III. Cerebral Neuroses (part 2)

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. 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. 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.

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. 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) 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.—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., 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 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. 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.

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:—

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.

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., 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, 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.

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.—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 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, 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, 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.

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.

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 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.—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. 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, 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.