauss, Psychol. d. Verbrechens, p. 180.—Maschka, Hdb. iii, p. 188.—Hofmann, Lehrb. d. ger. Med., p. 180.—Rosenbaum, Die Lustseuche.

142. How difficult, unpleasant, and dangerous for the jurist judgment of these “coitus-like” acts for the establishment of the objective fact of the crime may be is well shown by an article on the punishableness of male intercourse, in the Zeitschr. f. d. gesammte Strafrechtswissenschaft., Bd. vii, Heft 1, as well as by a similar one in Friedreich’s Blätter f. ger. Medicin, 1891, Heft 6. Vide, further, Moll, Conträre Sexualempfindung, p. 223 et seq., and Bernhardi, Der Uranismus, Berlin, 1882.

143. For interesting histories and notes, v. Krause, Psychol. des Verbrechens, p. 174.—Tardieu, Attentats.—Maschka, Handb., iii, p. 174. This vice seems to have come through Crete from Asia to Greece, and, in the times of classic Hellas, to have been wide-spread. From there it spread to Rome, where it flourished luxuriantly. In Persia and China (where it is actually tolerated) it is wide-spread, as it also is in Europe. (Comp. Tarnowsky et al.)

144. Lombroso (Der Verbrecher, p. 20 et seq.) shows that also, in case of animals, intercourse with the same sex occurs where normal indulgence is impossible.

145. Comp. Tardieu, Attentats, p. 198.—Martineau, Deutsche Med. Zeitung, 1882, p. 9.—Virchow’s Jahrb., 1881, i, p. 533.—Coutagne, Lyon Médical, Nos. 35, 36.

146. Comp. Mayer, Friedreich’s Blätter, 1875, p. 41.—Kraussold, Melancholie und Schuld, 1884, p. 20.—Andronico, Archiv di psich. scienze penali ed anthropol. crim., vol. iii, p. 145.

147. Comp. Maschka, Hdb., iii, p. 191 (good historical notes).—Legrand, La folie, p. 521.

148. Vide Westermarck, History of Human Marriage, chap. xiv. McMillan & Co., 1891.

September, 1893.

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☞ INDEX ON PAGE 2.

INDEX TO CATALOGUE.

| PAGE
Annual of the Universal Medical Sciences | 27, 28
ANATOMY.
Practical Anatomy—Boenning | 4
Structure of the Central Nervous System—Edinger | 8
Charts of the Nervo-Vascular System—Price and Eagleton | 17
Synopsis of Human Anatomy—Young | 26
BACTERIOLOGY.
Bacteriological Diagnosis—Eisenberg | 8
CLINICAL CHARTS, ETC.
Improved Clinical Charts—Bashore | 3
Symptom Register & Case Rec’d—Straub | 25
DOMESTIC HYGIENE, ETC.
Cholera—Vought | 15
The Daughter:t Her Health, Education, and Wedlock—Capp | 7
Consumption:t How to Prevent it—Davis | 5
Plain Talks on Avoided Subjects—Guernsey | 9
Heredity, Health, and Personal Beauty—Shoemaker | 22
ELECTRICITY.
Practical Electricity in Medicine and Surgery—Liebig and Rohé | 12
Electricity in the Diseases of Women—Massey | 13
International System of Electro-Therapeutics | 11
FEVER.
Fever:t its Pathology and Treatment—Hare | 10
Hay Fever—Sajous | 15
GYNECOLOGY.
Lessons in Gynecology—Goodell | 9
HEART, LUNGS, KIDNEYS, ETC.
Diseases of the Heart, Lungs, and Kidneys—Davis | 7
Diseases of the Heart and Circulation in Children—Keating and Edwards | 12
Diabetes:t its Cause, Symptoms, and Treatment—Purdy | 17
HYGIENE.
Climatology of Southern California—Remondino | 18
Text-Book of Hygiene—Rohé | 19
MATERIA MEDICA AND THERAPEUTICS.
Hand-Book of Materia Medica, Pharmacy, and Therapeutics—Bowen | 4
Ointments and Oleates—Shoemaker | 22
Materia Medica and Therapeutics—Shoemaker | 21
International Pocket Medical Formulary—Witherstine | 25
MISCELLANEOUS.
History of the Life of D. Hayes Agnew, M.D., LL.D.—Adams | 29
Book on the Physician Himself—Cathell | 5
Oxygen—Demarquay and Wallian | 7
Record-Book of Medical Examinations for Life-Insurance—Keating | 9
The Medical Bulletin, Monthly | 2
Physician’s Interpreter | 13
Circumcision—Remondino | 18
Medical Symbolism—Sozinskey | 23
International Pocket Medical Formulary—Witherstine | 25
The Chinese:t Medical, Political, and Social—Coltman | 6
Psychopathia Sexualis—Krafft-Ebing | 29
Universal Medical Journal | 26
A Practical Manual of Diseases of the Skin—Rohé | 19
NERVOUS SYSTEM, SPINE, ETC.
Spinal Concussion—Clevenger | 6
Structure of the Central Nervous System—Edinger | 8
Epilepsy:t its Pathology and Treatment—Hare | 10
Lectures on Nervous Diseases—Ranney | 30
OBSTETRICS.
Eclampsia—Michener and others | 15
Obstetric Synopsis—Stewart | 24
PHYSIOGNOMY.
Practical and Scientific Physiognomy—Stanton | 30
PHYSIOLOGY AND EMBRYOLOGY.
Physiology of Domestic Animals—Smith | 23
SURGERY AND SURGICAL OPERATIONS.
Tuberculosis of the Bones & Joints—Senn | 20
Circumcision—Remondino | 18
Principles of Surgery—Senn | 20
SWEDISH MOVEMENT AND MASSAGE.
Swedish Movement and Massage Treatment—Nissen | 15
THROAT AND NOSE.
Journal of Laryngology and Rhinology | 12
Hay Fever—Sajous | 15
Diseases of the Nose and Throat—Ivins | 10
VENEREAL DISEASES.
Syphilis To-day and in Antiquity—Buret | 4
Neuroses of the Genito-Urinary System in the Male—Ultzmann | 24
VETERINARY.
Age of Domestic Animals—Huidekoper | 11
Physiology of Domestic Animals—Smith | 23
VISITING-LISTS AND ACCOUNT-BOOKS.
Medical Bulletin Visiting-List or Physicians’ Call-Record | 14
Physicians’ All-Requisite Account-Book | 16

MEDICAL BULLETIN. A Monthly Journal of Medicine and Surgery.

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Bashore’s Improved Clinical Chart.

For the Separate Plotting of Temperature, Pulse, and Respiration. Designed for the Convenient, Accurate, and Permanent Daily Recording of Cases in Hospital and Private Practice.

By HARVEY B. BASHORE, M.D.

COPYRIGHTED, 1888, BY F. A. DAVIS.

50 Charts, in Tablet Form. Size 8 × 12 inches. Price, post-paid, in the United States and Canada, 50 Cents, net; in Great Britain, 3s. 6d.; in France, 6 fr. 60.

The above diagram is a little more than one-fifth (1–5) the actual size of the chart and shows the method of plotting, the upper curve being the Temperature, the middle the Pulse, and the lower the Respiration. By this method a full record of each can easily be kept with but one color ink.

It is so arranged that all practitioners will find it an invaluable aid in the treatment of their patients.

On the back of each chart will be found ample space conveniently arranged for recording “Clinical History and Symptoms” and “Treatment.”

By its use the physician will secure such a complete record of his cases as will enable him to review them at any time. Thus he will always have at hand a source of individual improvement and benefit in the practice of his profession, the value of which can hardly be overestimated.

BOENNING

A Text-Book on Practical Anatomy.

Including a Section on Surgical Anatomy.

By Henry C. Boenning, M.D., Lecturer on Anatomy and Surgery in the Philadelphia School of Anatomy; Demonstrator of Anatomy in the Medico-Chirurgical College, etc., etc.

Fully illustrated throughout with about 200 Wood-Engravings. In one handsome Octavo volume, printed in extra-large, clear type, making it specially desirable for use in the dissecting-room. Nearly 500 pages. Substantially bound in Extra Cloth. Also in Oil-Cloth, for use in the dissecting-room without soiling.

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This work is fully illustrated throughout with clear and instructive engravings. It is not as large as the usual text-books on anatomy, nor yet so small as many of the ready remembrances, but it occupies the middle ground, and will find an acceptable place with many students.—Columbus Med. Journal.

There is not an unnecessary word in this book of nearly five hundred pages. As a typographical specimen it is elegant. Systematic, comprehensive, and intensely practical, we heartily commend it to all medical students and practitioners.—Denver Med. Times.

BOWEN

Hand-Book of Materia Medica, Pharmacy, and Therapeutics.

By Cuthbert Bowen, M.D., B.A., Editor of “Notes on Practice.”

The second volume in the Physicians’ and Students’ Ready Reference Series. One 12mo volume of 370 pages. Handsomely bound in Dark-Blue Cloth.

Price, post-paid, in the United States and Canada, $1.40, net; in Great Britain, 8s. 6d.; in France, 9 fr. 25.

This excellent manual comprises in its 366 pages about as much sound and valuable information on the subjects indicated in its title as could well be crowded into the compass.—St. Louis Medical and Surgical Journal.

BURET

SYPHILIS In Ancient and Prehistoric Times.

With a Chapter on the Rational Treatment of Syphilis in the Nineteenth Century.

By Dr. F. Buret, Paris, France. Translated from the French, with the author’s permission, with notes, by A. H. Ohmann-Dumesnil, Professor of Dermatology and Syphilology in the St. Louis College of Physicians and Surgeons.

No. 12 in the Physicians’ and Students’ Ready-Reference Series. 230 pages. 12mo. Extra Dark-Blue Cloth.

Price, post-paid, in the United States and Canada, $1.25, net; in Great Britain, 6s. 6d.; in France, 7 fr. 75.

This volume, which is one of a series of three (the other two, treating of Syphilis in the Middle Ages and in modern times, now in active preparation), gives the most complete history of Syphilis from prehistoric times up to the Christian Era.

The subject throughout is treated in a clear, concise manner, and readers will find many things which are historically new.

In order to give some idea of the contents of this first volume, the following are cited as among the subjects treated:—

In What does Syphilis Consist? Origin of the Word Syphilis. The Age of Syphilis. Syphilis in Prehistoric Times. Tchoang.—Syphilis Among the Chinese 5000 Years Ago. Kasa.—Syphilis in Japan in the Ninth Century B.C. Syphilis Among the Ancient Egyptians, 1400 B.C. Syphilis Among the Ancient Assyrians and Babylonians. Syphilis Among the Hebrews in Biblical Times. Upadansa.—Syphilis Among the Hindoos, 1000 B.C. Sukon.—Syphilis Among the Greeks. Ficus.—Syphilis at Rome under the Cæsars. Conclusion: Rational Treatment of Syphilis in the Nineteenth Century.

CAPP

The Daughter: Her Health, Education, and Wedlock.

Homely Suggestions to Mothers and Daughters.

By William M. Capp, M.D., Philadelphia. This is just such a book as a family physician would advise his lady patients to obtain and read. It answers many questions which every busy practitioner of medicine has put to him in the sick-room at a time when it is neither expedient nor wise to impart the information sought.

It is complete in one beautifully printed (large, clear type) 12mo volume of 150 pages.

Handsomely bound in Extra Cloth, price, post-paid, in the United States and Canada, $1.00, net; Great Britain, 5s. 6d; France, 6 fr. 20.

In Paper Cover (Unabridged), 50 cts., net.

In the 144 pages allotted to him he has compressed an amount of homely wisdom on the physical, mental, and moral development of the female child from birth to maturity which is to be found elsewhere in only the great book of experience. It is, of course, a book for mothers, but is one so void of offense in expression or ideas that it can safely be recommended for all whose minds are sufficiently developed to appreciate its teachings.—Philadelphia Public Ledger.

Many delicate subjects are treated with skill and in a manner which cannot strike any one as improper or bold. The absolute ignorance in which most young girls are allowed to exist, even until adult life, is often productive of much misery, both mental and physical. Quite a number of books written by physicians for popular use have been prepared in such a way that the professional man can read between the lines strong bids for popular favor, etc. These objectionable features will not be found in Dr. Capp’s brochure, and for this reason it is worthy the confidence of physicians.—Medical News.

CATHELL

Book on the Physician Himself

And Things that Concern His Reputation and Success. A New (Tenth) Edition, Author’s Last Revision.

By D. W. Cathell, M.D., Baltimore, Md. This is the author’s final revision of one of the most useful, successful, and popular medical books ever published. It has been wisely and carefully revised throughout. The well-known charming style of the author is preserved intact, while the practical value of the book is truly enhanced by the addition of much of the author’s gathered wisdom not introduced into any previous edition. The volume has been brought to perfection, as far as human effort can achieve, and though enlarged to 350 Royal Octavo Pages the price has not been increased.

Handsomely Bound in Extra Cloth, price, in the United States and Canada, post-paid, $2.00, net; in Great Britain, 11s. 6d.; in France, 12 fr. 40.

“The Physician Himself” interested me so much that I actually read it through at one sitting. It is brimful of the very best advice possible for medical men. I, for one, shall try to profit by it.—Prof. William Goodell, Philadelphia.

It is marked with good common sense and replete with excellent maxims and suggestions for the guidance of medical men.—The British Medical Journal.

We advise our readers to buy it. It will give them food for thought and show them how to and how not to achieve reputation and success.—The Medical Age.

We cannot too strongly commend it to the attention of every young doctor. Many a lesson is pleasantly and gently taught in its pages which cannot otherwise be learned unless by bitter experience.—Canada Medical Record.

Of course, one reason for its occult power is that it is written with admirable grace and precision, besides presenting the ups and downs of a physician’s life in such a natural and perfect way. The book will help any one who will read it. It tells you how to begin practice; leads you into medical ethics properly, and, carefully studied, the pages of this book will be of great benefit to the young and old.—Charlotte Medical Journal.

This book is evidently the production of an unspoiled mind and the fruit of a ripe career. I admire its pure tone and feel the value of its practical points. How I wish I could have read such a guide at the outset of my career!—Prof. James Nevins Hyde, Chicago, Ill.

“The Physician Himself” is useful alike to the tyro and the sage—the neophyte and the veteran. It is a headlight in the splendor of whose beams a multitude of our profession shall find their way to success.—Prof. J. M. Bodine, Dean University of Louisville.

We have read one of the former, and smaller, editions through very carefully, and know of no work in medical literature more profitable for perusal and possession.—Denver Medical Times.

This book will do a world of good, a good that will be far-reaching and constant, and the fact that it has reached its tenth edition proves toward a higher and yet higher teaching, that “the elevation of the profession” is a consistent and timely aim.—Chicago Clinical Review.

CLEVENGER

Spinal Concussion.

Surgically Considered as a Cause of Spinal Injury, and Neurologically Restricted To a Certain Symptom Group, For Which is Suggested the Designation Erichsen’s Disease, as One Form of the Traumatic Neuroses.

By S. V. Clevenger, M.D., Consulting Physician Reese and Alexian Hospitals; Late Pathologist County Insane Asylum, Chicago, etc.

Special features consist in a description of modern methods of diagnosis by Electricity, a discussion of the controversy concerning hysteria, and the author’s original pathological view that the lesion is one involving the spinal sympathetic nervous system.

Every Physician and Lawyer should own this work.

In one handsome Royal Octavo Volume of nearly 400 pages, with thirty Wood-Engravings.

Price, post-paid, in United States and Canada, $2.50, net; in Great Britain, 14s.; in France, 15 fr.

This work really does, if we may be permitted to use a trite and hackneyed expression, “fill a long-felt want.” The subject is treated in all its bearings; electro-diagnosis receives a large share of attention, and the chapter devoted to illustrative cases will be found to possess especial importance.—Medical Weekly Review.

COLTMAN

THE CHINESE: Their Present and Future; Medical, Political, and Social.

By Robert Coltman, Jr., M.D., Surgeon in Charge of the Presbyterian Hospital and Dispensary at Teng Chow Fu; Consulting Physician of the American Southern Baptist Mission Society, etc.

Beautifully printed in large, clear type, illustrated with Fifteen Fine Engravings on Extra Plate Paper, from photographs of persons, places, and objects characteristic of China.

In one Royal Octavo volume of 212 Pages. Handsomely bound in Extra Cloth, with Chinese Side Stamp in gold.

Price, post-paid, in United States and Canada, $1.75, net; in Great Britain, 10s.; in France, 12 fr. 20.

The Chinaman is a source of absolute curiosity to the American, and anything in regard to his relationship to the medical profession will prove more than usually attractive to the average doctor. Such is the case with the work before us. It is difficult to put it aside after one has begun to read it.—Memphis Med. Monthly.

Dr. Coltman has written a very readable book, illustrated with reproductions of photographs taken by himself.—Boston Med. and Surg. Journal.

Attached to a number of hospitals and dispensaries, he has had ample opportunity to observe the medical aspect of the Chinese. The most prevalent diseases are such as affect the alimentary tract and eye troubles. Renal troubles are also frequent. Skin diseases are abundant and syphilis is far from infrequent. Erysipelas is rare and enteric fever infrequent. Cholera appears in epidemics and is then frightfully fatal. Leprosy, of course, is common, and the author states that it cannot be contagious, as is supposed by many, or it would assume a terrible prevalence in China, where lepers are permitted to go about free.

We will not further mention the subjects discussed in this excellent book. The style of the author is very interesting and taking, and much information is given in an entertaining manner. The political situation is very intelligently handled in its various bearings. The photo-engravings are handsome and well-executed, the book in general being gotten up in a very artistic manner. We can heartily commend this work not only to physicians, but to intelligent lay readers.—St. Louis Medical Review.

DAVIS

CONSUMPTION: How to Prevent it and How to Live with it.

Its Nature, Causes, Prevention, and the Mode of Life, Climate, Exercise, Food, and Clothing Necessary for its Cure.

By N. S. Davis, Jr., A.M., M.D., Professor of Principles and Practice of Medicine, Chicago Medical College; Physician to Mercy Hospital, Chicago; Member of the American Medical Association, etc.

This plain, practical treatise thoroughly discusses the prevention of Consumption, Hygiene for Consumptives, gives timely suggestions concerning the different climates and the important part they play in the treatment of this disease, etc., etc.,—all presented in such a succinct and intelligible style as to make the perusal of the book a pleasant pastime.

12mo. 143 pages. Handsomely bound in Extra Cloth.

Price, post-paid, in United States and Canada, 75 Cents, net; in Great Britain, 4s.; in France, 5 fr.

The questions of heredity, predisposition, prevention, and hygienic treatment of consumption are simply and sensibly dealt with. The chapters on how to live with tuberculosis are excellent.—Indiana Medical Journal.

The author is very thorough in his discussion of the subject, and the practical hints which he gives are of real worth and value. His directions are given in such a manner as to make life enjoyable to a consumptive patient, and not a burden, as is too frequently the case.—Weekly Medical Review.

By the Same Author

Diseases of the Lungs, Heart, and Kidneys.

By N. S. Davis, Jr., A.M., M.D.

The Nature, Pathological Anatomy, Symptoms, Causes, Diagnosis, and Treatment of the diseases of these important organs are comprehensively discussed in this conveniently arranged volume. Special and careful attention is given to Treatment, while nothing else is slighted. No. 14 in the Physicians’ and Students’ Ready-Reference Series. 12mo. 359 pages. Extra Dark-Blue Cloth.

Price, in United States and Canada, post-paid, $1.25, net; Great Britain, 6s. 6d.; France, 7 fr. 75.

The author evidently knows how to put “multum in parvo” without omitting anything essential to a clear understanding of the subject discussed.—St. Louis Medical Era.

It requires close thought, carefully and judiciously applied, to write a book as this one is written. A systematic treatise on the Diseases of the Lungs, Heart, and Kidneys, and their co-ordinate relation and sympathy, presenting many of the main points of dependence of one upon the other. This Dr. Davis has succeeded in doing to a nice degree, handing the student a book worthy of most serious study.—Medical Free Press.

DEMARQUAY

On Oxygen. A Practical Investigation of the Clinical and Therapeutic Value of the Gases in Medical and Surgical Practice,

With Especial Reference to the Value and Availability of Oxygen, Nitrogen, Hydrogen, and Nitrogen Monoxide.

By J. N. Demarquay, Surgeon to the Municipal Hospital, Paris, and of the Council of State; Member of the Imperial Society of Surgery, etc. Translated, with notes, additions, and omissions, by Samuel S. Wallian, A.M., M.D., ex-President of the Medical Association of Northern New York; Member of the New York County Medical Society, etc.

Royal Octavo, 316 pages; illustrated with 21 Wood-Cuts.

Price, post-paid, in United States and Canada, Cloth, $2.00, net; Half-Russia, $3.00, net. In Great Britain, Cloth, 11s. 6d.; Half-Russia, 17s. 6d. In France, Cloth, 12 fr. 40; Half-Russia, 18 fr. 60.

This is a handsome volume of 300 pages, in large print, on good paper, and nicely illustrated. Although nominally pleading for the use of oxygen inhalations, the author shows in a philosophical manner how much greater good physicians might do if they more fully appreciated the value of fresh-air exercise and water, especially in diseases of the lungs, kidneys, and skin. We commend its perusal to our readers.—The Canada Medical Record.

EISENBERG

Bacteriological Diagnosis.

Tabular Aids for Use in Practical Work.

By James Eisenberg, Ph.D., M.D., Vienna. Translated and augmented, with the permission of the author, from the second German Edition, by Norval H. Pierce, M.D., Surgeon to the Out-Door Department of Michael Reese Hospital; Assistant to Surgical Clinic, College of Physicians and Surgeons, Chicago, Ill.

Nearly 200 pages. In one Royal Octavo volume, handsomely bound in Cloth and in Oil-Cloth (for laboratory use).

Price, post-paid, in the United States and Canada, $1.50, net; in Great Britain, 8s. 6d.; in France, 9 fr. 35.

This book is a novelty in Bacteriological Science. It is a work of great importance to the teacher as well as to the student. It will be of inestimable value to the private worker, and is designed throughout as a practical guide in laboratory work. It is arranged in a tabular form, in which are given the specific characteristics of the various well-established bacteria, so that the worker may, at a glance, inform himself as to the identity of a given organism.

There is also an appendix, in which is given, in a concise and practical form, the technique employed by the best laboratories in the cultivation and staining of bacteria; the composition and preparation of the various solid, semi-solid, and fluid media, together with their employment; a complete list of stains and reagents, with formulæ for same; the methods of microscopic examination of bacteria, etc., etc., etc.

EDINGER

Twelve Lectures on the Structure of the Central Nervous System.

For Physicians and Students.

By Dr. Ludwig Edinger, Frankfort-on-the-Main. Second Revised Edition. With 133 Illustrations. Translated by Willis Hall Vittum, M.D., St. Paul, Minn. Edited by C. Eugene Riggs, A.M, M.D., Professor of Mental and Nervous Diseases, University of Minnesota; Member of the American Neurological Association.

The illustrations are exactly the same as those used in the latest German edition (with the German names translated into English), and are very satisfactory to the Physician and Student using the book.

The work is complete in one Royal Octavo Volume of about 250 pages, bound in Extra Cloth.

Price, post-paid, in the United States and Canada, $1.75, net; in Great Britain, 10s.; in France, 12 fr. 20.

One of the most instructive and valuable works on the minute anatomy of the human brain extant. It is written in the form of lectures, profusely illustrated, and in clear language.—The Pacific Record of Medicine and Surgery.

Since the first works on anatomy, up to the present day, no work has appeared on the subject of the general and minute anatomy of the central nervous system so complete and exhaustive as this work of Dr. Ludwig Edinger. Being himself an original worker, and having the benefits of such masters as Stilling, Weigeit, Geilach, Meynert, and others, he has succeeded in transforming the mazy wilderness of nerve-fibres and cells into a district of well-marked pathways and centres, and by so doing has made a pleasure out of an anatomical bugbear.—The Southern Medical Record.

Every point is clearly dwelt upon in the text, and where description alone might leave a subject obscure clever drawings and diagrams are introduced to render misconception of the author’s meaning impossible. The book is eminently practical. It unravels the intricate entanglement of different tracts and paths in a way that no other book has done so explicitly or so concisely.—Northwestern Lancet.

GOODELL

LESSONS IN GYNECOLOGY.

By William Goodell, A.M., M.D., etc., Professor of Clinical Gynecology in the University of Pennsylvania.

This exceedingly valuable work, from one of the most eminent specialists and teachers in gynecology, embraces all the more important diseases and the principal operations in the field of gynecology, and brings to bear upon them all the extensive practical experience and wide reading of the author. It is an indispensable guide to every practitioner who has to do with the diseases peculiar to women. Third Edition. With 112 Illustrations. Thoroughly revised and greatly enlarged. Royal octavo, 578 pages.

Price, in United States and Canada, Cloth, $5.00; Full Sheep, $6.00. Discount, 20 per cent., making it, net, Cloth, $4.00; Sheep, $4.80. Postage, 27 cents extra. Great Britain, Cloth, 22s. 6d.; Sheep, 28s., post-paid. France, 30 fr. 80.

It is too good a book to have been allowed to remain out of print, and it has unquestionably been missed. The author has revised the work with special care, adding to each lesson such fresh matter as the progress in the art rendered necessary, and he has enlarged it by the insertion of six new lessons.—Amer. Jour. of Obstet.

Extended mention of the contents of the book is unnecessary; suffice it to say that every important disease found in the female sex is taken up and discussed in a common-sense kind of a way. We wish every physician in America could read and carry out the suggestions of the chapter on “the sexual relations as causes of uterine disorders—conjugal onanism and kindred sins.” The department treating of nervous counterfeits of uterine diseases is a most valuable one.—Kansas City Medical Index.

GUERNSEY

Plain Talks on Avoided Subjects.

By Henry N. Guernsey, M.D., formerly Professor of Materia Medica and Institutes in the Hahnemann Medical College of Philadelphia; author of Guernsey’s “Obstetrics,” including the Disorders Peculiar to Women and Young Children; Lectures on Materia Medica, etc. The following Table of Contents shows the scope of the book:

Contents.—Chapter I. Introductory. II. The Infant. III. Childhood. IV. Adolescence of the Male. V. Adolescence of the Female. VI. Marriage: The Husband. VII. The Wife. VIII. Husband and Wife. IX. To the Unfortunate. X. Origin of the Sexes. In one neat 16mo volume, bound in Extra Cloth.

Price, post-paid, in the United States and Canada, $1.00; Great Britain, 6s.; France, 6 fr. 20.

KEATING
Record-Book of Medical Examinations
For Life-Insurance.

Designed by John M. Keating, M.D.

This record-book is small, compact, complete, and embraces all the principal points that are required by the different companies. It is made in two sizes, viz.: No. 1, covering one hundred (100) examinations, and No. 2, covering two hundred (200) examinations. The size of the book is 7 x 3¾ inches, and can be conveniently carried in the pocket.

| U. S. and Canada. | Great Britain. | France.
No. 1. For 100 Examinations, in Cloth, | $ .50, net | 3s. 6d. | 3 fr. 60
No. 2. For 200 Examinations, in Full Leather, with Side Flap, | 1.00, net | 6s. | 6 fr. 20

HARE

Epilepsy: Its Pathology and Treatment.

Being an Essay to which was Awarded a Prize of Four Thousand Francs by the Academie Royale de Medecine de Belgique, December 31, 1889.

By Hobart Amory Hare, M.D., B.Sc., Professor of Materia Medica and Therapeutics in the Jefferson Medical College, Phila.; Physician to St. Agnes’ Hospital and to the Children’s Dispensary of the Children’s Hospital; Laureate of the Royal Academy of Medicine in Belgium, of the Medical Society of London, etc.; Member of the Association of American Physicians.

No. 7 in the Physicians’ and Students’ Ready-Reference Series. 12mo. 228 pages. Neatly bound in Dark-Blue Cloth.

Price, post-paid, in United States and Canada, $1.25, net; Great Britain, 6s. 6d.; France, 7 fr. 75.

The task of preparing the work must have been most laborious, but we think that Dr. Hare will be repaid for his efforts by a wide appreciation of the work by the profession; for the book will be instructive to those who have not kept abreast with the recent literature upon this subject. Indeed, the work is a sort of dictionary of epilepsy—a reference guide-book upon the subject.—Alienist and Neurologist.

It is representative of the most advanced views of the profession, and the subject is pruned of the vast amount of superstition and nonsense that generally obtains in connection with epilepsy.—Medical Age.

Every physician who would get at the gist of all that is worth knowing on epilepsy, and who would avoid useless research among the mass of literary nonsense which pervades all medical libraries, should get this work.—The Sanitarian.

By the Same Author

Fever: Its Pathology and Treatment.

Being the Boylston Prize Essay of Harvard University for 1890. Containing Directions and the Latest Information Concerning the Use of the So-Called Antipyretics in Fever and Pain.

By Hobart Amory Hare, M.D., B.Sc., etc., etc.

No. 10 in the Physicians’ and Students’ Ready-Reference Series. 12mo. Neatly bound in Dark-Blue Cloth.

Illustrated with more than 25 new plates of tracings of various fever cases, showing beautifully and accurately the action of the Antipyretics. The work also contains 35 carefully prepared statistical tables of 249 cases showing the untoward effects of the antipyretics.

Price, post-paid, in the United States and Canada, $1.25, net; in Great Britain, 6s. 6d.; France, 7 fr. 75.

The author has done an able piece of work in showing the facts as far as they are known concerning the action of antipyrin, antifebrin, phenacetin, thallin, and salicylic acid. The reader will certainly find the work one of the most interesting of its excellent group, the Physicians’ and Students’ Ready-Reference Series.—The Dosimetric Medical Review.

IVINS

Diseases of the Nose and Throat.

A Text-Book for Students and Practitioners.

By Horace F. Ivins, M.D., Lecturer on Laryngology and Otology in the Hahnemann Medical College of Philadelphia; Laryngological Editor of “The Journal of Ophthalmology, Otology, and Laryngology”; Member of the American Institute of Homœopathy, of the Homœopathic Medical Society of the State of Pennsylvania, etc.

Royal Octavo, 507 Pages. With 129 Illustrations, Chiefly Original, including Eighteen (18) colored figures from Drawings and Photographs of Anatomical Dissections, etc.

Price, in United States, Extra Cloth, $4.00, net; Half-Russia, $5.00, net. Canada (duty paid), Cloth, $4.40, net; Half-Russia, $5.50, net. Great Britain, Cloth, 22s. 6d.; Sheep or Half-Russia, 28s. France, Cloth, 24 fr. 60; Half-Russia, 30 fr. 30.

HUIDEKOPER

Age of the Domestic Animals.

Being a Complete Treatise on the Dentition of the Horse, Ox, Sheep, Hog, and Dog, and on the Various Other Means of Determining the Age of these Animals.

By Rush Shippen Huidekoper, M.D., Veterinarian (Alfort, France); Professor of Sanitary Medicine and Veterinary Jurisprudence, American Veterinary College, New York; Late Dean of the Veterinary Department, University of Pennsylvania.

Royal Octavo, 225 pages, bound in Extra Cloth. Illustrated with 200 Engravings.

Price, post-paid, in the United States and Canada, $1.75, net; in Great Britain, 10s.; in France, 12 fr. 20.

This work presents a careful study of all that has been written on the subject from the earliest Italian writers. The author has drawn much valuable material from the ablest English, French, and German writers, and has given his own deductions and opinions, whether they agree or disagree with such investigators as Bracy Clark, Simonds (in English), Girard, Chauveau, Leyh, Le Coque, Goubaux, and Barrier (in German and French).

The literary execution of the book is very satisfactory, the text is profusely illustrated, and the student will find abundant means in the cuts for familiarizing himself with the various aspects presented by the incisive arches during the different stages of life. Illustrations do not always illustrate; these do.—Amer. Vet. Review.

Although written primarily for the veterinarian, this book will be of interest to the dentist, physiologist, anatomist, and physician. Its wealth of illustration and careful preparation are alike commendable.—Chicago Med. Recorder.

It is profusely illustrated with 200 engravings, and the text forms a study well worth the price of the book to every dental practitioner.—Ohio Journal of Dental Sciences.

International System of Electro-Therapeutics.

For Students, General Practitioners, and Specialists.

Chief Editor, Horatio R. Bigelow, M.D., Permanent Member of the American Medical Association; Fellow of the British Gynæcological Society; Fellow of the American Electro-Therapeutic Association; Member of the Philadelphia Obstetrical Society; Member of the Société d’Electro-Thérapie; Author of “Gynæcological Electro-Therapeutics” and “Familiar Talks on Electricity and Batteries,” etc. Assisted by upward of Thirty Eminent Specialists in Europe and America as Associate Editors.

The character of this work is such that the publishers confidently expect it will stand unrivalled, and be the vade mecum of the profession, as well as the standard text-book in all the colleges upon this important branch of medical science.

It will be handsomely and clearly printed, thoroughly illustrated with engravings, colored drawings, and plates where these will elucidate the text, and at the close of the volume there will be a full reference index.

Complete in One Royal Octavo Volume of about 900 Pages.

Price, in United States, Extra Cloth, $5.50, net; Sheep, $6.50, net; Half-Russia, $7.00, net. In Canada (duty paid), Cloth, $6.00, net; Sheep, $7.25, net; Half-Russia, $7.75, net. In Great Britain, Cloth, 32s.; Sheep, 37s. 6d.; Half-Russia, 40s. In France, Cloth, 34 fr. 70.; Sheep, 40 fr. 45; Half-Russia, 43 fr. 30.

Will be Published in October, 1893.

Journal of Laryngology, Rhinology, and Otology.

An Analytical Record of Current Literature Relating to the Throat, Nose, and Ear. Issued on the First of Each Month.

Edited by Dr. Norris Wolfenden, of London, and Dr. John Macintyre, of Glasgow, with the active aid and co-operation of Drs. Dundas Grant, Barclay J. Baron, and Hunter Mackenzie. Besides those specialists in Europe and America who have so ably assisted in the collaboration of the Journal, a number of new correspondents have undertaken to assist the editors in keeping the Journal up to date, and furnishing it with matters of interest.

Price, 13s. or $3.00 per annum, Strictly in Advance. Single copies, 1s. 3d. (30 Cents). Sample Copy, 25 Cents.

KEATING and EDWARDS

Diseases of the Heart and Circulation

In Infancy and Adolescence. With an Appendix Entitled “Clinical Studies on the Pulse in Childhood.”

By John M. Keating, M.D., Obstetrician to the Philadelphia Hospital, and Lecturer on Diseases of Women and Children; Surgeon to the Maternity Hospital; Physician to St. Joseph’s Hospital; Fellow of the College of Physicians of Philadelphia, etc.; and William A. Edwards, M.D., Instructor in Clinical Medicine and Physician to the Medical Dispensary in the University of Pennsylvania; Fellow of the College of Physicians: formerly Assistant Pathologist to the Philadelphia Hospital, etc.

Illustrated by Photographs and Wood-Engravings. About 225 pages. Octavo. Bound in Cloth.

Price, post-paid, in the United States and Canada, $1.50, net; in Great Britain, 8s. 6d.; in France, 9 fr. 35.

Drs. Keating and Edwards have produced a work that will give material aid to every doctor in his practice among children. The style of the book is graphic and pleasing, the diagnostic points are explicit and exact, and the therapeutical resources include the novelties of medicine as well as the old and tried agents.—Pittsburgh Med. Review.

It is not a mere compilation, but a systematic treatise, and bears evidence of considerable labor and observation on the part of the authors. Two fine photographs of dissections exhibit mitral stenosis and mitral regurgitation; there are also a number of wood-cuts.—Cleveland Medical Gazette.

LIEBIG and ROHÉ

Practical Electricity in Medicine and Surgery.

By G. A. Liebig, Jr., Ph.D., Assistant in Electricity, Johns Hopkins University; Lecturer on Medical Electricity, College of Physicians and Surgeons, Baltimore; Member of the American Institute of Electrical Engineers, etc.; and George H. Rohé, M.D., Professor of Obstetrics and Hygiene, College of Physicians and Surgeons, Baltimore; Visiting Physician to Bay View and City Hospitals; Director of the Maryland Maternité; Associate Editor “Annual of the Universal Medical Sciences,” etc.

Profusely illustrated by Wood-Engravings and Original Diagrams, and published in one Royal Octavo volume of 383 pages, bound in Extra Cloth.

Price, post-paid, in the United States and Canada, $2.00, net; in Great Britain, 11s. 6d.; in France, 12 fr. 40.

Any physician, especially if he be a beginner in electro-therapeutics, will be well repaid by a careful study of this work by Liebig and Rohé. For a work on a special subject the price is low, and no one can give a good excuse for remaining in ignorance of so important a subject as electricity in medicine.—Toledo Medical and Surgical Reporter.

The entire work is thoroughly scientific and practical, and is really what the authors have aimed to produce, “a trustworthy guide to the application of electricity in the practice of medicine and surgery.”—New York Medical Times.

In its perusal, with each succeeding page, we have been more and more impressed with the fact that here, at last, we have a treatise on electricity in medicine and surgery which amply fulfills its purpose, and which is sure of general adoption by reason of its thorough excellence and superiority to other works intended to cover the same field.—Pharmaceutical Era.

MASSEY

Electricity in the Diseases of Women.

With Special Reference to the Application of Strong Currents.

By G. Betton Massey, M.D., Physician to the Gynæcological Department of the Howard Hospital; late Electro-therapeutist to the Philadelphia Orthopædic Hospital and Infirmary for Nervous Diseases, etc. Second Edition. Revised and Enlarged. With New and Original Wood-Engravings. Handsomely bound in Dark-Blue Cloth. 240 pages. 12mo. No. 5 in the Physicians’ and Students’ Ready-Reference Series.

This work is presented to the profession as the most complete treatise yet issued on the electrical treatment of the diseases of women, and is destined to fill the increasing demand for clear and practical instruction in the handling and use of strong currents after the recent methods first advocated by Apostoli. The whole subject is treated from the present stand-point of electric science with new and original illustrations, the thorough studies of the author and his wide clinical experience rendering him an authority upon electricity itself and its therapeutic applications. The author has enhanced the practical value of the work by including the exact details of treatment and results in a number of cases taken from his private and hospital practice.

Price, post-paid, in the United States and Canada, $1.50, net; in Great Britain, 8s. 6d.; in France, 9 fr. 35.

A new edition of this practical manual attests the utility of its existence and the recognition of its merits. The directions are simple, easy to follow and to put into practice; the ground is well covered, and nothing is assumed, the entire book being the record of experience.—Journal of Nervous and Mental Diseases.

It is only a few months since we noticed the first edition of this little book; and it is only necessary to add now that we consider it the best treatise on this subject we have seen, and that the improvements introduced into this edition make it more valuable still.—Boston Medical and Surgical Journ.

The style is clear, but condensed. Useless details are omitted, the reports of cases being pruned of all irrelevant material. The book is an exceedingly valuable one, and represents an amount of study and experience which is only appreciated after a careful reading.—Medical Record.

Physicians’ Interpreter.

In Four Languages (English, French, German, and Italian). Specially Arranged for Diagnosis by M. von V.

The object of this little work is to meet a need often keenly felt by the busy physician, namely, the need of some quick and reliable method of communicating intelligibly with patients of those nationalities and languages unfamiliar to the practitioner. The plan of the book is a systematic arrangement of questions upon the various branches of Practical Medicine, and each question is so worded that the only answer required of the patient is merely Yes or No. The questions are all numbered, and a complete Index renders them always available for quick reference. The book is written by one who is well versed in English, French, German, and Italian, being an excellent teacher in all those languages, and who has also had considerable hospital experience. Bound in Full Russia Leather, for carrying in the pocket. Size, 5 × 2¾ inches. 206 pages.

Price, post-paid, in the United States and Canada, $1.00, net; in Great Britain, 6s.; in France, 6 fr. 20.

Many other books of the same sort, with more extensive vocabularies, have been published, but, from their size, and from their being usually devoted to equivalents in English and one other language only, they have not had the advantage which is pre-eminent in this—convenience. It is handsomely printed, and bound in flexible red leather in the form of a diary. It would scarcely make itself felt in one’s hip-pocket, and would insure its bearer against any ordinary conversational difficulty in dealing with foreign-speaking people, who are constantly coming into our city hospitals.—New York Medical Journal.

This little volume is one of the most ingenious aids to the physician which we have seen. We heartily commend the book to any one who, being without a knowledge of the foreign languages, is obliged to treat those who do not know our own language.—St. Louis Courier of Medicine.

The Medical Bulletin Visiting-List or Physicians’ Call Record.

Arranged upon an Original and Convenient Monthly and Weekly Plan for the Daily Recording of Professional Visits.

Frequent Rewriting of Names Unnecessary.

This Visiting-List is arranged so that the names of patients need be written but ONCE a month instead of FOUR times a month, as in the old-style lists. By means of a new feature, a simple device consisting of STUB OR HALF LEAVES IN THE FORM OF INSERTS, the first week’s visits are recorded in the usual way, and the second week’s visits are begun by simply turning over the half-leaf without the necessity of rewriting the patients’ names. This very easily understood process is repeated until the month is ended and the record has been kept complete in every detail of VISIT, CHARGE, CREDIT, etc., and the labor and time of entering and transferring names at least THREE times in the month has been saved. There are no intricate rulings; not the least amount of time can be lost in comprehending the plan, for it is acquired at a glance.

THE THREE DIFFERENT STYLES MADE.

The No. 1 Style of this List provides space for the DAILY record of seventy different names each month for a year; for physicians who prefer a List that will accommodate a larger practice we have made a No. 2 Style, which provides space for the daily record of 105 different names each month for a year, and for physicians who may prefer a Pocket Record-Book of less thickness than either of these styles we have made a No. 3 Style, in which “The Blanks for the Recording of Visits in” have been made into removable sections. These sections are very thin, and are made up so as to answer in full the demand of the largest practice, each section providing ample space for the DAILY RECORD OF 210 DIFFERENT NAMES for two months; or 105 different names daily each month for four months; or seventy different names daily each month for six months. Six sets of these sections go with each copy of No. 3 Style.

SPECIAL FEATURES NOT FOUND IN ANY OTHER LIST.

In this No. 3 Style the PRINTED MATTER, and such matter as the blank forms for Addresses of Patients, Obstetric Record, Vaccination Record, Cash Account, Birth and Death Records, etc., are fastened permanently in the back of the book. The addition of a removable section does not increase the thickness more than an eighth of an inch. This brings the book into such a small compass that no one can object to it on account of its thickness, as its bulk is VERY MUCH LESS than that of any visiting-list ever published. Every physician will at once understand that as soon as a section is full it can be taken out, filed away, and another inserted without the least inconvenience or trouble. Extra or additional sections will be furnished at any time for 15 cents each or $1.75 per dozen. This Visiting-List contains calendars, valuable miscellaneous data, important tables, and other useful printed matter usually placed in Physicians’ Visiting-Lists.

Physicians of many years’ standing and with large practices pronounce it the Best List they have ever seen. It is handsomely bound in fine, strong leather, with flap, including a pocket for loose memoranda, etc., and is furnished with a Dixon lead-pencil of excellent quality and finish. It is compact and convenient for carrying in the pocket. Size, 4 × 6⅞ inches.

| IN THREE STYLES. | NET PRICES.
No. 1. | Regular size, to accommodate 70 patients daily each month for one year, | $1.25
No. 2. | Large size, to accommodate 105 patients daily each month for one year, | $1.50
No. 3. | In which the “Blanks for Recording Visits in” are in removable sections, | $1.75
| Special Edition for Great Britain, without printed matter, | 4s. 6d.
N. B.—The Recording of Visits in this List may be Commenced at any time during the Year.

MICHENER

Hand-Book of Eclampsia; OR, NOTES AND CASES OF PUERPERAL CONVULSIONS.

By E. Michener, M.D.; J. H. Stubbs, M.D.; R. B. Ewing, M.D.; B. Thompson, M.D.; S. Stebbins, M.D. 16mo. Cloth.

Price, 60 cents, net; in Great Britain, 4s. 6d.; in France, 4 fr. 20.

NISSEN
A MANUAL OF INSTRUCTION FOR GIVING
Swedish Movement and Massage Treatment

By Prof. Hartvig Nissen, late Director of the Swedish Health Institute, Washington, D.C.; late instructor in Physical Culture and Gymnastics at the Johns Hopkins University, Baltimore, Md.; Instructor of Swedish and German Gymnastics at Harvard University’s Summer School, 1891, etc., etc.

This excellent little volume treats this very important subject in a practical manner. Full instructions are given regarding the mode of applying the Swedish Movement and Massage Treatment in various diseases and conditions of the human system with the greatest degree of effectiveness. This book is indispensable to every physician who wishes to know how to use these valuable handmaids of medicine.

Illustrated with 29 Original Wood-Engravings. In one 12mo volume of 128 Pages. Neatly bound in Cloth.

Price, post-paid, in the United States and Canada, $1.00, net; in Great Britain, 6s.; in France, 6 fr. 20.

The present volume is a modest account of the application of the Swedish Movement and Massage Treatment, in which the technique of the various procedures are clearly stated as well as illustrated in a very excellent manner.—North American Practitioner.

This manual is valuable to the practitioner, as it contains a terse description of a subject but too little understood in this country.... The book is got up very creditably.—N. Y. Med. Journal.

SAJOUS

HAY FEVER And Its Successful Treatment by Superficial Organic Alteration of the Nasal Mucous Membrane.

By Charles E. Sajous, M.D., formerly Lecturer on Rhinology and Laryngology in Jefferson Medical College; Chief Editor of the Annual of the Universal Medical Sciences, etc. With 13 Engravings on Wood. 103 pages. 12mo. Bound in Cloth, Beveled Edges.

Price, post-paid, in the United States and Canada, $1.00, net; in Great Britain, 6s.; in France, 6 fr. 20.

STRAUB

Symptom Register and Case Record.

Designed by D. W. Straub, M.D.

Giving in plain view, on one side of the sheet 7½ × 10½ inches, the Clinical Record of the sick, including Date, Name, Residence, Occupation, Symptoms, Inspection (Auscultation and Percussion), History, Respiration, Pulse, Temperature, Diagnosis, Prognosis, Treatment (special and general), and Remarks, all conveniently arranged, and with ample room for recording, at each call, for four different calls, each item named above, the whole forming a clinical history of individual cases of great value to every Practitioner.

Published in stiff Board Tablets of 50 sheets each, at 50 cts. net per tablet, and in Book-form, flexible binding, with Alphabetical Marginal Index, at 75 cts., net.

Physician’s All-Requisite Time- and Labor-Saving Account-Book.

Being a Ledger and Account-Book for Physicians’ Use, Meeting all the Requirements of the Law and Courts.

Designed by William A. Seibert, M.D., of Easton, Pa.

Probably no class of people lose more money through carelessly kept accounts and overlooked or neglected bills than physicians. Often detained at the bedside of the sick until late at night, or deprived of even a modicum of rest, it is with great difficulty that he spares the time or puts himself in condition to give the same care to his own financial interests that a merchant, a lawyer, or even a farmer devotes. It is then plainly apparent that a system of bookkeeping and accounts that, without sacrificing accuracy, but, on the other hand, ensuring it, at the same time relieves the keeping of a physician’s book of half their complexity and two-thirds the labor, is a convenience which will be eagerly welcomed by thousands of overworked physicians. Such a system has at last been devised, and we take pleasure in offering it to the profession in the form of The Physician’s All-Requisite Time- and Labor-Saving Account-Book.

There is no exaggeration in stating that this Account-Book and Ledger reduces the labor of keeping your accounts more than one-half, and at the same time secures the greatest degree of accuracy. We may mention a few of the superior advantages of The Physician’s All-Requisite Time- and Labor-Saving Account-Book, as follows:—

First—Will meet all the requirements of the law and courts.

Second—Self-explanatory; no cipher code.

Third—Its completeness without sacrificing anything.

Fourth—No posting; one entry only.

Fifth—Universal; can be commenced at any time of the year, and can be continued indefinitely until every account is filled.

Sixth—Absolutely no waste of space.

Seventh—One person must needs be sick every day of the year to fill his account, or might be ten years about it and require no more than the space for one account in this ledger.

Eighth—Double the number and many times more than the number of accounts in any similar book; the 300–page book contains space for 900 accounts, and the 600–page book contains space for 1800 accounts.

Ninth—There are no smaller spaces.

Tenth—Compact without sacrificing completeness; every account complete on same page—a decided advantage and recommendation.

Eleventh—Uniform size of leaves.

Twelfth—The statement of the most complicated account is at once before you at any time of month or year—in other words, the account itself as it stands is its simplest statement.

Thirteenth—No transferring of accounts, balances, etc.

To all physicians desiring a quick, accurate, and comprehensive method of keeping their accounts, we can safely say that no book as suitable as this one has ever been devised. A descriptive circular showing the plan of the book will be sent on application.

NET PRICES, SHIPPING EXPENSES PREPAID.

In U.S.

Canada
(duty paid).

Great Britain.

France.

No. 1. 300 Pages, for 900 Accounts per Year, Size 10×12, Bound in ¾-Russia, Raised Back Bands, Cloth Sides, | $5.00 | $5.50 | 28s. | 30 fr. 30.
No. 2. 600 Pages, for 1800 Accounts per Year, Size 10×12, Bound in ¾-Russia, Raised Back-Bands, Cloth Sides, | 8.00 | 8.80 | 42s. | 49 fr. 40

PRICE and EAGLETON

Three Charts of the Nervo-Vascular System.

Part I.—The Nerves. Part II.—The Arteries. Part III.—The Veins.

A New Edition, Revised and Perfected. Arranged by W. Henry Price, M.D., and S. Potts Eagleton, M.D. Endorsed by leading anatomists. Clearly and beautifully printed upon extra durable paper.

PART I. The Nerves.—Gives in a clear form not only the Cranial and Spinal Nerves, showing the formation of the different Plexuses and their branches, but also the complete distribution of the Sympathetic Nerves.

PART II. The Arteries.—Gives a unique grouping of the Arterial system, showing the divisions and subdivisions of all the vessels, beginning from the heart and tracing their CONTINUOUS distribution to the periphery, and showing at a glance the terminal branches of each artery.

PART III. The Veins.—Shows how the blood from the periphery of the body is gradually collected by the larger veins, and these coalescing forming still larger vessels, until they finally trace themselves into the Right Auricle of the heart.

It is therefore readily seen that “The Nervo-Vascular System of Charts” offers the following superior advantages:—

1. It is the only arrangement which combines the Three Systems, and yet each is perfect and distinct in itself.

2. It is the only instance of the Cranial, Spinal, and Sympathetic Nervous Systems being represented on one chart.

3. From its neat size and clear type, and being printed only upon one side, it may be tacked up in any convenient place, and is always ready for freshening up the memory and reviewing for examination.

Price, post-paid, in United States and Canada, 50 cents, net, complete; in Great Britain, 3s. 6d.; in France, 3 fr. 60.

For the student of anatomy there can possibly be no more concise way of acquiring a knowledge of the nerves, veins, and arteries of the human system. It presents at a glance their trunks and branches in the great divisions of the body. It will save a world of tedious reading, and will impress itself on the mind as no ordinary vade mecum, even, could. Its price is nominal and its value inestimable. No student should be without it.—Pacific Record of Medicine and Surgery.

These are three admirably arranged charts for the use of students, to assist in memorizing their anatomical studies.—Buffalo Med. and Surg. Jour.

PURDY

Diabetes: Its Cause, Symptoms and Treatment

By Chas. W. Purdy, M.D. (Queen’s University), Honorary Fellow of the Royal College of Physicians and Surgeons of Kingston; Member of the College of Physicians and Surgeons of Ontario; Author of “Bright’s Disease and Allied Affections of the Kidneys;” Member of the Association of American Physicians; Member of the American Medical Association; Member of the Chicago Academy of Sciences, etc.

Contents.—Section I. Historical, Geographical, and Climatological Considerations of Diabetes Mellitus. II. Physiological and Pathological Considerations of Diabetes Mellitus. III. Etiology of Diabetes Mellitus. IV. Morbid Anatomy of Diabetes Mellitus. V. Symptomatology of Diabetes Mellitus. VI. Treatment of Diabetes Mellitus. VII. Clinical Illustrations of Diabetes Mellitus. VIII. Diabetes Insipidus; Bibliography.

12mo. Dark Blue Extra Cloth. Nearly 200 pages.

No. 8 in the Physicians’ and Students’ Ready-Reference Series.

Price, post-paid, in the United States and Canada, $1.25, net; in Great Britain, 6s. 6d.; in France, 7 fr. 75.

This will prove a most entertaining as well as most interesting treatise upon a disease which frequently falls to the lot of every practitioner. The work has been written with a special view of bringing out the features of the disease as it occurs in the United States. The author has very judiciously arranged the little volume, and it will offer many pleasant attractions to the practitioner.—Nashville Journal of Medicine and Surgery.

While many monographs have been published which have dealt with the subject of diabetes, we know of none which so thoroughly considers its relations to the geographical conditions which exist in the United States, nor which is more complete in its summary of the symptomatology and treatment of this affection. A number of tables, showing the percentage of sugar in a very large number of alcoholic beverages, adds very considerably to the value of the work.—Medical News.

REMONDINO

History of Circumcision.

From the Earliest Times to the Present. Moral and Physical Reasons for its Performance; with a History of Eunuchism, Hermaphrodism, etc., and of the Different Operations Practiced upon the Prepuce.

By P. C. Remondino, M.D. (Jefferson), Member of the American Medical Association; of the American Public Health Association; Vice-President of California State Medical Society and of Southern California Medical Society, etc.

In one neat 12mo volume of 346 pages. Handsomely bound in Extra Dark-Blue Cloth, and illustrated with two fine wood-engravings, showing the two principal modes of Circumcision in ancient times. No. 11 in the Physicians’ and Students’ Ready-Reference Series.

Price, post-paid, in United States and Canada, $1.25, net; in Great Britain, 6s. 6d.; in France, 7 fr. 75.

A Popular Edition (unabridged), bound in Paper Covers, is also issued. Price, 50 Cents, net; in Great Britain, 3s.; in France, 3 fr. 60.

Every physician should read this book; he will there find, in a condensed and systematized form, what there is known concerning Circumcision. The book deals with simple facts, and it is not a dissertation on theories. It deals, in plain, pointed language, with the relation that the prepuce bears to physical degeneracy and disease, bases all its utterances on what has occurred and on what is known. The author has here gathered from every source the material for his subject, and the deductions are unmistakable.

This is a very full and readable book. To the reader who wishes to know all about the antiquity of the operation, with the views pro and con of the right of this appendage to exist, its advantages, dangers, etc., this is the book.—The Southern Clinic.

The operative chapter will be particularly useful and interesting to physicians, as it contains a careful and impartial review of all the operative procedures, from the most simple to the most elaborate, paying particular attention to the subject of after-dressings. It is a very interesting and instructive work, and should be read very liberally by the profession.—The Med. Brief.

The author’s views in regard to circumcision, its necessity, and its results, are well founded, and its performance as a prophylactic measure is well established.—Columbus Med. Journal.

By the Same Author

The Mediterranean Shores of America.

Southern California: Its Climatic, Physical, and Meteorological Conditions.

By P. C. Remondino, M.D. (Jefferson), etc.

Complete in one handsomely printed Octavo volume of nearly 175 pages, with 45 appropriate illustrations and 2 finely executed maps of the region, showing altitudes, ocean currents, etc. Bound in Extra Cloth.

Price, post-paid, in United States and Canada, $1.25, net; in Great Britain, 6s. 6d.; in France, 7 fr. 75.

Cheaper Edition (unabridged), bound in Paper, post-paid, in United States and Canada, 75 Cents, net; in Great Britain, 4s.; in France, 5 fr.

Italy, of the Old World, does not excel nor even approach this region in point of salubrity of climate and all-around healthfulness of environment. This book fully describes and discusses this wonderfully charming country. The medical profession, who have long desired a trustworthy treatise of true scientific value on this celebrated region, will find in this volume a satisfactory response to this long-felt and oft-expressed wish.

ROHÉ

Text-Book of Hygiene.

A Comprehensive Treatise on the Principles and Practice of Preventive Medicine from an American Stand-point.

By George H. Rohé, M.D., Professor of Obstetrics and Hygiene in the College of Physicians and Surgeons, Baltimore; Member of the American Public Health Association, etc.

Every Sanitarian should have Rohé’s “Text-Book of Hygiene” as a work of reference.

Second Edition, thoroughly revised and largely rewritten, with many illustrations and valuable tables. In one handsome Royal Octavo volume of over 400 pages, bound in Extra Cloth.

Price, post-paid, in United States, $2.50, net; Canada (duty paid), $2.75, net; Great Britain, 14s.; France, 16 fr. 20.

One prominent feature is that there are no superfluous words; every sentence is direct to the point sought. It is, therefore, easy reading, and conveys very much information in little space.—The Pacific Record of Medicine and Surgery.

It is unquestionably a work that should be in the hands of every physician in the country, and medical students will find it a most excellent and valuable text-book.—The Southern Practitioner.

The first edition was rapidly exhausted, and the book justly became an authority to physicians and sanitary officers, and a text-book very generally adopted in the colleges throughout America. The second edition is a great improvement over the first, all of the matter being thoroughly revised, much of it being rewritten, and many additions being made. The size of the book is increased one hundred pages. The book has the original recommendation of being a handsomely-bound, clearly-printed octavo volume, profusely illustrated with reliable references for every branch of the subject matter.—Medical Record.

The wonder is how Professor Rohé has made the book so readable and entertaining with so much matter necessarily condensed. Altogether, the manual is a good exponent of hygiene and sanitary science from the present American stand-point, and will repay with pleasure and profit any time that may be given to its perusal.—University Medical Magazine.

By the Same Author

A Practical Manual of Diseases of the Skin.

By George H. Rohé, M.D., Professor of Materia Medica, Therapeutics, and Hygiene, and formerly Professor of Dermatology in the College of Physicians and Surgeons, Baltimore, etc., assisted by J. Williams Lord, A.B., M.D., Lecturer on Dermatology and Bandaging in the College of Physicians and Surgeons; Assistant Physician to the Skin Department in the Dispensary of Johns Hopkins Hospital.

In one neat 12mo volume of over 300 pages bound in Extra Dark-Blue Cloth. No. 13 in the Physicians’ and Students’ Ready-Reference Series.

Price, post-paid, in the United States and Canada, $1.25, net; in Great Britain, 6s. 6d.; in France, 7 fr. 75.

The PRACTICAL character of this work makes it specially desirable for the use of students and general practitioners.

The nearly one hundred (100) reliable and carefully prepared Formulæ at the end of the volume add not a little to its practical value.

All the various forms of skin diseases, from Acne to Zoster (alphabetically speaking), are succinctly yet amply treated of, and the arrangement of the book, with its excellent index and unusually full table of contents, goes to make up a truly satisfactory volume for ready reference in daily practice.

SENN

Principles of Surgery.

By N. Senn, M.D., Ph.D., Professor of Practice of Surgery and Clinical Surgery in Rush Medical College, Chicago, Ill.; Professor of Surgery in the Chicago Polyclinic; Attending Surgeon to the Milwaukee Hospital; Consulting Surgeon to the Milwaukee County Hospital and to the Milwaukee County Insane Asylum.

This work, by one of America’s greatest surgeons, is thoroughly COMPLETE; its clearness and brevity of statement are among its conspicuous merits. The author’s long, able, and conscientious researches in every direction in this important field are a guarantee, of unusual trustworthiness, that every branch of the subject is treated authoritatively, and in such a manner as to bring the greatest gain in knowledge to the practitioner and student.

In one Royal Octavo volume, with 109 fine Wood-Engravings and 624 pages.

United States.

Canada
(duty paid).

Great Britain.

France.

Price, in Cloth, | $4.50, net | $5.00, net | 24s. 6d. | 27 fr. 20
Price, in Sheep or ½-Russia, | 5.50, net | 6.10, net | 30s. | 33 fr. 10

Stephen Smith, M.D., Professor of Clinical Surgery Medical Department University of the City of New York, writes: “There has long been great need of a work on the principles of surgery which would fully illustrate the present advanced state of knowledge of the various subjects embraced in this volume. The work seems to me to meet this want admirably.”

Frank J. Lutz, M.D., St. Louis, Mo., says: “It seems incredible that those who pretend to teach have done without such a guide before, and I do not understand how our students succeeded in mastering the principles of modern surgery by attempting to read our obsolete text-books. American surgery should feel proud of the production, and the present generation of surgeons owe you a debt of gratitude.”

The work is systematic and compact, without a fact omitted or a sentence too much, and it not only makes instructive but fascinating reading. A conspicuous merit of Senn’s work is his method, his persistent and tireless search through original investigations for additions to knowledge, and the practical character of his discoveries.—The Review of Insanity and Nervous Diseases.

After perusing this work on several different occasions, we have come to the conclusion that it is a remarkable work, by a man of unusual ability.—The Canada Medical Record.

The work is exceedingly practical, as the chapters on the treatment of the various conditions considered are based on sound deductions, are complete, and easily carried out by any painstaking surgeon.—Medical Record.

The book throughout is worthy of the highest praise. It should be adopted as a text-book in all of our schools.—University Medical Magazine.

By the Same Author

Tuberculosis of the Bones and Joints.

By N. Senn, M.D., Ph.D.

Illustrated with upwards of One Hundred (100) Engravings and Plates, many of them colored. Royal Octavo. Over 500 pages.

United States.

Canada
(duty paid).

Great Britain.

France.

Price, Extra Cloth, | $4.00, net | $4.40, net | 22s. 6d. | 24 fr. 60
Price, Sheep or ½-Russia, | 5.00, net | 5.50, net | 28s. | 30 fr. 30

To get an idea of the scope of the work read the following titles of chapters: History. Proofs which Establish the Tubercular Nature of the So-called Strumous Disease of Bones and Joints. Bacillus Tuberculosis. Histology of Tubercle. Histogenesis of Tubercle. Caseation. Tubercular Abscess. Topography of Bone and Joint Tuberculosis. Bone Tuberculosis. Etiology of Bone Tuberculosis. Symptoms and Diagnosis of Tubercular Bone Affections. Prognosis of Tubercular Disease of Bone. Treatment of Tuberculosis of Bone. Tuberculosis of Joints. Special Points in the Pathology of Synovial Tuberculosis. Etiology; Symptoms and Diagnosis, Prognosis. Treatment of Tuberculosis of Joints. Local Treatment. Tuberculin Treatment. Treatment of Tuberculosis of Joints by Parenchymatous and Intra-articular Injections. Operative Treatment. Resection. Atypical and Typical Resection. Immediate and Remote Results of Resection. Amputation. Post-Operative Treatment. Tuberculosis of Special Bones. Tuberculosis of the Bones of the Trunk. Tuberculosis of Pelvic Bones, Scapula, Clavicle, Sternum, and Ribs. Tuberculosis of Joints of Upper Extremity. Tuberculosis of Hip-Joint. Tuberculosis of Knee-Joint. Tuberculosis of Ankle-Joint and Tarsus.

All these subjects are handled in the author’s simple, direct, and vigorous style, and always with the practical side of the question kept in view, and leave nothing necessary or desirable untouched. We know of no book of equal learning, thoroughness, and utility upon the common and important class of cases composed under Tuberculosis of Bones and Joints. The illustrations are numerous and good, and the printing and other details of issuing a book have been attended to with an enterprise and ambition creditable to the publishers.—Cleveland Medical Gazette.

SHOEMAKER

Materia Medica and Therapeutics.

With Especial Reference to the Clinical Application of Drugs.

By John V. Shoemaker, A.M., M.D., Professor of Materia Medica, Pharmacology, Therapeutics, and Clinical Medicine, and Clinical Professor of Diseases of the Skin in the Medico-Chirurgical College of Philadelphia; Physician to the Medico-Chirurgical Hospital; Member of the American Medical Association, of the Pennsylvania and Minnesota State Medical Societies, the American Academy of Medicine, the British Medical Association; Fellow of the Medical Society of London, etc.

Second Edition. Thoroughly revised. In two volumes. Royal Octavo. Nearly 1100 pages.

Volume I is devoted to pharmacy, general pharmacology, and therapeutics, and remedial agents not properly classed with drugs.

Volume II is wholly taken up with the consideration of drugs, each remedy being studied from three points of view, viz.: the Preparations, or Materia Medica; the Physiology and Toxicology, or Pharmacology; and, lastly, its Therapy. Each volume is thoroughly and carefully indexed with clinical and general indexes, and the second volume contains a most valuable and exhaustive table of doses extending over several double-column octavo pages.

The Volumes may be Purchased Separately.

VOL. I.

United States.

Canada
(duty paid).

Great Britain.

France.

Extra Cloth, | $2.50, net | $2.75, net | 14s. | 16 fr. 20
Sheep, | 3.25, net | 3.60, net | 18s. | 20 fr. 20
VOL. II.

United States.

Canada
(duty paid).

Great Britain.

France.

Extra Cloth, | $3.50, net | $4.00, net | 19s. | 22 fr. 40
Sheep, | 4.50, net | 5.00, net | 25s. | 28 fr. 60

The well-known practical usefulness of this eminently standard work is now greatly increased by the very recent and accurate information it gives, from a clinical stand-point, concerning the new and useful drugs introduced to the medical profession since the issue of the first edition, two years ago; so that it is thoroughly abreast of the progress of therapeutic science, and hence really indispensable to every student and practitioner.

REVIEWS OF THE FIRST EDITION.

The value of the book lies in the fact that it contains all that is authentic and trustworthy about the host of new remedies which have deluged us in the last five years. The pages are remarkably free from useless information. The author has done well in following the alphabetical order.—N. Y. Med. Record.

In perusing the pages devoted to the special consideration of drugs, their pharmacology, physiological action, toxic action, and therapy, one is constantly surprised at the amount of material compressed in so limited a space. The book will prove a valuable addition to the physician’s library.—Occidental Med. Times.

It is a meritorious work, with many unique features. It is richly illustrated by well-tried prescriptions showing the practical application of the various drugs discussed. In short, this work makes a pretty complete encyclopædia of the science of therapeutics, conveniently arranged for handy reference.—Med. World.

SHOEMAKER

Heredity, Health, and Personal Beauty.

Including the Selection of the Best Cosmetics for the Skin, Hair, Nails, and all Parts Relating to the Body.

By John V. Shoemaker, A.M., M.D., Professor of Materia Medica, Pharmacology, Therapeutics, and Clinical Medicine, and Clinical Professor of Diseases of the Skin in the Medico-Chirurgical College of Philadelphia; Physician to the Medico-Chirurgical Hospital, etc., etc.

The health of the skin and hair, and how to promote them, are discussed; the treatment of the nails; the subjects of ventilation, food, clothing, warmth, bathing; the circulation of the blood, digestion, ventilation; in fact, all that in daily life conduces to the well-being of the body and refinement is duly enlarged upon. To these stores of popular information is added a list of the best medicated soaps and toilet soaps, and a whole chapter of the work is devoted to household remedies. The work is largely suggestive, and gives wise and timely advice as to when a physician should be consulted. This is just the book to place on the waiting-room table of every physician, and a work that will prove useful in the hands of your patients.

Complete in one handsome Royal Octavo volume of 425 pages, beautifully and clearly printed, and bound in Extra Cloth, Beveled Edges, with side and back gilt stamps and in Half-Morocco Gilt Top.

Price, in United States, post-paid, Cloth, $2.50; Half-Morocco, $3.50, net. Canada (duty paid), Cloth, $2.75; Half-Morocco, $3.90, net. Great Britain. Cloth. 14s.; Half-Morocco. 19s. 6d. France. Cloth. 15 fr.; Half-Morocco, 22 fr.

The book reads not like the fulfillment of a task, but like the researches and observations of one thoroughly in love with his subject, fully appreciating its importance, and writing for the pleasure he experiences in it. The work is very comprehensive and complete in its scope.—Medical World.

The book before us is a most remarkable production and a most entertaining one. The book is equally well adapted for the laity or the profession. It tells us how to be healthy, happy, and as beautiful as possible. We can’t review this book; it is different from anything we have ever read. It runs like a novel, and will be perused until finished with pleasure and profit. Buy it, read it, and be surprised, pleased, and improved.—The Southern Clinic.

This book is written primarily for the laity, but will prove of interest to the physician as well. Though the author goes to some extent into technicalities, he confines himself to the use of good, plain English, and in that respect sets a notable example to many other writers on similar subjects. Furthermore, the book is written from a thoroughly American stand-point.—Medical Record.

This is an exceedingly interesting book, both scientific and practical in character, intended for both professional and lay readers. The book is well written and presented in admirable form by the publisher.—Canadian Practitioner.

SHOEMAKER

Ointments and Oleates: Especially in Diseases of the Skin.

By John V. Shoemaker, A.M., M.D., Professor of Materia Medica, Pharmacology, Therapeutics, and Clinical Medicine, and Clinical Professor of Diseases of the Skin in the Medico-Chirurgical College of Philadelphia, etc., etc.

The author concisely concludes his preface as follows: “The reader may thus obtain a conspectus of the whole subject of inunction as it exists to-day in the civilized world. In all cases the mode of preparation is given, and the therapeutical application described seriatim, in so far as may be done without needless repetition.”

Second Edition, revised and enlarged. 298 pages. 12mo. Neatly bound in Dark-Blue Cloth. No. 6 in the Physicians’ and Students’ Ready-Reference Series.

Price, post-paid, in the United States and Canada, $1.50, net; in Great Britain, 8s. 6d.; in France, 9 fr. 35.

It is invaluable as a ready reference when ointments or oleates are to be used, and is serviceable to both druggist and physician.—Canada Medical Record.

To the physician who feels uncertain as to the best form in which to prescribe medicines by way of the skin the book will prove valuable, owing to the many prescriptions and formulæ which dot its pages, while the copious index at the back materially aids in making the book a useful one.—Medical News.

SMITH

Physiology of the Domestic Animals.

A Text-Book for Veterinary and Medical Students and Practitioners.

By Robert Meade Smith, A.M., M.D., Professor of Comparative Physiology in University of Pennsylvania; Fellow of the College of Physicians and Academy of the Natural Sciences, Philadelphia; of American Physiological Society; of the American Society of Naturalists, etc.

This new and important work, the most thoroughly complete in the English language on this subject, treats of the physiology of the domestic animals in a most comprehensive manner, especial prominence being given to the subject of foods and fodders, and the character of the diet for the herbivora under different conditions, with a full consideration of their digestive peculiarities. Without being overburdened with details, it forms a complete text-book of physiology adapted to the use of students and practitioners of both veterinary and human medicine. This work has already been adopted as the Text-Book on Physiology in the Veterinary Colleges of the United States, Great Britain, and Canada. In one Handsome Royal Octavo Volume of over 950 pages, profusely illustrated with more than 400 Fine Wood-Engravings and many Colored Plates.

United States.

Canada
(duty paid)

Great Britain.

France.

Price, Cloth | $5.00, Net | $5.50, Net | 28s. | 30 fr. 30
Price, Sheep, | 6.00, net | 6.60, net | 32s. | 36 fr. 20

A. Liautard, M.D., H.F.R.C., V.S., Professor of Anatomy, Operative Surgery, and Sanitary Medicine in the American Veterinary College, New York, writes:—“I have examined the work of Dr. R. M. Smith on the ‘Physiology of the Domestic Animals,’ and consider it one of the best additions to veterinary literature that we have had for some time.”

E. M. Reading, A.M., M.D., Professor of Physiology in the Chicago Veterinary College, writes:—“I have carefully examined the ‘Smith’s Physiology,’ published by you, and like it. It is comprehensive, exhaustive, and complete, and is especially adapted to those who desire to obtain a full knowledge of the principles of physiology, and are not satisfied with a mere smattering of the cardinal points.”

Dr. Smith’s presentment of his subject is as brief as the status of the science permits, and to this much-desired conciseness he has added an equally welcome clearness of statement. The illustrations in the work are exceedingly good, and must prove a valuable aid to the full understanding of the text—Journal of Comparative Medicine and Surgery.

Veterinary practitioners and graduates will read it with pleasure. Veterinary students will readily acquire needed knowledge from its pages, and veterinary schools, which would be well equipped for the work they aim to perform, cannot ignore it as their text-book in physiology.—American Veterinary Review.

Altogether, Professor Smith’s “Physiology of the Domestic Animals” is a happy production, and will be hailed with delight in both the human medical and veterinary medical worlds. It should find its place, besides, in all agricultural libraries.—Paul Paquin, M.D., V.S., in the Weekly Medical Review.

The author has judiciously made the nutritive functions the strong point of the work, and has devoted special attention to the subject of foods and digestion. In looking through other sections of the work, it appears to us that a just proportion of space is assigned to each, in view of their relative importance to the practitioner.—London Lancet.

SOZINSKEY

Medical Symbolism. Historical Studies in the Arts of Healing and Hygiene.

By Thomas S. Sozinskey, M.D., Ph.D., Author of “The Culture of Beauty,” “The Care and Culture of Children,” etc.

12mo. Nearly 200 pages. Neatly bound in Dark-Blue Cloth. Appropriately illustrated with upward of thirty (30) new Wood-Engravings. No. 9 in the Physicians’ and Students’ Ready-Reference Series.

Price, post-paid, in United States and Canada, $1.00, net; Great Britain, 6s.; France, 6 fr. 20.

He who has not time to more fully study the more extended records of the past, will highly prize this little book. Its interesting discourse upon the past is full of suggestive thought.—American Lancet.

Like an oasis in a dry and dusty desert of medical literature, through which we wearily stagger, is this work devoted to medical symbolism and mythology. As the author aptly quotes: “What some light braines may esteem as foolish toyes, deeper judgments can and will value as sound and serious matter.”—Canadian Practitioner.

In the volume before us we have an admirable and successful attempt to set forth in order those medical symbols which have come down to us, and to explain on historical grounds their significance. An astonishing amount of information is contained within the covers of the book, and every page of the work bears token of the painstaking genius and erudite mind of the now unhappily deceased author.—London Lancet.

STEWART

Obstetric Synopsis.

By John S. Stewart, M.D., formerly Demonstrator of Obstetrics and Chief Assistant in the Gynæcological Clinic of the Medico-Chirurgical College of Philadelphia: with an introductory note by William S. Stewart, A.M., M.D., Professor of Obstetrics and Gynæcology in the Medico-Chirurgical College of Philadelphia.

By students this work will be found particularly useful. It is based upon the teachings of such well-known authors as Playfair, Parvin, Lusk, Galabin, and Cazeaux and Tarnier, and contains much new and important matter of great value to both student and practitioner.

With 42 Illustrations. 202 pages. 12mo. Handsomely bound in Dark-Blue Cloth. No. 1 in the Physicians’ and Students’ Ready-Reference Series.

Price, post-paid, in the United States and Canada, $1.00, net; in Great Britain, 6s.; France, 6 fr. 20.

DeLaskie Miller, M.D., Professor of Obstetrics, Rush Medical College, Chicago, Ill., says:—“I have examined the ‘Obstetric Synopsis,’ by John S. Stewart, M.D., and it gives me pleasure to characterize the work as systematic, concise, perspicuous, and authentic. Among manuals it is one of the best.”

It is well written, excellently illustrated, and fully up to date in every respect. Here we find all the essentials of Obstetrics in a nutshell, Anatomy, Embryology, Physiology, Pregnancy, Labor, Puerperal State, and Obstetric Operations all being carefully and accurately described.—Buffalo Medical and Surgical Journal.

It is clear and concise. The chapter on the development of the ovum is especially satisfactory. The judicious use of bold-faced type for headings and italics for important statements gives the book a pleasing typographical appearance.—Medical Record.

This volume is done with a masterly hand. The scheme is an excellent one. The whole is freely and most admirably illustrated with well-drawn, new engravings, and the book is of a very convenient size.—St. Louis Medical and Surgical Journal.

ULTZMANN

The Neuroses of the Genito-Urinary System in the Male.

With Sterility and Impotence.

By Dr. R. Ultzmann, Professor of Genito-Urinary Diseases in the University of Vienna. Translated, with the author’s permission, by Gardner W. Allen, M.D., Surgeon in the Genito-Urinary Department, Boston Dispensary.

Full and complete, yet terse and concise, it handles the subject with such a vigor of touch, such a clearness of detail and description, and such a directness to the result, that no medical man who once takes it up will be content to lay it down until its perusal is complete,—nor will one reading be enough.

Professor Ultzmann has approached the subject from a somewhat different point of view from most surgeons, and this gives a peculiar value to the work. It is believed, moreover, that there is no convenient hand-book in English treating in a broad manner the Genito-Urinary Neuroses.

Synopsis of Contents.—First Part—I. Chemical Changes in the Urine in Cases of Neuroses. II. Neuroses of the Urinary and of the Sexual Organs, classified as: (1) Sensory Neuroses; (2) Motor Neuroses; (3) Secretory Neuroses. Second Part—Sterility and Impotence. The treatment in all cases is described clearly and minutely.

Illustrated. 12mo. Handsomely bound in Dark-Blue Cloth. No. 4 in the Physicians’ and Students’ Ready-Reference Series.

Price, post-paid, in the United States and Canada, $1.00, net; in Great Britain, 6s.; in France, 6 fr. 20.

This book is to be highly recommended, owing to its clearness and brevity. Altogether, we do not know of any book of the same size which contains so much useful information in such a short space.—Medical News.

Its scope is large, not being confined to the one condition,—neurasthenia,—but embracing all of the neuroses, motor and sensory, of the genito-urinary organs in the male. No one who has read after Dr. Ultzmann need be reminded of his delightful manner of presenting his thoughts, which ever sparkle with originality and appositeness.—Weekly Med. Review.

It engenders sound pathological teaching, and will aid in no small degree in throwing light on the management of many of the difficult and more refractory cases of the classes to which these essays especially refer.—The Medical Age.

VOUGHT

A Chapter on Cholera for Lay Readers.

History, Symptoms, Prevention, and Treatment of the Disease.

By Walter Vought, Ph.B., M D., Medical Director and Physician-in-Charge of the Fire Island Quarantine Station, Port of New York; Fellow of the New York Academy of Medicine, etc.

Illustrated. 12mo. 106 pages. Flexible Cloth.

Price, post-paid, in the United States and Canada, 75 cents, net; Great Britain, 4s.; France, 5 fr.

By complying with and conforming to (and this is perfectly practicable) the instructions so clearly, fully, and yet briefly given in this little volume, absolute security against the disease is assured.

It is written by so experienced and competent an authority—one who has had actual hand-to-hand conflict with an extensive epidemic—and in such a clear, succinct style, as to be easily comprehended and made available by every individual and household.

The following Condensed Table of Contents shows the scope and completeness of the work: Definition; History of Cholera; Cholera in America; Causes of the Disease; The Disease in Human Beings; The Germ in the Body; The Disease in Epidemic Form; Symptoms; The Diagnosis of the Disease; Prognosis; Treatment; Prevention; Method of Handling an Outbreak of Cholera on Shipboard; Quarantine; Disinfection.

A very thorough and conveniently arranged index adds greatly to the practical usefulness of the book.

WITHERSTINE
The International Pocket Medical Formulary
Arranged Therapeutically.

By C. Sumner Witherstine, M.S., M.D., Associate Editor of the “Annual of the Universal Medical Sciences”; Visiting Physician of the Home for the Aged, Germantown, Philadelphia; Late House-Surgeon Charity Hospital, New York.

More than 1800 formulæ from several hundred well-known authorities. With an Appendix containing a Posological Table, the newer remedies included; Important Incompatibles; Tables on Dentition and the Pulse; Table of Drops in a Fluidrachm and Doses of Laudanum graduated for age; Formulæ and Doses of Hypodermatic Medication, including the newer remedies; Uses of the Hypodermatic Syringe; Formulæ and Doses for Inhalations, Nasal Douches, Gargles, and Eye-Washes; Formulæ for Suppositories; Use of the Thermometer in Disease; Poisons, Antidotes and Treatment; Directions for Post-Mortem and Medico-Legal Examinations; Treatment of Asphyxia, Sun-stroke, etc.; Antiemetic Remedies and Disinfectants; Obstetrical Table; Directions for Ligations of Arteries; Urinary Analysis; Table of Eruptive Fevers; Motor Points for Electrical Treatment, etc.

This work, the best and most complete of its kind, contains about 275 printed pages, besides extra blank leaves judiciously distributed throughout the book, affording a place to record and index favorite formulæ. Elegantly printed, with red lines, edges, and borders; with illustrations. Bound in leather, with side-flap.

The alphabetical arrangement of the diseases and a thumb-letter index render reference rapid and easy.

As a student, the physician needs it for study, collateral reading, and, for recording the favorite prescriptions of his professors, in lecture and clinic; as a recent graduate, he needs it as a reference hand-book for daily use in prescribing; as an old practitioner, he needs it to refresh his memory on old remedies and combinations, and for information concerning newer remedies and more modern approved plans of treatment.

No live, progressive medical man can afford to be without it.

Price, post-paid, in United States and Canada, $2.00, net; Great Britain, 11s. 6d.; France, 12 fr. 40.

YOUNG

Synopsis of Human Anatomy.

Being a Complete Compend of Anatomy, Including the Anatomy of the Viscera, and Numerous Tables.

By James K. Young, M.D., Instructor in Orthopædic Surgery and Assistant Demonstrator of Surgery, University of Pennsylvania; Attending Orthopædic Surgeon, Out-Patient Department, University Hospital, etc.

While the author has prepared this work especially for students, sufficient descriptive matter has been added to render it extremely valuable to the busy practitioner, particularly the sections on the Viscera, Special Senses, and Surgical Anatomy.

The work includes a complete account of Osteology, Articulations, and Ligaments, Muscles, Fascias, Vascular and Nervous Systems, Alimentary, Vocal, and Respiratory and Genito-Urinary Apparatus, the Organs of Special Sense, and Surgical Anatomy.

In addition to a most carefully and accurately prepared text, wherever possible, the value of the work has been enhanced by tables to facilitate and minimize the labor of students in acquiring a thorough knowledge of this important subject. The section on the teeth has also been especially prepared to meet the requirements of students of dentistry.

Illustrated with 76 Wood-Engravings. 390 pages. 12mo. Bound in Extra Dark-Blue Cloth. No. 3 in the Physicians’ and Students’ Ready-Reference Series.

Price, post-paid, in the United States and Canada, $1.40, net; in Great Britain, 8s. 6d; in France, 9 fr. 25.

Every unnecessary word has been excluded, out of regard to the very limited time at the medical student’s disposal. It is also good as a reference-book, as it presents the facts about which he wishes to refresh his memory in the briefest manner consistent with clearness.—New York Medical Journal.

As a companion to the dissecting table, and a convenient reference for the practitioner, it has a definite field of usefulness.—Pittsburgh Medical Review.

The book is much more satisfactory than the “remembrances” in vogue, and yet is not too cumbersome to be carried around and read at odd moments—a property which the student will readily appreciate.—Weekly Medical Review.

The Universal Medical Journal

(Formerly THE SATELLITE).

A Monthly Magazine of the Progress of Every Branch of Medicine in all Parts of the World.

Edited by Charles E. Sajous, M.D., Editor-in-Chief of The Annual of the Universal Medical Sciences, and C. Sumner Witherstine, M.S., M.D., Associate Editor.

Subscription Price, in the United States of America, $2.00 per year; in other countries of the Postal Union, 8s. 6d. or 10 fr. 50c.

Subscribers to The Annual of the Universal Medical Sciences will now receive The Universal Medical Journal free, as formerly they did The Satellite. The Universal Medical Journal contains 32 pages of Text, Original Articles (a New Feature), Clinical Notes, and Correspondence by eminent foreign and American physicians, etc. The Best Time to Subscribe is—Now! It is improved in appearance, matter, style, size.

Annual of the Universal Medical Sciences.

A Yearly Report of the Progress of the General Sanitary Sciences Throughout the World.

Issue of 1893 Ready in June, 1893.

Edited by Charles E. Sajous, M.D., formerly Lecturer on Laryngology and Rhinology in Jefferson Medical College, Philadelphia, etc., and Seventy Associate Editors, assisted by over Two Hundred Corresponding Editors and Collaborators in America, Europe, Asia, and Africa. In Five Royal Octavo Volumes of about 500 Pages Each, bound in Cloth and Half-Russia, Magnificently Illustrated with Chromo-Lithographs, Engravings, Maps, Charts, and Diagrams. Being intended to enable any physician to possess, at a moderate cost, a complete Contemporary History of Universal Medicine, edited by many of America’s and Europe’s ablest teachers, and superior in every detail of print, paper, binding, etc.

SOLD ONLY BY SUBSCRIPTION, OR SENT DIRECT ON RECEIPT OF PRICE, SHIPPING EXPENSES PREPAID.

Subscription Price per Year (including the “UNIVERSAL MEDICAL JOURNAL” for one year): In U. S., 5 vols., Cloth, $15.00; Half-Russia, $20.00. Canada (duty paid), Cloth, $16.50; Half-Russia, $22.00. Great Britain, Cloth, £4 7s.; Half-Russia, £5 15s. France, Cloth, 93 fr. 95; Half-Russia, 124 fr. 35.

The Universal Medical Journal is a Monthly Magazine of the Progress of Every Branch of Medicine in All Parts of the World, Edited by the Chief Editor of the Annual and C. Sumner Witherstine, M.S., M.D., Associate Editor. Supplied to subscribers to the Annual free of charge; to all others, $2.00 per year in advance.

EDITORIAL STAFF OF THE “ANNUAL OF THE UNIVERSAL MEDICAL SCIENCES.”

Contributors to Series 1888, 1889, 1890, 1891, 1892.

Editor-in-Chief, CHARLES E. SAJOUS, M.D., Philadelphia.

SENIOR ASSOCIATE EDITORS.

Agnew, D. Hayes, M.D., LL.D., Philadelphia, series of 1888, 1889.

Baldy, J. M., M.D., Philadelphia, 1891, 1892.

Barton, J. M., A.M., M.D., Philadelphia, 1889, 1890, 1891, 1892.

Baruch, Simon, M.D., New York, 1892.

Birdsall, W. R., M.D., New York, 1889, 1890, 1891, 1892.

Booth, J. A., M.D., New York, 1892.

Brown, F. W., M.D., Detroit, 1890, 1891, 1882.

Bruen, Edward T., M.D., Philadelphia, 1889.

Brush, Edward N., M.D., Philadelphia, 1889, 1890, 1891.

Cattell, H. W., M.D., Philadelphia, 1892.

Cohen, J. Solis-, M.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

Cohen, S. Solis-, M.D., Philadelphia, 1892.

Conner, P. S., M.D., LL.D., Cincinnati, 1888, 1889, 1890, 1891, 1892.

Currier, A. F., A.B., M.D., New York, 1889, 1890, 1891, 1892.

Davidson, C. C., M.D., Philadelphia, 1888.

Davis, N. S., A.M., M.D., LL.D., Chicago, 1888, 1889, 1890, 1891, 1892.

Delafield, Francis, M.D., New York, 1888.

Delavan, D. Bryson, M.D., New York, 1888, 1889, 1890, 1891, 1892.

Dolley, C. S., M.D., Philadelphia, 1892.

Draper, F. Winthrop, A.M., M.D., New York, 1888, 1889, 1890, 1891, 1892.

Dudley, Edward C., M.D., Chicago, 1888.

Ernst, Harold C., A.M., M.D., Boston, 1889, 1890, 1891, 1892.

Forbes, William S., M.D., Philadelphia, 1888, 1889, 1890.

Garretson, J. E., M.D., Philadelphia, 1888, 1889.

Gaston, J. McFadden, M.D., Atlanta, 1890, 1891, 1892.

Gihon, Albert L., A.M., M.D., Brooklyn, 1888, 1889, 1890, 1891, 1892.

Goodell, William, M.D., Philadelphia, 1888, 1889, 1890.

Gray, Landon Carter, M.D., New York, 1890, 1891, 1892.

Griffith, J. P. Crozer, M.D., Philadelphia, 1889, 1890, 1891, 1892.

Guilford, S. H., D.D.S., Ph.D., Philadelphia, 1888.

Guiteras, John, M.D., Ph.D., Charleston, 1888, 1889.

Hamilton, John B., M.D., LL.D., Washington, 1888, 1889, 1890, 1891.

Hare, Hobart Amory, M.D., B.Sc., Philadelphia, 1888, 1889, 1890, 1891, 1892.

Henry, Frederick P., M.D., Philadelphia, 1889, 1890, 1891, 1892.

Holland, J. W., M.D., Philadelphia, 1888, 1889.

Holt, L. Emmett, M.D., New York, 1889, 1890, 1891, 1892.

Hooper, Franklin H., M.D., Boston, 1890, 1891, 1892.

Howell, W. H., Ph.D., M.D., Ann Arbor, 1889, 1890, 1891, 1892.

Hun, Henry, M.D., Albany, 1889, 1890.

Ingals, E. Fletcher, A.M., M.D., Chicago, 1889, 1890, 1891.

Jaggard, W. W., A.M., M.D., Chicago, 1890.

Johnston, Christopher, M.D., Baltimore, 1888, 1889.

Johnston, W. W., M.D., Washington, 1888, 1889, 1890, 1891, 1892.

Keating, John M., M.D., Philadelphia, 1889.

Kelsey, Charles B., M.D., New York, 1888, 1889, 1890, 1891, 1892.

Keyes, Edward L., A.M., M.D., New York, 1888, 1889, 1890, 1891, 1892.

Knapp, Philip Coombs, M.D., Boston, 1891, 1892.

Kyle, D. Braden, M.D., Philadelphia, 1892.

Laplace, Ernest, A.M., M.D., Philadelphia, 1890, 1891, 1892.

Lee, John G., M.D., Philadelphia, 1888.

Leidy, Joseph, M.D., LL.D., Philadelphia, 1888, 1889, 1890, 1891.

Longstreth, Morris, M.D., Philadelphia, 1888, 1889, 1890.

Loomis, Alfred L., M.D., LL.D., New York, 1888, 1889.

Lyman, Henry M., A.M., M.D., Chicago, 1888.

McGuire, Hunter, M.D., LL.D., Richmond, 1888.

Manton, Walter P., M.D., F.R.M.S., Detroit, 1888, 1889, 1890, 1891, 1892.

Martin, H. Newell, M.D., M.A., Dr.Sc., F.R.S., Baltimore, 1888, 1889.

Matas, Rudolph, M.D., New Orleans, 1890, 1891, 1892.

Mears, J. Ewing, M.D., Philadelphia, 1888, 1889, 1890, 1891.

Mills, Charles K., M.D., Philadelphia, 1888.

Minot, Chas. Sedgwick, M.D., Boston, 1888, 1889, 1890, 1891, 1892.

Montgomery, E. E., M.D., Philadelphia, 1891, 1892.

Morton, Thos. G., M.D., Philadelphia, 1888, 1889.

Munde, Paul F., M.D., New York, 1888, 1889, 1890, 1891, 1892.

O’Dwyer, Joseph, M.D., New York, 1892.

Oliver, Charles A., A.M., M.D., Philadelphia, 1889, 1890, 1891, 1892.

Packard, John H., A.M., M.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

Parish, Win. H., M.D., Philadelphia, 1888, 1889, 1890, 1892.

Parvin, Theophilus, M.D., LL.D., Philadelphia, 1888, 1889.

Peirce, C. N., D.D.S., Philadelphia, 1888.

Pepper, William, M.D., LL.D., Philadelphia, 1888.

Ranney, Ambrose L., M.D., New York, 1888, 1889, 1890.

Richardson, W. L., M.D., Boston, 1888, 1889.

Rockwell, A. D., A.M., M.D., New York, 1891, 1892.

Rohé, Geo. H., M.D., Baltimore, 1888, 1889, 1890, 1891, 1892.

Sajous, Chas. E., M.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

Sayre, Lewis A., M.D., New York, 1890, 1891, 1892.

Seguin, E. C., M.D., Providence, 1888, 1889, 1890, 1891.

Senn, Nicholas, M.D., Ph.D., Milwaukee, 1888, 1889.

Shakspeare, E. O., M.D., Philadelphia, 1888.

Shattuck, F. C., M.D., Boston, 1890.

Smith, Allen J., A.M., M.D., Philadelphia, 1890, 1891, 1892.

Smith, J. Lewis, M.D., New York, 1888, 1889, 1890, 1891, 1892.

Spitzka, E. C., M.D., New York, 1888.

Starr, Louis, M.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

Stimson, Lewis A., M.D., New York, 1888, 1889, 1890, 1891, 1892.

Sturgis, F. R., M.D., New York, 1888.

Sudduth, F. X., A.M., M.D., F.R.M.S., Minneapolis, 1888, 1889, 1890, 1891, 1892.

Thomson, William, M.D., Philadelphia, 1888.

Thomson, Win. H., M.D., New York, 1888.

Tiffany, L. McLane, A.M., M.D., Baltimore, 1890, 1891, 1892.

Turnbull, Chas. S., M.D., Ph.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

Tyson, James, M.D., Philadelphia, 1888, 1889, 1890.

Van Harlingen, Arthur, M.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

Vander Veer, Albert, M.D., Ph.D., Albany, 1890.

Vickery, H. F., M.D., Boston, 1892.

White, J. William, M.D., Philadelphia, 1889, 1890, 1891, 1892.

Whittaker, Jas. T., M.D., Cincinnati, 1888, 1889, 1890, 1891, 1892.

Whittier, E. N., M.D., Boston, 1890, 1891, 1892.

Wilson, James C., A.M., M.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

Wirgman, Chas., M.D., Philadelphia, 1888.

Witherstine, C. Sumner, M.S., M.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

Wyman, Walter, M.D., Washington, 1892.

Young, Jas. K., M.D., Philadelphia, 1891, 1892.

JUNIOR ASSOCIATE EDITORS.

Baldy, J. M., M.D., Philadelphia, 1890.

Bliss, Arthur Ames, A.M., M.D., Philadelphia, 1890, 1891, 1892.

Cattell, H. W., M.D., Philadelphia, 1890, 1891.

Cerna, D., M.D., Ph.D., Philadelphia, 1891, 1892.

Clark, J. Payson, M.D., Boston, 1890, 1891, 1892.

Crandall, F. M., M.D., New York, 1891, 1892.

Cohen, Solomon Solis-, A.M., M.D., Philadelphia, 1890, 1891.

Cryer, H. M., M.D., Philadelphia, 1889.

Deale, Henry B., M.D., Washington, 1891.

Dolley, C. S., M.D., Philadelphia, 1889, 1890, 1891.

Dollinger, Julius, M.D., Philadelphia, 1889.

Dorland, W. A., M.D., Philadelphia, 1891, 1892.

Eshner, A. A., M.D., Philadelphia, 1892.

Freeman, Leonard, M.D., Cincinnati, 1891, 1892.

Fuller, Eugene, M.D., New York, 1892.

Goodell, W. Constantine, M.D., Philadelphia, 1888, 1889, 1890.

Gould, Geo. M., M.D., Philadelphia, 1889, 1890.

Greene, E. M., M.D., Boston, 1891, 1892.

Griffith, J. P. Crozer, M.D., Philadelphia, 1888.

Hoag, Junius, M.D., Chicago, 1888.

Howell, W. H., Ph.D., B.A., Baltimore, 1888, 1889.

Hunt, William, M.D., Philadelphia, 1888, 1889.

Jackson, Henry, M.D., Boston, 1891, 1892.

Kirk, Edward C., D.D.S., Philadelphia, 1888.

Lloyd, James Hendrie, M.D., Philadelphia, 1888.

McCarthy, N. I., Philadelphia, 1892.

McDonald, Willis G., M.D., Albany, 1890.

Penrose, Chas. B., M.D., Philadelphia, 1890.

Powell, W. M., M.D., Atlantic City, 1889, 1890, 1891, 1892.

Quimby, Chas. E., M.D., New York, 1889.

Rau, Leonard S., M.D., New York, 1892.

Sayre, R. H., M.D., New York, 1890, 1891, 1892.

Smith, Allen J., A.M., M.D., Philadelphia, 1889, 1890.

Stengel, Alfred, M.D., Philadelphia, 1892.

Vickery, H. F., M.D., Boston, 1891, 1892.

Warfield, Ridgely B., M.D., Baltimore, 1891, 1892.

Warner, F. M., M.D., New York, 1891, 1892.

Weed, Charles L., A.M., M.D., Philadelphia, 1888, 1889.

Wells, Brooks H., M.D., New York, 1888, 1889, 1890, 1891.

Wolff, Lawrence, M.D., Philadelphia, 1890.

Wyman, Walter, A.M., M.D., Washington, 1891.

ASSISTANTS TO ASSOCIATE EDITORS.

Baruch, S., M.D., New York, 1888.

Beatty, Franklin T., M.D., Philadelphia, 1888.

Brown, Dillon, M.D., New York, 1888.

Buechler, A. F., M.D., New York, 1888.

Burr, Chas. W., M.D., Philadelphia, 1891.

Cohen, Solomon Solis-, M.D., Philadelphia, 1889.

Cooke, B. G., M.D., New York, 1888.

Coolidge, Algernon, Jr., M.D., Boston, 1890.

Currier, A. F., M.D., New York, 1888.

Daniels, F. H., A.M., M.D., New York, 1888.

Deale, Henry B., M.D., Washington, 1890, 1891, 1892.

Eshner, A. A., M.D., Philadelphia, 1891.

Gould, George M., M.D. Philadelphia, 1888.

Grandin, Egbert H., M.D., New York, 1888, 1889.

Greene, E. M., M.D., Boston, 1890.

Guiteras, G. M., M.D., Washington, 1890.

Hance, I. H., A.M., M.D., New York, 1891, 1892.

Klingenschmidt, C. H. A., M.D., Washington, 1890.

Kramer, S. P., M.D., Cincinnati. 1892.

Martin, Edward, M.D., Philadelphia, 1891, 1892.

McKee, E. S., M.D., Cincinnati, 1889, 1890, 1891, 1892.

Myers, F. H., M.D., New York, 1888.

Packard, F. A., M.D., Philadelphia, 1890.

Pritchard, W. B., M.D., New York, 1891, 1892.

Sangree, E. B., A.M., M.D., Philadelphia, 1890, 1892.

Sears, G. G., M.D., Boston, 1890.

Shultz, R. C., M.D., New York, 1891, 1892.

Souwers, Geo. F., M.D., Philadelphia, 1888.

Taylor, H. L., M.D., Cincinnati, 1889, 1890.

Vansant, Eugene L., M.D., Philadelphia, 1888.

Vickery, H. F., M.D., Boston, 1890.

Warner, F. M., M.D., New York, 1888, 1889, 1890.

Wells, Brooks H., M.D., New York, 1888.

Wendt, E. C., M.D., New York, 1888.

Westcott, Thompson S., M.D., Philadelphia, 1892.

Wilder, W. H., M.D., Cincinnati, 1889.

Wilson, C. Meigs., M.D., Philadelphia, 1889.

Wilson, W. R., M.D., Philadelphia, 1891, 1892.

THE BIOGRAPHY OF A GREAT SURGEON.

HISTORY OF THE

Life of D. Hayes Agnew, M.D., LL.D.

By J. Howe Adams, M.D.

This fascinating life history of one of the world’s greatest surgeons is now ready.

Dr. J. Howe Adams, the author, has been for many years a member of Dr. Agnew’s family, has had the valuable aid of Mrs. Agnew, and also access to documents and papers of unusual value and interest that would have been denied to most writers; so that the biography here presented is written, as it were, from the inside, and thus made doubly interesting and valuable as the narrative of the career of an eminent physician, surgeon, and benefactor of mankind. Royal Octavo, 376 pages, handsomely printed, with Portraits and other illustrations.

Price, in United States, Extra Cloth, $2.50 net: Half-Morocco, Gilt Top, $3.50 net, post-paid. In Canada (duty paid), Cloth, $2.75 net; Half-Morocco, $3.90 net. Great Britain, Cloth, 14s.; Half-Morocco, 19s. 6d. France, Cloth, 15 fr.; Half-Morocco, 22 fr.

SOLD ONLY BY SUBSCRIPTION, OR SENT DIRECT ON RECEIPT OF PRICE, SHIPPING EXPENSES PREPAID.

THE ONLY COMPLETE AND EXHAUSTIVE EXPOSITION OF THE SUBJECT.

Psychopathia Sexualis,

With Especial Reference to Contrary Sexual Instinct: A Medico-Legal Study of Sexual Insanity.

By Dr. R. von Krafft-Ebing, Professor of Psychiatry and Neurology, University of Vienna. Authorized Translation of the Seventh Enlarged and Revised German Edition, by Charles Gilbert Chaddock, M.D., Professor of Nervous and Mental Diseases, Marion-Sims College of Medicine, St. Louis; Fellow of the Chicago Academy of Medicine; Corresponding Member of the Detroit Academy of Medicine; Associate Member of the American Medico-Psychological Association, etc.

Professor von Krafft-Ebing’s study of the psychopathology of the sexual life easily supersedes all previous attempts to treat this important subject scientifically, and it is sure to commend itself to members of the medical and legal professions as a scientific explanation of many social and criminal enigmas to which no work in English offers a solution.

General Scheme of the Book.—I. Fragment of a Psychology of the Sexual Life; the Sexual Instinct; Sensuality and Morality; True Love, etc. II. Physiological Facts; Sexual Maturity; Control of the Sexual Instinct, etc. III. General Pathology; Importance of Pathological Manifestations; Sexual Perversion. IV. Special Pathology; Abnormal Sexual Manifestations in Mental Diseases; Insanity. V. Pathological Sexuality Before the Criminal Court; Frequency of Sexual Crimes; Increase; Loss of Responsibility.

One Royal Octavo Volume. 432 pages.

United States

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(duty paid).

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RANNEY

Lectures on Nervous Diseases.

From the Stand-Point of Cerebral and Spinal Localization, and the Later Methods Employed in the Diagnosis and Treatment of these Affections.

By Ambrose L. Ranney, A.M., M.D., Professor of the Anatomy and Physiology of the Nervous System in the New York Post-Graduate Medical School and Hospital; Professor of Nervous and Mental Diseases in the Medical Department of the University of Vermont, etc.; Author of “The Applied Anatomy of the Nervous System,” “Practical Medical Anatomy,” etc., etc.

It is now generally conceded that the nervous system controls all of the physical functions to a greater or less extent, and also that most of the symptoms encountered at the bedside can be explained and interpreted from the stand-point of nervous physiology.

Profusely illustrated with original diagrams and sketches in color by the author, carefully selected wood-engravings, and reproduced photographs of typical cases. One handsome royal octavo volume of 780 pages.

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Table of Contents

- Psychopathia Sexualis, WITH ESPECIAL REFERENCE TO Contrary Sexual Instinct: A MEDICO-LEGAL STUDY.

- PREFACE TO THE FIRST EDITION.

- TRANSLATOR’S PREFACE.

- TABLE OF CONTENTS.

- I. A FRAGMENT OF A PSYCHOLOGY OF THE SEXUAL LIFE.

- II. PHYSIOLOGY.

- The Act of Cohabitation.[27]

- III. GENERAL PATHOLOGY.[28]

- (NEUROLOGICAL AND PSYCHOLOGICAL.)

- II. SPINAL NEUROSES.

- 1. Affections of the Erection Centre.

- 2. Affections of the Ejaculation Centre.

- III. CEREBRAL NEUROSES.

- A. Paradoxia. Sexual Instinct Manifesting itself Independently of Physiological Processes.

- B. Anæsthesia Sexualis (Absence of Sexual Feeling).

- C. Hyperæsthesia (Abnormally Increased Sexual Desire).

- D. Paræsthesia of Sexual Feeling (Perversion of the Sexual Instinct).

- II. Great Diminution or Complete Absence of Sexual Feeling for the Opposite Sex, with Substitution of Sexual Feeling and Instinct for the Same Sex. (Homo-sexuality, or Contrary Sexual Instinct).

- III. Degree: Stage of Transition to Metamorphosis Sexualis Paranoica.

- DIAGNOSIS, PROGNOSIS, AND THERAPY OF CONTRARY SEXUAL INSTINCT.

- IV. SPECIAL PATHOLOGY. THE MANIFESTATIONS OF ABNORMAL SEXUAL LIFE IN THE VARIOUS FORMS AND STATES OF MENTAL DISTURBANCE.

- Arrest of Mental Development.

- States of Acquired Mental Weakness.

- (1) Dementia Consecutive to Psychoses.

- (2) Dementia After Apoplexy.

- (3) Dementia After Injury of Head.

- (4) Acquired Mental Weakness, Probably Resulting from Lues.

- Periodical Insanity.

- Satyriasis and Nymphomania.

- V. PATHOLOGICAL SEXUALITY IN ITS LEGAL ASPECTS.

- 1. Offense Against Morality in the Form of Exhibition.

- 2. Rape and Lust-Murder.

- 3. Bodily Injury, Injury to Property, and Torture of Animals Dependent on Sadism.[135]

- 4. Bodily Injury, Robbery, and Theft Dependent on Fetichism.

- 5. Violation of Individuals Under the Age of Fourteen.

- 6. Unnatural Abuse—Sodomy.[140]

- (a) Violation of Animals—Bestiality.[141]

- (b) With Persons of the Same Sex—Pederasty; Sodomy in its Strict Sense.

- Cultivated Pederasty.[143]

- Lesbian Love.[146]

- 7. Necrophilia.[147]

- 8. Incest.

- 9. Immoral Acts with Persons in the Care of Others; Seduction (Austrian).

- INDEX.

- THE FULL PROJECT GUTENBERG™ LICENSE