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*** START OF THE PROJECT GUTENBERG EBOOK 64931 ***

                         PSYCHOPATHIA SEXUALIS,
                       WITH ESPECIAL REFERENCE TO
                       Contrary Sexual Instinct:
                         A MEDICO-LEGAL STUDY.


                      By Dr. R. von KRAFFT-EBING,
      Professor of Psychiatry and Neurology, University of Vienna.

                         AUTHORIZED TRANSLATION
                                 OF THE
              SEVENTH ENLARGED AND REVISED GERMAN EDITION,
                                   BY
                    CHARLES GILBERT CHADDOCK, M.D.,
    Professor of Nervous and Mental Diseases, Marion-Sims College of
    Medicine, St. Louis; Fellow of the Chicago Academy of Medicine;
   Corresponding Member of the Detroit Academy of Medicine; Associate
     Member of the American Medico-Psychological Association, etc.

[Illustration]

                        PHILADELPHIA AND LONDON:
                    THE F. A. DAVIS CO., PUBLISHERS.
                                 1893.




        Entered according to Act of Congress, in the year 1892, by
                         THE F. A. DAVIS COMPANY,
 In the Office of the Librarian of Congress, at Washington, D. C., U. S.
                                    A.
                           All rights reserved.


     Philadelphia, Pa., U. S. A.:
 The Medical Bulletin Printing House,
         1916 Cherry Street.




                     PREFACE TO THE FIRST EDITION.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




                         TRANSLATOR’S PREFACE.


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

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

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

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

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

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

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

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

                                               CHARLES GILBERT CHADDOCK.

  ST. LOUIS, MO.,
        November, 1892.




                           TABLE OF CONTENTS.


                                                                    PAGE
   I. FRAGMENT OF A PSYCHOLOGY OF THE SEXUAL LIFE,                     1

      Power of the sexual instinct,                                    1

      Sexuality as the foundation of ethical feeling,                  1

      Love as a passion,                                               2

      History of development of sexuality,                             2

      Modesty,                                                         2

      Christianity,                                                    4

      Monogamy,                                                        4

      Woman’s place in Islam,                                          5

      Sensuality and morality,                                         5

      Decadence of sexual morality,                                    6

      Development of sexual feelings in the individual; puberty,       7

      Sensuality and religious enthusiasm,                             9

      Relations between the spheres of religion and sexuality,         9

      Sensuality and art,                                             10

      Idealizing tendency of first love,                              11

      True love,                                                      11

      Sentimentality,                                                 11

      Platonic love,                                                  12

      Love and friendship,                                            12

      Difference between male and female love,                        13

      Celibacy,                                                       14

      Unfaithfulness,                                                 15

      Marriage,                                                       15

      Desire for adornment,                                           16

      Facts of physiological fetichism,                               17

      Religious and erotic fetichism,                                 17

      Eyes, odors, voices, and mental qualities as fetiches,          21

      Hair, hand, and foot of woman as fetiches,                      22


  II. PHYSIOLOGY,                                                     23

      Sexual maturity,                                                23

      Duration of sexual instinct,                                    23

      Sexual sense,                                                   24

      Localization (?),                                               24

      Physiological development of sexuality,                         24

      Erection; erection-centre,                                      24

      Sexuality and the olfactory sense,                              26

      Flagellation an excitant of sexual desire,                      28

      Sects of flagellants,                                           28

      Paullini’s “Flagellum Salutis,”                                 29

      Erogenous zones,                                                31

      Control of the sexual instinct,                                 32

      Cohabitation,                                                   32

      Ejaculation,                                                    33


 III. GENERAL PATHOLOGY,                                              34

      Frequency and importance of pathological manifestations,        34

      Schema of the sexual neuroses,                                  34

      Spinal neuroses,                                                35

      Cerebral neuroses,                                              36

      Paradoxia sexualis,                                             37

      Anæsthesia sexualis (congenital),                               42

      Anæsthesia sexualis (acquired),                                 47

      Hyperæsthesia sexualis,                                         48

      Paræsthesia sexualis,                                           56

      Perversion and perversity,                                      56

      Sadism,                                                         57

      An attempt to explain sadism,                                   57

      Sadistic lust-murder,                                           62

      Anthropophagy,                                                  64

      Violation of corpses,                                           67

      Injury of women,                                                70

      Defilement of women,                                            79

      Symbolic sadism,                                                81

      Sadism with any object,                                         82

      Whipping of boys,                                               82

      Sadistic acts with animals,                                     84

      Sadism in woman,                                                87

      Masochism,                                                      89

      Relation of passive flagellation to masochism,                 101

      Ideal masochism,                                               115

      Symbolic masochism,                                            116

      Rousseau,                                                      119

      Larvated masochism,                                            123

      Feminine masochism,                                            137

      An attempt to explain masochism,                               139

      Masochism and sadism,                                          148

      Fetichism,                                                     152

      Part of the female body as a fetich,                           157

      Female attire as a fetich,                                     167

      Special materials as fetiches,                                 180

      Contrary sexual instinct, or homo-sexuality,                   185

      Acquired homo-sexuality,                                       188

      Simple reversal of sexual feeling,                             191

      Eviration and defemination,                                    197

      Transition to metamorphosis sexualis paranoica,                202

      Metamorphosis sexualis paranoica,                              216

      Congenital homo-sexuality,                                     222

      Psychical hermaphroditism,                                     230

      Urnings,                                                       255

      Effemination and viraginity,                                   279

      Androgyny and gynandry,                                        304

      Diagnosis, prognosis, and therapy of contrary sexuality,       319


  IV. SPECIAL PATHOLOGY,                                             358

      Pathological sexuality in the various forms of mental
        disease,                                                     358

      Imbecility,                                                    359

      Dementia,                                                      361

      Paretic dementia,                                              363

      Epilepsy,                                                      364

      Periodical insanity,                                           370

      Psychopathia sexualis periodica,                               371

      Mania,                                                         372

      Satyriasis and nymphomania,                                    373

      Melancholia,                                                   374

      Hysteria,                                                      375

      Paranoia,                                                      376


   V. PATHOLOGICAL SEXUALITY IN ITS LEGAL ASPECTS,                   378

      Dangers to society from sexual crimes,                         378

      Increase of sexual crimes,                                     378

      Causes,                                                        378

      Defective appreciation of such crimes by jurists,              379

      Conditions necessary to remove legal responsibility,           381

      Exhibition,                                                    382

      Violation of statues,                                          396

      Rape and lust-murder,                                          397

      Bodily injury, injury to property, and torture of animals
        dependent on sadism,                                         401

      Fetichism,                                                     401

      Violation of children,                                         402

      Sodomy,                                                        404

      Pederasty,                                                     408

      Cultivated pederasty,                                          414

      Social life of pederasts,                                      415

      Ball of the woman-haters,                                      417

      Pædicatio mulierum,                                            420

      Lesbian love,                                                  428

      Necrophilia,                                                   430

      Incest,                                                        431

      Immoral acts with persons in the care of others,               432




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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




                            II. PHYSIOLOGY.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

                        “‘Steriles moriuntur, et illis
              Turgida non prodest condita psycido Lyde:
              Nec prodest agili palmas præbere Luperco.’”

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

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

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

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

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

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

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

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

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

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

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

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


                      THE ACT OF COHABITATION.[27]

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

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

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

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

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




                      III. GENERAL PATHOLOGY.[28]


                   (NEUROLOGICAL AND PSYCHOLOGICAL.)


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

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

                     SCHEMA OF THE SEXUAL NEUROSES.

                        }                       }_a._ Anæsthesia.
                        }1. Sensory.            }_b._ Hyperæsthesia.
                        }                       }_c._ Neuralgia.
 I. PERIPHERAL.[29]     }2. Secretory.          }_a._ Aspermia.
                        }                       }_b._ Polyspermia.
                        }3. Motor.              }_a._ Pollutions
                        }                       }  (spasm).
                        }                       }_b._ Spermatorrhœa
                        }                       }  (paralysis).

 II. SPINAL.            }1. Affections of the erection centre.
                        }2. Affections of the ejaculation centre.

                        }1. Paradoxia.
                        }2. Anæsthesia.
 III. CEREBRAL.         }3. Hyperæsthesia.
                        }4. Paræsthesia.


                          II. SPINAL NEUROSES.


                _1. Affections of the Erection Centre._

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

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

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

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


               _2. Affections of the Ejaculation Centre._

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

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

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

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


                        III. CEREBRAL NEUROSES.

1. _Paradoxia_, _i.e._, sexual excitement occurring independently of the
period of the physiological processes in the generative organs.

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

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

4. _Paræsthesia_, (perversion of the sexual instinct, _i.e._,
excitability of the sexual functions to inadequate stimuli).

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


   A. PARADOXIA. SEXUAL INSTINCT MANIFESTING ITSELF INDEPENDENTLY OF
                        PHYSIOLOGICAL PROCESSES.


             _1. Sexual Instinct Manifested in Childhood._

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

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

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


          _2. Re-awakening of Sexual Instinct in Old Age._[32]

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

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

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

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

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

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

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

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

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

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

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

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


          B. ANÆSTHESIA SEXUALIS (ABSENCE OF SEXUAL FEELING).


                     _1. As a Congenital Anomaly._

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


                       _2. Acquired Anæsthesia._

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

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

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


         C. HYPERÆSTHESIA (ABNORMALLY INCREASED SEXUAL DESIRE).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


 D. PARÆSTHESIA OF SEXUAL FEELING (PERVERSION OF THE SEXUAL INSTINCT).

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

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

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

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


 _1. Sexual Inclination toward Persons of the Opposite Sex, with Perverse
                        Activity of the Instinct._

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The two following cases are similar to the foregoing:—

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The following case is of this nature:—

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The following case seems very similar:—

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Of late the subject has been given much attention.

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

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

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

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

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

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

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

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

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

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

  But little can be learned of any hereditary taint.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


                    AN ATTEMPT TO EXPLAIN MASOCHISM.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


                         MASOCHISM AND SADISM.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The following remarkable case came under my personal observation:—

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

Even bodily defects may become fetiches.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Following these two cases of shoe-fetichism, which apparently depend
merely upon accidental association, and are not favored by any inner
relation between the things themselves, is given the very strange case
of a fetichist who was excited sexually only by the idea of a night-cap
on the head of an ugly old woman; also a case arising apparently from
merely accidental association:—

  Case 89. L., aged 37, clerk, from tainted family, had his first
  erection at five years, when he saw his bed-fellow—an aged
  relative—put on a night-cap. The same thing occurred later, when he
  saw an old servant put on her night-cap. Later, simply the idea of an
  old, ugly woman’s head, covered with a night-cap, was sufficient to
  cause an erection. Simply the sight of a cap, or of a naked woman or
  man, made no impression, but the mere touch of a night-cap induced
  erection, and sometimes even ejaculation. L. was not a masturbator,
  and had never been sexually active until his thirty-second year, when
  he married a young girl with whom he had fallen in love. On his
  marriage-night he remained cold until, from necessity, he brought to
  his aid the memory-picture of an ugly woman’s head with a night-cap.
  Coitus was immediately successful. Thereafter it was always necessary
  for him to use this means. Since childhood he had been subject to
  occasional attacks of depression, with tendency to suicide, and now
  and then to frightful hallucinations at night. When looking out of
  windows, he became dizzy and anxious. He was a perverse, peculiar, and
  easily embarrassed man, of bad mental constitution. (Charcot and
  Magnan, _Arch. de neurol._, 1882, No. 12.)

In this very peculiar case, the simultaneous coincidence of the first
sexual excitation and an absolutely heterogeneous impression seems to
have determined the association.

Hammond (_op. cit._) also mentions a case of accidental associative
fetichism that is quite as peculiar. A married man, aged 30, who, in
other respects, was healthy, physically and mentally, is said to have
suddenly lost his sexual power, after moving to another house, and to
have regained it as soon as the furniture of the sleeping-room had been
arranged as it was before.

(c) _The Fetich is Some Special Material._—There is a third principal
group of fetichists who have as a fetich neither a portion of the female
body nor a part of female attire, but some particular material which is
so used, not because it is a material for female garments, but because
in itself it can arouse or increase sexual feelings. In many cases of
this kind, the act of feeling of such material during the sexual act
seems indispensable, in order to make the latter possible, or at least
satisfactory. Such materials are furs, velvet, and silk.

These cases differ from the foregoing instances of erotic
dress-fetichism, in that these materials, unlike female linen, do not
have any close relation to the female body; and, unlike shoes and
gloves, they are not related to certain parts of the person which have
peculiar symbolic significance. Moreover, this fetichism cannot be due
to an accidental association, like that in the cases of the night-caps
and the arrangement of the sleeping-room; for these cases form an entire
group having the same object. It must be presumed that certain tactile
sensations (a kind of tickling which stands in some distant relation to
lustful sensations?), in hyperæsthetic individuals, furnish the occasion
for the origin of this fetichism.

The following is a personal observation of a man affected with this
peculiar fetichism:—

  Case 90. N. N., aged 37; of a neuropathic family; neuropathic
  constitution. He makes the following statement: “From my earliest
  youth I have always had a deeply-rooted partiality for furs and
  velvet, in that these materials cause me sexual excitement, and the
  sight and touch of them give me lustful pleasure. I can recall no
  event that caused this peculiarity (such as the simultaneous
  occurrence of the first sexual excitation and an impression of these
  materials,—_i.e._, first excitation by a woman dressed in them); in
  fact, I cannot remember when this enthusiasm began. However, by this I
  would not exclude the possibility of such an event,—of an accidental
  connection in a first impression and consequent association; but I
  think it very improbable that such a thing took place, because I
  believe such an occurrence would have deeply impressed me. All I know
  is, that even when a small child I had a lively desire to see and
  stroke furs, and thus had an obscure sensual pleasure. With the first
  occurrence of definite sexual ideas,—_i.e._, the direction of sexual
  thoughts to woman,—the peculiar preference for women dressed in such
  materials was present. Since then, up to mature manhood, it has
  remained unchanged. A woman wearing furs or velvet, or, better, both,
  excites me much more quickly and intensely than one devoid of these
  auxiliaries. To be sure, these materials are not a _conditio sine qua
  non_ of excitation; the desire occurs also without them, in response
  to the usual stimuli; but the sight and, particularly, the touch of
  these fetich-materials form for me a powerful aid to other normal
  stimuli, and intensify erotic pleasure. Often merely the sight of only
  a passably pretty girl, dressed in these materials, causes me lively
  excitement, and overcomes me completely. Even the sight of my
  fetich-materials gives me pleasure, but the touch of them much more.
  (To the penetrating odor of furs I am indifferent—rather, it is
  unpleasant—and it is endurable only by reason of the association with
  pleasing visual and tactile impressions.) I have an intense longing to
  touch these materials while on a woman’s person, to stroke and kiss
  them, and bury my face in them. My greatest pleasure is, _inter
  actum_, to see and feel my fetich on the woman’s shoulder.

  “Fur, or velvet alone, exerts on me the effect described, the former
  much more intensely than the latter. The combination of the two has
  the most intense effect. Too, female garments of velvet and fur, seen
  and touched without the wearer, cause me sexual excitement; indeed,
  though to a less extent, the same effect is exerted by furs or robes
  having no relation to female attire, and also by the velvet and plush
  of furniture and drapery. Merely pictures of costumes of furs and
  velvet are objects of erotic interest to me; indeed, simply the word
  “fur” has a magic charm for me, and immediately calls up erotic ideas.

  “Fur is such an object of sexual interest for me that a man wearing
  fur that is effective (_v. infra_) makes a very unpleasant, repugnant,
  and disgusting impression on me; such as would be made on a normal
  person by a man in the costume and attire of a ballet-dancer.
  Similarly repugnant to me is the sight of an old or ugly woman clad in
  beautiful furs; because opposing feelings are thus aroused.

  “This erotic delight in furs and velvet is something entirely
  different from simple æsthetic pleasure. I have a very lively
  appreciation of beautiful female attire, and, at the same time, a
  particular partiality for point-lace; but it is purely of an æsthetic
  nature. A woman dressed in a point-lace _toilette_ (or in other
  elegant, elaborate attire) is more _beautiful_ than another; but one
  dressed in my fetich-material is more _charming_.

  “But furs exercise on me the effect described only when the fur has
  very thick, fine, smooth, and rather long hair, that stands out like
  that of the so-called bearded furs. I have noticed that the effect
  depends upon this. I am entirely indifferent not only to the common
  coarse, bushy furs, but also to those that are commonly regarded as
  beautiful and precious, from which the long hair has been removed
  (seal, beaver), or of which the hair is naturally short (ermine); and
  likewise to those of which the hair is over-long and lies down
  (monkey, bear). The specific effect is exerted only by the standing
  long hair of the sable, marten, skunk, etc. But velvet is made of
  thick, fine, standing hairs (fibres); and its effect may be due to
  this. The effect seems to depend upon a very definite impression of
  the points of thick, fine hair upon the end-organs of the sensory
  nerves.

  “But how this peculiar impression on the tactile nerves is related to
  sexual instinct is a perfect enigma to me. The fact is, that this is
  the case with many men. I would also state expressly that beautiful
  female hair pleases me, but plays no more important part than the
  other charm; and that while touching fur I have no thought of female
  hair. The tactile sensation, also, has not the least resemblance to
  that imparted by female hair. There is never association of any other
  idea. Fur, _per se_, arouses sensuality in me,—how, I cannot explain.

  “The mere æsthetic effect, the beauty of costly furs, to which every
  one is more or less susceptible; which, since Raphael’s Fornarina and
  Reuben’s Helene Fourment, has been used as the foil and frame of
  female beauty by innumerable painters; and which plays so important a
  _rôle_ in fashion,—the art and science of female dress,—this æsthetic
  effect, as has been remarked, explains nothing here. Beautiful furs
  have the same æsthetic effect on me as on normal individuals, and
  affect me in the same way that flowers, ribbons, precious stones, and
  other ornaments affect every one. Such things, when skillfully used,
  enhance female beauty, and thus, under certain circumstances, may have
  an indirect sensual effect. They never have a direct, powerful,
  sensual effect on me, as do the fetich-materials mentioned.

  “Though in me, and, in fact, in all ‘fetichists,’ the sensual and
  æsthetic effect must be strictly differentiated, nevertheless, that
  does not prevent me from demanding in my fetich a whole series of
  æsthetic qualities in form, style, color, etc. I could give a very
  lengthy description of these qualities that my taste demands; but I
  omit it as not being essential to the real subject in hand. I would
  only call attention to the fact that erotic fetichism is complicated
  with purely æsthetic tastes.

  “The specific erotic effect of my fetich-materials can be explained no
  better by the association with the idea of the person of the female
  wearing them, than by their æsthetic impression. For, in the first
  place, as has been said, these materials, as such, affect me when
  entirely isolated from the body; and, in the second place, articles of
  clothing of a much more private nature, and which undoubtedly call up
  associations, exert a much weaker influence over me. Thus the
  fetich-materials have an independent sensual value for me; why, is an
  enigma to me.

  “Feathers in women’s hats, fans, etc., have the same erotic
  fetichistic effect on me as furs and velvet (similar tactile sensation
  of airy, peculiar tickling). Finally, the fetichistic effect, with
  much less intensity, is exerted by other smooth materials (satin and
  silk); but rough goods (cloth, flannel) have a repelling effect.

  “In conclusion, I will mention that somewhere I read an article by
  Carl Vogt on microcephalic men, according to which these creatures, at
  the sight of furs, rushed for them and stroked them with every
  manifestation of delight. I am far from any thought, on this ground,
  to see in wide-spread fur-fetichism an atavistic retrogression to the
  taste of our hairy ancestors. Every cretin, with that simplicity
  belonging to his condition, touches anything that pleases him; and the
  act is not necessarily of a sexual nature; just as many normal men
  like to stroke a cat and the like, or even velvet and furs, and are
  not thus excited sexually.”

In the literature of this subject, there are a few cases belonging
here:—

  Case 91. A boy, aged 12, became powerfully excited sexually when he
  chanced to put on a fox-skin. From that time there was masturbation
  with the employment of furs, or by means of taking a furry dog to bed.
  Ejaculation would result, sometimes followed by an hysterical attack.
  His nocturnal pollutions were induced by dreaming that he lay entirely
  covered up in a white skin. He was absolutely insusceptible to stimuli
  coming from men or women. He was neurasthenic, suffered with delusions
  of being watched, and thought that every one noticed his sexual
  anomaly. He had tædium vitæ on account of this, and finally became
  insane. He had marked taint; his genitals were imperfectly formed, and
  he presented other signs of degeneration. (Tarnowsky, _op. cit._, p.
  22.)

  Case 92. C. is an especial lover of velvet. He is attracted in a
  normal way by beautiful women, but it particularly excites him to have
  the person with whom he has sexual intercourse dressed in velvet. In
  this, it is remarkable that it is not so much the sight as the touch
  of the velvet that causes the excitation. C. told me that stroking a
  woman’s velvet jacket would excite him sexually to an extent scarcely
  possible in any other way. (Dr. Moll, _op. cit._, p. 127.)

The following is a very peculiar case of material-fetichism. It is
combined with the impulse to injure the fetich, which, in this case,
represents an element of sadism toward the woman wearing the fetich, or
impersonal sadism toward objects, which is of frequent occurrence in
fetichists (comp. p. 170). This impulse to injure made this a remarkable
criminal case:—

  Case 93. In July, 1891, Alfred Bachmann, aged 25, locksmith, was
  brought before Judge I., in the second term of the criminal court, in
  Berlin. In April, 1891, the police had had numerous complaints,
  according to which some evil hand had cut women’s dresses with a very
  sharp instrument. On April 25, they were successful in arresting the
  perpetrator in the person of the accused. A policeman noticed how the
  accused pressed, in a remarkable manner, against a lady in the company
  of a gentleman, while they were going through a passage. The officer
  requested the lady to examine her dress, while he held the man under
  suspicion. It was ascertained that the dress had received quite a long
  slit. The accused was taken to the station, where he was examined.
  Besides a sharp knife, which he confessed he used for cutting dresses,
  two silk sashes, such as ladies wear on their dresses, were found on
  him; he also confessed that he had taken these from dresses in crowds.
  Finally, the examination of his person brought to light a lady’s silk
  neck-cloth. The accused said he had found this. Since his statement in
  this case could not be refuted, complaint was therefore made to rest
  on the result of the search; in two instances in which complaint was
  made by the injured parties his acts were designated as injury to
  property, and in two other instances as theft. The accused, a man who
  had been often punished before, with a pale, expressionless face,
  before the judge, gave a strange explanation of his enigmatical
  action. A major’s cook had once thrown him down-stairs when he was
  begging of her, and since that time he had entertained great hatred of
  the whole female sex. There was a doubt about his responsibility, and
  he was therefore examined by a physician. The medical expert gave the
  opinion, at the final trial, that there was no reason to regard the
  accused as insane, though he was of low intelligence. The culprit
  defended himself in a peculiar manner. An irresistible impulse forced
  him to approach women wearing silk dresses. _The touch of silk
  material gave him a feeling of delight_, and this went so far that,
  while in prison for examination, he had been excited if a silk thread
  happened to pass through his fingers while raveling rags. Judge Müller
  considered the accused to be simply a dangerous, vicious man, who
  should be made harmless for a long time. He advised imprisonment for
  one year. The court sentenced him to six months’ imprisonment, with
  loss of honor for a year.

The following case was communicated to me by a physician:—

  In a brothel a certain man was known by the name of “Velvet.” He
  dressed a puella pleasing to him in a black velvet dress, and excited
  and satisfied his sexual appetite simply by stroking his face with a
  part of the velvet skirt, touching the woman in no other way.

I am assured by an officer that, among masochists, a partiality for
furs, velvet, and feathers, is very frequent (comp. Case 44). In the
novels of Sacher-Masoch, fur plays an important part; indeed, it
furnishes a title to some of them. The explanation given there seems
far-fetched and unsatisfactory,—that fur (ermine) is the symbol of
royalty, and therefore the fetich of the men described in the novels.


  II. _Great Diminution or Complete Absence of Sexual Feeling for the
 Opposite Sex, with Substitution of Sexual Feeling and Instinct for the
       Same Sex. (Homo-sexuality, or Contrary Sexual Instinct)._

After the attainment of complete sexual development, among the most
constant elements of self-consciousness in the individual, are the
knowledge of representing a definite sexual personality and the
consciousness of desire, during the period of physiological activity of
the reproductive organs (production of semen and ova), to perform sexual
acts corresponding with that sexual personality,—acts which, consciously
or unconsciously, have a procreative purpose.

The sexual instinct and desire, save for indistinct feelings and
impulses, remain latent until the period of development of the sexual
organs. The child is _generis neutrius_; and though, during this latent
period,—when sexuality has not yet risen into clear consciousness, is
but virtually present, and unconnected with powerful organic
sensations,—too early excitation of the genitals may occur, either
spontaneously or as a result of external influence, and find
satisfaction in masturbation; yet, notwithstanding this, the _psychical_
relation to persons of the opposite sex is still absolutely wanting, and
the sexual acts during this period partake more or less of a reflex
spinal nature.

The fact of innocence, or of sexual neutrality, is the more remarkable,
since very early, in education, employment, dress, etc., the child
undergoes a differentiation from children of the opposite sex. These
impressions, however, remain destitute of mental meaning, because they
apparently are without sexual coloring; for the central organ (cortex)
of sexual emotions and ideas is not yet capable of activity, owing to
its undeveloped condition.

With the inception of anatomical and functional development of the
generative organs, and the differentiation of form belonging to each
sex, which goes hand in hand with it in the boy or girl, rudiments of a
mental feeling corresponding with the sex are developed; and in this, of
course, education and external influences in general have a powerful
effect upon the individual, who is now all attention.

If the sexual development is normal and undisturbed, a definite
character, corresponding with the sex, is developed. Certain definite
inclinations and reactions in intercourse with persons of the opposite
sex arise; and it is psychologically worthy of note with what relative
rapidity the definite mental type corresponding with the sex is evolved.

While modesty, for example, during childhood, is essentially but an
uncomprehended and incomprehensible exaction of education and imitation,
and in the innocence and _näiveté_ of the child but imperfectly
expressed; in the youth and maiden it becomes an imperative requirement
of self-respect; and, if in any way it is offended, intense vasomotor
reaction (blushing) and psychical emotion are induced.

If the original constitution is favorable and normal, and factors
injurious to the psycho-sexual development exercise no influence, then a
psycho-sexual personality is developed that is so unchangeable, and
corresponds so completely and harmoniously with the sex the individual
represents, that subsequent loss of the generative organs (as by
castration), or the climacteric or senility, cannot essentially alter
it. But this, of course, is not to declare that the castrated man or
woman, the youth and the aged man, the maiden and matron, the impotent
and the potent man, do not differ essentially from one another mentally.

An interesting and important question for what follows is, whether the
peripheral influences of the generative glands (testes and ovaries), or
central cerebral conditions, are the determining factors in
psycho-sexual development. The fact that congenital deficiency of the
generative glands, or removal of them before puberty, has a great
influence on physical and psycho-sexual development, so that the latter
is distorted and assumes a type more closely resembling the opposite sex
(eunuchs, certain viragoes, etc.), betokens their great importance in
this respect.

But that the physical processes taking place in the genital organs are
only co-operative, and not the exclusive factors in the process of
development of the psycho-sexual character, is shown by the fact that,
notwithstanding a normal anatomical and physiological state of these
organs, a sexual instinct may be developed which is the exact opposite
of that characteristic of the sex to which the individual belongs.

In this case, the cause is to be sought only in an anomaly of central
conditions,—in an abnormal psycho-sexual constitution. This
constitution, as far as its anatomical and functional foundation is
concerned, is absolutely unknown. Since, in almost all such cases, the
individual subject to the perverse sexual instinct displays a
neuropathic predisposition in several directions, and the latter may be
brought into relation with hereditary degenerate conditions, this
anomaly of psycho-sexual feeling may be called, clinically, a functional
sign of degeneration. This perverse sexuality appears spontaneously,
without external cause, with the development of sexual life, as an
individual manifestation of an abnormal form of the vita sexualis, and
then has the force of a _congenital_ phenomenon; or it develops upon a
sexuality the beginning of which was normal, as a result of very
definite injurious influences, and thus appears as an _acquired_
anomaly. Upon what this enigmatical phenomenon of acquired homo-sexual
instinct depends is still inexplicable, and only a matter for
hypothesis. Careful examination of the so-called acquired cases makes it
probable that the predisposition also present here consists of a latent
homo-sexuality, or, at least, bi-sexuality, which, for its
manifestation, requires the influence of accidental exciting causes to
rouse it from its slumber.

In so-called contrary sexual instinct there are degrees of the
phenomenon which quite correspond with the degrees of predisposition of
the individuals. Thus, in the milder cases, there is simple
hermaphroditism; in more pronounced cases, only homo-sexual feeling and
instinct, but limited to the vita sexualis; in still more complete
cases, the whole psychical personality, and even the bodily sensations,
are transformed to correspond with the sexual perversion; and, in the
complete cases, the physical form is correspondingly altered.

The following division of the various phenomena of this psycho-sexual
anomaly is made, therefore, in accordance with these clinical facts:—

A. _Homo-sexual Feeling as an Acquired Manifestation._—The determining
condition here is the demonstration of perverse feeling for the same
sex; not the proof of sexual acts with the same sex. These two phenomena
must not be confounded with each other; perversity must not be taken for
perversion.

Perverse sexual acts, not dependent upon perversion, often come under
observation. This is especially true with reference to sexual acts
between persons of the same sex, particularly pederasty. Here
paræsthesia sexualis is not necessarily at work; but hyperæsthesia, with
physical or mental impossibility of natural sexual satisfaction. Thus we
find homo-sexual intercourse in impotent masturbators or debauchees, or
_faute de mieux_ in sensual men and women in imprisonment, on
ship-board, in garrisons, bagnios, boarding-schools, etc.

There is an immediate return to normal sexual intercourse as soon as
obstacles to it are removed. Very frequently the cause of such temporary
aberration is masturbation and its results in youthful individuals.

Nothing is so prone to contaminate—under certain circumstances, even to
exhaust—the source of all noble and ideal sentiments, which arise of
themselves from a normally developing sexual instinct, as the practice
of masturbation in early years. It despoils the unfolding bud of perfume
and beauty, and leaves behind only the coarse, animal desire for sexual
satisfaction. If an individual, spoiled in this manner, reaches an age
of maturity, there is wanting in him that æsthetic, ideal, pure, and
free impulse which draws one toward the opposite sex. Thus the glow of
sensual sensibility wanes, and the inclination toward the opposite sex
becomes weakened. This defect influences the morals, character, fancy,
feeling, and instinct of the youthful masturbator, male or female, in an
unfavorable way, and, under certain circumstances, allows the desire for
the opposite sex to sink to _nil_; so that masturbation is preferred to
the natural mode of satisfaction.

Sometimes the development of higher sexual feelings toward the opposite
sex suffers, on account of hypochondriacal fear of infection in sexual
intercourse; or on account of an actual infection; or they suffer as a
result of a faulty education which points out such dangers and
exaggerates them. Again (especially in females), fear of the result of
coitus (pregnancy), or abhorrence of men, by reason of mental or moral
weakness, may direct into perverse channels an instinct that makes
itself felt with abnormal intensity. But too early and perverse sexual
satisfaction injures not merely the mind, but also the body; inasmuch as
it induces neuroses of the sexual apparatus (irritable weakness of the
centres governing erection and ejaculation; defective pleasurable
feeling in coitus), while, at the same time, it maintains the
imagination and libido in continuous excitement.

Almost every masturbator at last reaches a point where, frightened on
learning the results of the vice, or on experiencing them
(neurasthenia), or led by example or seduction to the opposite sex, he
wishes to free himself of the vice and re-instate his vita sexualis. The
moral and mental conditions are the most unfavorable possible. The pure
glow of sexual feeling is destroyed; the fire of sexual instinct is
wanting, and self-confidence, no less; for every masturbator is more or
less timid and cowardly. If the youthful sinner at last comes to make an
attempt at coitus, he is either disappointed because enjoyment is
wanting, on account of defective sensual feeling, or he is lacking in
the mental strength necessary to accomplish the act. The fiasco has a
fatal effect, and leads to absolute psychical impotence. A bad
conscience and the memory of past failures prevent success in any
further attempts. The constant libido sexualis, however, demands
satisfaction; but this moral and mental perversion separates him further
and further from women. For various reasons, however (neurasthenic
complaints, hypochondriacal fear of the results, etc.), the individual
is kept from masturbation. Occasionally, under such circumstances, there
may be bestiality. Intercourse with the same sex is then near at
hand,—as a result of occasional seduction or of the feelings of
friendship which, on the level of pathological sexuality, easily
associate themselves with sexual feelings. Passive and mutual onanism
then becomes the equivalent of the avoided act. If there is a
seducer,—which, unfortunately, is so frequent,—then the cultivated
pederast is produced,—_i.e._, a man who performs _quasi_ acts of onanism
with persons of his own sex, and, at the same time, feels and prefers
himself in an active _rôle_ corresponding with his real sex; who is
mentally indifferent not only to persons of the opposite sex, but also
to those of his own sex.

Sexual aberration in the _normally_ constituted, _untainted_, mentally
healthy individual, reaches this degree. No case has been demonstrated
in which perversity has been transformed into perversion,—into a
reversal of the sexual instinct.[101]

With tainted individuals, the matter is quite different. The latent
perverse sexuality is developed under the influence of neurasthenia
induced by masturbation, abstinence, or otherwise.

Gradually, in contact with persons of the same sex, sexual excitation by
them is induced. Related ideas are colored with lustful feelings, and
awaken corresponding desires. This decidedly degenerate reaction is the
beginning of a process of physical and mental transformation, a
description of which is attempted in what follows, and which is one of
the most interesting psychological phenomena that has been observed.
This metamorphosis presents different stages, or degrees.

_I. Degree: Simple Reversal of Sexual Feeling._—This degree is attained
when persons of the same sex have an aphrodisiac effect, and the
individual has a sexual feeling for them. Character and feeling,
however, still correspond with the sex of the individual presenting the
reversal of sexual feeling. He feels himself in the active _rôle_; he
recognizes his impulse toward his own sex as an aberration, and finally
seeks aid. With episodical improvement of the neurosis, at first even
normal sexual feelings may re-appear and assert themselves. The
following case seems well suited to exemplify this stage of the
psycho-sexual degeneration:—

  Case 94. _Acquired Contrary Sexual Instinct._—“I am an official, and,
  as far as I know, come of an untainted family. My father died of an
  acute disease; my mother is living and is _quite nervous_. _A sister
  has been very intensely religious for some years._

  “I myself am tall, and, in speech, gait, and manner, give a perfectly
  masculine impression. Measles is the only disease I have had; but
  since my thirteenth year I have suffered with so-called nervous
  headache. My sexual life began in my thirteenth year, when I became
  acquainted with a boy somewhat older than myself, with whom I took
  pleasure in mutual fondling of the genitals. I had the first
  ejaculation in my fourteenth year. Seduced to onanism by two older
  school-mates, I practiced it partly with others and partly alone; in
  the latter case, however, always with the thought of persons of the
  female sex. My libido sexualis was very great, as it is to-day. Later,
  I tried to win a pretty, stout servant-girl who had very large mammæ;
  id solum assecutus sum, ut me praesente superiorem corporis sui partem
  enudaret mihique concederet os mammasque osculari, dum ipsa penem meum
  valde erectum in manum suam recepit eumque trivit.

  “Notwithstanding my urgent demand for coitus, she would not allow it;
  but she finally permitted me to touch her genitals.

  “After going to the University, I visited a brothel and succeeded
  without especial effort.

  “There an event occurred which brought a change in me. One evening I
  accompanied a friend home, and in a mild state of intoxication I
  grasped him ad genitalia. He made but slight opposition. I then went
  up to his room with him, and we practiced mutual masturbation. From
  that time we indulged in it quite frequently; in fact, it came to
  immissio penis in os, with resultant ejaculations. But it is strange
  that I was not at all in love with this person, but passionately in
  love with another friend, near whom I never felt the slightest sexual
  excitement, and whom I never connected with sexual matters, even in
  thought. My visits to brothels, where I was gladly received, became
  more infrequent; in my friend I found a substitute, and did not desire
  sexual intercourse with women.

  “We never practiced pederasty, and that word was not even known
  between us. From the beginning of this relation with my friend, I
  again masturbated more frequently, and naturally the thought of
  females receded more and more into the background, and I thought more
  and more about young, handsome, strong men with the largest genitals.
  I preferred young fellows, from sixteen to twenty-five years old,
  without beards, but they had to be handsome and clean. Young laborers
  dressed in trousers of Manchester cloth or English leather,
  particularly masons, especially excited me.

  “Persons in my own position had hardly any effect on me; but, at the
  sight of one of those strapping fellows of the lower class, I
  experienced marked sexual excitement. It seems to me that the touch of
  such trousers, the opening of them, and the grasping of the penis, as
  well as kissing the fellow, would be the greatest delight. My
  sensibility to female charms is somewhat dulled; yet in sexual
  intercourse with a woman, particularly when she has well-developed
  mammæ, I am always potent without the help of imagination. I have
  never attempted to make use of a young laborer, or the like, for the
  satisfaction of my evil desires, and never shall; but I often feel the
  longing to do it. I often impress on myself the mental image of such a
  man, and then masturbate at home.

  “I am absolutely devoid of taste for female work. I rather like to
  move in female society, but dancing is repugnant to me. I have a
  lively interest in the fine arts. That my sexual sense is partly
  reversed is, I believe, in part due to greater convenience, which
  keeps me from entering into a relation with a girl; as the latter is a
  matter of too much trouble. To be constantly visiting houses of
  prostitution is, for æsthetic reasons, repugnant to me; and thus I am
  always returning to solitary onanism, which is very difficult for me
  to avoid.

  “Hundreds of times I have said to myself that, in order to have a
  normal sexual sense, it would be necessary for me, first of all, to
  overcome my irresistible passion for onanism,—a practice so repugnant
  to my æsthetic feeling. Again and again I have resolved with all my
  might to fight this passion; but I am still unsuccessful. When I felt
  the sexual impulse gaining strength, instead of seeking satisfaction
  in the natural manner, I preferred to masturbate, because I felt that
  I would thus have more enjoyment.

  “And yet experience has taught me that I am always potent with girls,
  and that, too, without trouble and without the help of imagining
  masculine genitals. In one case, however, I did not attain ejaculation
  because the woman—it was in a brothel—was devoid of every charm. I
  cannot avoid the thought and severe self-accusation that, to a certain
  extent, my contrary sexuality is the result of excessive onanism; and
  this especially depresses me, because I am compelled to acknowledge
  that I scarcely feel strong enough to overcome this vice by the force
  of my own will.

  “As a result of my relations with my fellow-student and school-mate
  for years, mentioned in this communication,—which, however, began
  while we were at the University, and after we had been friends for
  seven years,—the impulse to unnatural satisfaction of libido has grown
  much stronger. I trust you will permit the description of an incident
  which occupied me for months:—

  “In the summer of 1882, I made the acquaintance of a companion six
  years younger than myself, who, with several others, had been
  introduced to me and my acquaintances. I very soon felt a deep
  interest in this handsome man, who was unusually well proportioned,
  slim, and full of health. After a few weeks of association, this
  feeling became friendship, and at last passionate love, with feelings
  of the most intense jealousy. I very soon noticed that, in this,
  sexual excitation was also very marked; and, notwithstanding my
  determination, aside from all others, to keep myself in check in
  relation to this man, whom I respected so highly for his superior
  character, one night, after free indulgence in beer, as we were
  enjoying a bottle of champagne in my room and drinking to good, true,
  and lasting friendship, I yielded to the irresistible impulse to
  embrace him, etc.

  “When I saw him, next day, I was so ashamed that I could not look him
  in the face. I felt the deepest regret for my action, and accused
  myself bitterly for having thus sullied this friendship, which was to
  be and remain so pure and precious. In order to prove to him that I
  had lost control of myself only momentarily, at the end of the
  semester I urged him to make an excursion with me; and after some
  reluctance, the reason of which was only too clear to me, he
  consented. Several nights we slept in the same room without any
  attempt on my part to repeat my action. I wished to talk with him
  about the event of that night, but I could not bring myself to it;
  even when, during the next semester, we were separated, I could not
  induce myself to write to him on the subject; and when I visited him,
  in March, at X., it was the same. And yet I felt a great desire to
  clear up this dark point by an open statement. In October of the same
  year, I was again in X., and this time found courage to speak without
  reserve; indeed, I asked him why he had not resisted me. He answered
  that, in part, it was because he wished to please me, and, in part,
  owing to the fact that he was somewhat apathetic as a result of being
  a little intoxicated. I explained to him my condition, and also gave
  him “Psychopathia Sexualis” to read, expressing the hope that by the
  force of my own will I should become fully and lastingly master of my
  unnatural impulse. Since this confession, the relation between this
  friend and me has been the most delightful and happy possible; there
  are the most friendly feelings on both sides, which are heart-felt and
  true; and it is to be hoped that they will endure.

  “If I should not improve my abnormal condition, I am determined to put
  myself under your treatment; the more because, after a careful study
  of your work, I cannot count myself as belonging to the category of
  so-called urnings; and, too, because I have the firm conviction, or
  hope, at least, that a strong will, assisted and combined with
  skillful treatment, could transform me into a man of normal feeling.”

  Case 95. Ilma S.,[102] aged 29; single; merchant’s daughter. She comes
  of a family having bad nervous taint. Father was a drinker and died by
  suicide, as also did the patient’s brother and sister. A sister
  suffers with convulsive hysteria. Mother’s father shot himself while
  insane. Mother was sickly, and died paralyzed after apoplexy. The
  patient never had any severe illness. She is bright, enthusiastic, and
  dreamy. Menses at the age of eighteen without difficulty; but
  thereafter they were very irregular. At fourteen, chlorosis and
  catalepsy from fright. Later, hysteria gravis and an attack of
  hysterical insanity. At eighteen, relations with a young man which
  were not platonic. This man’s love was passionately returned. From
  statements of the patient, it seems that she was very sensual, and
  after separation from her lover practiced masturbation. After this she
  led a romantic life. In order to earn a living, she put on male
  clothing, and became a tutor; but she gave up her place because her
  mistress, not knowing her sex, fell in love with her and courted her.
  Then she became a railway-employé. In the company of her companions,
  in order to conceal her sex, she was compelled to visit brothels with
  them, and hear the most vulgar stories. This became so distasteful to
  her that she gave up her place, resumed the garments of a female, and
  again sought to earn her living. She was arrested for a theft, and on
  account of severe hystero-epilepsy was sent to the hospital. There,
  inclination and impulse toward the same sex were discovered. The
  patient became troublesome on account of passionate love for female
  nurses and patients.

  Her sexual perversion was considered congenital. With regard to this
  the patient made some interesting statements:—

  “I am judged incorrectly, if it is thought that I feel myself a man
  toward the female sex. In my whole thought and feeling I am much more
  a woman. I loved my cousin as only a woman can love a man.

  “The change of my feeling originated in this, that, in Pesth, dressed
  as a man, I had an opportunity to observe my cousin. I saw that I had
  wholly deceived myself in him. That gave me terrible heart-pangs. I
  knew that I could never love another man; that I belonged to those who
  love but once. Of similar effect was the fact that, in the society of
  my companions at the railway, I was compelled to hear the most
  offensive language and visit the most disreputable houses. As a result
  of the insight into men’s motives, gained in this way, I took an
  unconquerable dislike to them. However, since I am of a very
  passionate nature and need to have some loving person on whom to
  depend, and to whom I can wholly surrender myself, I felt myself more
  and more powerfully drawn toward intelligent women and girls who were
  in sympathy with me.”

The contrary sexual instinct of this patient, which was clearly
acquired, expressed itself in a stormy and decidedly sensual way, and
was further augmented by masturbation; because constant oversight in
hospitals made sexual satisfaction with the same sex impossible.
Character and occupation remained feminine. There were no manifestations
of viraginity. According to information lately received by the author,
this patient, after two years of treatment in an asylum, was entirely
freed from her neurosis and sexual perversion, and discharged cured.

  Case 96. X., aged 19; mother nervous; two sisters of mother’s father
  were insane. Patient of nervous temperament; well endowed mentally;
  well developed; normally formed. When he was twelve years old, he was
  seduced into mutual onanism by an elder brother.

  After this, the patient continued the vice alone. In the last three
  years, during the act of masturbation, he had had peculiar fancies in
  the sense of “contrary sexual instinct.”

  He fancies himself a female; as, for example, a ballet-dancer in the
  act of coitus with an officer or circus rider. These perverse fancies
  have accompanied the act of masturbation since the patient became
  neurasthenic. He understands the harm of masturbation, fights
  desperately against it, but always gives up to the impulse.

  If he is able to withstand the impulse for a few days, a normal desire
  for sexual intercourse with females is awakened; but a certain fear of
  infection holds these desires in check, and always drives him again to
  masturbation.

  It is worthy of remark that this unfortunate’s lascivious dreams
  concerned only females.

  In the course of the last few months, the patient had become very
  neurasthenic and hypochondriacal. He feared tabes.

  I advised treatment of the neurasthenia, suppression of masturbation,
  and marital cohabitation, if possible, after improvement of the
  neurasthenia.

  Case 97. Mr. X, aged 35, single, official; mother insane, brother
  hypochondriacal.

  Patient was healthy, strong, of lively sensual temperament. He had
  manifested powerful sexual instinct abnormally early, and masturbated
  while yet a small boy. He had coitus the first time at the age of
  fourteen, he says, with enjoyment and complete power. When fifteen
  years old, a man sought to seduce him, and performed manustupration on
  him. X. experienced a feeling of repulsion, and freed himself from the
  disgusting situation. At maturity he committed excesses in libido,
  with coitus; in 1880 he became neurasthenic, being afflicted with
  weakness of erection and ejaculatio præcox. He thus became less and
  less potent, and no longer experienced pleasure in the sexual act. At
  this time of sexual decadence, for a long time, he still had what was
  previously foreign to him, and is still incomprehensible to him,—an
  inclination for sexual intercourse with immature girls of the age of
  twelve or thirteen. His libido increased as virility diminished.

  Gradually he developed inclination for boys of thirteen or fourteen.
  He was impelled to approach them.

  Quodsi ei occasio data est ut tangere posset pueros qui ei placuere,
  penis vehementer se erexit tum maxime quum crura puerorum tangere
  potuisset. Abhinc feminas non cupivit. Nonnunquam feminas ad coitum
  coëgit sed erectio debilis, ejaculatio præmatura erat sine ulla
  voluptate.

  Now only youths interested him. He dreamed about them and had
  pollutions. After 1882 he now and then had opportunity concumbere cum
  juvenibus. This led to powerful sexual excitement, which he satisfied
  by masturbation. It was only exceptional for him to venture to touch
  his bed-fellow and indulge in mutual masturbation. He shunned
  pederasty. For the most part, he was compelled to satisfy his sexual
  needs by means of solitary masturbation. In the act he called up the
  vision of pleasing boys. After sexual intercourse with such boys, he
  always felt strengthened and refreshed, but morally depressed; because
  there was consciousness of having performed a perverse, indecent, and
  punishable act. He found it painful that his disgusting impulse was
  more powerful than his will.

  X. thinks that his love for his own sex has resulted from great excess
  in natural sexual intercourse, and bemoans his situation. On the
  occasion of a consultation, in December, 1889, he asked whether there
  were any means to bring him back to a normal sexual condition, since
  he had no real horror feminæ, and would very gladly marry.

  This intelligent patient, free from degenerative signs, presented no
  abnormal symptoms except those of sexual and spinal neurasthenia of
  moderate degree.

_II. Degree: Eviration and Defemination._—If, in cases of contrary
sexual instinct thus developed, no restoration occurs, then deep and
lasting transformations of the psychical personality may occur. The
process completing itself in this way may be briefly designated
_eviration_. The patient undergoes a deep change of character,
particularly in his feelings and inclinations, which become those of a
female. After this, he also feels himself to be a woman during the
sexual act, has desire only for passive sexual indulgence, and, under
certain circumstances, sinks to the level of a prostitute. In this
condition of deep and more lasting psycho-sexual transformation, the
individual is like the (congenital) urning of high grade. The
possibility of a restoration of the previous mental and sexual
personality seems, in such a case, excluded.

The following case is a classical example of this variety of lasting
acquired contrary sexual instinct:—

  Case 98. Sch., aged 30, physician, one day told me the story of his
  life and malady, asking explanation, and advice concerning certain
  anomalies of his vita sexualis. The following description gives, for
  the most part verbatim, the details of the autobiography; only in some
  portions is it shortened:—

  “My parents were healthy. As a child I was sickly; but with good care
  I thrived, and got on well in school. When eleven years old, I was
  taught to masturbate by my playmates, and gave myself up to it
  passionately. Until I was fifteen, I learned easily. On account of
  frequent pollutions, I became less capable, did not get on easily in
  school, and was uncertain and embarrassed when called on by the
  teacher. Frightened by my loss of capability, and recognizing that the
  loss of semen was responsible for it, I gave up masturbation; but the
  pollutions became even more frequent, so that I often had two or three
  in a night. In despair, I now consulted one physician after another.
  None were able to help me.

  “Since I grew weaker and weaker, by reason of the loss of semen, with
  the impulse to sexual satisfaction growing more and more powerful, I
  sought houses of prostitution. But I was there unable to find
  satisfaction; for, even though the sight of a naked female pleased me,
  neither orgasm nor erection occurred; and even manustupration by the
  puella was not capable of inducing erection. Scarcely would I leave
  the house, when the impulse would seize me again, and I would have
  violent erections. I grew ashamed before the girls, and ceased to
  visit such houses. Thus a couple of years passed. My sexual life
  consisted of pollutions. My inclination toward the opposite sex grew
  less and less. At nineteen I went to the University. The theatre had
  more attractions for me. I wished to become an actor. My parents were
  not willing. At the Capital I was compelled now and then to visit
  girls with my comrades. I feared such a situation; because I knew that
  coitus was impossible for me, and because my friends might discover my
  impotence. Therefore, I avoided, as far as possible, the danger of
  becoming the butt of jokes and ridicule.

  “One evening, in the opera-house, an old gentleman sat near me. He
  courted me. I laughed heartily at the foolish old man, and entered
  into his joke. Exinapinato genitalia mea prehendit, quo facto statim
  penis meus se erexit. Frightened, I demanded of him what he meant. He
  said that he was in love with me. Having heard of hermaphrodites in
  the clinics, I thought I had one before me, and became curious to see
  his genitals. The old man was very willing, and went with me to the
  water-closet. Sicuti penem maximum ejus erectum adspexi, perterritus
  effugi.

  “This man followed me, and made strange proposals which I did not
  understand, and repelled. He did not give me any rest. I learned the
  secrets of male love for males, and felt that my sexuality was excited
  by it. But I resisted the shameful passion (as I then regarded it),
  and, for the next three years, I remained free from it. During this
  time I repeatedly attempted coitus with girls in vain. My attempts to
  free myself of my impotence by means of medical treatment were also
  vain. Once, when my libido sexualis was troubling me again, I recalled
  what the old man had told me: that male-loving men were accustomed to
  meet on the E. Promenade.

  “After a hard struggle, and with beating heart, I went there, made the
  acquaintance of a blonde man, and allowed myself to be seduced. The
  first step was taken. This kind of sexual love was satisfactory to me.
  I always preferred to be in the arms of a strong man. The satisfaction
  consisted of mutual manustupration; occasionally in osculum ad penem
  alterius. I was then twenty-three years old. Sitting, together with my
  comrades, on the beds of patients in the clinic during the lectures,
  excited me so intensely that I could scarcely listen to the lectures.
  In the same year I entered into a formal love-relation with a merchant
  of thirty-four. We lived as man and wife. X. played the man, and fell
  more and more in love. I gave up to him, but now and then I had to
  play the man. After a time I grew tired of him, became unfaithful, and
  he became jealous. There were terrible scenes, which led to temporary
  separation, and finally to actual rupture. (The merchant afterward
  became insane, and died by suicide.)

  “I made many acquaintances, and loved the most ordinary people. I
  preferred those having a full beard, and who were tall and of middle
  age, and able to play the active _rôle_ well. I developed a proctitis.
  The professor thought it was the result of sitting too much while
  preparing for examinations. I developed a fistula, and had to undergo
  an operation; but this did not cure me of my desire to allow myself to
  be used passively. I became a physician, and went to a provincial
  city, where I had to live like a nun. I developed a desire to move in
  ladies’ society, and was gladly welcomed there; because it was found
  that I was not so one-sided as most men, and was interested in
  _toilettes_ and such feminine things. However, I felt very unhappy and
  lonesome. Fortunately, in this town, I made the acquaintance of a man,
  a ‘sister,’ who felt like me. For some time I was taken care of by
  him. When he had to leave, I had an attack of despair, with
  depression, which was accompanied by thoughts of suicide.

  “When it became impossible for me to longer endure the town, I became
  a military surgeon in the Capital. There I began to live again, and
  often made two or three acquaintances in one day. I had never loved
  boys or young people; only fully-developed men. The thought of falling
  into the hands of the police was frightful. Thus I have escaped the
  clutches of the blackmailer. At the same time, I could not keep myself
  from the satisfaction of my impulse. After some months I fell in love
  with an official of forty. I remained true to him for a year, and we
  lived like a pair of lovers. I was the wife, and was formally courted
  by the lover. One day I was transferred to a small town. We were in
  despair. The last night was spent in continually kissing and caressing
  one another.

  “In T. I was unspeakably unhappy, in spite of some ‘sisters’ whom I
  found. I could not forget my lover. In order to satisfy my sexual
  desire, which cried for satisfaction, I chose soldiers. Money obtained
  men; but they remained cold, and I had no enjoyment with them. I was
  successful in being re-transferred to the Capital. There, there was a
  new love-relation, but much jealousy; because my lover liked to go
  into the society of ‘sisters,’ and was proud and coquettish. There was
  a rupture. I was very unhappy and very glad to be transferred from the
  Capital. I now stayed in C., alone and in despair. Two infantry
  privates were brought into service, but with the same unsatisfactory
  result. When shall I ever find true love again?

  “I am over medium height, well developed, and look somewhat aged; and,
  therefore, when I wish to make conquests I use the arts of the toilet.
  My manner, movements, and face are masculine. Physically I feel as
  youthful as a boy of twenty. I love the theatre, and especially art.
  My interest in the stage is in the actresses, whose every movement and
  gesture I notice and criticise.

  “In the society of gentlemen I am silent and embarrassed, while in the
  society of those like myself I am free, witty, and as fawning as a
  cat, if a man is sympathetic. If I am without love, I become deeply
  melancholic; but the favors of the first handsome man dispel my
  depression. In other ways I am frivolous; anything but ambitious. My
  profession is nothing to me. Masculine pursuits do not interest me. I
  prefer novels and going to the theatre. I am effeminate, sensitive,
  easily moved, easily injured, and nervous. A sudden noise makes my
  whole body tremble, and I have to collect myself in order to keep from
  crying out.”

  _Remarks_: The foregoing case is certainly one of acquired contrary
  sexual instinct, since the sexual instinct and impulse were originally
  directed toward the female sex. Sch. became neurasthenic through
  masturbation.

  As an accompanying manifestation of the neurasthenic neurosis,
  lessened impressionability of the erection-centre and consequent
  relative impotence came on. As a result of this, sexual sensibility
  toward the opposite sex was lessened, with simultaneous persistence of
  libido sexualis. The acquired contrary sexual instinct must be
  abnormal, since the first touch by a person of the same sex is an
  adequate stimulus for the erection-centre. The perverse sexual feeling
  became complete. At first Sch. felt like a man in the sexual act; but
  more and more, as the change progressed, the feeling and desire of
  satisfaction changed to the form which, as a rule, characterizes the
  (congenital) urning.

  This eviration induces a desire for the passive _rôle_, and, further,
  for (passive) pederasty. It makes a deeper impress on the character.
  The character becomes feminine, inasmuch as Sch. now prefers to move
  in the society of actual females, has an increasing desire for
  feminine occupations, and, indeed, makes use of the arts of the toilet
  in order to improve his fading charms and make “conquests.”

The foregoing facts, concerning acquired contrary sexual instinct and
effemination, find an interesting confirmation in the following
ethnological data:—

  Even Herodotus describes a peculiar disease which frequently affected
  the Scythians. The disease consisted in this: that men became
  effeminate in character, put on female garments, did the work of
  women, and even became effeminate in appearance. As an explanation of
  this insanity of the Scythians,[103] Herodotus relates the myth that
  the goddess Venus, angered by the plundering of the temple at Ascalon
  by the Scythians, had made women of these plunderers and their
  posterity.

  Hippocrates, not believing in supernatural diseases, recognized that
  impotence was here a causative factor, and explained it, though
  incorrectly, as due to the custom of the Scythians, by attributing it
  to disease of the jugular veins induced by excessive riding. He
  thought that these veins were of great importance in the preservation
  of the sexual powers, and that when they were severed, impotence was
  induced. Since the Scythians considered their impotence due to divine
  punishment, and incurable, they put on the clothing of females, and
  lived as women among women.

  It is worthy of note that, according to Klaproth (“Reise in den
  Kaukasus,” Berlin, 1812, v, p. 285) and Chotomski, even at the present
  time impotence is very frequent among the Tartars, as a result of
  riding unsaddled horses. The same is observed among the Apaches and
  Navajos of the Western Continent, who ride excessively, scarcely ever
  going on foot, and are remarkable for small genitals and mild libido
  and virility. Sprengel, Lallemand, and Nysten recognized the fact that
  excessive riding may be injurious to the sexual organs.

  Hammond reports analogous observations of great interest concerning
  the Pueblo Indians of New Mexico. These descendants of the Aztecs
  cultivate so-called “mujerados,” of which every Pueblo tribe requires
  one in the religious ceremonies (actual orgies in the spring), in
  which pederasty plays an important part. In order to cultivate a
  “mujerado,” a very powerful man is chosen, and he is made to
  masturbate excessively and ride constantly. Gradually such irritable
  weakness of the genital organs is engendered that, in riding, great
  loss of semen is induced. This condition of irritability passes into
  paralytic impotence. Then the testicles and penis atrophy, the hair of
  the beard falls out, the voice loses its depth and compass, and
  physical strength and energy decrease. Inclinations and disposition
  become feminine. The “mujerado” loses his position in society as a
  man. He takes on feminine manners and customs, and associates with
  women. Yet, for religious reasons, he is held in honor. It is probable
  that, at other times than during the festivals, he is used by the
  chiefs for pederasty. Hammond had an opportunity to examine two
  “mujerados.” One had become such seven years before, and was
  thirty-five years old at the time. Seven years before, he was entirely
  masculine and potent. He had noticed gradual atrophy of the testicles
  and penis. At the same time he lost libido and the power of erection.
  He differed in nowise, in dress and manner, from the women among whom
  Hammond found him. The genital hair was wanting, the penis was
  shrunken, the scrotum lax and pendulous, and the testicles were very
  much atrophied and no longer sensitive to pressure. The “mujerado” had
  large mammæ like a pregnant woman, and asserted that he had nursed
  several children whose mothers had died. A second “mujerado,” aged
  thirty-six, after he had been ten years in the condition, presented
  the same peculiarities, though with less development of mammæ. Like
  the first, the voice was high and thin. The body was plump.[104]


_III. Degree: Stage of Transition to Metamorphosis Sexualis Paranoica._

A further degree of development is represented by those cases in which
bodily sensation is also transformed in the sense of a _transmutatio
sexus_. In this respect the following case is unique:—

  Case 99. _Autobiography._ “Born in Hungary in 1844, for many years I
  was the only child of my parents; for the other children died for the
  most part of general weakness. A brother came late, who is still
  living.

  “I come of a family in which nervous and mental diseases have been
  numerous. It is said that I was very pretty as a little child, with
  blonde locks and transparent skin; very obedient, quiet, and modest,
  so that I was taken everywhere in the society of ladies without any
  offense on my part.

  “With a very active imagination—my enemy through life—my talents
  developed rapidly. I could read and write at the age of four; my
  memory reaches back to my third year. I played with everything that
  fell into my hands,—with leaden soldiers, or stones, or ribbons from a
  children’s store; but a machine for working in wood, that was given to
  me as a present, I did not like. I liked best to be at home with my
  mother, who was everything to me. I had two or three friends, with
  whom I got on good-naturedly; but I liked to play with their sisters
  quite as well, who always treated me like a girl, which at first did
  not embarrass me. I must have already been on the road to become just
  like a girl; at least, I can still well remember how it was always
  said: ‘He is not intended for a boy.’ At this I tried to play the
  boy,—imitated my companions in everything, and tried to surpass them
  in wildness. In this I succeeded. There was no tree or building too
  high for me to reach its top. I took great delight in soldiers. I
  avoided girls more, because I did not wish to play with their
  play-things; and it always annoyed me that they treated me so much
  like one of themselves.

  “In the society of mature people, however, I was always modest, and,
  also, always regarded with favor. Fantastic dreams about wild
  animals—which once drove me out of bed without waking me—frequently
  troubled me. I was always very simply, but very elegantly, dressed,
  and thus developed a taste for beautiful clothing. It seems peculiar
  to me that, from the time of my school-days, I had a partiality for
  ladies’ gloves, which I put on secretly as often as I could. Thus,
  when once my mother was about to give away a pair of gloves, I made
  great opposition to it, and told her, when she asked why I acted so,
  that I wanted them myself. I was laughed at; and from that time I took
  good care not to display my preference for female things. Yet my
  delight in them was very great. I took especial pleasure in masquerade
  costumes,—_i.e._, only in female attire. If I saw them, I envied their
  owners. What seemed to me the prettiest sight was: two young men,
  beautifully dressed as white ladies, with masks on; and yet I would
  not have shown myself to others as a girl for anything; I was so
  afraid of being ridiculed. At school I worked very hard, and was
  always among the first. From childhood my parents taught me that duty
  came first; and they always set me an example. It was also a pleasure
  for me to attend school; for the teachers were kind, and the elder
  scholars did not plague the younger ones. We left my first home; for
  my father was compelled, on account of his business,—which was dear to
  him,—to separate from his family for a year. We moved to Germany. Here
  there was a stricter, rougher manner, partly in teachers and partly in
  scholars; and I was again ridiculed on account of my girlishness. My
  school-mates went so far as to give a girl, who had exactly my
  features, my name, and me hers; so that I hated the girl. But I later
  came to be on terms of friendship with her after her marriage. My
  mother tried to dress me elegantly; but this was repugnant to me,
  because it made me the object of joke. So, finally, I was delighted
  when I had correct trousers and coats. But with these came a new
  annoyance. They irritated my genitals, particularly when the cloth was
  rough; and the touch of tailors while measuring me, on account of
  their tickling, which almost convulsed me, was unendurable,
  particularly about the genitals. Then I had to practice gymnastics;
  and I simply could do nothing at all, or only indifferently the things
  that girls cannot do easily. While bathing I was troubled by feeling
  ashamed to undress; but I liked to bathe. Until my twelfth year I had
  a great weakness in my back. I learned to swim late, but ultimately so
  well that I took long swims. At thirteen I had pubic hair, and was
  about six feet tall; but my face was feminine until my eighteenth
  year, when my beard came in abundance and gave me rest from
  resemblance to woman. An inguinal hernia that was acquired in my
  twelfth year, and cured when I was twenty, gave me much trouble,
  particularly in gymnastics. Besides, from my twelfth year on, I had,
  after sitting long, and particularly while working at night, an
  itching, burning, and twitching, extending from the penis to my back,
  which the acts of sitting and standing increased, and which was made
  worse by catching cold. But I had no suspicion whatever that this
  could be connected with the genitals. Since none of my friends
  suffered in this way, it seemed strange to me; and it required the
  greatest patience to endure it; the more owing to the fact that my
  abdomen troubled me.

  “In _sexualibus_ I was still perfectly innocent; but now, as at the
  age of twelve or thirteen, I had a definite feeling of preferring to
  be a young lady. A young lady’s form was more pleasing to me; her
  quiet manner, her deportment, but particularly her attire, attracted
  me. But I was careful not to allow this to be noticed; and yet, I am
  sure that I should not have shrunk from the castration-knife, could I
  have thus attained my desire. If I had been asked to say why I
  preferred female attire, I could have said nothing more than that it
  attracted me powerfully; perhaps, too, I seemed to myself, on account
  of my uncommonly white skin, more like a girl. The skin of my face and
  hands, particularly, was very sensitive. Girls liked my society; and,
  though I should have preferred to have been with them constantly, I
  avoided them when I could; for I had to exaggerate in order not to
  appear feminine. In my heart I always envied them. I was particularly
  envious when one of my young girl friends got long dresses and wore
  gloves and veils. When, at the age of fifteen, I was on a journey, a
  young lady, with whom I was boarding, proposed that I mask as a lady
  and go out with her; but, owing to the fact that she was not alone, I
  did not acquiesce, much as I should have liked it. Others stood on
  very little ceremony with me. While on this journey, I was pleased at
  seeing boys in one city wearing blouses with short sleeves, and the
  arms bare. A lady elaborately dressed was like a goddess to me; and if
  even her hand touched me coldly I was happy and envious, and only too
  gladly would have put myself in her place in the beautiful garments
  and lovely form. Nevertheless, I studied assiduously, and passed
  through the Realschule and the Gymnasium in nine years, passing a good
  final examination. I remember, when fifteen, to have first expressed
  to a friend the wish to be a girl. In answer to his question, I could
  not give the reason why. At seventeen I got into fast society; I drank
  beer, smoked, and tried to joke with waiter-girls. The latter liked my
  society, but they always treated me as if I wore petticoats. I could
  not take dancing lessons, they repelled me so; but if I could have
  gone as a mask, it would have been different. My friends loved me
  dearly; I hated only one, who seduced me into onanism. Shame on those
  days, which injured me for life! I practiced it quite frequently, but
  in it seemed to myself like a double man. I cannot describe the
  feeling; I think it was masculine, but mixed with feminine elements. I
  could not approach girls; I feared them, but they were not strange to
  me. They impressed me as being more like myself; I envied them. I
  would have denied myself all pleasures if, after my classes, at home I
  could have been a girl and thus have gone out. Crinoline and a
  smoothly-fitting glove were my ideals. With every lady’s gown I saw I
  fancied how I should feel in it,—_i.e._, as a lady. I had no
  inclination toward men. But I remember that I was somewhat lovingly
  attached to a very handsome friend with a girl’s face and dark hair,
  though I think I had no other wish than that we both might be girls.

  “At the high-school I finally once had coitus; hoc modo sensi, me
  libentius sub puella concubuisse et penem meum cum cunno mutatum
  maluisse. To my astonishment, too, the girl had to treat me as a girl,
  and did it willingly; but she treated me as if I were she (she was
  still quite inexperienced, and, therefore, did not laugh at me).

  “When a student, at times I was wild, but I always felt that I assumed
  this wildness as a mask. I drank and duelled, but I could not take
  lessons in dancing, because I was afraid of betraying myself. My
  friendships were close, but without other thoughts. It pleased me most
  to have a friend masked as a lady, or to study the ladies’ costumes at
  a ball. I understood such things perfectly. Gradually I began to feel
  like a girl.

  “On account of unhappy circumstances, I twice attempted suicide.
  Without any cause I once slept fourteen days, had many hallucinations
  (visual and auditory at the same time), and was with both the living
  and the dead. The latter habit of thought remains. I also had a friend
  (a lady) who knew my hobby and put on my gloves for me; but she always
  looked upon me as a girl. Thus I understood women better than other
  men did, and in what they differed from men; so I was always treated
  _more feminarum_,—as if they had found in me a female friend. On the
  whole, I could not endure obscenity, and indulged in it myself only
  out of braggadocio when it was necessary. I soon overcame my aversion
  to foul odors and blood, and even liked them. I was wanting in only
  one respect: I could not understand my own condition. I knew that I
  had feminine inclinations, but believed that I was a man. Yet I doubt
  whether, with the exception of the attempts at coitus, which never
  gave me pleasure (which I ascribe to onanism), I ever admired a woman
  without wishing I were she; or without asking myself whether I should
  not like to be the woman, or be in her attire. Obstetrics I learned
  with difficulty (I was ashamed for the exposed girls, and had a
  feeling of pity for them); and even now I have to overcome a feeling
  of fright in obstetrical cases; indeed, it has happened that I thought
  I felt the traction myself. After filling several positions
  successfully as a physician, I went through a military campaign as a
  volunteer surgeon. Riding, which, while a student, was painful to me,
  because in it the genitals had more of a feminine feeling, was
  difficult for me (it would have been easier in the female style).

  “Still, I always thought I was a man with obscure masculine feeling;
  and whenever I associated with ladies, I was still soon treated as an
  inexperienced lady. When I wore a uniform for the first time, I should
  have much preferred to have slipped into a lady’s costume, with a
  veil; I was disturbed when the stately uniform attracted attention. In
  private practice I was successful in the three principal branches.
  Then I made another military campaign; and during this I came to
  understand my nature; for I think that, since the first ass, no beast
  of burden has ever had to endure with so much patience as I have.
  Decorations were not wanting, but I was indifferent to them.

  “Thus I went through life, such as it was, never satisfied with
  myself, full of dissatisfaction with the world, and vacillating
  between sentimentality and a wildness that was for the most part
  affected.

  “My experience as a candidate for matrimony was very peculiar. I
  should have preferred not to marry, but family circumstances and
  practice forced me to it. I married an energetic, amiable lady, of a
  family in which female government was rampant. I was in love with her
  as much as one of us can be in love,—_i.e._, what we love we love with
  our whole hearts, and live in it, even though we do not show it as
  much as a genuine man does. We love our brides with all the love of a
  woman, almost as a woman might love her bridegroom. But I cannot say
  this for myself; for I still believed that I was but a depressed man,
  who would come to himself, and find himself out by marriage. But, even
  on my marriage-night, I felt that I was only a woman in man’s form;
  sub femina locum meum esse mihi visum est. On the whole, we lived
  contented and happy, and for two years were childless. After a
  difficult pregnancy, during which I was in mortal fear of death, the
  first boy was born in a difficult labor,—a boy on whom a melancholy
  nature still hangs; who is still of melancholy disposition. Then came
  a second, who is very quiet; a third, full of peculiarities; a fourth,
  a fifth; and all have predisposition to neurasthenia. Since I always
  felt out of my own place, I went much in gay society; but I always
  worked as much as human strength would allow. I studied and operated;
  and I experimented with many drugs and methods of cure, always on
  myself. I left the regulation of the house to my wife, as she
  understood house-keeping very well. My marital duties I performed as
  well as I could, but without personal satisfaction. Since the first
  coitus, the masculine position in it has been repugnant, and, too,
  difficult for me. I should have much preferred to have the other
  _rôle_. When I had to deliver my wife, it almost broke my heart; for I
  knew how to appreciate her pain. Thus we lived long together, until
  severe gout drove me to various baths, and made me neurasthenic. At
  the same time, I became so anæmic that every few months I had to take
  iron for some time; otherwise I would be almost chlorotic or
  hysterical, or both. Stenocardia often troubled me; then came
  unilateral cramps of chin, nose, neck, and larynx; hemicrania and
  cramps of the diaphragm and chest-muscles. For about three years I had
  a feeling as if the prostate were enlarged,—a bearing-down feeling, as
  if giving birth to something; and, also, pain in the hips, constant
  pain in the back, and the like. Yet, with the strength of despair, I
  fought against these complaints, which impressed me as being female or
  effeminate, until three years ago, when a severe attack of arthritis
  completely broke me down.

  “But before this terrible attack of gout occurred, in despair, to
  lessen the pain of gout, I had taken hot baths, as near the
  temperature of the body as possible. On one of these occasions it
  happened that I suddenly changed, and seemed to be near death. I
  sprang with all my remaining strength out of the bath: I had felt
  exactly like a woman with libido. Too, at the time when the extract of
  Indian hemp came into vogue, and was highly prized, in a state of fear
  of a threatened attack of gout (feeling perfectly indifferent about
  life), I took three or four times the usual dose of it, and almost
  died of haschisch poisoning. Convulsive laughter, a feeling of unheard
  of strength and swiftness, a peculiar feeling in brain and eyes,
  millions of sparks streaming from the brain through the skin,—all
  these feelings occurred. But I could not force myself to speak. All at
  once I saw myself a woman from my toes to my breast; I felt, as before
  while in the bath, that the genitals had shrunken, the pelvis
  broadened, the breasts swollen out; a feeling of unspeakable delight
  came over me. I closed my eyes, so that at least I did not see the
  face changed. My physician looked as if he had a gigantic potatoe
  instead of a head; my wife had the full moon on her nates. And yet I
  was strong enough to briefly record my will in my note-book when both
  left the room for a short time.

  “But who could describe my fright, when, on the next morning, I awoke
  and found myself feeling as if completely changed into a woman; and
  when, on standing and walking, I felt vulva and mammæ! When at last I
  raised myself out of bed, I felt that a complete transformation had
  taken place in me. During my sickness a visitor said: ‘He is too
  patient for a man.’ And the visitor gave me a plant in bloom, which
  seemed strange, but pleased me. From that time I was patient, and
  would do nothing in a hurry; but I became tenacious, like a cat,
  though, at the same time, mild, forgiving, and no longer bearing
  enmity,—in short, I had a woman’s disposition. During the last
  sickness I had many visual and auditory hallucinations,—spoke with the
  dead, etc.; saw and heard familiar spirits; felt like a double person;
  but, while lying ill, I did not notice that the man in me had been
  extinguished. The change in my disposition was a piece of good fortune
  which came over me like lightning, and which, had it come with me
  feeling as I formerly did, would have killed me; but now I gave myself
  up to it, and no longer recognized myself. Owing to the fact that I
  still often confounded neurasthenic symptoms with the gout, I took
  many baths, until an itching of the skin with the feeling of scabies,
  instead of being diminished, was so increased that I gave up all
  external treatment (I was made more and more anæmic by the baths), and
  hardened myself as best I could. But the imperative female feeling
  remained, and became so strong that I wear only the mask of a man, and
  in everything else feel like a woman; and gradually I have lost memory
  of the former individuality. What was left of me from the gout, the
  influenza ruined entirely.

  “_Present Condition_: I am tall, slightly bald, and the beard is
  growing gray. I begin to stoop. Since having the influenza, I have
  lost about a quarter of my strength. Owing to a valvular lesion, my
  face looks somewhat red; full beard; chronic conjunctivitis; more
  muscular than fat. The left foot seems to be developing varicose
  veins, and it often goes to sleep; but it is not really thickened,
  though it seems to be.

  “The mammary region, though small, swells out perceptibly. The abdomen
  is feminine in form; the feet are placed like a woman’s, and the
  calves, etc., are feminine; and it is the same with arms and hands. I
  can wear ladies’ hose, and gloves, 7½ to 7¾ in size. I also wear a
  corset without annoyance. My weight varies between 168 and 184 pounds.
  Urine without albumen or sugar, but it contains an excess of uric
  acid. But if there is not too much uric acid in it, it is clear, and
  almost as clear as water after any excitement. Bowels usually regular;
  but should they not be, then come all the symptoms of female
  obstipation. Sleep is poor,—for weeks at a time only two or three
  hours long. Appetite quite good; but, on the whole, my stomach will
  not bear more than that of a strong woman, and reacts to irritating
  food with cutaneous eruption and burning in the urethra. The skin is
  white, and, for the most part, feels quite smooth; there has been
  unbearable cutaneous itching for the last two years; but during the
  last few weeks it has diminished, and is now present only in the
  popliteal spaces and on the scrotum.

  “Tendency to perspire. Perspiration was previously as good as wanting,
  but now there are all the odious peculiarities of the female
  perspiration, particularly about the lower part of the body; so that I
  have to keep myself cleaner than a woman. (I perfume my handkerchief,
  and use perfumed soap and _eau-de-Cologne_.)

  “_General Feeling_: I feel like a woman in a man’s form; and even
  though I often am sensible of the man’s form, yet it is always in a
  feminine sense. Thus, for example, I feel the penis as clitoris; the
  urethra as urethra and vaginal orifice, which always feels a little
  wet, even when it is actually dry; the scrotum as labia majora; in
  short, I always feel the vulva. And all that that means one alone can
  know who feels or has felt so. But the skin all over my body feels
  feminine; it receives all impressions, whether of touch, of warmth, or
  whether unfriendly, as feminine, and I have the sensations of a woman.
  I cannot go with bare hands, as both heat and cold trouble me. When
  the time is past when we men are permitted to carry sun-umbrellas, I
  have to endure great sensitiveness of the skin of my face, until
  sun-umbrellas can again be used. On awaking in the morning, I am
  confused for a few moments, as if I were seeking for myself; then the
  imperative feeling of being a woman awakens. I feel the sense of the
  vulva (that one is there), and always greet the day with a soft or
  loud sigh; for I have fear again of the play that must be carried on
  throughout the day. I had to learn everything anew; the
  knife—apparatus, everything—has felt different for the last three
  years; and with the change of muscular sense I had to learn everything
  over again. I have been successful, and only the use of the saw and
  bone-chisel are difficult; it is almost as if my strength were not
  quite sufficient. On the other hand, I have a keener sense of touch in
  working with the curette in the soft parts. It is unpleasant that, in
  examining ladies, I often feel their sensations; but this, indeed,
  does not repel them. The most unpleasant thing I experience is fœtal
  movement. For a long time—several months—I was troubled by reading the
  thoughts of both sexes, and I still have to fight against it. I can
  endure it better with women; with men it is repugnant. Three years ago
  I had not yet consciously seen the world with a woman’s eyes; this
  change in the relation of the eyes to the brain came almost suddenly,
  with violent headache. I was with a lady whose sexual feeling was
  reversed, when suddenly I saw her changed in the sense I now feel
  myself,—viz., she as man,—and I felt myself a woman in contrast with
  her; so that I left her with ill-concealed vexation. At that time she
  had not yet come to understand her own condition perfectly.

  “Since then, all my sensory impressions are as if they were feminine
  in form and relation. The cerebral system almost immediately adjusted
  itself to the vegetative; so that all my ailments were manifested in a
  feminine way. The sensitiveness of all nerves, particularly that of
  the auditory and olfactory and trigeminal, increased to a condition of
  nervousness. If only a window slammed, I was frightened inwardly; for
  a man dare not tremble at such things. If food is not absolutely
  fresh, I perceive a cadaverous odor. I could never depend on the
  trigeminus; for the pain would jump whimsically from one branch of it
  to another; from a tooth to an eye. But, since my transformation, I
  bear toothache and migraine more easily, and have less feeling of fear
  with stenocardia. It seems to me a strange fact that I feel myself to
  be a fearful, weak being, and yet, when danger threatens, I am much
  rather cool and collected; and this is true in dangerous operations.
  The stomach rebels against the slightest indiscretion (in female diet)
  that is committed without thought of the female nature, either by
  ructus or other symptoms; but particularly against abuse of
  alcoholics. The indisposition after intoxication that a man who feels
  like a woman experiences is much worse than any a student could get
  up. It seems to me almost as if one feeling like a woman were entirely
  controlled by the vegetative system.

  “Small as my nipples are, they demand room, and I feel them as mammæ;
  just as during the beginning of puberty, the nipples swelled and
  pained. On this account, the white shirt, the waistcoat, and the coat
  trouble me. I feel as though the pelvis were female; and it is the
  same with the anus and nates. At first the sense of a female abdomen
  was troublesome to me; for it cannot bear trousers, and it always
  possesses or induces the feminine feeling. I also have the imperative
  feeling of a waist. It is as if I were robbed of my own skin, and put
  in a woman’s skin that fitted me perfectly, but which felt everything
  as if it covered a woman; and whose sensations passed through the
  man’s body, and exterminated the masculine element. The testes, even
  though not atrophied or degenerated, are still no longer testes, and
  often cause me pain, with the feeling that they belong in the abdomen,
  and should be fastened there; and their mobility often bothers me.

  “Every four weeks, at the time of the full moon, I have the molimen of
  a woman for five days, physically and mentally, only I do not bleed;
  but I have the feeling of a loss of fluid; a feeling that the genitals
  and abdomen are (internally) swollen. A very pleasant period comes
  when, afterward and later in the interval for a day or two, the
  physiological desire for procreation comes, which with all power
  permeates the woman. My whole body is then filled with this sensation,
  as an immersed piece of sugar is filled with water, or as full as a
  soaked sponge. It is like this: first, a woman longing for love, and
  then, for a man; and, in fact, the desire, as it seems to me, is more
  a longing to be possessed than a wish for coitus. The intense natural
  instinct or the feminine concupiscence overcomes the feeling of
  modesty, so that indirectly coitus is desired. I have never felt
  coitus in a masculine way more than three times in my life; and even
  if it were so in general, I was always indifferent about it. But,
  during the last three years, I have experienced it passively, like a
  woman; in fact, oftentimes with the feeling of feminine ejaculation;
  and I always feel that I am impregnated. I am always fatigued as a
  woman is after it, and often feel ill, as a man never does. Sometimes
  it caused me so great pleasure that there is nothing with which I can
  compare it; it is the most blissful and powerful feeling in the world;
  at that moment the woman is simply a vulva that has devoured the whole
  person.

  “During the last three years I have never lost for an instant the
  feeling of being a woman, and now, owing to habit, this is no longer
  annoying to me, though during this period I have felt debased; for a
  man could endure to feel like a woman without a desire for enjoyment;
  but when desires come! The happiness ceases; then come the burning,
  the heat, the feeling of turgor of the genitals (when the penis is not
  in a state of erection the genitals do not play any part). In case of
  intense desire, the feeling of sucking in the vagina and vulva is
  really terrible—a hellish pain of lust hardly to be endured. If I then
  have opportunity to perform coitus, it is better; but, owing to
  defective sense of being possessed by the other, it does not afford
  complete satisfaction; the feeling of sterility comes with its weight
  of shame, added to the feeling of passive copulation and injured
  modesty. I seem almost like a prostitute. Reason does not give any
  help; the imperative feeling of femininity dominates and rules
  everything. The difficulty in carrying on one’s occupation, under such
  circumstances, is easily appreciated; but it is possible to force
  one’s self to it. Of course, it is almost impossible to sit, walk, or
  lie down; at least, any one of these cannot be endured long; and with
  the constant touch of the trousers, etc., it is unendurable.

  “Marriage then, except during coitus, where the man has to feel
  himself a woman, is like two women living together, one of whom
  regards herself as in the mask of a man. If the periodical molimen
  fail to occur, then come the feelings of pregnancy or of sexual
  satiety, which a man never experiences, but which take possession of
  the whole being, just as the feeling of femininity does, and are
  repugnant in themselves; and, therefore, I gladly welcome the regular
  molimen again. When erotic dreams or ideas occur, I see myself in the
  form I have as a woman, and see erected organs presenting. Since the
  anus feels feminine, it would not be hard to become a passive
  pederast; only positive religious command prevents it, as all other
  deterrent ideas would be overcome. Since such conditions are
  repugnant, as they would be to any one, I have a desire to be sexless,
  or to make myself sexless. If I had been single, I should long ago
  have taken leave of testes, scrotum, and penis.

  “Of what use is female pleasure, when one does not conceive? What good
  comes from excitation of female love, when one has only a wife for
  gratification, even though copulation is felt as though it were with a
  man? What a terrible feeling of shame is caused by the feminine
  perspiration! How the feeling for dress and ornament lowers a man!
  Even in his changed form, even when he can no longer recall the
  masculine sexual feeling, he would not wish to be forced to feel like
  a woman. He still knows very well that, before, he did not constantly
  feel sexually; that he was merely a human being uninfluenced by sex.
  Now, suddenly, he has to regard his former individuality as a mask,
  and constantly feel like a woman, only having a change when, every
  four weeks, he has his periodical sickness, and in the intervals his
  insatiable female desire. If he could but awake without immediately
  being forced to feel like a woman! At last he longs for a moment in
  which he might raise his mask; but that moment does not come. He can
  only find amelioration of his misery when he can put on some bit of
  female attire or finery, an under-garment, etc.; for he dare not go
  about as a woman. To be compelled to fulfill all the duties of a
  calling with the feeling of being a woman costumed as a man, and to
  see no end of it, is no trifle. Religion alone saves from a great
  lapse; but it does not prevent the pain when temptation affects the
  man who feels as a woman; and so it must be felt and endured! When a
  respectable man who enjoys an unusual degree of public confidence, and
  possesses authority, must go about with his vulva—imaginary though it
  be; when one, leaving his arduous daily task, is compelled to examine
  the _toilette_ of the first lady he meets, and criticise her with
  feminine eyes, and read her thoughts in her face; when a journal of
  fashions possesses an interest equal to that of a scientific work (I
  felt this as a child); when one must conceal his condition from his
  wife, whose thoughts, the moment he feels like a woman, he can read in
  her face, while it becomes perfectly clear to her that he has changed
  in body and soul,—what must all this be? The misery caused by the
  feminine gentleness that must be overcome! Oftentimes, of course, when
  I am away alone, it is possible to live for a time more like a woman;
  for example, to wear female attire, especially at night, to keep
  gloves on, or to wear a veil or a mask in my room, so that thus there
  is rest from excessive libido. But when the feminine feeling has once
  gained an entrance, it imperatively demands recognition. It is often
  satisfied with a moderate concession, such as the wearing of a
  bracelet above the cuff; but it imperatively demands some concession.
  My only happiness is to see myself dressed as a woman without a
  feeling of shame; indeed, when my face is veiled or masked, I prefer
  it so, and thus think of myself. Like every one of Fashion’s fools, I
  have a taste for the prevailing mode; so greatly am I transformed. To
  become accustomed to the thought of feeling only like a woman, and
  only to remember the previous manner of thought to a certain extent in
  contrast with it; and, at the same time, to express one’s self as a
  man,—it requires a long time and an infinite amount of persistence.

  “Nevertheless, in spite of everything, it will happen that I betray
  myself by some expression of feminine feeling, either in _sexualibus_,
  when I say that I feel so and so, expressing what a man without the
  female feeling cannot know; or when I accidentally betray that female
  attire is my talent. Before women, of course, this does not amount to
  anything; for a woman is greatly flattered when a man understands
  something of her matters; but this must not be displayed to my own
  wife. How frightened I once was when my wife said to a friend that I
  had great taste in ladies’ dress! How a haughty, stylish lady was
  astonished when, as she was about to make a great error in the
  education of her little daughter, I described to her in writing and
  verbally all the feminine feelings! To be sure, I lied to her, saying
  that my knowledge had been gleaned from letters. But her confidence in
  me is as great as ever; and the child, who was on the road to
  insanity, is rational and happy. She had confessed all the feminine
  inclinations as sins; now she knows what, as a girl, she must bear and
  control by will and religion; and she feels that she is human. Both
  ladies would laugh heartily, if they knew that I had only drawn on my
  own sad experience. I must also add that I now have a finer sense of
  temperature and, besides, a sense of the elasticity of the skin and
  tension of the intestines, etc., in patients, that was unknown to me
  before; that in operations and autopsies, poisonous fluids more
  readily penetrate my (uninjured) skin. Every autopsy causes me pain;
  examination of a prostitute, or a woman having a discharge, a
  cancerous odor, or the like, is actually repugnant to me. In all
  respects I am now under the influence of antipathy and sympathy, from
  the sense of color to my judgment of a person. Women usually see in
  each other the periodical sexual disposition; and, therefore, a lady
  wears a veil, if she is not always accustomed to wear one, and usually
  she perfumes herself, even though it be only with handkerchief or
  gloves; for her olfactory sense in relation to her own sex is intense.
  Odors have an incredible effect on the female organism; thus, for
  example, the odors of violets and roses quiet me, while others disgust
  me; and with ihlang-ihlang I cannot contain myself for sexual
  excitement. Contact with a woman seems homogeneous to me; coitus with
  my wife seems possible to me because she is somewhat masculine, and
  has a firm skin; and yet it is more an _amor lesbicus_.

  “Besides, I always feel passive. Often at night, when I cannot sleep
  for excitement, it is finally accomplished, si femora mea distensa
  habeo, sicut mulier cum viro concumbens, or if I lie on my side; but
  an arm or the bed-clothing must not touch the mammæ, or there is no
  sleep; and there must be no pressure on the abdomen. I sleep best in a
  chemise and night-robe, and with gloves on; for my hands easily get
  cold. I am also comfortable in female drawers and petticoats, because
  they do not touch the genitals. I liked female dresses best when
  crinoline was worn. Female dresses do not annoy the feminine-feeling
  man; for he, like every woman, feels them as belonging to his person,
  and not as something foreign.

  “My dearest associate is a lady suffering with neurasthenia, who,
  since her last confinement, feels like a man, but who, since I
  explained these feelings to her, coitu abstinet as much as possible, a
  thing I, as a husband, dare not do. She, by her example, helps me to
  endure my condition. She has a more perfect memory of the female
  feelings, and has often given me good advice. Were she a man and I a
  young girl, I should seek to win her; for her I should be glad to
  endure the fate of a woman. But her present appearance is quite
  different from what it formerly was. She is a very elegantly dressed
  gentleman, notwithstanding bosom and hair; she also speaks quickly and
  concisely, and no longer takes pleasure in the things that please me.
  She has a kind of melancholy dissatisfaction with the world, but she
  bears her fate worthily and with resignation, finding her comfort only
  in religion and the fulfillment of duty. At the time of the menses,
  she almost dies. She no longer likes female society and conversation,
  and has no liking for delicacies.

  “A youthful friend felt like a girl from the very first, but he had
  inclinations toward the male sex. His sister had the opposite
  condition; and when the uterus demanded its right, and she saw herself
  as a loving woman, in spite of her masculinity, she cut the matter
  short, and committed suicide by drowning.

  “Since complete effemination, the principal changes I have observed in
  myself are:—

  “1. The constant feeling of being a woman from top to toe.

  “2. The constant feeling of having female genitals.

  “3. The periodicity of the monthly molimen.

  “4. The regular occurrence of female desire, though not directed to
  any particular man.

  “5. The passive female feeling in coitus.

  “6. After that, the feeling of impregnation.

  “7. The female feeling in thought of coitus.

  “8. At the sight of women, the feeling of being of their kind, and the
  feminine interest in them.

  “9. At the sight of men, the feminine interest in them.

  “10. At the sight of children, the same feeling.

  “11. The changed disposition and much greater patience.

  “12. The final resignation to my fate, for which I have nothing to
  thank but positive religion; without it I should have long ago
  committed suicide.

  “To be a man and to be compelled to feel that chaque femme est futuée
  ou elle désire d’être, is hardly to be endured.”

The foregoing autobiography, scientifically so important, was
accompanied by the following no less interesting letter:—

  “SIR: I must next beg your indulgence for troubling you with my
  communication. I lost all control, and thought of myself only as a
  monster before which I myself shuddered. Then your work gave me
  courage again; and I determined to go to the bottom of the matter, and
  examine my past life, let the result be what it might. It seemed a
  duty of gratitude to you to tell you the result of my recollection and
  observation, since I had not seen any description by you of an
  analogous case; and, finally, I also thought it might perhaps interest
  you to learn, from the pen of a physician, how such a worthless human,
  or masculine, being thinks and feels under the weight of the
  imperative idea of being a woman.

  “It is not perfect; but I no longer have the strength to reflect more
  upon it, and have no desire to go into the matter more deeply. Much is
  repeated; but I beg you to remember that any mask may be allowed to
  fall off, particularly when it is not voluntarily worn, but enforced.

  “After reading your work, I hope that, if I fulfill my duties as
  physician, citizen, father, and husband, I may still count myself
  among human beings who do not deserve merely to be despised.

  “Finally, I wished to lay the result of my recollection and reflection
  before you, in order to show that one thinking and feeling like a
  woman can still be a physician. I consider it a great injustice to
  debar woman from Medicine. A woman, through her feeling, gets on the
  track of many ailments which, in spite of all skill in diagnosis,
  remain obscure to a man; at least, in the diseases of women and
  children. If I could have my way, I should have every physician live
  the life of a woman for three months; then he would have a better
  understanding and more consideration in matters affecting the half of
  humanity from which he comes; then he would learn to value the
  greatness of women, and appreciate the difficulty of their lot.”

  _Remarks_: The badly-tainted patient is originally psycho-sexually
  abnormal, in that, in character and in the sexual act, he feels as a
  female. This abnormal feeling remained purely a psychical anomaly
  until three years ago, when, owing to severe neurasthenia, it received
  overmastering support in imperative bodily sensations of a
  _transmutatio sexus_, which now dominate consciousness. Then, to the
  patient’s horror, he felt bodily like a woman; and, under the impulse
  of his imperative feminine sensations, he experienced a complete
  transformation of his former masculine feeling, thought, and will; in
  fact, of his whole vita sexualis, in the sense of eviration. At the
  same time, his ego is able to control these abnormal psycho-physical
  manifestations, and prevent descent to paranoia,—a remarkable example
  of imperative feelings and ideas on the basis of neurotic taint, which
  is of great value for a comprehension of the way in which the
  psycho-sexual transformation may be accomplished.

_IV. Degree: Metamorphosis Sexualis Paranoica._—A final possible stage
in this disease-process is the delusion of a transformation of sex. It
arises on the basis of sexual neurasthenia that has developed into
neurasthenia universalis, resulting in a mental disease,—paranoia.

The following cases show the development of the interesting
neuro-psychological process to its height:—

  Case 100. K., aged 36, single, servant, received at the clinic on
  February 26, 1889, is a typical case of paranoia persecutoria,
  resulting from neurasthenia sexualis, with olfactory hallucinations,
  sensations, etc. He comes of a predisposed family. Several brothers
  and sisters were psychopathic. Patient has an hydrocephalic skull,
  depressed in the region of the right fontanelle; eyes neuropathic. He
  has always been very sensual; began to masturbate at nineteen; had
  coitus at twenty-three; begat three illegitimate children. He gave up
  further sexual intercourse, on account of fear of begetting more
  children, and of being unable to provide for them. Abstinence proved
  very painful to him. He also gave up masturbation, and was then
  troubled with pollutions. A year and a half ago he became sexually
  neurasthenic, had diurnal pollutions, became thereafter ill and
  miserable, and, after a time, generally neurasthenic, finally
  developing paranoia. A year ago he began to have paræsthetic
  sensations,—as if there were a great coil in the place of his
  genitals; and then he felt that his scrotum and penis were gone, and
  that his genitals were changed into those of a female. He felt the
  growth of his breasts; that his hair was that of a woman; and that
  feminine garments were on his body. He thought himself a woman. The
  people in the street gave utterance to corresponding remarks: “Look at
  the woman! The old blowhard!” In a half dreamy state, he had the
  feeling as if he played the part of a woman in coitus with a man.
  During it he had the most lively feelings of pleasure. During his stay
  at the clinic, a remission of the paranoia occurred, and, at the same
  time, a marked improvement of the neurasthenia. Then the feelings and
  ideas due to a developing metamorphosis sexualis disappeared.

A more advanced case of eviration, on the way to a transformatio sexus
paranoica, is the following:—

  Case 101. Franz St., aged 33; school-teacher; single; probably of
  tainted family; always neuropathic; emotional, timid, intolerant of
  alcohol; began to masturbate at eighteen. At thirty there were
  manifestations of neurasthenia sexualis (pollutions with consequent
  fatigue, which at last began to occur during the day; pain in the
  region of the sacral plexus, etc.). Gradually, spinal irritation,
  pressure in the head, and cerebral neurasthenia were added. Since the
  beginning of 1885 the patient had given up coitus, in which he no
  longer experienced pleasurable feeling. He masturbated frequently.

  In 1888 he began to have delusions of suspicion. He noticed that he
  was avoided, and that he had unpleasant odors about him (olfactory
  hallucinations). In this way he explained the altered attitude of
  people, and their sneezing, coughing, etc. He smelled corpses and foul
  urine. He recognized the cause of his bad smells in inward pollutions.
  He recognized these in a feeling he had as if a fluid flowed up from
  the symphysis toward the breast. Patient soon left the clinic.

  In 1889 he was again received in an advanced stage of paranoia
  masturbatoria persecutoria (delusions of physical persecution).

  In the beginning of May, 1889, the patient attracted notice, in that
  he was cross when he was addressed as “mister.” He protested against
  it, because he was a woman. Voices told him this. He noticed that his
  breasts were growing. Some weeks before, others had touched him in a
  sensual manner. He heard it said that he was a whore. Of late, dreams
  of pregnancy. He dreamed that, as a woman, he indulged in coitus. He
  felt the immissio penis, and, during the hallucinatory act, also a
  feeling of ejaculation.

  Head straight; facial form long and narrow; parietal eminences
  prominent; genitals normally developed.

The following case, observed in the asylum at Illenau, is a pertinent
example of lasting delusional alteration of sexual consciousness:—

  Case 102. _Metamorphosis Sexualis Paranoica._—N., aged 23, single,
  pianist, was received in the asylum at Illenau in the last part of
  October, 1865. He came of a family in which there was said to be no
  hereditary taint; but it was tuberculous (father and brother died of
  pulmonary tuberculosis). Patient, as a child, was weakly and dull,
  though especially talented in music. He was always of abnormal
  character; silent, retiring, unsocial, and sullen. He practiced
  masturbation after fifteen. After a few years neurasthenic symptoms
  (palpitation of the heart, lassitude, occasional pressure in the head,
  etc.), and also hypochondriacal symptoms, were manifested. During the
  last year he had worked with great difficulty. For about six months
  neurasthenia had increased. He complained of palpitation of the heart,
  pressure in the head, and sleeplessness; was very irritable, and
  seemed to be sexually excited. He declared that he must marry for his
  health. He fell in love with an artist, but almost at the same time
  (September, 1865) he fell ill with paranoia persecutoria (ideas of
  enemies, derision in the street, poison in food; obstacles were placed
  on the bridges to keep him from going to his _inamorata_). On account
  of increasing excitement and conflicts with those about him that he
  considered inimical to him, he was taken to the asylum. At first he
  presented the picture of a typical paranoia persecutoria with symptoms
  of sexual, and later general, neurasthenia, though the delusions of
  persecution did not rest upon this neurotic foundation. It was only
  occasionally that the patient heard such sentences as this: “Now the
  semen will be drawn out of him. Now the bladder will be cut out.”

  In the course of the years 1866–68, the delusions of persecution
  became less and less apparent, and were for the most part replaced by
  erotic ideas. The somatic and mental basis was a lasting and powerful
  excitation of the sexual sphere. The patient fell in love with every
  woman he saw, heard voices which told him to approach her, and begged
  to be allowed to marry, declaring that, if he was not given a wife, he
  would waste away. With continuance of masturbation, in 1869, signs of
  future effemination made themselves manifest. “He would, if he should
  get a wife, love her only platonically.” The patient grows more and
  more peculiar, lives in a circle of erotic ideas, sees prostitution
  practiced in the asylum, and now and then hears voices which impute
  immoral conduct with women to him. For this reason he avoids the
  society of women, and only associates with them for the sake of music
  when two witnesses are with him.

  In the course of the year 1872, the neurasthenic condition became
  markedly increased. Now paranoia persecutoria again comes into the
  foreground, and takes on a clinical coloring from the neurotic basis.
  Olfactory hallucinations occur. Magnetic influences are at work on him
  (false interpretation of sensations due to spinal asthenia). With
  continued and intense sexual excitement and excess in masturbation,
  the process of effemination constantly progresses. Only episodically
  is he a man and inclined toward a woman, complaining that the
  shameless prostitution of the men in the house makes it impossible for
  a lady to come to him. He is dying of magnetically poisoned air and
  unsatisfied love. Without love he cannot live. He is poisoned by lewd
  poison that affects his sexual desire. The lady that he loves is sunk
  in the lowest vice. The prostitutes in the house have fortune-chains;
  that is, chains in which, without moving, a man can indulge in lustful
  pleasure. He is ready now to satisfy himself with prostitutes. He is
  possessed of a wonderful ray of thought that emanates from his eyes,
  which is worth twenty millions. His compositions are worth 500,000
  francs. With these indications of delusions of grandeur, there are
  also those of persecution—the food is poisoned by venereal excrement;
  he tastes and smells poison, hears infamous accusations, and asks for
  instruments to close his ears. From August, 1872, however, the signs
  of effemination become more and more frequent. He acts somewhat
  affected, declaring that he can no longer live among men that drink
  and smoke. He thinks and feels like a woman. He must thenceforth be
  treated like a woman and transferred to a female ward. He asks for
  confections and delicate desserts. Occasionally, on account of
  tenesmus and cystospasm, he asks to be transferred to a lying-in
  hospital and treated as a woman very ill in pregnancy. The abnormal
  magnetism of masculine attendants has an unfavorable effect on him. At
  times he still feels himself to be a man, but in a way which indicates
  his abnormally altered sexual feeling. He pleads only for satisfaction
  by means of masturbation, or for marriage without coitus. Marriage is
  a sensual institution. The girl that he would take for a wife must be
  a masturbator. About the end of December, 1872, his personality became
  completely feminine. From that time he remained a woman. He had always
  been a woman, but in his babyhood a French Quaker, an artist, had put
  masculine genitals on him, and by rubbing and distorting his thorax
  had prevented the development of his breasts. After this he demanded
  to be transferred to the female department, protection from men that
  wished to violate him, and asked for female clothing. Eventually he
  also desired to be given employment in a toy-shop, with crocheting and
  embroidery work to do, or a place in a dress-making establishment with
  female work. From the time of the transformatio sexus, the patient
  begins a new reckoning of time. He conceives his previous personality
  in memory as that of a cousin.

  He always speaks of himself in the third person, and calls himself the
  Countess V., the dearest friend of the Empress Eugenie; asks for
  perfumes, corsets, etc. He takes the other men of the ward for girls,
  tries to raise a head of hair, and demands “Oriental Hair-Remover,” in
  order that no one may doubt his gender. He takes delight in praising
  onanism, for “she had been an onanist from fifteen, and had never
  desired any other kind of sexual satisfaction.” Occasionally
  neurasthenic symptoms, olfactory hallucinations, and persecutory
  delusions are observed. All the events up to the time of December,
  1872, belong to the personality of the cousin.

  The patient’s delusion that he is the Countess V. can no longer be
  corrected. She proves her identity by the fact that the nurse has
  examined her, and finds her to be a lady. The countess will not marry,
  because she hates men. Since he is not provided with female clothing
  and shoes, he spends the greatest part of the day in bed, acts like an
  invalid lady of position, affectedly and modestly, and asks for
  bon-bons and the like. His hair is done, up in a knot as well as it
  allows, and the beard is pulled out. Breasts are made out of biscuits.

  In 1874 caries began in the left knee-joint, to which pulmonary
  tuberculosis was soon added. Death on December 2, 1874. Skull normal.
  Frontal lobes atrophic. Brain anæmic. Microscopical (Dr. Schüle): In
  the superior layer of the frontal lobe, ganglion cells somewhat
  shrunken; in the adventitia of the vessels, numerous fat-corpuscles;
  glia unchanged; isolated pigment particles and colloid bodies. The
  lower layers of the cortex normal. Genitals very large; testicles
  small, lax, and show no change macroscopically on section.

The delusion of sexual transformation, displayed, in its conditions and
phases of development, in the foregoing case, is a manifestation
remarkably infrequent in the pathology of the human mind. Besides the
foregoing cases, personally observed, I have seen such a case, as an
episodical phenomenon, in a lady having contrary sexuality (Case 92 of
the sixth edition of this work), one in a girl affected with original
paranoia, and another in a lady suffering with original paranoia.

Save for a case briefly reported by Arndt, in his text-book (p. 172),
and one quite superficially described by Sérieux (“Recherches Clinique,”
p. 33), and the two cases known to Esquirol, I cannot recall any cases
of delusion of sexual transformation in literature. Arndt’s case may be
briefly given here, though, like Esquirol’s cases, it gives nothing
concerning the genesis of the delusion:—

  Case 103. A middle-aged woman in the asylum at Greifswald thought she
  was a man, and acted out her belief. She cut her hair short, and
  parted it on one side in the military fashion. A sharply-cut profile,
  a nose somewhat large, and a certain heaviness of all the features
  gave the face something characteristic, and, in combination with the
  short hair combed smoothly over the ears, gave the whole head a
  decidedly masculine appearance. She was tall and lean; her voice low
  and rough; the larynx angularly prominent; her attitude erect; her
  gait, like all her movements, heavy, but not awkward. She looked like
  a man in female dress. Asked how she had come to think she was a man,
  she would almost always cry excitedly: “Just look at me! Don’t I look
  like a man? I feel like a man, too. I have always felt so, but I only
  gradually came to understand it clearly. The man who should be my
  husband is not a real man. I raised my children myself. I always felt
  somewhat like this, but I came to understand later. Did I not always
  work like a man? The man who passed for my husband only helped. He did
  what I planned. From my youth I have been more masculine than
  feminine. I have always had more liking for the garden and farm than
  for work in the house and kitchen. But I never understood the reason.
  Now I know I am a man, and I shall bear myself like one. It is a shame
  to make me always wear women’s clothes.”

  Case 104. X., aged 26, tall, and of handsome appearance. Since his
  earliest youth he has loved to wear female attire. As he grew up, he
  managed it so that, when he was a participant in theatricals, he
  always had a female part. After an attack of mental excitement, he
  imagined that he was actually a woman, and tried to convince others of
  it.

  He liked to undress himself, and dress his hair and put on female
  clothing. In this state he wished to go out on the street. In other
  respects he was perfectly reasonable. He would spend the whole day
  arranging his hair and looking at himself in the glass, costuming
  himself in a night-dress as much like a woman as possible. In walking
  he imitated women. One day, when Esquirol acted as if about to lift up
  his dress, he flew into a passion and upbraided him for his want of
  modesty (Esquirol).

  Case 105. Mrs. X., widow. Owing to the death of her husband and loss
  of fortune, she had been greatly troubled in mind. She became
  disturbed mentally, and was admitted to the Salpêtrière after
  attempting suicide.

  Mrs. X., lean, thin; constantly maniacal; she believes herself a man,
  and flies angry if she is addressed as “madam.” Once, when male
  clothing was placed at her disposal, she was beside herself with joy.
  She died, in 1802, of a consumptive malady; and she expressed her
  delusion of being a man until shortly before her death (Esquirol).

I have already mentioned the interesting relations existing between the
facts of delusional transformation of sex and the so-called insanity of
the Scythians.

Marandon (“Annales médico-psychologiques,” 1877, p. 161), like others,
has erroneously presumed that with the ancient Scythians there was an
actual delusion, and that the condition was not merely that of
eviration. According to the law of empirical actuality, the delusion, so
infrequent to-day, must also have been very infrequent in ancient times.
Since it can only be conceived as arising on the basis of a paranoia,
there can be no thought of its endemic occurrence; it can only be
regarded as a superstitious manifestation of eviration (the result of
anger of the goddess), as is also evident from the statements of
Hippocrates.

The facts of the so-called Scythian insanity, as well as the facts
lately learned about the Pueblo Indians, are also noteworthy
anthropologically, in that atrophy of the testes and genitals in
general, and approximation to the female type, physically and mentally,
were observed. This is the more remarkable, since, in men who have lost
their procreative organs, such a reversal of instinct is quite as
unusual as in women, mutatis mutandis, after the natural or artificial
climacteric.

B. _Homo-Sexual Feeling as an Abnormal Congenital
Manifestation._[105]—The essential feature of this strange manifestation
of the sexual life is the want of sexual sensibility for the opposite
sex, even to the extent of horror, while sexual inclination and impulse
toward the same sex are present. At the same time, the genitals are
normally developed, the sexual glands perform their functions properly,
and the sexual type is completely differentiated.

Feeling, thought, will, and the whole character, in cases of the
complete development of the anomaly, correspond with the peculiar sexual
instinct, but not with the sex which the individual represents
anatomically and physiologically. This abnormal mode of feeling may not
infrequently be recognized in the manner, dress, and calling of the
individuals, who may go so far as to yield to an impulse to don the
distinctive clothing corresponding with the sexual _rôle_ in which they
feel themselves to be.

Anthropologically and clinically, this abnormal manifestation presents
various degrees of development:—

1. Traces of hetero-sexual, with predominating homo-sexual, instinct
(psycho-sexual hermaphroditism).

2. There exists inclination only toward the same sex (homo-sexuality).

3. The entire mental existence is altered to correspond with the
abnormal sexual instinct (effemination and viraginity).

4. The form of the body approaches that which corresponds to the
abnormal sexual instinct. However, actual transitions to hermaphrodites
never occur, but, on the contrary, completely differentiated genitals;
so that, just as in all pathological perversions of the sexual life, the
cause must be sought in the brain (androgyny and gynandry).

  The first definite communications[106] concerning this enigmatical
  phenomenon of Nature are made by Caspar (“Ueber Nothzucht und
  Päderastie,” Caspar’s _Vierteljahrsschrift_, 1852, i), who, it is
  true, classes it with pederasty, but makes the pertinent remark that
  this anomaly is, in most cases, congenital, and, at the same time, to
  be regarded as a mental hermaphroditism. There exists here an actual
  disgust of sexual contact with women, while the imagination is filled
  with beautiful young men, and with statues and pictures of them. It
  did not escape Casper that in such cases emissio penis in anum
  (pederasty) is not the rule, but that, by means of other sexual acts
  (mutual onanism), sexual satisfaction is sought and obtained.

  In his “Clinical Novels” (1863, p. 33) Casper gives the interesting
  confession of a man showing this perversion of the sexual instinct,
  and does not hesitate to assert that, aside from vicious imagination
  and vice, as a result of over-indulgence in normal sexual intercourse,
  there are numerous cases in which pederasty has its origin in a
  remarkable, obscure impulse, which is congenital and inexplicable.
  About the middle of the “sixties,” a certain assessor, Ulrichs,
  himself subject to this perverse instinct, came out and declared, in
  numerous articles,[107] that the sexual mental life was not connected
  with the bodily sex; that there were male individuals that felt like
  women toward men (“anima muliebris in corpore virili inclusa”). He
  called these people “_urnings_,” and demanded nothing less than the
  legal and social recognition of this sexual love of the urnings as
  congenital and, therefore, as right; and the permission of marriage
  among them. Ulrichs failed, however, to prove that this certainly
  congenital and paradoxical sexual feeling was physiological, and not
  pathological.

  Griesinger (_Archiv f. Psychiatrie_, i, p. 651) threw the first ray of
  light on these facts, anthropologically and clinically, by pointing
  out the marked hereditary taint of the individual, in a case which
  came under his own observation.

  We have Westphal (_Archiv f. Psychiatrie_, ii, p. 73) to thank for the
  first systematic consideration of the manifestation in question, which
  he defined as “congenital reversal of the sexual feeling, with
  consciousness of the abnormality of the manifestation,” and designated
  with the name, since generally accepted, of _contrary sexual
  instinct_. At the same time, he began a series of cases,[108] which,
  up to this time, has reached ninety-three, those reported in this
  monograph not being included.

  Westphal leaves it undecided as to whether contrary sexual feeling is
  a symptom of a neuropathic or of a psychopathic condition, or whether
  it may occur as an isolated manifestation. He holds fast to the
  opinion that the condition is congenital.

From the cases published up to 1877, I have designated this peculiar
sexual feeling as a functional sign of degeneration, and as a partial
manifestation of a neuro-psychopathic state, in most cases hereditary,—a
supposition which has found renewed confirmation in a consideration of
additional cases. The following peculiarities may be given as the signs
of this neuro-psychopathic taint:—

1. The sexual life of individuals thus organized manifests itself, as a
rule, abnormally early, and thereafter with abnormal power. Not
infrequently still other perverse manifestations are presented besides
the abnormal method of sexual satisfaction, which in itself is
conditioned by the peculiar sexual feeling.

2. The psychical love manifest in these men is, for the most part,
exaggerated and exalted in the same way as their sexual instinct is
manifested in consciousness, with a strange and even compelling force.

3. By the side of the functional signs of degeneration attending
contrary sexual feeling are found other functional, and in many cases
anatomical, evidences of degeneration.

4. Neuroses (hysteria, neurasthenia, epileptoid states, etc.) co-exist.
Almost always the existence of temporary or lasting neurasthenia may be
proved. As a rule, this is constitutional, having its root in congenital
conditions. It is awakened and maintained by masturbation or enforced
abstinence.

In male individuals, owing to these practices or to congenital
disposition, there is finally neurasthenia sexualis, which manifests
itself essentially in irritable weakness of the ejaculation centre. Thus
it is explained that, in most of the cases, simply embracing and
kissing, or even only the sight of the loved person, induce the act of
ejaculation. Frequently this is accompanied by an abnormally powerful
feeling of lustful pleasure, which may be so intense as to suggest a
feeling of magnetic currents passing through the body.

5. In the majority of cases, psychical anomalies (brilliant endowment in
art, especially music, poetry, etc., by the side of bad intellectual
powers or original eccentricity) are present, which may even go so far
as pronounced conditions of mental degeneration (dementia, moral
insanity).

In many urnings, either temporarily or permanently, insanity of a
degenerative character (pathological emotional states, periodical
insanity, paranoia, etc.) makes its appearance.

6. In almost all cases where an examination of the physical and mental
peculiarities of the ancestors and blood-relations has been possible,
neuroses, psychoses, degenerative signs, etc., have been found in the
families.[109]

The depth of congenital contrary feeling is shown by the fact that the
lustful dream of the male-loving urning has for its content only male
individuals; that of the female-loving woman, only female individuals,
with corresponding situations.

The observation of Westphal, that the consciousness of one congenitally
defective in sexual desires toward the opposite sex is painfully
affected by the impulse toward the same sex, is true in only a number of
cases. Indeed, in many instances, the consciousness of the abnormality
of the condition is wanting. The majority of urnings are happy in their
perverse sexual feeling and impulse, and unhappy only in so far as
social and legal barriers stand in the way of the satisfaction of their
instinct toward their own sex.

The study of contrary sexual feeling points directly to anomalies of the
cerebral organization of the affected individuals. Gley (_Revue
philosoph._, January, 1884) believes that he is able to solve the riddle
by the theory that the individuals have a female brain and male sexual
glands; and, further, that pathological brain conditions determine the
sexual life, while normally the sexual organs determine the sexual
functions of the brain.

One of my patients offered me an interesting theory in explanation of
original contrary sexual instinct. He started with the actual
bi-sexuality shown by the fœtus anatomically up to a certain age. While
normally the organs which attain complete development exclusively
condition and determine the sexual type, and the influence of the
opposite organs, which remain rudimentary, is _nil_, it is conceivable
that, under the influence of a factor inimical to the normal development
of the brain (hereditary taint, etc.), these rudimentary organs likewise
exercise an influence which, under certain circumstances, may be even
greater than that of the fully developed organs which determine the
external sexual type.

In a similar manner, Kiernan (_Medical Standard_, 1888) and G. Frank
Lydston (_Phila. Med. and Surg. Reporter_, 1888) attempt to explain a
part of the cases of congenital sexual paranoia. Magnan, too (_Ann. méd.
psychol._, 1885, p. 458), writes, in all earnestness, of the brain of a
woman in the body of a man, and _vice versâ_.[110]

The attempted explanations of congenital urnings are not less
superficial; for instance, that of Ulrichs, who, in his “Memnon,” 1868,
speaks of an “anima muliebris virili corpore inclusa (virili corpori
innata),” and thus tries to explain the congenital origin and the female
character of his abnormal sexual instinct. The idea of the patient, the
subject of Case 124, is original. He supposes that when his father begat
him he thought to beget a girl, but, instead of a girl, a boy resulted.
One of the strangest explanations of congenital contrary sexual feeling
is made by Mantegazza (_op. cit._, p. 106, 1886).

According to this author, in such individuals there exist anatomical
anomalies which, by an error of Nature, consist in a distribution to the
rectum of the nerves intended for the genitals; so that only in this
situation the lustful sensation is aroused which otherwise results from
stimulation of the genitals. But how does this author, in other ways so
acute, explain the great majority of cases, where pederasty is abhorred
by those affected with contrary sexual feeling? Besides, Nature never
makes such leaps. Mantegazza rests his hypothesis upon the statements of
an acquaintance, a celebrated writer, who assured him that he was not
sure that he took a greater pleasure in coitus than in defecation!
Allowing the correctness of his experience, still it would only prove
that the man was sexually abnormal, and that his pleasure in coitus was
reduced to a minimum.

An explanation of congenital contrary sexual feeling may perhaps be
found in the fact that it represents a peculiarity bred in descendants,
but arising in ancestry. The hereditary factor might be an _acquired_
abnormal inclination for the same sex in the ancestors (_v. infra_),
found fixed as a congenital abnormal manifestation in the descendants.
Since, according to experience, acquired physical and mental
peculiarities, not simply improvements, but essentially defects, are
transmitted, this hypothesis becomes tenable. Since individuals affected
with contrary sexual feeling not infrequently beget children,—at least,
they are not absolutely impotent (women never are),—a transmission to
descendants is possible.

This supposition is decidedly favored by Case 124, in which the
eight-year-old daughter of an individual affected with contrary sexual
feeling, practiced mutual masturbation—a sexual act—at an age which
permits the presumption of contrary sexual feeling. No less significant
is the communication made to me by a young man of twenty-six, who
belongs to the third group of contrary sexuality. He knew with certainty
that his father, who had died some years before, was also subject to
contrary sexuality. An informant assured me, at least, that he knew many
other men with whom his father had sustained “relations.” Whether, in
the case of the father, it was an acquired or a congenital contrary
sexual instinct, and to what group he belonged, could not be
ascertained.

The foregoing hypothesis seems the more plausible, when it is considered
that the first three degrees of congenital contrary sexual instinct
correspond exactly with the developmental stages which are discoverable
in the development of the acquired anomaly. One, therefore, feels
inclined to designate the various degrees of congenital contrary sexual
instinct as various degrees of an hereditarily-induced sexual anomaly,
acquired from the progenitors or otherwise developed. Here, too, the law
of progressive heredity must be taken into consideration.

The sexual acts, by means of which male urnings seek and find
satisfaction, are multifarious. There are individuals, of fine feeling
and strength of will, who sometimes satisfy themselves with platonic
love, with the risk, however, of becoming nervous (neurasthenic) and
insane, as a result of this enforced abstinence. In other instances, for
the same reasons which may lead normal individuals to avoid coitus,
onanism, _faut de mieux_, is indulged in.

In urnings with nervous systems congenitally irritable, or injured by
onanism (irritable weakness of the ejaculation centre), simple embraces
or caresses, with or without contact of the genitals, are sufficient to
induce ejaculation and consequent satisfaction. In less irritable
individuals, the sexual act consists of manustupration by the loved
person, or mutual onanism, or imitation of coitus between the thighs. In
urnings morally perverse and potent, quoad erectionem, the sexual desire
is satisfied by pederasty,—an act, however, which is repugnant to
perverted individuals that are not defective morally, much in the same
way as it is to normal men. The statement of urnings is remarkable, that
the sexual act with persons of the same sex, which is adequate for them,
gives them a feeling of great satisfaction and accession of strength,
while satisfaction by solitary onanism, or by enforced coitus with a
woman, affects them in an unfavorable way, making them miserable and
increasing their neurasthenic symptoms. The manner of satisfaction of
the female urning is little known. In one of my cases, the girl
masturbated, and during the act felt herself to be a man; and her fancy
created a beloved female person. In another case, the act consisted of
practicing onanism on the person loved, and fondling her genitals.

_Amor lesbicus_ is presumably not infrequent here, for which an enlarged
clitoris or an artificial priapus may be used.

As to the frequency[111] of the occurrence of the anomaly, it is
difficult to reach a just conclusion, since those affected with it break
from their reserve only very infrequently; and in criminal cases the
urning with perversion of sexual instinct is usually classed with the
person given to pederasty for simply vicious reasons. According to
Casper’s and Tardieu’s, as well as my own, experience, this anomaly is
much more frequent than reported cases would lead us to presume.

Ulrichs (“Kritische Pfeile,” p. 2, 1880) declares that, on an average,
there is one person affected with contrary sexual instinct to every two
hundred mature men, or to every eight hundred of the population; and
that the percentage among the Magyars and South Slavs is still
greater,—statements which may be regarded as untrustworthy. The subject
of one of my cases knows personally, at his home (13,000 inhabitants),
fourteen urnings. He further declares that he is acquainted with at
least eighty in a city of 60,000 inhabitants. It is to be presumed that
this man, otherwise worthy of belief, makes no distinction between the
congenital and the acquired anomaly.

1. _Psychical Hermaphroditism._[112]—The characteristic mark of this
degree of inversion of the sexual instinct is that, by the side of the
pronounced sexual instinct and desire for the same sex, a desire toward
the opposite sex is present; but the latter is much weaker and is
manifested episodically only, while the homo-sexuality is primary, and,
in time and intensity, forms the most striking feature of the vita
sexualis.

The hetero-sexual instinct may be but rudimentary, manifesting itself
simply in unconscious (dream) life; or (episodically, at least) it may
be powerfully exhibited.

The sexual instinct toward the opposite sex may be strengthened by the
exercise of will and self-control; by moral treatment, and possibly by
hypnotic suggestion; by improvement of the constitution and the removal
of neuroses (neurasthenia); but especially by abstinence from
masturbation. However, there is always the danger that homo-sexual
feelings, in that they are the most powerful, may become permanent, and
lead to enduring and exclusive contrary sexual instinct. This is
especially to be feared as a result of the influences of masturbation
(just as in acquired inversion of the sexual instinct) and its
neurasthenia and consequent exacerbations; and, further, it is to be
found as a consequence of unfavorable experiences in sexual intercourse
with persons of the opposite sex (defective feeling of pleasure in
coitus, failure in coitus on account of weakness of erection and
premature ejaculation, infection). On the other hand, it is possible
that æsthetic and ethical sympathy with persons of the opposite sex may
favor the development of hetero-sexual desires. Thus it happens that the
individual, according to the predominance of favorable or unfavorable
influences, experiences now hetero-sexual, now homo-sexual, feeling.

It seems to me probable that such hermaphrodites from constitutional
taint are not infrequent.[113] Since they attract very little attention
socially, and since such secrets of married life are only exceptionally
brought to the knowledge of the physician, it is at once apparent why
this interesting and practically important transitional group to the
group of absolute contrary sexuality, has thus far escaped scientific
investigation. Many cases of frigiditas uxoris and mariti may possibly
depend upon this anomaly. Sexual intercourse with the opposite sex is,
in itself, possible. At any rate, in cases of this degree, no horror
sexus alterius exists. Here is a fertile field for the application of
medical and moral therapeutics (_v. infra_). The differential diagnosis
from acquired contrary sexual instinct may present difficulties; for in
such cases, as long as the vestiges of a normal sexual instinct are not
absolutely lost, the actual symptoms are the same (_v. infra_). In the
first degree, the sexual satisfaction of homo-sexual impulses consists
in passive and mutual onanism and coitus inter femora.

  Case 106. _Psychical Hermaphroditism in a Lady._—Mrs. M., aged 44,
  exemplifies the fact that an inverted and a normal sexual instinct may
  be united in one person, be it in man or woman. The father of this
  lady was very musical, and very talented as an artist. He took life
  easily; and to his extraordinary beauty was added a great admiration
  for the opposite sex. After several apoplectic attacks, he died
  demented in an asylum. Father’s brother was neuro-psychopathic, and
  when a child was a somnambulist; and all his life he was afflicted
  with hyperæsthesia sexualis. Thus, although married and the father of
  married sons, he tried to seduce his niece, Mrs. M., with whom he was
  wildly in love, when she was eighteen years old. Father’s father was
  very eccentric and a distinguished actor. He first studied theology,
  but, as a result of partiality for the dramatic muse, he became an
  actor and singer. He committed excesses in baccho et venere; was a
  spendthrift and luxurious. He died at forty-nine, of apoplexia
  cerebri. Mother’s father and mother died of tuberculosis of the lungs.

  Mrs. M. was one of eleven children, of whom six are still living. Two
  brothers, who resembled the mother physically, died, at sixteen and
  twenty, of tuberculosis. A brother suffers with laryngeal phthisis.
  Four living sisters and Mrs. M. resemble the father physically, and
  the eldest is unmarried, very nervous, and shy of people. Two younger
  sisters are married, healthy, and have healthy children. The other is
  unmarried, and suffers with nervous complaints. Mrs. M. has four
  children, several of whom are delicate and neuropathic.

  The patient can tell nothing of importance concerning her childhood.
  She learned easily, and was æsthetically and poetically inclined. She
  was considered a little high-strung, and too much given to
  novel-reading and sentimentality. Her constitution was neuropathic,
  and she was extremely sensitive to changes of temperature, sometimes
  having annoying cutis anserina as a result of slight draughts. It is
  remarkable that one day, when she was about ten years old, she thought
  that her mother no longer loved her; and she put matches in her coffee
  to make herself really sick, that she might thus excite her mother’s
  love for her.

  Puberty began, without difficulty, at the age of eleven. Thereafter
  the menses were regular. Before the time of puberty sexuality
  manifested itself, and, according to the opinion of the patient, its
  promptings have been abnormally intense all her life. The first
  feelings and impulses were decidedly inverted. She conceived a
  passionate but platonic love for a young lady. She wrote verses and
  sonnets to her, and was perfectly happy if she could admire “the
  entrancing charms” of her goddess in the bath, or steal a glimpse of
  her neck, shoulders, and breast while she was dressing. The wild
  impulse to touch these physical charms was always overcome. While a
  young girl, she had actually been in love with Madonnas of Raphael and
  Guido Reni. In all kinds of weather she would run after pretty girls
  and ladies for hours at a time, admiring their beauty, losing no
  opportunity to please them, offering them bouquets, etc. The patient
  asserted that, until the age of nineteen, she was absolutely without a
  suspicion of a difference of sex; because she had been educated as in
  a cloister by a very prudish aunt, who was an old maid. As a result of
  this great ignorance, the patient became the victim of a man who was
  passionately in love with her, and who had coitus with her by means of
  stratagem. She became the wife of this man, bore one child, and lived
  an “eccentric” sexual life with him. She felt perfectly satisfied with
  married intercourse. After a few years she became a widow. Since then,
  women have again been the object of her love, primarily, as the
  patient thinks, from fear of the results of sexual intercourse with a
  man.

  At twenty-seven, second marriage, without love, to a phthisical
  husband. Patient was three times confined, and fulfilled her maternal
  duties. Her physical health failed, and in the later years of this
  married life she had an increasing aversion for her husband, partly
  due to a sense of his disease, though, at the same time, there was
  constantly present an intense desire for sexual indulgence.

  Three years after the death of her second husband, the patient
  discovered the fact that her nine-year-old daughter, by her first
  husband, was given to masturbation, and that she was failing in
  physical health. The patient read of this vice, and could not overcome
  the impulse to indulge in the practice, becoming, in consequence, an
  onanist. She is unable to bring herself to give the details of this
  period of her life. She says that she was frightfully excited
  sexually, and had to send her daughters from home to save them from
  terrible consequences; but the two boys she was able to keep at home.

  Patient became neurasthenic ex masturbatione (spinal irritation,
  feeling of pressure in head, weariness, lack of mental control), and,
  at times, had dysthymia and painful tædium vitæ. Her sexual feeling
  would be directed at one time to women, at another to men. She was
  able to restrain herself, and suffered much from abstinence,
  especially because, on account of her neurasthenic troubles, she
  sought to obtain relief in masturbation, though only in case of great
  necessity. At the present time, though forty-four years old, and
  menstruating regularly, she suffers intensely with a passion for a
  young man whose presence she cannot avoid on account of the exigencies
  of occupation.

  Patient presents nothing remarkable in external appearance. She is
  gracefully formed, but the muscular system is not strongly developed.
  Pelvis is, in all respects, that of a female, but the arms and legs
  are decidedly large and of masculine form. Ladies’ shoes do not fit
  her, but, being opposed to exciting attention, she forces her feet
  into female shoes, and they are, therefore, much deformed. Genitals
  normally developed, and present no other abnormality than descent of
  the uterus, with hypertrophy of the vaginal portion. On thorough
  examination it is seen that the patient is essentially homo-sexual,
  and that the desire for the opposite sex is but episodical and
  sensual. Thus, at present, she suffers intensely with sexual desires
  for every man with whom she comes in contact, but it is a more refined
  and higher pleasure for her to imprint a kiss on the soft, round cheek
  of a maiden. This pleasure is one she often enjoys, because she is
  much beloved as the “dear aunt” by all the “sweet creatures”; for she
  voluntarily does them the most various chivalrous favors, always
  feeling herself at such times as a man.

  Case 107. _Contrary Sexual Instinct with Sexual Satisfaction in
  Hetero-Sexual Intercourse._—Mr. Z., aged 36, Hollander, consulted me,
  in 1888, on account of an anomaly of his sexual feelings, which had
  become a matter of anxiety to him in connection with an intended
  marriage. Patient’s father was neuropathic, and suffered with
  nightmare and night-terrors. Grandfather was mentally unsound;
  father’s brother an idiot. Patient’s mother and her family were
  healthy and normal mentally. The patient had four sisters and one
  brother, the latter being subject to moral insanity. Three sisters are
  healthy, and living happy married lives.

  As a child, the patient was weak, nervous, and subject to
  night-terrors, like his father; but he never had any severe sickness
  except coxitis, as a result of which he limps slightly. Sexual
  impulses were manifested early. At eight, without any teaching, he
  began to masturbate. From his fourteenth year, ejaculation. He was
  mentally well endowed, and his principal interest was in art and
  literature. He was always weak muscularly, and had no inclination for
  boyish sports and later for manly occupations. He had a certain
  interest for female _toilettes_, ornaments, and occupations. From the
  time of puberty the patient noticed in himself an inexplicable
  inclination toward male persons. Youths of the lowest classes were
  especially attractive to him. Cavalrymen especially excited his
  interest. He experienced a lustful desire to press himself against
  such individuals from behind. Occasionally, in crowds, it was possible
  for him to do this; and in such an event an intense feeling of
  pleasure passed over him. After his twenty-second year, on such
  occasions, he now and then had an ejaculation. From that time
  ejaculation occurred when a sympathetic man laid his hand on the
  patient’s thigh. He was now in great anxiety lest he might sometime
  assault a man sexually. People of the lower classes, wearing tight,
  brown trousers, were especially dangerous for him. His greatest
  pleasure would be: to embrace such a man and press himself on him;
  but, unfortunately, the morality of his country did not allow such a
  thing. Pederasty seemed disgusting to him.

  It gave him great pleasure to gain a sight of the genitals of males.
  He was always compelled to look at the genitals of every man he met.
  In circuses, theatres, etc., only male performers interested him.
  Patient has never noticed any inclination for women. He does not avoid
  them, even dances with them on occasion, but he never feels the
  slightest sensual excitation under such circumstances.

  At the age of twenty-eight the patient was neurasthenic as a result of
  his excessive masturbation.

  Then frequent pollutions in sleep occurred, which weakened him very
  much. It was only occasionally that he dreamed of men when he had
  pollutions; and never of women. A lascivious dream-picture (pederasty)
  had occurred but once. He dreamed of dying-scenes, of being attacked
  by dogs, etc. After these, as before, he suffered with great libido
  sexualis. Often there came up before him such lascivious thoughts as
  gloating over the death of animals in the slaughter-house, or allowing
  himself to be whipped by boys; but he always overcame such desires,
  and also the impulse to dress in a military uniform.

  In order to cure himself of masturbation, and to thoroughly satisfy
  his libido, he determined to frequent brothels. He first attempted
  sexual intercourse with a woman when twenty-one, after over-indulgence
  in wine. The beauty of the female form, and female nudity in general,
  made no impression on him. However, he was able to enjoy the act of
  coitus, and thereafter he visited brothels regularly for “purposes of
  health.”

  From this time he took great pleasure in hearing men tell stories of
  their sexual relations with the opposite sex.

  Ideas of flagellation would also come to him while in a brothel, but
  the retention of such fancies was not essential for the performance of
  coitus. He considered sexual intercourse with prostitutes only a
  remedy against the desire for masturbation and men,—a kind of
  safety-valve to prevent compromising himself with some man.

  The patient now wishes to marry, but fears not only that he could have
  no love for a decent woman, but also that he might be impotent for
  intercourse with one. Hence his thought and need of medical advice.

  The patient is very intelligent, and is, in all respects, of masculine
  appearance. In dress and manner he presents nothing that would attract
  attention. Gait, voice, and skeleton,—the pelvis especially,—masculine
  in character. Genitals of normal development. The normal growth of
  hair for a male is abundant. The patient’s relatives and friends have
  not the slightest suspicion of his sexual anomalies. In his inverted
  sexual fancies, he has never felt himself in the _rôle_ of a woman
  toward a man. For some years he has been entirely free from
  neurasthenic troubles.

  The question as to whether he considered himself a subject of
  congenital inversion of sexual instinct he could not answer. It seems
  probable that there was a congenital weak inclination for the opposite
  sex, with a greater one for the same sex, which, as a result of early
  masturbation in consequence of the homo-sexual instinct, was still
  more weakened, but not reduced to _nil_. With the cessation of
  masturbation, the feeling for women became in a measure more natural,
  but only in a coarsely sensual way.

  Since the patient explained that, for reasons of family and business,
  it was necessary for him to marry, it was impossible to avoid this
  delicate question.

  Fortunately, the patient limited his inquiries to the question as to
  his virility as a husband; and it was necessary to reply that he was
  virile, and that he would probably be so in conjugal intercourse with
  the wife of his choice,—at least, if she were to be in mental sympathy
  with him; besides, that he could at all times improve his power by
  exercising his imagination in the right direction.

  The main thing was to strengthen the sexual inclination for the
  opposite sex, which was defective, but not absolutely wanting. This
  could be done by avoiding and opposing all homo-sexual feelings and
  impulses, possibly with the help of the artificial inhibitory
  influences of hypnotic suggestion (removal of homo-sexual desires by
  suggestion); by the excitation and exercise of normal sexual desires
  and impulses; by complete abstinence from masturbation, and
  eradication of the remnants of the neurasthenic condition of the
  nervous system by means of hydrotherapy, and possibly general
  faradization.

I am indebted to a physician, aged thirty, for the following
autobiography, which in another respect is noteworthy:—

  Case 108. _Mental Hermaphroditism; Abortive Contrary Sexual
  Instinct._—“In my ancestry I am somewhat predisposed hereditarily. My
  grandfather on my father’s side was a high-liver and a speculator. My
  father was a man of character, but for more than thirty years he has
  suffered with folie circulaire, without, however, being much hindered
  by it in business. My mother, like her father before her, suffers with
  stenocardiac attacks. My mother’s father and brother are said to have
  been sexually hyperæsthetic. My only sister, about nine years older
  than myself, was twice subject to attacks of eclampsia, and during
  puberty was religiously exalted, and probably also sexually
  hyperæsthetic. During many years she had to suffer with a severe
  hysterical neurosis, but she is now completely well.

  “As an only son, and born late, I was the apple of my mother’s eye;
  and I have her indefatigable care to thank that I survived childhood,
  after having passed through all the possible diseases of children
  (hydrocephalus, measles, croup, small-pox, and, at thirteen, chronic
  intestinal catarrh that lasted a year). My mother, being herself very
  religious, raised me, without spoiling me, in a religious way, and
  implanted in me, as the guiding moral principle, an unyielding
  devotion to duty, which was further carried to an extreme in me by a
  teacher whom I still call a friend. Owing to my delicate health, my
  childhood, in greater part, was spent in bed; and I was thus given to
  quiet occupations, especially reading; and thus as a boy I came to
  be—if not _blasé_—premature at least. As early as eight or nine the
  parts of books that excited me most were those where injuries or
  operations that had to be endured by beautiful girls or ladies, were
  described. Thus I was thrown into great excitement by a story in which
  was pictured a maiden that had run a thorn into her foot, with a boy
  taking it out for her. Indeed, every time that I looked upon this
  picture, which was in nowise lascivious, I had an erection. Whenever
  possible, I went to see chickens killed; and if I had missed that, I
  looked at the spots of blood, and stroked the warm bodies of the
  birds, with pleasurable shudders. I would emphasize the fact that I
  have always been a great lover of animals, and have felt disgust and
  pity while killing larger animals, and even in the vivisection of
  frogs.

  “The killing of chickens is still a great sexual stimulus for me, and
  especially holding them, during which I have palpitation of the heart
  and precordial oppression. It is of interest that my father had a
  passion for binding together the hands of girls and young women.

  “I think that another of my sexual abnormalities is attributable to
  this strain of cruelty. As I shall clearly describe later, one of my
  favorite games was that of an improvised doll-theatre, where I
  prescribed the parts of my companions. Almost always it was a young
  girl who, at the command of her papa, whom I represented, had to have
  a painful operation done on her foot. The more the girl cried, the
  more satisfaction I had. How I came to hit upon the foot as the
  constant object of operation will be seen from the following: When a
  very young boy, I happened to see my eldest sister change her
  stockings. When she hastily hid her feet, my attention was attracted,
  and immediately the sight of her bare feet to the ankles came to be
  the ideal of my longing. Naturally, this made my sister very careful;
  and thus there was occasioned a constant quarrel, which, on my part,
  was kept up with all the wiles of cunning and flattery, and with even
  explosions of anger, until my seventeenth year. In other respects my
  sister was very indifferent. Indeed, her kiss is repugnant to me.
  _Faute de mieux_, I made use of the feet of servants; masculine feet
  had no effect on me. My greatest desire would have been to cut the
  nails, or, _sit venia verbo_, the corns, on the beautiful foot of a
  woman. My lustful dreams were concerned with these things. Indeed, I
  applied myself to the study of medicine really in the expectation of
  gaining an opportunity to satisfy my desires, or cure them. Thank God,
  I attained the latter. After undertaking the first dissection of the
  lower extremity of a female, this unhappy desire was removed from me.
  I was unhappy because I was always deeply ashamed of this impulse. I
  think I may spare further details concerning it, since this peculiar
  enthusiasm, which even inspired me to write verses, has been
  sufficiently described by others.

  “Now, concerning the last phase of my sexual errors: I was about
  thirteen, and had just begun to mature, when a school-mate, who
  happened to be our guest, teased me one night by kicking me with his
  bare feet under the covers. I seized his foot, and immediately became
  greatly excited, and had a pollution after it,—the first that I had.
  The boy was peculiarly girlish in form, and was also mentally
  effeminate. Too, another comrade who had very small and delicate hands
  and feet, whom I once saw in a bath, caused unusual excitement in me.
  I thought it a great piece of good fortune to be in bed with either of
  these, though any nearer sexual intercourse than embracing them never
  came into my mind. Moreover, I always thrust such thoughts aside with
  aversion. Some years later, when about sixteen or eighteen, I made the
  acquaintance of two other boys that awakened my sexual feeling. When I
  played with either of these, I immediately had an erection. Both were
  very energetic and lively, but delicately formed and child-like. At
  the occurrence of puberty I lost interest in both of them, though a
  warm friendship was preserved. I should never have allowed myself to
  have indulged in vicious practices with them.

  “When I went to the University, I forgot completely these errors of my
  libido sexualis, and from principle I kept from sexual intercourse
  until I was twenty-four, in spite of the contempt of my companions.
  When pollutions became too frequent, and I began to fear cerebral
  neurasthenia ex abstinentia, I gave myself up to normal sexual
  indulgence, though somewhat mechanically; and it was, of course, very
  beneficial to me.

  “The especial field of work to which I have devoted myself is
  responsible for the fact that I am almost impotent with puellis
  publicis, and also for the fact that the naked form of a woman
  disgusts rather than excites me. The act always satisfies me the most,
  if, during it, I can keep the vision of the face before me; but since,
  on the other hand, the idea that the girl near me is enjoyed by
  another is unbearable, for years I have found it absolutely necessary
  for my mental comfort, in spite of the pecuniary sacrifice, to keep a
  mistress, and, indeed, a virgin. Otherwise the most terrible jealousy
  made me absolutely incapable of work. I must also mention that, at
  thirteen, I fell in love platonically for the first time; and since
  then I have often pined in chaste love. What distinguishes my case
  from all others is the fact that I have never once masturbated in my
  life.

  “Some weeks ago, in sleep, I was frightened by a dream of a naked boy,
  from which I awoke with an erection. In conclusion, I venture to
  undertake the difficult task of describing my present condition:
  Medium height, gracefully formed. Skull dolichocephalic, with
  prominence in the occipital region; circumference, 59 centimetres;
  frontal prominence marked; glance somewhat neuropathic; pupils medium;
  teeth very defective; musculature strong and tense; abundant hair,
  blonde. Varicocele on the left side; frenulum too short, which
  hindered me in coitus. I severed it myself three years ago. Since then
  ejaculation is retarded, and pleasurable feeling much diminished.
  Temperament choleric. Quick of comprehension; good at drawing
  conclusions; energetic; for one hereditarily predisposed, very
  persevering. I learn languages easily, and have a good ear for music,
  but otherwise I have no talent for the arts. I am always ambitious to
  do my duty, but I am constantly troubled with tædium vitæ, and only
  kept from attempts at suicide by my religion and the thought of my
  mother. Otherwise I am a typical candidate for suicide. I am
  ambitious, jealous, have a fear of paralysis; left-handed. I am filled
  with socialistic ideas. I like adventures, and I am courageous. I have
  decided never to marry.”

  Case 109. _Psychical Hermaphroditism. Autobiography._—“I was born in
  1868. The families of both my parents are healthy; at any rate, mental
  disease has never occurred in them. My father was a merchant; he is
  now sixty-five years old, and for years has been nervous and
  especially inclined to be melancholic. Before his marriage, my father
  is said to have lived fast. My mother is healthy, though not very
  strong. There are two other healthy children.

  “I was very early developed sexually, and in my fourteenth year was so
  much troubled by pollutions that I was frightened. Under what
  circumstances they occurred, particularly the nature of the dreams
  that were connected with them, I am no longer able to state. The fact
  is, that for years I have only felt myself drawn toward men sexually;
  and, with every effort and a terrible struggle, I am still unable to
  overcome this unnatural impulse that is so repugnant to me. It is said
  that I had many severe illnesses in my childhood, and that my life was
  often despaired of. To this was probably due the fact that I was
  spoiled and made very delicate. I was always much in the house,
  preferred to play with dolls rather than with soldiers, and I liked to
  play quietly in the house better than to play noisily in the streets.
  I entered the Gymnasium at the age of ten. Though I was lazy, I was
  among the best scholars; for I learned very easily, and was the
  favorite of my teacher. From my earliest childhood (seventh year), I
  took pleasure in little girls. I remember that, even until my
  thirteenth year, I had formal love-affairs with them, and was jealous
  of those who associated with them; that I took pleasure in looking
  under the petticoats of my sister’s friends and the servants; and that
  I had erections when touching the persons of my female playmates. I
  can, however, recall with certainty that boys attracted and excited me
  sexually just as early and powerfully. I always took great delight in
  reading and in the theatre. I had a doll-theatre, with which I played
  by preference. I knew whole pieces by heart, and copied the actors I
  saw, taking especially the female parts, in which I was delighted to
  put on female attire.

  “As my sexual life became more pronounced, my inclination for boys won
  the upper hand. I fell completely in love with my companions, and had
  lustful feeling if one of them who pleased me touched my body. I
  became very shy, and refused to take gymnastic and swimming lessons. I
  thought I was different from my comrades, and did not like to undress
  before them. I liked to look at the penes of my companions, and easily
  had erections. I masturbated but once, and that in my youth. When a
  friend told me that one could have pleasure without women, I likewise
  tried it; but I found no pleasure in it. At that time, also, a book
  fell in my hands which warned against the effects of onanism. After
  that one trial I never did it again. In my fourteenth or fifteenth
  year, I made the acquaintance of two younger boys who excited me
  sexually to the highest degree. I was especially in love with one of
  them. I became sexually excited in his presence, and was restless when
  I did not have him near me. I was jealous of those who associated with
  him, and embarrassed in his presence. He had no suspicion of my
  condition. I felt very unhappy, and often wept gladly, feeling then
  relieved. Yet I could not understand this feeling, and always felt its
  irregularity. I was also especially unhappy because my ability to work
  disappeared all at once. I, who before had learned with ease, suddenly
  had difficulty; my thoughts were never on the subject. Only by
  straining every nerve could I get anything through my head. I always
  had to study aloud, in order to keep my attention on the matter in
  hand. My memory, which was previously excellent, often left me in the
  lurch. Nevertheless, I continued to be a good scholar, and I still
  pass for a talented man; but I have terrible difficulty in learning
  anything. I exerted all my energy to free myself from this sad
  condition. Daily I went swimming; I practiced turning, rode much, and
  practiced fencing, in all of which I enjoyed myself very much. I still
  like to be on a horse’s back, though I know nothing about horses, and
  have no particular talent for physical exercises. I was never absent
  from a drinking-party, and I smoked. I was much liked. In _cafés_ I
  associated much with waitresses, and liked to amuse myself with them,
  without, however, being sexually excited by them. Among my friends and
  teachers, I passed for a man who was much with women, and spoiled by
  them. Unfortunately, this was not true.

  “At the age of nineteen I went to the University. My first semester
  was spent at the University of B., and it is still terrible to recall
  it. My sexual appetite powerfully excited me, and at night, for hours
  at a time, I ran about looking for men, especially when I was
  intoxicated. The next morning I would be crazy about myself.
  Fortunately, I found no one. In the second semester, I went to M. This
  was my happiest time. I had pleasant friends, and, for a wonder, took
  pleasure in women, and was very happy about it. I had a love-affair
  with a young girl of spoiled character, with whom I spent wild nights.
  I was extraordinarily virile. I, who had formerly been chaste, also
  associated with other women, as never before. I felt fresh and well
  after coitus. I was not charmed so much by the female figure, which
  was never beautiful to me, as by—I know not what. In short, I knew
  women whose touch immediately induced erection. This joy and state of
  delight did not last long. I was so foolish as to take rooms with a
  friend. We had one sleeping-room. My friend was very talented and
  amiable, and a favorite with women; and it was by these
  characteristics that he at first so strongly attracted me. In fact, I
  love only highly-educated men; uneducated, powerful persons are able
  to excite me intensely only for the moment, and cannot retain my
  affections. I soon fell in love with my friend. Then came the terrible
  time that destroyed my health. I slept in the same room with my
  friend, and had to see him undress daily; so that it required all my
  strength to keep from betraying myself. I became nervous, cried
  easily, and was jealous of those who associated with my friend. I
  still associated with women; but it was only with difficulty that I
  could perform coitus, which, like woman, was repugnant to me. The same
  women who had excited me intensely, no longer had any effect on me. I
  followed my friend to W., where he met an earlier friend, with whom he
  associated. I became jealous and sick with love and longing. At the
  same time, I associated with women again, but seldom, and only with
  difficulty, indulged in coitus. I became terribly depressed and almost
  insane. Work was out of the question. I led a foolish, wild life, and
  spent a great amount of money, almost throwing it away. Then, after
  six weeks of it, I broke down, and had to visit a water-cure, where I
  spent many months. There I came to myself again, and soon became much
  liked; for I can be very gay, and I take great pleasure in the society
  of educated ladies. In conversation, I prefer married women to younger
  girls; I am also very gay in the society of gentlemen at the
  beer-table and bowling-alley.

  “At this sanitarium I met a man of twenty-nine, who was apparently
  constituted like myself. The fellow forced himself upon me, and wanted
  to embrace and kiss me; but he was very repugnant to me, though he
  excited me, and his touch caused erection, and even ejaculation. One
  evening he got me to perform mutual onanism. After it I spent a most
  frightful, sleepless night; I was terribly disgusted with the whole
  affair, and thought I should never do such a thing with a man again.
  All day long I could get no rest. It was terrible to me that, in spite
  of this, and against my will, this man so excited me sexually; yet, on
  the other hand, it gave me satisfaction that he was in love with me,
  and apparently had to go through struggles similar to my earlier ones.
  From that time I was successful in keeping him away from me.

  “I again went to various Universities, and also visited many
  water-cures, with temporary, but never permanent, benefit. I fell in
  love, too, with many friends, but never so deeply as with the friend
  at M. I no longer had sexual intercourse, neither with women—I was
  incapable of it—nor with men; for I had no opportunity for it with the
  latter, and I forced myself to avoid it. I still often met my friend
  of M.; we are as good friends as ever, and, much to my delight, he no
  longer excites me. It is usually so; when for a long time I have not
  seen a person who excites me, the sexual influence disappears.

  “I passed my examinations with distinction. During the last year
  before they took place,—when I was twenty-three,—I began to practice
  masturbation; for I could find no other way in which to gratify my
  burdensome sexual appetite. Still, I did it very infrequently; for
  after it I was always disgusted, and spent a sleepless night. But when
  I have drunk much, I lose all strength; and then I run about for
  hours, seeking men, and finally come to onanism, to awake the next day
  with a dull head and a horror of myself, and go about all day in a
  melancholy state. As long as I have control of myself, I use all my
  strength to combat my nature. It is terrible when one can have no
  pleasure in associating with friends, and every erect soldier or
  butcher-boy makes one tremble and throb. It is frightful when night
  comes, and I watch at the window for some one to urinate against a
  wall across the way, and give me an opportunity to see his genitals.
  These thoughts are terrible; and besides, there is the consciousness
  of the immorality and criminality of my state of mind and my longing.
  I have a repugnance for myself that I cannot describe. I consider my
  condition abnormal; I cannot think that it is congenital, but I
  believe that the impulse was bred in me by faulty education. My
  suffering makes me reckless and egotistical; it takes away all
  kindness of disposition, and makes me careless about my family. I am
  moody, and often almost insane; often I am so depressed that I know
  not what to do, and then am easily moved to tears. And yet I have a
  horror of sexual intercourse with men. One evening when I came from a
  drinking-party, drunk and excited and in a half-conscious state, and,
  full of desire, was wandering about, I met a young man, who got me to
  perform mutual masturbation. Though he excited me, after the act I was
  beside myself. To-day, when I go by the place, I am overcome with
  horror; and lately, when riding by it, without any cause, I fell from
  my gentle horse, that I know so well,—I was so overcome by the memory
  of my unworthy deed.

  “I love family life and children, and social intercourse; and, with my
  position in society, I am suited to have a family. But I must give up
  all that; and yet, I cannot abandon hope of cure. And so I vacillate
  between hopeful gaiety and frightful hopelessness, and neglect
  business and family. Indeed, I do not ask that I may marry and found a
  family; I wish only to overcome the terrible inclination for the male
  sex; only to associate quietly with my friends, and to learn to
  respect myself again.

  “No one has any suspicion of my condition; I pass rather for a great
  _roué_,—a reputation I try to maintain. I often try to have relations
  with girls, for which I often have opportunity. I have known many who
  loved me, and who would have sacrificed their honor for me; but I have
  no love to offer them, and nothing sexual to give. And yet I can love
  a man. I am excited only by young men,—_i.e._, aged from seventeen to
  twenty-five, without full beards, and preferably with no beards at
  all. I can love only those that are educated, respectable, and
  amiable. I am, in short, very proud, and quick; I am also
  enthusiastic, and easily led by persons who please me. These I try to
  imitate, but I am very sensitive with them, and easily hurt. I put
  much value on appearances, love beautiful furniture and dress, and
  assume a distinguished manner and elegant address. I am unhappy in
  that my neurasthenic condition keeps me from doing and learning what I
  should like.”

  Last fall I made the patient’s acquaintance. He is destitute of
  degenerative signs, and of perfectly masculine appearance, even though
  he is delicately formed and slender. Genitals perfectly normal.
  Appearance distinguished, with nothing striking. He is much troubled
  about his sexual perversion, and wishes to be freed from it at any
  price. In spite of the greatest effort on the part of both physician
  and patient, only a slight degree of hypnosis, insufficient for
  suggestive treatment, could be induced.

  Case 110. _Psychical Hermaphroditism—Mouth-fetichism._—“I am
  thirty-one years old, and an official in a manufactory. My parents are
  healthy, and have nothing abnormal about them. My paternal grandfather
  is said to have had brain disease; my maternal grandmother died
  melancholic; a cousin of my mother was given to drink; several other
  blood-relations are abnormal mentally.

  “I was four years old when my sexual appetite awoke. A man between
  twenty and thirty years old, who played with us children, and took us
  in his arms, excited in me the desire to embrace and kiss him
  passionately. This desire for sensual kissing on the mouth is
  characteristic of me, and it still forms the chief charm of my sexual
  gratification.

  “I experienced a similar excitation in about my ninth year. A man who
  was ugly and dirty, and had a red beard, likewise excited in me this
  desire for him. Here was manifested, for the first time, a
  characteristic peculiar to me, which is still present,—_i.e._, the
  peculiar stimulus which coarseness—the filthiness of a person in dress
  and conduct—is to my senses at times.

  “While in the Gymnasium, from my eleventh to my fifteenth year, I was
  affected with a passion for a comrade. In this case, it was also my
  greatest pleasure to embrace him, and kiss him on the mouth. I was
  often seized with a desire for him as intense as that I now have for
  persons I love. I think, however, that I first had erections in my
  thirteenth year. During these years, as I have said, I had only the
  desire to embrace and kiss; cupiditas videndi vel tangendi aliorum
  genitalia mihi plane deerat. I was a perfectly innocent, _näive_ boy,
  and, until my fifteenth year, did not know the meaning of an erection;
  indeed, I never once ventured to kiss the beloved person; for I felt
  that it would be doing something strange. I felt no desire to
  masturbate, and also had the good fortune not to be seduced to it by
  older comrades. I have never yet masturbated; I feel a certain
  repugnance for it.

  “In my fourteenth and fifteenth years I was seized with a passion for
  several young persons, some of whom still attract me. Thus I was very
  much in love with a boy with whom I had never spoken. It was even a
  delight to meet him on the street.

  “That my passions were of a sensual nature is shown by the fact that,
  when I pressed and caressed the hands of those I loved, I had powerful
  erections. But it has always been my greatest pleasure amplecti et os
  osculari; I desired nothing else.

  “I did not know that what I experienced was sexual love; I only said
  to myself that it was impossible that I alone felt such stimuli.

  “Until my fifteenth year a woman had never excited me; but one
  evening, when I was alone with our servant-girl in a room, I
  experienced the same desire that I had for many boys. At first I
  played with her; and, when I found that she liked to be kissed, I
  covered her with kisses. I felt such sensual pleasure in it as I now
  seldom experience. Mouth to mouth, we kissed each other, and after
  about ten minutes ejaculation occurred. Thus I gratified myself two or
  three times a week. I soon began a similar relation with our cook, and
  with other servant-girls. Ejaculation always took place after kissing
  for about ten minutes.

  “In the meantime, I had taken dancing-lessons. There I was first
  charmed by a nice girl; but this love soon disappeared, and I fell in
  love with another girl, with whom I never became acquainted, but at
  the sight of whom I felt an attraction like that of boys, and unlike
  the purely brutal passion I felt for other girls. At this time my
  impulse for girls was at its acme; I was pleased by about an equal
  number of girls and boys. As mentioned above, I gratified my
  sensuality by kissing the servant-girl and inducing ejaculation. Thus
  I spent the time from my sixteenth to my eighteenth year. The
  departure of the servant deprived me of opportunity.

  “Then came two or three years during which I had to give up sexual
  pleasure. In general, girls pleased me less; and, too, now that I had
  grown older, I was ashamed to surrender myself to the servant-girls.

  “It was not possible for me to obtain a mistress; for, notwithstanding
  my years, I was carefully watched by my parents, and associated but
  little with young men, and thus had but little independence. With the
  diminution in the desire for women, the attractiveness of youths
  increased.

  “Since I had had, since my sixteenth year, frequent pollutions at
  night with dreams,—in part of women and in part of men,—which weakened
  and depressed me exceedingly, I desired to make an end of them by
  means of normal coitus. But scruples and the belief that prostitutes
  would have no effect on me, kept me from the brothel until my
  twenty-first year. For two or three years I went through a daily
  struggle (if there had been male houses of prostitution, no scruples
  would have hindered me). Finally I visited a brothel. I could not even
  induce erection; for one reason because the girl, though she was
  unusually fresh and pretty for a prostitute, did not affect me; but
  really because she would not kiss me on the mouth. I was very much
  depressed, and thought I was impotent. Three weeks afterward I visited
  another prostitute, and she immediately induced erection by her kiss.
  She was erect and had thick lips, and was much more sensual than the
  first one. After only three minutes of simple kissing, mouth to mouth,
  ejaculation was induced,—of course, ante portam. Thus it was only
  after I had visited prostitutes about seven times that I was
  successful in coitus.

  “At one time I would have no erection at all, because the girl made no
  impression on me; again I would ejaculate prematurely. The first times
  I was reluctant penem introducere; and, too, even after I was
  successful in normal coitus, I found no pleasure in it. Sensual
  satisfaction comes with kissing on the mouth; for me this is the
  principal thing, coitus serving only as something secondary to
  embracing. Coitus, no matter how much the woman might charm me, would
  be an indifferent matter without kissing; indeed, erection disappears,
  or does not occur at all, when the woman will not kiss on the mouth.
  Yet, I cannot kiss every woman, but only such as have faces pleasing
  to me; a prostitute, the sight of whom is repugnant to me, with any
  amount of kissing, which then only disgusts me, cannot excite me.

  “Thus, during the last four years, I have visited brothels about every
  ten days or two weeks. Only seldom does coitus fail; for I have
  learned my peculiarities, and in the choice of a prostitute know
  immediately whether she will excite me or have no effect. Of late,
  however, it has again happened that I thought the woman would
  stimulate me, and yet no erection occurred. This happened when, the
  day before, I had to repress too forcibly the desire for men.

  “At first, when I went to brothels, the sensual pleasure was very
  slight; only a very few times did I have true lustful feeling (as in
  kissing previously). Now, on the contrary, for the most part I
  experience sensual pleasure. The lower houses have a particular charm
  for me; for of late the coarseness of the women, the dark entrance,
  the yellow light of the lamps, and all the surroundings, have a
  peculiar charm for me; probably because my sensuality is unconsciously
  excited by meeting soldiers, who frequent such places, and who at the
  same time lend a certain charm to the women. If I but find a woman
  whose face attracts me, I can have intense lustful pleasure. Besides
  by prostitutes, my desire can be excited by peasant-girls,
  servant-girls, working-women, and girls of the lower classes,—in
  general, by those in common dress. Red cheeks, thick lips, and erect
  forms please me particularly. I am absolutely indifferent to
  respectable women and young ladies.

  “My pollutions are usually without lustful pleasure, and often occur
  with dreams of men, but very seldom—almost never—with dreams of women.
  As is shown by the last circumstance, in spite of regular coitus, my
  desire is still for young men. Indeed, I may say that it has only
  increased, and that very markedly. Though immediately after coitus the
  girls have no charm for me, yet the kiss of a pleasing woman could
  immediately induce erection again. For the first few days after
  coitus, young men seem the most attractive to me.

  “Sexual congress with women does not satisfy all my sensual desire. I
  have days when I frequently have erections with an intense desire for
  young men; then come quieter days, with moments of complete
  indifference for women and latent desire for men. On the other hand,
  too great sensual rest makes me melancholy; viz., when such rest
  follows moments of repressed excitement. Only, then, when the thought
  of beloved youths again causes erection, do I feel light-hearted
  again. Then the rest changes to intense nervousness; I feel depressed,
  and sometimes have headache (after repressed erection). This
  nervousness often increases to ungovernable restlessness, which I then
  seek to overcome by coitus.

  “Last year an essential change took place in my sexual life, when I
  dared to enjoy male love for the first time. In spite of pleasurable
  coitus with women (more correctly, pleasurable kissing with resultant
  ejaculation), my desire for young men gave me no peace. I determined
  to go to a brothel much frequented by soldiers, and, in extremity, to
  buy a soldier for myself. I had the good luck to meet immediately one
  like myself, who, notwithstanding his much lower station, in character
  and behavior was not unworthy of me. What I experienced (and still
  experience) with this young man is something different from what I
  feel with women. The sensual pleasure is not greater than with
  prostitutes, whose kisses and embraces excite me extraordinarily; but
  I can experience lustful pleasure with him at any time, and for him I
  have a feeling that is wanting for women. Unfortunately, I have been
  able to embrace and kiss him only about eight times.

  “Though we have been separated many months, he having been sent to a
  garrison in Hungary, we have not forgotten each other, and keep up a
  regular correspondence. In order to possess him, I dared to go to a
  brothel and there embrace him, being in danger of being betrayed.

  “Early in our acquaintance there came a time when I heard nothing more
  of him; for he did not think he could trust me. During these weeks I
  endured anxiety and pain that brought me into a state of depression
  and anxious restlessness, such as I had never before experienced.
  Scarcely to have found a lover and then to be compelled to lose him,
  seemed the greatest misfortune to me. When, thanks to my efforts, we
  met again, my joy was unbounded; indeed, I was so excited that, in his
  embrace again for the first time, in spite of my sensual lust, I could
  not induce ejaculation.

  “Usus sexualis in osculis et amplexionibus solis constitit, pene meo
  ludere ei licebat (while the touch on it of a woman’s hand is
  unendurable to me, and I never allow it). It is also to be noted that,
  in the company of my lover, I immediately have an erection; the
  pressure of his hand, or even his look, is sufficient. Evenings, for
  hours at a time, I have gone about with him, never tiring of his
  society for a moment, despite his inferior station. With him I feel
  happy, and the sexual satisfaction is merely the crowning of our love.
  Although I had finally found the man like myself, whom I had so long
  sought, and I could at last enjoy male love, yet I have not become
  insensitive to women; and I visit brothels when I am too sorely
  troubled by desire. I had hoped to be able to spend this winter in the
  city where my lover is; but this is, unfortunately, impossible, and I
  am now forced to be separated from him for an indefinite period.
  Nevertheless, we shall try to see each other, if only for a short
  time, and only once or twice a year; at least, I hope that in the
  future we may again be together for a longer time. Thus, for this
  winter, I am again compelled to be without a friend like myself. I
  had, indeed, resolved, on account of the danger of discovery, never to
  try to find another urning; but this is impossible. Sexual intercourse
  with women does not satisfy me, and my desire for young men constantly
  increases. I am often afraid of myself; afraid that, in asking all
  prostitutes, as I do, whether they know others like me, I might be
  discovered. Yet I cannot keep from seeking a youth like myself;
  indeed, I know that in case of necessity I shall buy a soldier, though
  I know perfectly well the penalty meted out to one caught in such
  circumstances.

  “I can no longer do without male love; without it I should always be
  out of harmony with myself. My ideal would be to be associated with a
  number like myself; but I should be satisfied if I could have
  unrestrained intercourse with one lover. I could easily dispense with
  women, if I had regular male satisfaction; but I think that at long
  intervals I should embrace a woman for the sake of variety, as my
  nature is absolutely hermaphroditic in a psycho-sexual sense (women I
  can only desire sensually, but I can love and sensually desire young
  men). If there were marriage between men, I think I should not avoid a
  life-long union; while marriage with a woman seems to me something
  impossible. For, in the first place, though the woman charmed me, the
  charm would soon be lost in regular intercourse, and then all sexual
  indulgence, if not impossible, would certainly be devoid of pleasure
  for me; and, in the second place, true love for the wife would be
  wanting—the attraction that I feel with young men I love, and which
  makes the intercourse that is not simply sensual seem desirable to me.
  The constant association with a youth physically pleasing and in
  mental harmony with me, and who could understand all my feelings and
  share my intellectual opinions and desires, would, it seems to me, be
  the greatest happiness.

  “The young men who please me must be between eighteen and
  twenty-eight. As I have grown older, the limit of age in those
  pleasing to me has increased; otherwise, I am pleased with the most
  various forms. The principal _rôle_, if not the exclusive one, is
  played by the face. Blondes excite me more than dark persons; they
  must have no beard, but merely a small moustache that is not too
  thick, or none at all. As for the rest, the only thing I can say is,
  that certain kinds of faces please me. Faces with large, straight
  noses are excluded, as are also pale cheeks; but there are exceptions.
  I regard soldiers with favor, and many please me when in uniform who
  do not affect me when in civil dress. Just as in women certain
  ordinary articles of dress (like light-colored jackets) please me, so
  the military costume attracts me. To go to dance-halls—usually
  beer-halls—where there are many soldiers, and mix with the crowd of
  soldiers and boys that please me, and try to get a kiss and
  embrace,—this mingling with them would, of course, be an excitant only
  of sensuality; intellectually and socially, everything common in
  speech and conduct is repugnant to me.

  “With young men of higher position, my sensual desire is less
  prominent.

  “What I have said of the attractiveness of certain kinds of dress is
  not to be understood in the sense that they attract me in themselves.
  This charm only means that the dress may help to strengthen or make
  prominent the attraction exerted by the face, when, perhaps, the same
  face in itself would not attract me to the same extent. I may say the
  same thing, though with a different meaning, of the odor of lighted
  cigars. In indifferent persons the odor of cigars is rather repugnant
  than pleasing to me, but exciting in those sexually attractive. The
  kiss of a prostitute smelling of cigar-smoke, affords greater pleasure
  (because, even though in part unconsciously, I am reminded of the kiss
  of a man). Therefore, I took pleasure in kissing my lover just after
  he had smoked. (It is to be noted that I myself have never smoked a
  cigar or cigarette, and have never even tried to smoke.) I am tall and
  thin; my face is masculine; my eyes are restless; and in my whole form
  I often have something girlish. My health leaves much to be desired.
  It is much influenced by my sexual anomaly. As previously mentioned, I
  am very nervous, and I often have paroxysms of onomatomania. At times,
  I also have terrible depression and melancholia, when I see the
  difficulty of gratification corresponding with my male-loving nature;
  and when I am greatly excited sexually, and have overcome the desire,
  owing to impossibility of male gratification. In such conditions,
  often the depression is associated with absolute lack of sexual
  desire. In work I am industrious, but often too quick; for I am
  inclined to work too rapidly and violently. I have a lively interest
  in art and literature. Among poets and writers of fiction, I prefer,
  for the most part, those who describe refined feelings, peculiar
  passions, and far-fetched impressions; an artificial or
  hyper-artificial style pleases me. Likewise in music, it is the
  nervous, exciting music of a Chopin, a Schumann, a Schubert, or a
  Wagner, etc., that is in most perfect harmony with me. Everything in
  art that is not only original, but _bizarre_, attracts me.

  “I do not like physical exercise, and do not practice it.

  “In character I am kind and compassionate; and, though I have much to
  suffer with my anomaly, I am not unhappy because I love young men, but
  because the satisfaction of such love is considered improper, and
  because I cannot gratify it without restraint. I cannot regard male
  love as a vice, though I can well understand why it is considered
  vicious. But, since this love is regarded as criminal, in gratifying
  it I am in harmony with myself, but not with our age of the world;
  and, therefore, I must, necessarily, be somewhat depressed; the more,
  since I have a frank character that hates a lie. The pain of having
  always to hide it all in myself has induced me to confess my anomaly
  to a few friends, of whose silence and appreciation I am confident.
  Nevertheless, my situation often seems sad. On account of the
  difficulty of gratification and the general abhorrence of male love, I
  am often a little proud that I have such anomalous feelings. Of
  course, I shall never marry. This does not seem any misfortune, even
  though I love family life, and have thus far lived only with my
  parents. I live in the hope that later I shall have a lover; I must
  have one; without one, the future seems dark and barren, and all the
  ambitions usually cherished—honor, position, etc.—seem empty and
  unattractive. If I should not have this hope fulfilled, I know I shall
  be unable to long devote myself to my business with pleasure, and I
  shall soon be in a condition to sacrifice everything to obtain male
  love. I no longer have any moral scruples on account of my anomalous
  inclination; I have, in fact, never been troubled because I felt
  attracted to boys. I am much more inclined to judge morality and
  immorality in accordance with my feelings than in accordance with
  fixed principles; for I have always been given to skepticism, and have
  never yet studied out a fixed belief for myself. As yet, only what
  injures others seems to me to be evil and immoral, and that that I
  would not have inflicted on myself; and, in this direction, I may say
  that I try to infringe on the rights of others as little as possible,
  and that I am capable of great indignation at injustice inflicted on
  another. But, why love of men should be something immoral, I cannot
  understand; purposeless activity of the sexual instinct (if the
  immoral is to be seen in all that is useless and unnatural) is also
  found in intercourse with prostitutes, and even in marriage where
  means to prevent conception are used; and it seems to me that the
  sexual intercourse of men must be placed on the same level with all
  sexual congress that has not procreation as an end. But that only
  sexual gratification that has this purpose is moral, seems to me to be
  questionable. Certainly, sexual satisfaction that is not directed to
  procreation is not contrary to nature; and, whether it has not other
  purposes unknown to us, is uncertain; and, even if it were
  purposeless, it would not necessarily be despicable (it is not certain
  that the measure of a moral act is its usefulness).

  “I am very certain that present prejudice will disappear, and that
  when once such individuals experience male-love, the right of
  unrestricted love will be acknowledged. For the possibility of such
  recognition one need but recall the Greeks and their friendships,
  which were nothing but sexual love; and one has only to think that,
  despite such unnatural vice, practiced by their greatest men in
  intellectual and æsthetic matters, the Greeks are still regarded as an
  unattainable example, and held up for imitation.

  “I have already thought of having my anomaly cured by hypnotism. If it
  were to be of any use, which I doubt, yet I should certainly desire to
  be assured of a lasting love for women. For even though I cannot
  satisfy myself with men, yet I prefer to feel this capability of
  inordinate lust and love, even ungratified, to being absolutely
  without feeling. Thus I still have the hope that I shall find
  opportunity to satisfy the love I desire, the love that would make me
  happy; and I should not prefer the suggestive removal of homo-sexual
  feelings, without the simultaneous substitution of a hetero-sexual
  equivalent, to my present condition. Finally, I should like to add, in
  contrast with the statements of urnings in the published biographies,
  that I, at least, find it very difficult to recognize those like
  myself. Though I have described my sexual anomaly somewhat in detail,
  it seems to me that the following notes are important for a better
  understanding of my condition:—

  “Of late I have given up immissio penis, and confined myself to coitus
  inter femoræ puellæ. Ejaculation occurs earlier than with conjunctio
  membrorum, and I experience a certain lustful feeling in the penis
  itself. If this manner of sexual intercourse is quite pleasant to me,
  it is, perhaps, in part to be referred to the fact that in this kind
  of sexual indulgence the sex is quite indifferent, and I am, perhaps,
  unconsciously reminded of masculine embrace. But this memory is
  absolutely unconscious, and but obscurely felt; for I am not indebted
  to my imagination for my pleasure, but it is due immediately to
  kissing the woman’s mouth. I feel that the charm which the brothel and
  prostitutes have for me also begins to fade; but I am sure certain
  women will always be able to excite me by their kisses. Still, no
  woman is, or ever will be, so attractive as to induce me to overcome
  obstacles in winning her; but even the danger of discovery and
  disgrace could only with difficulty restrain me from seeking a man’s
  embraces.

  “Thus I lately allowed myself to be induced to buy a soldier at a
  prostitute’s house. The lustful pleasure was very great, but the
  subsequent feeling of satisfaction was especially very exhilarating.
  The next day I felt similarly strengthened (capable of erection at any
  moment); and though I have not yet been able to meet the soldier
  again, the thought that I shall venture to purchase another gives me
  peace. But I could be perfectly satisfied only in finding one feeling
  like myself, of my own position and education.

  “I have not yet mentioned that the female form (with the exception of
  the face) and genitals have no attraction for me (to touch the latter
  with my hand would be disgusting to me); but membrum virile me tangere
  dum os meum os ejus osculatur, mihi exoptatum esse; indeed, to kiss
  that of a very pleasing man would not be disgusting to me. Onanism, as
  has been said, would be quite impossible for me.”

  Case 111. _Psychical Hermaphroditism._-Hetero-sexual feeling early
  interfered with by masturbation, but episodically very intense.
  Homo-sexual feeling _ab origine_ perverse (sexual excitation by men’s
  boots).

  Mr. X., of high social position, Russian, aged 28, came to me in
  September, 1887, in a despairing mood, to consult me on account of a
  perversion of his vita sexualis, which made life seem almost
  unbearable to him, and which had repeatedly brought him near to
  suicide. The patient comes of a family in which neuroses and psychoses
  have been of frequent occurrence. In the father’s family there had
  been consanguineous marriages for three generations. The father is
  said to have been a healthy man, and to have lived morally in
  marriage. However, his father’s preference for fine-looking servants
  seems remarkable to the son. The mother’s family is described as
  eccentric. The mother’s grandfather and great-grandfather died
  melancholic; her sister was insane; a daughter of the grandfather’s
  brother was hysterical, and had nymphomania. Only three of the
  mother’s twelve brothers and sisters married. Of these, one brother
  was homo-sexual, and always nervous as a result of excessive
  masturbation.

  The patient’s mother is said to be a bigot, and of small mental
  endowment, nervous, irritable, and inclined to melancholia. Patient
  has a sister and a brother. The brother is frequently melancholy, and,
  though mature, has never shown the slightest trace of sexual
  inclinations. The sister is an acknowledged beauty, and much sought by
  gentlemen. This lady is married, but childless, as reported, owing to
  the impotence of her husband. She has always been indifferent to the
  attentions shown her by men, but is charmed by female beauty, and
  actually in love with some of her female friends.

  With respect of himself, the patient asserts that, when four years
  old, he dreamed of handsome jockeys wearing shining boots. Too, he
  never dreamed of women when he grew older. His nightly pollutions were
  always induced by “boot-dreams.” From his fourth year he had a
  peculiar partiality for men, or, more correctly, for lackeys wearing
  shining boots. At first they only excited his interest, but, with
  development of his sexual functions, the sight of them caused powerful
  erections and lustful pleasure. It was only servants’ boots that
  affected him; the same kind of boots on persons of like social station
  were without effect on him. In a homo-sexual sense, there was no
  sexual impulse connected with these situations. Even the thought of
  such a possibility was disgusting to him. At times, however, he had
  sensually-colored ideas,—like being his servant’s servant, and drawing
  off his boots; but the idea of being stepped on by him, or of having
  to blacken his boots, was most pleasing. The pride of the aristocrat
  rose up against such thoughts. In general, these notions about boots
  were disgusting and painful to him.

  Sexual instinct was early and powerfully developed. It first found
  expression in indulgence in sensual thoughts about boots, and, after
  puberty, in dreams accompanied by pollutions; otherwise, the mental
  and physical development was undisturbed. Patient was well endowed
  mentally,—learned easily, finished his studies, and became an officer.
  On account of his distinguished, manly appearance and his high
  position, he was much sought in society.

  He characterizes himself as a clever, quiet, strong-willed, but
  superficial man. He asserts that he is a passionate hunter and rider,
  and that he has never had any inclination for feminine pursuits. In
  the society of ladies he has always been reserved; dancing always
  tired him. He had never had any interest in a lady of high social
  position. As for women, only the buxom peasant girls, such as are the
  models of painters in Rome, had interested him. He had, however, never
  felt any sexual interest in such representatives of the female sex. In
  the theatre and circus only male performers had excited his interest;
  but, at the same time, they had caused him no sensual feelings. As for
  men, only their boots excited him, and, indeed, only when the wearers
  belonged to the servant class and were handsome men. Men of his own
  position, wearing never so fine boots, were absolutely indifferent to
  him.

  With reference to his sexual inclinations, the patient is still
  uncertain whether he feels more inclination toward the opposite sex or
  toward his own sex. He is inclined to think that originally he had
  more inclination for women, but that this sympathy was, in any case,
  very weak. He states with certainty that the sight of a naked man made
  no impression on him, and that the sight of male genitals was even
  repugnant to him. In the case of women, this was not exactly the case,
  but he was not excited sexually even by the most beautiful feminine
  form. When a young officer, he was now and then compelled to accompany
  his comrades to brothels. He was the more easily persuaded to this,
  since he hoped by this means to be rid of his vile partiality for
  boots; but he was impotent unless he brought the thought of boots to
  his aid. Under such circumstances, the act of cohabitation was
  normally performed, but without pleasurable feeling. Patient felt no
  impulse to intercourse with women, always requiring some external
  cause,—_i.e._, persuasion. Left to himself, his vita sexualis
  consisted in reveling in ideas about boots, and in corresponding
  dreams with pollutions. Since more and more there became connected
  with them the impulse to kiss his servant’s boots, to draw them off,
  etc., the patient determined to use every means to rid himself of this
  disgusting desire, which deeply wounded his pride. At that time, being
  in his twentieth year, and in Paris, he recalled a very beautiful
  peasant girl, who lived in his distant home. He hoped, with her
  assistance, to free himself of his perverse sexual inclination. He
  went directly home, and tried to win the girl’s favor. It seems that
  the patient was not naturally homo-sexual. He asserts that at that
  time he was actually in love with this person, and that her glance, or
  the touch of her dress, gave him sensual pleasure; and, when she once
  kissed him, he had a powerful erection. After about a year and a half,
  the patient succeeded in gaining his desires with this person.

  He was potent, but ejaculated tardily (ten to twenty minutes), and
  never had a pleasurable feeling in the act.

  After about a year and a half of sexual intercourse with this girl,
  his love for her grew cold, because he did not find her so “fine and
  pure” as he wished. From this time it was necessary for him to call
  upon ideas about boots for help, which had been latent, in order to be
  potent in sexual intercourse with her. In proportion as his power
  failed, these ideas arose spontaneously. Thereafter he had coitus with
  other women. Now and then, especially when the woman was in sympathy
  with him, the act took place without any assistance of imagination. It
  once happened that the patient committed a rape. It is remarkable that
  on this single occasion he had a pleasurable feeling in the (forced)
  act. Immediately after the deed he had a feeling of disgust. When, an
  hour after the forced indulgence, he had coitus with the same woman,
  with her consent, he experienced no feeling of pleasure.

  With decrease of virility,—_i.e._, when it was preserved only in
  connection with ideas about boots,—libido for the opposite sex
  decreased. The patient’s slight libido and weak inclination for women
  are evidenced by the fact that, while he still sustained sexual
  relations with the peasant girl, he began to masturbate. He learned
  the vice from “Rousseau’s Confessions,” the book accidentally falling
  into his hands. The boot-fancies immediately linked themselves with
  corresponding impulses. He then had violent erections, masturbated,
  and ejaculation afforded him a lively feeling of pleasure, which was
  denied to him in coitus; and at first he felt himself fresher and
  brighter, as a result of the masturbation.

  In time, however, symptoms of sexual, and, later, of general,
  neurasthenia, with spinal irritation, appeared. He then at first gave
  up masturbation, and sought his first love; but she was now more than
  ever indifferent to him. Since he finally became impotent, even when
  he called ideas of boots to his assistance, he gave up women entirely,
  and again practiced masturbation; by which he felt himself protected
  from the impulse to kiss and blacken servants’ boots. At the same
  time, he continued to feel that his sexual position was a painful one.
  He again occasionally attempted coitus, and was successful in it as
  soon as he thought of blackened boots. Too, after continued abstinence
  from masturbation, he was sometimes successful in coitus without any
  artificial aid.

  The patient says that his sexual needs are intense. If he has not had
  an ejaculation in a long time, he becomes congestive and psychically
  much excited, and tormented by repugnant images of boots, so that he
  is forced to have coitus, or, preferably, to masturbate.

  For some time his moral position has been complicated most painfully
  by the fact that, as the last of a wealthy line of high position, and
  at the importunate desire of his parents, he must marry. The bride is
  of rare beauty, and mentally in perfect sympathy with him; but, as a
  woman, she is as indifferent to him as any other. Æsthetically she
  satisfies him “as a work of art;” in his eyes, she is an ideal. To
  honor her in a platonic way would be happiness worth striving for; but
  to possess her as a wife is a painful thought. He is certain
  beforehand that with her he will be impotent, save with the help of
  ideas of boots. To use such means, however, is in opposition to his
  respect and his moral and æsthetic feeling for the lady. Were he to
  soil her with such thoughts, she would lose, in his eyes, all her
  æsthetic value; and then he would become impotent for her, and she
  would become repugnant to him. The patient considers his position one
  of despair, and confesses that he has lately been repeatedly near
  suicide.

  He is a man of much intelligence, and decidedly of masculine
  appearance, with abundant growth of beard, deep voice, and normal
  genitals. The eye has a neuropathic expression. No signs of
  degeneration. Symptoms of spinal neurasthenia. It was possible to
  reassure the patient, and give him hope of his future.

  The medical advice consisted in means for combating the neurasthenia,
  and the interdiction of masturbation and indulgence of the fancy in
  images of boots, in the hope that, with the removal of the
  neurasthenia, cohabitation without ideas of boots would become
  possible; and that, in time, the patient would become morally and
  physically capable of marriage.

  In the latter part of October, 1888, the patient wrote me that he had
  resolutely resisted masturbation and his imagination. In the interval
  he had had but one dream about boots, and scarcely a pollution. He had
  been free from homo-sexual inclinations, but, in spite of this, there
  was often considerable sexual excitement, without anything like
  adequate libido for women. In this deplorable situation, he was
  compelled, by circumstances, to marry in three months.

_2. Homo-Sexual Individuals, or Urnings._—In distinction from the
preceding group of psycho-sexual hermaphrodites, there are here, _ab
origine_, sexual desires and inclinations for persons of the same sex
exclusively; but, in contrast with the following group, the anomaly is
limited to the vita sexualis, and does not more deeply and seriously
affect the character and mental personality.

The vita sexualis of these urnings, _mutatis mutandis_, is entirely like
that in normal hetero-sexual love; but, since it is the exact opposite
of the natural feeling, it becomes a caricature, and this the more,
since these individuals, at the same time, as a rule, are subject to
hyperæsthesia sexualis, and, therefore, their love for their own sex is
emotional and passionate.

The urning loves and deifies the male object of his affections, just as
a man idealizes the woman he loves. He is capable of the greatest
sacrifice for him, and experiences the pangs of unfortunate, often
unrequited, love; suffers from the unfaithfulness of the beloved object,
and is subject to jealousy, etc.

The attention of the male-loving man is given only to male dancers,
actors, athletes, statues, etc. The sight of female charms is
indifferent to him, if not repulsive. A naked woman is disgusting to
him, while the sight of male genitals, hips, etc., affords him infinite
pleasure.

The bodily contact of a sympathetic man induces a thrill of delight;
and, since such individuals are mostly sexually neurasthenic,
congenitally or from onanism or enforced abstinence from sexual
intercourse, under such circumstances ejaculation is very easily
induced, which, in the most intimate intercourse with women, cannot be
induced at all, or only by mechanical means. The sexual act with a man,
in many instances, affords pleasure, and leaves behind a feeling of
well-being. Should the urning be able to force himself to coitus, in
which, as a rule, disgust has the effect of an inhibitory concept, and
makes the act impossible, then his feeling is something like that of a
man compelled to take disgusting food or drink. However, experience
teaches that not infrequently urnings falling in this group marry,
either out of ethical or social considerations.

Such unfortunates are relatively potent, in that in marital intercourse
they incite their imagination, and, instead of thinking of their wives,
they call up the image of some loved male person. But for them coitus is
a great sacrifice, and no pleasure; and it makes them, for days after,
nervous and miserable. If such urnings, by means of powerful excitation
of their imagination, or under the influence of alcoholic drinks, or by
erections induced by an overfilled bladder, etc., are enabled to
overcome the inhibitory feelings and ideas, then they are still entirely
impotent; while simply the touch of a man may induce powerful erection,
and even ejaculation.

Dancing with a woman is unpleasant to an urning, but to dance with a
man, especially one with an attractive form, seems to him the greatest
of pleasures. The male urning, in so far as he possesses higher culture,
is not opposed to non-sexual intercourse with women, when by mind and
refinement they make conversation pleasant. It is only of woman in her
sexual _rôle_ that he has a horror. The homo-sexual woman offers the
same manifestations, _mutatis mutandis_. In this degree of sexual
degeneration, character and occupation correspond with the sex which the
individual represents. The sexual perversion remains isolated, but an
anomaly of the mental being of the individual which deeply affects the
social existence. In accordance with this, many of these individuals, in
the sexual act, feel themselves in the _rôle_ which would naturally
belong to them in hetero-sexual intercourse.

However, transitions to group 3 occur, in as much as sometimes the
passive _rôle_ which corresponds with the homo-sexual manner of feeling,
is thought of or desired, or at least forms the subject of dreams.
Moreover, inclinations for occupations and tendencies of taste are
manifested, which do not correspond with the sex of the individual. In
many cases, one gets the impression that such symptoms are artificial,
the result of educational influences; in other cases, that they
represent deeper acquired degenerations of the original anomaly, induced
by the perverse sexual activity (masturbation), analogous to the signs
of progressive degeneration observed in acquired inversion of the sexual
instinct.

With regard to the manner of sexual satisfaction, it must be stated that
with many male urnings simple embraces are sufficient to induce
ejaculation, since they are subject to irritable weakness of the sexual
apparatus. In case of sexual hyperæsthesia, and where there is
paræsthesia of the moral sense, great pleasure is afforded by
intercourse with persons of the lowest condition. On the same basis,
desires to commit pederasty (active, of course) and other similar acts
occur, though it is but seldom, and apparently only in cases of moral
defect, and by reason of libido nimia in individuals especially
passionate, that pederasty is indulged in. The sensual desire of mature
urnings, _in contradistinction from old and decrepit debauchees, who
prefer boys (and indulge in pederasty by preference), seems never to be
directed to immature males_. Only for want of better material, and in
case of violent passion, does the urning become dangerous to boys. The
manner of sexual satisfaction in female urnings may be mutual and
passive masturbation. To them coitus is quite as disgusting, wearisome,
and inadequate as it is to the male urning.

  Case 112. The following is an extract from a very circumstantial
  autobiography which a physician affected with contrary sexual instinct
  has put at my disposal:—

  “I am now forty years old, of healthy family,[114] and have always
  been healthy and considered a model of physical and mental strength
  and energy. I am of powerful build, but have only a moderate beard,
  and, with the exception of hair in the axillæ and on the mons veneris,
  my body is hairless. The penis, even soon after birth unusually large,
  measures, in statu erectionis, 24 centimetres long by 11 centimetres
  in circumference. I am a skillful rider, athlete, and swimmer, and
  have passed through two great campaigns as a military surgeon. I never
  experienced any taste for female attire and vocation. Up to the time
  of puberty I was shy toward the female sex, and I am yet shy with new
  acquaintances.

  “I have always had a distaste for dancing. In my eighth year an
  inclination for my own sex made its appearance. I next experienced
  pleasure in regarding my brother’s genitals. I induced my brother to
  indulge with me in mutual fondling of the genitals, as a result of
  which I had an erection. Later, in bathing with the school-children,
  the boys excited a lively interest in me; the girls, none at all. I
  had so little interest in them that, as late as my fifteenth year, I
  believed that they also had a penis. In company with boys like myself,
  I took pleasure in mutual manustupration. At eleven and a half years I
  was given a strict tutor, and thereafter could steal to my friends but
  seldom. I learned very easily, but could not get along with my
  teacher; and when one day he made it too hard for me, I became furious
  and struck at him with a knife, and would have gladly stabbed him, if
  he had not fallen into my arms. In my thirteenth year, for a similar
  cause, I escaped from the teacher, and wandered about for six weeks in
  the neighboring country.

  “I now entered the Gymnasium. At that time I was already sexually
  developed, and amused myself while bathing with my comrades in the way
  above mentioned, and later by imitatio coitus between the thighs. I
  was then thirteen years old. I took absolutely no pleasure with girls.
  Violent erections caused me to play with my genitals, and I came to
  take my penis in my mouth, which I succeeded in doing by bending over.
  This induced ejaculation. I thus learned masturbation. I was much
  frightened, looked upon myself as a criminal, and confessed to a
  companion of sixteen. He encouraged and quieted me, and entered into a
  love-bond with me. We were happy, and satisfied ourselves by mutual
  onanism. At the same time, I masturbated. After two years the bond was
  broken; but to this day, when we occasionally meet,—my friend is a
  high official,—the old fire lights up anew.

  “That time with my friend H. was a happy one, the return of which I
  would gladly buy with my heart’s blood. Then life was a pleasure,
  learning was mere play, and I had a feeling for everything beautiful.

  “During this time a physician, a friend of my father’s, seduced me by
  caressing me and practicing masturbation on me on the occasion of a
  visit, and by explaining the sexual act to me. He advised me never to
  practice manustupration, since it was injurious to health. He then
  practiced mutual onanism with me, and explained that this was the only
  way in which he could perform the sexual function. He had a horror of
  women, and, therefore, had lived unhappily with his deceased wife. He
  gave me a pressing invitation to visit him as often as possible. The
  physician was a pompous man, and the father of two sons aged fourteen
  and fifteen respectively, with whom in the following year I entered
  into love-relations similar to those I had with my friend H.

  “I was ashamed of my unfaithfulness to him, but at the same time
  continued my relations with the physician. He practiced mutual
  masturbation with me, showed me our spermatozoa under the microscope,
  and pornographic works and pictures, which, however, did not please
  me, because I had interest only for male forms. On the occasion of
  later visits, he asked me to do him a favor which he had never yet
  enjoyed, and which he very much desired. Since I loved him, I
  acquiesced in everything. He dilated my anus with instruments, and
  practiced pederasty on me, and at the same time performed
  masturbation, so that I experienced pleasure and pain at once. After
  this discovery I went immediately to my friend H., with the thought
  that this beloved man would be able to give me still greater pleasure.
  We practiced pederasty on each other, but were both deceived, and did
  not repeat it; for passively I had only pain, and actively no
  pleasure, while mutual onanism gave us both the greatest enjoyment.
  Thereafter, out of gratitude, I was still frequently at the disposal
  of the physician only. Up to my fifteenth year I practiced passive or
  mutual onanism with my friend. Now I was quite grown, and had all
  kinds of signs made to me by women and girls; but I fled from them as
  Joseph did from Potiphar’s wife. At fifteen I came to the Capital. I
  had but infrequent opportunity for the satisfaction of my sexual
  inclination. I reveled in the sight of pictures and statues of male
  forms, and could not keep from kissing the beloved statues. The
  fig-leaves on the genitals were my principal annoyance.

  “At seventeen I went to the University. There, again, I lived two
  years with my friend H.

  “When I was in my eighteenth year, while in a state of mild
  intoxication, I was set on to have coitus with a woman. I forced
  myself to it, but immediately afterward I fled the house, overcome
  with disgust. Just as after the first active manustupration, I had a
  feeling as if I had committed a crime. On the occasion of another
  attempt, while in a sober condition, in spite of every effort of a
  beautiful naked girl, I could not get an erection; though the mere
  sight of a boy or the touch of a man’s hand on my thigh, would always
  throw my penis into violent erection. A short time before, my friend
  H. had had a similar experience. In vain we racked our brains to
  discover the reason for it. Now I let women alone, and found enjoyment
  with friends in passive and mutual onanism, among others with both the
  sons of the physician, who had used them for pederasty after my
  departure.

  “When nineteen years old, I made the acquaintance of two genuine
  urnings:—

  “A., aged 56, of effeminate appearance, beardless, of small endowment
  mentally, possessing a powerful sexual desire that had been manifested
  abnormally early, had indulged in urnings’ love since his sixth year.
  Once a month he visited the Capital. I had to sleep with him. He was
  insatiable in mutual onanism, and made me take part in active and
  passive pederasty, which was an unpleasant part of the bargain for
  me.”

  “B., a merchant, aged 36, of masculine appearance, was as passionate
  as I was. He knew how to make his manipulations on me such a stimulus
  that I had to serve him passively in pederasty. He was the only one
  with whom I ever had any pleasure in passive pederasty. He confessed
  to me that when he but knew that I was near, he had the most painful
  erections; and that when I could not serve him, he was compelled to
  satisfy himself by masturbation.

  “While pursuing these love-affairs, I was clinical assistant in
  hospital, and was considered ambitious and skillful in my work. I
  naturally sought throughout literature for an explanation of my sexual
  peculiarity. I found it in part as a crime deserving punishment, while
  for myself I could only recognize in it the natural satisfaction of my
  sexual desire. I was aware that this was congenital with me. But
  feeling myself in opposition to the whole world, often near insanity
  and suicide, I again sought to satisfy my powerful sexual desire with
  women. The result was always the same,—either want of sufficient
  erection, or, when it became possible, to force myself to the act,
  disgust and horror of its repetition. As a military surgeon, I
  suffered terribly from the sight and touch of thousands of naked male
  forms. Fortunately, I formed a love-bond with a lieutenant affected
  similarly, and passed again a time of happiness. For love of him I
  consented to pederasty, for which he longed. We loved each other until
  he lost his life at Sedan. From that time I never gave myself to
  active or passive pederasty, although I had many love-affairs, and was
  a person much sought.

  “At twenty-three I went to the country as a physician, and was sought
  and esteemed. I satisfied myself with boys over fourteen. I interested
  myself in political affairs, and made an enemy of the clergyman, and,
  being betrayed by one of my lovers, was denounced and compelled to
  flee. The legal investigation, fortunately, did me no harm. I was able
  to return, but I was greatly shaken; and I went to the war (1870) as a
  soldier, in the hope of meeting my death. I returned, however, with
  many distinctions, much matured; and I found still more pleasure in
  earnest work in my profession. I hoped that the extinction of my
  excessive sexual desire was near at hand, exhausted by the great
  hardships of the campaign.

  “Scarcely had I recovered, when the old unbounded desire again
  appeared, and led to new unbridled satisfaction. Of course, I often
  thought of it; but my inclination, so revolting to the world, did not
  seem so to me.

  “For a year, by means of the greatest exercise of my will, I
  abstained; then I went to the Capital to force myself to cohabit with
  a woman. I, who at the sight of the dirtiest ragamuffin had painful
  erections, could scarcely induce one with the most beautiful woman.
  Overcome, I returned home and obtained a young man-servant for my
  personal service and satisfaction.

  “The solitude of life as a country physician, and the longing for
  children, drove me to marriage; besides, I wished to make an end to
  gossip, and I hoped finally to triumph over my fatal desire.

  “I knew a young girl, of whose respect and love for me I was
  convinced. Through my esteem and honor for my wife, I was enabled to
  perform the conjugal duties, and begat four boys. The boyish
  appearance of my wife was of effectual assistance. I called her my
  ‘Raphael.’ I forced into my fancy images of boys, in order to induce
  erection. If my fancy ceased for a moment, the erection failed. I was
  unable to sleep with my wife. Within the last few years coitus has
  become constantly more difficult to attain, and for two years we have
  given up all attempts. My wife knows my mental condition, and her
  esteem and love for me may become estranged.

  “My sexual inclination for my own sex is unchanged, and,
  unfortunately, too often forces me to become untrue to my wife. To
  this day, the sight of a youth of sixteen puts me into violent sexual
  excitement with painful erections, so that occasionally I am compelled
  to help myself with manustupration of him and onanism on myself.

  “The sufferings I endure are indescribable. _Faute de mieux_, I have
  my wife practice manustupration on me; but what my wife’s hand
  accomplishes with great effort in half an hour is produced by the hand
  of a boy in a few seconds. Thus I live, miserable, a slave of the law
  and of my duty to my wife! I never had pleasure in active or passive
  pederasty. If I ever practiced or suffered it, it was only from
  gratitude or desire to please.”

The physician to whom I owe the preceding autobiography assures me that
he, up to this time, has had sexual intercourse with at least six
hundred urnings. There were, indeed, many among them who to-day occupy
high and respected positions. Only about ten per cent. of them came
later to love women. Another portion did not avoid women, but were more
inclined to their own sex; the remainder were exclusively and lastingly
urnings.

This physician asserted that among the six hundred he never found
abnormal formation of the genitals; but there were, however, frequent
approaches to the female form, as well as incomplete growth of hair,
delicate complexion, and higher voice. Development of the mammæ was not
infrequent. He asserted that from his thirteenth to his fifteenth year
he had milk in his mammæ, which his friend H. sucked out. Only about ten
per cent. of this number showed inclination for female occupations, etc.
All his acquaintances were affected with a sexual desire that was
abnormally powerful, and made its appearance abnormally early. The vast
majority felt themselves as the man in their relations with the other,
and satisfied themselves by mutual onanism, or by manustupration on the
person of the lover, or by masturbation at his hands. The majority were
inclined to active pederasty; but very frequently the law and æsthetic
feeling were reasons for the non-performance of the act. Those feeling
themselves toward the others as women were few, and the inclination to
passive pederasty was very infrequent.

  In the beginning of 1887, this physician was arrested for having
  commuted acts of indecency on the persons of two boys under fourteen
  years. The crime consisted in his having first rubbed mentulam
  propriam inter femora viri until ejaculatio, and the same procedure
  cum mentula propria inter femora pueri. At the examination it was
  recognized that an abnormal instinct was in play, though, at the same
  time, it was shown that the culprit was not mentally unsound, and not
  deprived of free will; at least, he had not acted in obedience to an
  uncontrollable impulse. Therefore, he was sentenced to prison for one
  year, the mildest possible punishment.

  Case 113. Mr. X., Hungarian, merchant, consulted me on account of
  neurasthenia and sleeplessness, which had existed for years. The
  investigation of the cause of his trouble led the patient to confess
  that he had an abnormal sexual instinct for his own sex, that he was
  very passionate, and that his nervous trouble might well come from
  that. The following, taken from the history of this intelligent
  patient, possesses scientific interest:—

  “My abnormal sexual instinct reaches back to my childhood. When three
  years old, I got hold of a journal of fashions. The beautiful pictures
  of the men I kissed until the paper was torn to tatters, but I paid no
  attention to the female figures. I did not like to play with boys. I
  preferred to play with girls, because they always had dolls. I
  especially liked to cut out dolls’ clothes; and to-day, in spite of my
  thirty-three years, dolls still possess an interest for me. When a
  boy, for hours I would lurk about available places, in order to get a
  sight of male genitals. When I succeeded, a strange, dizzy feeling
  came over me. Weak, unattractive men or boys made no impression on me.
  At thirteen I began to masturbate. From my thirteenth till my
  fifteenth year, I slept with a handsome young man. That was happiness.
  Hours at a time at night, with erections, I would wait for his return.
  If in bed he chanced to touch my genitals, it gave me delight. At
  fourteen I had a school-mate whose instincts were like my own. For
  hours at a time, during school-hours, we held each other’s genitals.
  Ah, those were happy hours! As often as I could, I lingered in
  bath-houses. That was always a feast for me. The sight of male
  genitals induced violent erections. At sixteen I came to the
  metropolis. Seeing so many handsome men charmed me. In my eighteenth
  year I attempted coitus with a prostitute, but disgust and fear made
  it impossible. Other attempts were failures, until my nineteenth year,
  when I tried again with success; but the act afforded me no pleasure,
  rather inducing a feeling of disgust. I conquered myself, and was
  proud of my success at being a man, which I had gradually begun to
  doubt.

  “Subsequent attempts were no longer successful. The disgust was too
  great. When the woman was undressing, it became necessary, on account
  of my feeling of repugnance, to put out the light. I now considered
  myself impotent, consulted physicians, and visited baths and
  sanitariums to cure my supposed impotence; for I still did not know
  what to think of it. I took pleasure in the society of ladies, perhaps
  out of conceit; for I impressed most ladies as being sympathetic and
  amiable; but I valued in them nothing more than mental and æsthetic
  qualities. I liked to dance with them; but if one pressed against me
  in dancing, I experienced a feeling of repugnance, and even disgust,
  and felt like striking her. If in joke I happened to dance with a
  gentleman, I always took the part of the lady. I would press and rub
  against him, and take a perfect delight in it. When I was eighteen, a
  gentleman who came into the office, said, ‘That is a fine youth; in
  the East he would bring a pound sterling every time!’ I puzzled my
  head over that. Another gentleman liked to joke with me, and steal
  kisses of me as he was going away, which I would have given him only
  too gladly. He afterward became my lover. These circumstances excited
  my attention, and I waited for an opportunity.

  “When I was twenty-five years old, it happened that a man who was
  formerly a Capucine monk became attracted to me. For me he was like a
  Mephistopheles. Finally he spoke to me. To this day I can almost feel
  the beating of my heart that he caused me; I almost fainted. He made a
  rendezvous for that evening at a public house. I went, but at the
  threshold I turned back, afraid. On the next evening he met me again.
  He overcame my scruples, and took me to his room. I was scarcely able
  to walk for excitement. My seducer made me sit on his sofa, and,
  smiling at me, he fixed his wonderful black eyes on me, and I lost
  consciousness. This delight, this ideal, divine sense of pleasure that
  filled my whole being,—I could write too much about it. I think only
  an innocent youth, over head and ears in love, who for the first time
  has his love’s longing fulfilled, could be as happy as I was that
  night. My seducer demanded my life, in joke; but I at first thought
  him in earnest. I begged him to let me be happy for a time, and then,
  united to him, I would end my life. It would have been entirely in
  accordance with the high-flown ideas I entertained at that time. For
  five years after that, I kept up a relation with the man, who is still
  so dear to me. Oh, how happy, and yet, often, how unhappy, I was
  during those years! If I but saw him speak to a handsome young man, I
  became wildly jealous.

  “When twenty-seven, I became engaged to a young lady. Her mind and
  æsthetic feeling, as well as financial considerations, induced me to
  think of marriage. At the same time, I am very fond of children, and,
  whenever I meet even the commonest day-laborer and his wife and a
  pretty child, I envy the man his good fortune. Thus I made a fool of
  myself. I managed to get through the time of courtship; when kissing
  my bride I felt more anxiety and fear than pleasure. On one or two
  occasions, however, after luxurious dinners, while kissing her
  passionately, I had erections. How happy I was at that! I saw myself
  already a father. I twice came near breaking off the engagement. On my
  marriage-day, when all the guests had assembled, I locked myself in a
  room, cried like a child, and felt that I could not proceed with the
  ceremony. At the persuasion of all the relatives, to whom I made the
  best excuses that occurred to me, I allowed myself to be taken, in
  ordinary street-costume, to the altar.

  “As great good fortune would have it, at the time of the marriage, my
  wife was menstruating. Oh, how thankful I was for this excuse! I am
  now convinced that this circumstance is all that made later
  cohabitation possible. How it later became possible for me to cohabit
  with my wife, and have a lovely boy, I do not know. He is the comfort
  of my ruined life. I can only thank God for the happiness of having a
  child. I was a cheat, so to speak, in the marriage-bed. My wife, whom
  I respect for her high qualities of character, has no suspicion of my
  condition, but she often complains of my coldness. With her goodness
  of heart and simplicity, it was possible for me to make her think that
  the conjugal duty should be performed but once a month. Since she is
  in nowise sensual, and I can find excuse in my nervousness, I am
  successful in keeping up the swindle. Cohabitation is the greatest
  sacrifice for me. By taking considerable wine, and by making use of
  the erections which occur in the morning, as the result of an
  overfilled bladder, it is possible for me to perform coitus once a
  month; but it affords me no pleasurable feeling, and I am worried and
  experience an increase of my nervous difficulties all day long after
  it. The consciousness of having fulfilled my duty toward my wife, whom
  in all other respects I love, affords me moral consolation and
  satisfaction. With a man, it is otherwise. With him I can perform the
  act several times in a night, always taking the sexual _rôle_ of a
  man. In this, I experience the greatest pleasure, the purest
  happiness. I feel myself refreshed and invigorated by it. Of late, my
  desire for men has somewhat decreased; in fact, I have courage even to
  avoid a handsome young man that approaches me. Will it last? I fear
  not. I am absolutely unable to do without male love; if I am compelled
  to forego it, I become depressed, feel weary and miserable, and have
  pain and pressure in my head. I have always regarded my pitiable
  peculiarity as something congenital, and I would feel happy if I had
  only not married. I pity my good wife. Often the fear seizes me that I
  cannot endure it with her longer; then thoughts about divorce,
  suicide, and flight to America come to me.”

  No one seeing the patient to whom I owe this communication would
  suspect his condition. His outward appearance is, in all respects,
  masculine; he has a well-developed, full beard, strong and deep voice,
  and normal genitals. The cranium is normally formed; signs of
  degeneration are absolutely wanting, and only an exquisitely nervous
  eye makes one suspect a neuropathic condition. The vegetative organs
  perform their functions normally. The patient presents the usual
  symptoms of a neurasthenia, which may, in all essentials, be ascribed
  to sexual excesses with persons of his own sex, in a man abnormally
  passionate; and to the injurious influences of forced, though
  infrequent, coitus with the wife where horror feminæ exists.

  The patient declares that he comes from healthy parents, and that he
  knows of no neuroses or mental disease in his ancestry. His elder
  brother was married three years. There was a separation, because the
  husband never had sexual intercourse with his wife. He married a
  second time. The second wife also complained of neglect on the part of
  the husband; but she had four children, concerning whose legitimacy no
  doubt was ever raised. A sister is hysteropathic.

  The patient says that, when a young man, he suffered with momentary
  attacks of dizziness, during which it seemed to him as if he were
  about to die. He says that he has always been very excitable and
  emotional, and an enthusiast for the arts, especially poetry and
  music. He himself designates his character as enigmatical, abnormal,
  nervous, restless, extravagant, and undecided. He is often exalted
  without real reason, and then again depressed, even to thoughts of
  suicide. He may pass through quick and sudden changes,—“religious and
  frivolous, optimistic and cynical, cowardly and brave, credulous,
  amiable, and suspicious; inclined to do others harm, and sorrowful to
  tears over the misfortunes of others; and with this, generous to
  excess, and then again miserly _à la Harpagon_.” The patient is
  certainly a tainted individual. He seems to be very well endowed
  intellectually, and, as he says, to have learned easily, and been
  among the first at school.

  The marriage of this man was not happy. Notwithstanding the fact that
  it was but very infrequently that he performed the inadequate and
  injurious sexual act with his wife, and that he sought and found a
  substitute in male lovers, he remained neurasthenic. His disease, at
  times, presents marked exacerbations, even manifesting itself in
  despairing depression about his matrimonial, sexual, and mental
  condition, which even extends to violent tædium vitæ.

  His wife became hysteropathic and anæmic, and the patient attributed
  this to sexual abstinence. Try as he would to force himself, of late
  years he has not been able to perform coitus, erection failing
  completely; while, in intercourse with male lovers, he is very potent.

  The son of these unfortunate parents, who is now over nine years old,
  develops well. The patient adds that formerly, in coitus with his
  wife, he was potent only when he thought of a beloved man. (From the
  author’s “Lehrb. der Psychiatrie.”)

  Case 114. _Autobiography._ “The writer of this is a congenital urning.
  If I have not consorted with other urnings, nevertheless, I am fully
  informed of my condition; for it has been my lot to see almost all
  literature on the subject. A short time ago, your work, ‘Psychopathia
  Sexualis,’ was sent to me. I saw in it that you were working and
  studying without prejudice in the interest of science and humanity.

  “If I cannot tell you much that is new, yet I will speak of a few
  things which I trust you will receive as one more stone to be used by
  you in your work; which, I am confident, will, in your hands, aid in
  saving us.

  “When you presume that there is often an hereditary tainted condition,
  perhaps you are right. My father was subject to spinal disease before
  my birth; later, he became mentally unsound, and took his own life.

  “Another point, which I am inclined to doubt, is the one mentioned by
  you in another place,—_i.e._, that onanism practiced from youth may
  lead to perverse instinct.

  “I (merchant, owner of a small business, unmarried) am in the
  beginning of my thirtieth year. I am apparently healthy, and show
  scarcely a deviation from the normal masculine type. The first sexual
  impulses were immediately and exclusively directed to the male sex,
  and I experienced them from my tenth year. I have masturbated since my
  twelfth year. Since, in spite of all attempts, coitus with women was
  always absolutely impossible for me; and since I have never had desire
  for women—on the contrary, rather aversion; and since my attempts have
  never resulted in the slightest erection, I have been compelled to
  satisfy myself by onanism.

  “If now I am to confess the manner of my sexual satisfaction, I may
  say that in my earlier years my fellow-pupils and companions excited
  me sexually. Now my impulse consists in a desire for boys of about
  ten, but mostly for youths of from fifteen to twenty years.

  “For a long time, strong and healthy cadets, of fine form, have had a
  particular charm for me; and by their handsome uniforms and fine
  presence they especially excite my desire. I have no opportunity to
  approach them, or even to enter into distant social intercourse with
  them; but I am compelled to satisfy myself with following them in the
  streets and squares; or in restaurants, horse-cars or railways, by
  sitting near them, and, when it is possible to do it unnoticed, under
  such circumstances, by practicing onanism. My most ardent wish has
  often been to become the friend, servant, or slave of such a young
  man.

  “I have never even dreamed of direct pederasty; my desire has always
  been bodily contact, embrace, manustupration of my genitals by my
  lover, and, on my part, a kiss on his genitals or podex.

  “I often have the desire, however, to represent Sacher-Masoch in his
  ‘Venus in Furs.’ There a man makes himself the voluntary slave of a
  woman, and feels an intense thrill of lustful pleasure, if he is only
  chastised and humiliated by her. But I naturally feel that I could,
  under no circumstances, become the slave of a woman, but only of a
  man; more correctly, of a young man; one, however, for whom I should
  have such an infinite love that I could give myself up entirely to his
  mercy or cruelty.

  “The lustful images that float before my mind in masturbation are
  those of this or that young man that I have just seen. As a sad and
  incomplete substitute, I practice this onanism constantly.

  “I pass into a lustful dream in this way (and I say all here, because
  I wish to write only the truth and the whole truth): I choose a young
  man that pleases me by his form, and in imagination give myself up to
  involuntary obedience to him. I imagine that he wishes to humiliate
  me, and that he commands me, for example, to kiss his feet; or compels
  me to smell his socks. For want of the desired actuality, I take my
  own socks, smell of them, take them into my mouth, rub them over my
  genitals, and immediately erection and ejaculation, with sensual
  pleasure, take place.

  “Yes, I am so dominated by this mental imagery that I imagine that the
  young man is my confessor, and, in order to humiliate me, orders me to
  eat of his excrement. Here again, in want of actuality, I eat of my
  own excrement, but only in small quantity. Then, with an imperfect
  feeling of disgust and violent palpitation of the heart, erection and
  ejaculation take place.

  “However, I come to this vile, feverish imagery and the performance of
  these acts, only when it has not been possible for me for a long time
  to satisfy myself by onanism in the immediate vicinity of a young man.

  “This is for me more natural, because I then have more pleasure, and
  experience a more perfect physical and mental benefit, even though my
  ideal of actual and direct satisfaction in mutual understanding were
  never to be accorded me.

  “I almost believe that the above-mentioned disgusting imagery is only
  the evil result of constant want of normal satisfaction,—_i.e._, of my
  normal satisfaction as an urning; and that with a regular
  satisfaction, body to body, the imagery that becomes almost insane
  would be less intense, and certainly would not go to such
  extravagance. Or it is the ultimate result of an attempt at
  abstinence; for these idiotic, sensual images only come after a long
  period of it.

  “I believe, indeed, that, under other social conditions, I should be
  capable of great and noble love and self-sacrifice. My thoughts are in
  no way exclusively carnal or diseased. How often, at the sight of a
  handsome young man, a deep feeling of impatience seizes me, and I
  breathe at once the sweet words of Heine:—

     “‘Du bist wie eine Blume, so hold, so schön, so rein,’ etc.[115]

  “And once, when I was compelled to part with a young man who had
  honored and valued me as his friend and protector, though my love had
  remained unknown to him, those fine verses by Scheffel kept passing
  through my mind, especially the last,—_mutatis mutandis_:—

             “‘Grau wie der Himmel, steht vor mir die Welt,
             Doch wend’ es sich zum Guten oder Bösen,
             Du, lieber Freund, in Treuen denk’ ich Dein!
             Behüt Dich Gott! es wär’ zu schön gewesen,
             Behüt Dich Gott, es hat nicht sollen sein!’[116]

  “I have never independently revealed my love to a young man, and have
  never spoiled or injured one morally; but I have, now and then, made
  the way easy for many. Under such circumstances, nothing is too much
  trouble, and I obtain victims as only I can.

  “When I have an opportunity to have such a beloved friend about me, to
  educate, protect, and help, if my recognized love find a (natural,
  unsexual) return, then all my disgusting mental imagery grows less and
  less intense; then my love becomes almost platonic and ennobled, to
  sink again into the mire when this worthy satisfaction is removed.

  “As for the rest, and without over-estimating myself, I may say that I
  am not one of the worst of men. Brighter mentally than the average
  man, I take interest in all that moves humanity. I am amiable, and
  easily moved to pity, and am incapable of doing any animal, much less
  a man, an injury; but, on the contrary, do good wherever I can.

  “When I have nothing to reproach myself with in my own conscience, and
  must, at the same time, set myself in opposition to the judgment of
  the world, I suffer very much. Indeed, I have done no one harm, and I
  consider my love, in its noblest activity, to be quite as holy as that
  of a normal man; but, with the unhappy lot which impatience and
  ignorance cast upon us, I suffer even to the extent of tædium vitæ.

  “No pen, no tongue can describe all the misery, all the unhappy
  situations, the constant fear of having this peculiarity recognized,
  and of being cast from society. The one thought that, as soon as
  recognized, one’s existence would be lost, and he would be cast away
  from all, is as terrible as any thought can be. Then all the good that
  one had ever done would be forgotten; then, in the pride of his great
  morality, every normal man would be moved to scorn, even though he
  himself had been never so frivolous in his own love.

  “Then what does our misery amount to? We may, cursing man, end our
  unhappy lives. Truly, I often long for the quiet of an asylum. My life
  may end when it will, the quicker the better; I am ready.

  “To refer to one more point: I also believe, like the others that have
  written to you, that our nervousness is first acquired as a result of
  our unhappy, unspeakably miserable life among our fellow-creatures.

  “And still another: You write, at the conclusion of your work,
  concerning the repeal of the legal enactments concerned. Indeed,
  humanity would not be destroyed if they were repealed. In Italy there
  is no such law, as far as I know; and Italy is not a wilderness, but a
  cultivated nation.

  “As for myself, compelled as I am to undermine my life by onanism, the
  law could not touch me; for I have never sinned against it in a
  letter. But, at the same time, I suffer under the accursed scorn to
  which we are subjected. How can the ideas of society be changed, so
  long as there is a law which strengthens it in its immorality? The law
  must, of course, correspond with public opinion; but it should not be
  in harmony with the erroneous opinion of ignorance, but only in accord
  with the ideas of the best and most scientific thinkers,—not with the
  wish and prejudice of the vulgar. True thinking minds cannot much
  longer be satisfied with the old idea.

  “Pardon me, Professor, if I close without a signature. Do not try to
  find me. I could tell you nothing more. I give you these lines in the
  interest of future sufferers. Publish from them, in the interest of
  science, truth, and justice, what seems to you to be necessary.”

  Case 115. On a summer evening, at twilight, X. Y., a physician of a
  city in North Germany, was detected by a watchman while committing a
  misdemeanor with a countryman in a field. He was practicing
  masturbation on him, and then mentulam alius in os suum immisit. X.
  escaped legal prosecution by flight. The authorities dismissed the
  complaint, because there had been no publicity, and because immissio
  membri in anum had not taken place. Among X.’s effects was found an
  extensive correspondence of a perverse sexual character, which showed
  that he had had perverse intercourse for years with all classes of
  people.

  X. came of a neurotic family. His paternal grandfather died by suicide
  while insane. His father was a weak, peculiar man. One brother
  masturbated at the age of two. A cousin was sexually perverse, and
  practiced perverse acts, similar to those of X., while a youth; he
  became weak-minded, and died of spinal disease. A paternal great-uncle
  was an hermaphrodite. His mother’s sister was insane. His mother is
  said to have been healthy. X.’s brother is nervous and irascible.

  X., likewise, was nervous as a child. The mewing of a cat would create
  great fear in him; and if one but imitated the voice of a cat, he
  would cry bitterly, and run to others for protection. Slight physical
  disturbance caused violent fever. He was a quiet, dreamy child, of
  excitable imagination, but of slight mental capabilities. He did not
  indulge much in boyish games; he preferred feminine pursuits. It gave
  him especial pleasure to curl the hair of the house-maid or of his
  brother.

  At thirteen X. went to an Institute. There he practiced mutual
  masturbation, seduced his comrades, and, by his cynical conduct, made
  them unmanageable; so that he had to be taken home. At that time the
  parents found love-letters with lascivious contents, showing perverse
  sexuality. From the age of seventeen he studied under the strict
  surveillance of a professor in a Gymnasium. He made but sad progress
  in learning. He had only a talent for music.

  After finishing his studies, the patient entered the University, at
  the age of nineteen. There he attracted attention by his cynical
  character and his association with young persons who were thought to
  be given to masculine love. He began to be dandified; wore striking
  cravats, and shirts that were low cut; he forced his feet into narrow
  shoes, and curled his hair in a remarkable way. This peculiarity
  disappeared when he left the school, and had returned home.

  At the age of twenty-four he was for a long time neurasthenic. From
  that time until his twenty-ninth year, he was earnest and skillful in
  his profession; but he avoided the society of the opposite sex, and
  constantly associated with men of doubtful character.

  The patient would not allow a personal examination. In writing, he
  made the excuse for this that it would be of no use, because his
  impulse to his own sex had existed from his earliest childhood, and
  was congenital. He had always had horror feminæ, and had never been
  inclined to avail himself of the charms of women. Toward men he felt
  himself in the _rôle_ of a man. He recognized his impulse toward his
  own sex as abnormal, and excused his sexual indulgence as being the
  result of an abnormal natural condition.

  Since his flight X. lives out of Germany, in Southern Italy, and, as I
  learned from a letter, now, as before, he indulges in perverse love.
  X. is an earnest, stately man, of masculine features, well-grown
  beard, and normally developed genitals. Dr. X. furnished me, a short
  time ago, with his autobiography, of which the following is worthy of
  mention:—

  “When, at the age of seven, I entered the private school, I felt very
  uncomfortable, and found very little sympathy with my companions. Only
  toward one of them, who was a very handsome child, did I feel
  attracted, and I loved him wildly. In childish games I always knew how
  to arrange it so that I could appear in feminine attire; and my
  greatest pleasure was to form intricate coiffures for our
  servant-girls. I often regretted that I was not a girl.

  “My sexual instinct awakened when I was thirteen, and from the moment
  of its appearance was directed toward youthful, strong men. At first I
  was not really certain that this was abnormal, but consciousness of it
  came when I saw and heard how my companions were characterized
  sexually. I began to masturbate at the age of thirteen. At seventeen I
  left home and went to the Gymnasium of a large Capital, where I was
  put to board with a married professor of the Gymnasium, with whose son
  I afterward had sexual relations. It was with him that I first had
  sexual satisfaction. Thereafter I made the acquaintance of a young
  artist, who very soon noticed that I was abnormal, and confessed to me
  that he was in the same condition. I learned from him that this
  abnormality was very frequent; and this knowledge overcame the trouble
  that I had had in supposing that I was alone in my abnormality. This
  young man had an extensive acquaintance with persons in like
  condition, to which he introduced me. There I became the object of
  general attention, for on all sides I was declared to be very
  attractive physically. I soon became insanely loved by an old
  gentleman; but, not finding him to my taste, I endured him but a short
  time, and then gave ear to a young and handsome officer who lay at my
  feet. He was really my first love.

  “After passing my final examination, at the age of nineteen, free from
  the discipline of school, I made the acquaintance of a great number of
  people like myself, and among them Karl Ulrichs (Numa Numantinus).

  “When, later, I took up the study of medicine, and associated with
  many normal youths, I was often in a position where I was compelled to
  visit public prostitutes. After having consorted to no purpose with
  various prostitutes, some of whom were very beautiful, the opinion was
  spread among my acquaintances that I was impotent, and I strengthened
  this by telling of previous sexual excesses. At that time I had
  numerous external relations with persons who prized my physical
  peculiarities, which were considered very beautiful. The result of
  this was, that I was exciting somebody all the time; and I received
  such a mass of love-letters that I was often in embarrassment. The
  acme of this was reached later, when, as a physician, I lived in the
  hospital. There I moved about like a celebrated person, and the scenes
  of jealousy that took place, on my account, almost led to the
  discovery of the whole thing. Shortly after this, I fell ill with an
  inflammation of my shoulder-joint, from which I recovered after three
  months. During this illness I received subcutaneous injections of
  morphine several times daily, which were suddenly discontinued, and
  which I practiced thereafter secretly after my recovery. For the
  purpose of special study, I spent some months in Vienna, before
  entering into private practice, and there, by means of some
  recommendations, I gained entrance to various circles of people like
  myself. I there learned that the abnormality in question, in its
  various forms, is spread through the lower classes as well as the
  higher, and that those who are approachable for money are not
  infrequently met among the higher classes.

  “When I established myself in the country, I hoped to cure myself of
  the morphine habit by means of cocaine; and then I became a victim of
  cocaine, which, only after three relapses, I was able to rid myself of
  (about two years ago). In my position, it was impossible for me to
  find sexual satisfaction, and I noticed with pleasure that the use of
  cocaine had overcome my desire. When, on the first occasion, at the
  urgent request of my aunt, I had emancipated myself from cocaine, I
  traveled for a few weeks, in order to improve my health, the perverse
  impulses were again awakened in their old strength, and, one evening,
  while out in the fields by the city amusing myself with a man, I
  noticed that I had been detected by the authorities and advertised;
  but that the act of which I was accused was not punishable, in
  accordance with the opinion expressed by the highest court of the
  German kingdom. I had, therefore, to be careful; for already the
  announcement of the crime had been heralded on all sides. I saw that,
  after this, I would be compelled to leave Germany, and find a new home
  where neither the law nor public opinion would be opposed to that
  impulse, which, like all abnormal instincts, could not be overcome by
  the will. Since I was never deceived for a moment about the matter, in
  recognizing my impulses as opposed to social usages, I repeatedly
  attempted to become master of them; but by these efforts they were
  increased in power. This same observation has been communicated to me
  by acquaintances. Since I was exclusively drawn toward strong,
  youthful, and masculine individuals, and they were very seldom
  inclined to yield to my wishes, I was compelled to buy them. Since my
  desire was limited to persons of the lower classes, I was always able
  to find such as were purchasable with money. I hope that the following
  statements will not awaken your repugnance. At first I intended to
  omit them; but, for the completeness of this communication, I may
  include them, since they serve to enrich the clinical material. I am
  compelled to perform the sexual act in the following way:—

  “Pene juvenis in os recepto, ita ut commovendo ore meo effecerim, ut
  is quem cupio, semen ejaculaverit, sperma in perinæum exspuo, femora
  comprimi jubeo et penem meum ad versus et intra femora compressa
  immitto. Dum hæc fiunt, necesse est, ut juvenis me, quantum potest,
  amplectatur. Quæ prius me fecisse narravi, eandem mihi afferunt
  voluptatem, acsi ipse ejaculo. Ejaculationem pene in anum immittendo
  vel manu terendo assequi, mihi nequaquam amœnum est.

  “Sed inveni, qui penem meum receperint atque ea facientes, quæ supra
  exposui, effecerint, ut libidines meæ plane sint saturatæ.

  “Concerning my person, I must still mention the following: I am 186
  centimetres tall, of masculine appearance, and, with the exception of
  abnormal irritability of the skin, healthy. My hair and beard are
  black and thick. My genitals are of medium size and normally formed. I
  am able, without any trace of fatigue, to perform the sexual act from
  four to six times in twenty-four hours. My life is very regular. I use
  alcohol and tobacco very sparingly. I play the piano quite well, and
  some of my unpretentious compositions have been much applauded. I have
  lately finished a novel, which, as my first work, has been very
  favorably criticised by my friends. The story has several problems
  taken from the life of urnings in the subject-matter.

  “Among the large number of fellow-sufferers that are personally known
  to me, I have naturally been in a position to make observations
  concerning the condition and the degrees of abnormality; and, perhaps,
  the following communications may be of service to you:—

  “The most abnormal thing that I am acquainted with, was the impulse of
  a gentleman who lived in Berlin. He preferred, above all others, young
  fellows with unwashed feet, which he would lick passionately. A
  gentleman in Leipzig was similar to him; who, where it was possible,
  would linguam in anum immittere, preferring the parts to be uncleaned.
  Several have assured me that the sight of riding-boots or of parts of
  military uniforms, induced such excitement in them that ejaculation
  resulted. A man in Paris compelled a friend ut in os ei mingat.

  “With reference to the degree in which many feel themselves as women,
  which is with me not the case, two persons in Vienna are examples.
  They bore feminine names. One is a barber who calls himself ‘French
  Laura’; the other was formerly a butcher, who calls himself
  ‘Selcher-Fanny.’ Both of them never missed an opportunity, during the
  carnival time, to show themselves in very fantastic feminine masks. In
  Hamburg there is a person that many people believe to be a woman,
  because he always goes about the house in feminine attire, and only
  occasionally leaves the house, and always in such clothing. This man
  wished to stand as godmother at a christening, and, as a result of it,
  gave rise to great scandal.

  “Feminine timidity, frivolity, obstinacy, and weakness of character,
  are the rule in such individuals.

  “Several cases of perverse sexuality are known to me where epilepsy
  and psychoses are present. Hernias are remarkably frequent. In
  practice many persons come to me to be treated for diseases of the
  anus, because of recommendation by friends. I saw two syphilitic and
  one local chancre, and several fissures; and at present I am treating
  a gentleman for condylomata of the anus, which form a rounded tumor as
  large as a fist. One case of primary affection of the soft palate I
  saw in Vienna, in a young man who was accustomed to frequent
  mask-balls dressed as a girl, and entice young men; he would then
  pretend that he was menstruating, and thus induce the others to use
  him per os. The assertion was made that in this way he had deceived
  fourteen men in one evening. Since, in none of the publications
  concerning contrary sexuality that I have seen, I have found anything
  concerning the intercourse of pederasts among themselves, I venture to
  communicate something concerning it in conclusion:—

  “As soon as individuals that are affected with contrary sexuality
  become acquainted, there is a detailed narration of their experiences,
  loves, and seductions, as far as the social difference between them
  allows such entertainment. Only in very few cases is this amusement
  uncommon with new acquaintances. Among themselves, they call
  themselves ‘aunts’; in Vienna, ‘sisters’; and two very masculine
  public prostitutes in Vienna, whom I accidentally became acquainted
  with, and who lived in a perverse sexual relation with each other,
  told me that for the corresponding condition in women the name ‘uncle’
  was used. Since becoming conscious of my abnormal instinct, I have met
  thousands of such individuals.

  “Almost every large city has some meeting-place, as well as a
  so-called promenade. In smaller cities there are relatively few
  ‘aunts,’ though in a small town of 2300 inhabitants I found eight, and
  in one of 7000 eighteen of whom I was absolutely sure,—to say nothing
  of those whom I suspected. In my own town of 30,000 inhabitants, I
  personally know about one hundred and twenty ‘aunts.’ The greater
  number of them, and I especially, possess the capability of judging
  another immediately as to whether they are alike or not, which, in the
  language of the ‘aunts,’ is called ‘reasonable’ or ‘unreasonable.’ My
  acquaintances are often astounded at the certainty of my judgment.
  Individuals that are apparently absolutely masculine I recognize as
  ‘aunts’ at the first sight. On the other hand, I am able to behave
  myself in such a masculine way that, in circles to which I have been
  introduced by acquaintances, there is a doubt as to my genuineness.
  When I am in the mood, I can act exactly like a girl.

  “Since the majority of ‘aunts,’ like myself, in no way regret their
  abnormality, but would be sorry if the condition were to be changed;
  and, moreover, since the congenital condition, according to my own and
  all other experience, cannot be influenced; therefore, all our hope
  rests upon the possibility of a change of the laws with reference to
  it, so that only rape or the commission of public offense, when this
  can be proved at the same time, shall be punishable.”

  Case 116. _Contrary Sexual Instinct in a Woman._—S. J., aged 38,
  governess, came to me for advice about a nervous trouble. Her father
  was temporarily insane, and died of a brain disease. The patient is an
  only child, and even when quite young she suffered with feelings of
  anxiety and painful ideas. She thought, for example, that she would
  awake in her coffin after it had been closed; that at confession she
  might forget something, and make a sinful confession. She suffered
  much with headache. She was always very much excited and apprehensive,
  but yet she had to see horrible things, like corpses, etc.

  Even in her earliest childhood, the patient was excited sexually, and
  began to masturbate without any teaching. The menses began at
  fourteen, and were always accompanied by colicky pains, violent sexual
  excitement, migraine, and depression. After her eighteenth year she
  learned to repress her impulse to masturbate.

  The patient has never felt any inclination toward persons of the
  opposite sex. If she thought of marriage, it was only because she
  sought in matrimony a means of being supported. On the other hand, she
  felt powerfully attracted by girls. At first she regarded this
  inclination as friendship; but in the depth of her attachment to
  female friends, and in the longing she constantly felt for them, she
  recognized that the feeling was something more than friendship.

  The patient cannot understand how a girl can love a man, but she can
  easily see how a man might love a girl. She always has a lively
  interest in beautiful women and girls, and is powerfully excited at
  sight of them. Her longing had always been to kiss and embrace such
  dear creatures. She had never dreamed of a man, but only of girls. Her
  delight had been to revel in the sight of them. Separation from such
  female friends had always made her desperate.

  The patient, whose appearance is perfectly feminine and very
  respectable, states that she has never felt herself in any particular
  _rôle_ with her friends, not even in dreams. Female pelvis; large
  mammæ; no sign of beard.

  Case 117. Mrs. R., Russian, aged 35, of high social position, was
  brought to me, in 1886, by her husband for advice.

  Father was a physician, and very neuropathic. Paternal grandfather was
  healthy and normal, and reached the age of ninety-six. Facts
  concerning paternal grandmother are wanting. All the children of
  father’s family are said to have been nervous. The patient’s mother
  was nervous, and suffered with asthma. The mother’s parents were
  healthy. One of the mother’s sisters had melancholia.

  From her tenth year patient has been subject to habitual headache.
  With the exception of measles, she has had no illness. She was
  capable, and enjoyed the best of training, having especial talent for
  music and languages. It became necessary for her to prepare herself
  for the work of a governess, and during her earlier years she was
  mentally overworked. She passed through an attack of melancholia _sine
  delirio_, of some months’ duration, at seventeen. The patient asserts
  that she has always had sympathy only for her own sex, and found only
  an æsthetic interest in men. She never had any taste for female work.
  As a little girl, she preferred to play with boys.

  She says she remained well until her twenty-seventh year. Then,
  without external cause, she became depressed and considered herself a
  bad, sinful person, had no pleasure in anything, and was sleepless.
  During this time of illness she was also troubled with imperative
  conceptions: that she must think of the death of herself and her
  relatives. Recovery after about five months. She then became a
  governess, was overworked, but remained well, except for occasional
  neurasthenic symptoms and spinal irritation.

  At twenty-eight she made the acquaintance of a lady five years younger
  than herself. She fell in love with her, and her love was returned.
  The love was very sensual, and satisfied by mutual masturbation. “I
  loved her as a god; her’s is a noble soul,” she said, when she
  mentioned this love-bond. It lasted four years, and was ended by the
  (unfortunate) marriage of her friend.

  In 1885, after much emotional strain, the patient became ill with
  symptoms of hystero-neurasthenia (dyspepsia, spinal irritation, and
  tonic spasmodic attacks; attacks of hemiopia with migraine and
  transitory aphasia; pruritus pudendi et ani). In February, 1886, these
  symptoms disappeared.

  In March she became acquainted with her present husband, and married
  him without taking much time for reflection; for he was rich, much in
  love with her, and his character was in sympathy with her own.

  On April 6th, she read the sentence, “Death misses no one.” Like a
  flash of lightning in a clear sky, the former imperative conceptions
  of death returned. She was forced to meditate on the most horrible
  manner of death for herself and those about her, and constantly
  imagine death-scenes. She lost rest and sleep, and took no pleasure in
  anything. Her condition improved. Late in May, 1886, she was married,
  but was still troubled by painful thoughts at that time: that she
  would bring misfortune on her husband and those about her.

  First coitus on June 6, 1886. She was deeply depressed morally by it.
  She had had no such conception of matrimony. The husband, who really
  loved his wife, did all he could to quiet her. He consulted
  physicians, who thought all would be well after pregnancy. The husband
  was unable to explain the peculiar behavior of his wife. She was
  friendly toward him, and suffered his caresses. In coitus, which was
  actually carried out, she was entirely passive, and after the act she
  was tired, exhausted all day long, nervous, and troubled with spinal
  irritation.

  A bridal tour brought about a meeting with her old friend, who had
  lived in an unhappy marriage for three years. The two ladies trembled
  with joy and excitement as they sank into each other’s arms, and
  became inseparable. The husband saw that this friendly relation was a
  peculiar one, and hastened their departure. He had an opportunity to
  ascertain, through the correspondence of his wife with this friend,
  that the letters interchanged were like those of two lovers.

  Mrs. R. became pregnant. During pregnancy the remains of depression
  and imperative ideas disappeared. In September, during about the ninth
  week of pregnancy, abortion took place. After that, renewed symptoms
  of hystero-neurasthenia. In addition to this, there were anteflexio et
  latero-positio dextra uteri, anæmia, and atonia ventriculi.

  At the consultation the patient gave the impression of a very
  neuropathic, tainted person. The neuropathic expression of the eyes
  cannot be described. Appearance entirely feminine. With the exception
  of a very narrow, arched palate, there was no skeletal abnormality.
  With difficulty the patient could be brought to give the details of
  her sexual abnormality. She complained that she had married without
  knowing what marriage between men and women was. She loved her husband
  dearly for his mental qualities, but marital intercourse was a pain to
  her; she did it unwillingly, without ever finding any satisfaction in
  it. Post actum, all day long she was weary and exhausted. Since the
  abortion and the interdiction of sexual intercourse by the physicians,
  she had been better; but she thought of the future with horror. She
  esteemed her husband, and loved him mentally; but she would do
  anything for him, if he would but avoid her sexually in the future.
  She hoped to have sensual feeling for him in time. When he played the
  violin, she seemed to feel the beginning of an inclination for him
  that was something more than friendship; but it was only transitory,
  and she could get no assurance for the future in it. Her greatest
  happiness was in correspondence with her former lover. She felt that
  this was wrong, but she could not give it up; for to do so made her
  miserable.

It is remarkable that the anomaly may be long limited to mere perversion
of the sexual instinct, and that the impulse to perverse indulgence may
make its appearance after some accidental cause,—_e.g._, seduction, or
some neurosis. Such cases might easily be mistaken for acquired contrary
sexual instinct (_v. supra_), if, with reference to the sexual feeling,
they should not be demonstrated by the history to be original and
congenital.

  Case 118. Mrs. C., aged 32, wife of an official, a large, not uncomely
  woman, feminine in appearance, comes of a neuropathic and emotional
  mother. A brother was psychopathic, and died of drink. Patient was
  always peculiar, obstinate, silent, quick-tempered, and eccentric. The
  brothers and sisters are excitable people. Pulmonary phthisis has been
  frequent in her family. When only a girl of thirteen, with signs of
  great sexual excitement, she attracted attention by enthusiastic love
  for a female friend of her own age. Her education was strict, though
  the patient secretly read many novels, and wrote innumerable poems.
  She married at eighteen to free herself from unpleasant circumstances
  at home.

  She says she has always been indifferent toward men. In fact, she
  avoided balls. Female statues pleased her. Her greatest happiness was
  to think of marriage with a beloved woman. She was not aware of her
  sexual peculiarity until marriage, and the thing had remained
  inexplicable to her. Patient did her marital duty, and bore three
  children, two of whom were subject to convulsions. She lived
  pleasantly with her husband, but she esteemed him only for his moral
  qualities. She gladly avoided coitus. “I should have preferred
  intercourse with a woman.”

  Until 1878 she had been neurasthenic. On the occasion of a sojourn at
  a watering-place, she made the acquaintance of a female urning, whose
  history I have reported as Case 6, in the _Irrenfreund_, No. 1, 1884.

  The patient came home a changed person. Her husband says: “She was no
  longer a woman, no longer had any love for me and the children, and
  would have no more of marital approaches. She was inflamed with
  passionate love for her female friend, and had taste for nothing
  else.” After the husband forbade her lover the house, there was
  interchange of letters with such expressions in them as “My dove! I
  live only for you, my soul.” There were meetings and frightful
  excitement when an expected letter did not come. The relation was in
  nowise platonic. From certain indications it is presumable that mutual
  masturbation was the means of sensual satisfaction. This relation
  lasted until 1882, and made the patient decidedly neurasthenic.

  She absolutely neglected the house, and her husband hired a woman of
  sixty years as a house-keeper, and also a governess for the children.
  The patient fell in love with both, who, at least, allowed caresses,
  and profited materially through the love of their mistress.

  In the latter part of 1883, on account of developing pulmonary
  tuberculosis, she had to go south. There she became acquainted with a
  Russian lady of forty years, and fell passionately in love with her;
  but she did not meet with a return of love in her sense. One day
  insanity became manifest. She thought the Russian lady a nihilist;
  that she was magnetized by her; and she presented formal persecutory
  delusions. She fled, and was caught in an Italian city, and placed in
  a hospital, where she soon became quiet. Again she followed the lady
  with her love, felt herself very unhappy, and planned suicide.

  When she returned home, she was greatly depressed because she did not
  have the lady, and was contrary toward her family. A delusive, erotic
  state of excitement came on about the end of May, 1884. She danced,
  shouted, and called herself a man; demanded her former lovers, and
  said she was of royal blood. She escaped from the house in male
  attire, and was taken to the asylum in a state of eroto-maniacal
  excitement. After a few days the exaltation disappeared. The patient
  became quiet, and made a despairing attempt at suicide; and after it
  she was in great anguish of mind with tædium vitæ. The perverse sexual
  feeling grew less and less noticeable, and the tuberculosis
  progressed. The patient died of phthisis in the beginning of 1885.

  The examination of the brain presented nothing unusual as far as
  architecture and arrangement of convolutions were concerned. Weight of
  brain 1150 grammes. Skull slightly asymmetrical. No anatomical signs
  of degeneration. External and internal genitals without anomaly.

3. _Effemination and Viraginity._—There are various transitions from the
foregoing cases to those making up this category, characterized by the
degree in which the psychical personality, especially in general manner
of feeling and inclinations, is influenced by the abnormal sexual
feeling. In this group, fully-developed cases in men are females in
feeling; in women, males. This abnormality of feeling and of development
of the character is often apparent in childhood. The boy likes to spend
his time with girls, play with dolls, and help his mother about the
house; he likes to cook, sew, knit, and develops taste in female
_toilettes_, so that he may even become the adviser of his sisters. As
he grows older he eschews smoking, drinking, and manly sports, and, on
the contrary, finds pleasure in adornment of person, art,
_belles-lettres_, etc., even to the extent of giving himself entirely to
the cultivation of the beautiful. Since women possess corresponding
inclinations, he prefers to move in the society of women.

If he can assume the _rôle_ of a female at a masquerade, it is his
greatest delight. He seeks to please his lover, so to speak, by
studiously trying to represent what pleases the female-loving man in the
opposite sex,—sweetness, sympathy, taste for æsthetics, poetry, etc.
Efforts to approach the female appearance in gait, attitude, and style
of dress are frequently seen.

The female urning, even when a little girl, presents the reverse. Her
favorite place is the play-ground of boys. She seeks to rival them in
their games. The girl will have nothing to do with dolls; her passion is
for playing horse, soldier, and robber. For female employments there is
manifested not merely a lack of taste, but often unskillfulness in them.
The _toilette_ is neglected, and pleasure found in a coarse, boyish
life. Instead of an inclination for the arts, there is manifested an
inclination and taste for the sciences. Occasionally there may be
attempts to smoke and drink. Perfumes and cosmetics are abhorred. The
consciousness of being born a woman, and, therefore, of being compelled
to renounce the University, with its gay life, and the army, induces
painful reflections.

In the inclinations of the amazon for manly sports, the masculine soul
in the female bosom manifests itself; and not less in the show of
courage and manly feeling. The female urning loves to wear her hair and
have her clothing in the fashion of men; and it is her greatest
pleasure, when opportunity offers, to appear in male attire. Her ideals
are historical and contemporary feminine personalities distinguished for
mind and energy.

With reference to the sexual feeling and instinct of these urnings, so
thoroughly permeated in all their mental being, the men, without
exception, feel themselves to be females; the women feel themselves to
be males. Thus they feel themselves to be antagonistic to persons of
their own sex constituted like themselves; for, of course, they are like
them in form. But, on the other hand, they are drawn toward those of
their own sex that are homo-sexual or sexually normal. The same jealousy
which occurs in normal sexual life also occurs here, when rivalry is
threatened; and, indeed, since they are, as a rule, hyperæsthetic
sexually, this jealousy is often boundless.

In cases of completely-developed contrary sexuality, hetero-sexual love
is looked upon as a thing absolutely incomprehensible; sexual
intercourse with a person of the opposite sex is unthinkable,
impossible. Such an attempt brings on the inhibitory concept of disgust
or even horror, which makes erection impossible. Only two of my
transitional cases to the third category were able, with the help of
their imagination, by thinking of themselves as men with reference to
the woman, to have cohabitation; but the act, which was inadequate for
them, was a great sacrifice, and afforded them no pleasure.

In homo-sexual intercourse the man always feels himself, in the act, as
a woman; the woman, as a man. The means of indulgence, in the case of a
man, where there is irritable weakness of the ejaculation centre, are
simply _succubus_, or passive _coitus inter femora_; in other cases,
passive masturbation, or _ejaculatio viri dilecti in ore proprio_. Many
have a desire for passive pederasty; occasionally a desire for active
pederasty occurs. In one attempt of this kind, the man desisted because
of the disgust which seized him when the act reminded him of coitus.

_There was never inclination for immature persons (boy-love)._ Not
infrequently there were only platonic desires. The sexual satisfaction
of the female probably consists of _amor lesbicus_, or active
masturbation.

  Case 119. _Autobiography._ “1. _Descent:_ I am now in my twenty third
  year. I have chosen the study of the technical arts as an occupation,
  and am completely satisfied with it. I had but the mild diseases of
  children, while the other children, who are now healthy, had to pass
  through severe illnesses. My parents are both living, and my father is
  an advocate. He, like my mother, is, as we say, nervously
  hyper-sensitive. In my father’s family there were two other children,
  who died early.

  “2. _My person:_ As for my physical peculiarities, I am of robust
  figure, without being of especially handsome form; eyes, gray; hair,
  blonde; hair and beard correspond with my sex and years. The mammæ and
  genitals are normally developed. My gait is firm and almost heavy; my
  bearing, careless. It is remarkable that the breadth of the pelvis is
  exactly equal to that of the shoulders.

  “I am naturally well endowed mentally. In one of my certificates my
  talents are, in fact, called ‘excellent.’ Without any particular
  desire to excel in them, I passed my examinations with distinction. I
  have an interest in everything that concerns the well-being of
  humanity, and in science, art, and industry. With my energy it is
  comparatively easy to postpone for a time the satisfaction of my
  desires, which will be described hereafter. Intentionally and
  consciously, I curse the morality of to-day, which forces those who
  are abnormal sexually to break laws that are voluntarily established,
  and regards sexual congress of two persons of the same sex as a matter
  depending on the choice of the individual, and a matter in which
  law-makers have a right to interfere. From my studies I have found the
  most earnest incentives to construct, on the basis of the Darwinian
  theory, after Carneri’s method, a system of morals, which, to be sure,
  does not harmonize with the prevailing system, but which seeks to
  elevate and improve mankind in accordance with natural law.

  “I think that there are not many marks of hereditary taint in me.
  There is a certain hyper-sensitiveness. A very intense dream-life is
  perhaps important. In general, it is occupied with indifferent
  matters, and never has so-called sensual images as a subject; at most,
  in this direction, it is concerned only with female attire and putting
  it on, which for me is a lustful thought. At the same time, until my
  sixteenth year, it often went to the extent of somnambulism, or, very
  frequently, as is still often the case, to loud talking in sleep.

  “3. _My inclinations:_ The above-mentioned abnormal proclivity is the
  fundamental factor in my sexual feeling. When I am dressed like a
  woman, I feel perfectly satisfied. A peculiar feeling of peace and
  comfort comes over me, which allows me to work mentally with greater
  ease. My libido for indulgence in sexual intercourse is extremely
  slight. Too, I have much love and taste for female handiwork, and,
  without assistance, I learned to crochet and embroider, and I like to
  do these things in secret. I also like other female employments, like
  sewing, etc.; so that at home, where I keep my proclivity perfectly
  concealed, and guard against indulging it by involuntary activity, I
  have often won the praise of being as good as a servant-girl; which
  did not make me ashamed, but, on the contrary, filled me with secret
  pride. I can make nothing out of dancing with women; I liked to dance
  only with my school-fellows, for which the manner of our instruction
  in dancing gave opportunity. But in this it gave me pleasure only when
  I could dance as a lady. A multitude of other desires and dreams,
  which seem to have something typical about them, I pass over, because
  they seem exactly similar to those described in ‘Psychopathia
  Sexualis.’ .... In other respects my inclinations are not different
  from those of my sex. I smoke and drink moderately, love delicacies,
  and have no pleasure in physical exercises.

  “4. _Development:_ After this brief description of my personality, I
  may pass on to an analysis of the developmental history of my
  abnormality. As soon as I was able, to some extent, to think
  independently, and I understood the difference between the sexes, it
  was my secret and fixed desire to be a girl. In fact, I believed I was
  one. But when in the bath I saw the same genitals on other boys, the
  impossibility of my thought became apparent. I reduced my wish, and
  hoped that I was at least an hermaphrodite. And, owing to the fact
  that I had a certain shyness about looking closely at pictures or
  descriptions of the genitals, this hope was entertained,
  notwithstanding the fact that I had abundant opportunity to read
  writings on the subject, until my studies compelled me to make a
  closer acquaintance with the matter. During this time I read
  everything I could get about hermaphroditism, and longed to be in the
  place of the female who, as the newspapers often reported, had been
  raised as a male and been restored to her sex by accident. The
  recognition of my masculinity made an end of this dreaming, and did
  not fill me with any especial delight. I tried to destroy my sexual
  glands by gradual pressure, but pain soon caused me to desist. My
  longing is still for the external characteristics of the female
  sex,—for a pretty coiffure, a rounded breast, a slim waist.

  “At the age of twelve I first had an opportunity to put on female
  attire; and I soon came to drape myself, by means of bed-clothes,
  bed-linen, etc., with female petticoats. When I grew older, it was my
  greatest delight to put on my sister’s dresses secretly, even if it
  could be but for a few moments, and with constant danger of detection.
  Later, much to my delight, I had an opportunity to play a female
  _rôle_ in a love-scene; and it is said that I was not at all bad in
  the part. When I began to lead an independent life as a student, I
  immediately obtained female dresses and linen, which I kept in order
  myself. When at night, safe from discovery, I can put on one article
  after another, from corset to apron and bracelet, I am perfectly
  satisfied, and devote myself to some quiet employment, inwardly happy
  and full of delight in doing it. While dressing, an erection usually
  occurs, but it is never followed by an ejaculation, and soon
  disappears. I also try to approximate the female appearance in
  externals, by arranging my hair appropriately and removing the beard,
  which I should have preferred to tear out.

  “5. _Sexual inclinations:_ In passing to the description of my sexual
  proclivities, I desire, first, to note, in general, that puberty
  occurred normally, as I judge from the pollutions that occurred, the
  change of voice, etc. Pollutions still occur regularly once every
  three weeks, seldom more frequently. With them I never experience any
  lustful feeling. I have never practiced onanism; until lately I knew
  nothing more of it than its name, and I had to seek direct information
  about it, in order to understand it. Any touch on the erect penis is
  disturbing and painful to me, and without lustful feeling.

  “Previously I behaved very shyly toward women, but I now act quietly,
  and associate with them as with my kind. Direct excitation, in a
  sexual sense, by a woman, sometimes occurred; but when I try to
  analyze this, it seems to me that it was never her person, but rather
  her attire alone, that was effectual. I fell in love with her dress,
  and the thought of wearing one like it was heavenly. Thus sexual
  excitation never took place, not even in brothels where I was led by
  friends, in spite of the sight of the greatest voluptuousness and
  beauty. But friendly feelings for the female sex were in my heart. I
  imagined how, dressed as a woman and unrecognized, I could stay with
  them, associate with them, and take pleasure with them. I prefer the
  impression made on me by girls whose breasts have not yet fully
  developed, particularly those wearing the hair short; for such girls
  are more nearly like me and my aspect. Once I was so fortunate as to
  find a girl who felt unhappy in her sex. We formed a firm bond of
  friendship with one another, and we often took delight in the idea of
  exchanging places. Perhaps it is not inappropriate or unimportant for
  the characterization, to record the following: Some months ago, when
  the story was running through the newspapers of an Hungarian countess
  who, dressed as a man, had married, and felt like a man, in all
  earnestness, I thought of offering myself to her, in order to contract
  an inverted marriage,—she as husband, I as wife.... I have never
  attempted coitus, and have never felt any desire for it. But since I
  foresaw that the erection necessary with a woman would be wanting, I
  thought of putting on some of her clothing; and I think that then the
  expected result would occur.

  “As for my behavior toward male persons, first of all, it is to be
  emphasized that I had the warmest friendships during my school-days.
  My heart was full of happiness, if I could do some small service for
  the object of my devotion. I really worshiped him passionately. But,
  on the slightest occasion, I evinced terrible jealousy; and while my
  anger lasted I felt as if I could neither live nor die. When
  reconciliation occurred, for a short time I was the happiest of
  creatures. I also tried to make friends of boys, whom I bribed with
  sweetmeats, and whom I should gladly have kissed. Though my love
  always remained platonic, yet it is abnormal. An expression that I
  unconsciously made at that time about an elder friend, whom I
  worshiped, shows that. I said I loved him so that I should have liked
  to marry him. And even now, when I indulge but little in intercourse,
  I am easily taken with a handsome man with a fine beard and refined
  features. Yet I have never met a being feeling like myself, whom I
  could confide in, and with whom I could live as a female friend. I
  never attempted to exercise my inclinations directly, and never
  committed any foolish act of this kind. Finally I ceased to visit
  museums where nude male figures were displayed; for the erections,
  which were sure to occur, were exceedingly annoying. I had often
  secretly wished to sleep with a man, and often found opportunity. I
  was asked by a rather unattractive elderly man to sleep with him. Cum
  eo concubui, ille genitalia mea tetigit; and though his person was
  unattractive to me, I was filled with an intense feeling of lust. I
  felt as if completely surrendered to him; in a word, _I felt like a
  woman_.

  “If I may be permitted to add a concluding word to what I have already
  said, I wish to state expressely that, though I am conscious of the
  abnormality of my inclinations, I have no desire to change them; I
  long only for a time when, more easily and with less danger of
  discovery, I can give rein to my desires and experience a delight that
  will harm no one.”

  Case 120. Miss Z., aged 31, artist, comes for consultation on account
  of neurasthenic symptoms. She is remarkable for coarse, masculine
  features, a deep voice, short hair, a masculine style of dress,
  masculine gait, and self-consciousness. In other respects she is
  feminine, with well-developed mammæ and a female pelvis, and without
  any indication of beard.

  Examination with reference to contrary sexual instinct gives a
  positive result:—

  The patient states that even when a little girl she preferred to play
  with boys, and particularly “soldier,” “merchant,” and “robber.” She
  was very wild and unrestrained in these games with boys, but never had
  any proclivity for dolls or female employment, of which she learned
  only the most ordinary things (knitting, sewing).

  In school she made good progress, being especially interested in
  mathematics and chemistry. She early had a desire for sculpture, and
  showed talent for it. Her greatest ambition was to become a real
  artist. In her dreams of the future, she never thought of marriage. As
  an artist, she was interested in handsome men, but she was really
  attracted only by female forms; she saw male forms only “in the
  distance.” She could never endure “trumpery”; “manly dress” was all
  that pleased her. The ordinary society of girls was repugnant to her,
  because their talk about _toilettes_, ornaments, and love-affairs with
  men, seemed stale and tiresome to her. On the other hand, since her
  childhood she had had enthusiastic friendships with certain girls; at
  the age of ten she was in love with a girl companion, and wrote her
  name everywhere. Since then she had had numerous female friends, with
  whom she had indulged in passionate kissing. She pleased the girls, as
  a rule, because of her masculine bearing. She wrote poems to her
  female friends, and could have done anything out of love for them. To
  her it was very remarkable that she was embarrassed before girls,
  especially when they were friends. She could not undress before them.
  The more she loved a friend, the more modest she was before her.

  At the present time she has such a relation. She kisses and embraces
  her Laura, walks by her window, and suffers all the pangs of jealousy,
  particularly when she sees her conversing with men. Her only wish is
  to live always with this female friend.

  The patient states, however, that twice in her life men have made an
  impression on her. She thinks that if she had been really sought,
  there would have been a marriage; for she is very fond of family life
  and children. If a man wished to possess her, it would be necessary
  for him to win her; she herself would prefer to win a female friend.
  She thinks woman is more beautiful and ideal than man. In her
  infrequent erotic dreams, the subject had always been a female. She
  had never dreamed of men. She does not think that she could now love a
  man; for men are false, and she herself is nervous and anæmic.

  She considers herself a woman in all respects, but regrets that she is
  not a man. Even at the age of four it had been her greatest pleasure
  to put on boys’ clothes. She certainly had a masculine character, and,
  too, had never wept. Her greatest passion was for riding, gymnastics,
  fencing, and driving. She suffered much because no one about her
  understood her. It seemed silly to her to talk about feminine things.
  Many of her acquaintances had thought that she should really have been
  a man.

  The patient says that she was never sensual. In embracing female
  friends, she had often experienced a peculiar lustful feeling.
  Embracing and kissing had been her only manner of expressing her
  friendship.

  The patient states that she comes of a nervous father, and an insane
  mother who, as a young girl, had been passionately in love with her
  own brother, and had tried to induce him to flee with her to America.
  The patient’s brother is a very eccentric, peculiar man.

  The patient presents no external degenerative signs; head regular. She
  says the menses began at fourteen, and that they have been regular,
  but always painful.

  Case 121. “In order to designate at once my unhappy diseased condition
  with its correct name, I will state at the beginning that it bears all
  the marks of what, in your work, ‘Psychopathia Sexualis,’ you have
  named _effemination_.

  “I am now thirty-eight years old, and, thanks to my abnormality, I
  look back on a life that has been full of indescribable suffering; so
  that I am often astonished to think what capacity for suffering a man
  has. Of late consciousness of the suffering I have endured has become
  the source of a kind of self-respect, which, in itself, makes my life,
  in a measure, endurable.

  “But I shall now endeavor to describe my condition with all truth. I
  am physically healthy, and, as far as I can remember, have never had
  any severe illness. I come of a healthy family. But my parents are
  both of a very excitable nature, my father being of the so-called
  choleric, and my mother of the sanguine, temperament; she has a strong
  tendency to mild melancholia. She is a lively woman, loved for her
  good-heartedness and active benevolence; but she is still very
  dependent and deficient in self-confidence. All these peculiarities
  were marked in her father. I mention this fact, because I am told that
  I resemble them both; and as far as the last two peculiarities are
  concerned, I can myself acknowledge the resemblance. But when I made
  attempts, by means of my inner strength and by thinking of my own
  power, to rend the bond that, with magic force, draws me to men, there
  was always a residuum left that I could not eradicate. As far as I can
  remember, I have always had this elementary longing for a male lover.
  To be sure, its first expressions were of a coarse, sensual nature. I
  do not know whether I was yet ten years old, when, while lying in bed
  in the day-time, I suddenly discovered how, by pressure on my
  genitals, I induced a new and intoxicating feeling, while fancying
  that a man of my acquaintance performed sensual manipulations on me.
  It was only many years afterward that I learned that this was onanism.
  At first I was so frightened and so depressed by the inexplicableness
  of my longing, that I then made my first attempt at suicide. If I had
  only put it into execution! For since then there has been such
  frequent violent agitation of mind and body that my heart has been
  bound as with a chain, and made cold. I may say at once that, up to
  the present time, onanism has not loosened me from its clutches; it
  has overcome all attempts and efforts to escape, and my desire to
  resist it is almost destroyed. Three or four times I have given it up
  for a month at a time, usually under the influence of mental
  excitement.

  “When about thirteen, I had my first love. To-day it seems as if my
  greatest wish then was to kiss my school-fellow’s fresh, rosy lips. It
  was a passion full of romantic dreams. At the age of fifteen or
  sixteen it became more violent, when I first experienced the insane
  pangs of a jealousy which is more terrible than that of natural love
  can be. This second period of my life lasted for years, though I spent
  but a few days with the object of my passion; and then we did not see
  each other for fifteen years. Gradually my feeling cooled, and I then
  fell passionately in love several times with other men, who, with the
  exception of one, were about my own age.

  “My love—if you will kindly allow this expression for a feeling
  condemned by the majority of mankind—has never been returned; I have
  never had intercourse with a man in any way that would not bear the
  light of day; never has any one shown even extraordinary interest in
  me, though one of my friends discovered my secret longing; and yet I
  have had a burning desire for masculine love. In this longing my
  feelings seem to me to be entirely those of a loving woman; and I
  notice, with horror, that my sensual ideas grow more and more like
  those of a woman. During the periods when I am free from any
  particular love, my longing degenerates so that, in my onanistic
  manipulations, I conjure up only coarse, sensual ideas. But I am still
  finally able to overcome these. My efforts to repress the love,
  however, are absolutely vain. At the present time I am again suffering
  with such an exaggerated state of feeling that has existed for months;
  and I have pondered so much over its peculiarities that I think I can
  describe my feelings truthfully. In this way I have made the peculiar
  observation that I have never loved a bearded man. From this it might
  easily be presumed that I am given to so-called boy-love; but that is
  not the case. For, to the sensual charm, on closer association, a
  mental interest is added. With this begins the mental pain. I am
  seized with such a passionate longing that I am willing to sacrifice
  myself, in a way. I excite confidence in myself; and from this mutual
  feeling a heart-felt friendship might be engendered, if deep down in
  my soul were not sleeping the demon which impels me to the closest of
  relationships, which is allowed only between human beings of opposite
  sex. My whole being, every fibre of my body, longs for it, and I am
  consumed by a hot, glowing passion. I wonder that here I can again
  describe in unfeeling words the feelings that coursed through my whole
  being. Of course, by the struggle of years, I have been forced to
  learn to conceal my inclination, and smile when torn by pain. For, in
  never having my love returned, I have learned to know all the
  sufferings of love. Jealousy—insane, blinding jealousy—of any and
  every body who casts but a friendly glance at the object of my secret
  love!

  “I have emphasized the mental element, in order to show how deeply
  rooted my abnormal impulse is. I have never felt the slightest touch
  of sensual love for the opposite sex. The idea of being forced to
  associate sensually with women is repugnant to me. At times I have
  suffered enough on being assured of the love of young girls. Like
  every young man, I have had abundant opportunity to enjoy the modern
  social pleasures, dancing among them. I like to dance; but if I could
  dance with men, as a girl, I should be really happy.

  “I wish once more to remark that my love is entirely sensual. How
  could I otherwise explain the fact that the pressure of my lover’s
  hand, often merely his glance, causes palpitation and erection! I have
  done everything to eradicate this love from my—let us say ‘heart.’ I
  have tried to still it by means of onanism; to drag it in the mire, in
  order to raise myself above it. (About ten years ago, during such a
  time of love, I avoided onanism, and felt that my feeling of love
  elevated me.) I still entertain the delusion that if the object of my
  love were to tell me he loved me, that he loved me, and only me, I
  should willingly give up sensual gratification to repose in faithful
  arms. But that is certainly a self-deception.

  “Honored sir, I have a responsible occupation, and I think I can give
  the assurance that my abnormal inclination has never, even in a hair’s
  breadth, caused me to deviate from the duty imposed on me. Aside from
  this abnormality, I am not insane, and I might ultimately become
  contented; but I have, particularly of late years, suffered too much
  not to look on the future with painful feeling. For the future will
  certainly not bring fulfillment of the desire which constantly glows
  under the ashes,—the desire to possess a lover who understands and
  returns my love. Such a relation would make me truly happy. I have
  thought much about the origin of my abnormality, particularly because
  I think I am forced to assume that it was not inherited. I believe
  that onanism has changed the inborn feeling into a burning passion. I
  might long ago have put an end to my misery, since I have no fear of
  death, and since in religion—which, strange to say, has not departed
  from my impure heart—I find no warning against suicide. But the
  consciousness that I am not alone responsible, and that a worm has
  nipped my whole life in the bud,—a certain comfort that has sprung up
  of late out of indescribable suffering,—leads me to see whether
  comparative happiness in life cannot be obtained on an entirely new
  basis: something which fills the whole heart. I think I could be happy
  under the influence of quiet family life. But I dare not conceal from
  you the fact that the thought of married life with a wife is terrible
  to me, and that I make the attempt of a change of life with a bleeding
  heart; for thus I absolutely abandon the hope that is always awake;
  namely, the delusion that fate may yet bring me the desired happiness.

  “This delusion is so deeply rooted in me that I think nothing but
  hypnotic suggestion could help me. If you could advise me, you would
  make me unspeakably happy. Of course, your strictest injunction would
  be to abandon onanism. How gladly I would follow it! But if I were not
  to have direct physical, some mechanical, means at hand to help me, I
  should certainly be unable to free myself from this vice; and this the
  more, because I fear that, by long years of habit, my nature has
  become accustomed to it. Of course, I have not escaped the effects of
  it, even though they are not so terrible as they are often pictured. I
  suffer with mild nervousness, am, indeed, weakened, and have
  periodical disturbance of digestion; but I can still endure hard work,
  and take a certain pleasure in it, when it is not too great. I am
  depressed, but I can be happy, and, fortunately, I take pleasure in my
  calling, and am interested in various things, particularly music, art,
  and _belles-lettres_. I have never indulged in female pursuits.

  “As may be seen from the foregoing, I like to associate with men,
  especially with those who are handsome; but I have never had intimate
  relations with them. A wide gulf separates me from them!

  “_Postscript:_ I feared that in the foregoing I had not described my
  sexual life with sufficient exactness. It consists only in onanism;
  but in it I abandon myself to almost all the repugnant acts that are
  comprehended under coitus inter femora, ejaculatio in ore, etc.

  “My _rôle_ is passive. When I am seized by a passion, the ideas
  change, and become entirely a desire to be impregnated. The struggle
  against such a passion is so terrible, because my mind is also
  implicated. I long for the closest, the most complete union that can
  be conceived as existing between two men,—always together, common
  interests, unlimited confidence, sexual union. I think that natural
  love is different from this only in its degree of warmth; it does not
  reach the boiling-point of our passion. Just now I am fighting the
  battle over again; with force I stifle the insane passion that has so
  long enthralled me. All night long I walk about, followed by the image
  of him I love; for love of whom I would give up all I possess. How sad
  it is that the noblest feeling given to man—friendship—is sullied by
  common sensual feeling!

  “I wish once more to state that I cannot come to the determination to
  transform my sexual life by means of sexual intercourse with the
  opposite sex. The thought of such intercourse fills me with repugnance
  and disgust.”

  Case 122. “I write, as well as I can, the history of my suffering,
  actuated only by the desire, by this autobiography, to clear up to
  some extent the misunderstanding and errors concerning ‘contrary
  sexual instinct’ which are still so widely prevalent.

  “I am thirty-seven years old, and come of healthy parents, both of
  whom were very nervous. I only mention this, because I have often had
  the thought that my contrary sexual instinct came by way of
  inheritance; but this is nothing more than vague. Of my grandparents,
  whom I did not know, the only remarkable thing I can mention is, that
  my maternal grandfather was known as a great Don Juan.

  “I was rather a weak child, and during my first two years suffered
  severely with fits, as a result of which my understanding and memory
  may have suffered; for I learn but slowly things which do not
  particularly interest me, and easily forget them. I may also mention
  that, during the time before I was born, my mother was subject to
  violent mental excitement, and was often frightened. From my third
  year I have been perfectly well, and have escaped severe illness. Only
  when a boy, from the age of twelve to sixteen, I had peculiar,
  indescribable nervous sensations, which made themselves felt in my
  head and finger-tips, and in which it seemed to me as if my whole
  being were about to cease. For many years, however, these attacks have
  ceased to occur. I am rather a powerful man, with abundant growth of
  hair, and in all respects masculine.

  “Even when a boy of six years, I came independently to masturbate,
  and, until my nineteenth year, I practiced the vice quite
  persistently; and even now, _faute de mieux_, I quite frequently
  resort to it, notwithstanding the fact that I understand the vileness
  of the passion, and always feel somewhat weakened after it. But sexual
  intercourse with a man does not affect me in the least; on the
  contrary, it gives me a feeling of being strengthened. I began school
  at the age of seven, and soon experienced an intense feeling of
  sympathy for my companions, which, however, made no other impression
  on me. In the Gymnasium, at the age of fourteen, my companions
  explained to me the sexual life of man, which, up to that time, was
  absolutely unknown to me; but I was not much interested in the matter.
  At this time I also practiced mutual onanism with two or three friends
  who had seduced me into it; and it had an extraordinary charm for me.
  I was still perfectly unconscious of the perversity of my sexual
  instinct, and considered my vices as sins of youth, like those
  committed by all boys of the same age. Interest in the female sex I
  thought would come in time. Thus I became nineteen years old. During
  the following years I fell insanely in love three times,—once with a
  very handsome actor, then with a bank employé, and with one of my
  friends, the last two being men who were nothing less than beautiful,
  and calculated to excite sensual feeling. But this love was merely
  platonic, and occasionally found expression in glowing poetry. It was,
  perhaps, the most perfect period of my life; for I regarded everything
  with pure, innocent eyes. In my twenty-first year

I gradually began to notice that I was not constituted exactly like my
comrades; for I found no pleasure in masculine pursuits. I had but
little liking for smoking, drinking, and card-playing, and I was
frightened to death by a brothel. I have never been in one; I was always
able to avoid visiting one on some pretext or other. But I now began to
think about myself; I often felt terribly lonesome, miserable, and
unhappy, and longed for a friend constituted like myself, without,
however, ever thinking that there could be other men like me. At
twenty-two I made the acquaintance of a young man who finally explained
to me contrary sexual instinct and the individuals affected with it. He,
being also an urning, was in love with me. It was as if scales had
fallen from my eyes; and I bless the day this explanation came to me.
From that time I saw the world with different eyes; I saw that many
others were given the same fate; and I began to learn to content myself
with this lot as well as I could. Unfortunately, I did not succeed very
well, and I am still often seized with bitterness and a deep hatred of
the modern ideas which treat us poor urnings with such terrible
harshness. For what is our fate? In most cases we are not understood,
and are derided and despised; and even when all goes well, and we are
understood, we are still pitied like invalids or the insane,—and pity
was always sickening to me. I now began to play a part, in order to
deceive my fellow-men as to my state of mind; and it always gave me
great satisfaction to succeed in this. I made the acquaintance of
several men like myself, with whom I established relations, which,
however, never lasted long; for I was very fearful and cautious; but, at
the same time, I was very particular and easily wearied.

“I have always absolutely despised pederasty as something unworthy a
man, and I only wish that all those like me would do the same; but,
unfortunately, with many this is not the case. If all like me thought as
I do, then the contempt and scoffing of men that feel differently would
be a still greater injustice to us than it now is.

“Toward the man I love I feel completely like a woman, and, therefore,
in the sexual act I am quite passive. In general, my whole sensibility
and feeling are feminine. I am vain, coquettish, fond of ornament, and
like to please others. I love to dress myself beautifully, and, in cases
where I wish to please, I even make use of the arts of the toilet, in
which I am quite skilled.

“While I have but little interest in politics, I am passionately fond of
music and an inspired follower of Richard Wagner. I have noticed this
preference in the majority of us; I find that this music is perfectly in
accord with our nature.

“I play the violin quite well; I like reading, and read much, but I have
little interest in anything else. Everything else in life is quite
indifferent to me, owing to the deep resignation that more and more
takes possession of me.

“Even though I should have reason to be satisfied with my fate, in that
I have an assured position in a technical employment in a large city of
Germany, still I take no pleasure in my calling. I should be best suited
if, independent and free, I could travel about with a handsome lover,
and live for music and literature, particularly for the theatre, which
seems to me to be one of the greatest pleasures. A connection with a
court theatre I think of as being very acceptable.

“The only position or calling that seems really desirable to me is that
of a great artist,—singer, actor, painter, or sculptor; and it seems to
me that it would be even finer to be born to the throne of a king,—a
wish that is in harmony with my pronounced desire for power. (If there
is really such a thing as transmigration of souls, a subject I have
studied much, and which seems to me to clear up much, I must have lived
at one time as an emperor, or ruler of some kind.) But a man must be
born to all this; and since I am not, I am without ambition for
so-called social honors and distinctions.

“As to my tastes, I must mention a painful dissension there is in them.
Handsome, intellectual young men of at least twenty years, who must be
of my own social station, seem to me to be suited rather for platonic
love; but with them I satisfy myself completely with a straightforward,
though ideal, friendship, which seldom goes beyond a few kisses. But I
can be excited sensually only by coarse, powerful men that are at least
of my own age, and mentally and socially beneath me. The reason for this
strange phenomenon may be that my pronounced feeling of shame and my
innate apprehensiveness, with my cautious disposition, have the effect
of an inhibitory idea with men of my own social position; so that with
them it is with difficulty and seldom that I can induce sexual
excitement in myself. That this diversity is painful to me is owing to
the fact that I am always afraid to discover myself to these simple men,
below me in station, who may often be bought with money. But I cannot
imagine anything worse than a scandal, which would at once drive me to
suicide. For I can think of nothing more terrible than, through some
slight act of carelessness or the enmity of any man, suddenly to be
branded before the world, and to be powerless to avert it. But what is
it that we do that is so different from what normally constituted men
can do, at least, quite as frequently without embarrassment, and without
shame? That we do not feel as the crowd feels is not our fault, but a
cruel trick of Nature.

“Innumerable times I have puzzled my brain to know whether science, or
any of her free and unprejudiced devotees, could think of any way in
which to give us step-children of Nature a more endurable position
before the law and mankind. But I have always reached the same sad
conclusion, that when one enters the lists in behalf of anything, he
must first know thoroughly, and be able to explain, that for which he
contends. And who is to-day able to perfectly explain and define
contrary sexual instinct? Yet there must be some correct explanation of
it; there must be some way in which the mass of mankind can be brought
to a milder and more reasonable judgment of it; and, first of all, there
must be some way to show that contrary sexual instinct should not be
regarded as meaning the same as pederasty, as the majority of men—I may
say all—regard it. By such an act a man might erect for himself an
immortal monument in the gratitude of thousands of men of present and
future generations; for there have been, are, and will ever be, urnings,
and in greater number than perhaps has been suspected.

“In Wilbrand’s work, ‘Fridolin’s Secret Marriage,’ I find a very
plausible theory given in explanation of this matter; for I myself have
repeatedly had opportunity to observe that all urnings do not love men
with the same intensity, but that there are innumerable
sub-varieties,—from the most feminine man to the man of contrary
sexuality who is equally sensitive to female charms. This may also
account for the so-called difference between congenital and acquired
contrary sexual instinct, which, in my inadequate opinion, does not
exist. Yet, in all the fifty-five individuals I have become acquainted
with in the three years since I came to understand this matter, I have
met the same peculiarities of temperament, disposition, and character.
Almost all of them are more or less idealists: they smoke but little, or
not at all; they are bigoted, vain, desirous of admiration, and
superstitious; and, unfortunately, I must confess that they combine more
the defects and the reverse sides of both sexes than their good
qualities. For woman in a sexual _rôle_ I experience a feeling of true
horror, which I could never overcome, even with the help of my extremely
lively imagination. I have never attempted it, because I am thoroughly
convinced of the fruitlessness of such an attempt, that seems to me
unnatural and sinful.

“In purely social and friendly relations, I like to associate with
ladies and girls, and I am gladly welcomed in ladies’ society; for I am
much interested in the fashions for ladies, and know how to talk of such
things with great skill. When I wish to, I can be very gay and amiable;
but my faculty for conversation is, for the most part, only assumed, and
it always tires me. I have always had great skill in female work, and
shown interest in it. As a child, and up to my thirteenth year, I was
passionately fond of playing with dolls, whose clothes I made myself;
and it still affords me much pleasure to work at beautiful embroidery,
which, unfortunately, I can do only in secret. I have the same
preference for knick-knacks, photographs, flowers, sweetmeats,
toilet-articles, and such feminine things; and my room, which I arranged
and decorated myself, is like the over-crowded boudoir of a lady.

“As particularly remarkable, I wish still to mention that I have never
suffered with pollutions. I dream very much, and intensely, almost every
night; occasionally I have lascivious dreams, which have only men as
subjects, but I always wake out of them before it comes to ejaculation.
In reality I am not very passionate sexually, and I have periods lasting
from four to six weeks, in which I have almost no sexual desire.
Unfortunately, these periods are infrequent, and they are usually
followed by an awakening of my intense sexual desire that is only the
more violent; which, when it is unsatisfied, causes intense physical and
mental suffering. I then become moody, depressed, sensitive, irritable,
and retiring; peculiarities, however, which, with the first opportunity
I have for sexual gratification, again disappear. I must mention, also,
that often, on the slightest occasion, my mood may change several times
during the day; it is like April weather.

“I dance well, and like to; but I love dancing only for its rhythmical
movement, and because of my partiality for music.

“In conclusion, I wish to speak of something that always arouses
repugnance in me. We are usually considered diseased, and that is
absolutely incorrect. For in every disease there is a means of cure or
amelioration; but no power in the world can take from an urning his
perverse natural constitution. Even suggestion, which has been used with
so much apparent success, cannot induce any enduring change in the
mental life of an urning. In us, effect is mistaken for cause. We are
considered diseased, because in time the majority of us really become
ill. I am almost convinced that two-thirds of us, in later life, when we
really live so long, have a mental defect of one kind or another; and
this is only too easily explained. For, what strength of will and nerves
is required for one to constantly dissimulate, lie, and play the
hypocrite all his life! How often in the society of normal men, when the
conversation turns to contrary sexual instinct, must one agree with the
words of abuse and contempt, while every one of them wounds the heart.
On the other hand, there are always the tiresome and indecent jokes and
talk about women, etc., that must be heard; and which to-day, in
so-called ‘good society,’ are popular—and to show interest and give
attention to them! Daily and hourly to see so many handsome men to whom
one cannot reveal himself; to be compelled to go without a friend,
intercourse with whom we desire so much; and besides, constantly the
fearful anxiety of betraying one’s self before the eyes of the world,
and then standing covered with ignominy and shame! It is really no
wonder that the majority of us are incapable of real work; for we need
all our strength of will and power of endurance for the struggle with
our own fate. How injurious it is to our nerves constantly to be
compelled to shut up all these thoughts and feelings in our hearts;
where our lively fancy, feeding on it all, plays all the more intensely,
so that we go about with a burning fire within us that only too often
threatens to consume us! Happy are those of us that are never denied the
strength to lead such a life; but those, too, are happy that have passed
beyond it.”

Case 123. _Autobiography._ “In what follows, you will find the
description of the character, as well as the mental and sexual
disposition, of an urning,—_i.e._, of an individual who, in spite of his
masculine form, feels as a woman, whose senses women do not excite, and
whose sexual desires are constantly directed toward men.

“Convinced that the enigma of our existence can be solved, or, at least,
illuminated, only by the unprejudiced thought of scientific men, I
describe my life only with the aim of perhaps clearing up this cruel
error of Nature, and possibly doing a kindness to people like me to come
in later generations; for there will be urnings as long as men are born,
just as it is a fact that they have existed in every age. With the
progress of science in our epoch, men will see in me and those like me
not objects of hatred, but objects of pity, which deserve not the odium,
but the compassion, of their more fortunate brothers. I shall be as
brief as possible in my communication, and also objective; and, with
reference to my caustic, often cynical, style, I may note that, above
all, I shall be honest, and, therefore, not avoid strong expressions;
for they are most happily suited to the subject in hand.

“I am in my thirty-fifth year; a merchant, with a fair income; somewhat
above average height, slim, weak of muscle, with full beard, and quite
ordinary face, and, at first sight, in nowise different from ordinary
men. On the other hand, my gait is feminine, and particularly mincing in
fast walking; the movements are awkward and displeasing, indicative of a
want of manly feeling. The voice is neither feminine nor shrill, but
rather a baritone.

“This is my external appearance.

“I do not smoke or drink, and can neither whistle, ride, do gymnastic
feats, fence, nor shoot. I have absolutely no interest in horses or
dogs, and have never had a gun or sword in my hand. In inner feeling and
sexual desire, I am completely a woman. Without thorough education,—I
passed through but few classes in the Gymnasium,—I am yet intelligent,
like to read well-written, improving books, and have good judgment; but
I allow myself to be carried away by the feelings of the moment, and I
am easily influenced by any one who knows my weakness and how to make
use of it. Constantly making resolves, I have never the energy to carry
them out; like a woman, I am moody and nervous, often irritated without
reason, and sometimes mean. Toward persons that do not please me, I am
arrogant, unjust, and often shamefully insulting.

“In all my conduct I am superficial, and often frivolous, and I have no
deep moral feeling. I have little consideration for parents and brothers
and sisters. I am not egotistic, but, on occasion, self-sacrificing. I
cannot withstand tears, and can—like a woman—be won by amiability and
entreaty.

“In my earliest years I avoided playing soldier, gymnastics, or the
rough games of my manly comrades, and ran about with little girls, with
whom I was much more in sympathy than with boys. I was retiring,
bashful, and often blushing. When no more than twelve or thirteen years
old, the close-fitting uniform of a handsome soldier gave me the most
peculiar feeling; and while, during the next few years, my comrades were
always talking about girls, and even engaged in love-affairs, I could,
for hours at a time, run after a well-built man with well-rounded hips,
and feast my eyes on the sight.

“Without thinking much of these impressions, so different from the
feelings of my comrades, I began to masturbate, always during the act
thinking of a heroic, handsome form; and this continued until my
seventeenth year, when I learned from a companion constituted like
myself a true explanation of my condition. Since that time I have been
with girls eight or ten times; but, in order to have an erection, it was
always necessary to think of a handsome man of my acquaintance. And I am
thoroughly convinced that to-day, even with the help of imagination, I
should be unable to have intercourse with a girl.

“Shortly after my discovery I preferred to associate with mature,
powerful urnings; for at this time I had neither mind nor opportunity to
associate with real men. Since this my taste has changed entirely, and
men, real men, of twenty-five or thirty-five years, with supple,
powerful forms, are the only ones that ravish my senses, and charm me as
if I were a woman. Circumstances have allowed me, during these years, to
make about a dozen male acquaintances that would serve my purpose for a
gulden or two a visit. If I am alone in a room with a handsome youth, my
greatest pleasure is membrum ejus vel maxime si magnum atque crassum
est, manibus capere et apprehendere et premere, turgentes nates
femoraque tangere atque totum corpus manibus contrectare et, si
conceditur, os faciem atque totum corpus, immovero nates, ardentibus
osculis obtegere. Quodsi membrum magnum purumque est, dominusque ejus
mihi placet, ardente libidine mentulam ejus in os meum receptam
complures horas sugere possum, neque autem delector, si semen in os meum
ejaculatur, cum maxima eorum qui “urnings” nominantur pars hac re non
modo delectatur, sed etiam semen nonnunquam devorat.

“The most intense delight, however, is experienced when I find a real
man, qui membrum meum in os recepit et erectionem in ore suo concedit.

“Improbable as it sounds, I am yet able to find some coarse fellows who
will allow themselves to be used for this purpose. They learn the thing
while in military service, for urnings know that under such
circumstances they can be made to do the most for money; and when the
fellows are once trained, circumstances often compel them, in spite of
their passion for the opposite sex, to continue the practice.

“With certain exceptions, urnings make no impression on me, because
everything feminine is repugnant to me. At the same time, there are some
that know how to give me the most intense pleasure, just as a real man
can; and I prefer to consort with them, for the reason that sometimes
they return my passionate caresses. In _tête-à-tête_ with such a person,
I throw all check from my excited senses, and give my animal passions
free rein, osculor, premo, amplector eum, linguam meam in os ejus
immitto; ore cupiditate tremente ejus labrum superius sugo, faciem meam
ad ejus nates adpono et odore voluptari e natibus emanente voluptate
obstupescor. Real men, in close-fitting uniform, make the deepest
impression on me; and if I have an opportunity to embrace and kiss such
a ravishing fellow, ejaculation takes place at once,—a weakness which I
attribute to my frequent masturbation. In my earlier years I practiced
it very frequently, almost every time I saw a man pleasing to me, whose
image I kept before my eye during the act. For this my taste is in
nowise difficult to please—like that a servant-girl might have in
finding her ideal in a dragoon guard. A handsome face is a pleasant
supplement, inflaming my sensual desire, but in no respect an essential.
The requisite remains: vir inferiore corporis parte robusta et bene
formosa, turgidis femoribus durisque natibus, while the upper portion of
the body may be slim. Corpulence disgusts me. A sensual mouth with
pretty teeth affects me more intensely; and if the person has also a
membrum pulchrum magnum et æqualiter formatum, all my demands—the most
far-reaching—are fulfilled.

“When I was younger, with men that pleased me and excited my passions
intensely, ejaculation took place from five to eight times in a night,
and now it occurs from four to six times; for I am unusually strong
sensually, and, as an example, even the clinking of a hussar’s sword may
excite me. At the same time, I have a very lively fancy, and spend most
of my leisure hours thinking of handsome men with strong limbs; and I
would be delighted to look on when a powerful fellow, using force, magna
mentula præditus me præsente puellam futuat; mihi persuasum est, fore ut
hoc aspectu sensus mei vehementissima perturbatione afficiantur et dum
futuit corpus adolescentis pulchri tangam et, si liceat, ascendam in eum
dum cum puella concumbit atque idem cum eo faciam et membrum meum in
ejus anum immittam. The accomplishment of these cynical ideas—with which
my mind is often filled—is hindered only by my limited means; otherwise,
I should long ago have had the reality.

“Soldiers have the greatest charm for me, but I have also a weakness for
butchers, fakirs, drivers, circus-riders, and boat-captains; and all
these must be supple and powerfully built. Urnings I hate in intimate
relation, and for the majority of them I have an inexplicable and unjust
aversion. I have never had but one urning for an intimate friend. On the
other hand, the most affectionate and enduring ties bind me to men of my
own age, in whose company I delight, but with whom I have no sexual
relations, and who have no idea of my condition.

“Talk on politics and economics, like every other earnest subject, I
hate; though I gossip with considerable sense and peculiar pleasure
about the theatre. At operas I see myself on the stage, feel myself
applauded by the public, and would prefer to sing as a passive heroine,
or in the dramatic _rôle_ of a woman.

“The most interesting subject of conversation for me, and those like me,
is, however, always—men; for us this is inexhaustible. Their secret
charms are described in the most minute details, mentulæ æstimantur,
quanta sint magnitudine, quanta, crassitudine; de forma earum atque
rigiditate conferimus, alter ab altero cognoscit cujus semen celerius,
cujus tardius ejaculetur. I may add that, of my four brothers, one gave
himself to the service of urnings, without himself being one; and all
four are ladies’ men, and indulge in sexual excesses. The genitals of
the men of our family are, without exception, unusually developed.

“In conclusion, I repeat the words with which I began these lines. I
could not choose my expressions, because my object in the foregoing has
been to afford material for the study of the urning’s existence, and
absolute truth was essential. I beg the numerous cynics to keep this
circumstance in mind.”

In October, 1890, the writer of the foregoing lines presented himself to
me. In all essentials his appearance corresponded with his description.
Genitals large, with abundant growth of hair. His parents had been well
nervously. One brother had shot himself on account of nervous trouble;
three others were intensely nervous. The patient came to me in a state
of despair. He could not endure such a life any longer; for he had been
admonished about intercourse with men that could be bought; and with his
extreme sensual nature he was unable to abstain. Too, he could not
understand how he could be made to love women, and enjoy the nobler joys
of life. He had had love for men since his thirteenth year.

He felt in all respects like a woman, and longed to be won by men that
were not urnings. When he was with an urning, it was just as if two
girls were together. He would prefer being sexless to living longer as
he was. Would not castration help him?

An attempt at hypnosis with the highly excited patient induced only a
very slight degree of lethargy.

Case 124. B., waiter, aged 42, single, was sent to me by his physician,
with whom he was in love, as one who was suffering from contrary sexual
feeling. B. very willingly, and in a decent manner, gave a history of
his past life, especially of his sexual life, and was glad at least to
have an authoritative opinion concerning his sexual condition, which had
always appeared to him abnormal.

B. knew nothing to report of his grandparents. His father had been a
passionate, excitable man, a drinker, and always very sensual. After he
had begotten twenty-four children by one wife, he was divorced from her;
and after that his landlady became three times pregnant by him. His
mother was healthy.

Of the twenty-three children, but six were living; several were nervous,
but not sexually abnormal, with the exception of one sister, who always
sought men.

B. asserts that from childhood he was sickly. At eight his sexual life
began. He masturbated, and became possessed of the idea penem aliorum
puerorum in os arrigere, which gave him the greatest pleasure. At twelve
he began to fall in love with men, usually with those between thirty and
forty, with moustaches. Even at that time his sexual desire was greatly
developed, and he had erections and pollutions. From that time, indeed,
he masturbated daily, and during the act thought of a beloved man. Yet
his greatest delight had been penem viri in os arrigere. During the act
he had ejaculation, with an intense feeling of pleasure. Only about
twelve times had he had this pleasure. He had never felt disgust with
the penis of another sympathetic man; quite the contrary. He had never
accepted proffers of pederasty; actively or passively, it was very
disgusting to him. In the perverse sexual act he had always thought of
himself in the _rôle_ of a woman. His passion for men in sympathy with
him had been unbounded. He would have done everything for a lover; even
at the sight of him he would tremble with excitement and joy.

At nineteen he often allowed himself to be taken by his comrades to
houses of prostitution. He never had pleasure in coitus, and only in the
moment of ejaculation felt satisfaction. In order to get an erection
with a woman, it was always necessary, in the act, for him to think of a
beloved man. He would always have preferred to have the woman allow
immissio penis in os, which, however, was always denied him. _Faute de
mieux_, he had practiced coitus, and, indeed, twice became a father. The
last child, a girl of eight, had already begun to practice masturbation
and mutual onanism, which troubled him very much as a father. He wished
to know whether there was any remedy for it.

The patient asserted that he always felt himself toward men in a
feminine _rôle_ (also in sexual intercourse). He had always thought that
his sexual perversion had resulted from his father’s wishing to beget a
girl when he begat him. His brothers and sisters had always joked him on
account of his feminine manners. Sweeping and house-cleaning had always
been pleasant occupations for him. His activities in this direction had
often been wondered at, and he was considered more skillful than a girl.
Whenever he could, he dressed like a woman. At the carnival he appeared
at the dances masked as a female. He was very successful at coquetry on
such occasions, because he had a feminine nature.

He had never had real pleasure in drinking, smoking, or in masculine
occupations or pleasures; but, on the other hand, he loved to sew, and
as a child had often been scolded for his playing with dolls. His
interest at the circus or theatre was confined to men. Frequently he
could not overcome the impulse to hang around water-closets, in order to
get sight of male genitals.

Feminine charms had never pleased him. Coitus had been possible only
when he thought of a beloved man. Nocturnal pollutions were always
induced by lascivious dreams of men.

In spite of much sexual excess, B. had never suffered from neurasthenia
sexualis, and, besides, there was not a symptom of neurasthenia
discoverable in him.

Patient is delicate, and his whiskers and moustache, which made their
appearance in his twenty-eighth year, are thin. Externally, with the
exception of a weaving gait, he presents nothing which would point to
his feminine nature. He asserts that he has often been joked about his
feminine gait. His conduct is in all respects decent. His genitals are
large, well developed, and normal in all respects, and the growth of
genital hair is abundant; the pelvis is masculine. The head is rachitic,
somewhat hydrocephalic, with prominence of the parietal bones. The face
is remarkably small. The patient says that he is irritable and easily
angered.

Case 125. On May 1, 1880, G., Ph.D., and a writer, was brought to the
clinic for mental diseases, at Graz, by the public authorities. While on
his return from Italy, G. found a soldier in Graz who gave himself up to
him for hire, but ultimately denounced G. to the police, because G. had
openly confessed his love for men. The authorities considered his mental
condition doubtful, and sent him to alienists for examination. To the
physicians G. related, with cynical openness, that years before, in M.,
he had had just such an affair with the police, and was in prison
fourteen days. In the South there was no danger from such people; it was
only in Germany and Austria that the thing was regarded as an evil.

G. is fifty years old, tall, powerful, and has a humerous expression,
and a cynical, coquettish manner; the eye has a neuropathic, swimming
expression; the teeth of the under jaw stand far back from those of the
upper jaw. The cranium is normal, the voice masculine, and the beard
abundant. The genitals are well formed, though the testicles are
somewhat small. With the exception of slight emphysema of the lungs and
external fistula in ano, there are no remarkable anomalies of the
vegetative organs. G.’s father was subject to periodical insanity. His
mother was a high-strung person, and she had an insane sister. Of the
children, four died in childhood.

With the exception of scrofulosis, G. asserts that he was healthy. He
obtained the degree of Doctor of Philosophy; at twenty-five, he had
hæmoptysis, and went to Italy, where he has since lived, with slight
interruption, by writing and by giving private lessons. G. says that he
often has congestions, and also some spinal irritation,—_i.e._, pain in
his back,—but otherwise he has a genial disposition; only he is not much
of a financier; and at the same time, like all old prostitutes, he has a
very good appetite. Further, he states, with great satisfaction and
remarkable cynicism, that he has congenital contrary sexual instinct.
When only five years old, it was his greatest pleasure to get sight of a
penis, and he hung about appropriate places, in order to enjoy that
pleasure. Even before puberty he practiced masturbation. At the time of
puberty he noticed an inward feeling for friends. An obscure impulse
pointed out to him the way his love would take. He was actually impelled
to kiss young men, and now and then to caress their genitals. When
twenty-six years old, he first began to have sexual intercourse with
men, toward whom he felt like a woman. Even as a child, it was his
greatest delight to put on female attire. He was often chastised by his
father because, in the effort to satisfy this impulse, he put on his
sister’s clothing. If he happened to see a _ballet_, only the male
dancers interested him. Since he could remember, he had had a horror
feminæ. If he happened to visit a brothel, it was only to see young men.
He was, indeed, a rival of prostitutes. If he saw a young man, he just
looked at his eyes; in case these pleased him, then came the
mouth—whether it was well formed for kissing; then he would look at the
genitals—whether they were well developed. G. pointed, with great
feeling of self-satisfaction, to his poetical works, and tried to make
it appear that persons with natures like his were poetically endowed. He
gave as examples Voltaire, Frederick the Great, Eugene of Savoy, and
Plato, as well as numerous distinguished men of the present, who,
according to his opinion, were urnings. His greatest pleasure was to
have a sympathetic young man read his verses to him. During the last
summer he had had such a lover. When he had to part with him, he was
quite undone, and he did not eat or sleep until gradually he had
regained his former condition. He said that the love of urnings was a
passionate, inner fire. According to his statement, in Naples the
_effeminelli_ lived in a quarter together, just as in Paris the
_grisettes_ live with their lovers. They sacrifice themselves for their
lovers, and care for the household, just as the grisettes do. On the
other hand, an urning repels an urning, “just as one prostitute does
another—that is the curse.”

The need of intercourse with males occurs about once a week with G. He
is happy in his peculiar sexuality, which he, it is true, considers
peculiar, but which he will not regard as abnormal or wrong. He thinks
that nothing remains for him and those like him but to raise what is
unnatural in themselves to the supernatural. He looks upon the love of
urnings as the higher, the ideal, as godlike, an abstract love. When
shown that such a love is far from the purpose of Nature and the
preservation of the race, he expresses the pessimistic thought that the
world should die out, and the earth turn round its axis without men, who
were on it only for trouble. As reason and explanation of his unnatural
sexual feeling, G. refers to Plato, “who certainly was no beast.” Plato
expressed allegorically the idea that men were originally balls. The
gods had divided these into two hemispheres. For the most part, man is
suited to woman, but sometimes man to man. In the latter case, the
impulse to union is quite as powerful as in the former, and they
strengthen each other in the same way. G. further relates that his
dreams, when they were erotic, never had women, but only men, for their
subjects. Male-love was the only kind that could satisfy him. He
considered it disgusting for one human being to be prodding about in the
abdomen of another with his penis, since he had heard that in this
disgusting fashion coitus was usually carried out. He had never had the
curiosity to inform himself concerning the female genitals; the subject
was disgusting to him. The indulgence of his sexual appetite he did not
consider a vice, but the result of a natural impulse which compelled him
to it. It conduced to self-preservation. Onanism was a poor substitute,
and, moreover, injurious, while urning-love was morally elevating and
conducive to physical well-being.

With moral indignation, which in contrast with his cynicism in other
directions appeared ridiculous, he protested against the classification
of urnings with those who indulged in pederasty. He looked on the podex
with disgust, as it was a secreting organ. The intercourse of urnings
always took place in front, and was combined onanism.

This was the extent of G.’s disclosures, whose mental condition was
certainly congenitally abnormal. As proof of this, may be cited his
cynicism; his incredible frivolity in his application of his vices to
religion, in which direction we cannot follow him without overstepping
the bounds set by scientific inquiry; his perverse philosophical ideas
with reference to his sexual perversion; his perverse manner of looking
at the world; his ethical defect in all directions; his vagabondage; and
his perverse mind and exterior. G. makes the impression of an original
paranoiac. (Personal case. _Zeitschrift für Psychiatrie._)

Case 126. Taylor had occasion to examine a certain Eliza Edwards, aged
24. It was discovered that she was of masculine sex. E. had worn female
clothing from her fourteenth year, and also been an actress. The hair
was worn long after the manner of females, and parted in the middle. The
form of the face was feminine, but otherwise the body was masculine. The
beard was carefully pulled out. The masculine, well-developed genitals
were fixed in an upward position by an artful bandage. The condition of
the anus indicated passive pederasty.

Case 127. An official of middle age, who for some years had been happy
in family life, and was married to a virtuous woman, presented a
peculiar manifestation of contrary sexual feeling.

One day, through the indiscretion of a prostitute, the following scandal
became public: About once a week X. would appear in a house of
prostitution, and there dress himself up as a woman, always requiring,
as a part of his costume, a coiffure. When his toilet was completed, he
would lie down on the bed, and have the prostitute perform
manustupration. But he very much preferred to have a male person (a
servant of the house). This man’s father was hereditarily tainted, had
been insane several times, and was afflicted with hyperæsthesia and
paræsthesia sexualis.

Case 128. C. R., maid-servant, aged 26, suffered from the time of her
development with original paranoia and hysteria. As a result of her
delusions, her life had been somewhat romantic, and in 1884, in
Switzerland, where she had gone as a result of delusions of persecution,
she came under the observation of the authorities. On this occasion, it
was ascertained that R. was affected with contrary sexual instinct.

Concerning her parents and relatives there is no information at hand. R.
asserted that, with the exception of an inflammation of the lungs at the
age of sixteen, she had never been severely ill.

First menstruation at fifteen, without any difficulties; thereafter it
was very often irregular and abnormally excessive. The patient declared
that she never had had inclinations toward the opposite sex, and had
never allowed the approach of a man. She never could understand how her
friends could describe the beauty and amiability of men. But it was
charming and inspiring for her to imprint a kiss on the lips of a
beloved female friend. She had a love for girls that was
incomprehensible to her. She had passionately loved and kissed some of
her female friends, and she would have given up her life for them. Her
greatest delight would have been to have constantly lived with such a
friend and absolutely possessed her.

In this she felt toward the beloved girl like a man. Even as a little
child, she had an inclination only for the play of boys, and she loved
to hear shooting and military music, was always much excited by them,
and would gladly have gone as a soldier. The chase and war have been her
ideals. In the theatre only feminine performers interested her. She knew
very well that the whole of this inclination was unwomanly, but she
could not help it. It had always been a great pleasure for her to go
about in male clothing, and in the same way she had always preferred
masculine work, and had shown unusual skill in it; while with reference
to feminine occupations, especially handiwork, she had to say the
contrary. The patient had also a weakness for smoking and spirits. On
account of persecutory delusions, in order to rid herself of her
persecutions, the patient had often gone about in male attire, and
played the part of a man. She did this with such (congenital) skill
that, as a rule, she was able to deceive people concerning her sex.

It is authoritatively established that in 1884, for a long time, the
patient went about in male attire, now in the garments of a civilian,
now in the uniform of a lieutenant; and in August of the same year,
dressed as a male servant, she fled to Switzerland as a result of
delusions of persecution. There she found service in a merchant’s
family, and fell in love with the daughter of the house, “the beautiful
Anna,” who, on her side, not recognizing the sex of R., fell in love
with the handsome young man.

Concerning this episode the patient makes the following characteristic
statement: “I was madly in love with Anna. I don’t know how it came
about, and I cannot put myself right concerning this impulse. In this
fatal love lies the reason why I played the _rôle_ of a man so long. I
have never yet felt any love for a man, and I believe that my love is
for the female and not the male sex. I can in nowise understand my
condition.”

From Switzerland R. wrote letters home to her friend, Amelia, which were
produced at the examination. They are letters showing passionate love,
which goes beyond the bounds of friendship. She apostrophizes her
friend, “My flower, sun of my heart, longing of my soul.” She was her
greatest happiness on earth; her heart was hers. And in her letters to
her friend’s parents she wrote: “You, too, should watch your flower,
for, if she should die, you also would be unable to endure life.”

For the purpose of investigating her mental condition, R. remained for
some time in an asylum. On one occasion, when Anna was allowed to pay R.
a visit, there was no end of passionate embraces and kisses. The visitor
acknowledged freely that they had before secretly embraced and kissed in
the same way.

R. is a tall, slim, stately person, of feminine form in all respects,
but with masculine features. Cranium regular; no anatomical signs of
degeneration. Genitals normal and indicative of virginity. All the
circumstances indicate that she has only indulged in platonic love.
Glance and appearance are indicative of a neuropathic person. Severe
hysteria, occasional cataleptoid attacks, with visionary and delirious
states. The patient is very easily brought into a state of somnambulism
by hypnotic influence, and in this condition is susceptible to all
possible suggestions. (Personal case. _Friedreich’s Blätter_, 1886, Heft
1.)

4. _Androgyny and Gynandry._—Forming direct transitions from the
foregoing groups are those individuals of contrary sexuality in whom not
only the character and all the feelings are in accord with the abnormal
sexual instinct, but also the skeletal form, the features, voice, etc.;
so that the individual approaches the opposite sex anthropologically,
and in more than a psychical and psycho-sexual way. This anthropological
form of the cerebral anomaly apparently represents a very high degree of
degeneration; but that this variation is based on an entirely different
ground than the teratological manifestation of hermaphroditism, in an
anatomical sense, is clearly shown by the fact that thus far, in the
domain of contrary sexuality, no transitions to hermaphroditic
malformation of the genitals have been observed. The genitals of these
persons always prove to be fully differentiated sexually, though not
infrequently there are present anatomical signs of degeneration
(epispadiasis, etc.), in the sense of arrests of development in organs
that are otherwise well differentiated.

There is yet wanting a sufficient record of cases belonging to this
interesting group of women in masculine attire with masculine genitals,
and men in feminine dress with the sexual organs of the female. Every
experienced observer of his fellow-men remembers masculine persons that
were very remarkable for their womanish character and type (wide hips,
form rounded by abundant development of adipose tissue, absence or
insufficient development of beard, feminine features, delicate
complexion, falsetto voice, etc.); and, on the other hand, women that,
by reason of build, pelvis, gait, attitude, heavy and decidedly
masculine features, rough and deep voice, etc., had little to remind one
of femininity.

We have already met some indications of such an anthropological
transformation in foregoing groups, as in Case 106, where the woman had
the feet of a man; and in Case 112, where there was development of mammæ
and production of milk during puberty.

In persons belonging to the fourth group, and in certain ones in the
third, forming transitions to the fourth, there seems to be a feeling of
shame (sexual) toward persons of the same sex, and not toward those of
the opposite sex.

  Case 129. _Androgyny._ Mr. v. H., aged 30, single; of neuropathic
  mother. Nervous and mental diseases are said not to have occurred in
  the patient’s family, and his only brother is said to be mentally and
  physically completely normal. The patient developed tardily
  physically, and, therefore, spent much of his time at the sea-shore
  and climatic resorts. From childhood he was of neuropathic
  constitution, and, according to the statements of his relatives,
  unlike other boys. His disinclination for masculine pursuits and his
  preference for feminine amusements were early remarked. Thus he
  avoided all boyish games and gymnastic exercises, while doll-play and
  feminine occupations were particularly pleasing to him. Thereafter he
  developed well physically, and escaped severe illnesses, but he
  remained mentally abnormal, incapable of an earnest aim in life, and
  decidedly feminine in thought and feeling.

  In his seventeenth year pollutions occurred, became more frequent, and
  finally took place during the day; so that the patient grew weak, and
  manifested various nervous disturbances. Symptoms of neurasthenia
  spinalis made their appearance, and have lasted up to the last few
  years, but they have become milder with the decrease in the number of
  pollutions. Onanism is denied, but is very probable. An indolent,
  effeminate, dreamy habit of thought has become more and more
  noticeable ever since puberty. All efforts to induce the patient to
  take up an earnest pursuit in life were vain. His intellectual
  functions, though formally quite undisturbed, were never equal to the
  motive of an independent character, and the higher ideals of life. He
  remained dependent, an overgrown child; and nothing more clearly
  indicated his original abnormal condition than an actual incapability
  to take care of money, and his own confession that he had no ability
  to use money reasonably; that as soon as he had money he wasted it for
  curios, toilet-articles, and the like.

  Incapable as he was of a reasonable use of money, the patient was no
  more capable of leading a social existence; indeed, he was incapable
  of gaining an insight into its significance and value.

  He learned very poorly, spending his time in _toilettes_ and artistic
  nothings, particularly in painting, for which he evinced a certain
  capability; but in this direction he accomplished nothing, since he
  was wanting in perseverence. He could not be brought to take up any
  earnest thought; he had a mind only for externals, was always
  distracted, and serious things quickly wearied him. Preposterous acts,
  senseless journeys, waste of money, and debts repeatedly occur
  throughout the course of his later life; and even for these positive
  faults in his life he was wanting in understanding. He was self-willed
  and intractable, and never did well as soon as an attempt was made to
  put him on his feet and point out to him his own interests.

  With these manifestations of an original abnormal and defective mind,
  there were notable indications of perverse sexual feeling, which were
  also indicated in the somatic habitus of the patient. Sexually, the
  patient felt like a woman toward men, and had inclinations toward
  people of his own sex, with indifference, if not actual
  disinclination, for females.

  In his twenty-second year it is asserted that he had sexual
  intercourse with women, and was able to perform the act of
  cohabitation normally; but, partly on account of increase of
  neurasthenic symptoms which was occasional after coitus, and partly on
  account of fear of infection,—but really by reason of a want of
  satisfaction,—he soon ceased to indulge in such intercourse.
  Concerning his abnormal sexual condition, he is not quite clear; he is
  conscious of an inclination toward the male sex, but confesses, only
  in a shame-faced way, that he has certain pleasurable feelings of
  friendship for masculine individuals, which, however, are not
  accompanied by any sensual feelings. The female sex he does not
  exactly abhor; he could even bring himself to marry a woman who could
  have an attraction for him, by means of similarity in artistic tastes,
  if he could but be freed from conjugal duties, which were unpleasant
  to him, and the performance of which made him tired and weak. He
  denied having had sexual intercourse with men, but his blushing and
  embarrassment, and, still more, an occurrence in N., where the
  patient, some time before, provoked a scandal by attempting to have
  sexual intercourse with youths, gave him the lie.

  Too, his external appearance, habitus, form, gestures, manners, and
  dress are remarkable, and decidedly recall the feminine form and
  characteristics. The patient, however, is over middle height, but
  thorax and pelvis are decidedly of feminine form. The body is rich in
  fat; the skin is well cared for, delicate, and soft. This impression
  of a woman in masculine dress is further increased by a thin growth of
  hair on the face, which is shaven, with the exception of a small
  moustache; by the mincing gait; the shy, effeminate manner; the
  feminine features; the swimming, neuropathic expression of the eyes;
  the traces of powder and paint; the curtailed cut of the clothing,
  with the bosom-like prominence of the upper garments; the fringed,
  feminine cravat; and the hair brushed down smoothly from the brow to
  the temples. The physical examination makes undoubted the feminine
  form of the body. The external genitals are well developed, though the
  left testicle has remained in the canal; the growth of hair on the
  mons veneris is thin, and the latter is unusually rich in fat and
  prominent. The voice is high, and without masculine timbre.

  Too, the occupation and manner of thought of v. H. are decidedly
  feminine. He has a boudoir and a well-supplied toilet-table, with
  which he spends many hours in all kinds of arts for beautifying
  himself. He abhors the chase, practice with arms, and such masculine
  pursuits, and calls himself an _æsthete_; speaks with preference of
  his paintings and attempts at poetry. He is interested in feminine
  occupations, which—_e.g._, embroidery—he engages in, and calls his
  greatest pleasure. He could spend his life in an artistic and æsthetic
  circle of ladies and gentlemen, in conversation, music, and æsthetics.
  His conversation is preferably about feminine things,—fashions,
  needlework, cooking, and household work.

  The patient is well nourished, but anæmic. He is of neuropathic
  constitution, and presents symptoms of neurasthenia, which are
  maintained by a bad manner of life, lying abed, living in-doors, and
  effeminateness. He complains of occasional pain and pressure in the
  head, and habitual obstipation. He is easily frightened; complains of
  occasional lassitude and fatigue, and drawing pains in the
  extremities, in the direction of the lumbo-abdominal nerves. After
  pollutions, and regularly after eating, he feels tired and relaxed; he
  is sensitive to pressure over the spinous processes of the dorsal
  vertebræ, as also to pressure along accessible nerves. He feels
  peculiar sympathies and antipathies for certain persons, and, when he
  meets people for whom he has an antipathy, he falls into a condition
  of peculiar fear and confusion. His pollutions, though now they occur
  but seldom, are pathological, in that they occur by day, and are
  unaccompanied by any sensual excitement.

  _Opinion:_ 1. Mr. v. H., according to all observations and reports, is
  mentally an abnormal and defective person, and that, in fact, _ab
  origine_. His contrary sexual instinct represents a part of his
  abnormal physical and mental condition.

  2. This condition, in that it is congenital, is incurable. There
  exists defective organization of the highest cerebral centres, which
  renders him incapable of leading an independent life, and of obtaining
  a position in life. His perverse sexual instinct prevents him from
  exercising normal sexual functions; and this is attended by all the
  social consequences of such an anomaly, and the danger of satisfaction
  of perverse impulses arising out of his abnormal organization, with
  consequent social and legal conflicts. Fear of the latter, however,
  cannot be great, since the (perverse) sexual impulse of the patient is
  weak.

  3. Mr. v. H., in the legal sense of the word, is not irresponsible,
  and neither fit for, or in need of, treatment in a hospital for the
  insane. It is possible for him—though but an overgrown child, and
  incapable of personal independence—to live in society, though under
  the care and guidance of normal individuals. Too, to a certain extent,
  it is possible for him to respect the laws and restrictions of
  society, and to judge his own acts; but, with respect of possible
  sexual errors and conflicts with criminal laws, it must be emphasized
  that his sexual instinct is abnormal, having its origin in organic
  pathological conditions; and this circumstance should eventually be
  used in his favor. On account of his notorious lack of independence,
  he cannot be discharged from parental care or guardianship, inasmuch
  as otherwise he would be ruined financially.

  4. Mr. v. H. is also physically ill. He presents signs of slight
  anæmia and of neurasthenia spinalis. A rational regulation of his
  manner of life and a tonic regimen, and, if possible,
  hydro-therapeutic treatment, seem necessary. The suspicion that this
  trouble has its origin in early masturbation should be entertained,
  and the possibility of the existence of spermatorrhœa, that is of
  importance etiologically and therapeutically, lies near. (Personal
  case. _Zeitschr. f. Psychiatrie._)

  Case 130. Miss X., aged 38, consulted me, late in the fall of 1881, on
  account of severe spinal irritation and obstinate sleeplessness, in
  combating which she had become addicted to morphine and chloral. Her
  mother and sister were nervous sufferers, but the rest of the family
  were healthy. The trouble dated from a fall on her back in 1872, at
  which time the patient was terribly frightened, though, when a girl,
  she had been subject to muscular cramps and hysterical symptoms.
  Following this shock, a neurasthenic and hysterical neurosis
  developed, with predominating spinal irritation and sleeplessness.
  Episodically, hysterical paraplegia, lasting as long as eight months,
  and hysterical hallucinatory delirium, with convulsive attacks,
  occurred. In the course of this, symptoms of morphinism were added. A
  stay of some months in the hospital relieved the latter, and
  considerably improved the neurasthenic neurosis, in the treatment of
  which general faradization exerted a remarkably favorable influence.

  Even at the first meeting, the patient produced a remarkable
  impression by reason of her attire, features, and conduct. She wore a
  gentleman’s hat, her hair closely cut, eye-glasses, a gentleman’s
  cravat, a coat-like outer garment of masculine cut that reached well
  down over her gown, and boots with high heels. She had coarse,
  somewhat masculine features; a harsh, deep voice; and made rather the
  impression of a man in female attire than that of a lady, if one but
  overlooked the bosom and the decidedly feminine form of the pelvis.
  During the long time that she was observed, there were never signs of
  erotocism. When questioned concerning her attire, she would only
  respond that the style she chose suited her better. Gradually it was
  ascertained from her that, even when she was a small girl, she had had
  a preference for horses and masculine pursuits, and never any interest
  in feminine occupations. Later she developed a particular pleasure in
  reading, and prepared herself to be a teacher. Dancing had never
  pleased her; it had always seemed silly to her. Too, the _ballet_ had
  never interested her. Her greatest pleasure had always been in the
  circus. Until her sickness, in 1872, she had neither had inclination
  for persons of the opposite nor for those of her own sex. From that
  time she had, what was remarkable to herself, a peculiar friendship
  for females, particularly for young ladies; and she had a desire, and
  satisfied it, to wear hats and coats of masculine style. Since 1869,
  besides, she had worn her hair short, and parted it on the side, as
  men do. She asserts that she was never sensually excited in the
  company of men, but that her friendship and self-sacrifice for
  sympathetic ladies was unbounded; while from that time she also
  experienced repugnance for gentlemen and their society.

  Her relatives report that, before 1872, the patient had a proposal of
  marriage, which she refused; and that when she returned from a sojourn
  at a watering-place, in 1874, she was sexually changed, and
  occasionally showed that she did not regard herself as a female.

  Since that time she would associate only with ladies, and has had a
  kind of love-relation with one or another, and made remarks which
  indicated that she looked upon herself as a man. This predilection for
  women was decidedly more than mere friendship, since it expressed
  itself in tears, jealousy, etc.

  When, in 1874, she was stopping at a watering-place, a young lady, who
  took her for a man in disguise, fell in love with her. When this lady
  married, later, the patient was for a long time depressed, and spoke
  of unfaithfulness. Moreover, since her sickness, her relatives were
  struck by her desire for masculine attire, her masculine conduct, and
  disinclination for feminine pursuits; while previously, at least
  sexually, she had presented nothing unusual.

  Further investigations showed that the patient had a love-relation,
  which was not purely platonic, with the lady described in Case 118;
  and that she wrote her affectionate letters like those of a lover to
  his beloved. In 1887 I again saw the patient in a sanitarium, where
  she had been placed on account of hystero-epileptic attacks, spinal
  irritation, and morphinism. The contrary sexual feeling existed
  unchanged, and only by the most careful watching was the patient kept
  from improper advances toward her fellow-patients.

  Her condition remained quite unchanged until 1889. Then the patient
  began to fail, and she died of “exhaustion,” in August, 1889. The
  autopsy showed, in the vegetative organs, amyloid degeneration of the
  kidneys, fibroma of the uterus, and cyst of the left ovary. The
  frontal bone was much thickened, uneven on the inner surface, with
  numerous exostoses; dura adherent to vault of cranium. Long diameter
  of skull, 175 millimetres; lateral diameter, 148 millimetres; weight
  of the œdematous, but not atrophied, brain, 1175 grammes. The meninges
  delicate, easily removed. Cortex pale. Convolutions broad, not
  numerous, regularly arranged. Nothing abnormal in cerebellum and great
  ganglia.

  Case 131. _Gynandry._[117] History: On November 4, 1889, the
  step-father of a certain Count Sandor V. complained that the latter
  had swindled him out of 800f., under the pretense of requiring a bond
  as secretary of a stock company. It was ascertained that Sandor had
  entered into matrimonial contracts and escaped from the nuptials in
  the spring of 1889; and, more than this, that this ostensible Count
  Sandor was no man at all, but a woman in male attire,—Sarolta
  (Charlotte), Countess V.

  S. was arrested, and, on account of deception and forgery of public
  documents, brought to examination. At the first hearing S. confessed
  that she was born on Sept. 6, 1866; that she was a female, Catholic,
  single, and worked as an authoress under the name of Count Sandor V.

  From the autobiography of this man-woman I have gleaned the following
  remarkable facts that have been independently confirmed:—

  S. comes of an ancient, noble, and highly-respected family of Hungary,
  in which there have been eccentricity and family peculiarities. A
  sister of the maternal grandmother was hysterical, a somnambulist, and
  lay seventeen years in bed, on account of fancied paralysis. A second
  great-aunt spent seven years in bed, on account of a fancied fatal
  illness, and at the same time gave balls. A third had the whim that a
  certain table in her _salon_ was bewitched. If anything were laid on
  this table, she would become greatly excited and cry, “Bewitched!
  bewitched!” and run with the object into a room which she called the
  “Black Chamber,” and the key of which she never let out of her hands.
  After the death of this lady, there were found in this chamber a
  number of shawls, ornaments, bank-notes, etc. A fourth great-aunt,
  during two years, did not leave her room, and neither washed herself
  nor combed her hair; then she again made her appearance. All these
  ladies were, nevertheless, intellectual, finely educated, and amiable.

  S.’s mother was nervous, and could not bear the light of the moon.

  From her father’s family it is said she had a trace too much. One line
  of the family gave itself up almost entirely to spiritualism. Two
  blood-relations on the father’s side shot themselves. The majority of
  her male relatives are unusually talented; the females are decidedly
  narrow and domestic. S.’s father had a high position, which, however,
  on account of his eccentricity and extravagance (he wasted over a
  million and a half), he lost.

  Among many foolish things that her father encouraged in her was the
  fact that he brought her up as a boy, called her Sandor, allowed her
  to ride, drive, and hunt, admiring her muscular energy.

  On the other hand, this foolish father allowed his second son to go
  about in female attire, and had him brought up as a girl. This farce
  ceased in his fifteenth year, when the son was sent to a higher
  school.

  Sarolta-Sandor remained under her father’s influence till her twelfth
  year, and then came under the care of her eccentric maternal
  grandmother, in Dresden, by whom, when the masculine play became too
  obvious, she was placed in an Institute, and made to wear female
  attire.

  At thirteen she had a love-relation with an English girl, to whom she
  represented herself as a boy, and ran away with her.

  Sarolta returned to her mother, who, however, could do nothing, and
  was compelled to allow her daughter to again become Sandor, wear male
  clothes, and, at least once a year, to fall in love with persons of
  her own sex.

  At the same time, S. received a careful education, and made long
  journeys with her father,—of course, always as a young gentleman. She
  early became independent, and visited _cafés_, even those of doubtful
  character, and, indeed, boasted one day that in a brothel she had had
  a girl sitting on each knee. S. was often intoxicated, had a passion
  for masculine sports, and was a very skillful fencer.

  She felt herself drawn particularly toward actresses, or others of
  similar position, and, if possible, toward those who were not very
  young. She asserts that she never had any inclination for a young man,
  and that she has felt, from year to year, an increasing dislike for
  young men.

  “I preferred to go into the society of ladies with ugly, ill-favored
  men, so that none of them could put me in the shade. If I noticed that
  any of the men awakened the sympathies of the ladies, I felt jealous.
  I preferred ladies who were bright and pretty; I could not endure them
  if they were fat or much inclined toward men. It delighted me if the
  passion of a lady was disclosed under a poetic veil. All immodesty in
  a woman was disgusting to me. I had an indescribable aversion for
  female attire,—indeed, for everything feminine,—but only in as far as
  it concerned me; for, on the other hand, I was all enthusiasm for the
  beautiful sex.”

  During the last ten years S. had lived almost constantly away from her
  relatives, in the guise of a man. She had had many _liaisons_ with
  ladies, traveled much, spent much, and made debts.

  At the same time, she carried on literary work, and was a valued
  collaborator on two noted journals of the Capital.

  Her passion for ladies was very changeable; constancy in love was
  entirely wanting.

  Only once did such a _liaison_ last three years. It was years before
  that S., at Castle G., made the acquaintance of Emma E., who was ten
  years older than herself. She fell in love with her, made a
  marriage-contract with her, and they lived together, as man and wife,
  for three years at the Capital.

  A new love, which S. regarded as a fate, caused her to sever her
  matrimonial relations with E. The latter would not have it so. Only
  with the greatest sacrifice was S. able to purchase her freedom from
  E., who, it is reported, still looks upon herself as a divorced wife,
  and regards herself as the Countess V.! That S. also had the power to
  excite passion in other women is shown by the fact that when she
  (before her marriage with E.) had grown tired of a Miss D., after
  having spent thousands of guldens on her, she was threatened with
  shooting by D. if she should become untrue.

  It was in the summer of 1887, while at a watering-place, that S. made
  the acquaintance of a distinguished official’s family. Immediately she
  fell in love with the daughter, Marie, and her love was returned.

  Her mother and cousin tried in vain to break up this affair. During
  the winter, the lovers corresponded zealously. In April, 1888, Count
  S. paid her a visit, and in May, 1889, attained her wish; in that
  Marie—who, in the meantime, had given up a position as teacher—became
  her bride in the presence of a friend of her lover, the ceremony being
  performed in an arbor, by a false priest, in Hungary. S., with her
  friend, forged the marriage-certificate. The pair lived happily, and,
  without the interference of the step-father, this false marriage,
  probably, would have lasted much longer. It is remarkable that, during
  the comparatively long existence of the relation, S. was able to
  deceive completely the family of her bride with regard to her true
  sex.

  S. was a passionate smoker, and in all respects her tastes and
  passions were masculine. Her letters and even legal documents reached
  her under the address of “Count S.” She often spoke of having to
  drill. From remarks of the father-in-law, it seems that S. (and she
  afterward confessed it) knew how to imitate a scrotum with
  handkerchiefs or gloves stuffed in the trousers. The father-in-law
  also, on one occasion, noticed something like an erected member on his
  future son-in-law (probably a priapus). She also occasionally remarked
  that she was obliged to wear a suspensory bandage while riding. The
  fact is, S. wore a bandage around the body, possibly as a means of
  retaining a priapus.

  Though S. often had herself shaved _pro forma_, the servants in the
  hotel where she lived were convinced that she was a woman, because the
  chambermaids found traces of menstrual blood on her linen (which S.
  explained, however, as hæmorrhoidal); and, on the occasion of a bath
  which S. was accustomed to take, they claimed to have convinced
  themselves of her real sex by looking through the key-hole.

  The family of Marie make it seem probable that she for a long time was
  deceived with regard to the true sex of her false bridegroom. The
  following passage in a letter from Marie to S., August 26, 1889,
  speaks in favor of the incredible simplicity and innocence of this
  unfortunate girl: “I don’t like children any more, but if I had a
  little Bezerl or Patscherl by my Sandi,—ah, what happiness, Sandi
  mine!”

  A large number of manuscripts allow conclusions to be drawn concerning
  S.’s mental individuality. The chirography possesses the character of
  firmness and certainty. The characters are genuinely masculine. The
  same peculiarities repeat themselves everywhere in their
  contents,—wild, unbridled passion; hatred and resistance to all that
  opposes the heart thirsting for love; poetical love, which is not
  marred by one ignoble blot; enthusiasm for the beautiful and noble;
  appreciation of science and the arts.

  Her writings betray a wonderfully wide range of reading in classics of
  all languages, in citations from poets and prose writers of all lands.
  The evidence of those qualified to judge literary work shows that S.’s
  poetical and literary ability is by no means small. The letters and
  writings concerning the relation with Marie are psychologically worthy
  of notice.

  S. speaks of the happiness there was for her when by M.’s side, and
  expresses boundless longing to see her beloved, if only for a moment.
  After such a happiness, she could have but one wish,—to exchange her
  cell for the grave. The bitterest thing was the knowledge that now
  Marie, too, hated her. Hot tears, enough to drown herself in, she had
  shed over her lost happiness. Whole quires of paper are given up to
  the apotheosis of this love, and reminiscences of the time of the
  first love and acquaintance.

  S. complained of her heart, that would allow no reason to direct it;
  she expressed emotions which were such as only could be felt,—not
  simulated. Then, again, there were outbreaks of most silly passion,
  with the declaration that she could not live without Marie. “Thy dear,
  sweet voice; the voice whose tone perchance would raise me from the
  dead; that has been for me like the warm breath of Paradise! Thy
  presence alone were enough to alleviate my mental and moral anguish.
  It was a magnetic stream; it was a peculiar power your being exercised
  over mine, which I cannot quite define; and, therefore, I cling to
  that ever-true definition: I love you because I love you. In the night
  of sorrow I had but one star,—the star of Marie’s love. That star has
  lost its light; now there remains but its shimmer,—the sweet, sad
  memory which even lights with its soft ray the deepening night of
  death,—a ray of hope.”

  This writing ends with the apostrophe: “Gentlemen, you learned in the
  law, psychologists and pathologists, do me justice! Love led me to
  take the step I took; all my deeds were conditioned by it. God put it
  in my heart.

  “If He created me so, and not otherwise, am I then guilty; or is it
  the eternal, incomprehensible way of fate? I relied on God, that one
  day my emancipation would come; for my thought was only love itself,
  which is the foundation, the guiding principle, of His teaching and
  His kingdom.

  “O God, Thou All-pitying, Almighty One! Thou seest my distress; Thou
  knowest how I suffer. Incline Thyself to me; extend Thy helping hand
  to me, deserted by all the world. Only God is just. How beautifully
  does Victor Hugo describe this in his ‘Legendes du Siècle’! How sad do
  Mendelssohn’s words sound to me: ‘Nightly in dreams I see thee’!”

  Though S. knew that none of her writings reached her lover, she did
  not grow tired writing of her pain and delight in love, in page after
  page of deification of Marie. And to induce one more pure flood of
  tears, on one still, clear summer evening, when the lake was aglow
  with the setting sun like molten gold, and the bells of St. Anna and
  Maria-Wörth, blending in harmonious melancholy, gave tidings of rest
  and peace, she wrote: “For that poor soul, for this poor heart that
  beat for thee till the last breath.”

  _Personal Examination:_ The first meeting which the experts had with
  S. was, in a measure, a time of embarrassment to both sides; for them,
  because perhaps S.’s somewhat dazzling and forced masculine carriage
  impressed them; for her, because she thought she was to be marked with
  the stigma of moral insanity. She had a pleasant and intelligent face,
  which, in spite of a certain delicacy of features and diminutiveness
  of all its parts, gave a decidedly masculine impression, had it not
  been for the absence of a moustache. It was even difficult for the
  experts to realize that they were concerned with a woman, despite the
  fact of female attire and constant association; while, on the other
  hand, intercourse with the man Sandor was much more free, natural, and
  apparently correct. The culprit also felt this. She immediately became
  more open, more communicative, more free, as soon as she was treated
  like a man.

  In spite of her inclination for the female sex, which had been present
  from her earliest years, she asserts that in her thirteenth year she
  first felt a trace of sexual feeling, which expressed itself in
  kisses, embraces, and caresses, with sensual pleasure, and this on the
  occasion of her elopement with the red-haired English girl from the
  Dresden Institute. At that time feminine forms exclusively appeared to
  her in dream-pictures, and ever since, in sensual dreams, she has felt
  herself in the situation of a man, and occasionally, also, at such
  times, experienced ejaculation.

  She knows nothing of solitary or mutual onanism. Such a thing seemed
  very disgusting to her, and not conducive to manliness. She had, also,
  never allowed herself to be touched ad genitalia by others, because it
  would have revealed her great secret. The menses began at seventeen,
  but were always scanty, and without pain. It was plain to be seen that
  S. had a horror of speaking of menstruation; that it was a thing
  repugnant to her masculine consciousness and feeling. She recognized
  the abnormality of her sexual inclinations, but had no desire to have
  them changed, since in this perverse feeling she felt both well and
  happy. The idea of sexual intercourse with men disgusted her, and she
  also thought it would be impossible.

  Her modesty was so great that she would prefer to sleep among men
  rather than among women. Thus, when it was necessary for her to answer
  the calls of nature or to change her linen, it was necessary for her
  to ask her companion in the cell to turn her face to the window, that
  she might not see her.

  When occasionally S. came in contact with this companion,—a woman from
  the lower walks of life,—she experienced a sexual excitement that made
  her blush. Indeed, without being asked, S. related that she was
  overcome with actual fear when, in her cell, she was compelled to
  force herself into the unusual female attire. Her only comfort was,
  that she was at least allowed to keep a shirt. Remarkable, and what
  also speaks for the significance of olfactory sensations in her vita
  sexualis, is her statement that, on the occasions of Marie’s absence,
  she had sought those places on which Marie’s head was accustomed to
  repose, and smelled of them, in order to experience the delight of
  inhaling the odor of her hair. Among women, those who are beautiful,
  or voluptuous, or quite young do not particularly interest her. The
  physical charms of women she makes subordinate. As by magnetic
  attraction, she feels herself drawn to those between twenty-four and
  thirty. She found her sexual satisfaction exclusively in corpora
  feminæ (never in her own person), in the form of manustupration of the
  beloved woman, or cunnilingus. Occasionally she availed herself of a
  stocking stuffed with oakum as a _priapus_. These admissions were made
  only unwillingly by S., and with apparent shame; just as in her
  writings, immodesty or cynicism are never found.

  She is religious, has a lively interest in all that is noble and
  beautiful,—men excepted,—and is very sensitive to the opinion others
  may entertain of her morality.

  She deeply regrets that in her passion she made Marie unhappy, and
  regards her sexual feelings as perverse, and such a love of one woman
  for another, among normal individuals, as morally reprehensible. She
  has great literary talent and an extraordinary memory. Her only
  weakness is her great frivolity and her incapability to manage money
  and property reasonably. But she is conscious of this weakness, and
  does not care to talk about it.

  She is 153 centimetres tall, of delicate skeleton, thin, but
  remarkably muscular on the breast and thighs. Her gait in female
  attire is awkward. Her movements are powerful, not unpleasing, though
  they are somewhat masculine, and lacking in grace. She greets one with
  a firm pressure of the hand. Her whole carriage is decided, firm, and
  somewhat self-conscious. Her glance is intelligent; mien somewhat
  diffident. Feet and hands remarkably small, having remained in an
  infantile stage of development. Extensor surfaces of the extremities
  remarkably well covered with hair, while there is not the slightest
  trace of beard, in spite of all shaving experiments. The hips do not
  correspond in any way with those of a female. Waist is wanting. The
  pelvis is so slim, and so little prominent, that a line drawn from the
  axilla to the corresponding knee is straight,—not curved inward by a
  waist, or outward by the pelvis. The skull is slightly oxycephalic,
  and in all its measurements falls below the average of the female
  skull by at least one centimetre.

  The circumference of the head is 52 centimetres; the occipital
  half-circumference, 24 centimetres; the line from ear to ear, over the
  vertex, 23 centimetres; the anterior half-circumference, 28.5
  centimetres; the line from glabella to occiput, 30 centimetres; the
  ear-chin line, 26.5 centimetres; long diameter, 17 centimetres;
  greatest lateral diameter, 13 centimetres; diameter at auditory meati,
  12 centimetres; zygomatic diameter, 11.2 centimetres. The upper jaw
  projects strikingly, its alveolar process projecting beyond the under
  jaw about 0.5 centimetre. The position of the teeth is not fully
  normal; the right upper canine has not developed. Mouth remarkably
  small. Ears prominent; lobes not differentiated, passing over into the
  skin of the cheek. Hard palate narrow and high; voice rough and deep;
  mammæ fairly developed, soft, and without secretion. Mons veneris
  covered with thick, dark hair. Genitals completely feminine, without
  trace of hermaphroditic appearance, but at the stage of development of
  those of a ten-year-old girl. The labia majora touch each other almost
  completely; labia minora have a cock’s-comb-like form, and project
  under the labia majora. The clitoris is small, and very sensitive.
  Frenulum delicate; perineum very narrow; introitus vaginæ narrow;
  mucous membrane normal. Hymen wanting (probably congenitally);
  likewise, the carunculæ myrtiformes. Vagina so narrow that the
  insertion of a membrum virile would be impossible, and it is also very
  sensitive; certainly coitus had not taken place. Uterus is felt,
  through the rectum, to be about the size of a walnut, immovable, and
  retroflected.

  The pelvis appears generally narrowed (dwarf-pelvis), and of decidedly
  masculine type. The distance between anterior superior spines is 22.5
  centimetres (instead of 26.3 centimetres). Distance between the crests
  of the ilii, 26.5 centimetres (instead of 29.3 centimetres); between
  the trochanters, 27.7 centimetres (31); the external conjugate
  diameter, 17.2 centimetres (19 to 20); therefore, presumably, the
  internal conjugate would be 7.7 centimetres (10.8). On account of
  narrowness of the pelvis, the direction of the thighs is not
  convergent, as in a woman, but straight.

  The opinion given showed that in S. there was a congenitally abnormal
  inversion of the sexual instinct, which, indeed, expressed itself,
  anthropologically, in anomalies of development of the body, depending
  upon great hereditary taint; further, that the criminal acts of S. had
  their foundation in her abnormal and irresistible sexuality.

  S.’s characteristic expressions—“God put love in my heart. If He
  created me so, and not otherwise, am I, then, guilty; or is it the
  eternal, incomprehensible way of fate?”—are really justified.

  The court granted pardon. The “countess in male attire,” as she was
  called in the newspapers, returned to her home, and again gave herself
  out as Count Sandor. Her only distress is her lost happiness with her
  beloved Marie.

  A married woman, in Brandon, Wisconsin, whose case is reported by Dr.
  Kiernan (_The Medical Standard_, 1888, November and December), was
  more fortunate. She eloped, in 1883, with a young girl, married her,
  and lived with her as husband undisturbed.

  An interesting “historical” example of androgyny is a case reported by
  Spitzka (_Chicago Medical Review_, August 20, 1881). It was that of
  Lord Cornbury, Governor of New York, who lived in the reign of Queen
  Anne. He was apparently affected with moral insanity; was terribly
  licentious, and, in spite of his high position, could not keep himself
  from going about in the streets in female attire, coquetting with all
  the allurements of a prostitute.

  In a picture of him that has been preserved, his narrow brow,
  asymmetrical face, feminine features, and sensual mouth at once
  attract attention. It is certain that he never actually regarded
  himself as a woman.

                  *       *       *       *       *

Moreover, in individuals afflicted with contrary sexual instinct, in
themselves, the perverse sexual feeling and inclination may be
complicated with other perverse manifestations. Thus here, with
reference to the activity of the instinct, there may be acts quite
analogous to acts indulged in by individuals in perverse satisfaction of
the instinct, but who, at the same time, have a natural inclination
toward persons of the opposite sex.

Owing to the circumstance that abnormally increased sexuality is almost
a regular accompaniment of contrary sexual feeling, acts of lustful
cruelty in the satisfaction of libido are easily possible. A remarkable
example of this is the case of Zastrow (Casper-Liman, 7. Auflage, Bd. i,
p. 190; ii, p. 487), who bit one of his victims (a boy), tore his
prepuce, slit the anus, and strangled the child.

  Z. came of a psychopathic grandfather and melancholic mother. His
  brother indulged in abnormal sexual pleasures, and committed suicide.

  Z. was a congenital urning, and in habitus and occupation masculine.
  There was phimosis. Mentally, he was a weak, perverse, unsocial man.
  He had horror feminæ, and, in his dreams, he felt himself like a woman
  toward a man. He was painfully conscious of his want of normal sexual
  feeling and his perverse instinct, and sought satisfaction in mutual
  onanism, with frequent desire for pederasty.

Similar sadistic feelings of this kind, in those afflicted with contrary
sexual instinct, are found in some of the foregoing histories (comp.
Cases 107 and 108 of this edition, and Case 96 of the sixth edition).
But masochism also occurs (comp. Case 43, sixth edition; Cases 111 and
114 of this edition; and Case 3, in the first edition of “Neue
Forschungen”).

  As examples of perverse sexual satisfaction dependent on contrary
  sexual instinct, may be mentioned the Greek, who, as Athenäus reports,
  was in love with a statue of Cupid, and defiled it, in the temple of
  Delphi; and besides the monstrous cases reported by Tardieu
  (“Attentats,” p. 272), the terrible one reported by Lombroso (“L’uomo
  delinquente,” p. 200), of a certain Artusio, who wounded a boy in the
  abdomen, and abused him sexually _by means of the incisions_.

  Cases 86, 110, and 111, also, show that fetichism may also occur with
  contrary sexual instinct.


     DIAGNOSIS, PROGNOSIS, AND THERAPY OF CONTRARY SEXUAL INSTINCT.

While up to this time contrary sexual instinct has had but an
anthropological, clinical, and forensic interest for science, now, as a
result of the latest investigations, there is some thought of therapy in
this incurable condition, which so heavily burdens its victims,
socially, morally, and mentally.

A preparatory step for the application of therapeutic measures is the
exact differentiation of the acquired from the congenital cases; and
among the latter, again, the assignment of the concrete case to its
proper position in the categories that have been established
empirically.

The diagnostic differentiation of the acquired from the congenital
condition is made without difficulty in the early stages of the anomaly.

If sexual inversion has already taken place, then the history of the
development of the case will throw light upon it.

The important decision, prognostically, as to whether the contrary
sexual instinct is congenital or acquired, can only be made in such
cases by means of the most minute details of the history.

The establishment of the fact that contrary sexual instinct existed
before indulgence in masturbation is of great importance with reference
to deciding whether the anomaly is congenital or not. In this, however,
a difficulty arises, owing to the possibility of imperfect localization
of past events (illusions of memory).

For the presumption of acquired contrary sexual instinct, it is
important to prove the existence of hetero-sexual instinct before the
beginning of solitary or mutual onanism.

In general, the acquired cases are characterized in that:—

1. The homo-sexual instinct appears secondarily, and always may be
referred to influences (masturbatic neurasthenia, mental) which
disturbed normal sexual satisfaction. It is, however, probable that
here, in spite of powerful sensual libido, the feeling and inclination
for the opposite sex are weak _ab origine_, especially in a spiritual
and æsthetic sense.

2. The homo-sexual instinct, as long as inversio sexualis has not taken
place, is looked upon, by the individual affected, as vicious and
abnormal, and yielded to only _faute de mieux_.

3. The hetero-sexual instinct long remains predominant, and the
impossibility of its satisfaction gives pain. It weakens in proportion
as the homo-sexual feeling gains in strength.

On the other hand, in congenital cases (_a_) the homo-sexual instinct is
the one that occurs primarily, and becomes dominant in the vita
sexualis. It appears as the natural manner of satisfaction, and also
dominates the dream-life of the individual. (_b_) The hetero-sexual
instinct fails completely, or, if it should make its appearance during
the life of the individual (psycho-sexual hermaphroditism), it is still
but an episodical phenomenon which has no root in the mental
constitution of the individual, and is essentially but a means of
satisfaction of sexual desire.

The differentiation of the above groups of congenital contrary sexuality
from one another, and from the cases in which the anomaly is acquired,
will, after the foregoing, present no difficulties.

The prognosis of the cases of acquired contrary sexual instinct is, at
all events, much more favorable than that of the congenital cases. In
the former, the occurrence of effemination—the mental inversion of the
individual, in the sense of perverse sexual feeling—is the limit beyond
which there is no longer hope of benefit from therapy. In the congenital
cases, the various categories established in this book form as many
stages of psycho-sexual taint, and benefit is _probable_ only within the
category of the psychical hermaphrodites, though _possible_ (_vide_ the
case of Schrenk-Notzing) in that of the urnings.

The prophylaxis of these conditions becomes thus the more important,—for
the congenital cases, prohibition of the reproduction of such
unfortunates; for the acquired cases, protection from the injurious
influences which experience teaches may lead to the fatal inversion of
the sexual instinct.

Numerous predisposed individuals meet this sad fate, because parents and
teachers have no suspicion of the danger which masturbation brings in
its train to such children.

In many schools and academies masturbation and vice are actually
cultivated. At present much too little attention is given to the mental
and moral peculiarities of the pupils. If only the tasks are done,
nothing more is asked. That many pupils are thus ruined in body and soul
is never considered. In obedience to affected prudery, the vita sexualis
is veiled from the developing youth, and not the slightest attention
given to the excitations of his sexual instinct. How few family
physicians are ever called in, during the years of development of
children, to give advice to their patients that are often so greatly
predisposed!

It is thought that all must be left to Nature; in the meantime, Nature
rises in her power, and leads the helpless, unprotected innocent into
dangerous by-paths.

A more detailed treatment of this prophylactic side of the subject is
impossible here.[118]

To parents and teachers, the experiences detailed in this work, and
numerous scientific works on masturbation, give suggestions.

The lines of treatment, when contrary sexual instinct exists, are the
following:—

1. Prevention of onanism, and removal of other influences injurious to
the vita sexualis.

2. Cure of the neurosis (neurasthenia sexualis and universalis) arising
out of the unhygienic conditions of the vita sexualis.

3. Mental treatment, in the sense of combating homo-sexual, and
encouraging hetero-sexual, feelings and impulses.

The most important part of the treatment lies in fulfilling the third
indication, particularly with reference to onanism.

Only in very few cases, where acquired contrary sexual instinct has not
progressed far, can the fulfillment of 1 and 2 be sufficient, as the
following case, fully reported by the author in the _Irrenfreund_, 1884,
No. 1, proves:—

  Case 132. Count Z., aged 51, of psychopathic mother, was early sent to
  a military school, and there was taught onanism. He developed well,
  and had normal sexual feelings, but, as a result of masturbation, he
  became somewhat neurasthenic in his seventeenth year. He enjoyed
  intercourse with women, was married at twenty-five, but after a year
  more became neurasthenic, and absolutely lost his inclination for
  women. In its place came contrary sexual instinct. Involved in an
  accusation for high treason, he was sent to prison for two years, and
  then to Siberia for five years. In these seven years, under the
  influence of continued masturbation, neurasthenia and contrary sexual
  instinct constantly increased. With his freedom restored at the age of
  thirty-five, the patient began to visit all kinds of health-resorts on
  account of his great neurasthenia; and this has since been his
  occupation. In all these years his abnormal sexual feeling has not
  changed in any way. For the most part, he lived away from his wife,
  whom, it is true, he esteemed for her mental qualities; though he
  avoided her, as he did every other woman. His contrary sexual feeling
  is purely platonic. “Friendship,” sweet embraces, and kisses sufficed
  him. Pollutions, which occasionally occurred, were induced by
  lascivious dreams which had for subject persons of his own sex. Also,
  during the day, the most beautiful woman had no charm for him, while
  simply the sight of handsome men induced erection and ejaculation.
  Only athletes and male dancers in the circus and _ballet_ interested
  him. At times of greater excitability, even masculine statues gave him
  erections. Now and again he resumed his old vice of masturbation. This
  man of æsthetic culture had a horror of pederasty.

  He felt, always, that his perverse sexual feeling was something
  abnormal, without, however, in his apparently much weakened libido and
  virility, feeling unhappy.

  The examination gave the usual findings of neurasthenia. Development,
  manner, and attire presented nothing remarkable. Electrical massage
  was unusually successful. After a few sittings the patient was
  mentally and physically much better. After twenty sittings libido was
  again awakened, not in the same way, but normally, as the patient had
  felt until his twenty-fifth year. Lascivious dreams were concerned
  only with women; and one day the patient joyfully gave the information
  that he had had coitus, and that he had had the same natural feeling
  in it that he had had twenty-six years before. He then began to live
  with his wife again, and hoped that he was lastingly freed from
  neurasthenia and contrary sexual instinct. His hope was fulfilled for
  the six years during which I was able to keep the patient under
  observation.

As a rule, physical treatment, even though it be re-inforced morally by
good advice with reference to the avoidance of masturbation, the
repression of homo-sexual feelings and impulses, and the encouragement
of hetero-sexual desires, will not prove sufficient, even in cases of
acquired contrary sexual instinct.

Here a method of mental treatment—hypnotic suggestion—is all that can
bring benefit.

The following case is interesting; and it is an example of successful
auto-suggestion that gives encouragement for the milder forms of the
anomaly:—

  Case 133. _Autobiography of a Psychical Hermaphrodite. Successful
  Struggle against Homo-sexual Inclinations made by the Patient
  himself._—“My father once had a stroke, but has recovered save for
  paralysis of the face. My mother was very anæmic and melancholic. Both
  suffered severely with hæmorrhoids, and my father ascribed to this
  trouble the lumbar pain with which he suffered from time to time after
  his marriage.

  “I am, if I may so express myself, a passive character. When a child,
  I indulged in all kinds of fancies, religious as well as others. I
  suffered with incontinence of urine, and it is said that in sleep I
  handled my genitals, so that my father fastened my hands to the bed!
  (I was then a mere child, and had not masturbated.) I was always very
  shy and embarrassed in social intercourse. When about fourteen or
  fifteen years old, I was seduced into onanism. The impulse and desire
  for women, occurring in connection with the awakening sexual feeling,
  were, in reality, only of a platonic nature; I was also without the
  society of ladies. When about eighteen, I attempted to satisfy my
  sexual desire in the natural way, more in obedience to a feeling of
  curiosity than from inner longing. Since that time, without having
  experienced any real inclination for women, as often as possible I
  have satisfied my desire by means of sexual intercourse.

  “Soon after puberty I became very anæmic, and appeared much older than
  I really was. Then came melancholic and peculiar ideas. It was a
  delight to me to fancy myself humiliated in the extreme. It may be of
  interest to add that, at that time, I was troubled with religious
  doubts, and only later found the courage to rise above religions. I
  fell in love with young men. At first I opposed these ideas; later
  they became so powerful that I became a genuine urning. Women seemed
  to me to be human beings of the second class. I was in a state of
  despair. My sickened soul was filled with tædium vitæ and thoughts
  inimical to humanity. One day I read: ‘What will it come to?’ And ere
  I knew it, I was a socialist; but an ideal one. Life again had value
  for me, for I had an ideal,—the joyous struggle for the social
  elevation of the proletariat. This caused a powerful revolution in me.
  As in my best years (from the age of sixteen to seventeen), I took
  interest in art, particularly in dramatic art. I am, at the present
  time, writing a play and a story, and I am occupied with the grandest
  thoughts. I read a remark of Schlegel’s concerning Sophocles, who was
  indebted to his physical exercise for his energy and creative power,
  and to music for his artistic proportions. In another place I read:
  ‘The dramatist must, above all things, be mentally intact.’ This
  depressed me; for my contrary sexual feelings could not arise in a
  perfectly normal mind.

  “I thought of having myself treated hypnotically; but shame held me
  back. Then I said to myself that I was a weakling, indeed, to have so
  little confidence in myself, and began in earnest to combat my
  abnormal desires. At the same time, I struggled against my nervousness
  by leading the proper kind of a life. I rowed, fenced, and was much in
  the open air; and I was delighted when, at last, I awoke and seemed to
  be an entirely different man. When I thought of the time from my
  twentieth to my twenty-sixth year, it seemed to me that, during those
  years, a strange and depressive being had been dwelling within me.

  “I was astonished that the handsomest rider or the trimmest waiter
  excited in me almost no interest; even the muscular masons had no
  effect on me. I was disgusted when I thought that, at one time, such
  men had seemed handsome to me. My self-respect increased; I am
  good-natured, but my character is entirely active. Since my twentieth
  year my appearance has steadily improved. My appearance now
  corresponds perfectly with my years. There were recurrences of my
  abnormal inclinations, to be sure; but I struggled against them
  energetically. I satisfy my libido only by means of natural
  intercourse, and I hope that, by continuing to lead a proper life, my
  pleasure in natural coitus will increase.”

As a rule, only suggestion coming from a second person, and that by
means of hypnosis, promises any success. In such cases, the object of
post-hypnotic suggestion is to remove the impulse to masturbation and
homo-sexual feelings and impulses, and to encourage hetero-sexual
feelings with a sense of virility. A prerequisite is, of course, the
possibility to induce hypnosis of sufficient intensity. It is,
unfortunately, in these very cases of neurasthenia that this is
impossible, since they are often excited, embarrassed, and in no
condition to concentrate their thoughts.

Thus, in a case reported by me in the _International. Centralblatt für
die Physiologie und Pathologie der Harn- und Sexualorgane_, Bd. i, Heft
2, p. 58, it was impossible for me to induce hypnosis, though the
patient desired it, and did everything to make it successful. By reason
of the great benefit that can be given to such unfortunates, and with
Ladame’s case in view (_v. infra_), in the future, in all such cases,
everything should be done to bring about hypnosis,—the only means of
salvation. The result, in the three following cases, was satisfactory:—

  Case 134. _Contrary Sexual Instinct Acquired through
  Masturbation._—Mr. X., merchant, aged 29. Father’s parents healthy.
  Nothing nervous in father’s family. Father was an irritable, peevish
  old man. One brother of the father was a man-about-town, and died
  unmarried. Mother died in third confinement, when the patient was six
  years old; she had a deep, rough, masculine voice, and coarse
  appearance. Of the children, one brother is irritable, “melancholic,”
  and indifferent to women.

  When a child patient had scarlet fever with delirium. Until his
  fourteenth year he was light-hearted and social, but, after that,
  quiet, solitary, and “melancholic.” The first trace of sexual feeling
  appeared in his tenth or eleventh year, and at that time he learned
  masturbation from other boys, and practiced mutual onanism with them.
  At the age of thirteen or fourteen, ejaculation for the first time.
  Patient has felt no evil results of onanism until the last three
  months.

  In school he learned easily, but was troubled with headaches. After
  the age of twenty, pollutions, in spite of daily practice of onanism.
  With pollutions, “procreative” dreams, as man and wife might perform
  the act, occurred. In his seventeenth year he was seduced into mutual
  onanism by a man having a love for men. He found satisfaction in this,
  inasmuch as he was always very passionate sexually. It was a long time
  before the patient again sought new opportunities for intercourse with
  males. He did it simply to rid himself of semen. He felt no friendship
  or love for the person with whom he had intercourse. He felt
  satisfaction only when he played the passive _rôle_,—when
  manustupration was practiced on him. When the act was once completed,
  he had no respect for the individual. If it happened that, later, he
  came to respect the man, then he ceased to indulge in the act with
  him. Later it became indifferent to him whether he masturbated or had
  masturbation practiced on him. When he himself practiced onanism, he
  always thought of pleasing men practicing onanism on him during the
  act. He preferred a hard, rough hand.

  The patient thought that, had he not been led astray, he would have
  arrived at a natural mode of satisfaction of his sexual desires. He
  never felt love for his own sex, though he had pleased himself with
  the thought of loving men. At first he had had sensual inclinations
  toward the opposite sex. He had taken pleasure in dancing, and he had
  been pleased with women, but he had taken more pleasure in the figure
  than the face. Too, he had had erections at the sight of women that
  pleased him. He had never attempted coitus, for fear of infection;
  whether he was potent or not with women, he did not know. He thought
  he could be so no longer, because his feeling for women had grown
  cold, especially during late years.

  While previously, in his sensual dreams, he had had ideas of both men
  and women, of late years he had dreamed only of approaches to men; he
  could not remember that he had dreamed, in late years, of sensual
  relations with a woman. At the theatre, as well as in the circus and
  _ballet_, the feminine figure had always interested him. In museums
  masculine and feminine statues had affected him equally.

  Patient is a great smoker, a beer-drinker, loves male society, and is
  a gymnast and skater. Anything dandified was repugnant to him, and he
  had never felt any desire to please men; he would even have preferred
  to please women.

  He now felt his position to be painful, because onanism had obtained
  the upper hand. Masturbation, that had previously been practiced
  without evil effects, now began to disclose its bad results.

  Since July, 1889, he had suffered with neuralgia of the testicles. The
  pain occurred particularly at night; and at night there was also
  trembling (increased reflex excitability).

  Sleep was not refreshing, and he would wake up with pain in the
  testicles. He was inclined, now, to indulge more frequently in
  onanism. He was afraid of the consequences of the habit. He hoped that
  his sexual life might still be turned into normal channels. Now, he
  thought of the future; he had a relation with a girl, who was
  attractive to him, and the thought to possess her as a wife was
  pleasing.

  For five days he had abstained from onanism, but he could scarcely
  believe that he would be able, with his own strength, to overcome the
  habit. Of late he had been very much depressed, having lost all desire
  for work, and become tired of life.

  Patient is tall, powerful, well nourished, and has a thick growth of
  beard. Skull and skeleton normal. Knee-jerks very prompt; deep
  reflexes in upper extremities much increased. Pupils dilated, equal,
  and act promptly. Carotids of equal calibre; hyperæsthesia urethræ;
  cords and testicles not sensitive; genitals normal.

  The patient was calmed, and given hope for the future, provided that
  he give up onanism and attempt to transfer his sexual desires from
  persons of his own sex to females.

  Hip-baths (24° to 20° R.); ext. secal. conut. aquos., 0.5; antipyrin,
  1.0 (_pro die_); pot. brom., 4.0 (evenings), were ordered.

  December 13th. To-day the patient came, in a disturbed condition of
  mind, complaining that, unaided, he was unable to resist the impulse
  to masturbate, and he asked for help.

  A trial of hypnosis induced a condition of deep lethargy in the
  patient.

  He was given the following suggestions:—

  1. I can not, must not, and will not masturbate again.

  2. I abhor the love for my own sex, and shall never again think men
  handsome.

  3. I shall and will become well again, fall in love with a virtuous
  woman, be happy, and make her happy.

  December 14th. While out walking to-day, patient saw a handsome man,
  and felt himself powerfully drawn toward him.

  From this time there were hypnotic sittings every second day, with the
  above suggestions.

  December 18th (fourth sitting), somnambulism occurred; the impulse to
  onanism and interest in men disappear.

  At the eighth sitting “complete virility” was added to the above
  suggestions. The patient feels himself morally elevated and physically
  strengthened. The neuralgia of the testicles has disappeared. He now
  found that he was without sexual feeling.

  He now believed himself free from masturbation and contrary. sexual
  inclination.

  After the eleventh sitting he thought that further help was
  unnecessary. He wished to go home, and marry. He felt well and potent.
  Early in January, 1890, treatment ceased.

  In March, 1890, the patient wrote: “I have since had several occasions
  on which it has been necessary for me to use all my moral strength in
  order to overcome my habit, and, thank God, I have been successful in
  freeing myself from this vice. Several times I have had opportunity
  for sexual intercourse, and I have found pleasure in it. I look calmly
  on my happy future.”

  Case 135. _Acquired Contrary Sexual Instinct. Marked Improvement under
  Hypnotic Treatment._—Mr. P., born in 1863, official in a manufactory.
  He comes of a highly respected patrician family of Middle Germany, in
  which nervousness and insanity have been of frequent occurrence.

  His great-grandfather on the father’s side and his sister died insane;
  the grandmother died of apoplexy; father’s brother died insane, and a
  daughter of the latter died of cerebral tuberculosis. The maternal
  grandmother was melancholic for years; maternal grandfather, insane. A
  maternal uncle took his life in an attack of insanity. The patient’s
  father is very nervous. An elder brother is very neurasthenic, and has
  anomalies of the vita sexualis; another is the subject of Case 155; a
  third is eccentric in conduct, and is said to be subject to fixed
  ideas. A sister suffers with convulsions, and another died of them
  when a little child.

  The patient is constitutionally predisposed; for he was early very
  peculiar, irritable, irascible, and impressed those around him as
  being abnormal.

  His vita sexualis appeared very early and in great intensity, and was
  satisfied, without any seductions, in onanism. From his sixteenth year
  the prematurely developed boy visited brothels of the Capital, using
  his permissions to go out on Sundays and holidays for that purpose. He
  took pleasure in coitus, but during the week he satisfied himself with
  onanism. After his twentieth year, when he became independent, the
  patient indulged with prostitutes excessively, and fell ill with
  neurasthenia sexualis, becoming relatively impotent and unsatisfied in
  coitus, owing to weakness of erection and premature ejaculation. His
  sexual libido became more powerful than ever, and was satisfied in
  onanism. Early in 1888 the patient made the acquaintance of a young
  man. “By his pleasing face, his attractive manner, and his beautiful
  form, he conquered me entirely. I wished to speak to him, and was
  happy at mere sight of him. I was completely in love with him. With
  this, my love for women was extinguished. Any man could excite me to
  such an extent that, for some moments, I would feel my memory fail,
  and I would stammer.

  “Soon after this I made the acquaintance of a gentleman who was
  likewise very attractive, and who had a decided influence on my future
  life. He was male-loving. I confessed to him that I no longer felt
  anything but aversion for the female sex, and that I was attracted to
  men.

  “When I once asked my companion how he brought it about that soldiers
  would surrender themselves to him, he answered that the principal
  thing was skill; almost any of them could be brought to it. Late in
  1888, thinking of these words, I was attracted by an officer’s
  servant, and was intensely excited by him, but ejaculation never
  occurred. Since I saw that the soldier would surrender himself without
  trouble, I approached him. Alium quondam militem in cubiculum allectum
  rogavi ut veste exuta mecum in lectum concumberet. Rogatus fecit quæ
  volui et alter alterius penem trivit.

  “Though after this success I misused many persons, I was never really
  in love, so to speak, with but one. He was a very handsome young
  fellow of seventeen. His voice was so attractive to me, and his manner
  was so delicately proper, that I cannot forget him. In my dreams I
  thought only of handsome young men, and often for whole nights I could
  not sleep, owing to sensual feeling.”

  Early in 1889 the patient’s conduct awakened a suspicion of male-love.
  A threatening communication frightened him, and plunged him in deep
  depression, so that he contemplated suicide. At the advice of the
  family physician, he came to the Capital. Since the patient was unable
  to overcome his habitual desires by his own will, hypnotic treatment
  was undertaken. It induced but mild lethargy, and, in opposition to
  the seduction of former lovers, it had but little effect.

  At that time the patient was wanting in earnest desire. There was some
  improvement in matters, in the face of the disgrace to relatives and
  the prospect of a legal examination that was actually threatening. The
  patient determined to attempt a cure with the author.

  I found him to be a delicate, pale, very neurasthenic man, much
  depressed, and despairing about the future. He was without
  degenerative signs. He realized his perverted situation, and seemed to
  be willing to do anything in order to become again a decent, moral
  man.

  He regretted exceedingly his sexual perversion, which he regarded as
  abnormal, but also as having been acquired. He made no attempt to
  conceal the fact that he could not control himself with young men, and
  likewise he would not say that he could abstain from onanism, to
  which, _faute de mieux_, he was driven. Only a powerful, imperious
  will could keep him from it.

  Thus far his male-love had consisted exclusively of mutual onanism.
  Erections occurred only when touching men he loved; ejaculation
  resulted early, but simple embrace was not sufficient. He had never
  felt himself in any particular sexual _rôle_ toward a man. Genitals
  and vegetative organs normal.

  In addition to treatment directed to his neurasthenia, on April 8,
  1890, hypnotic suggestion was begun. Hypnosis was easily induced by
  simply looking at him, with verbal suggestion. After a half-minute the
  patient passed into deep lethargy, with a cataleptiform state of the
  muscles. The awakening was brought about by suggesting it at counting
  three. Post-hypnotic suggestions were always successful. The
  intra-hypnotic suggestions were:—

  1. The interdiction of onanism.

  2. The command that male-love should be felt to be disgraceful and
  despicable, and that it should be impossible.

  3. The command to regard only women as beautiful; to approach them, to
  dream of them, and to have libido and erection at sight of them.

  The sittings occurred daily. On April 14th, the patient announced,
  with thankfulness and a kind of moral satisfaction, that he had had
  pleasure in coitus, and had ejaculated tardily. On April 16th, he felt
  free from inclination to masturbate, attracted to women, and perfectly
  indifferent to men. He dreamed of female charms and coitus with women.
  May 1st, the patient seemed and felt himself to be normal sexually. He
  has become a different man mentally, full of courage and
  self-confidence. He has coitus with complete satisfaction, and thinks
  that he is insured against relapse.

  In a later letter Mr. P. writes: “As was only to be expected, I find
  myself lastingly freed from my errors. All that remains to remind me
  of my unhappy time are the dreams, which, though they are infrequent,
  come from my past, which I have no power to banish, and which
  sometimes, indeed, pleasantly occupy my thoughts. But by my own will I
  yet hope soon to succeed in freeing myself absolutely from them.
  Should I ever become weak again, the ideas you have impressed on me
  would, I am sure, make an energetic resistance, and I should not
  succumb.”

  On October 20, 1890, P. wrote me: “I am completely cured of onanism,
  and I have no pleasure in male-love. Yet complete virility does not
  seem to have been re-established, notwithstanding the fact that I lead
  a virtuous life. Nevertheless, I feel satisfied.”

  Case 136. _Acquired Contrary Sexual Instinct._—Mr. Z., aged 32,
  divorced. He comes of a hysteropathic mother. Maternal grandmother
  suffered with hysteria, and her brothers and sisters were neurotic.
  One brother is an urning. Z. was but poorly endowed mentally, and did
  not learn easily. No sickness besides scarlatina. When thirteen, he
  was taught to masturbate by companions in a school. Sexually, he was
  hyperæsthetic, and, at seventeen, began to indulge in coitus, with
  full pleasure and power. For reasons of position and money, he married
  at twenty-six. The marriage was very unhappy. After a year Mrs. Z.
  became incapable of coitus, by reason of uterine disease. Z. satisfied
  his inordinate desires with other women, _faute de mieux_, by
  masturbation. Besides, he gave himself up to play, led an absolutely
  dissolute life, became exceedingly neurasthenic, and sought to
  strengthen his weakened nerves by drinking great quantities of wine
  and brandy. To his essential cerebral asthenia were added peripheral
  alcoholic cramps and globus, and he became very emotional. His libido
  nimia continued unabated. On account of his disgust of prostitutes and
  fear of infection, satisfaction by coitus was exceptional. For the
  most part, the patient helped himself with onanism.

  Four years ago he noticed weakening of erection and decrease of libido
  for women. He began to feel himself drawn toward men, and his
  lascivious dreams were no longer concerned with women, but with men.

  Three years ago, while being rubbed by a bath-attendant, he became
  powerfully excited sexually (the attendant also had an erection, to
  patient’s surprise). He could not keep from embracing and kissing the
  attendant, and allowing him to perform masturbation on him, the
  attendant doing it most willingly. From this time this mode of sexual
  indulgence was all that he cared for. Women became a matter of entire
  indifference to him; he devoted himself exclusively to men. With them
  he practiced mutual masturbation, and had a longing to sleep with
  them. He abhorred pederasty. He was entirely satisfied until (August,
  1890) an anonymous letter, warning him to be careful, brought him to
  his senses. He was much frightened, had hysterical attacks, and became
  much depressed. He was embarrassed before men, seemed like a pariah in
  society, contemplated suicide, and finally confessed to a priest, who
  comforted him. He now fell into a religious state (equivalent), and,
  out of remorse and to cure himself of his abnormal sexual
  inclinations, wished to go into a cloister. While in this state, my
  “Psychopathia Sexualis” fell into his hands. He was frightened and
  filled with shame, but found a comfort in it, inasmuch as he concluded
  that he must have some malady. His first thought was to rehabilitate
  himself sexually in his own eyes. He overcame all disinclination, and
  visited a brothel. At first he was not successful, on account of great
  excitement, but he finally succeeded.

  Since, however, his contrary sexual inclinations were not overcome, in
  spite of all his efforts to put them down, he finally came to me,
  asking for assistance. He felt himself to be terribly unfortunate, and
  very near to despair and suicide. He saw destruction before him, and
  would be saved at any price.

  His confession was interrupted by numerous hysterical attacks.
  Comforting and encouraging words about his future had a calming
  influence.

  Physically, patient presented a slightly retreating brow, with no
  other anatomical signs of degeneration. Spinal irritation, exaggerated
  deep reflexes, and a sense of pressure in the head pointed to a
  neurasthenic condition. No genital anomalies, though there was
  hyperæsthesia urethræ. Mien distressed; attitude relaxed; mind
  distracted and vacillating.

  Hip baths, massage, ergot with antipyrin and pot. brom., ordered, with
  interdiction of onanism, intercourse with men, and lascivious thoughts
  of them.

  After a few days the patient came complaining that he was not equal to
  the task. He said his will was too weak. In this precarious situation,
  it seemed that nothing but hypnotic treatment could bring improvement.

  September 11, 1889. First sitting. Bernheim’s method used, in order to
  induce lethargy as quickly as possible.

  Suggestions:—

  1. I abhor onanism, and will not masturbate again.

  2. I regard the inclination for men disgusting,—horrible; and I shall
  never think men handsome and enticing.

  3. Women alone I find enticing. Once a week I shall cohabit, with full
  pleasure and power.

  The patient received these suggestions, and repeated them in a
  drawling tone.

  The sittings took place every second day. After the fifteenth, it was
  possible to induce the somnambulic stage of hypnosis with any
  post-hypnotic suggestions desired.

  The patient improved morally and mentally, but symptoms of cerebral
  neurasthenia troubled him still, and, now and then, dreams of men
  occurred; and there were, also, in the waking state, inclinations
  toward men, which depressed him exceedingly.

  Treatment until September 24th. Result: Free from onanism; no longer
  excitable to men, though impressionable to women. Normal coitus once
  in eight days. Hysterical symptoms absent; neurasthenic symptoms much
  ameliorated.

  On October 6th the patient reported by letter that he was feeling
  well, and expressed his gratitude for his salvation; he felt as if
  given a new life.

  December 9, 1889, patient again came for treatment. Of late he had had
  lascivious dreams of men twice, but had experienced no inclination
  toward men in the waking state. He had also resisted the impulse to
  masturbate, though, while living alone in the country, he had had no
  opportunity for coitus. He had inclinations only for the opposite sex,
  and, as a rule, dreamed only of females. Returned to the city, he had
  indulged in coitus with pleasure. The patient felt himself morally
  rehabilitated, being almost free from neurasthenic symptoms; and,
  after three more hypnotic sittings, he declared himself perfectly
  well, and confident that he would not relapse. Such a relapse
  occurred, however, in September, 1890, when, after over-exertion on an
  excursion into the mountains, and emotional strain with want of
  opportunity for coitus, he had again become neurasthenic.

  Again he had dreams of men, and felt drawn toward attractive male
  forms; he masturbated many times, and, after returning to the city,
  found no real pleasure in coitus. By means of anti-neurasthenic
  treatment and hypnosis, it was possible soon to restore the previous
  condition.

  In the course of the years 1890 and 1891 the patient now and then had
  contrary sexual feelings and dreams, but only when, as a result of
  emotional strain or excesses, his neurosis re-appeared. At such times
  satisfaction in coitus was wanting. He would then find it necessary to
  undergo a few hypnotic sittings, in order to restore his
  equilibrium—always with success.

  At the end of 1891 the patient pointed with satisfaction to the fact
  that, since treatment, he had been able to avoid masturbation and
  male-intercourse, and had regained his self-confidence and
  self-respect.

The foregoing details of the successful results of hypnotic suggestion,
in cases of acquired contrary sexual feeling, make it seem possible that
those unfortunates that are afflicted with the congenital perversion may
be helped in some degree by the same means.

To be sure, here the condition is entirely different, since a congenital
condition must be combated, an abnormal psycho-sexual life annihilated,
and a new one created. _A priori_ this task seems impossible; at least,
in the perfect urning. That the apparently impossible is artificially
possible may be seen from the case of Schrenk-Notzing, which follows
below. It far surpasses the case reported by me (_v. infra_), in which
at least the homo-sexual feelings and impulses were removed by means of
hypnotic suggestion.

The case of Ladame (_v. infra_) is an analogous one. The conditions are
more favorable in psycho-sexual hermaphrodites, where at least there are
rudiments of hetero-sexual feelings that may be strengthened and made
operative by suggestion.

  Case 137. “I was born in 1858, out of wedlock. It was only late that I
  was able to trace my obscure origin, and obtain knowledge of my
  parents; and this knowledge is, unfortunately, very obscure and
  imperfect. My father and mother were cousins. My father died three
  years ago. He had later married, and, as far as I know, had several
  healthy children.

  “I do not think that my father had contrary sexual feelings. Without
  knowing him as my father, I often saw him when I was a child. He was a
  powerful, masculine man. As for the rest, it is said that, at the time
  of my birth, or before, he was sexually ill.

  “I have often seen my mother on the street, but I did not then know
  that she was my mother. At the time of my birth she may have been
  about twenty-four years old. She was tall, and quick and energetic of
  movement, and her character was decided. At the time of my birth she
  is reported to have gone about much in male attire, to have worn short
  hair, to have smoked a long pipe, and in general to have been
  remarkable for her eccentric character. She was exceedingly well
  educated, and is said to have been beautiful in her youth. She left a
  fortune,—considerable even when measured by our present ideas,—but she
  died unmarried.

  “In any case, all this would point to homo-sexual inclinations, or, at
  least, to abnormalities. On the other hand, several years before my
  birth, my mother took care of a little girl. This step-sister, whom I
  never knew, married young, but early in her married life, for reasons
  unknown to me, she poisoned herself.

  “I am 1.7 metres tall, measure 92 centimetres around the waist, and
  102 centimetres around hips, and, therefore, I think my pelvis is
  somewhat over-developed. The subcutaneous fat has always been
  abundant. Skeletal form is strong. The muscular system is well formed,
  but, from lack of exercise, perhaps owing to the influence of early,
  long-continued, and frequent indulgence in onanism, it is not well
  developed; so that I appear stronger than I really am. Hair of head
  and face is normal; genital hair, somewhat thin. The upper portion of
  the body is as good as without hair. In all other ways my appearance
  is fully masculine. Gait, attitude, and voice are those of a fully
  developed man, and other urnings have often told me that they would
  never have suspected my passion. I served in the army, and always
  found pleasure in all knightly exercises,—riding, fencing, swimming,
  etc.

  “My early training was under a priest. I had but few real playmates.
  The family life of my foster-parents was faultless. In October, 1861,
  I entered the Institute. Here I indulged in my first perverse acts,
  which I shall describe more fully when I come to the development of my
  sexual life.

  “I finished the Gymnasium, served my voluntary years in the army, and
  then studied forestry, being now a director of estates. During my
  early years my mental development was very slow. I first learned to
  speak in my third year, and thus the supposition that I had
  hydrocephalus was strengthened. From the time of beginning school, my
  mental development was abnormal; indeed, I learned easily, but I have
  never been able to concentrate my activity on any particular subject.
  I have a great interest in art and æsthetics, but almost none in
  music. In early years my character was the worst possible. Without
  being able to give any reason for it, during the last twelve years
  there has been an entire transformation. Now, there is nothing I hate
  more than a lie, and I never speak untruth even in jest. In financial
  matters, without being avaricious, I have become an economical
  manager.

  “It is enough that, with a deep feeling of shame, I look back on my
  past; and, if I could be freed from my unhappy sexual perversion, or
  perversity, I should justly regard myself as a true gentleman. I am
  kind, and always ready to be charitable to the extent of my means; I
  am gay-spirited, and regarded with favor socially. I have no trace of
  that nervous irritability which is so often noticeable in others like
  me. Too, I am not wanting in personal courage. There is nothing in the
  early period of my development that points to abnormality. To be sure,
  as a child, I liked to lie in bed on my abdomen, and, of a morning, I
  often took delight in rolling about on my abdomen, much to the
  amusement of my foster-parents; but I cannot recall that, at such
  times, I ever had sensual feeling. I never sought much to play with
  girls, and I never played with dolls. I early heard talk about sexual
  matters; but I never thought anything about it. In my dreams, too, at
  that time, there was nothing sexual; and, in my association with boys
  of my own age, there was nothing of that kind. I think I may say that
  my vita sexualis was really first awakened after I had been seduced
  into mutual masturbation, in my thirteenth year, by a room-mate at the
  Institute. At that time ejaculation did not take place, but first
  about a year later. Nevertheless, I gave myself up to the vice of
  onanism passionately. At this time, however, the first signs of
  homo-sexual inclination were manifested. Youthful, powerful men,
  market-helpers, workmen, and soldiers took possession of my dreams,
  and played an important _rôle_ in my fancy while masturbating. At this
  time was also first shown the tendency to pederasty, especially
  passive. Up to my fourteenth year I frequently made mutual attempts at
  pederasty with my seducer, but neither of us were successful in
  bringing about immissio. At the same time, there was also a weak
  inclination for the female sex. About a year after the first
  indulgence in onanism, I was once with a puella publica, but I had
  neither ejaculation nor any especial feeling of sensual pleasure.
  Thereafter, and up to my nineteenth year, I performed coitus in public
  houses about six times. Erection and ejaculation occurred promptly,
  but without marked sensual pleasure. At least onanism, particularly
  mutual onanism, I liked quite as much. I have never had any love for
  athletes. About ten years ago, while at H., a watering-place, I
  thought I was in love with a beautiful lady of a highly respectable
  family; I was happy in her presence, and thought myself happy in
  finding my love returned. For a time this affair kept me from
  masturbating; I was only afraid that, weakened by onanism that had
  been practiced for years, I should be incapable of performing my
  marital duty. When we became widely separated, my feeling quickly
  cooled; I found that I had deceived myself; and, after about two
  years, without jealousy, I was able to hear that the lady had married.
  My inclination for women—if, in reality, I have ever had any—grew
  colder and colder. Two and a half years ago, when I visited a public
  house with very virile friends, I last performed coitus. There was
  erection, but no ejaculation. Women have become indifferent to me. A
  prostitute who acts coarsely excites my repugnance. With intellectual
  women, particularly when they are elderly, I like to converse, but in
  their society I am often unskillful and awkward, often devoid of tact.
  I have never been able to find any charm in woman’s physical form.

  “But, to return to the perverse inclinations. When, at the age of
  fourteen, I went to H., I lost sight of my lover and seducer. He was
  some years older than I, and was an official; and, in this capacity,
  when I was nineteen, I again met him once on the railway. We
  immediately cut the journey short, and lodged together, attempting
  mutual pederasty; but, on account of pain, immissio was not
  successful. We amused ourselves in mutual onanism. In H. I had sexual
  intercourse with two fellow-students, but this intercourse was
  confined to frequent mutual onanism, owing to the fact that they were
  not inclined to pederasty. During the last year of my stay (when I was
  nineteen), I had intercourse with another person, which likewise
  consisted of onanism; but our intercourse was more intimate, and we
  always retired, and practiced mutual onanism in bed. From Easter,
  1869, until July, 1870, I had no lover. I practiced onanism alone.
  When the war broke out, I offered myself as a volunteer, but was not
  accepted. At the same time a former school-mate offered himself. He
  had developed into a remarkably handsome man. I had to spend one night
  with him in an over-crowded hotel. Though as students we had never
  associated sexually, he was not averse to my desire, and attempted
  pederasty. In this instance pain prevented success; but, in the
  attempt, ejaculatio ante anum meum occurred. Even now I can recall the
  pleasurable feeling I had in it,—a feeling previously unknown. After
  the war I frequently met this friend, but our intercourse was later
  limited to onanism. During the following eighteen years I had but two
  opportunities for homo-sexual intercourse. The first was in the winter
  of 1879, on the occasion of meeting a handsome hussar in a railway
  carriage. I induced him to sleep with me at an hotel. Later he
  confessed to me that he had previously practiced mutual masturbation
  with the son of a landed proprietor of his town. I could not bring him
  to pederasty. On the other hand, I induced ejaculation in him by
  receptio penis ejus in os meum. This caused me no satisfaction, but
  rather disgust. I have never tried it again; and, too, I have never
  allowed receptio penis mei in os alterius. In 1887, likewise on the
  railway, I made the acquaintance of a sailor, and induced him to stay
  with me at an hotel. He said he had never practiced pederasty, but he
  was ready for it. He was apparently sensually excited; he had an
  erection immediately, and performed the act with evident passion. It
  was the first time that pederasty was successfully performed. I had
  terrible pain, but also indescribable pleasure.

  “With my sojourn here, my vita sexualis has undergone a complete
  change. I have learned how easy it is to find persons who, partly for
  money and partly from desire, yield to our inclinations. I have also
  not been spared annoying experiences with cheats. Until the end of the
  last year (since then, owing to fear of venereal infection, I have not
  gone beyond mutual masturbation), I enjoyed male-love to the full
  extent, particularly in passive pederasty. I have never practiced
  active pederasty, because I have found no one able to endure the pain.

  “Generally, I seek my lovers among cavalrymen and sailors, and,
  eventually, among workmen, especially butchers and smiths. Robust
  forms, with healthy facial complexions, attract me especially.
  Leathern riding-trousers have a particular charm for me. I have no
  partiality for kissing and the like. I also love large, hard, and
  calloused hands.

  “I do not wish to leave unmentioned that, under certain circumstances,
  I have great control of myself.

  “As director of an estate, I lived in a large house. My personal
  servant was a very handsome young man who had served in the hussars.
  After once having spoken with him, in general terms, on the subject,
  and found that he could not be approached, for years I lived in close
  intimacy with him, and enjoyed his beauty, but never touched him. I
  think that, to this day, he knows nothing of my passion. Likewise, two
  and a half years ago, in C., I made the acquaintance of a sailor, who
  is still regarded by me and my acquaintances as one of the handsomest
  men we know. After an absence of more than two years, on invitation,
  he visited me a few weeks ago. I knew how to arrange matters so that
  we slept in the same room, and I burned with desire to be nearer to
  him. As a preliminary, however, I sounded him in confidential talk;
  and, when I found that he despised everything connected with
  male-love, I had not the heart to approach him more closely. For weeks
  we slept in the same room, and I took constant delight in his divine
  form (at first, was sexually excited, in fact); I bathed with him, in
  the Roman manner, in order to see his beautiful form naked,—but he
  never learned anything of my passion. I still have an ideal, platonic
  relation with this young man, who, for one of his position, has an
  unusual education and fine talent for poetry.

  “Until my thirty-eighth year I had not a clear understanding of my
  condition. I always thought that, by early and frequent masturbation,
  I had become averse to women, and hoped always that, when the right
  woman came, I should be able to abandon onanism and find pleasure in
  her. Here it was that I first came to fully understand my condition,
  after making the acquaintance of others suffering and feeling like
  myself. At first I was frightened; later I came to look upon my fate
  as something not dependent on myself. Too, I made no further effort to
  resist temptation.

  “Two or three weeks ago ‘Psychopathia Sexualis’ fell into my hands.
  The work has made an unexpectedly deep impression on me. At first I
  read the work with an interest that was undoubtedly lascivious. The
  description of the cultivation of _mujerados_, for example, excited me
  uncommonly. The thought of a young, powerful man being emasculated in
  this manner, in order, later, to be used for pederasty by a whole
  tribe of wild, powerful, and sensual Indians, so excited me that I
  masturbated five times during the next two days, fancying myself such
  a presumptive _mujerado_. The farther I read in the book, however, the
  more I saw its moral earnestness; the more I felt disgust with my
  condition; and the more I saw that I must do everything, if it were
  possible, to bring about a change in my condition. When I had finished
  the book, I was determined to seek assistance from its author.

  “The reading of this work had an undoubted effect. Since then I have
  masturbated only twice, and have practiced onanism with cavalrymen
  only twice. In every instance I have had really less pleasure and
  satisfaction than before, and I always have the feeling: ‘Ah, if I
  could only be free from it!’ Nevertheless, I confess that, even now,
  in the society of handsome soldiers, I immediately have erection.

  “In conclusion, I may add that, in spite of, or, perhaps, on account
  of, onanism, I have never had pollutions. The ejaculation of semen,
  which usually consists of only a few drops, and it has always been so,
  takes place only after prolonged friction. If, for any reason, I have
  not masturbated for a long time, the ejaculation takes place quickly,
  and is more abundant. About twelve years ago Hansen tried in vain to
  hypnotize me.”

  In the spring of 1891 the writer of the foregoing autobiography
  visited me, with the declaration that he could live no longer in his
  condition; that he looked to hypnotic treatment as the only hope of
  salvation, for he had not strength enough to resist his impulse to
  masturbation and satisfaction with persons of his own sex. He felt
  like a pariah; like an unnatural man; like one outside the laws of
  nature and society, and in danger of criminal prosecution. He felt
  moral repugnance when he performed the act with a man, but yet the
  sight of any handsome soldier actually electrified him. For years he
  had not had the slightest sympathy with women, not even mentally.

  The patient looked to be exactly the person, physically and mentally,
  described by himself in his autobiography. His head was exquisitely
  hydrocephalic, and also plagiocephalic. At first attempts at hypnosis
  met with difficulties. Only by Braid’s method, with the help of a
  little chloroform, was deep lethargy attained at the third sitting.
  From that time simply looking at a shining object was sufficient. The
  suggestions consisted of the command to avoid masturbation, the
  removal of homo-sexual feelings, and the assurance that the patient
  would have inclination for women and be virile, and have pleasure only
  in hetero-sexual intercourse. Masturbation was indulged in but once;
  after the eighth sitting the patient dreamed of a woman.

  When, after the fourteenth sitting, the patient had to return, on
  account of pressing business, he declared that he was quite free from
  any inclination to masturbate or to indulge in male-love, but that he
  was by no means absolutely free from his partiality for men. He felt a
  returning interest in the female sex, and hoped to be freed finally
  from his unhappy condition by continuance of the treatment.

  Case 138. _Psychical Hermaphroditism._—Mr. von P., aged 25, single,
  comes of a neuropathic family. As a child he had convulsions. He
  recovered, but remained weak, emotional, and irritable. No severe
  illnesses. Before his tenth year sexuality was manifested. His
  earliest remembrance concerning it was that of lascivious feelings in
  company with the servants of the house. When older, he had sensual
  dreams which were of intercourse with men. In circuses the male
  performers alone interested him.

  Youthful, powerful men were most enticing to him. Often, he could
  scarcely resist the longing to fall on their necks and kiss them. Of
  late simply the touching of such persons had become sufficient to give
  him pleasure and induce ejaculation. The impulse to engage in
  “affairs” with men he had, thus far, fortunately resisted. The patient
  is a psychical hermaphrodite, in so far as he is not insensitive to
  the charms of women, and finds men more pleasing than women. In fact,
  feminine nudity had never pleased him, and he can remember only to
  have dreamed once of coitus with a woman.

  On account of his great sexual desire, and because he was ashamed to
  give himself up to men, after his twentieth year he began to have
  sexual intercourse with women. Since then, he has very seldom indulged
  in manual onanism, but often in mental masturbation, during which the
  forms of handsome men float through his fancy.

  He had coitus with success, but without pleasure or sensual feeling.
  On account of circumstances, he was forced to abstain from his
  twenty-second until his twenty-fourth year. This abstinence was
  painful, and he relieved himself, now and then, by mental onanism.

  When, a year ago, he had opportunity again for coitus, he noticed
  failure of libido for women, imperfect erection, and premature
  ejaculation. Finally he gave up coitus; then libido for men was
  manifested.

  In the condition of irritable weakness of the ejaculatory centre, mere
  touching of sympathetic men was sufficient to induce ejaculation.

  Patient is an only child. The circumstances of his family demand that
  he marry. He justly hesitates to do this, thinks he is mentally
  impotent, and asks for advice and help.

  He points out that his feeling for men must be eradicated in order to
  help him.

  Patient’s appearance is, in all respects, masculine. His head is
  slightly hydrocephalic and rhombic. Abundant growth of beard. Genitals
  normal; cremasteric reflex cannot be excited. No manifestations of
  neurasthenia. Neuropathic eyes. Pollutions infrequent. Erections occur
  only as a result of contact with men.

  July 16, 1889, hypnotic suggestion, after Bernheim’s method, was
  begun. It was first at the third sitting that deep lethargy was
  induced.

  Suggestions: “You have no longer any desire for men. Only woman is
  beautiful and desirable. You will love a woman, marry, be happy, and
  make her happy. You are fully potent; you feel that already.”

  In daily hypnosis, which never goes beyond lethargy, the patient
  accepts the suggestions. On July 24th, he announces that he has had
  pleasure in coitus; and the male servants no longer interest him. At
  the same time, he still finds men more beautiful than women. On August
  1, 1889, it was necessary to discontinue treatment. Result: Completely
  potent; entire indifference for men, but also for women.

The same treatment met with decided success in a case of psycho-sexual
hermaphroditism, reported by me in vol. i of the _Internat. Centralblatt
für die Physiol. u. Path. der Harn- und Sexualorgane_.

  Case 139. Mr. von X., aged 25, landed proprietor. He comes of a
  neuropathic, passionate father. Father is said to have been normal
  sexually. His mother was nervous, as were her two sisters. Maternal
  grandmother was nervous, and his maternal grandfather was a _roué_,
  much given to venery. Patient is like his mother, and an only child.
  From birth he was weak, suffered much with migraine, and was nervous.
  He passed through several illnesses. At fifteen he began masturbation,
  without having been taught it.

  Until his seventeenth year he says he never had feeling for men, or,
  in fact, any sexual inclination; but at this time desire for men
  arose. He fell in love with a comrade. His friend returned his love.
  They embraced and kissed and indulged in mutual onanism. Occasionally
  patient practiced coitus inter femora viri. He abhorred pederasty.
  Lascivious dreams were concerned only with men. In the circus and
  theatre males alone interested him. The inclination was for those of
  about twenty years. Handsome, tall forms were enticing to him. Given
  these conditions, he was quite indifferent to other characteristics of
  the men. In his sexual affairs with men his part was always that of a
  man.

  After his eighteenth year the patient was always a source of anxiety
  to his highly respected parents, for he then began a love-affair with
  a male waiter, who fleeced him and made him an object of remark and
  ridicule. He was taken home. He consorted with servants and hostlers.
  He caused a scandal. He was sent away for travel. In London he got
  into a “blackmailing scrape,” but succeeded in escaping to his home.

  He profited in no way by this bitter experience, and again showed
  disgraceful inclinations toward men. Patient was sent to me to be
  cured of his fatal peculiarity (December 12, 1888). Patient is a tall,
  stately, robust, well-nourished young man, of masculine build; large,
  well-formed genitals. Gait, voice, and attitude are masculine. He has
  no pronounced masculine passions. He smokes but little, and only
  cigarettes; drinks little, and is fond of confectionery. He loves
  music, arts, æsthetics, flowers, and moves in ladies’ society by
  preference. He wears a moustache, the face being otherwise cleanly
  shaved. His garments are in nowise remarkable. He is a soft, _blasé_
  fellow, and a do-nothing. He lies abed mornings, and can scarcely be
  made to rise before noon. He says he has never regarded his
  inclination toward his own sex as abnormal. He looks upon it as
  congenital; but, taught by his evil experiences, he wishes to be cured
  of his perversion. He has little faith in his own will. He has tried
  to help himself, but always begins to masturbate. This he finds
  injurious, inasmuch as it causes slight neurasthenic symptoms. There
  is no moral defect. The intelligence is a little below the average.
  Careful education and aristocratic manners are apparent. The exquisite
  neuropathic eye betrays the nervous constitution. The patient is not a
  complete and hopeless urning. _He has hetero-sexual feelings, but his
  sensual inclinations toward the opposite sex are manifested weakly and
  infrequently._ When nineteen, he was first taken to a brothel by
  friends. He experienced no horror feminæ, had efficient erections, and
  some pleasure in coitus, but not the instinctive delight he
  experienced while embracing men.

  Since then, patient asserts that he has had coitus six times, twice
  _sua sponte_. He gives the assurance that he is always capable of it,
  but he does it only _faute de mieux_, as he does masturbation, when
  the sexual impulse troubles him, as a substitute for intercourse with
  men. He has thought of the possibility of finding a sympathetic lady
  and marrying her. He would regard marital cohabitation and abstinence
  from intercourse with men as hard duties.

  Since there were rudiments of hetero-sexual feelings present, and the
  case could not be looked upon as hopeless, it seemed that treatment
  was indicated. The indications were clear enough, but there was no
  support for them in the will of the indolent patient, so unconscious
  of his own position. It lay near to seek support for the moral
  influence in hypnosis. The fulfillment of this hope seemed doubtful,
  because the famous Hansen had tried several times, in vain, to
  hypnotize him.

  At the same time, by reason of the most important social interests of
  the patient, it was necessary to make another attempt. To my great
  surprise, Bernheim’s procedure induced immediately a condition of deep
  lethargy, with possibility of post-hypnotic suggestion.

  At the second sitting somnambulism was induced by merely looking at
  him. The patient is obnoxious to suggestions of all kinds; indeed,
  contractures are induced by stroking him. He is awakened by counting
  three. Awakened, patient has amnesia for all the events of the
  hypnotic state. Hypnosis is induced every second or third day for the
  communication of hypnotic suggestions. At the same time, moral and
  hydro=therapeutic measures are employed.

  The hypnotic suggestions were as follow:—

  1. I abhor onanism, because it makes me sick and miserable.

  2. I no longer have inclination toward men; for love of men is against
  religion, nature, and law.

  3. I feel an inclination toward women; for woman is lovely and
  desirable, and created for man.

  During the sittings the patient always repeats these suggestions.
  After the fourth sitting it was noticeable that, when taken into
  society, he paid court to ladies. Shortly after that, when a famous
  prima-donna sang, he was all enthusiasm for her. Some days later the
  patient sought the address of a brothel.

  At the same time, he preferred the society of young gentlemen; but the
  most careful watching failed to reveal anything suspicious.

  February 17th. Patient asks to be allowed to indulge in coitus, and is
  very well satisfied with his experience with one of the _demi-monde_.

  March 16th. Up to this time, hypnosis twice a week. The patient always
  passes into deep somnambulism by simply being looked at, and, at
  request, repeats the suggestions. He is obnoxious to all kinds of
  post-hypnotic suggestion, and, in the waking state, knows not the
  least of the influences exerted on him in the hypnotic state. In the
  hypnotic condition he always gives the assurance that he is free from
  onanism and sexual feeling for men. Since he gives the same answers in
  hypnosis,—_e.g._, that on such and such a date he practiced onanism
  for the last time, and that he is too much under the will of the
  physician to be able to lie,—his assertions deserve belief; the more,
  since he looks well and is free from all neurasthenic symptoms, and,
  in the society of men, not the slightest suspicion rests on him. An
  open, free, and manly bearing is developed.

  Moreover, since, of his own will, he now and then indulges in coitus
  with pleasure, and occasional pollutions are induced by lascivious
  dreams which concern women, there can be no doubt of the favorable
  change of his vita sexualis; and it is presumable that the hypnotic
  suggestions have developed into auto-suggestive inclinations, which
  direct his feelings, thoughts, and will. Probably the patient will
  always remain a natura frigida; but he more often speaks of marriage,
  and of his intention to win a wife as soon as he has become acquainted
  with a sympathetic lady.

  In July, 1889, I received a letter from his father, which told me of
  his good health and conduct.

  On May 24, 1890, by chance, I met my former patient, while on a
  journey. His bright, healthful appearance allowed the most favorable
  opinion of his condition. He told me that he still had sympathetic
  feeling for some men, but never anything like love. He occasionally
  had pleasurable coitus with women, and now thought of marriage.

  I hypnotized him, in the former manner, to try him, and asked for the
  commands I had given him. In a deep condition of somnambulism, and in
  the same tone of voice as formerly, the patient repeated the
  suggestions he had received in December, 1888,—an excellent example of
  the possible duration and power of post-hypnotic suggestion.

  Case 140. _Psychical Hermaphroditism; Improvement with Hypnotic
  Treatment._—Mr. von K., aged 23; of distinguished family; well endowed
  mentally; scrofulous as a child. His father is said to have been
  dissipated. His father’s brother is said to have been subject to
  contrary sexuality.

  The patient states that, when only seven years old, he had a peculiar
  inclination for male persons. It was particularly coachmen and
  servants having moustaches for whom he showed partiality at that time.
  He experienced a peculiar delightful sensation when he pressed himself
  against such persons.

  The patient entered the cadet corps early, and there he was seduced
  into mutual onanism, and also learned imitatio coitus inter femora
  viri. At the age of seventeen he had coitus with a prostitute for the
  first time. He performed the act perfectly, but had not the slightest
  pleasure in it; and he learned that this kind of gratification
  amounted to nothing, or that he must be different from other young
  men.

  Nevertheless, he often had coitus, and contracted gonorrhœa. After
  this he experienced an increasing aversion for the female sex, and
  indulged in coitus less and less frequently; in fact, only when, with
  intense libido, he could not gain opportunity for intercourse with
  men. His inclination for men predominated more and more, and he was
  attracted exclusively by those handsomely formed, and having as little
  beard as possible. He descended to the most revolting
  practices,—coitus buccalis, active and passive pederasty.

  The patient was deeply ashamed of such depravity, and was constantly
  endeavoring to get into better ways by means of coitus with women. But
  he came to the despairing conclusion that his moral strength was
  insufficient, that he was indifferent about intercourse with women, or
  that it was repugnant to him; and that he was created for sexual
  intercourse with persons of his own sex. In fact, he had never dreamed
  of women, but always of men; and that at a time, too, when he had no
  suspicion of the difference between the sexes.

  The patient comes for consultation, because he sees that he is
  jeopardizing the happiness of his whole life, and recognizes the
  unnaturalness and immorality of his sexual life. He does not regard
  his condition as hopeless; for he has no horror of women, and three
  weeks ago he had successful coitus with one, though it was devoid of
  all pleasure and mental satisfaction. He has no doubt that he was
  really created to love men; but, owing to acquired neurasthenia, in
  the sexual act with a man he experiences no such pleasure as formerly.
  He had given up his position as an officer, because the soldiers
  excited him so sexually that he feared he might compromise himself.

  The patient is devoid of degenerative signs. His appearance is
  perfectly masculine, and his genitals are normal. Examination of the
  semen revealed abundance of spermatozoa. The penis is large and well
  developed; the growth of hair ad genitalia, as well as on the rest of
  the body, is abundant. The patient has masculine tastes, but has never
  been partial to drinking and smoking. A neuropathic eye is all that
  points to a nervous constitution.

  In his sexual acts with men, he states that, as a rule, he has felt as
  a man, only now and then as a woman.

  An attempt at hypnosis leads to lethargy, with cataleptic condition of
  the muscles, and the opportunity is used to impart suitable
  suggestions.

  After the fourth sitting he expressed himself as satisfied, and
  wondered that men made no impression on him. He wished to try his
  fortune with women, but was afraid that he was impotent.

  After the sixth sitting, without advice, he attempted coitus cum
  muliere. His libido was very great, but inter actum this and erection
  left him.

  After the ninth sitting the patient was forced to discontinue
  treatment, owing to business that called him home. He was satisfied,
  in that he felt indifferent and capable of resistance to men. He felt
  sure that he would not relapse into his former vices. At the same
  time, he had not the slightest interest in the female sex.

  Case 141. Mr. X., aged 31, chemist, comes of a neuropathic family, and
  from childhood has been nervous, emotional, and apprehensive, and
  afflicted with migraine. He remembers distinctly that, when a very
  small boy, he had a lustful feeling at the sight of the half-naked
  persons in the work-shop at his father’s house, and felt drawn to
  them. When he began school, he felt in the same way toward his
  companions. At the age of eleven, without teaching, he began to
  masturbate, during which he thought of his comrades. Later there were
  enthusiastic friendships. His vita sexualis gained the upper hand. As
  he grew up, women also interested him, but his chief interest was in
  men of the higher circles of society. He felt that this inclination
  was abnormal, and sought the acquaintance of puellis; he often had
  coitus, but never with any real pleasure. Thus he became more and more
  given to contrary sexuality, practiced mutual masturbation and coitus
  inter femora viri, and occasionally gave himself up to passive
  pederasty; but he soon abandoned this, on account of the pain it
  caused him.

  He asserts that he feels perfectly masculine, and has never had female
  inclinations. Skeleton and attitude perfectly masculine; strabismus;
  abundant beard; genitals entirely normal. No aversion to the female
  sex. Occasional coitus with puellis, but without satisfaction. The
  patient feels exceedingly unhappy, and clearly recognizes his abnormal
  position; at any price, he wishes to be freed from his homo-sexual
  inclination, and made capable of marriage. “It is terrible to have to
  act a farce constantly.” At the first attempt at hypnosis, after
  Bernheim’s method, the patient passes into a state of deep lethargy.
  He proves to be very susceptible to suggestion, and suitable
  suggestions are imparted. After the fourth sitting, he states, with
  gratitude, that men become indifferent, and he begins to have pleasure
  in coitus; but he did not feel mentally satisfied, owing to the fact
  that he was limited to puellæ publicæ. After the fourteenth sitting he
  declared that he required no more treatment. He was in love with a
  young lady, and thought of marrying her. He asked for her hand, and
  was refused. Soon after, while he was on a journey in Italy, men
  interested him again. He had a relapse, and asked for further
  treatment. A few sittings re-established the _status quo ante_.

  Case 142. _Psychical Hermaphroditism; Successful Treatment by Hypnotic
  Suggestion._—Mr. von Z., aged 29. He asserts that he comes of healthy
  grandparents; of a healthy father, but of a nervous mother. He is an
  only child, and was petted by his mother. At the age of eight he was
  powerfully excited sexually by a male servant, who showed him
  pornographic pictures and his penis.

  When twelve years old, Z. fell in love with his tutor. On going to
  sleep, the naked form of this man appeared before him. He thought of
  himself as in a female _rôle_ in relation to him, and thought to marry
  him some time.

  At the age of thirteen, at a private ball, his fancy was excited by a
  young governess, and, at fifteen, he fell in love with a young lady.
  He remained very excitable sensually; but, thereafter, exclusively so
  to men pleasing to him. Masturbation was not practiced.

  At the age of twenty the patient became neurasthenic (ex
  abstinentia?). He now attempted coitus, but was not successful. On the
  other hand, he had intense desire on an occasion when he saw a naked
  man in a steam-bath. The latter noticed his excitement, approached
  him, and performed masturbation on him, giving the patient intense
  delight. He felt powerfully attracted to this man, and, thereafter,
  allowed him to repeat the act. In the meantime, there were attempts at
  coitus with females, which always ended in a fiasco. The patient was
  much troubled by this, and consulted physicians, who explained his
  impotence as due to nervousness, and thought that it would soon pass
  off.

  Until his twenty-fifth year his sexual indulgence consisted of
  masturbation by the beloved man about once a month. At this time he
  last felt attracted to a woman. It was to a young peasant-girl. She
  would not accede to his wishes. Since his lover was also unattainable,
  the patient began to masturbate alone. With this, his neurasthenia
  increased. For this reason he was unable to finish his studies; he
  became shy, dysthymic, abulic, and now vainly tried cures at various
  hydropathic establishments. On account of continued severe
  (cerebro-spinal) neurasthenia, the patient came to me for advice, in
  the latter part of February, 1890.

  A tall, slim man, of aristocratic and decidedly masculine manners.
  Neuropathic appearance; large ears, the lobes of which run into and
  lose themselves in the skin of the cheeks. Genitals perfectly normal.
  The usual picture of cerebro-spinal neurasthenia of moderate degree.
  Great depression; complaint of being dissatisfied with life, even to
  tædium vitæ; he is pained by his sexual anomaly, especially because he
  is urged by his family to marry.

  He is interested in women only mentally, not physically. Sexually, his
  only interest is in men of distinction. His dreams have never been
  about persons of the opposite sex, but of those of his own sex. In
  these lascivious dreams he has always seen himself in the _rôle_ of a
  woman.

  The most refined woman has never been able to induce erection or even
  libido in him.

  His sexual intercourse with men has consisted of passive or mutual
  masturbation. He had practiced solitary onanism only infrequently and
  _faute de mieux_. During the last five months he had abstained, and
  had had no male intercourse since August, 1889.

  An attempt at hypnosis, after Bernheim’s method, failed; prolonged
  stroking of the brow induced deep lethargy, with catalepsy.

  This method is used, in order to carry out suggestive treatment of
  this patient, who is so worthy of compassion. The hypnotic state is
  always the same; he cannot be brought into a state of somnambulism.

  At the third sitting the patient is given the suggestions: ever
  despise onanism and male love; find women beautiful, and dream of
  them.

  After the sixth sitting (March 10th) a moral transformation takes
  place in his mind. The patient becomes quieter, feels more free, and
  dreams now and then of women, and no longer of men, finding that the
  latter have become indifferent to him. He gratefully states that he
  has no more inclination to masturbation. He approaches women, but he
  notices that they have not the least attraction for him.

  On March 19th, business called the patient home; so that the treatment
  had to be discontinued.

  On May 17, 1890, the patient returned for treatment. He asserted that
  he had not masturbated in the interval, and that he had resisted his
  inclination to men. Too, he had not dreamed of men, but twice of
  women, though only platonically. His cerebral asthenia (ex
  abstinentia?) had increased. He apparently suffers for the want of
  mental and sensual satisfaction of his vita sexualis; for homo-sexual
  love and masturbation have become impossible for him, and intercourse
  with women is denied him. The patient is thus painfully depressed to
  the extent of tædium vitæ.

  He is now subjected to anti-neurasthenic treatment (hydro-therapeutic
  and electro-therapeutic), and the treatment by hypnosis is resumed.
  Only after ten weeks of painstaking treatment did the neurasthenic
  symptoms disappear. Progressing parallel with this, there was a change
  of his mental personality.

  The patient was gratified to note that he grew stronger; that his
  sexual life no longer played a dominating part. Though he felt more
  drawn toward men than women, yet he easily resisted homo-sexual
  desires. His former _boudoir_ became a work-room; instead of to
  adornment and frivolous reading, he gave himself to walks in the
  mountains and forests. On account of the danger of a fiasco, the
  initiative in hetero-sexual attempts was left to the patient.

  It was not until the fourteenth week of treatment that the patient
  made an attempt. It was perfectly successful. The patient became
  happy, and sound in body and mind, and expressed the best hope of his
  future, even having thoughts of marriage.

  He experienced increasing pleasure in normal sexual intercourse; he
  occasionally had lascivious dreams of women, and no longer dreamed of
  men.

  The patient stopped treatment at the end of September. He felt
  perfectly normal in hetero-sexual intercourse, devoid of neurasthenia,
  and had thoughts of marriage. Yet he freely confessed that he still
  always had erections at the sight of a naked, handsome man; though he
  could easily resist the desires that arose, and in dreams had
  exclusively “_relations avec la femme_.”

  In April, 1891, I again saw the patient, and he was in the best of
  health. He regarded his vita sexualis as perfectly normal; for he had
  coitus regularly with pleasure and full virility, dreamed only of
  women, and had no inclination to masturbation. Yet he made the
  interesting confession that frequently, post coitum, he still had a
  temporary “_gout pour l’homme_,” which he could easily control. He
  thought he was lastingly cured, and was occupied with thoughts of
  marriage.

  Case 143. _Congenital Contrary Sexual Feeling. Successful Removal of
  Homo-Sexual Feelings by Suggestions._—L., doctor of philosophy, aged
  34, German, consulted me, in the spring of 1888, on account of
  perversion of his vita sexualis, and asked whether he could not be
  freed from it by means of hypnotic treatment.

  Patient came of a healthy mother, in whose family, for generations,
  there had been neither insanity nor nervous disease. He, like his only
  brother, is much like his father mentally. His brother is very
  sensual, and also psychically abnormal, and given to over-indulgence
  in drink.

  His father was a neuropathic, eccentric man. Nothing is known of any
  abnormal sexual manifestations in him, though, like all his brothers,
  he had a tendency to over-indulgence in alcohol.

  This vice seems to have been inherited from his mother (grandmother of
  patient), who was a notorious drinker. The father of this woman
  (great-grandfather of patient) was also a great drinker. No other
  ancestral history was obtainable.

  Patient states that from childhood he was nervous and easily excited.
  He learned very easily, and had a talent for languages. He was always
  interested in art, particularly in music and poetry. His education was
  excellent, and given at home. When he was thirteen, his father told
  him that he should never touch his genitals, for it was wrong to do
  so, and to do it might bring unhappiness.

  Occasionally his father showed him pictures of syphilitic diseased
  conditions, etc., in an anatomical museum, and the patient was
  disgusted and frightened. He believed that his later fear of sexual
  intercourse with women was partly nourished by this early erroneous
  teaching.

  However, the patient seeks the principal cause of his sexual
  perversion in a defect of organization. When a small boy, he had a
  silly enthusiasm for companions. He also remembers that, at that time,
  he had a desire only for girlish games, and preferred the society of
  girls. When a boy, he had a passion for crocheting and embroidering.
  At fourteen he was still without any sexual knowledge, and fell into
  the hands of a pederast. He ran away, frightened, when he learned what
  was to be done with him. When fifteen, a sympathetic companion was
  accustomed to lay his head in the patient’s lap. This gave the patient
  a peculiar pleasurable feeling, but he knew no explanation of it. At
  sixteen he had the first erections—at the sight of men.

  At twenty he first learned that his sexual condition was perverse, and
  recognized the fact that what he had taken for friendship was love. He
  was much frightened at the discovery, and much pained. His sympathies
  were directed toward young men of the upper class that were handsomely
  formed and of pleasing appearance.

  The society of ladies had no effect on him. He was never attracted by
  the charms of the opposite sex. In his fifteenth year he had a sensual
  dream, in which he thought a girl of elegant figure sat opposite him,
  on a sofa.

  In the theatre it was only the art of the actresses that he admired;
  the actors excited his real interest.

  Drinking and smoking had always been very repugnant to him. Hunting
  and gymnastics, and other masculine occupations, had no interest for
  him. He did not enter the army, because his general physical weakness
  precluded it.

  The patient has but little sexual desire. He has never had any impulse
  to satisfy himself with persons of his own sex. Some years ago, when
  he first tried to embrace a man lovingly, he had powerful erection and
  became greatly excited; but he was able to control himself and to
  repel his lover. Thereafter he always avoided such attempts. It was
  only seldom that he became powerfully excited sexually, and even then
  he was not driven to satisfy himself. He was never given to onanism.
  During the establishment of puberty, the patient had frequent dreams
  with pollutions, but these were not induced by erotic fancies of any
  kind.

  Some years ago, for a long time, ejaculation was always induced by the
  embrace of a sympathetic man, but this condition of irritable weakness
  disappeared. As years passed, the patient, who had always had a desire
  for marriage and a family, became anxious on account of the conviction
  that the inclination toward females, for which he had hoped, would
  never come. It became more and more clear to him that he was abnormal,
  and he began to have fears about his virility and his future happiness
  in life.

  In order to test the matter, he sought a brothel. He found a
  prostitute of beautiful form; he had the best will to satisfy himself
  that he was virile; the woman did all she could, but in vain. There
  was no erection, and he withdrew, ashamed. New attempts, under the
  most favorable circumstances, were likewise failures, though the
  patient brought his imagination to his aid, and thought himself to be
  embracing a man instead of a woman.

  He now realized that his ideal—to consummate marriage—was impossible.
  He felt himself very unfortunate, and dissatisfied with life. Besides,
  it forced itself upon him that morally he was lowered, because he
  could not overcome his inclination for his own sex, and his friendship
  for respectable men of his circle was degraded by sexual feelings. In
  his consultation with me, the patient was unending in the description
  of his painful situation. His ideal was marriage. He longed for it,
  for purely ethical reasons. He thought of it as something holy; but
  the begetting of children, the sexual act, was very repugnant to him.
  At the same time, he saw that he could not really marry without being
  potent. Would not hypnotic suggestion exercise a favorable influence
  on his sexual life? He had not the energy of a man of normal sexual
  condition. He seemed to himself to be all wrong. He would endure
  all—to be poor and miserable—if he could but have a normal sexual
  inclination.

  When the patient was gently told of the congenital and deep
  constitutional significance of his sexual anomaly, and shown that,
  therefore, the creation of a normal sexual condition was doubtful, he
  thought that he would be satisfied to remain in his condition. But he
  wished to know whether it were not possible to eradicate his
  inclination for men, without attempting to create an equivalent for
  women; and if, in hypnosis, it could not be suggested to him that, in
  the future, men be a matter of indifference to him, and that, in
  intercourse with his friends, he no longer be excited sexually. Such a
  result would elevate very much his moral feeling, and make him
  satisfied and unembarrassed in social relations with his friends.

  The possibility of such suggestive removal of feelings by hypnosis
  could not be gainsaid, though he was in doubt as to whether he could
  be hypnotized or not, since the hypnoscope had proved to have no
  effect upon him.

  Out of pity and scientific interest, I decided to make an immediate
  attempt at hypnosis, after Bernheim’s method.

  The patient passed easily into a condition of deep lethargy, and, in a
  drawling voice, repeated the following suggestion: “I feel that, from
  this time, I am sexually indifferent to men; and, that a man is as
  sexually indifferent to me as a woman.”

  When I counted three,—having suggested previously that he awake at
  three,—the patient came to himself, as if out of a deep sleep, and
  performed immediately the post-hypnotic suggestion to open the door of
  the stove. He said that he had not lost consciousness entirely, that
  he had felt as one paralyzed and without will, and that he had felt a
  peculiar creeping sensation in all his limbs.

  After five days the patient came again. In manner he was a different
  person, and he said, joyfully, that he felt like another man. Energy
  and will-power—the loss of which he had felt so keenly—had returned.
  He felt, now, entirely unembarrassed toward men, and had a new joy in
  living.

  The following seven days he was hypnotized. Hypnosis is no longer as
  deep as at first, though the suggestion is always accepted and
  repeated. However, he is quite profoundly influenced; for, the
  suggestion given, he sleeps on, in a state of lethargy, for ten
  minutes, and has to be awakened by suggestion. This always occurs as
  if from a deep sleep,—slowly, and through a stage of somnolence.

  After the eighth sitting the patient found himself well and happy, and
  in possession of full self-confidence. He had the feeling and the
  evidence that men had no influence on him.

  He thought he could dispense with hypnotic treatment, and gratefully
  took his leave, with the promise that, should the influence of the
  suggestion fade, he would come again. Since then, I have heard nothing
  more of this interesting patient, and I have reason to hope that he
  remains improved.

  The patient is, in all respects, of masculine appearance; beard
  abundant. Physically, with the exception of slight neurasthenic
  symptoms, he presents nothing remarkable. Genitals normal. (Personal
  case. _Internat. Centralblatt_, etc., Bd. i, Heft 1.)

  Case 144. X., aged 33; single; tall. Mentally, of small endowment;
  comes of tainted family. Paternal grandfather died at thirty-four with
  a mental disease, which is said to have developed as a result of
  onanism and spermatorrhœa. His father and brother suffered with
  disturbances of the sexual functions. There was insanity in the
  mother’s family; other branches of the family were noted for their
  irritable and eccentric character.

  The patient has too small a head, a retreating brow, abnormal ears,
  sparse growth of hair, and a hernia, which is probably congenital.
  Genitals large, and normally developed.

  Great impressionability; neuropathic constitution; occasional tædium
  vitæ. For several years, peculiar, imperative ideas: that he is a
  locomotive; a horse; a velocipede; and, that he must act accordingly.
  From his earliest youth, contrary sexual feeling (congenital). Horror
  feminæ; sexual inclination toward boys; satisfaction by sensual
  contact, and, _faute de mieux_, masturbation. One day he had an affair
  with a boy dressed in gray, which made a deep impression on him. Since
  then, while masturbating, the image of the boy comes into his mind;
  and he cannot see gray clothes without having powerful erections. On
  the advice of physicians whom he consulted, he attempted coitus with
  women, but was cold and impotent, notwithstanding the assistance of
  memory-pictures of the boy dressed in gray; and he finally gave up the
  efforts.

  March 27th, first hypnotic sitting. Small result. He resists, and says
  his fancy keeps him from going to sleep.

  In a further series of sittings he declares that he experiences
  unfavorable effects,—is more excited, and troubled by imperative ideas
  and the desire to masturbate. He makes fun of the physician and
  hypnotism, and offers much resistance, with the expression that
  hypnotism is good for nothing, and only makes people crazy.

  However, gradually it became possible to induce somnambulism. After
  twenty-five sittings the patient confessed that he was better, and
  that he was less troubled with imperative ideas and onanism. The
  sittings were repeated every week or two. The patient felt mentally
  and morally well, ceased to masturbate, but, at the end of treatment,
  was indifferent toward the opposite sex (Dr. Ladame, _Revue de
  l’hypnotisme_, September 1, 1889).

In the two foregoing cases there was successful suggestive removal of
homo-sexual feelings,—a result which, as Case 143 shows, means a great
improvement for such unfortunate individuals, in that it protects them
from shame and the law. An entirely different and phenomenal result is
presented by the following case, reported by Dr. v. Schrenk-Notzing in
the _Wiener internat. klin. Rundschau_, October 6, 1889, No. 40, which
is a case of effemination. It discloses a new method of treatment of
urnings; but it is necessary to guard against illusions. Only where
hypnosis can be deepened to somnambulism, are decided and lasting
results to be expected:—

  Case 145. _Congenital Contrary Sexual Instinct Improved by Hypnotic
  Suggestion._—R., official, aged 28. January 20, 1888, he sought
  medical advice. He is the brother of the patient who is the subject of
  Case 135, and, therefore, of a badly tainted family (_v. supra_).
  Toward the end of treatment, he confessed that he was the author of
  the autobiography which was published as Case 83 in the fifth edition
  of this work, and it is here reproduced:—

  “In brief, my abnormality consists of this, that in sexual relations I
  feel myself to be completely feminine. Since my earliest youth, in my
  sexual acts and fancies, I have always had before my eyes only images
  of masculine beings and masculine genitals.

  “Until I went to the University, I found nothing in this (I had never
  spoken with others about my fancies, but rather, while at the
  Gymnasium, lived a silent and retired life).

  “While at the University, it struck me that female persons made not
  the slightest impression on me. Since then, in houses of prostitution,
  etc., I have attempted coitus, or only to obtain an erection, with
  women, but always in vain.

  “Erection ceased immediately, as soon as I was in a room alone with a
  woman. At first I considered it impotence, though, at the same time, I
  was so excited sexually that I had to masturbate several times during
  the day in order to sleep.

  “Quite different, however, has been the development of my feelings
  toward the masculine sex, and it has grown stronger every year. At
  first they expressed themselves in extraordinary, enthusiastic
  friendship for certain persons, under whose windows at night I would
  wait for hours; whom in all possible ways I would try to meet on the
  streets, and with whom I sought to come in contact. I wrote such
  persons the most passionate letters, in which, however, I was shy in
  expressing my feelings too plainly. Later, after my twentieth year, I
  came to understand the essential nature of my inclinations,
  particularly from the sensual pleasure I experienced as soon as I came
  in direct contact with any of these friends. These persons were all
  finely built men, with dark hair and eyes. I have never had my
  feelings excited by boys. Real pederasty is absolutely
  incomprehensible to me. About this time (twenty-second to twenty-third
  year) the circle of my beloved friends grew more and more extensive.
  Now I can scarcely see a handsome man on the street without having the
  wish to possess him excited in me. The fact is, I especially love
  persons of the lower classes, whose powerful forms attract
  me,—soldiers, policemen, car-drivers, etc.,—_i.e._, all that wear
  uniforms. If one of these returns my look, I feel a kind of thrill go
  through my whole body. I am especially excitable in the evening, and
  merely the heavy tread of a soldier is alone sufficient to induce the
  most powerful erections. I take a very peculiar pleasure in following
  such persons and looking at them. As soon as I learn that they are
  married, or that they consort with girls, my excitement very
  frequently ceases.

  “A few months ago I became able to control my inclinations to such an
  extent that they were not directly noticeable. About this time I
  followed a soldier who seemed likely to acquiesce in my desire, and
  spoke to him. For money he was ready for anything. At once I was
  filled with a most violent longing to embrace and kiss him, and the
  danger of being noticed did not deter me from doing it. He had
  scarcely grasped my genitals when ejaculation followed. With this
  meeting, I had finally attained the long-desired goal of my life. I
  knew that my whole nature would find its happiness and satisfaction in
  it, and from this time I gave myself up entirely to the effort to find
  a person whom I could love, and from whom I should never part. For my
  acts I do not experience the slightest twinge of conscience.

  “To be sure, in quiet moments, I very well appreciate the difference
  between my way of thinking and the way of the world; as a lawyer, too,
  I naturally recognize the dangers of a relation of the kind I desire;
  but, as long as my entire nature does not change, I shall not be able
  to give up the opportunities offered me. Nevertheless, I should be
  willing to undergo any cure to be freed from my abnormal condition.

  “I recognize my feminine feeling, among other things, in the fact that
  any sensual idea in connection with a woman must be forced, and seems
  unnatural to me. I am also sure that my respect for a woman—I move
  much in the society of ladies, and enjoy it—would change immediately
  to repugnance, were I to notice any sensual inclination in her toward
  me. In my dreams and sensual fancies of men, I always think of myself
  in such positions with them that their faces are always toward mine.
  My greatest delight would be to have a powerful man, undressed, take
  me in his arms with a force I could not resist. In such situations I
  always think of myself in a passive _rôle_, and have to force my
  feelings, in order to think of myself in any other position. In this,
  I am truly feminine. Great as my desire may be to approach certain
  persons, my struggle is as great not to allow this to be noticed.
  Moustaches, abundance of hair, and even dirt, seem to be especially
  enticing. It is hardly necessary to say that, to me, my condition,
  with reference to society, is absolutely desperate; and, if I had not
  the hope of finding a being that would understand me, life would be
  scarcely endurable. I feel that sexual commerce with a man is the only
  means of successfully combating my impulse to onanism. Though this has
  a very bad effect on me, I cannot keep myself from it constantly,
  because, as I have often found, I will be even more weakened by
  pollutions at night and persistent erections during the day.

  “Up to this time I have truly loved but two men. Both were officers,
  remarkably endowed mentally, handsomely and gracefully formed, and of
  dark skin and eyes. I became acquainted with the first at the
  University. I was madly in love with him, and suffered unspeakably on
  account of his indifference. I spent nights under his window, simply
  to be near him. When he was officially transferred, I was in despair.

  “Soon after, I became acquainted with an officer that resembled him,
  who likewise enchained me at first sight. I sought every opportunity
  to meet him, spent the day in the streets, and at places where I hoped
  to get a sight of him. I knew how the blood came into my face when,
  unsuspected, I saw him. When I saw him friendly with others, I could
  scarcely contain myself for jealousy. When I sat near him, I was
  impelled to touch him. I could scarcely conceal my excitement when I
  touched his knee or thigh. I never ventured, however, to express my
  feelings to him; for, from his conduct, I was convinced that he would
  not understand them or share them.

  “I am twenty-seven years old, of medium height, and well-developed,
  and would be considered handsome. My chest is somewhat narrow, hands
  and feet small, and voice weak. Mentally, I think I am well endowed;
  for I passed the State examination with distinction, speak several
  languages, and am a good painter.

  “In my calling I pass for one that is industrious and conscientious.
  My acquaintances think me cold and peculiar. I do not smoke, do not
  play games, and cannot sing or whistle. My gait, like my voice, is
  somewhat affected. I have much taste for elegance, love adornment,
  sweetmeats, and perfumes, and prefer the society of ladies.”

  From Dr. von Schrenk’s notes of the case, it is learned, further, that
  social and criminal deterrents, on the one hand, and uncontrollable
  desire for his own sex, on the other, caused violent mental struggles,
  and made life unendurable. For this reason the patient confided in the
  physician. January 22, 1889, hypnotic treatment, with suggestion,
  after the method of Nancy, was begun with the patient. Gradually it
  became possible to induce somnambulism.

  The suggestions were made with reference to indifference to men, and
  ability to resist them, and to increase of interest in women;
  masturbation was thus forbidden, and women substituted for men in
  lascivious dreams. After a few sittings pleasure at sight of women was
  induced. At the seventh sitting successful coitus was suggested; this
  was fulfilled.

  During the next three months the patient remained, under the influence
  of occasional hypnotic suggestions, in the full possession of normal
  sexual functions. April 22, 1889, there was a relapse, induced by a
  companion. At the next sitting, remorse and shame. As expiation,
  coitus with a woman in the presence of his seducer.

  The patient complained that coitus with women below him in station did
  not satisfy his æsthetic feelings. He hoped to find satisfaction in a
  happy marriage. After forty-five sittings (May 2, 1889) the patient
  considered himself cured. Treatment ceased. He became engaged to a
  young lady some weeks later, and presented himself again, after six
  months, as a happy bridegroom. He thought that, in his happiness with
  his wife, he had a sure preventive against relapse.

  The author emphasizes the fact that the hypnotic treatment had no
  injurious collateral effect, and leaves undecided the question as to
  whether the cure is permanent or not, with R.’s very bad heredity. But
  he expresses the conviction that, in case of relapse, renewed hypnotic
  treatment would not be contra-indicated.

Since the incredible result of this case interested me exceedingly, as
did its further course, I wrote to the author, requesting information
concerning his patient.

Dr. v. Schrenk very kindly placed at my disposal the following letter,
which he had received from the patient in January, 1890:—

  “By means of suggestive treatment given me by Baron Schrenk, for the
  first time I became possessed of the psychical condition that
  permitted me to have intercourse with a woman, which, up to that time,
  in spite of repeated efforts, I had been unable to do successfully.

  “Since my æsthetic needs were unsatisfied by intercourse with
  prostitutes, I thought to find my real salvation in matrimony. The
  earlier friendly inclination toward a lady known in my youth offered
  me the opportunity, the more because I believed that she, of all
  others, would be in a position to awaken feelings for the opposite sex
  which were absolutely foreign to me. Her character,—_i.e._, our
  harmony,—is in such accord with my inclinations that I am fully
  convinced that I shall also find complete psychical satisfaction. This
  conviction has not changed during the eight months of my engagement.

  “I intend to be married in about four weeks.

  “As far as my position with respect of my own sex is concerned, my
  power of resistance—and this is the lasting positive result of this
  treatment—is absolutely changed in degree. While previously it was
  impossible for me to overcome an intense sexual excitation when I saw
  a finely formed car-driver, to-day, in the company of my former
  lovers, I am without sexual excitement. At the same time, I must add
  that now, as formerly, their society has a certain attraction for me,
  though it is not to be compared with my earlier passion.

  “On the other hand, I have refused repeated persuasions to indulge in
  sexual intercourse with men, without expending much force in
  resistance,—persuasions which formerly I should have been unable to
  resist. I may say, indeed, that it is a feeling of compassion for my
  former lovers, that have proved their passionate devotion to me, which
  keeps me from directly repulsing them. My action seems to be due to a
  feeling of duty, rather than to inner need.

  “Since the conclusion of treatment, I have not consorted with
  prostitutes. This circumstance, and the numerous letters and
  persuasions from my former lover, may well be the reason why, in the
  eight months that have elapsed, I have allowed him to persuade me to
  sexual intercourse on three or four occasions. At these times I have
  always been conscious of being completely master of myself, as
  compared with my earlier passionate condition in like situations, as
  the violent reproaches of my friend convinced me. _I always feel a
  certain unconquerable repugnance, which cannot be based on moral
  grounds, but which, I believe, must be attributed to the treatment._ I
  no longer feel a love for him in the former sense. Besides, since the
  treatment, I have sought no opportunities for sexual intercourse with
  men, and I feel no need of it. But, formerly, not a day passed on
  which I did not feel impelled to it, so that at times I was unable to
  think of anything else. Awake or dreaming, ideas of sexual content are
  very infrequent.

  “I may express the belief that my marriage, that is to take place in a
  few weeks, and the much desired change of place that is bound to it,
  will entirely remove the residuum of my earlier condition. I conclude
  these lines with the honest assurance that, subjectively, I am another
  man, and that this change has restored the mental equilibrium that was
  previously wanting.”

The foregoing words, which Dr. v. Schrenk completes with the verbal
statement of the patient that he had not practiced onanism again, are a
brilliant proof of the lasting effect of post-hypnotic suggestion. I
consider the hetero-sexual instinct of the patient to be the artificial
creation of his excellent physician; and the patient himself seems to
recognize this, in that he speaks of a repugnance which “does not rest
on moral grounds, but which depends on the treatment.”

The further fate of this interesting patient may be learned from the
following letter, kindly submitted by Dr. v. Schrenk:—

  “Honored Sir: Having been home some days from my wedding-journey, I
  wish to send you a short report of my present condition. During the
  week before my wedding I was in great excitement, because I feared
  that I should be unable to perform certain duties. The impelling
  thoughts of my friend, who wished another meeting with me, at any
  price, had no effect on me. We had not seen each other since I heard
  from you last. [Receipt of the professor’s letter.] However, I was
  much troubled with the thought that my marriage must be unhappy. Now,
  however, I have no anxiety. To be sure, on the first night, success
  was difficult,—to induce sexual excitation in myself,—but on the
  following night, and since, the influences needed for a normal man, I
  believe, would have been sufficient for me. I am also convinced that
  the harmony between us, which, of course, is mentally of long
  standing, will become more and more complete. A relapse to the former
  condition seems impossible. It is, perhaps, significant for my present
  condition, that I one night dreamed of my former lover, and that the
  dream was not sensual, and did not excite me sensually.

  “I am satisfied with my present circumstances. I am, of course, well
  aware that my present inclinations are far from being of a degree
  equal to what they formerly were. I believe, however, that they will
  daily grow stronger. Already my former life is incomprehensible, and I
  cannot understand why I did not earlier think to overcome the abnormal
  sexual instinct by normal sexual indulgence. A relapse would now be
  possible only with an entire change of my mental life; and, in a word,
  it seems impossible.

                                      “Your obedient servant,      ——d.”

From a letter of Dr. v. Schrenk’s, of December 7th, I extract the
following:—

  “In this case the cure seems to be of longer duration than I expected;
  for, on speaking with the patient, some months ago, he said that he
  was perfectly happy in marriage, and, as I hear, he expects soon the
  happiness of a father.”

  Dr. v. Schrenk has reported in the _Wiener internationalen klinischen
  Rundschau_, 1891, No. 26, later and very interesting facts concerning
  his patient, which, therapeutically, are very satisfactory.




                         IV. SPECIAL PATHOLOGY.

  THE MANIFESTATIONS OF ABNORMAL SEXUAL LIFE IN THE VARIOUS FORMS AND
                     STATES OF MENTAL DISTURBANCE.


                     ARREST OF MENTAL DEVELOPMENT.

Sexual life in idiots is, in general, but slightly developed. It is
wanting entirely in idiots of high grade. In such instances the genitals
are frequently small and deformed, and menstruation is late or does not
occur at all. There is impotence, or sterility, as the case may be. Even
in idiots of low grade, sexuality is not prominent. In infrequent cases
it is manifested with a certain periodicity, and then with greater
intensity. It may then be expressed impulsively, and be violently
satisfied. Perversions of the sexual instinct do not occur at the lowest
levels of mental development.

When the desire for sexual satisfaction is opposed in these cases, great
passion is excited, with danger of murderous assault on the persons
attacked. It is to be expected that idiots should not exercise choice,
and they attempt to satisfy the sexual instinct on their nearest
relatives.

  Thus Marc-Ideler reports the case of an idiot who attempted to rape
  his sister, and had almost strangled her when he was discovered.

  Friedreich reports an analogous case (_Friedreich’s Blätter_, 1858, p.
  50).

  I have repeatedly had occasion to give opinions in cases of attempts
  to rape little girls.

  Giraud (_Annal. méd. psych._, 1885, Nr. 1) also reports a case of this
  kind. Consciousness of the significance of the act is always wanting;
  an instinctive knowledge that such obscene acts are not publicly
  permitted is often present, and causes the attempted sexual act to be
  undertaken in a deserted place.

In imbeciles the sexual instinct is usually developed as in normal
individuals. The moral inhibitory ideas are cloudy, and, therefore, the
sexual impulse is more or less openly manifested. For this reason
imbeciles are sources of disturbance in society. Abnormal intensity and
perversion of the sexual instinct are infrequent.

The most frequent manner of satisfaction of the sexual desire is
onanism. The weak-minded seldom make sexual attacks on adults of the
opposite sex.

Sexual satisfaction with animals is frequently attempted. The great
majority of cases of injury (sexual) to animals must be attributed to
imbeciles. Children are quite often their victims.

  Emminghaus (Maschka’s Handb. iv., p. 234) draws attention to the
  frequency of open manifestation of sexual instinct, which comprises
  open masturbation, exhibition of the genitals, attacks on children and
  those of the same sex, and sodomy.

Giraud (_Annal. méd. psychol._, 1855, Nr. 1) has reported a whole series
of immoral attacks on children:—

  1. H., aged 17, imbecile, enticed a little girl into a barn, by giving
  her nuts. There he exposed her genitals and showed his own, making
  movements of coitus on the child’s abdomen. He had no idea of the
  moral significance of the act.

  2. L., aged 21; imbecile; degenerate. While he was watching cattle,
  his sister of eleven years, with a playmate of eight years, came and
  told him how some unknown man had attempted to do them violence. L.
  led the children to a deserted house and attempted coitus with the
  younger child, but let her go because no emission occurred, and
  because the child cried out. On the way home he promised to marry her
  if she would not say anything. At the trial he thought that by
  marriage he could right the wrong he had done.[119]

  3. G., aged 21, microcephalic, imbecile, has masturbated since his
  sixth year, and practiced active and passive pederasty. He has
  repeatedly tried to perform pederasty with boys, and attacked little
  girls. He was absolutely without an understanding of his acts. His
  sexual desire was manifested periodically and intensely, as in
  animals.[120]

  4. B., aged 21; imbecile. While alone in a forest with his sister of
  nineteen, he demanded that she allow coitus. She refused. He
  threatened to strangle her, and stabbed her with a knife. The
  frightened girl fondled his penis, and he then left her and quietly
  went on with his work. B. has a deformed, microcephalic skull, and has
  no sense of the significance of his act.

Emminghaus (_op. cit._, p. 234) reports the case of an exhibitionist:—

  Case 146. A man, aged 40, married, had for sixteen years been
  accustomed to exhibit himself in parks, at dusk, to little girls and
  servants, and drew their attention to himself by whistling. After
  having been frequently punished for it, he avoided the places, but he
  carried on his practice elsewhere. Hydrocephalus. Mental weakness of
  slight degree. Mild sentence passed.

  Case 147. X., of tainted family; imbecile; defective and perverted in
  intellect, feeling, and will. For help and protection he was brought
  before an officer. It was complained that he had repeatedly exposed
  his genitals to servant-girls, and had shown himself at windows with
  the upper portion of his body naked. No other manifestations of sexual
  instinct. No onanism reported. (Sander, _Archiv f. Psych._, i, p.
  655.)

  Case 148. _Pederasty with a Child._—On April 8, 1884, at ten o’clock
  A.M., while X. was sitting on the street, holding a boy of eighteen
  months on her lap, a certain Vallario approached and took the child
  from X., saying he was going to take it for a walk. He went the
  distance of half a kilometre, and returned, saying that the child had
  fallen from his arms, and thus injured its anus. The anus was torn,
  and blood was pouring from it. At the place where the deed was done,
  traces of semen were found. V. confessed his horrible crime, and, at
  his final trial, he acted so strangely that an examination of his
  mental condition was made. He had impressed the prison attendants as
  being an imbecile. V., aged 45, mason, defective morally and
  intellectually, is dolicho-microcephalic; has narrow, deformed facial
  bones, and the halves of the face and the ears are asymmetrical; the
  brow is low and retreating; genitals normal. V. shows general
  diminution of cutaneous sensibility, is imbecile, and has no ideas. He
  lives in the present, has no ambition, and does nothing of his own
  will. He has no desires and no emotional feeling. He has never had
  coitus. Nothing more could be ascertained about his vita sexualis.
  Proofs of intellectual and moral idiocy, due to microcephaly; the
  crime is referred to a perverse, uncontrollable sexual impulse. Sent
  to an asylum. (Virgilio, _il Manicomio_, V. year, No. 3.)

A case mentioned by L. Meyer (_Arch. f. Psych._, Bd. i, p. 103) shows
how female imbeciles may indulge in shameless prostitution and
immorality.[121]


                  STATES OF ACQUIRED MENTAL WEAKNESS.

The numerous anomalies of the vita sexualis in senile dementia have been
described in the section on “General Pathology.” In other conditions of
acquired mental weakness,—those due to apoplexy; trauma capitis; to the
secondary stages of psychoses; or to inflammatory processes in the
cortex (lues, paretic dementia),—perversions of the sexual instinct seem
to be infrequent; and here the immoral sexual acts seem to depend on
abnormally increased or uninhibited sexual feeling, which, in itself, is
not abnormal.


                (1) _Dementia Consecutive to Psychoses._

Casper (_Klin. Novellen_, Fall 31) reports a case that belongs here. It
is that of a physician, aged 33, who attempted rape on a child. He was
weakened mentally, as a result of hypochondriacal melancholia. He
excused his deed in a very silly way, and had no appreciation of the
moral and criminal meaning of the act, which was apparently the result
of a sexual impulse that could not be controlled on account of his
mental weakness.

Case 21, in Liman’s _Zweifelhafte Geisteszuständen_, is an analogous
case (dementia after melancholia; offense against morals by exhibition).


                     (2) _Dementia After Apoplexy._

  Case 149. B., aged 52. He passed through a cerebral attack, and was no
  longer able to carry on his business as a merchant.

  One day, in the absence of his wife, he locked two girls in the house,
  gave them liquors to drink, and then carried out sexual acts with the
  children. He commanded them to say nothing, and went to his business.
  The medical expert established mental weakness, resulting from
  repeated apoplexies. B., who, up to this time, had been wellbehaved,
  says he committed the criminal act because of an uncontrollable and
  incomprehensible impulse; and that, when he came to himself, he was
  ashamed, and sent the girls away. Since his apoplectic attack, B. had
  been weak-minded, incapable of business, and hemiplegic; but, soon
  after arrest, he made an unskillful attempt at suicide. He often cried
  childishly. His moral and intellectual energy in opposing his sensual
  impulses was certainly much weakened. No sentence. (Giraud, _Ann. méd.
  Psychol._ March, 1881.)


                  (3) _Dementia After Injury of Head._

  Case 150. K., when fourteen years old, was injured on the head by a
  horse. The skull was fractured in several places, and several pieces
  of bone required removal.

  From that time K. was weak mentally, passionate, and ill-tempered.
  Gradually he developed an inordinate and truly beastly sensuality,
  which drove him to the most immoral acts. One day he raped a girl of
  twelve, and strangled her for fear of discovery. Arrested, he
  confessed. The medical experts declared him responsible, and he was
  executed.

  The autopsy revealed ossification of almost all the sutures,
  remarkable asymmetry of the halves of the skull, and evidences of
  healed fractures. The affected hemisphere had bands of cicatricial
  tissue running through it, and was one-third smaller than the other.
  (_Friedreich’s Blätter_, 1885, Heft 6.)


     (4) _Acquired Mental Weakness, Probably Resulting from Lues._

  Case 151. X., officer, had repeatedly committed immoral acts with
  little girls; among other things, he had induced them to perform
  manustupration on him, had exposed his genitals, and handled theirs.

  X., formerly healthy, and of blameless life, was infected with
  syphilis in 1867. In 1879 paralysis of the left abducens occurred.
  Thereafter mental weakness was noticed, with a change of his
  disposition and character. Headache, occasional incoherence of speech,
  failure of power of thought and logic, occasional inequality of
  pupils, and paresis of the right facial muscles, were observed.

  X., aged 37, shows no trace of lues when examined. The paralysis of
  the left abducens is still present. The left eye is amblyopic. He is
  mentally weak. Concerning the trial that was before him, he said it
  was nothing but a harmless misunderstanding. Indications of aphasia.
  Weakness of memory, particularly for recent events. Superficial
  emotional reaction; rapid exhaustion of memory and ability to speak.
  Proved: that the ethical defect and the perverse sexual impulse are
  the symptoms of an abnormal condition of brain induced by lues.

  Suspension of criminal proceedings. (Personal case. _Jahrbücher für
  Psychiatrie._)

(5) _Paretic Dementia._

Here the sexual life is usually abnormally affected; in the incipient
stages of the disease, as well as in episodical states of excitement, it
is intensified, and sometimes perverse. In the final stages libido and
sexual power usually become _nil_.

Just as in the prodromal stage of the senile forms, one sees here, in
connection with more or less evident losses in the moral and
intellectual spheres, expressions of an apparently intensified sexual
instinct (obscene talk, openness in intercourse with the opposite sex,
thoughts of marriage, frequenting of brothels, etc.), which is
characteristic of the clouding of consciousness.

Seduction, abduction, and public scandal are here the order of the day.
At first there is still some appreciation of the circumstances, though
the cynicism of the acts is striking enough. As the mental weakness
increases, such patients become criminal by reason of exhibition,
masturbation in the streets, and attempts at immoral acts with children.

If conditions of mental excitement come on, attempts at rape are
committed, or, at least, grossly immoral acts,—the patient attacks women
on the street, appears in public in very imperfect dress; or,
half-clothed, tries to force his way into strange houses, to cohabit
with the wife of an acquaintance, or to marry the daughter on the spot.

  Numerous cases belonging to this category are cited by Tardieu
  (“Attentats aux moeurs”); Mendel (“Progressive Paralyse der Irren,”
  1880, p. 123); Westphal (_Arch. f. Psych._, vii, p. 622); and a case
  by Petrucci (_Annal. méd. Psychol._, 1875) shows that bigamy may also
  occur here.

  The brutal disregard of consequences with which the patients in the
  advanced stages attempt to satisfy their sexual instinct, is
  characteristic.

  In a case reported by Legrand (“La folie,” p. 519), the father of a
  family was found masturbating in the open street. After the act he
  consumed his semen.

  A patient seen by me, an officer, of a prominent family, in broad
  daylight, made attacks on little girls at a watering-place.

  A similar case is reported by Dr. Régis (“De la dynamie ou exaltation
  fonctionnelle au début de la paral. gén.,” 1878).

  Cases reported by Tarnowsky (_op. cit._, p. 82) show that also
  pederasty and bestiality may occur in the prodromal stages and course
  of this malady.

_Epilepsy._—Epilepsy is allied to the acquired states of mental weakness
because it often leads to them, and then all the possibilities of
reckless satisfaction of the sexual impulse that have been mentioned may
occur. Moreover, in many epileptics the sexual instinct is very intense.
For the most part, it is satisfied by masturbation, now and then by
attacks on children, and by pederasty. Perversion of the instinct with
perverse sexual acts seems to be infrequent.

Much more important are the numerous cases in literature in which
epileptics, who, during intervals, present no signs of active sexual
impulse, but manifest it in connection with epileptic attacks, or during
the time of equivalent or post-epileptic exceptional mental states.
These cases have scarcely yet been studied clinically, and forensically
not at all; but they deserve careful study. In this way certain cases of
violence and rape would be understood, and legal murders prevented.

From the following facts, it will certainly be clear that the cerebral
changes which accompany the epileptic outbreak may induce an abnormal
excitation of the sexual instinct. Besides, in the exceptional mental
states of epileptics, they are unable to resist their impulses, by
reason of the disturbance of consciousness.

  For years I have known a young epileptic, of bad heredity, who, always
  after frequent epileptic seizures, attacks his mother, and tries to
  violate her.[122] After a time he comes to himself, and has no memory
  of his acts. In the intervals he is very strict in morals, and has but
  slight sexual inclination.

  Some years ago I became acquainted with a young peasant, who, during
  epileptic attacks, masturbated shamelessly, but during the intervals
  was above reproach.

  Simon (“Crimes et délits,” p. 220) mentions an epileptic girl of
  twenty-three, well educated, and of the best morals, who, in attacks
  of vertigo, would shout out obscene words, then raise her dress, make
  lascivious movements, and try to tear open her under-garments.

  Kiernan (_Alienist and Neurologist_, January, 1884) reports the case
  of an epileptic who always had, as an aura, the vision of a beautiful
  woman in lascivious attitudes, which induced ejaculation. After some
  years, with treatment with potassium bromide, the vision was changed
  to that of a devil attacking him with a pitchfork. The instant this
  reached him, he became unconscious.

  The same author speaks of a very respectable man who had, two or three
  times a year, epileptic attacks of furor and dysthymia, with impulses
  to pederasty, which lasted a week or two; and of a lady who, with
  epilepsy that came on during the climacterium, had sexual desire for
  boys.

  Case 152. W., of good heredity, previously healthy; before and after,
  sound mentally, quiet, kind, temperate. On April 18, 1877, he had no
  appetite. On the 14th, in the presence of his wife and children, he
  demanded coitus, first of his wife’s friend, who was present, then of
  his wife. Taken away, he had an epileptoid attack; after this he
  became wildly maniacal and destructive, threw hot water on those that
  tried to approach him, and threw a child in the stove. Then he soon
  became quiet, but for some days remained confused, and finally came to
  himself with no memory of the events of his attack. (Kowalewsky,
  _Jahrbücher f. Psych._, 1879.)

  Another case, examined by Casper (_Klin. Novellen_, p. 267), may be
  attributed to epilepsy (larvated). A respectable man attacked four
  women, one after another, in the open street (once before two
  witnesses), and violated one of them, “notwithstanding that his young,
  pretty, and healthy wife” lived hard by.

The epileptic significance of the sexual acts in the following cases is
unequivocal:—

  Case 153. L., official, aged 40; a kind husband and father. During
  four years he has offended public morals twenty-five times, for which
  he has had to endure long imprisonment.

  In the first seven complaints he was accused of exposing his genitals
  to girls from eleven to thirteen years old, while riding by them, and
  calling their attention by obscene words. While in confinement, he had
  exposed his genitals at a window which opened on a popular street.

  L.’s father was insane; his brother was once met on the street wearing
  only a shirt. During his military service L. had had two attacks of
  severe fainting. Since 1859 he had suffered with peculiar attacks of
  vertigo, at such times becoming weak, tremulous, and deathly pale; it
  grew dark before his eyes, and he saw bright stars, and was forced to
  get support in order to keep upright. After violent attacks, great
  weakness, profuse sweating.

  Since 1861 he had been very irritable, which, respected though he was
  as an official, caused him much trouble in his work. His wife noticed
  the change in him. He had days when he would run about the house as if
  insane, holding his head between his hands, striking the wall, and
  complaining of headache. In 1864 he fell to the ground four times,
  lying there stiff, with eyes open. Confused states of consciousness
  were also proved to have occurred.

  L. declared that he had not the slightest remembrance of the crime of
  which he was accused. Observation showed further and more violent
  attacks of epileptic vertigo. L. was not sentenced. In 1875 paretic
  dementia developed with a rapidly fatal result. (Westphal, _Arch. f.
  Psych._, vii, p. 113.)

  Case 154. A rich man of twenty-six had lived for a year with a girl
  with whom he was very much in love. He cohabited infrequently, and was
  never perverse.

  Twice during the year, after excessive indulgence in alcohol, he had
  had epileptic attacks. One evening after dinner, where he had taken
  much wine, he hurried to the house of his mistress, and into her
  sleeping-apartment, although the servant told him she was not at home.
  From there he hastened into a room where a boy of fourteen was
  sleeping, and began to violate him. At the cry of the child, whose
  prepuce and hand he had injured, the servant hurried to them. He left
  the boy and attacked the maid; after that he went to bed and slept
  twelve hours. When he awoke, he had an indistinct remembrance of
  intoxication and coitus. Thereafter there were repeated epileptic
  attacks. (Tarnowsky, _op. cit._, p. 52.)

  Case 155. X., of high social position, led a dissolute life for some
  time, and had epileptic attacks. He became engaged. On his
  wedding-day, shortly before the ceremony, he appeared, on his
  brother’s arm, before the assembled guests. When he came before his
  bride, he exposed his genitals and began to masturbate. He was at once
  taken to an expert in mental disease. On the way he constantly
  masturbated, and for some days was actuated by this impulse, which
  gradually decreased in intensity. After this paroxysm the patient had
  only a confused memory of the events, and could give no explanation of
  his acts. (Tarnowsky, _op. cit._, p. 53.)

  Case 156. Z., aged 27; very bad heredity; epileptic. He violated a
  girl of eleven, and then killed her. He lied about the deed. Absence
  of memory, _i.e._, mental confusion at the time of the crime, was not
  proved. (Pugliese, _Arch. di Psich._, viii, p. 622.)

  Case 157. V., aged 60, physician, violated children. Sentenced to
  imprisonment for two years. Dr. Marandon later proved the existence of
  epileptoid attacks of apprehensiveness, dementia, erotic and
  hypochondriacal delusions, and occasional attacks of fear.
  (Lacassagne, _Lyon. méd._, 1887, No. 51.)

  Case 158. On August 4, 1878, H., aged 15, was picking gooseberries
  with several little girls and boys as her companions. Suddenly she
  threw L., aged 10, to the ground and exposed her, and ordered A., aged
  8, and O., aged 5, to bring about conjunctio membrorum with the girl;
  and they obeyed.

  H. had a good character. For five years she had been subject to
  irritability, headache, vertigo, and epileptic attacks. Her mental and
  physical development had been arrested. She had not menstruated, but
  she manifested menstrual molimena. Her mother is suspected to be
  epileptic. For three months H., after seizures, had frequently done
  strange things, and afterward had no memory of them.

  H. seems to have been deflowered. Mental defect is not apparent. She
  said she had no memory of the act of which she was accused. According
  to her mother’s testimony, she had an epileptic attack on the morning
  of August 4th, and she had been, on that account, told by her mother
  not to leave the house. (Pürkauer, _Friedreich’s Blätter f. ger.
  Med._, 1879.)

  Case 159. _Immoral Acts of an Epileptic in States of Abnormal
  Unconsciousness._—T., revenue-collector; aged 52; married. He is
  accused of having practiced immorality with boys for about seventeen
  years, by practicing masturbation on them, and by inducing them to
  carry out the act on himself. The accused, a respected officer, is
  overcome by the terrible crime attributed to him, and declares that he
  knows nothing of the deeds of which he is accused. His mental
  integrity is questionable. His family physician, who has known him
  twenty years, emphasizes his peculiar, retiring disposition and his
  mercurial moods. His wife asserts that T. once tried to throw her in
  the water, and that he sometimes had outbreaks in which he tore off
  his clothing, and tried to throw himself out of windows. T. knew
  nothing of these attacks. Other witnesses testified to strange changes
  of mood and peculiarities of character. A physician reports the
  observation of occasional attacks of vertigo and convulsions in him.

  T.’s grandmother was insane; his father was affected with chronic
  alcoholism, and of late years had had epileptiform attacks. The
  father’s brother was insane, and had killed a relative while in a
  delirious state. Another uncle of T. had killed himself. Of T.’s three
  children, one was weak-minded, another cross-eyed, and the third was
  subject to convulsions. The accused asserted that he had occasional
  attacks in which consciousness was so reduced that he did not know
  what he was about. These attacks were ushered in by an aura-like pain
  in the back of his neck. He was then impelled to go out in the air. He
  did not know where he went. His wife had perfectly satisfied him
  sexually. For eighteen years he had had chronic eczema (actual) of the
  scrotum, which had often caused him to have extraordinary sexual
  excitement. The opinions of the six experts were contradictory
  (sane,—attacks of larvated epilepsy); the jury disagreed, so that he
  was dismissed. Dr. Legrand du Saulle, who was called as an expert
  witness, found that, until his twenty-second year, T. had urinated in
  bed from ten to eighteen times a year. After that time the enuresis
  nocturna had ceased; but, from that time, states of mental confusion,
  lasting from an hour to a day, had occurred occasionally, and they
  left the patient without any memory of them. Soon again T. was
  arrested for public immorality, and sentenced to imprisonment for
  fifteen months. In prison he grew sick, and apparently much weaker
  mentally. For this reason he was pardoned, but the mental weakness
  increased. T. was noticed to have repeated epileptoid convulsions
  (tonic convulsion with tremor and loss of consciousness). (Auzouy,
  _Annal. méd. psychol._, 1874, Nov.; Legrand du Saulle, “Étude méd.
  légale,” etc., p. 99.)

The following case of immoral acts with children, observed by the author
and reported in _Friedreich’s Blätter_, will serve to conclude this
group,[123] so important in its legal bearings. It is the more
important, in that a state of unconsciousness was established at the
time of the act, and because, for allied reasons, the facts related in
Latin show how a complicated and refined act becomes possible in such a
state of unconsciousness.

  Case 160. P., aged 49; married; hospital beneficiary. He was accused
  of having committed the following terrible acts with two girls—D.,
  aged ten, and G., aged nine,—whom he had taken to his work-shop on May
  25, 1883.

  D. testifies: “I was in the meadow with G. and my sister J., aged
  three. P. called us into his shop and fastened the door. Tum nos
  exosculabatur, linguam in os meum demittere tentabat faciemque mihi
  lambebat; sustulit me in gremium, bracas aperuit, vestes meas
  sublevavit, digitis me in genitalibus titillabat et membro femina mea
  fricabat ita ut humida fierem. When I cried, he gave me twelve
  kreuzers, and threatened to shoot me if I told on him. At last he
  tried to persuade me to come again the next day.”

  G. testified: “P. nates et genitalia D. æ exosculatus, iisdem me
  conatibus aggressus est. Deinde filiolum quoque tres annos natum in
  manus acceptum osculatus est nudatumque parti suæ virili appressit.
  Postea quæ nobis essent nomina interrogavit ac censuit, genitalia D. æ
  meis multo esse majora. Quin etiam nos impulit, ut membrum suum
  intueremur, manibus comprehenderemus et videremus, quantopere id esset
  erectum.”

  At his examination, May 29th, P. said he had but an indistinct
  recollection of having fondled, caressed, and made presents to a
  little girl a short time before. If he had done anything more, it must
  have been in an irresponsible condition. Besides, he had suffered for
  years with weakness in his head, as result of an injury. On June 22d
  he knew nothing of the events of May 25th, and nothing of his
  examination on May 29th. This amnesia was shown, also, on
  cross-examination.

  P. comes of a family affected with cerebral disease; a brother was
  epileptic. P. was formerly a drinker. Years before, he had actually
  suffered an injury to his head. Since then, from time to time, he has
  had attacks of mental disturbance, introduced by moroseness,
  irritability, tendency to alcoholic excesses, apprehension, and
  delusions of persecution sufficient to induce threats and deeds of
  violence. At the same time, he would have auditory hyperæsthesia,
  vertigo, headache, and cerebral congestion,—all this, with great
  mental confusion and amnesia for the whole period of the attack, which
  would sometimes last for weeks.

  During the intervals he was subject to headache, which started from
  the seat of injury on the head (a small scar in the skin over the
  right temple), which was painful on pressure. With exacerbation of the
  headache, he became very irritable, morose to an extent that inclined
  him to suicide, and mentally like one drunk. In 1879, while in such a
  state, he made an impulsive attempt at suicide, of which he afterward
  had no memory. Soon after this, being sent to hospital, he gave the
  impression of being epileptic, and, for a long time, was treated with
  pot. bromide. At the end of 1879 he was taken to the infirmary, no
  actual epileptic attack having been observed.

  During his lucid intervals he was a virtuous, industrious,
  good-natured man, and had never shown any sexual excitement; and,
  until this time, never sexual inclinations, even during his mental
  confusion. Moreover, until lately, he had lived with his wife. At the
  time of the criminal act, he had shown signs of an approaching attack,
  and had asked the physician to prescribe pot. bromide.

  P. asserted that, since the injury to his head, he had been intolerant
  of heat and alcohol, which immediately brought on headache and
  confusion. The medical examination proved the truth of his assertions
  about mental weakness, irritability, and poor sleep.

  If pressure were made at the seat of the trauma, P. became congested,
  irritable, confused, and trembled all over; he appeared excited;
  consciousness was disturbed, and remained so for hours.

  At times, when he is free from the sensations that start from the
  scar, he seems kind, free, willing, and open, though he is mentally
  weak and cloudy. P. was not sentenced. (_Vide Friedreich’s Blätter_
  for full report.)


                          PERIODICAL INSANITY.

Just as in cases of non-periodical mania, an abnormal intensity or a
noticeable prominence of the sexual sphere is very often manifested in
the periodical attacks (_v. infra_, “Mania”).

The following case, reported by Servaes (_Arch. f. Psych._), shows that
it then may also be perverted:—

  Case 161. Catharine W., aged 16; she has not yet menstruated;
  previously healthy.

  Seven weeks before admission (December 3, 1872), melancholic
  depression and irritability. November 27th, maniacal outbreak, lasting
  two days; thereafter, melancholic. December 6th, normal condition.

  December 24th (twenty-eight days after the first maniacal attack),
  silent, shy, depressed. December 27th, exaltation (jolly, laughing,
  etc.), with violent love for an attendant (female). December 31st,
  suddenly melancholic catalepsy, which disappeared after two hours.
  January 20, 1873, new attack like the previous one. A similar one on
  February 18th, with traces of menses. The patient had no memory
  whatever for what occurred in the paroxysms, and blushed scarlet with
  astonishment and shame when told about them.

  Thereafter there were abortive attacks, which entirely disappeared, to
  give place to the normal mental condition in June.

In a case reported by Gock (_Arch. f. Psych._, v), which was probably
circular insanity, in a man of very bad heredity, during the stage of
exaltation there was manifestation of sexual feeling for men. In this
case, however, the patient thought himself a girl, and it is
questionable whether the sexual inclination was induced by the delusion
or by a contrary sexual instinct.

In connection with these cases of abnormal manifestation of the sexual
instinct are those which, as a symptom of mania, manifest an abnormal
and frequently a perverse sexual instinct in an impulsive way, analogous
to dipsomania, which forms the nucleus of the psychical disturbance,
while in the intervals the sexual instinct is neither intense nor
perverse.

Quite a pure case of such periodical psychopathia sexualis, connected
with the process of menstruation, is the following, reported by Anjel
(_Arch. f. Psych._, xv, H. 2):—

  Case 162. A quiet lady, near the climacteric. Very bad heredity. In
  her youth, attacks of petit mal. Always eccentric, quick-tempered;
  very moral; childless marriage.

  Several years ago, after a violent emotional disturbance, a
  hystero-epileptic attack, with post-epileptic insanity of several
  weeks’ duration. Thereafter there was sleeplessness for several
  months. Following this, there was always menstrual insomnia, and the
  impulse to embrace and kiss boys of ten, and fondle their genitals.
  During this excitement there was no desire for coitus; certainly not
  for intercourse with adults.

  The patient often speaks openly of this impulse, and asks to be
  watched, as she is not to be trusted. In the intervals she anxiously
  avoids all talk of it, is very modest, and in nowise passionate
  sexually.

  With reference to the still imperfectly-known cases of periodical
  psychopathia sexualis of this kind, Tarnowsky (_op. cit._, p. 38) has
  made valuable contributions, though his cases were not all of a
  periodic nature; and one of the cases, taken from a work of the
  author’s, is not rightly understood (Case 8, p. 37), since sodomy was
  only subsidiary, and the abnormal intense libido sexualis was not
  periodic.

  Tarnowsky reports cases where married, cultured men, the fathers of
  families, were, from time to time, compelled to perform the most
  terrible sexual acts, while during the intervals they were sexually
  normal, abhorred their paroxysmal sexual acts, and shuddered before
  the expectation of their repetition.

  If a new paroxysm came on, the normal sexual instinct disappeared; a
  state of mental excitement arose with insomnia, and thoughts and
  impulses to commit the perverse sexual acts, with anxious confusion
  and an increasing impulse to the abhorred indulgence. In this state
  the act was a relief, because it ended the condition. The analogy with
  dipsomania is complete.

For other cases (of periodical pederasty), _vide_ Tarnowsky, _op. cit._,
p. 41. The case there reported, on page 46, belongs in the category of
epilepsy.

The following case, reported by Anjel (_Arch. f. Psych._, xv, H. 2), is
one of the most typical of the convulsive-like occurrence of sexual
excitement:—

  Case 163. A gentleman of high social position, aged 45; generally
  respected and beloved; heredity good; very moral; married fifteen
  years. Previously normal sexually; the father of several healthy
  children, and living in happy matrimony. Eight years ago he suffered a
  violent fright. For some weeks thereafter he had a feeling of
  apprehension and cardiac attacks. Then came attacks, at intervals of
  several months or a year, of what the patient called his “moral
  catarrh.” He became sleepless. After three days, loss of appetite,
  increasing irritability, strange appearance; fixed stare, staring into
  space; paleness, changing with redness; tremor of the fingers; red,
  shining eyes, with peculiar glassy expression; and violent, quick
  manner of speech. There was a desire for girls of from five to ten
  years, even for his own daughters. He would beg his wife to guard the
  children. For days at a time, while in this state, he would shut
  himself in his room. Previously he was compelled to pass school-girls
  on the street, and he found a peculiar pleasure in exposing his
  genitals before them, by acting as if about to urinate.

  For fear of exposure, he shuts himself in his room, full of desire,
  incapable of movement, and torn by feelings of fear. Consciousness
  seems to be undisturbed. The attacks last from eight to fourteen days.
  The cause of their return is not clear. Improvement is sudden; there
  is great desire for sleep, and, after this is satisfied, he is again
  well. In the interval there is nothing abnormal. The author assumes an
  epileptic foundation, and considers the attacks to be the psychical
  equivalents of epileptic convulsions (!).

_Mania._—With the general excitation that here exists in the psychical
organ, the sexual sphere is likewise often implicated. In maniacal
individuals of the female sex, this is the rule. In certain cases, it
may be questionable whether the instinct, which, in itself, is not
intensified, is simply recklessly manifested, or whether it is present
in actual abnormal intensity. For the most part, the latter is the true
assumption,—certainly so where sexual delusions and their religious
equivalents are constantly expressed. In accordance with the degrees of
intensity of the disease, the intensified instinct is expressed in
different forms.

In simple maniacal exaltation in men, courting, frivolity, and
lasciviousness in speech, and frequenting of brothels, are observed; in
women, inclination for the society of men, personal adornment, perfumes,
talk of marriage and scandals, suspicion of the virtue of other women;
or there is manifested the religious equivalent,—pilgrimages, missionary
work, desire to go into a cloister or to become the servant of a priest;
and in this case there is much talk about innocence and virginity.

At the height of mania there may be seen invitations to coitus,
exhibition, obscenity, great excitation at sight of women, tendency to
smear the person with saliva, urine, and even fæces; religio-sexual
delusions,—to be under the protection of the Holy Ghost, to have given
birth to Christ, etc.; open onanism, and pelvic movements of coitus.

In maniacal men care must be taken to prevent shameless masturbation and
sexual attacks on women.


                      SATYRIASIS AND NYMPHOMANIA.

States of mental excitement, in which an abnormal intense sexual impulse
is prominent, are called satyriasis (in males) and nymphomania (in
women), or uteromania.

Moreau considers these cases peculiar to themselves, but he is certainly
in error. The sexual complexus of symptoms is always but the partial
manifestation of a general psychosis (mania, hallucinatory insanity?).

The essential element of the state of sexual excitement is a condition
of psychical hyperæsthesia with involvement of the sexual sphere. The
imagination calls up only sexual images, which may lead to
hallucinations, illusions, and true hallucinatory delirium.

The most indifferent ideas excite sensual association, and the lustful
coloring of the ideas and apperceptions is very much intensified.

The abnormal state of consciousness implicates the whole course of
feeling and desire, and is accompanied by general physical excitement
like that that accompanies coitus (v. “Physiology”). Often the genitals
are in a constant state of turgor (priapism in males).

The man affected with this sexual passion seeks to satisfy his desire at
any price, and, therefore, becomes very dangerous to women. _Faute de
mieux_, he practices onanism or sodomy. The nymphomaniacal woman seeks
men by exhibition, or to attract them by her sensual conduct; at the
sight of men she is intensely excited sexually, and satisfies herself by
masturbation, or by pelvic movements of coitus.

Satyriasis is infrequent. Nymphomania is more frequently observed, and
not seldom in the climacteric. It may occur in senility.
Abstinence,[124] with constant excitation of the sexual sphere as a
result of psychical or peripheral irritation (pruritus pudendi, oxyuris,
etc.), may cause these conditions, but probably only in those
predisposed.

The assertion that it may also result from poisoning by cantharides
seems to depend upon confounding it with priapism. The primary lustful
feeling that accompanies priapism due to cantharides soon becomes
painful. Satyriasis and nymphomania are acute abnormal psycho-sexual
states.

There are also cases that, not without reason, might be called chronic
satyriasis or nymphomania. To these belong the men who, for the most
part as a result of abusus veneris, or more particularly of
masturbation, suffer with neurasthenia sexualis, and at the same time
have intense libido sexualis. The imagination, as in acute cases, is in
a state of excitement, and the mind full of obscene images; so that the
most elevated ideas are besmirched with the most cynical images and
thoughts.

The thought and desire of such men are solely directed to the sexual
sphere; and since their flesh is weak, led on by their fancy, they come
to indulge in the grossest perversions of the sexual act.

Analogous cases in women may be called chronic nymphomania. They
naturally lead to prostitution. Legrand du Saulle (“La folie,” p. 510)
reports interesting cases which apparently are pure.

_Melancholia._—The thoughts and feelings of melancholiacs are not
favorable for the excitation of sexual desires. At the same time, these
patients sometimes masturbate. In my experience such cases have always
been hereditarily predisposed and previously given to onanism. The act
did not seem to be so much due to a lustful desire as to be induced by
habit, _ennui_, anxiety, and the impulse to change temporarily the
painful mental condition.

_Hysteria._—In this neurosis the sexual life is very frequently
abnormal; indeed, always in predisposed individuals. All the possible
anomalies of the sexual function may occur here, with sudden changes and
peculiar activity; and, on an hereditary degenerate basis and in moral
imbecility, they may appear in the most perverse forms. The abnormal
change and inversion of the sexual feeling are never without effect upon
the patient’s disposition.

The following case, reported by Giraud, is one of this nature worthy of
repetition:—

  Case 164. Marian L., of Bordeaux. At night, while the household was
  asleep under the influence of narcotics she had administered, she had
  given the children of the house to her lover for sexual enjoyment, and
  had looked on at the immoral acts. It was found that L. was hysterical
  (hemianæsthesia and convulsive attacks), but before her illness she
  had been a moral, trustworthy person. Since her illness she had become
  a shameless prostitute, and lost all moral sense.

In the hysterical the sexual sphere is often abnormally excited. This
excitement may be intermittent (menstrual?). Shameless prostitution,
even in married women, may result. In a milder form the sexual impulse
expresses itself in onanism, going about in a room naked, smearing the
person with urine and other things, or wearing male attire, etc.

Schüle (_Klin. Psychiatrie_, 1886, p. 237) finds very frequently an
abnormally intense sexual impulse “which disposes girls, and even women
living in happy marriage, to become Messalinas.”

The author cited knows cases in which, on the wedding-journey, attempts
at flight with men, who had been accidentally met, were made; and
respected wives who entered into _liaisons_, and sacrificed everything
to their insatiable impulse.

In hysterical insanity the abnormally intense sexual impulse may express
itself in delusions of jealousy, unfounded accusations against men for
immoral acts,[125] hallucinations of coitus,[126] etc.

Occasionally frigidity may occur, with absence of lustful feeling,—due,
for the most part, to genital anæsthesia.

_Paranoia._—Abnormal manifestations in the sexual sphere, in the various
forms of paranoia, are not infrequent. Many of these cases are developed
on sexual abuse (masturbatic paranoia) or sexual excitement; and,
according to experience, in individuals psychically degenerate, with
other functional signs of degeneracy, the sexual sphere is, for the most
part, deeply implicated.

In paranoia religiosa and erotica the abnormally intense and, under
certain circumstances, perverse sexual instinct is most clearly
manifested. In the first variety, however, the condition of sexual
excitation is expressed not so much in a direct method of satisfaction
of the sexual desires as (there are exceptions) in platonic love,—in
enthusiastic admiration of a person of the opposite sex who is pleasing
æsthetically. Under certain circumstances, the enthusiasm is for a
fanciful person, a portrait, or a statue.

A love for the opposite sex that is weak and purely mental, too, often
has its basis in weakness of the genitals due to long-continued
masturbation; and, under the guise of virtuous admiration of a beloved
person, great lasciviousness and sexual perversion are often concealed.
Episodically, especially in women, violent sexual excitement may occur
as a nymphomania.

For the most part, paranoia religiosa rests upon sexuality which
manifests itself in a sexual impulse that is abnormally early and
intense. The libido finds satisfaction in masturbation or religious
enthusiasm, the object of which may be a certain minister, saint, etc.

The psycho-pathological relations between the sexual and religious
domains have been described in detail on p. 8 _et seq._

Apart from masturbation, sexual crimes are relatively frequent in
religious paranoia.

Marc’s work (p. 160) contains a remarkable example of religious
insanity.

Giraud (_Annal. méd. psychol._) has reported a case of rape of a little
girl by a religious paranoiac, aged 43, who was temporarily erotic.
Here, also, belongs a case of incest (Liman, _Vierteljahrsschr. f. ger.
Med._).

  Case 165. M. impregnated his daughter. His wife, mother of eighteen
  children, and herself pregnant by her husband, lodged the complaint.
  M. had had religious paranoia for two years. “It was revealed to me
  that I should beget the Eternal Son with my daughter. Then a man of
  flesh and blood would arise by my faith, who would be eighteen hundred
  years old. He would be a bridge between the Old and New Testaments.”
  This command, which he deemed divine, was the cause of his insane act.

Sexual acts that have a pathological motive sometimes occur in
persecutory paranoia.

  Case 166. A married woman of thirty had, by means of money and
  sweetmeats, enticed a boy of five, who played near her, handled his
  genitals, and then attempted coitus. She was a teacher, who had been
  betrayed and then cast off. Previously moral, for some time she had
  given herself to prostitution. The explanation of her immoral change
  was given, when it was found that she had various delusions of
  persecution, and thought she was under the secret influence of her
  seducer, who impelled her to sexual acts. She also believed that the
  boy had been put in her way by her seducer. Coarse sensuality as a
  motive for her crime came less into consideration, as it would have
  been easy for her to satisfy sexual desire in a natural way. (Küssner,
  _Berl. klin. Wochenschrift._)

Cullerre (“Perversions sexuelles chez les persécutés,” in _Annal.
médico-psychol._, March, 1886) has reported similar cases,—the case of a
patient who, suffering with paranoia sexualis persecutoria, tried to
violate his sister, giving as a reason that the impulse was given him by
Bonapartists.

In another case a captain, suffering with delusions of persecution by
electro-magnetism, was driven to pederasty,—a thing he abhorred. In a
similar case the persecutor impelled to onanism and pederasty.




            V. PATHOLOGICAL SEXUALITY IN ITS LEGAL ASPECTS.


The laws of all civilized nations punish those who commit perverse
sexual acts. Inasmuch as the preservation of chastity and morals is one
of the most important reasons for the existence of the commonwealth, the
state cannot be too careful, as a protector of morality, in the struggle
against sensuality. This contest is unequal; because only a certain
number of the sexual crimes can be legally combated, and the infractions
of the laws by so powerful a natural instinct can be but little
influenced by punishment. It also lies in the nature of the sexual
crimes, that but a part of them ever reach the knowledge of the
authorities. Public sentiment, in that it looks upon them as
disgraceful, lends much aid.

Criminal statistics prove the sad fact that sexual crimes are
progressively increasing in our modern civilization.[127] This is
particularly the case with immoral acts with children under the age of
fourteen. The moralist sees in these sad facts nothing but the decay of
general morality, and in some instances comes to the conclusion that the
present mildness of the laws punishing sexual crimes, in comparison with
their severity in past centuries, is in part responsible for this.

The medical investigator is driven to the conclusion that this
manifestation of modern social life stands in relation to the
predominating nervousness of later generations, in that it begets
defective individuals, excites the sexual instinct, leads to sexual
abuse, and, with continuance of lasciviousness associated with
diminished sexual power, induces perverse sexual acts.

It will be clearly seen, from what follows, how such an opinion is
justified, especially with respect of the increasing number of sexual
crimes committed on children. It is at once evident, from what has gone
before, that neuropathic, and even psychopathic, states are largely
determinate for the commission of sexual crimes. Here nothing less than
the responsibility of many of the men who commit such crimes is called
in question.

Psychiatry cannot be denied the credit of having recognized and proved
the psycho-pathological significance of numerous monstrous, paradoxical
sexual acts. Law and Jurisprudence have thus far given but little
attention to the facts resulting from investigations in psychopathology.
Law is, in this, opposed to Medicine, and is constantly in danger of
passing judgment on individuals who, in the light of science, are not
responsible for their acts.

Owing to this superficial treatment of acts that deeply concern the
interests and welfare of society, it becomes very easy for justice to
treat a delinquent, who is as dangerous to society as a murderer or a
wild beast, as a criminal, and, after punishment, release him to prey on
society again; on the other hand, scientific investigation shows that a
man mentally and sexually degenerate _ab origine_, and therefore
irresponsible, must be removed from society for life, but not as a
punishment.

A judge who considers only the crime, and not its perpetrator, is always
in danger of injuring not only important interests of society (general
morality and safety), but also those of the individual (honor).

In no domain of criminal law is co-operation of judge and medical expert
so much to be desired as in that of sexual delinquencies; and here only
anthropological and clinical investigation can afford light and
knowledge. The nature of the act can never, in itself, determine a
decision as to whether it lies within the limits of mental pathology, or
within the bounds of mental physiology. The perverse act does not
indicate perversion of instinct. At any rate, the most monstrous and
perverse sexual acts have been committed by persons of sound mind. The
perversion of feeling must be shown to be pathological. This proof is to
be obtained by learning the conditions attending its development, and by
proving the existence of a general neuropathic or psychopathic
condition.

The _species facti_ is important; but it allows, however, only
presumptions, since the same sexual act, according as it is committed by
an epileptic, paralytic, or a man of sound mind, takes on other features
and peculiarities, in accordance with the manner in which it is done.

Periodical recurrence of the act under identical circumstances, and an
impulsive manner in carrying it out, give rise to weighty presumptions
that it is of pathological significance. The decision, however, must
follow after referring the act to its psychological motive
(abnormalities of thought and feeling), and after showing this
elementary anomaly to be but one symptom of a general neuropathic
condition,—either an arrest of mental development, or a condition of
psychical degeneration, or a psychosis.

The cases discussed in the portion of this work devoted to general and
special pathology will certainly be useful to the medical expert, in
assisting him to discover the motive of the act. To obtain the facts
necessary to allow a decision of the question whether immorality or
abnormality occasioned the act, a medico-legal examination is
required,—an examination which is made according to the rules of
science; which takes account of both the past history of the individual
and the present condition,—the anthropological and clinical data.

The proof of the existence of an original, congenital anomaly of the
sexual sphere is important, and points to the need of an examination in
the direction of a condition of psychical degeneration. An acquired
perversity, to be pathological, must be found to depend upon a
neuropathic or psychopathic state.

Practically, paretic dementia and epilepsy must first come to mind. The
decision concerning responsibility will depend on the demonstration of
the existence of a psychopathic state in the individual convicted of a
sexual crime.

This is indispensable, to avoid the danger of covering simple immorality
with the cloak of disease.

Psychopathic states may lead to crimes against morality, and at the same
time remove the conditions necessary to the existence of responsibility,
under the following circumstances:—

1. To oppose the normal or intensified sexual desire, there may be no
moral or legal notions, owing to (_a_) the fact that they may never have
been developed (states of congenital mental weakness); or to (_b_) the
fact that they have been lost (states of acquired mental weakness).

2. When the sexual desire is increased (states of psychical exaltation)
and consciousness simultaneously clouded, the mental mechanism is too
much disturbed to allow the opposing ideas, virtually present, to exert
their influence.

3. When the sexual instinct is perverse (states of psychical
degeneration). It may, at the same time, be intensified.

Cases of sexual delinquency that occur outside of states of mental
defect, degeneration, or disease, can never be excused on the ground of
irresponsibility.

In many cases, instead of an abnormal psychical condition, a neurosis
(local or general) is found. Inasmuch as the transitions from a neurosis
to a psychosis are easy, and elementary psychical disturbances are
frequent in the former, and constant in profound perversion of the
sexual life, the neurotic affection—_e.g._, impotence, irritable
weakness, etc.—exerts an influence on the motive of the incriminating
act; and a just judge, notwithstanding the lack of legal
irresponsibility due to mental defect or disease, will recognize the
circumstances which ameliorate the heinousness of the crime.

For various reasons the practical jurist will, in all cases of sexual
crimes, call medical experts to make a psychiatric examination.

To be sure, his own conscience and judgment must be the guides when
necessity makes them his only reliance. Under the following
circumstances _indices_ are given which point to a pathological
condition:—

The accused is senile. The sexual crime is committed openly, with
remarkable cynicism. The manner of obtaining sexual satisfaction is
silly (exhibition), or cruel (mutilation or murder), or perverse
(necrophilia, etc.).

From what experience teaches, it may be said that, among the sexual acts
that occur, rape, mutilation, pederasty, _amor lesbicus_, and bestiality
may have a psycho-pathological basis.

In case of lust-murder,—in as far as it goes beyond murder itself,—and
likewise in case of mutilation of corpses, psychopathic conditions are
probable.

Exhibition and mutual masturbation make pathological states seem very
probable. Masturbation of another and passive onanism may occur in
connection with senile dementia and contrary sexual feeling, but also
with mere sensuality.

Cunnilingus and fellare (penem in os mulieris arrigere) have not thus
far been shown to depend upon psycho-pathological conditions.

These horrible sexual acts seem to be committed only by sensual men who
have become satiated or impotent from excessive indulgence in a normal
way. Pædicatio mulierum does not seem to be psychopathic, but rather a
practice of married men of low morality, who wish to prevent pregnancy;
and of satiated cynics in non-marital sexual indulgence.

The practical importance of the subject makes it necessary that the
sexual acts threatened with punishment as sexual crimes be considered by
jurists from the stand-point of the medico-legal expert. Thus there is
an advantage gained, in that the psycho-pathological acts, according to
circumstances, are placed in the right light by comparison with
analogous acts that fall within the domain of physiological psychology.


         1. OFFENSE AGAINST MORALITY IN THE FORM OF EXHIBITION.

 (Austrian Statutes, § 516; Abridgment, § 195. German Statutes, § 183.)

In man’s present condition of civilization, modesty is a characteristic
and motive so firmly fixed by centuries of education that presumption of
a psycho-pathological element necessarily arises when public decency is
coarsely offended.

The presumption is justifiable that an individual who in this way has
offended public decency and his own self-respect was incapable of moral
feeling (idiots); or that it has been lost (states of acquired mental
weakness); or that he has acted while in a clouded state of
consciousness (transitory insanity, states of partial consciousness).

A very distinctive act which belongs here is that of _exhibition_
(exposure). The cases thus far recorded are exclusively those of men who
ostentatiously expose their genitals to persons of the opposite sex, in
some instances following them, without, however, becoming aggressive.

The silly manner of this sexual activity, or really sexual
demonstration, points to intellectual and moral weakness; or, at least,
to temporary inhibition of the intellectual and moral functions, with
excitation of libido dependent upon a decided disturbance of
consciousness (abnormal unconsciousness, mental confusion); and, at the
same time, the virility of these individuals is called in question. Thus
there are various categories of exhibitionists.

The first category includes states of mental weakness in which, owing to
the causative cerebral (or spinal) disease, consciousness is clouded,
and the ethical and intellectual functions are interfered with; and in
which there can be no opposition made to a sexual desire that has either
always been intense, or that has been intensified by the
disease-process. At the same time, impotence exists, and no longer
permits expression of the sexual instinct in violent acts (rape), but
only in acts that are silly.

The majority of reported cases[128] fall in this category. They are
those of individuals afflicted with senile dementia, paretic dementia,
or mental defects due to alcoholism, epilepsy, etc.

  Case 167. Z., high official, aged 60; widower; father of a family. He
  had excited offense in that, during fourteen days, he had repeatedly
  exposed his genitals at his window, to a girl of eight years who lived
  opposite him. After a few months, under like circumstances, this man
  repeated his indecent act. At his examination he acknowledged the
  depravity of his action, and could give no excuse for it. Death, a
  year later, due to cerebral disease. (Lasègue, _op. cit._)

  Case 168. Z., aged 78; seaman. He had repeatedly exhibited his
  genitals on children’s play-grounds, and in the neighborhood of girls’
  schools. This was the only way in which he was active sexually. He was
  married, and the father of ten children. Twelve years before, he had
  suffered a severe head-injury, since which he had had a deep scar,
  which indented the bone. Pressure on this scar caused pain; at the
  same time his face would flush, his expression become fixed, and he
  would grow somnolent, with convulsive movements in the right upper
  extremity (apparently epileptoid state in connection with cortical
  disease). Besides, there was senile dementia and advanced senium. It
  is not reported whether the exhibition coincided with epileptoid
  attacks or not. Senile dementia proved; pardoned. (Dr. Schuchardt,
  _op. cit._)

Pelanda (_op. cit._) has reported a number of cases of this kind:—

  1. Paralytic, aged 60. At the age of fifty-eight he began to exhibit
  himself to women and children. In the asylum at Verona, for a long
  time thereafter, he was lascivious and also attempted _fellatio_.

  2. A drinker, aged 66, suffering with folie circulaire. His exhibition
  was first noticed in church during divine service. His brother was
  likewise an exhibitionist.

  3. A drinker, predisposed, aged 49. He was always very excitable
  sexually; in an asylum on account of chronic alcoholism. He exhibited
  himself whenever he saw a woman.

  4. A man, aged 64; married; father of fourteen children. Great
  predisposition. Rachitic, microcephalic head. For years he had been an
  exhibitionist, in spite of repeated punishment.

  Case 169. X., merchant, born in 1833; single. He had repeatedly
  exhibited himself to children, or even urinated at the same time;
  once, under these circumstances, he had kissed a little girl, driving
  her away. Twenty years previously X. had had a severe attack of mental
  disease, lasting two years, in which he is said to have had an
  apoplectic attack. Later, after loss of his fortune, he gave himself
  to drink, and of late years had often appeared absent-minded. His
  condition was that of alcoholism, senium præcox, and mental weakness.
  Penis small; phimosis; testicles atrophic. Proof of mental disease;
  pardoned. (Dr. Schuchardt, _op. cit._)

Such cases recall the lasciviousness of youthful, sexuallyexcited
persons that are still more or less boyish; but also that of many mature
cynics of low morality, who find pleasure in defiling the walls of
public closets, etc., with drawings of male and female genitals,—a kind
of ideal exhibition which, however, is still widely separated from
actual exhibition.

Another category of exhibitionists is made up of epileptics. This
category is essentially to be distinguished from the foregoing, in that
a conscious motive for the exhibition is wanting; and it appears much
more like an impulsive act which, without any consideration of external
circumstances, is performed as if it were an abnormal organic necessity.

At the time of the act there is always a state of imperfect
consciousness; and thus is explained the fact that the unfortunate
individual, without consciousness of the meaning of his act, or, at
least, without cynicism, does it in obedience to a blind impulse. On
regaining consciousness, he regrets and abhors it if there is not
permanent mental weakness.

The prime motive in this state of imperfect consciousness, as with other
impulsive acts, is a feeling of apprehensive oppression. If a sexual
feeling become associated with it, then the ideas are given a certain
direction in the sense of a corresponding (sexual) act.

How sexual ideas very easily arise temporarily in epileptics may be
understood from the discussion under “Epilepsy.”

If, however, such an association has once been formed; if a particular
act has taken place in an attack,—it is the more easily repeated in
every subsequent attack; for, so to speak, a known tract has been
established in the path of motivity.

The feeling of anxiety, with the state of imperfect consciousness,
causes the associated sexual impulse to appear as a command,—an inner
force, which is acted upon in a purely impulsive manner and in a state
of absolute irresponsibility.

  Case 170. K., a subordinate official, aged 29; of neuropathic family;
  living in happy marriage, and the father of one child. He has
  repeatedly, especially at dusk, exhibited himself to servant-girls. K.
  is tall, slim, pale, nervous, and hasty in manner. _There is imperfect
  memory of the crimes._ Since childhood there have been frequent severe
  congestive attacks, with intense flushing of the face, a rapid, tense
  pulse, and a fixed, absent stare. At the same time there were, now and
  then, confusion and vertigo. In this (epileptic) exceptional state K.
  would answer only after repeated questioning, and then _it was as if
  he were waking from a dream_. K. states that he has always felt
  excited and restless for some hours before his criminal acts, and
  experienced a feeling of fear, with oppression, and congestion of the
  head. In this condition he had often been giddy, and experienced an
  indistinct feeling of sexual excitement. At the height of such states
  he had left the house, without any purpose in view, and exposed his
  genitals anywhere. When he had reached home again, he had had but a
  dreamy remembrance of what had occurred, and felt very weak and
  depressed. It is also remarkable that, while exhibiting his genitals,
  he had used lighted matches to make them visible. The opinion was to
  the effect that the criminal acts depended upon epilepsy, and were
  imperative impulses; but he was, nevertheless, sentenced, with the
  assumption of extenuating circumstances. (Dr. Schuchardt, _op. cit._).

  Case 171. L., aged 39; single; tailor. His father was probably a
  drinker; he had two epileptic brothers, one of whom was insane. The
  patient himself has slight epileptic attacks, and from time to time
  states of imperfect consciousness, in which he runs about aimlessly,
  and thereafter does not know where he has been. He was considered a
  moral man, but he is now accused of having exhibited and played with
  his genitals in a strange house five or six times. His memory of these
  acts was very imperfect.

  On account of repeated desertion from the army (probably likewise in
  epileptic states of imperfect consciousness), L. had been severely
  punished. In imprisonment he became insane with “epileptic insanity,”
  was sent to the Charité, and from there discharged “cured.” As far as
  the criminal acts were concerned, cynicism and wantonness could be
  excluded. That they were committed in a state of imperfect
  consciousness is probable from the fact, among other things, that to
  the policeman who arrested him, the “imbecile,” who was then in a
  cloudy state of consciousness, was in a remarkable mental state.
  (Liman, _Vierteljahrsschrift f. ger. Med._, N. F. xxxviii, H. 2.)

  Case 172. L., aged 37. From October 15th to November 2d, he had many
  times given offense, by exhibiting himself to girls in daylight on the
  open street, and even in schools, into which he forced himself. It
  happened occasionally that he wanted the girls to perform
  manustupration or allow coitus, and, when refused, he performed
  masturbation before them. In G., in a public-house, he rapped on the
  window, with his penis exposed, so that the children and servant-girl
  in the kitchen were forced to see it.

  After his arrest it was ascertained that since 1876 L. had very
  frequently caused trouble by exhibitions, but had always escaped
  punishment, owing to the demonstration of mental disease by
  physicians. On the other hand, he had been punished for desertion and
  theft in the army, and, later, once, as a civilian, for stealing
  cigars. L. had repeatedly been in asylums on account of insanity
  (attacks of insanity). Besides, he was often remarkable on account of
  his changeable, quarrelsome character, occasional excitement, and
  inconstancy.

  L.’s brother died of paralysis. He himself presents no degenerative
  signs; no epileptic antecedents. During the time of observation he is
  neither insane nor mentally weakened. He behaves himself very well,
  and expresses great regret for his sexual crimes. About himself he
  states that, though no drinker, he occasionally has an impulse to
  drink. Soon after beginning, congestion of the head, vertigo,
  restlessness, anxiety, and oppression come on. He then passes into a
  dreamy state. An irresistible impulse now forces him to expose
  himself; and he then experiences a feeling of relief and breathes more
  easily. When he has once exposed himself, he knows nothing more of
  what he does. As precursors of such attacks, he had often, a short
  time before, had flames before the eyes, and vertigo. For the time of
  his clouded state of consciousness, he had but a clouded, dreamy
  memory.

  It was only after a time that sexual ideas and impulses had become
  associated with these apprehensive, cloudy states of consciousness.
  Years ago, in such states, without motive and with great danger, he
  had deserted; once he had jumped from a third-story window; on another
  occasion he had left a good position to wander about aimlessly in a
  neighboring country, where he was at once arrested for exhibition.

  When, outside of his abnormal periods, L. once became intoxicated,
  there was no exhibition. In the lucid state his sexual feeling and
  intercourse are perfectly normal. (Dr. Hotzen, _Friedreich’s Blätter_,
  1890, H. 6). For other instances, _vide_ Cases 153, 155.

A clinical group that very nearly approaches the epileptic
exhibitionists is made up of certain neurasthenic individuals, in whom,
likewise, there may occur attacks (epileptoid?) of imperfect
consciousness[129] in connection with a feeling of apprehensive
oppression; and with this sexual impulses may be associated, resulting
in acts of exhibition having an impulsive character.

  Case 173. Dr. S., academic teacher, had aroused public indignation by
  being seen repeatedly running about in the Zoological Garden at
  Berlin, before ladies and children, with his genitals hanging out. S.
  admitted this, but denied all thought or consciousness of causing
  public offense, and excused himself by saying that his running about
  with exposed genitals afforded him relief from nervous excitement.
  Mother’s father was insane, and died by suicide; his mother was
  constitutionally neuropathic, a somnambulist, and had been temporarily
  insane. The culprit was neuropathic, had been a somnambulist, and had
  had continuous aversion to sexual intercourse with females. In his
  youth he practiced onanism. He was a neurasthenic man, shy, torpid,
  and easily became embarrassed and confused. He was sexually always
  much excited. Frequently he dreamed that he was running about with
  exposed genitals, or that, dressed only in a shirt, he hung from a
  fence with his head downward, so that the shirt fell down, exposing
  his erected penis. His dreams would induce pollution, and he would
  then have rest for a few days or an entire week.

  Also, in his waking state, the impulse would often come upon him, just
  as in his dreams, to run about with exposed genitals. As he was about
  to expose himself, he would become very hot, and then he would run
  aimlessly about. The member would become moist with secretion, but
  pollution was never induced. Finally, when it had become flaccid, he
  would put it up, and then come to himself, glad if no one had seen
  him. In such conditions of excitement he seemed to be in a dream; as
  if intoxicated. He had never had the intention to offend women. S. was
  not epileptic. His declarations had the impress of truth. He had
  actually never followed or spoken to women while in this condition.
  Frivolity and coarseness were excluded. In agreement with Westphal,
  the author regards S. as belonging “to a class of individuals of
  peculiar hypochondriacal tendencies, in whom the attention is
  constantly directed, in an abnormal way, to certain bodily sensations
  and processes; who brood over these, connecting all kinds of peculiar
  conceptions with them, at last making use of quite as strange means to
  combat the bodily sensations and ideas.” At least, S.’s act was due to
  pathological sensation and idea, and S. was in a condition of
  pathological disturbance of mental action at the time of the
  commission of his acts. In the case of this exhibitionist, the manner
  of satisfaction of the sexual instinct may be considered as peculiar
  to the individual. (Liman, _Vierteljahrsschrift für gerichtel. Med._,
  N. F. xxxviii, Heft 2.)

  Case 174. X., aged 38; married; father of one child. Always sullen and
  silent. Suffers frequently with headache. Very neurasthenic, though
  not insane. He is troubled much at night by pollutions. He has
  repeatedly followed shop-girls, for whom he had lain in wait, exposing
  and handling his genitals. In one case he even followed a girl into a
  shop. (Trochon, _Arch. de l’anthropologie criminelle_, iii, p. 256.)

In the following case the exhibition seems subsidiary to the impulsive
desire to satisfy sudden, intense libido, by means of masturbation:—

  Case 175. R., coachman, aged 49, Vienna; married since 1866;
  childless. Father neuropathic and given to sexual excesses; died of
  cerebral disease. He presents no degenerative signs.

  At the age of twenty-nine he suffered a severe concussion by falling
  from a height. Up to that time the vita sexualis had been normal.
  Since that time, every three or four months, he has been seized with
  very painful sexual excitement, accompanied by an intense desire to
  masturbate. A feeling of weariness and discomfort, with a desire for
  alcoholic indulgence, precedes this. In the intervals he is sexually
  cold, and has but very infrequent desire for his wife, who, moreover,
  for five years has been sick, and incapable of cohabitation. He gives
  the assurance that, as a young man, he never masturbated, and that, in
  the intervals between his attacks, he has never thought of satisfying
  himself sexually in this way.

  The impulse to masturbation during the attack is always excited by
  certain feminine charms,—short cloak, pretty foot and ankle, elegant
  appearance. Age makes no difference; even little girls excite him. The
  impulse is sudden and unconquerable. R. describes the situation and
  act as characteristically impulsive. He had often tried to resist it;
  but then he would grow hot, terribly frightened, his head would burn,
  and he would seem to be in a fog; but he never lost consciousness. At
  the same time he would have violent, darting pain in the testicles and
  spermatic cords. He regretted it, but had to confess that the impulse
  was stronger than his will. In such a situation it forced him to
  masturbate, no matter where he might be. After ejaculation he would
  become calm, and regain his self-control. He regarded it as a terrible
  affliction. Defense shows that R. has been punished six times for
  similar offenses—exhibition and masturbation in the open street.

  On November 4, 1889, R., while in his worst condition, happened to be
  in the street as a crowd of school-girls went by. This awakened his
  unconquerable impulse. There was not time to run to a closet, he was
  so excited. There was immediate exhibition, masturbation in front of a
  house,—great scandal and immediate arrest. R. is not weak-minded, and
  has no ethical defect. He bemoans his fate, deeply regrets his act,
  and fears new attacks. He regards his condition as abnormal,—as a fate
  against which he is powerless.

  He thinks himself still virile. Penis abnormally large. Cremasteric
  reflex present; patellar reflex increased. Weakness of the sphincter
  of the bladder, that has existed for some years. Various neurasthenic
  difficulties.

  The opinion showed that R. was subject to the influence of abnormal
  conditions, and had acted impulsively. Patient was sent to an asylum,
  from which he was discharged after a few months.

In the foregoing case the important point, clinically, lies not in the
neurosis that is present, but rather in the impulsive character of the
act (exhibition dependent on masturbation).

With the enumeration of the categories of imbeciles, of mentally
weakened individuals, and of the exhibitionists that are in a neurotic
(epileptic or neurasthenic) state of imperfect consciousness, apparently
the clinical and forensic side of this phenomenon is still unexhausted;
in addition to these, there is another class, the representatives of
which, owing to deep hereditary taint (hereditary degenerative
neurosis?), are impelled to periodical and very impulsive exhibition.

With reference to these conditions of psychopathia sexualis periodica
(comp. “Periodical Insanity”), in which the accidentally-awakened
impulse to exhibition is but a partial manifestation of a clinical
whole, like dipsomania periodica, Magnan, from whom I borrow the
following instructive cases, justly lays the greatest stress upon the
impulsive, periodical feature of these abnormal impulses; and no less
upon the fact that they are often accompanied by terrible anxiety,
which, after the realization of the impulse, gives place to a feeling of
relief.

These facts, and no less, the clinical picture of degeneracy that, for
the most part, is referable to injurious conditions that are hereditary,
or that exercise an injurious effect on the development of brain in
early years (rachitis, etc.), are, medicolegally, of decisive importance
[with reference to the question of responsibility].

  Case 176. G., aged 29, waiter in a _café_. In 1888, while standing
  under a church-door, he exhibited himself to several girls working
  opposite. He confessed the act, and also that, many times, in the same
  place and at the same time of day, he had been guilty of the same
  crime, having been punished for it, the year before, with imprisonment
  for one month.

  G. has very nervous parents. His father is mentally unstable and very
  irascible. His mother is at times insane, and suffers with severe
  nervous disease.

  G. has always had nervous twitching of the face, and constant
  alternation of causeless depression, with tædium vitæ, and periods of
  elation. At the ages of ten and fifteen, for slight cause, he wished
  to commit suicide. When excited, he has similar twitching of the
  extremities. He presents constant general analgesia. In prison he was
  at first beside himself with shame about the disgrace he had brought
  on his family, and said he was the worst of men, deserving the
  severest punishment.

  Until his nineteenth year G. had satisfied himself with solitary and
  mutual masturbation, and, on one occasion, he had practiced onanism
  with a girl. From that time, working in a _café_, the female customers
  had excited him so intensely that ejaculation was often induced. He
  suffered with almost constant priapism, and, as his wife stated, in
  spite of coitus, it often disturbed his rest at night. For seven years
  he had repeatedly exhibited himself at his window, and also exposed
  himself naked to female neighbors living opposite.

  In 1883 he married out of desire. Marital intercourse did not satisfy
  his needs. At times his sexual excitement was so intense that he had
  headache, and seemed confused, like one drunk, strange, and incapable
  of work.

  Case 177. B., aged 27; of neuropathic mother and alcoholic father. He
  has one brother who is a drinker; and an hysterical sister.

  After his eleventh year, onanism, solitary or mutual. After his
  fifteenth year, impulses to exhibition. He attempted it at a
  street-urinal; he felt pleasure in it, but also immediately twinges of
  conscience. If he attempted to oppose his impulse thereafter, he
  became apprehensive, and had a feeling of oppression in his chest.
  When a soldier, he was often impelled to expose himself, under various
  pretexts, to his comrades.

  After his seventeenth year he had sexual congress with women. It gave
  him great pleasure to show himself naked before them. He continued his
  exhibition on the street. Since he could but infrequently count on
  female spectators at urinals, he changed his place to churches. In
  order to exhibit himself at such places, he always had to strengthen
  his courage by drinking. Under the influence of spirits, the impulse,
  at other times controllable with difficulty, became irresistible. He
  was not sentenced. He lost his position, and then drank more. Not long
  after, he was again arrested for exhibition and masturbation in a
  church.

  Case 178. X., aged 35; barber’s assistant. Repeatedly punished for
  offense against decency, he is again arrested; for, during three
  weeks, he had been hanging around girls’ schools, trying to attract
  the attention of the pupils, and, when he had succeeded in this, had
  exhibited himself. Occasionally he had promised them money, with the
  words, “Habeo mentulam pulcherrimam, venite ad me ut eam lambatis.” At
  his examination X. confessed everything, but did not know how it had
  come about. He was the most reasonable of men in other respects, but
  had the impulse to commit this crime, and could not overcome it.

  In 1879, when in the army, he was once out on leave, and had run
  around exhibiting himself to children: imprisonment for a year. The
  same crime in 1881. He chased the crying children, and “stared” at
  them: imprisonment of one year and three months. Two days after his
  discharge, he said to two little girls: “If you want to see my tail,
  come with me to this (market) booth.” He denied these words, and
  claimed drunkenness: imprisonment for three months.

  In 1883, renewed exhibition; during the act he said nothing. At his
  examination he stated that, since a severe illness, eight years
  previously, he had suffered with such excitations: imprisonment for
  one month.

  In 1884, exhibition before girls in a church-yard; again in 1885. He
  declared: “I understand my crime, but it is like a disease. When it
  comes over me, I cannot keep from such acts. It sometimes happens
  that, for quite a long time, I am free from these inclinations.”
  Imprisonment for six months.

  Discharged on August 12, 1885, he had a relapse on August 15. The same
  excuse was given. This time he underwent medical examination. The
  examination revealed no mental disturbance. Sentenced to three years.
  After discharge, a series of new exhibitions. On this occasion,
  examination revealed the following:—

  His father suffered with chronic alcoholism, and is said to have been
  guilty of the same crime. Mother and sister nervously ill, and the
  whole family of excitable temperament.

  _From his seventh to his eighteenth year X. suffered with epileptic
  convulsions._ First cohabitation at sixteen; later, gonorrhœa and, it
  is stated, syphilis. After that, normal sexual intercourse until his
  twenty-first year. At that time he often had to pass a play-ground,
  and he occasionally had to urinate there; and it happened that the
  children looked at him, out of curiosity.

  He noticed, occasionally, that this looking at him caused him sexual
  excitement, and induced erection, and even ejaculation. He now found
  more pleasure in this kind of sexual gratification, and became
  indifferent about coitus, satisfying himself only in this manner. He
  felt that all his thought was ruled by this, and he dreamed only of
  exhibitions, with pollutions. His attempts to control his impulse
  became more and more ineffectual. It came over him with such force
  that he noticed nothing around him, and saw and heard nothing, and was
  like one “devoid of reason,”—like “a bull trying to butt his head
  through a wall.”

  X. has an abnormally broad head. Small penis; the left testicle
  deformed. Patellar reflex absent. Symptoms of neurasthenia, especially
  cerebral. Frequent pollutions. For the most part, his dreams are about
  normal coitus, only infrequently about exhibition before little girls.

  With reference to his sexual acts, he states that the impulse to seek
  and approach little girls is primary; only when he has succeeded in
  attracting their attention to his exposed genitals do erection and
  ejaculation occur. He does not lose consciousness in the act. After it
  he is troubled about his deed, and, if undiscovered, says to himself,
  “Once more I have escaped the authorities.”

  In prison he did not have the impulse; there, he was troubled only
  with dreams and pollutions. In freedom he had daily sought opportunity
  to satisfy himself with exhibition. He would give ten years of his
  life to be free from the thing; “this life of constant anxiety, this
  alternation between freedom and imprisonment, is unendurable.”

  The opinion assumed a congenital (?) perversity of the sexual
  instinct, with unmistakable hereditary taint, neuropathic
  constitution, asymmetry of cranium, and defective development of the
  genitals.

  It is also worthy of remark _that the exhibition began when the
  epilepsy ceased; so that one might think of a vicarious phenomenon_.

  The sexual perversity developed, with predisposition, through
  accidental association of ideas of sexual content (children looking at
  him while urinating) with an act that, in itself, was purposeless.

  The patient was not sentenced, but sent to an asylum. (Dr. Freyer,
  _Zeitschr. f. Medicinalbeamte_, 3 Jahrg., No. 8.)

  Case 179. At 9 o’clock at night, in the spring of 1891, a lady, in
  great trepidation, came to the policeman in the city park of X., with
  the statement that a man, absolutely naked in front, had approached
  her from the bushes, and she had run away, frightened. The officer
  went at once to the place indicated, and found a man, who exposed
  ventrem et genitalia nuda. He attempted to escape, but was overtaken
  and arrested. He stated that he had been sexually excited by alcohol,
  and had been on the point of going to a prostitute. On his way through
  the park, however, he recalled the fact that exhibition gave him much
  greater pleasure than was afforded him by coitus, in which he seldom,
  and only _faute de mieux_, indulged. After drawing up his shirt, he
  posted himself in the bushes, and, when two women came up the path, he
  approached them with exposed genitals. In such exhibition he had a
  pleasurable feeling of warmth, and the blood mounted to his head.

  The accused works in a manufactory, and his employer states that he is
  faithful, saving, sober, and intelligent.

  In 1886 B. had been punished because he had twice exhibited himself
  publicly,—once in broad daylight, and once at night, under a lamp.

  B., aged 37, single, makes a peculiar impression, owing to his
  dandified dress and affected manner. His eyes have a neuropathic,
  languishing expression; around his mouth plays a smile of
  self-satisfaction. He is said to come of healthy parents. A sister of
  his father, and one of his mother, were insane. Others of their
  relatives were thought religiously eccentric.

  B. has never had any severe illness. From childhood he was eccentric
  and imaginative. He loved romances about knights and others, was
  entirely absorbed by them, and even went so far as to identify himself
  in fancy with the heroes. He always thought himself a little better
  than others, and thought much of elegant dress and ornament; and when
  he strutted about on Sundays, he imagined himself a high official.

  B. has never had epileptic symptoms. In youth, moderate indulgence in
  masturbation; later, moderate indulgence in coitus. Previously, never
  any perverse sexual feelings or impulses. Retired manner of life; in
  leisure hours, reading (popular novels, heroic tales, Dumas, and
  others). B. was no drinker. Exceptionally he made himself a kind of
  punch, by which he was always excited sexually.

  For some years, with marked decrease of libido, after such alcoholic
  indulgence, he had had “accursedly silly thoughts,” and developed the
  desire genitalia adspectui feminarum publice exhibere.

  If he got into this state, he felt warm, his heart beat violently,
  blood rushed to his head, and he could then no longer resist his
  impulse. He heard and saw nothing more, and was absolutely absorbed in
  his lust. Afterward he had often pounded his crazy head with his
  fists, and firmly resolved never to do such a thing again; but the
  crazy ideas had always returned.

  In his exhibition his penis became only half-erected, and ejaculation
  never occurred; even in coitus it was always tardy. In exhibition he
  was satisfied with genitalia sua adspicere, and he had the lustful
  thought that this sight must be very pleasant to women, since he liked
  so much to see genitalia feminarum. He was capable of coitus only when
  the puella showed herself very partial to him; without this, he
  preferred rather to pay and go without doing anything. In his dreams
  he exhibited himself to young, voluptuous women.

  The medico-legal opinion recognized the hereditary psychopathic
  character of the culprit, and the perverse, impulsive desire to
  perform the incriminating acts; and pointed out, further, the
  remarkable fact that in B., who was otherwise sober and saving, the
  impulses to indulge in alcohol depended on abnormal conditions that
  recurred periodically, and forced him to indulge. That, during his
  attacks, B. was in an exceptional psychical state, in a kind of mental
  confusion, and absolutely absorbed in his perverse sexual fancy, is
  clearly shown by the _species facti_. Thus is explained the fact that
  he became aware of the approach of the police only when it was too
  late to try to escape. In this hereditary and degenerate impulsive
  exhibitionism, it is interesting to note how the perverse sexual
  impulse is awakened from its latency by the influence of alcohol.

A forensically important variety of exhibition, which, clinically,
certainly rests upon a similar neurotic and degenerate foundation, and
which expresses itself in a peculiar act, conditioned by violent libido
(hyperæsthesia sexualis), associated with diminished virility, is made
up of the so-called _frotteurs_.

The three following cases, borrowed from Magnan (_op. cit._), are
typical:—

  Case 180. D., aged 44, hereditarily predisposed, drinker, and
  suffering with lead poisoning. Until the last year he had masturbated
  much, and often drawn pornographic pictures, and shown them to his
  acquaintances. He had repeatedly dressed himself as a woman in secret.
  For two years, since becoming impotent, he had felt desire, while in
  crowds at dusk, mentulam denudare eamque ad nates mulieris crassissimæ
  terere. Once, when discovered in the act, he had been sentenced to
  imprisonment for four months.

  His wife kept a milk-shop. Iterum iterumque sibi temperare non potuit
  quin genitalia in ollam lacte completam mergeret. In the act he felt
  lustful pleasure, “as if touched with velvet.” He was cynical enough
  to use this milk for himself and the customers. During imprisonment
  alcoholic persecutory insanity developed in him.

  Case 181. M., aged 31; married six years; father of four children;
  badly predisposed; subject to melancholia at times. Three years
  before, he was discovered by his wife with a silk dress on,
  masturbating. One day he was discovered, in a store, in the act of
  _frottage_ on a lady. He was very repentant, and asked to be severely
  punished for his irresistible impulse.

  Case 182. G., aged 33; badly predisposed hereditarily. At an
  omnibus-station he was discovered in the act of _frottage_ with his
  penis on a lady. Deep repentance; but he stated that at the sight of a
  noticeable posteriora of a lady, he was irresistibly impelled to
  practice _frottage_, and that he became confused and knew not what he
  did. Sent to an asylum.

  Case 183. A _frotteur_. Z., born in 1850; of blameless life
  previously; of good family; private official. He is well-to-do
  financially; untainted. After a short married life he became a
  widower, in 1873. For some time he had attracted attention in
  churches, because he crowded up behind women, both old and young
  indifferently, and toyed with their tournures. He was watched, and one
  day he was arrested in the act. Z. was terribly frightened, and in
  despair about his situation; and, in making a full confession, he
  begged for pardon, for nothing but suicide remained for him.

  For two years he had been subject to the unhappy impulse to go in
  crowds of people,—in churches, at box-offices of theatres, etc,—and
  press up behind females and manipulate the prominent portion of their
  dresses, having orgasm and ejaculation during the act.

  Z. states that he was never given to masturbation, and had never been
  in any way perverse sexually. Since the early death of his wife, he
  had gratified his great sexual desire in temporary love-affairs,
  having always had an aversion for prostitutes and brothels. The
  impulse to _frottage_ had suddenly seized him, two years before, while
  he happened to be in church. Though he was conscious that it was
  wrong, he could not help yielding to it immediately. Since then he had
  been excitable to the posteriora of females, and had been actually
  impelled to seek opportunity for _frottage_. The only thing on women
  that excited him was the tournure; every other part of the body and
  attire was a matter of indifference to him; and it made no difference
  to him whether the woman was old or young, beautiful or ugly. Since
  this began, he had had no more inclination for natural gratification.
  Of late _frottage_ scenes had appeared in his dreams. During his acts
  he was fully conscious of his situation and the act, and tried to
  perform it in such a way as to attract as little attention as
  possible. After his act he was always ashamed of what he had done.

  The medical examination revealed no sign of mental disease or mental
  weakness, but symptoms of neurasthenia sexualis,—ex abstinentia
  libidinosi (?),—which was also proved by the circumstance that even
  simple touching of the fetich with the unexposed genitals sufficed to
  induce ejaculation. Apparently Z., weakened sexually and distrusting
  his virility, and yet libidinous, had come to practice _frottage_ by
  having the sight of posteriora feminæ fall together accidentally with
  sexual excitement; and this associative combination of a perception
  with a feeling permitted the former to attain the significance of a
  fetich.

As an act which offends public morals, and which is, therefore,
punishable, the violation of statues—a whole series of cases of which
Moreau (_op. cit._) has collected from ancient and modern times—may be
enumerated here. They are, unfortunately, given too much like anecdotes
to allow satisfactory judgment of them. They always give the impression
of being pathological,—like the story of a young man (related by
Lucianus and St. Clemens, of Alexandria) who made use of a Venus of
Praxiteles for the gratification of his lust; and the case of Clisyphus,
who violated the statue of a goddess in the Temple of Samos, after
having placed a piece of meat on a certain part. In modern times, the
_Journal L’événement_ of March 4, 1877, relates the story of a gardener
who fell in love with a statue of the Venus of Milo, and was discovered
attempting coitus with it. At any rate, these cases stand in etiological
relation with abnormally intense libido and defective virility or
courage, or lack of opportunity for normal sexual gratification.

The same thing, must be assumed in the case of the so-called
_voyeurs_,[130]—_i.e._, men who are so cynical that they seek to get
sight of coitus, in order to assist their virility; or who seek to have
orgasm and ejaculation at the sight of an excited woman. Concerning this
moral aberration, which, for various reasons, cannot be further
described here, it will suffice to refer to Coffignon’s book, “La
Corruption à Paris.” The revelations, in the domain of sexual
perversity, and also perversion, which this book makes, are horrible.


                        2. RAPE AND LUST-MURDER.

   (Austrian Statutes, § 125, 127; Austrian Abridgment, § 192; German
                           Statutes, § 177.)

By the term rape, the jurist understands coitus, outside of the marriage
relation, with an adult, enforced by means of threats or violence; or
with an adult in a condition of defenselessness or unconsciousness; or
with a girl under the age of fourteen years. Immissio penis, or, at
least, conjunctio membrorum (Schütze), is necessary to establish the
fact. To-day, rape on children is remarkably frequent. Hofmann (“Ger.
Med.,” i, p. 155) and Tardieu (“Attentats”) report horrible cases.

The latter establishes the fact that, from 1851 to 1875 inclusive,
22,017 cases of rape came before the courts in France, and, of these,
17,657 were committed on children.

The crime of rape presumes a temporary, powerful excitation of sexual
desire, induced by excess in alcohol, or by some other condition. It is
highly improbable that a man morally intact would commit this most
brutal crime. Lombroso (Goltdammer’s _Arch._) considers the majority of
men who commit rape to be degenerate, particularly when the crime is
done on children or old women. He asserts that, in many such men, he has
found actual signs of degeneracy.

It is a fact that rape is very often the act of degenerate male
imbeciles,[131] where, under some circumstances, the bond of blood is
not respected.

Cases as a result of mania, satyriasis, and epilepsy, have occurred, and
are to be kept in mind.

The crime of rape may follow the murder of the victim.[132] There may be
unintentional murder, murder to destroy the only witness of the crime,
or murder out of lust (_v. supra_). Only for cases of the latter kind
should the term _lust-murder_[133] be used.

The motives of lust-murder have been previously considered. The cases
given in illustration are characteristic of the manner of the deed. The
presumption of a murder out of lust is always given when injuries of the
genitals are found, the character and extent of which are such as could
not be explained by merely a brutal attempt at coitus; and, still more,
when the body has been opened, or parts (intestines, genitals) torn out,
and are wanting.[134]

Lust-murders dependent upon psychopathic conditions are never committed
with accomplices.

  Case 184. _Weak-mindedness, Epilepsy. Attempt at Rape; Murder._—On the
  evening of May 27, 1888, an eight-year-old boy, Blasius, was playing
  with other children in the neighborhood of the village of S. An
  unknown man came along and enticed the boy into the woods. The next
  day the boy’s body was found in a ravine, with the abdomen slit open,
  an incised wound in the cardiac region, and two stab-wounds in the
  neck.

  Since, on May 21st, a man, answering to the description given of the
  murderer by the children, had attempted to treat a six-year-old girl
  in a similar manner, and had only accidentally been detected, it was
  presumed to be a case of lust-murder. It was proved that the body was
  found in a heap, with only the shirt and jacket on; also, that there
  was a long incision in the scrotum.

  Suspicion fell upon a peasant, E.; but, on confrontation with the
  children, it was not possible to identify him with the stranger who
  had enticed the boy into the woods. Besides, with the help of his
  sister, he proved an alibi. The untiring efforts of the officers
  brought new evidence to light, and finally E. confessed. He had
  enticed the girl into the woods, thrown her down, exposed her
  genitals, and was about to abuse her; but, as she had an eruption on
  her head, and was crying loudly, his desire cooled, and he fled.

  After he enticed the boy into the woods, with the pretext of showing
  him a bird’s nest, he was taken with a desire to abuse him. Since the
  boy refused to take off his trousers, he did it for him; and when the
  boy began to cry out, he stabbed him twice in the neck. Then he made
  an incision, just above the pubes, in imitation of female genitals, in
  order to use it to satisfy his lust. But, since the body grew cold
  immediately, he lost his desire, and, cleaning his knife and hands
  near the body, he fled. When he saw the boy dead, he was filled with
  fear, and his limbs became weak.

  During his examination E. looked apathetically at a garland. He had
  acted in a state of mental weakness. He could not understand how he
  came to do such a thing. He must have been beside himself; for he
  often became senseless, so that he would almost fall down. Previous
  employers report that he had periods when he was devoid of thought and
  confused, doing no work all day, and avoiding others. His father
  states that E. learned with difficulty, was unskillful at work, and
  often so obstinate that one did not think to punish him. At such times
  he would not eat, and occasionally ran away and remained all day. At
  such times he also seemed quite lost in thought, screwed his face up,
  and said senseless things. When quite a boy, he still sometimes wet
  the bed, and often came home from school with wet or soiled clothing.
  He was very restless in sleep, so that no one could sleep beside him.
  He had never had playmates. He had never been cruel, bad, or immoral.

  His mother gave similar testimony; and further, that, in his fifth
  year, E. first had convulsions, and once lost the power of speech for
  seven days. Sometime about his seventh year he once had convulsions
  for forty days, and was also dropsical. Later, too, he was often
  seized in sleep, and he often then talked in his sleep; and mornings,
  after such nights, the bed was found wet.

  At times it was impossible to do anything with him. Since his mother
  did not know whether it was due to viciousness or disease, she did not
  venture to punish him.

  Since his convulsions, in his seventh year, he had failed so in mind
  that he could not learn even the common prayers; and he also became
  very irascible.

  Neighbors, persons prominent in the community, and teachers, state
  that E. was peculiar, weak-minded, and irascible; that at times he was
  very strange, and apparently in an exceptional mental state.

  The examinations of the medical experts gave the following results:—

  E. is tall, slim, and poorly nourished. His head measures 53
  centimetres in circumference. The cranium is rhombic, and in the
  occipital region flattened.

  His expression is devoid of intelligence; his glance is fixed,
  expressionless; his attitude is careless, and his body is bent
  forward. Movements are slow and heavy. Genitals normally developed.
  E.’s whole appearance points to torpidity and mental weakness.

  There are no signs of degenerative marks, no abnormality of the
  vegetative organs, and no disturbances of motility or sensibility. He
  comes of a perfectly healthy family. He knows nothing of convulsions
  or of wetting his bed at night, but he states that, of late years, he
  has had attacks of vertigo and loss of mind.

  At first, in circumlocution, he denies the murder. Later, in great
  contrition, before the examining judge, he confessed all, and gave a
  clear motive for his crime. He had never had such a thought before.

  He has been given to onanism for years; he even practiced it twice
  daily. He states that, for want of courage, he had never ventured to
  ask coitus of a woman, though in dreams such scenes exclusively passed
  before him. Neither in dreams nor in the waking state had he ever had
  perverse instincts; particularly no sadistic or contrary sexual
  feelings. Too, the sight of the slaughter of animals had never
  interested him. When he enticed the girl into the woods, his desire
  was to satisfy his lust with her; but how it happened that he tried
  such a thing with a boy, he could not explain. He thought he must have
  been out of his mind at that time. The night after the murder he could
  not sleep on account of fear; he had twice confessed already, to ease
  his conscience. He was only afraid of being hung. This should not be
  done, as he had done the deed in a weak-minded condition.

  He could not tell why he had cut open the boy’s abdomen. It had not
  occurred to him to handle the intestines, smell them, etc. He stated
  that, after the attempt on the girl in the day-time, and in the night,
  after the murder of the boy, he had convulsions. At the time of his
  crime he was indeed conscious, but he had not thought at all of what
  he did.

  He suffered much with headache; could not endure heat, thirst, or
  alcohol; there were times when he was perfectly confused. The test of
  his intelligence showed a high grade of weak-mindedness.

  The opinion (Dr. Kautzner, of Graz) showed the imbecility and neurosis
  of the accused, and made it probable that his crime, for which he had
  only a general recollection, had been committed in an exceptional
  (præ-epileptic) mental state, conditioned by the neurosis. Under all
  circumstances, E. was considered dangerous, and probably would require
  commitment to an asylum for life.


 3. BODILY INJURY, INJURY TO PROPERTY, AND TORTURE OF ANIMALS DEPENDENT
                            ON SADISM.[135]

 (Austrian, § 152, 411; German, § 223 [bodily injury]. Austrian, § 85,
 468; German, § 303 [injury to property]. Austrian Police Regulations;
             German Statutes, § 360 [torture of animals].)

Aside from lust-murder, described in the foregoing section, as milder
expressions of sadistic desires, impulses to stab, flagellate, or defile
females, to flagellate boys, to maltreat animals, etc., also occur.

The deep degenerative significance of such cases is clearly demonstrated
by the series of examples given under “General Pathology.” Such mentally
degenerate individuals, should they be unable to control their perverse
impulses, could only be objects of care in asylums.


      4. BODILY INJURY, ROBBERY, AND THEFT DEPENDENT ON FETICHISM.

 (Austrian, § 190; German, § 249 [robbery]. Austrian, § 171, 460; German,
                             § 242 [theft].)

It is seen from the section on fetichism, under “General Pathology,”
that pathological fetichism may become the cause of crimes. There are
now recognized, as such, hair-despoiling (Cases 78, 79, 80); robbery or
theft of female linen, handkerchiefs, aprons (Cases 82, 83, 85, 86),
shoes (Cases 68, 87, 88), and silks (Case 93). It cannot be doubted that
such individuals are subjects of deep mental taint. But, for the
assumption of an absence of mental freedom and consequent
irresponsibility, it must be proved that there was an irresistible
impulse, which, either owing to the strength of the impulse itself, or
to the existence of mental weakness, made control of the punishable,
perverse impulsion impossible. Such crimes and the peculiar manner in
which they are performed,—in which they differ very much from common
robbery and theft,—always demand a medico-legal examination. But that
the act _per se_ does not, by any means, necessarily arise from
psycho-pathological conditions is shown by the infrequent cases of
hair-despoiling[136] simply for the purpose of gain.


         5. VIOLATION OF INDIVIDUALS UNDER THE AGE OF FOURTEEN.

   (Austrian Statutes, § 128, 132; Austrian Abridgment, § 189, 191^3;
                     German Statutes, § 174, 176^3)

By violation of sexually immature individuals, the jurist understands
all the possible immoral acts with persons under fourteen years of age
that are not comprehended in the term rape. The term violation, in the
legal sense of the word, comprehends the most horrible perversions and
acts, which are possible only to a man who is controlled by lust and
morally weak, and, as is usually the case, lacking in sexual power.

A common feature of these crimes, committed on persons that are more or
less children, is that they are unmanly, childish, and often silly. It
is a fact that such acts, with exceptions in pathological cases, like
those of imbeciles, paretics, and senile dements, are almost exclusively
committed by young men who lack courage or have no faith in their
virility; or by _roués_ who have, to some extent, lost their virility.
It is psychologically incomprehensible that an adult of full virility,
and mentally sound, should indulge in sexual abuses with children.

The imagination of debauchees, in actively or passively picturing the
immoral acts, is exceedingly lively; and that the following enumeration
of the sexual acts of this kind known to law exhausts all the
possibilities is questionable. Most frequently the abuse consists of
sexual handling (under some circumstances, flagellation[137]), active
manustupration, or seducing children by inducing them to perform
onanism, or lustful handling, on the seducer. Less frequent acts are
cunnilingus, irrumare on boys or girls, pædicatio puellarum, coitus
inter femora, and exhibition.

  In a case which Maschka reports (“Handb.,” iii, p. 174), a young man
  had naked girls, from eight to twelve years old, dance about in his
  room, and urinate before him, until he ejaculated. Not infrequently
  boys are abused by sensual women, who undertake to bring about
  conjunctio membrorum with them, in order to satisfy themselves by
  means of friction or onanism.[138]

  Tardieu saw one of the most disgusting examples. A servant, in company
  with her lover, masturbated children intrusted to them, performed
  cunnilingus with a girl of seven, and introduced parsnips and potatoes
  into her vagina, and put similar things into the rectum of a baby of
  two years!

  Case 185. Z., aged 62; deeply tainted, masturbator. He states he has
  never had coitus, but has frequently practiced fellatio. He is in an
  asylum, on account of paranoia. It had been his greatest pleasure to
  entice girls, aged from ten to fourteen years, and practice
  cunnilingus and other vile acts with them. In these acts he had orgasm
  and ejaculation. Masturbation did not give him the same satisfaction,
  and induced ejaculation only with difficulty. _Faute de mieux_ he also
  practiced fellatio with men; occasionally an exhibitionist. Phimosis;
  asymmetrical cranium. (Pelanda, _Arch. di Psichiatria_, x. fascic. 3,
  4.)

  Case 186. X., priest, aged 40. He was accused of enticing girls, aged
  from ten to thirteen, undressing and fondling them lustfully, and
  finally masturbating. He is tainted, and has been an onanist from
  childhood; morally imbecile; always very excitable sexually. Head
  somewhat small. Penis unusually large; indications of hypospadiasis.
  (Pelanda, _loc. cit._)

  Case 187. K., aged 23; laborer. He was accused and convicted of
  repeatedly enticing boys, and now and then girls, to an out-of-the-way
  place, and practicing abuses with them (mutual masturbation, fellatio
  puerorum, fondling of the genitals of the girls).

  K. is an imbecile, and physically deformed, being scarcely 1.5 metres
  tall; cranium rachitic and hydrocephalic; teeth bad,—furrowed,
  defective, and irregular. Large lips, idiotic expression, stuttering
  speech, and an awkward attitude complete the picture of
  psycho-physical degeneration. K. behaves like a child discovered in
  some mischievous act. Scarcely any growth of beard. Genitals well and
  normally developed. He has a superficial consciousness of having done
  something improper, but he is unconscious of the moral, social, and
  legal significance of his crimes.

  K. comes of a drunken father, and a mother who became insane from the
  abuse of her husband, and died in an asylum. In his babyhood the boy
  was almost blinded by corneal ulcers, and, after his sixth year, he
  grew up with an almoner, and later with difficulty earned his living
  as an organ-grinder. His brother is good for nothing, and the culprit
  himself was considered a surly, quarrelsome, evil, moody, irritable
  man. The opinion emphasized the intellectual, moral, and physical
  defect of the culprit.

Unfortunately it must be admitted that the most revolting of these
crimes are done by sane individuals who, by reason of satiety in normal
sexual indulgence, lasciviousness, and brutality, and not seldom during
intoxication, forget that they are human beings.

A great number of these cases, however, certainly depend upon
pathological states. This is particularly true where old men become the
seducers of children.[139]

I agree with Kirn, who, under all circumstances, in cases of this kind,
holds a mental examination to be always necessary; since, frequently
enough, a re-awakened, perverse, abnormally intense, and uncontrollable
sexual desire is shown to be one of the manifestations of a senile
dementia.


                    6. UNNATURAL ABUSE—SODOMY.[140]

 (Austrian Statutes, § 129; Abridgment, § 190; German Statutes, § 175.)


              (a) _Violation of Animals—Bestiality._[141]

Violation of animals, monstrous and revolting as it seems to mankind, is
by no means always due to psycho-pathological conditions. Low morality
and great sexual desire, with lack of opportunity of natural indulgence,
are the principal motives of this unnatural means of sexual
satisfaction, which is resorted to by women as well as by men.

  To Polak we owe the knowledge that in Persia bestiality is frequently
  practiced because of the delusion that it cures gonorrhœa; just as in
  Europe an idea is still prevalent that intercourse with children heals
  venereal disease.

  Experience teaches that bestiality with cows and horses is none too
  infrequent. Occasionally the acts may be undertaken with goats,
  bitches, and, as a case of Tardieu’s and one by Schauenstein show
  (Lehrb., p. 125), with hens.

  The action of Frederick the Great, in the case of a cavalryman who had
  committed bestiality with a mare, is well known: “The fellow is a
  beast, and shall be reduced to the infantry.”

  The intercourse of females with beasts is limited to dogs. A monstrous
  example of the moral depravity in large cities is related by Maschka
  (“Handb.,” iii),—the case of a Parisian female who showed herself in
  the sexual act with a trained bull-dog, to a secret circle of _roués_,
  at 10 francs a head.

There has been, heretofore, but little legal consideration of the mental
condition in those given to violation of animals. In several cases known
to the writer, the individuals were weak-minded. In Schauenstein’s case
there was insanity.

The following case of bestiality is one that was certainly conditioned
by disease. He was an epileptic. In this case the desire for animals
appeared as an equivalent of the normal sexual desire:—

  Case 188. X., peasant, aged 40; Greek-Catholic. Father and mother were
  hard drinkers. Since his fifth year patient has had epileptic
  convulsions,—_i.e._, he falls down unconscious, lies still two or
  three minutes, and then gets up and runs wildly about with staring
  eyes. Sexuality was first manifested at seventeen. The patient had
  inclinations neither for women nor for men, but for animals (birds,
  horses, etc.). He had intercourse with hens and ducks, and later with
  horses and cows. Never any onanism.

  The patient paints pictures of saints; is of very limited
  intelligence. For years, religious paranoia, with states of ecstasy.
  He has an “unspeakable” love for the Virgin, for whom he would
  sacrifice his life. Taken to hospital, he proves to be free from
  infirmity and signs of degeneration.

  He had always had an aversion for women. In a single attempt at coitus
  with a woman he was impotent, but with animals he was always potent.
  He is ashamed before women; coitus with women he regards almost as a
  sin. (Kowalewsky, _Jahrb. f. Psychiatrie_, vii, Heft 3.)

  Case 189. On the afternoon of September 23, 1889, W., aged 16,
  shoemaker’s apprentice, caught a goose in a neighbor’s garden, and
  committed bestiality on the fowl until the neighbor approached. On
  being accused by the neighbor, W. said, “Is there anything wrong with
  the goose?” and then went away. At his examination he confessed the
  act, but excused himself on the ground of temporary loss of mind.
  Since a severe illness, in his twelfth year, he several times a month
  had attacks, with heat in his head, in which he was intensely excited
  sexually, could not help himself, and did not know what he did. He had
  done the act in such an attack. He answered for himself in the same
  way at the trial, and stated that he knew nothing of the _species
  facti_ except from the statements of the neighbor. His father states
  that W., who comes of a healthy family, has always been sickly since
  an attack of scarlatina in his fifth year, and that, at the age of
  twelve, he had a febrile cerebral disease. W. had a good reputation,
  learned well in school, and, later, helped his father in his work. He
  was not given to masturbation.

  The medical examination revealed no intellectual or moral defect. The
  physical examination revealed normal genitals; penis relatively
  greatly developed; marked exaggeration of the patellar reflexes. In
  other respects, negative result.

  The history of the condition at the time of the deed was not to be
  depended upon. There was no history of previous attacks of mental
  disturbance, and there were none during the six weeks of observation.
  There was no perversion of the vita sexualis. The medical opinion
  allowed the possibility that some organic cause (cerebral congestion),
  dependent upon cerebral disease, may have exercised an influence at
  the time of the commission of the criminal act. (From the opinion of
  Dr. Fritsch, of Vienna.)

  Case 190. _Impulsive Sodomy._—A., aged 16; gardener’s boy; born out of
  wedlock; father, unknown; mother, deeply tainted, hystero-epileptic.
  A. has a deformed, asymmetrical cranium, and deformity and asymmetry
  of the bones of the face; the whole skeleton is also deformed,
  asymmetrical, and small. From childhood he was a masturbator; always
  morose, apathetic, and fond of solitude; very irritable, and
  pathological in his emotional reaction. He is imbecile, probably much
  reduced physically by masturbation, and neurasthenic. Besides, he
  presents hysteropathic symptoms (limitation of the visual field,
  dyschromatopsia; diminution of the senses of smell, taste, and hearing
  on the right side; anæsthesia of the right testicle, clavus, etc.).

  A. is convicted of having committed masturbation and sodomy on dogs
  and rabbits. When twelve years old he saw how boys masturbated a dog.
  He imitated it, and thereafter he could not keep from abusing dogs,
  cats, and rabbits in this vile manner. Much more frequently, however,
  he committed sodomy on female rabbits,—the only animal that had a
  charm for him. At dusk he was accustomed to repair to his master’s
  rabbit-pen, in order to gratify his vile desire. Rabbits with torn
  rectums were repeatedly found. The act of bestiality was always done
  in the same manner. There were actual attacks which came on every
  eight weeks, always in the evening, and always in the same way. A.
  would become very uncomfortable, and have a feeling as if some one
  were pounding his head. He felt as if losing his reason. He struggled
  against the imperative idea of committing sodomy with the rabbits, and
  thus had an increasing feeling of fear and intensification of
  headache, until it became unbearable. At the height of the attack
  there was sound of bells, cold perspiration, trembling of the knees,
  and, finally, loss of resistive power, and impulsive performance of
  the perverse act. As soon as this was done, he lost all anxiety; the
  nervous cycle was completed, and he was again master of himself,
  deeply ashamed of the deed, and fearful of the return of an attack. A.
  states that, in such a condition, if called upon to choose between a
  woman and a female rabbit, he could make choice only of the latter. In
  the intervals, of all domestic animals, he is partial only to rabbits.
  In his exceptional states simple caressing or kissing, etc., of the
  rabbit suffices, as a rule, to afford him sexual satisfaction; but
  sometimes he has, when doing this, such furor sexualis that he is
  forced to wildly perform sodomy on the animal.

  The acts of bestiality mentioned are the only acts which afford him
  sexual satisfaction, and they constitute the only manner in which he
  is capable of sexual indulgence. A. states that, in the act, he never
  had a lustful feeling, but satisfaction, inasmuch as he was thus freed
  from the painful condition into which he was brought by the imperative
  impulse.

  The medical evidence easily proved that this human monster was a
  psychically degenerate, irresponsible invalid, and not a criminal.
  (Boeteau, _La France médicale_, 38th year, No. 38.)

The following case seems to be devoid of a psychopathic basis:—

  Case 191. _Sodomy._—In a provincial town a man was caught in
  intercourse with a hen. He was thirty years old, and of high social
  position. The chickens had been dying one after another, and the man
  causing it had been searched for a long time. To the question of the
  judge, as to the reason for such an act, the accused said that his
  genitals were so small that coitus with women was impossible. Medical
  examination showed that the genitals were actually extremely small.
  The man was mentally entirely sound.

  There were no statements concerning any abnormalities at the time of
  puberty, etc. (Gyurkovechky, “Männl. Impotenz,” 1889, p. 82.)


   (b) _With Persons of the Same Sex—Pederasty; Sodomy in its Strict
                                Sense._

German law takes cognizance of unnatural sexual relations only between
men; Austrian, between those of the same sex; and, therefore, unnatural
relations between women are punishable.

Among the immoralities between men, pederasty (immissio penis in anum)
claims the principal interest. Indeed, the jurist thought only of this
perversity of sexual activity; and, according to the opinions of
distinguished interpreters of the law (Oppenhoff, “Stgsb.,” Berlin,
1872, p. 324, and Rudolf and Stenglein, “D. Strafgesb. f. d. Deutsche
Reich,” 1881, p. 423), immissio penis in corpus vivum belongs to the
criminal act covered by § 175.

According to this interpretation, legal punishment would not follow
other improper acts between male persons, _so long as they were not
complicated with offense to public decency, with force, or undertaken
with boys under the age of fourteen_. Of late this interpretation has
again been abandoned, and the crime of unnatural abuse between men has
been assumed when merely acts _similar to cohabitation_ were
performed.[142]

The study of contrary sexual instinct has placed male love of males in a
very different light from that in which it, and particularly pederasty,
stood at the time the statutes were framed. The fact that there is no
doubt about the pathological basis of many cases of contrary sexual
instinct shows that pederasty may also be the act of an irresponsible
person, and makes it necessary, in court, to examine not merely the
deed, but also the mental condition of the perpetrator.

The principles laid down previously must also be adhered to here. Not
the deed, but only an anthropological and clinical judgment of the
perpetrator can permit a decision as to whether we have to do with a
perversity deserving punishment, or with an abnormal perversion of the
mental and sexual life, which, under certain circumstances, excludes
punishment. The next legal question to settle is whether the contrary
sexual feeling is congenital or acquired; and, in the latter case,
whether it is abnormal perversion or moral perversity.

Congenital contrary sexual instinct occurs only in predisposed (tainted)
individuals, as a partial manifestation of a defect evidenced by
anatomical or functional abnormalities, or both. The case becomes
clearer, and the diagnosis more certain, if the individual, in character
and disposition, seems to correspond entirely with his sexual
peculiarity; and if the inclination toward persons of the opposite sex
is entirely wanting, and horror of sexual intercourse with them is felt;
and if the individual, in the impulses to satisfy the contrary sexual
instinct, shows other anomalies of the sexual sphere, such as more
pronounced degeneration in the form of periodicity of the impulse and
impulsive conduct, and is a neuropathic and psychopathic person.

Another question concerns the mental condition of the urning. If this be
such as to remove the possibility of moral responsibility, then the
pederast is not a criminal, but an irresponsible insane person. This
condition in congenital urnings is apparently less frequent than
another. As a rule, these cases present elementary psychical
disturbances, which do not remove responsibility. But this does not
settle the question of the responsibility of the urning. The sexual
instinct is one of the most powerful organic needs. There is no law that
looks upon its satisfaction outside of marriage as punishable in itself;
if the urning feels perversely, it is not his fault, but the fault of a
condition natural to him. His sexual instinct may be æsthetically very
repugnant, but, from his stand-point, it is natural. And, too, in the
majority of these unfortunates, the perverse sexual instinct is
abnormally intense, and their consciousness recognizes it as nothing
unnatural. Thus they fail to have moral and æsthetic ideas to assist
them in resisting the instinct. Innumerable normally constituted men are
in a position to overcome the desire for satisfaction of their libido
without suffering from it in health. Many neuropathic individuals,—and
urnings are almost always neuropathic,—on the contrary, become nervously
ill when they do not satisfy the sexual desire, either as Nature prompts
or in a way that is for them perverse.

The majority of urnings are in a painful situation. On the one hand,
there is an impulse toward persons of their own sex that is abnormally
intense, the satisfaction of which has a good effect, and is natural to
them; on the other, is public sentiment which stigmatizes their acts,
and the law which threatens them with punishment. Before them lies
mental despair,—even insanity and suicide,—at the very least, nervous
disease; behind them, shame, loss of position, etc. It cannot be doubted
that, under these circumstances, states of necessity and compulsion may
be created by the unfortunate natural disposition and constitution.
Society and the law should understand these facts. The former must pity,
and not despise, such unfortunates; the latter must cease to punish
them,—at least, while they remain within the limits which are set for
the activity of their sexual instinct.

  As a confirmation of these opinions and demands concerning these
  step-children of Nature, it is permissible to reproduce here the
  memorial of an urning to the author. The writer of the following lines
  is a man of high position in London:—

  “You have no idea what a constant struggle we all—particularly those
  of us that have the most mind and finest feelings—have to endure, and
  how we suffer under the prevailing false ideas about us and our
  so-called immorality.

  “Your opinion that the phenomenon under consideration is primarily due
  to a congenital ‘pathological’ disposition will, perhaps, make it
  possible to overcome existing prejudices, and awaken pity for poor,
  ‘abnormal’ men, instead of the present repugnance and contempt. Much
  as I believe that the opinion expressed by you is exceedingly
  beneficial to us, I am still compelled, in the interest of science, to
  repudiate the word ‘pathological’; and you will permit me to express a
  few thoughts with respect of it.

  “Under all circumstances the phenomenon is anomalous; but the word
  ‘pathological’ conveys another meaning, which I cannot think suits
  this phenomenon; at least, as I have had occasion to observe it in
  very many cases. I will allow, _a priori_, that, among urnings, a far
  higher proportion of cases of insanity, of nervous exhaustion, etc.,
  may be observed than in other normal men. Does this increased
  nervousness necessarily depend upon the character of urningism, or is
  it not, in the majority of cases, to be ascribed to the effect of the
  laws and the prejudices of society, which prohibit the indulgence of
  their sexual desires, depending on a congenital peculiarity, while
  others are not thus restrained?

  “The youthful urning, when he feels the first sexual promptings and
  näively expresses them to his comrades, soon finds that he is not
  understood; he shrinks into himself. If he tell his parents or teacher
  what moves him, that which is as natural to him as swimming is to a
  fish is described as wrong and sinful, and he is told it must be
  fought and overcome at any price. Then an inner conflict begins, a
  powerful repression of sexual inclinations; and the more the natural
  satisfaction of desire is repressed, the more lively the fancy
  becomes, and paints the very pictures that the wish is to banish. The
  more energetic the character that carries on this inner conflict, the
  more the whole nervous system must suffer. Such a powerful repression
  of an instinct so deeply implanted in us, in my opinion, develops the
  abnormal symptoms which are observed in many urnings; but this does
  not necessarily follow from the urning’s disposition.

  “Some continue the conflict for a longer or shorter time, and thus
  injure themselves; others at last come to the knowledge that the
  powerful instinct born in them cannot possibly be sinful, and,
  therefore, they cease to try to do the impossible,—the repression of
  the instinct. Then, however, begin constant suffering and excitement.
  When a normal man seeks satisfaction of sexual inclination, he knows
  how to find it easily; it is not so with the urning. He sees men that
  attract him, but he dares not say—nay, not even betray by a look—what
  his feelings are. He thinks that he alone of all the world has such
  abnormal feelings. Naturally he seeks the society of young men; but he
  does not venture to confide in them. Thus he comes to provide himself
  with a satisfaction that he cannot otherwise obtain. Onanism is
  practiced inordinately, and followed by all the evil results of that
  vice. When, after a time, the nervous system has been injured, the
  abnormality is again not the result of urningism, but it is produced
  by the onanism to which the urning resorts, as a result of the public
  sentiment that denies him opportunity to satisfy the sexual instinct
  that is natural to him.

  “Or, let us suppose the urning has had the rare fortune to soon find a
  person like himself; or, that he has been introduced by an experienced
  friend to the events of the world of urnings. Then he is spared much
  of the inner conflict; but, at the same time, fearful cares and
  anxieties follow his footsteps. Now he knows that he is not the only
  one in the world that has such abnormal feelings; he opens his eyes
  and wonders that he meets so many of his kind in all social circles
  and in all callings; he also learns that, in the world of urnings, as
  in the other, there is prostitution, and that men as well as women can
  be bought. Thus there is no longer any want of opportunity for sexual
  satisfaction. But here how differently the experience is gained from
  that obtained in the normal manner of sexual indulgence!

  “Let us consider the happiest case. After longing all one’s life, the
  friend of like feeling is found. But he cannot be approached openly,
  as a lover approaches the girl he loves. In constant fear, both must
  conceal their relations; nay, even intimacy that might easily excite
  suspicion—especially should they not be of like age, or should they
  belong to different classes—must be kept from the world. Thus, even in
  this relation, is forged a chain of anxiety and fear that the secret
  will be betrayed or discovered, which leaves them no joy in the
  indulgence. The slightest thing that would not affect others makes
  them tremble with fear that suspicion might be excited and the secret
  discovered, and destroy social position and business. Could this
  constant anxiety and care be endured without leaving a trace, without
  exerting an influence on the entire nervous system?

  “Another less fortunate man does not find a friend of like feeling,
  but falls into the hands of a handsome man, who sought him until the
  secret was discovered. Now the most refined blackmail is extorted. The
  unfortunate, persecuted man, brought to the alternative of paying or
  of losing his social position, and bringing disgrace on himself and
  his family, pays; and the more he gives, the more voracious the
  vampire becomes; until at last there remains nothing but absolute
  financial ruin or dishonor. Who can wonder that nerves are not equal
  to such a terrible struggle!

  “They give way; insanity comes on; and the miserable man at last finds
  the rest in an asylum that he could not find in the world. Another, in
  the same situation, driven to despair, finds relief in suicide. It
  cannot be known how many of the suicides of young men are to be
  attributed to this combination of circumstances.

  “I do not think that I am in error when I declare that at least
  one-half of the suicides of young men are due to such conditions. Even
  in those cases where urnings are not persecuted by a heartless
  villain, but where a happy relation between two men exists, discovery,
  or even the fear of it, very often leads to suicide. How many
  officers, how many soldiers, having such relations with their
  subordinates or companions, in the moment when they have believed
  themselves discovered, have sought to escape the threatened disgrace
  by means of a bullet! And it is the same in all callings.

  “Therefore, if it must be admitted that, among urnings, more mental
  abnormalities and more insanity are actually observed than among other
  men, yet this does not prove that the mental disturbance is a
  necessary accompaniment of the urning’s condition, and that the latter
  induces the former.

  “According to my firm conviction, by far the greater number of cases
  of mental disturbance or abnormal disposition observed in urnings are
  not to be attributed to the sexual anomaly; but they are caused by the
  existing notions concerning urnings, and the resulting laws, and
  dominant public sentiment concerning the anomaly. Any one with an
  adequate idea of the mental and moral suffering, of the anxiety and
  care, that the urning must endure; of the constant hypocrisy and
  secrecy he must practice, in order to conceal his inner instinct; of
  the difficulties that meet him in satisfying his natural desire,—can
  only be surprised that more insanity and nervous disturbance does not
  occur in urnings. The greater part of these abnormal states would not
  be developed, if the urning, like another, could find a simple and
  easy way in which to satisfy his sexual desire,—if he were not forever
  troubled by these anxieties!”

_De lege lata_, as far as the urning is concerned, the paragraph with
reference to pederasty must not be applied without the proof of actual
pederasty; and psychical and somatic abnormalities must be examined by
experts with respect of an estimate in the individual of the question of
guilt.

_De lege ferenda_, the urnings wish a repeal of the paragraphs. The
jurist could not consent to this, if he were to remember that pederasty
is much more frequently a disgusting vice than the result of physical
and mental infirmity; and that, moreover, many urnings, though driven to
sexual acts with their own sex, are yet in nowise compelled to indulge
in pederasty,—a sexual act which, under all circumstances, must stand as
cynical, disgusting, and, when passive, as certainly injurious. Whether
for reasons of expediency (difficulty of fixing the guilt, encouragement
of blackmail, etc.), it would not be opportune to strike from the
statutes the legal punishment of the male-loving man, and to protect
youth by the use of the paragraphs concerning sexual abuses, is a future
question for jurists.

What has been said concerning congenital contrary sexuality and its
relation to the law is also applicable to the acquired abnormality. The
accompanying neurosis or psychosis should have much diagnostic and
forensic weight with reference to the question of guilt.

It only remains to describe acquired non-pathological pederasty,—one of
the saddest pages in the history of human delinquencies:—


                       CULTIVATED PEDERASTY.[143]

The motives that bring to pederasty a man originally normal sexually and
of sound mind are various. It is used temporarily as a means of sexual
satisfaction _faute de mieux_,—as in infrequent cases of
bestiality,—where abstinence from normal sexual indulgence is a
necessity.[144] It thus occurs on ship-board during long voyages, in
prisons, in baths, etc. It is highly probable that, among men subjected
to such conditions, there are single individuals of low morals and great
sensuality, or actual urnings, who seduce the others. Lust, imitation,
and desire further their purpose.

The strength of the sexual instinct is most markedly shown by the fact
that such circumstances are sufficient to overcome repugnance for the
unnatural act.

Another category of pederasts is made up of old _roues_ that have become
supersatiated in normal sexual indulgence, and who find in pederasty a
means of exciting sensual pleasure, the act being a new method of
stimulation. Thus they temporarily renew their power, that has been
psychically and physically reduced to so low a state. The new sexual
situation makes them, so to speak, relatively potent, and makes pleasure
possible that is no longer possible in normal intercourse. In time power
to indulge in pederasty is also lost. The individual may thus finally be
reduced to passive pederasty as a stimulus to make possible temporary
active pederasty; just as, occasionally, flagellation or looking on at
obscene acts (Maschka’s case of mutilation of animals) is resorted to
for the same purpose.

The termination of sexual activity expresses itself in all kinds of
abuse of children,—cunnilingus, fellare, and other enormities.

This kind of pederasts is the most dangerous, since they deal mostly
with boys, and ruin them in body and soul.

  In reference to this, the experiences of Tarnowsky (_op. cit._, p. 53
  _et seq._), gathered from the society of St. Petersburg, are terrible.
  The places where pederasty is cultivated are Institutes. Old _roués_
  and urnings play the _rôle_ of seducers. At first it is difficult for
  the person to carry out the disgusting act. Fancy is made to assist by
  calling up the image of a woman. Gradually, with practice, the
  unnatural act becomes easy, and at last the individual, like one
  injured by masturbation, becomes relatively impotent for women, and
  lustful enough to find pleasure in the perverse act. Such individuals,
  under certain circumstances, give themselves for money.

  As Tardieu, Hofmann, Simon, and Taylor show, such individuals are not
  infrequently found in large cities. From numerous statements made to
  me by urnings, it is learned that actual prostitution and houses of
  prostitution for male-loving men exist in large cities. The arts of
  coquetry used by these male prostitutes are noteworthy,—ornament,
  perfumes, feminine styles of dress, etc., to attract pederasts and
  urnings. This imitation of feminine peculiarities is spontaneous and
  unconscious in congenital cases, and in many acquired cases of
  (abnormal) contrary sexual instinct.

The following lines are of interest to the psychologist, and offer the
officers of the law important facts concerning the social life and
practice of pederasts:—

  Coffignon, “La Corruption à Paris,” p. 327, divides active pederasts
  into “_amateurs_,” “_entreteneurs_,” and “_souteneurs_.”

  The “_amateurs_” (“_rivettes_”) are debauched persons, but also
  frequently congenitally perverse sexually, of position and fortune,
  who are forced to guard themselves against detection in the
  gratification of their homo-sexual desires. For this purpose they
  visit brothels, lodging-houses, or the private houses of female
  prostitutes, who are usually on good terms with male prostitutes. Thus
  they escape blackmail.

  Some of these “_amateurs_” are cunning enough to indulge their vile
  desires in public places. They thus run the risk of arrest, but, in a
  large city, little risk of blackmail. Danger is said to add to their
  secret pleasure.

  The “_entreteneurs_” are old sinners who, even with the danger of
  falling into the hands of blackmailers, cannot deny themselves the
  pleasure of keeping a (male) mistress.

  The “_souteneurs_” are pederasts that have been punished, who keep
  their “_jesus_,” whom they send out to entice customers (“_faire
  chanter les rivettes_”), and who then, at the right moment, if
  possible, appear for the purpose of plucking the victim.

  Not infrequently they live together in bands, the members, in
  accordance with individual desire, living together as husbands and
  wives. In such bands there are formal marriages, betrothals, banquets,
  and introductions of brides and grooms into their apartments.

  These “_souteneurs_” attach their “_jesus_” to themselves.

  The passive pederasts are “_petits jesus_,” “_jesus_,” or “_aunts_.”

  The “_petits jesus_” are lost, depraved children, whom accident places
  in the hands of active pederasts, who seduce them, and reveal to them
  the horrible means of earning a livelihood, either as “_entretenus_”
  or as male street-walkers, with or without “_souteneurs_.”

  The most suitable and promising “_petits jesus_” are given into the
  hands of persons who instruct these children in the art of female
  dress and manner. Gradually they then seek to emancipate themselves
  from their teachers and masters, in order to become “_femmes
  entretenues_”; and not infrequently by means of anonymous denunciation
  of their “_souteneurs_” to the police.

  It is the object of the “_souteneur_” and the “_petit jesus_” to make
  the latter appear young, as long as possible, by means of all the arts
  of the toilet.

  The limit of age is about twenty-five years; then they all become
  “_jesus_” and “_femmes entretenues_” and are then sustained by several
  “_souteneurs_.” The “_jesus_” fall into three categories: “_filles
  gallantes_,” _i.e._, those that have fallen again into the hands of a
  “_souteneur_”; “_pierreuses_” (ordinary street-walkers, like their
  female colleagues); and “_domestics_.”

  The “_domestics_” hire out to active pederasts, either to gratify
  their desires or to obtain “_petits jesus_” for them.

  A sub-group of these “_domestics_” is formed by such of them as enter
  the service of “_petits jesus_” as “_femmes de chambre_.” The
  principal object of these “_domestics_” is to use their positions to
  obtain compromising knowledge, with which they later practice
  blackmail, and thus assure themselves ease in their old age.

  The most horrible class of active pederasts is made up of the
  “_aunts_,”—_i.e._, the “_souteneurs_” of (male) prostitutes,—who,
  though normal sexually, are morally depraved, and practice pederasty
  (passive) only for gain, or for the purpose of blackmail.

  The wealthy “_amateurs_” have their reunions and places of meeting,
  where the passive ones appear in female attire, and horrible orgies
  take place. The waiters, musicians, etc., at such gatherings, are all
  pederasts. The “_filles gallantes_” do not venture, except during the
  carnival, to show themselves on the street in female dress; but they
  know how to lend to their appearance something indicative of their
  calling, by means of style of dress, etc. They entice by means of
  gesture, peculiar movements of the hands, etc., and lead their victims
  to hotels, baths, or brothels.

  What the author says of blackmail is generally known. There are cases
  where pederasts have allowed their entire fortune to be wrung from
  them.

The following notice from a Berlin (National?) newspaper, of February,
1884, which fell into my hands by accident, seems suited to show
something of the life and customs of urnings:—

  “_The Woman-Haters’ Ball._—Almost every social element of Berlin has
  its social reunions,—the fat, the bald-headed, the young,—and why not
  the woman-haters? This species of men, so interesting psychologically
  and none too edifying, had a great ball to-day. ‘Grand Vienna
  Mask-Ball,’—so ran the notice. The sale of tickets was very rigorous;
  they wish to be very exclusive. Their rendezvous was a well-known
  dance-hall. We enter the hall about midnight. The graceful dancing is
  to the strains of a fine orchestra. Thick tobacco-smoke, veiling the
  gas-lights, does not allow the details of the moving mass to become
  obvious; only during the pause between the dances can we obtain a
  closer view. The masks are by far in the majority; black dress-coats
  and ball-gowns are seen only now and then.

  “But what is that? The lady in rose-tarletan, that just now passed us,
  has a lighted cigar in the corner of her mouth, and puffs like a
  trooper; and she also wears a small, blonde beard, lightly painted
  out. And yet she is talking with a very _décolleté_ ‘angel’ in
  _tricots_, who stands there, with bare arms folded behind her,
  likewise smoking. The two voices are masculine, and the conversation
  is likewise very masculine; it is about the ‘d— tobacco, that permits
  no air.’ Two men in female attire. A conventional clown stands there,
  against a pillar, in soft conversation with a ballet-dancer, with his
  arm around her faultless waist. She has a blonde ‘Titus-head,’
  sharp-cut profile, and apparently a voluptuous form. The brilliant
  ear-rings, the necklace with a medallion, the full, round shoulders
  and arms, do not permit a doubt of her ‘genuineness,’ until, with a
  sudden movement, she disengages herself from the embracing arm, and,
  yawning, moves away, saying, in a deep bass, ‘Emile, you are too
  tiresome to-day!’ The ballet-dancer is also a male!

  “Suspicious now, we look about further. We almost suspect that here
  the world is topsy-turvy; for here goes, or, rather, trips, a man—no,
  no man at all, even though he wears a carefully trained moustache. The
  well-curled hair; the powdered and painted face with the blackened
  eyebrows; the golden ear-rings; the bouquet of flowers reaching from
  the left shoulder to the breast, ornamenting the elegant black gown;
  the golden bracelets on the wrists; the elegant fan in the
  white-gloved hand,—all these things are anything but masculine. And
  how he toys with the fan! How he dances and turns, and trips and
  lisps! And yet kindly Nature made this doll a man. He is a salesman in
  a great millinery store, and the ballet-dancer mentioned is his
  ‘colleague.’

  “At a little corner-table there seems to be a great social circle.
  Several elderly gentlemen press around a group of _décolleté_ ladies,
  who sit over a glass of wine and—in the spirit of fun—make jokes that
  are none too delicate. Who are these three ladies? ‘Ladies!’ laughs my
  knowing friend. ‘Well, the one on the right, with the brown hair and
  the short, fancy dress, is called “Butterrieke,” and he is a
  hair-dresser; the second one—the blonde in a singer’s costume, with
  the necklace of pearls—is known here by the name of “Miss Ella of the
  tight-rope,” and he is a ladies’ tailor; and the third,—that is the
  widely-celebrated “Lottie.”

  “But that person cannot possibly be a man? That waist, that bust,
  those classic arms, the whole air and person are markedly feminine!

  “I am told that ‘Lottie’ was once a book-keeper. To-day she, or,
  rather, he, is exclusively ‘Lottie,’ and takes pleasure in deceiving
  men about his sex as long as possible. ‘Lottie’ is singing a song that
  would hardly do for a drawing-room, in a high voice, acquired by years
  of practice, which many a soprano might envy. ‘Lottie’ has also
  ‘worked’ as a female comedian. Now the quondam book-keeper has so
  entered into the female _rôle_ that he appears on the street in female
  attire almost exclusively, and, as the people with whom he lodges
  state, uses an embroidered night-dress.

  “On closer examination of the assembly, to my astonishment, I discover
  acquaintances on all hands: my shoemaker, whom I should have taken for
  anything but a woman-hater—he is a ‘troubadour,’ with sword and plume;
  and his ‘Leonora,’ in the costume of a bride, is accustomed to place
  my favorite brand of cigars before me in a certain cigar-store.
  ‘Leonora,’ who, during an intermission, removes her gloves, I
  recognize with certainty by her large, blue hands. Right! There is my
  haberdasher, also; he moves about in a questionable costume as
  Bacchus, and is the swain of a repugnantly bedecked Diana, who works
  as a waiter in a beer-restaurant. The real ‘ladies’ of the ball cannot
  be described here. They associate only with one another, and avoid the
  woman-hating men; and the latter are exclusive, and amuse themselves,
  absolutely ignoring the charms of the women.”

These facts deserve the careful attention of the police, who should be
placed in a position to cope with male prostitution, as they now do with
that of women.

Male prostitution is certainly much more dangerous to society than that
of females; it is the darkest stain on the history of humanity.

From the statements of a high police official of Berlin, I learn that
the police of Berlin are conversant with the male _demi-monde_ of the
German Capital, and do all they can to suppress blackmail among
pederasts,—a practice which often does not stop short of murder.

The foregoing facts justify the wish that the law-maker of the future
may, for reasons of utility, at least, abandon the prosecution of
pederasty.

With reference to this point, it is worthy of note that the French Code
does not punish it so long as it does not become an offense to public
decency. Probably for politico-legal reasons, the new Italian Penal Code
passes over the crime of unnatural abuse in silence, as do the statutes
of Holland and, as far as I know, Belgium and Spain.

In how far such cultivated pederasts are to be regarded as mentally and
morally sound may remain an open question. The majority of them suffer
with genital neuroses. At least, in these cases, there are the stages of
transition to acquired pathological contrary sexual instinct. The
responsibility of these individuals, who are certainly much lower than
the women who prostitute themselves, in general cannot be questioned.

The various categories of male-loving men, with respect of the manner of
sexual indulgence, may be thus characterized in general:—

The congenital urning becomes a pederast only exceptionally, and
eventually resorts to it after having practiced and exhausted all the
possible immoral acts with males. Passive pederasty is for him the
ideally and practically adequate form of the sexual act. He practices
active pederasty only to please another. The most important point here
is the congenital and unchangeable perversion of the sexual instinct.

It is otherwise with the pederast by cultivation. He has once acted
normally sexually, or, at least, had normal inclinations, and
occasionally has intercourse with the opposite sex. His sexual
perversity is neither congenital nor unchangeable. He begins with
pederasty and ends in other perverse sexual acts, induced by weakness of
the centres for erection and ejaculation. At the height of his power,
his sexual desire is not for passive, but for active pederasty. He
yields himself to passive pederasty only to please another; for money,
in the _rôle_ of a male prostitute; or as a means, when virility is
declining, to make active pederasty still occasionally possible.

A horrible act, that must be alluded to, in conclusion, is pædicatio
mulierum,[145] and even uxorum. Sensual individuals sometimes do it with
hardened prostitutes, or even with their wives. Tardieu gives examples
where men, usually practicing coitus, sometimes indulged in pederasty
with their wives. Occasionally fear of a repetition of pregnancy may
induce the man to perform, and the woman to tolerate, the act.

  Case 192. _Imputation of pederasty that was not proved._ _Résumé_ from
  the legal proceedings:—

  On May 30, 1888, Dr. S., chemist, of H., in an anonymous letter, was
  accused by his step-father of having immoral relations with G., aged
  19, the son of a butcher. Dr. S. received the letter, and, astounded
  by its contents, hastened to his lawyer, who promised to proceed
  discreetly in the matter, and to ascertain from the authorities
  whether he would be publicly prosecuted.

  On the next morning, G., who lived in the house of Dr. S., was
  arrested. At the time he was sick with gonorrhœa and orchitis. Dr. S.
  tried to induce the authorities to release G., and advised caution,
  but he was refused. In his statement to the judge, S. said that he
  became acquainted with G. on the street, three years previously, and
  then saw no more of him until the fall of 1887, when he met him in his
  father’s shop. After November G. supplied Dr. S.’s kitchen with
  meat,—coming in the evening to get the order, and bringing the meats
  the next morning. Thus S. gradually became well acquainted with G.,
  and came to have a very friendly feeling for him. When S. fell ill and
  was, for the most part, confined to his bed until the middle of May,
  1888, G. gave him so much attention that S. and his wife were much
  attracted to him on account of his harmless, child-like, and happy
  disposition. Dr. S. showed and explained to him his collection of
  curiosities, and they spent the evenings pleasantly together, the wife
  also being usually present; besides, S. and G. experimented in making
  sausages, jelly, etc. In February, 1888, G. fell ill with gonorrhœa.
  Dr. S., being his friend, and having studied medicine for several
  terms, took care of G., procured medicine for him, etc. In May, G.
  being still sick, and, for several reasons, inclined to leave home, S.
  and his wife took him into their own home to care for him. S. denied
  the truth of all the suspicions that had been raised by this relation,
  and defended himself by pointing to his life of previous
  respectability, his education, and to the fact that G., at the time,
  was suffering with a disgusting, contagious disease, and that he
  himself had a painful affection (nephritic calculus, with occasional
  attacks of colic).

  Opposed to this statement of Dr. S.’s must be mentioned the facts that
  were brought out in court, and which led to conviction in the first
  trial.

  The relation of S. to G. had, by reason of its obviousness, given
  cause for remark by private individuals, as well as by those in public
  houses. G. spent almost all his evenings with S.’s family, and,
  finally, came to be quite at home there. They took walks together.
  Once, while out on such a walk, S. said to G. that he was a pretty
  fellow, and that he (S.) was very fond of him. On the same occasion,
  there was also talk of sexual matters, and also of pederasty. S. said
  he touched on these subjects only to warn G. With reference to the
  intercourse at home, it was proved that occasionally S., while sitting
  on a sofa, embraced G., and kissed him. This happened in the presence
  of the wife, as well as of the servant-girls. When G. was ill with
  gonorrhœa, S. instructed him in the method of using a syringe, and, at
  the time, took the penis in his hand. G. testified that S., in answer
  to his question why he was so fond of him, said, “I don’t know,
  myself.” When, one day, G. remained away, S., with tears in his eyes,
  complained of it to him when he returned. S. also told him that his
  marriage was unhappy, and, in tears, begged G. not to leave him; that
  he must take the place of his wife.

  From all this resulted the just accusation, that the relation between
  the culprits had a sexual direction. The fact that all was open and
  known to everybody, according to the complaint, did not speak for the
  harmlessness of the relation, but more for the intensity of the
  passion of S. The spotless life of the accused was allowed, as well as
  his honesty and gentleness. The probability of an unhappy marriage,
  and that S. was of a very sensual nature, was shown.

  During the course of the trial, G. was repeatedly examined by the
  medical experts. He is scarcely of medium size, pale, and of powerful
  frame; penis and testicles are very perfectly developed (large).

  In consonance with the accusation, it was found that the anus was
  pathologically changed, in that there were no wrinkles in the skin
  about it and the sphincter was relaxed; and it was presumed that these
  changes pointed to the probability of passive pederasty.

  The conviction was based on these facts. The judgment passed
  recognized that the relation that existed between the culprits did not
  necessarily point to unnatural abuses, any more than did the physical
  conditions found on the person of G.

  However, by reason of the combination of the two facts, the court was
  convinced of the guilt of both culprits, and held it proved: “That the
  abnormal condition of G.’s anus had been caused by the frequently
  repeated introduction of the penis of S., and that G. voluntarily
  permitted the performance of this immoral act on himself.”

  Thus the conditions of § 175, R. St. G. B., seemed to be covered. In
  passing sentence, there was consideration of S.’s education, which
  made him appear to be G.’s seducer; in G.’s case, this fact and his
  youth were given weight; and the previous respectability of both was
  held in view. Thus Dr. S. was sentenced to imprisonment for eight
  months, and G. for four months.

  The culprits appealed to the Supreme Court at Leipzig, and prepared
  themselves, in case the appeal should be denied, to collect evidence
  sufficient to call for a new trial.

  They subjected themselves to examination and observation by
  distinguished experts. The latter declared that G.’s anus presented no
  signs of indulgence in passive pederasty.

  Since it seemed of importance to those interested to make clear the
  psychological aspect of the case, which was not touched on at the
  trial, the author was intrusted with the examination and observation
  of Dr. S. and G.

  _Results of the Personal Examination, from December 11 to 13, 1888, in
  Graz._—Dr. S., aged 37; two years married, without children.
  Ex-Director of the City Laboratory of H. He comes of a father who is
  said to have been nervous, owing to great activity; who had an
  apoplectic attack in his fifty-seventh year, and died, at the age of
  sixty-seven, of another attack of apoplexy. His mother is living, and
  is described as a strong person, who has been nervous for years. Her
  mother reached quite an old age, and is said to have died of a
  cerebellar tumor. A brother of the mother’s father is said to have
  been a drinker. The paternal grandfather died early, of softening of
  the brain.

  Dr. S. has two brothers, who are in perfect health.

  He states that he is of nervous temperament, and has been of strong
  constitution. After articular rheumatism, which he had in his
  fourteenth year, he suffered with great nervousness for some months.
  Thereafter he often suffered with rheumatic pains, palpitation, and
  shortness of breath. These symptoms gradually disappeared with
  sea-bathing. Seven years ago he had gonorrhœa. This disease became
  chronic, and for a long time caused bladder-difficulty.

  In 1887 he had his first attack of renal colic, and he had such
  attacks repeatedly during the winter of 1887 and 1888, until May 16,
  1888, when quite a large renal calculus was passed. Since then his
  condition had been quite satisfactory. While suffering with stone,
  during coitus, at the moment of ejaculation, he felt severe pain in
  the urethra, and the same pain on urinating.

  With reference to his life, S. states that he attended the Gymnasium
  until he was fourteen, but after that, owing to the results of his
  severe illness, he studied privately. He then spent four years in a
  drug-store, and then studied medicine for six semesters at the
  University, serving, in the war of 1870, as a voluntary hospital
  assistant. Since he had no certificate of graduation from the
  Gymnasium, he gave up the study of medicine, and obtained the degree
  of doctor of philosophy. Then he served in the Museum of Minerals in
  K., and later as assistant in the Mineralogical Institute of H.
  Thereafter he made special studies in the chemistry of food-stuffs,
  and five years ago became Director of the City Laboratory.

  He makes all these statements in a prompt, precise manner, and does
  not think long about his answers; so that one is more and more led to
  think that he is a man who loves and speaks the truth,—the more,
  since, on the following day, his statements are identical. With
  reference to his vita sexualis, Dr. S., in a modest, delicate, and
  open way, states that, in his eleventh year, he began to have a
  knowledge of the difference of the sexes, and for some time, until his
  fourteenth year, was given to onanism. He first had coitus at
  eighteen, and thereafter indulged moderately. His sensual desire had
  never been very great, but, until lately, the sexual act had been
  normal in every way, and accompanied by gratifying pleasurable feeling
  and full virility. Since his marriage, two years ago, he had cohabited
  with his wife exclusively. He had married his wife out of love, and
  still loved her, having coitus with her at least several times a week.
  The wife, who was also at hand, confirmed these statements.

  All cross-questioning with reference to a perversion of sexual feeling
  toward men Dr. S. answered repeatedly in the negative, to repeated
  examination, and that without contradiction or any thought of the
  answers. Even when, in order to trap him, he is told that the proof of
  a perverse sexual instinct would be of avail in the trial, he sticks
  to his statements. One gains the important impression that S. has not
  the slightest knowledge of the facts of male-love. Thus it is learned
  that his lascivious dreams have never been about men; that he is
  interested only in female nudity; that he liked to dance with ladies,
  etc. No traces of any kind of sexual inclination for his own sex can
  be discovered in S. With reference to his relations with G., Dr. S.
  expresses himself exactly as he did at his examination before the
  court. In explanation of his partiality for G., he can only say that
  he is nervous, and a man of feeling and great sensibility, and very
  sensitive to friendliness. During his illness he had felt very
  lonesome and depressed; his wife had frequently been with her parents;
  and thus it had happened that he had become friendly with G., who was
  so gentle and kind. He still had a weakness for him, and felt
  remarkably quiet and contented while in his society.

  He had had two such close friendships previously: when he was yet a
  student, with a corps-brother, a Dr. A. whom he also embraced and
  kissed; later, with a Baron M. When it happened that he could not see
  him for a few days, he became depressed, and even cried.

  He also had a similar feeling and attachment for animals. Thus he had
  a poodle that died a short time ago, mourned like a member of the
  family; and he had often kissed the animal. (On relating this, the
  tears came to his eyes.) His brother confirmed these statements, with
  the remark, with reference to his brother’s remarkable friendship for
  A. and M., that in these instances there was not the slightest
  suspicion of sexual coloring or relation. Too, the most careful and
  detailed examination of Dr. S. gave not the slightest reason for such
  a presumption.

  He states that he never had the slightest sensual feeling for G., to
  say nothing of erection or sensual desire. His partiality for G.,
  which bordered on jealousy, S. explained as due merely to his
  sentimental temperament and his inordinate friendship. G. was still as
  dear to him as if he were his son.

  It is worthy of note that S. stated that when G. told him about his
  love-adventures with girls, it had hurt him only because G. was in
  danger of injuring himself and ruining his health by dissipation. He
  had never felt hurt himself by this. If he knew a good girl for G. he
  would be glad to rejoice with him, and do all he could to promote
  their marriage.

  S. states that it was first in the course of his legal examination
  that he saw how he had been careless in his intercourse with G., by
  causing gossip. His openness he explained as due to the innocence of
  the friendship.

  It is worthy of note that S.’s wife never noticed anything suspicious
  in the intercourse between her husband and G., though the most simple
  wife would instinctively notice anything of that nature. Mrs. S. had
  also made no opposition to receiving G. into the house. On this point
  she remarked that the guest-chamber in which G. lay ill, was on the
  second floor, while the living apartments were on the fourth; and,
  further, that S. never associated alone with G. as long as he was in
  the house. She states that she is convinced of her husband’s
  innocence, and that she loves him as before.

  Dr. S. states freely that formerly he had often kissed G., and talked
  with him about sexual matters. G. was much given to women, and in
  friendship he had often warned him about sexual dissipation,
  particularly when G., as often happened, did not look well. He had
  once said that G. was a handsome fellow; it was in a perfectly
  harmless relation.

  The kissing of G. had been due to inordinate friendship, when G. had
  shown him some particular attention, or pleased him especially. In the
  act he had never had any sexual feeling. Too, when he had now and then
  dreamed of G., it was in a perfectly harmless way.

  It appeared of great importance to the author to form also an opinion
  of G.’s personality. On December 12th, the desired opportunity was
  given, and G. was carefully examined.

  G. is a young man, aged 20, of delicate build, whose development
  corresponds with his years; and he appears to be neuropathic and
  sensual. The genitals are normal and well developed. The author thinks
  he may be permitted to pass over the condition of the anus, as he does
  not feel called upon to pass judgment upon it. With prolonged
  association with G., one gets the impression that he is a harmless,
  kind, and artless man, who is light-minded, but not morally depraved.
  Nothing in his dress or manner indicates perverse sexual feeling.
  There cannot be the slightest suspicion that he is a male courtesan.

  When G. is introduced _in medias res_, he states that S. and he,
  feeling their innocence, had told the matter as it actually was, and
  on this the whole trial had been based.

  At first, S.’s friendship, and especially the kissing, had seemed
  remarkable, even to him. Later he had convinced himself that it was
  merely friendship, and had then thought no more about it.

  G. had looked upon S. as a father-like friend; for he was so
  unselfish, and loved him so.

  The expression “handsome fellow” was made when G. had a love-affair,
  and when S. expressed his fears about a happy future for G. At that
  time S. had comforted him, and said that his (G.’s) appearance was
  pleasing, and that he would make an eligible match.

  Once S. had complained to him (G.) that his wife was inclined to
  drink, and burst into tears. G. was touched by his friend’s
  unhappiness. On this occasion S. had kissed him, and begged for his
  friendship, and asked him to visit him frequently.

  S. had never spontaneously directed the conversation to sexual
  matters. G. once asked what pederasty was, of which he had heard much
  while in England; and S. had explained it to him.

  G. acknowledges that he is sensual. At the age of twelve he had been
  made acquainted with sexual matters by school-mates. He had never
  masturbated, had first had coitus at the age of eighteen, and had
  since visited brothels frequently. He had never felt any inclination
  for his own sex, and had never experienced any sexual excitement when
  S. kissed him. He had always had pleasure in coitus normally
  performed. His lascivious dreams had always been of women. With
  indignation, and pointing to his descent from a healthy and
  respectable family, he repels the insinuation of having been given to
  passive pederasty. Until the gossip about them came to his ears, he
  had been innocent and devoid of suspicion. The anal anomalies he tries
  to explain in the same way that he did at the trial. Auto-masturbation
  in ano he denies.

  It should be noted that Mr. J. S. claims to be no less astonished by
  the charge against his brother of male-love than those more closely
  associated with him. Yet he could not understand what attached his
  brother to G.; and all the explanations which S. made to him
  concerning his relation to G. were vain.

  The author took the trouble to observe Dr. S. and G., in a natural
  way, while they were dining, in company with S.’s brother and Mrs. S.,
  in Graz. This observation revealed not the slightest sign of improper
  friendship.

  The general impression which Dr. S. made on me was that of a nervous,
  sanguine, somewhat overstrained individual, but, at the same time,
  kind, open-hearted, and very emotional.

  Dr. S. is physically strong, somewhat corpulent, with a symmetrical,
  brachycephalic cranium. The genitals are well developed; the penis
  somewhat bellied; the prepuce somewhat hypertrophied.

  _Opinion._—Pederasty is, unfortunately, not infrequent among mankind
  to-day; but still, occurring among the peoples of Europe, it is an
  unusual, perverse, and even monstrous manner of sexual gratification.
  It presumes a congenital or acquired perversion of the sexual
  instinct, and, at the same time, defect of moral sense that is either
  original or acquired, as a result of pathological influences.

  Medico-legal science is thoroughly conversant with the physical and
  psychical conditions from which this aberration of the sexual instinct
  arises; and in the concrete and doubtful case it seems requisite to
  ascertain whether these empirical, subjective conditions necessary for
  pederasty are present. Too, it is essential to distinguish between
  active and passive pederasty.

  Active pederasty occurs:—

  I. As a _non-pathological_ phenomenon:—

  1. As a means of sexual gratification, in case of great sexual desire,
  with enforced abstinence from natural sexual intercourse.

  2. In old debauchees, who have become satiated with normal sexual
  intercourse, and more or less impotent, and also morally depraved; and
  who resort to pederasty, in order to excite their lust with this new
  stimulus, and aid their virility, that has sunk so low psychically and
  physically.

  3. Traditionally, among certain barbarous races that are devoid of
  morality.

  II. As a _pathological_ phenomenon:—

  1. Upon the basis of congenital contrary sexual instinct, with
  repugnance for sexual intercourse with women, or even absolute
  incapability of it. But, as even Casper knew, pederasty, under such
  conditions, is very infrequent. The so-called urning satisfies himself
  with a man by means of passive or mutual onanism, or by means of
  coitus-like acts (_e.g._, coitus inter femora); and he resorts to
  pederasty only very exceptionally, as a result of intense sexual
  desire, or with a low or lowered moral sense, out of desire to please
  another.

  2. On the basis of acquired contrary sexual instinct:—

  (_a_) As a result of long years of onanism, which finally causes
  impotence for women with continuance of intense sexual desire.

  (_b_) As a result of severe mental disease (senile dementia,
  brain-softening of the insane, etc.), in which, as experience teaches,
  an inversion of the sexual instinct may take place.

  Passive pederasty occurs:—

  I. As a _non-pathological_ phenomenon:—

  1. In individuals of the lowest class, who, having had the misfortune
  to be seduced in boyhood by debauchees, endured pain and disgust for
  the sake of money, and became depraved morally, so that, in more
  mature years, they have fallen so low that they take pleasure in being
  male prostitutes.

  2. Under circumstances analogous to those of I, 1,—as a remuneration
  to another for having allowed active pederasty.

  II. As a _pathological_ phenomenon:—

  1. In individuals affected with contrary sexual instinct, with
  endurance of pain and disgust, as a return to men for the bestowal of
  sexual favors.

  2. In urnings who feel toward men like women, out of desire and lust.
  In such female-men there is horror feminæ and absolute incapability
  for sexual intercourse with women. Character and inclinations are
  feminine.

  The empirical facts that have been gathered by legal medicine and
  psychiatry are all included in this classification. Before the court
  of medical science, it would be necessary to prove that a man belonged
  to one of the above categories in order to carry the conviction that
  he was a pederast.

  In the life and character of Dr. S., one searches in vain for signs
  which place him in one of the categories of active pederasts which
  science has established. He is neither one forced to sexual
  abstinence, nor one made impotent for women by debauchery; neither is
  he congenitally male-loving, nor alienated from women by masturbation,
  and attracted to men through continuance of sexual desire; and,
  finally, he is not sexually perverse as a result of severe mental
  disease.

  In fact, the general conditions necessary for the occurrence of
  pederasty are wanting in him,—moral imbecility or moral depravity, on
  the one hand, and inordinate sexual desire, on the other.

  It is likewise impossible to classify the accomplice, G., in any of
  the empirical categories of passive pederasty; for he possesses
  neither the peculiarities of the male prostitute nor the clinical
  marks of effemination; and he has not the anthropological and clinical
  stigmata of the female-man. He is, in fact, the very opposite of all
  this.

  In order to make a pederastic relation between the two plausible
  medico-scientifically, it would be requisite for Dr. S. to present the
  antecedents and marks of the active pederasts of I, 2, and G., those
  of the passive pederasts of II, 1 or 2.

  The assumption lying at the basis of the verdict is, from a
  psychological stand-point, legally untenable.

  With the same right, every man might be considered a pederast. It
  remains to consider whether the explanations given by Dr. S. and G. of
  their remarkable friendship are psychologically valid.

  Psychologically it is not without parallel that so sentimental and
  eccentric a man as S.—without any sexual excitement whatever—should
  entertain a transcendental friendship. It suffices to recall the
  friendship of school-girls, the self-sacrificing friendship of
  sentimental young persons in general, and the partiality which this
  sensitive man sometimes showed even for domestic animals,—where no one
  would think of sodomy. With S.’s mental character, extraordinary
  friendship for the youth G. may be easily comprehended. The openness
  of this friendship permits the conclusion that it was innocent, much
  rather than that it depended upon sensual passion.

  The defendants succeeded in obtaining a new trial. The new trial took
  place on March 7, 1890. There was much evidence presented in favor of
  the accused.

  The previous moral life of S. was generally acknowledged. The Sister
  of Charity who cared for G. in S.’s house, never noticed anything
  suspicious in the intercourse between S. and G. S.’s former friends
  testified to his morality, his deep friendship, and his habit of
  kissing them on meeting or leaving them. The anal abnormalities
  previously found on G. were no longer present. Experts called by the
  court allowed the possibility that they had been due simply to digital
  manipulations; their diagnostic value in any case was contested by the
  experts called by the defense.

  The court recognized that the imputed crime had not been proved, and
  exonerated the defendants.


                           LESBIAN LOVE.[146]

Where the sexual intercourse is between adults, its legal importance is
very slight; it could come into consideration only in Austria. In
connection with urningism, this phenomenon is of anthropological and
clinical value. The relation is the same, _mutatis mutandis_, as between
men. Lesbian love does not seem to approach urningism in frequency. The
majority of female urnings do not act in obedience to an innate impulse,
but they are developed under conditions analogous to those which produce
the urning by cultivation.

These “forbidden friendships” flourish especially in penal institutions
for females.

  Kraussold (_op. cit._) reports: “The female prisoners often have such
  friendships, which, when possible, extend to mutual manustupration.

  “But temporary manual gratification is not the only purpose of such
  friendships. They are made to be enduring,—entered into
  systematically, so to speak,—and intense jealousy and a passion for
  love are developed which could scarcely be surpassed between persons
  of opposite sex. When the friend of one prisoner is merely smiled at
  by another, there are often the most violent scenes of jealousy, and
  even beatings.

  “When the violent prisoner has been put in irons, in accordance with
  the prison-regulations, she says ‘she has had a child by her friend.’”

We are indebted to Parent-Duchatelet (“De la prostitution,” 1857, vol.
i, p. 159) for interesting communications concerning Lesbian love.

  According to this experienced author, repugnance for the most
  disgusting and perverse acts (coitus in axilla, inter mammæ, etc.)
  which men perform on prostitutes is not infrequently responsible for
  driving these unfortunate creatures to Lesbian love. From his
  statements it is seen that it is essentially prostitutes of great
  sensuality who, unsatisfied with intercourse with impotent or perverse
  men, and impelled by their disgusting practices, come to indulge in
  it.

  Besides these, there are prostitutes who let themselves be known as
  given to tribadism; persons who have been in prisons for years, and in
  these hot-beds of Lesbian love, ex abstinentia, acquired this vice.

  It is interesting to know that prostitutes hate those who practice
  tribadism,—just as men abhor pederasts; but female prisoners do not
  regard the vice as indecent.

  Parent mentions the case of a prostitute who, while intoxicated, tried
  to force another to Lesbian love. The latter became so enraged that
  she denounced the indecent woman to the police. Taxil (_op. cit._ p.
  166, 170) reports similar instances.

  Mantegazza (“Anthropol. culturhistorische Studien,” p. 97) also finds
  that sexual intercourse between women has especially the significance
  of a vice which arises on the basis of unsatisfied hyperæsthesia
  sexualis.

  In many cases of this kind, however, aside from congenital contrary
  sexual instinct, one gains the impression that, just as in men (_vide
  supra_), the cultivated vice gradually leads to acquired contrary
  sexual instinct, with repugnance for sexual intercourse with the
  opposite sex.

  At least Parent’s cases were probably of this nature. The
  correspondence with the lover was quite as sentimental and exaggerated
  in tone as it is between lovers of the opposite sex; unfaithfulness
  and separation broke the heart of the one abandoned; jealousy was
  unbridled, and led to bloody revenge. The following cases of Lesbian
  love, by Mantegazza, are certainly pathological, and possibly examples
  of congenital contrary sexual instinct:—

  1. On July 5, 1777, a woman was brought before a court in London, who,
  dressed as a man, had been married to three different women. She was
  recognized as a woman, and sentenced to imprisonment for six months.

  2. In 1773, another woman, dressed as a man, courted a girl, and asked
  for her hand; but the trick did not succeed.

  3. Two women lived together as man and wife for thirty years. On her
  death-bed the “husband” confessed her secret to those about her.

  Coffignon (_op. cit._, p. 301) makes later statements worthy of
  notice.

  He reports that this vice is, of late, quite the fashion,—partly owing
  to novels on the subject, and partly as a result of excessive work on
  sewing-machines, the sleeping of female servants in the same bed,
  seduction in schools by depraved pupils, or seduction of daughters by
  perverse servants.

  The author declares that this vice (“saphism”) is met more frequently
  among ladies of the aristocracy and prostitutes.

  He does not differentiate physiological and pathological cases, nor,
  among the latter, the acquired and congenital cases. The details of a
  few cases, which are certainly pathological, correspond exactly with
  the facts that are known about men of contrary sexuality.

  The saphists have their places of meeting, recognize each other by
  peculiar glances, carriage, etc. Saphistic pairs like to dress and
  ornament themselves alike, etc. They are then called “_petites sœurs_”
  (little sisters).


                          7. NECROPHILIA.[147]

                      (Austrian Statutes, § 306.)

This horrible kind of sexual indulgence is so monstrous that the
presumption of a psychopathic state is, under all circumstances,
justified; and Maschka’s recommendation, that the mental condition of
the perpetrator should always be investigated, is well founded. In any
case, an abnormal and decidedly perverse sensuality is required to
overcome the natural repugnance which man has for a corpse, and permit a
feeling of pleasure to be experienced in sexual congress with a cadaver.

Unfortunately, in the majority of the cases reported, the mental
condition was not examined; so that the question whether necrophilia is
compatible with mental soundness must remain open. But any one having
knowledge of the horrible aberrations of the sexual instinct would not
venture, without further consideration, to answer the question in the
negative.


                               8. INCEST.

 (Austrian Statutes, § 132; Abridgment, § 189; German Statutes, § 174.)

The preservation of the moral purity of family life is a product of
civilization;[148] and feelings of intense displeasure arise in an
ethically intact man at thought of lustful feeling toward a member of
the same family. Only great sensuality and defective ideas of laws and
morals can lead to incest.

Both conditions may, in tainted families, be operative. Drinking and a
state of intoxication in men; weak-mindedness which does not allow the
development of the feeling of shame, and which, under certain
circumstances, is associated with eroticism in females,—these facilitate
the occurrence of incestuous acts. External conditions which facilitate
their occurrence are due to defective separation of the sexes among the
lower classes.

As a decidedly pathological phenomenon, the author has found incest in
states of congenital and acquired mental weakness, and infrequently in
cases of epilepsy and paranoia.

In many of the cases, probably a majority, it is not possible, however,
to find a pathological basis for the act which so deeply wounds not only
the tie of blood, but also the feeling of a civilized people. But in
many of the cases reported in literature, to the honor of humanity, the
presumption of a psychopathic basis is possible.

  In the Feldtmann case (Marc-Ideler, vol. i, p. 18), where a father
  constantly made immoral attacks on his adult daughter, and finally
  killed her, the unnatural father was weak-minded and, besides,
  probably subject to periodical mental disease. In another case of
  incest between father and daughter (_loc. cit._, p. 247), the latter,
  at least, was weak-minded. Lombroso (_Archiv. di Psichiatria_, viii,
  p. 519) reports the case of a peasant, aged 42, who practiced incest
  with his daughters, aged, respectively, 22, 19, and 11; he even forced
  the youngest to prostitute herself, and then visited her in a brothel.
  The medico-legal examination showed predisposition, intellectual and
  moral imbecility, and alcoholism.

  There was no mental examination in the case reported by Schürmeyer
  (_Deutsche Zeitschr. für Staatsarzneikunde_, xxii, H. 1), in which a
  mother laid her son of five and a half years on herself, and practiced
  abuse with him; and in that given by Lafarque (_Journ. Méd. de
  Bordeaux_, 1874), where a girl, aged 17, laid her brother, aged 13,
  upon herself, brought about membrorum conjunctionem, and performed
  masturbation on him.

  The following cases are those of tainted individuals: Magnan (_Ann.
  méd.-psych._, 1885) mentions an unmarried woman, aged 29, who, though
  indifferent toward other children or even men, suffered frightfully in
  the presence of her nephew, and could scarcely control her impulse to
  cohabit with him. This sexual peculiarity continued only as long as
  the nephew was quite young.

  Legrand (_Ann. méd.-psych._, May, 1876) mentions a girl, aged 15, who
  seduced her brother into all manner of sexual excesses on her person;
  and when, after two years of this incestuous practice, her brother
  died, she attempted to murder a relative. In the same article there is
  the case of a married woman, aged 36, who hung her open breast out of
  a window, and indulged in abuse with her brother, aged 18; and also
  the case of a mother, aged 39, who practiced incest with her son, with
  whom she was madly in love, became pregnant by him, and induced
  abortion.

Through Casper we know that depraved mothers in large cities sometimes
treat their little daughters in a most horrible fashion, in order to
prepare them for the sexual use of debauchees. This crime belongs
elsewhere.


     9. IMMORAL ACTS WITH PERSONS IN THE CARE OF OTHERS; SEDUCTION
                              (AUSTRIAN).

 (Austrian Statutes, § 131; Abridgment, § 188; German Statutes, § 173).

Allied to incest, but still less repugnant to moral sensibility, are
those cases in which persons seduce those entrusted to them for care or
education, and who are more or less dependent upon them, to commit or
suffer vicious practices. Such acts, which especially deserve legal
punishment, seem only exceptionally to have psychopathic significance.




                                 INDEX.


 Abuse, unnatural, 404

 Acts for self-humiliation, 134

 Æsthetics and sexuality, 10

 Amor lesbicus, 428

 Anæsthesia sexualis, acquired, 47
   congenital, 42

 Androgyny, 304

 Areas, erogenous, 31

 Attraction, sexual, 16


 Baudelaire, 122

 Binet, 18, 19, 21, 121

 Bondage, sexual, 141

 Bote, 202

 Boys, whipping of (sadistic), 82

 Brunn, 19


 Cæsars, 58

 Capitals as breeding-places of sensuality, 7

 Christianity, influence of, 4, 6
   contrasted with Mohammedanism, 5

 Cohabitation, 32

 Contrary sexual instinct, 185
   causes of, 188
   degrees of, 187

 Corpses, mutilation of, 67

 Cruelty, passively endured, 89
   and love, 9
   and lust, 9
   sources of, 86


 Decadence, moral, 6

 Defemination, 197

 Defilement of women, 79

 Delirium acutum, 54

 Dementia and psychopathia sexualis, 361
   paretic, and psychopathia sexualis, 363

 Descartes, 162

 Diagnosis of contrary sexuality, 319

 Durga, 57


 Effemination, 279

 Ejaculation centre, 31
   affections of, 36

 Epilepsy and psychopathia sexualis, 364

 Equus eroticus, 111

 Erection centre, 24
   affections of, 35

 Esquirol, 220, 221

 Eviration, 197

 Exhibition, 382

 Eyes, neuropathic, 21


 Family life, 6

 Fetichism, 17
   and crime, 401
   of apron, 170
   of feathers, 182
   of female attire, 167
   of female person, 157
   of foot and shoe, 123, 176
   of furs, 181
   of hair, 20
   of hand, 158
   of handkerchief, 171
   of glove, 175
   of material, 180
   of odors, 21
   of silk, 183
   of velvet, 180
   of voice, 22
   religious, 17

 Fiction and sexual perversion, 123

 Flagellation, 28, 152
   and masochism, 99
   differentiation of, 100
   for reflex effect, 99
   heroines of, 29

 Flagellum salutis, 29

 Friendship and love, 19

 Frigiditas uxoris, 46

 Frottage, 394


 Gley, 226

 Griesinger, 224

 Gynandry, 304


 Hair, as a fetich, 20

 Hair-despoilers, 162, 164, 165

 Herodotus, 200

 Hermaphroditism, psychical, 230
   cases of, 232–255

 Hippocrates, 201

 Homo-sexuality, 185, 255
   acquired, 188
   causes of, 188
   congenital, 222
   degrees of, I, 191; II, 197; III, 202; IV, 216
   explanation of, 227

 Holder, 202

 Hyperæsthesia sexualis, 48
   cases of, 51–55

 Hypnosis, therapeutics, 322–357

 Hysteria, 375


 Idiocy and psychopathia sexualis, 358

 Imbecility and contrary sexuality, 359

 Ink, throwing of, 80

 Insanity, and contrary sexuality, 358
   periodical, 372

 Incest, 431


 Japanese women, 3

 Juvenal, 31


 Kiernan, 227

 Kiernan’s explanation of sadism, 152

 Kleist, 88


 Ladame’s case, 344

 Libido sexualis, 24–32

 Love and cruelty, 9
   and friendship, 19
   and religion, 8
   fetichism of, 19
   Lesbian, 428
   of man and woman compared, 15
   platonic, 11, 12
   true, 11
   youthful, 11

 Lust and cruelty, 10, 57
   and battle, 58, 60
   and murder, 62, 397
   and the passive endurance of cruelty, 90
   and plunder, 58

 Lupercal, 31

 Lydston, 162, 227


 Magnan, 20, 227

 Mania, 373

 Mantegazza, 7, 227

 Marschalls Gilles de Rays, 58

 Maudsley, 1

 Masoch, Sacher-, 89

 Masochism, 89
   and flagellation, 99
   and sadism, 148
   explanation of, 139
   in women, 137
   larvated, 123
   rudimentary, 101
   symbolic, 115

 Melancholia, 374

 Messalinas, 88

 Metamorphosis sexualis paranoica, 216
   transition to, 202

 Modesty, origin of, 2, 15
   in women, 15

 Mohammedan women, 5

 Morality, progress in, 5

 Morals, decadence of, and pathology, 6

 Mujerados, 201


 Necrophilia, 430

 Nervi erigentes, 24

 Neuroses, cerebral, 36
   sexual, 34
   spinal, 35

 Nymphomania, 373


 Olfactory fetichism, 21
   hallucinations and sexuality, 28
   sense and sexual sense, 26


 Paradoxia sexualis, 37

 Paræsthesia sexualis, 56

 Paranoia, 376

 Pathological sexuality in its legal aspects, 378

 Pathology, general, 34
   special, 358

 Pederasty, 408
   cultivated, 414
   false imputation of, 420

 Penthesilia, 88

 Perfumes as a fetich, 21, 26

 Physiology, 23

 Priapism, 35

 Prognosis of contrary sexuality, 319

 Psychology, sexual, 1

 Psychopathia sexualis periodica, 371

 Puberty, its psychological importance, 7
   relation to poetry, 7
     to religious feeling, 7

 Pueblo Indians, 201


 Rape, 397

 Religion and sensuality, 8

 Reversal of sexual feeling, 191

 Robbery, 401

 Rousseau, 119


 Sacher-Masoch, 89

 Sade, Marquis de, 57, 71

 Sadism, 57, 401
   and masochism, 148
   atavistic, 152
   cases of, 62–67
   in women, 87
   physiological relations of, 59
   symbolic, 81
   with animals, 84
   with other objects, 82

 Satyriasis, 373

 Schema of sexual neuroses, 34

 Schopenhauer, 41

 Scythians, insanity of the, 200

 Schrenk-Notzing’s case, 351

 Senile libido, 40, 41

 Sensuality, 5
   religious equivalent of, 8

 Servants, immoral acts of, with children, 432

 Sexuality, source of ethical feeling, 1
   and the social feeling, 1
   simple reversal of, 191

 Sexual attraction, 16
   bondage, 141
   desire, physiology of, 23
   instinct in childhood, 37
     in old age, 38
   promptings, first, 7
   satisfaction in received cruelty and abuse, 91
   selection, 2

 Shoe-fetichism, 123
   cases of, 124–134

 Silk-fetichism, 183

 Siva, 57

 Sodomy, 404

 Spanking, dangers of, 28

 Stefanowsky, 123

 Sterility, 13

 Sulphuric acid, throwing of, 80

 Suggestion, hypnotic, 322–357


 Theft, 401

 Torture of animals, 401

 Therapy of contrary sexuality, 321


 Ulrichs, 227

 Urning, memorial of one, 410

 Urnings, 255
   cases of, 257–279
   laws concerning, 413


 Vampirism, 87

 Vanity, 16

 Velvet-fetichism, 180

 Violation of children, 402

 Viraginity, 279

 Virility, loss of, 12

 Voice as a fetich, 22


 Westermarck, 15, 16, 20

 Westphal, 224

 Whitechapel murderer, 64

 Woman, elevation of, 3
   in Old Testament and Gospels, 4
   position of, 2
   sexual appetite of, 15
     _rôle_ of, 13

 Woman-haters’ ball, 417

 Women, defilement of, 79
   injury of, 70
   masochism in, 137


 Zones, erogenous, 31

-----

Footnote 1:

  “Meanwhile, until Philosophy shall at last unite and maintain the
  world, Hunger and Love impel it onward.”

Footnote 2:

  Hartmann’s philosophical view of love, in the “Philosophy of the
  Unconscious,” p. 583, Berlin, 1869, is the following: “Love causes
  more pain than pleasure. Pleasure is illusory. Reason would cause love
  to be avoided if it were not for the fatal sexual instinct; therefore,
  it would be best for a man to have himself castrated.” The same
  opinion, minus the consequence, is also expressed by Schopenhauer
  (“Die Welt als Wille und Vorstellung,” 3. Aufl., Bd. ii, p. 586 u.
  ff.).

Footnote 3:

  “No physical or moral misery, no suffering, however corrupt it may be,
  should frighten him who has devoted himself to a knowledge of man and
  the sacred ministry of medicine; in that he is obliged to see all
  things, let him be permitted to say all things.”

Footnote 4:

  The Latin is left untranslated.

Footnote 5:

  The works of Moll and von Schrenck-Notzing have since appeared.—TRANS.

Footnote 6:

  Die Suggestions-Therapie, etc., F. Enke, Stuttgart, 1892.

Footnote 7:

  Comp. Lombroso, “The Criminal.”

Footnote 8:

  Comp. Westermarck, “History of Human Marriage.” McMillan & Co., 1891.

Footnote 9:

  This generally entertained idea, also held by many historians,
  requires some limitation, in that the symbolic and sacramental
  character of marriage was first made clear and unequivocal by the
  Council of Trent, even though there was ever in the spirit of
  Christianity that which would free woman and raise her from the
  inferior position occupied by her in the ancient world and the Old
  Testament.

  That this took place so late may well be due in part to the traditions
  of Genesis of the secondary creation of woman from the rib of man, and
  of her part in the Fall, and the consequent curse: “Thy will shall be
  to thy husband.” Since the Fall, for which the Old Testament made
  woman responsible, became the corner-stone of the fabric of
  churchteachings, the wife’s social position could but remain inferior
  until the spirit of Christianity had gained a victory over tradition
  and scholasticism.

  It is remarkable that, with the exception of the interdiction of
  putting away a wife (Matt. xix, 9), the gospels contain nothing
  favoring woman. Gentleness toward the adulteress and the repentant
  Magdalene does not affect the position of the wife in itself. The
  Epistles of Paul specifically declare that the position of woman shall
  not be altered (II Corinth. xi, 3–12; Ephes. v, 22: “Wives, submit
  yourselves unto your husbands;” and 33, “And the wife _see_ that she
  reverence her husband”).

  Passages in Tertullian show how the Fathers of the Church were
  prejudiced against woman by Eve’s guilt: “Woman, thou shouldst forever
  go in sorrow and rags, thy eyes filled with tears! Thou hast brought
  man to the ground!” St. Hieronymus has nothing good to say of woman.
  He says, “Woman is a door for the devil, a way to evil, the sting of
  the scorpion.” (“De cultu feminarum,” i, 1.)

  Canonical Law declares: “Only man was created in the image of God, not
  woman; therefore, woman should serve him and be his maid!”

  The Provincial Council of Macon, in the sixth century, earnestly
  debated the question whether woman had a soul.

  The effect of these ideas in the Church on the peoples embracing
  Christianity was direct. Among the Germans, after the acceptance of
  the new faith, for the foregoing reason, the weregild for a wife—the
  simple expression of her value—decreased (J. Falke, “Die ritterliche
  Gesellschaft,” p. 49. Berlin, 1862). Concerning the value of each sex
  among the Jews, _vide_ Leviticus, xxvii, 3 and 4.

  Moreover, polygamy, which is expressly recognized in the Old Testament
  (Deut. xxi, 15), is nowhere explicitly interdicted in the New
  Testament. Christian princes (_e.g._, the Marovingian kings, Clotar I,
  Childebert I, Pepin I, and many of the royal Franks) lived in
  polygamy; and at that time the Church made no opposition to it
  (Weinhold, “Die deutschen Frauen im Mittelalter,” ii, p. 15). Comp.
  also Unger, “Die Ehe,” etc., and the excellent work by Louis Bridel,
  “La femme et le droit,” Paris, 1884.

Footnote 10:

  Comp. Friedländer “Sittengeschichte Roms.” Wiedemeister, “Der
  Cäsarenwahnsinn.” Suetonius. Moreau, “Des aberrations du sens
  génésique.”

Footnote 11:

  These statements, however, are opposed to Friedreich (“Hdb. d.
  gerichtsärztl Praxis,” i, p. 271, 1843), and also Lombroso (_op.
  cit._, p. 42), according to whom pederasty is very frequent among the
  uncivilized Americans.

Footnote 12:

  Comp. Friedreich, “gerichtl. Psychologie,” p. 389, who has collected
  numerous examples. Thus the nun Blanbekin was always troubled with the
  thought about what had become of the part lost at the circumcision of
  Christ. Veronica Juliani, canonized by Pope Pius II, in memory of the
  divine lion, took an actual lion in her bed and kissed it, and let it
  suck from her breast; and even secreted a few drops of milk for it.
  St. Catherine, of Genoa, often burned with such inward fire that, in
  order to cool herself, she would lie down on the ground and cry “Love,
  love, I can endure it no longer!” At the same time she felt a peculiar
  inclination for her confessor. One day she lifted his hand to her nose
  and smelled an odor which penetrated to her heart, “a heavenly
  perfume, so delightful that it would wake the dead.” St. Armelle and
  St. Elizabeth were troubled with a similar longing for the child
  Jesus. The temptations of St. Anthony, of Padua, are well known. An
  old prayer is significant: “O, that I had found thee, Holy Emanuel; O,
  that I had thee in my bed to bring delight to body and soul. Come and
  be mine, and my heart shall be thy resting-place.”

Footnote 13:

  Comp. Friedreich, “Diagnostik der psych. Krankheiten,” p. 347 _u.
  ff._; Neumann, “Lehrb. d. Psychiatrie,” p. 80.

Footnote 14:

  The relation of this trio finds its expression not only in the events
  of real life, as above indicated, but also in romance, and even in the
  sculpture of degenerate eras. As an example we may point to the group
  of St. Theresa, by Bernini, who “sinks in an hysterical faint on a
  marble cloud, with an amorous angel plunging the arrow (of divine
  love) into her heart” (Lübke).

Footnote 15:

  A Russian religious sect.

Footnote 16:

  Westermarck (_op. cit._, p. 211), after a careful review of the
  evidence, says: “These facts appear to prove that the feeling of
  shame, far from being the original cause of man’s covering his body,
  is, on the contrary, a result of this custom; and that the covering,
  if not used as a protection from climate, owes its origin, at least in
  a great many cases, to the desire of men and women to make themselves
  attractive.”—TRANS.

Footnote 17:

  This is not literally the case. “It is expressly stated, of the women
  of several savage peoples, that they are less desirous of
  self-decoration than the men.”—Westermarck, _op. cit._, p. 184. And
  the same writer (p. 182) says that “it is a common notion that women
  are by nature vainer and more addicted to dressing and decorating
  themselves than men. This certainly does not hold good for savage and
  barbarous peoples in general.”—TRANS.

Footnote 18:

  Comp. Max Müller, who derives the word fetich etymologically from
  _factitious_ (artificial, an insignificant thing).

Footnote 19:

  Deutsches Montagsblatt, Berlin, August 20, 1888.

Footnote 20:

  Magnan’s “spinal cérébral postérieur,” who finds pleasure in every
  woman, and on whom every woman looks with favor, has only desire to
  satisfy his lust. Purchased or forced love is not real love
  (Mantegazza). The one who originated the saying, “Sublata lucerna
  nullum discrimen inter feminas,” must have been a cynic indeed. Power
  in a man to perform love’s act is no proof that this makes possible
  the greatest pleasure of love. There are, indeed, urnings who are
  potent for women,—men who do not love their wives, but who are still
  able to perform the marital “duty.” In most cases of this kind,
  indeed, there is no lustful pleasure; it is essentially a kind of
  onanistic act, for the most part made possible by means of help of
  imagination that calls up another beloved person. By this deception
  sensual pleasure can be induced, but this rudimentary psychical
  satisfaction is the result of a mental trick, just as in solitary
  onanism, where fancy has to assist in order to induce sensual
  pleasure. As a rule, the degree of orgasm necessary as a means to the
  attainment of lustful pleasure seems attainable only when the
  imagination intervenes. Where mental impediments exist (indifference,
  repugnance, disgust, fear of infection or pregnancy, etc.), sensual
  pleasure seems usually wanting.

Footnote 21:

  “The important part played by the hair of the head as a stimulant of
  sexual passion appears in a curious way from Mr. Sibree’s account of
  King Radàma’s attempt to introduce European customs among the Hovas
  of Madagascar. As soon as he had adopted the military tactics of the
  English, he ordered that all his officers and soldiers should have
  their hair cut, but this command produced so great a disturbance
  among the women of the capital that they assembled in great numbers
  to protest against the king’s order, and could not be quieted until
  they were surrounded by troops, and their leaders cruelly
  speared.”—Westermarck, _op. cit._

  Here male hair was a physiological fetich of females. It represents a
  relation of the sexes that civilization has gradually reversed. While
  in civilized society woman exercises her ingenuity to increase her
  attractiveness, among savages it is the men who are anxious to
  increase their physical charms. This reversal of the primitive
  relation is a very interesting fact, and is probably to be explained
  by the transference of the “liberty of choice” from woman to man which
  civilization has gradually induced. Westermarck (_op. cit._, p. 185)
  says: “It should be noted that it is, as a rule, the man only that
  runs the risk of being obliged to lead a single life. Hence it is
  obvious that, to the best of his ability, he must endeavor to be taken
  into favor by making himself as attractive as possible. In civilized
  Europe, on the other hand, the opposite occurs. Here it is the woman
  that has the greatest difficulty in getting married, and she is also
  the vainer of the two.”—TRANS.

Footnote 22:

  The olfactory centre is presumed by Ferrier (“Functions of the Brain”)
  to be in the region of the _gyrus uncinatus_. Zuckerkandl (“Ueber das
  Riechcentrum,” 1887), from researches in comparative anatomy,
  concludes that the olfactory centre has its seat in Ammon’s horn.

Footnote 23:

  Comp. Laycock, who (“Nervous Diseases of Women,” 1840) found that in
  women the love for musk and similar perfumes was related to sexual
  excitement.

Footnote 24:

  Also in the insanity of gestation.—TRANS.

Footnote 25:

  The following case, reported by Binet, seems to be in opposition to
  this idea. Unfortunately nothing is said concerning the mental
  characteristics of the person. In any event, it is certainly
  confirmatory of the relations existing between the olfactory and
  sexual senses:—

  D., a medical student, was seated on a bench in a public park, reading
  a book (on pathology). Suddenly a violent erection disturbed him. He
  looked up and noticed that a lady, redolent with perfume, had taken a
  seat upon the other end of the bench. D. could attribute the erection
  to nothing but the unconscious olfactory impression made upon him.

Footnote 26:

  Meibomius, “De flagiorum usu in re medica,” London, 1765; Boileau,
  “The History of the Flagellants,” London, 1783.

Footnote 27:

  Comp. Roubaud, “Traité de l’impuissance et de la stérilité.” Paris,
  1878.

Footnote 28:

  Literature: Parent-Duchatelet, Prostitution dans la ville de Paris,
  1837.—Rosenbaum, Entstehung der Syphilis, Halle, 1839; also, Die
  Lustseuche im Alterthum, Halle, 1839.—Descuret, La médecine des
  passions, Paris, 1860.—Casper, Klin. Novellen, 1863.—Bastian, Der
  Mensch in der Geschichte.—Friedländer, Sittengeschichte
  Roms.—Wiedemeister, Cäsarenwahnsinn.—Scherr, Deutsche Cultur- und
  Sittenge- schichte, Bd. i, Cap. 9.—Tardieu, Des attentats aux mœurs.,
  7 édit., 1878.—Emminghaus, Psychopathol., pp. 98, 225, 230,
  232.—Schüle, Handbuch der Geisteskrankheiten, p. 114.—Marc, Die
  Geisteskrankheiten, übers v. Ideler, ii, p. 128.—v. Krafft, Lehrb. der
  Psychiatrie, 4 Aufl., i, p. 90; Lehrb. d. ger. Psychopathol., 2 Aufl.,
  p. 234; Archiv f. Psychiatrie, vii, 2.—Moreau, Des aberrations du sens
  génésique, Paris, 1880.—Kirn, Allg. Zeitschr. f. Psychiatrie, xxxix,
  Heft 2 u. 3.—Lombroso, Geschlechtstrieb u. Verbrechen in ihren
  gegenseitigen Beziehungen (Goltdammer’s Archiv, Bd. xxx.).—Tarnowsky,
  Die krankhaften Erscheinungen des Geschlechtssinns, Berlin,
  1886.—Ball, La Folie érotique, Paris, 1888.—Serieux, Recherches
  cliniques sur les anomalies de l’instinct sexuel, Paris,
  1888.—Hammond, Sexual Impotence.

Footnote 29:

  _Vide_ Ultzmann, Genito-Urinary Neuroses in the Male (published by The
  F. A. Davis Co., Philadelphia), for discussion of peripheral neuroses.

Footnote 30:

  An interesting example of how an imperative conception of non-sexual
  content can exert an influence is related by Magnan (_Ann. méd.
  psych._, 1885): Student, aged 21, strongly predisposed hereditarily,
  previously a masturbator, constantly struggles with the number 13 as
  an imperative conception. As soon as he attempts coitus the imperative
  idea inhibits erection and makes the act impossible.

Footnote 31:

  Louyer-Villermay speaks of masturbation in a girl of 3 or 4 years, and
  Moreau (“Aberrations du sens génésique,” 2 édit., p. 209) of the same
  in one of 2 years. See, further, Maudsley, “Physiology and Pathology
  of Mind;” Hirschsprung (Kopenhagen), Berlin, klin. Wochenschr., 1866,
  Nr. 38; Lombroso, “The Criminal,” Cases 10, 19, and 21.

Footnote 32:

  Comp. Kirn, Zeitschr. f. Psych., Bd. xxxix. Legrand du Saulle, Annal.
  d’hyg., 1868, Oct.

Footnote 33:

  The translator has lately seen a case of this kind that illustrates
  the lack of care taken by our criminal courts. A very infirm man, aged
  55 to 60, under favoring circumstances, made an unsuccessful sexual
  assault on a girl aged about 18. At his trial he made full confession,
  and explained his act as due to ordinary sinfulness. He was the father
  of a family and living with his wife, and up to that time blameless
  sexually. He was sentenced to five years of hard labor! He was
  incapable of almost the lightest work. Conversation with him while in
  jail showed at once that he was well advanced in senile dementia.
  Legal question concerning his mental condition was not raised,—because
  he confessed, probably!

Footnote 34:

  Cases, _vide_ Laségue: “Les exhibitionistes,” Union médicale, 1877,
  May 1st.

Footnote 35:

  Legrand du Saulle, La folie devant les tribunaux, p. 530.

Footnote 36:

  Kirn, Maschka’s Handb. d. ger. Med., pp. 373, 374; Allg. Zeitschrift
  f. Psychiatrie, Bd. xxxix, p. 220.

Footnote 37:

  Die Welt als Wille und Vorstellung, 1859, B. ii, p. 461 _et seq._

Footnote 38:

  “Ueber männliche Sterilität,” Wiener med. Presse, 1878, Nr. 1. “Ueber
  Potentia generandi et coeundi,” Wiener Klinik, 1885, Heft 1, S. 5.
  Translated under the title of Genito-Urinary Neuroses, etc. The F. A.
  Davis Company, Philadelphia.

Footnote 39:

  In individuals in whom intense sexual hyperæsthesia is associated with
  acquired irritable weakness of the sexual apparatus, it is possible
  that simply at the sight of a pleasing female figure, without
  peripheral irritation of the genitals, not only the mechanism of
  erection, but also that of ejaculation, may be excited to action from
  the psycho-sexual centre. For such individuals, all that is necessary
  to induce orgasm, or even ejaculation, is to imagine themselves in a
  sexual situation with a female that sits opposite them in
  railway-coupé or drawing-room. Hammond (_op. cit._, p. 40) describes
  several cases of this kind that came to him for treatment for
  impotence that followed; and he mentions that these individuals used
  the term “ideal coitus” for the act. Dr. Moll, of Berlin, told me of a
  similar case; and in this instance the same designation was chosen for
  the act.

Footnote 40:

  So named from the notorious Marquis de Sade, whose obscene novels
  treated of lust and cruelty. In French literature the expression
  “Sadism” has been applied to this perversion.

Footnote 41:

  U. A. Novalis, in his “Fragments”; Görres, “Christliche Mystik,” Bd.
  iii, p. 460.

Footnote 42:

  Comp. also Alfred deMusset’s famous verses to the Andalusian girl:—

   “Qu’elle est superbe en son désordre—quand elle tombe les seins nus—
   Qu’on la voit, béante, se tordre—dans un baiser de rage et mordre—
     En hurlant des mots inconnus!”

Footnote 43:

  During the excitement of battle the idea of lust forces its way into
  consciousness. Comp. the description of a battle by a soldier, by
  Grillparzer:—

  “And as the signal rang out, the armies met, breast to breast—lust of
  the gods!—here, there, the murderous steel slays enemy, friend. Given
  and taken—death and life—with wavering change—wildly raging in
  frenzy.”

Footnote 44:

  Schulz (Wiener Med. Wochenschrift, No. 49, 1869) reports a remarkable
  case of a man, aged 28, who could perform coitus with his wife only
  after working himself into an artificial fit of anger.

Footnote 45:

  Concerning analogous acts in rutting animals, _vide_ Lombroso, “The
  Criminal.”

Footnote 46:

  Among animals it is always the male who pursues the female with
  proffers of love. Playful or actual flight of the female is not
  infrequently observed; and then the relation is like that between the
  beast of prey and the victim.

Footnote 47:

  The conquest of woman takes place to-day in the social form of
  courting, in seduction and deception. From the history of civilization
  and anthropology we know that there have been times, as there are
  savages to-day that practice it, where brutal force, robbery, or even
  blows that made a woman powerless, were made use of to obtain love’s
  desire. It is possible that tendencies to such outbreaks of sadism are
  atavistic.

Footnote 48:

  In the Jahrbücher für Psychologie, ii, p. 128, Schäfer (Jena) refers
  to the reports of two cases by A. Payer. In the first case states of
  great sexual excitement were induced by the sight of battles or of
  paintings of them; in the second, by cruel torturing of small animals
  (_vide_ Case 24). It is added: “The pleasure of battle and murder is
  so predominantly an attribute of the male sex throughout the animal
  kingdom, that there can be no question about the close relation
  existing between this side of the masculine character and male
  sexuality. I believe, too, that by unprejudiced observation I can show
  that, in men who are absolutely normal mentally and physically, the
  first indefinite and incomprehensible precursors of sexual excitement
  may be induced by reading exciting scenes of the chase and
  war,—_i.e._, they give rise to unconscious longings for a kind of
  satisfaction in warlike games (wrestling), in which, also, the
  fundamental sexual impulse to the most perfect and intense contact
  with a companion is expressed, with the more or less clearly defined
  secondary thought of conquest.”

Footnote 49:

  It sometimes happens that an accidental sight of blood, etc., is what
  first excites the preformed psychical mechanism of the sadistic
  individual, and awakens the instinct.

Footnote 50:

  Comp. Metzger’s ger. Arzneiw., herausgegeben von Remer, p. 539;
  Klein’s Annalen, x, p. 176, xviii, p. 311; Heinroth, System der psych,
  ger. Med., p. 270; Neuer Pitaval, 1855, 23, Th. (Fall Blaize Ferrage).

Footnote 51:

  Comp. Spitzka, The Journal of Nervous and Mental Disease, December,
  1888; Kiernan, The Medical Standard, November, December, 1888.

Footnote 52:

  Simon (Crimes et Délits, p. 209) mentions an experience of
  Lacassagne’s, to whom a respectable man said that he was never
  intensely excited sexually except when a spectator at a funeral.

Footnote 53:

  Taxil (_op. cit._) gives more detailed accounts of this sexual
  monster, which must have been a case of habitual satyriasis,
  accompanied by perverse sexual instinct. Sade was so cynical that he
  actually sought to idealize his cruel lasciviousness, and become the
  apostle of a theory based upon it. He became so bad (among other
  things he made an invited company of ladies and gentlemen erotic by
  causing to be served to them chocolate bon-bons which contained
  cantharides) that he was committed to the insane asylum at Charenton.
  During the revolution of 1790, he escaped. Then he wrote obscene
  novels filled with lust, cruelty, and the most obscene scenes. When
  Bonaparte became Consul, Sade made him a present of his novels
  magnificently bound. The Consul had the works destroyed, and the
  author committed to Charenton again, where he died, at the age of
  sixty-four.

Footnote 54:

  Comp. Krauss, Psychologie des Verbrechens, 1884, p. 188; Dr. Hofer,
  Annalen der Staatsarzneikunde, 6 Jahrgang, Heft 2; Schmidt’s
  Jahrbücher, Bd. lix, p. 94.

Footnote 55:

  According to newspaper reports, in December, 1890, several similar
  attacks were made in Mainz. A young fellow between fourteen and
  sixteen years old pressed against women and girls and stabbed them in
  the legs with a sharp-pointed instrument. He was arrested, and seemed
  to be insane. Further details of the case are not known.

Footnote 56:

  Leo Taxil (La Corruption, Paris, Noiret, p. 223) makes the same
  statements. There are also men who demand introductio linguæ
  meretricis in anum.

Footnote 57:

  Leo Taxil (_op. cit._, p. 234) relates that in Parisian brothels
  instruments are kept ready which look like knouts, but which are
  merely tubes filled with air, such as clowns use in circuses. Sadistic
  men use them to create for themselves the illusion that they are
  whipping women.

Footnote 58:

  The legend is especially spread throughout the Balkan peninsula. Among
  the Greeks it has its origin in the myth of the _lamiæ_ and
  _marmolykes_,—blood-sucking women. Goethe made use of this in his
  “Bride of Corinth.” The verses referring to vampirism, “suck thy
  heart’s blood,” etc., can be thoroughly understood only when compared
  with their ancient sources.

Footnote 59:

  In the latest literature we find the matter treated, but particularly
  in Sacher-Masoch’s novels, which are hereafter to be alluded to, and
  in Ernest von Wildenbruch’s “Brunhilde,” Rachilde’s “La Marquise de
  Sade,” etc.

Footnote 60:

  So named from the writer, Sacher-Masoch, whose romances and novels
  have as their particular object the description of this perversion.

Footnote 61:

  Comp., _supra_, Introduction, p. 28.

Footnote 62:

  The author’s “Neue Forschungen auf d. Gebiet d. Psychopathia
  Sexualis,” Stuttgart, 1891, which is, for the most part, incorporated
  in this edition of “Psychopathia Sexualis.”

Footnote 63:

  This difference of courage in the face of events in nature, on the one
  hand, and in the face of personal conflict, on the other, is certainly
  remarkable (comp. Case 44), even though it is the only indication of
  effemination mentioned in this case.

Footnote 64:

  Transactions of the Colorado State Medical Society, quoted in the
  Alienist and Neurologist, 1883, p. 345.

Footnote 65:

  “To be at the feet of an imperious mistress; to obey her orders; to be
  compelled to sue her for pardon,—these things are my most intense
  delight.”

Footnote 66:

  “Never daring to express my desire, I at least gave it rein under
  circumstances that served to preserve in me the idea of it.”

Footnote 67:

  “What Rousseau loves in women is not only the frowning brow, the
  threatening hand, the angry glance, the imperious attitude, but it is
  also the emotional state of which these are the objective translation;
  he loves the fierce, disdainful woman who crushes him at her feet with
  the weight of her royal displeasure.”

Footnote 68:

  However, the domain of masochism must be sharply differentiated from
  the principal subject of that work, which is, that love contains an
  element of suffering. Unrequited love has always been described as
  “sweet, but sorrowful;” and poets have spoken of “blissful pain” or
  “painful bliss.” This must not, as it is by Z., be confounded with the
  manifestations of masochism, any more than the characterization of an
  unyielding lover as “cruel” should be. It is remarkable, however, that
  Hamerling (“Amor und Psyche,” iv, Gesang) uses perfect masochistic
  pictures, flagellation, etc., to express this feeling.

Footnote 69:

  The desire to be trod upon also occurs in religious enthusiasts (comp.
  Turgenjew, “Sonderbare Geschichten”).

Footnote 70:

  In this story the writer describes a man whose greatest pleasure lies
  in being treated like a slave by a beautiful woman, whom he loves.
  Besides numerous scenes in which the man is whipped by the woman,
  there are others in which he is trod upon by her. It is this act that
  forms the principal means of excitement in the case above described.

Footnote 71:

  In Continental hotels the guests are accustomed to put their shoes in
  the corridors at night, to be cleaned.

Footnote 72:

  However, against the theory that foot- and shoe-fetichism is a
  manifestation of (latent) masochism, Dr. Moll (_op. cit._, p. 136)
  raises the objection that it is still unexplained why the fetichist so
  often prefers boots with high heels, then boots and shoes of a
  particular kind—buttoned or laced. To this objection it may be
  remarked that, in the first place, the high heels characterize the
  shoes as feminine; and, in the second place, that in spite of the
  sexual character of his inclination, the fetichist demands all kinds
  of æsthetic qualities in his fetich (comp. Case 90).

Footnote 73:

  There is apparently a connection between foot-fetichism and the fact
  that certain persons of this kind, whom coitus does not satisfy, or
  who are unable to perform it, find a substitute for it in tritus
  membri inter pedes mulieris.

Footnote 74:

  Analogy with the excesses of religious enthusiasm is found even here.
  The religious enthusiast, Antoinette Bouvignon de la Porte, mixed her
  food with fæces to punish herself (Zimmermann, _op. cit._, p. 124).
  The beatified Marie Alacoque, to “mortify” herself, licked up with her
  tongue the dejections of patients, and sucked their toes covered with
  sores.

Footnote 75:

  The laws of the early Middle Ages gave the husband the right to kill
  the wife; those of the later Middle Ages, the right to beat her. The
  latter right was used freely, even by those of high standing (comp.
  Schultze, Das höfische Leben zur Zeit des Minnesangs, Bd. i, p. 163
  _et seq._). Yet, by the side of this, the paradoxical chivalry of the
  Middle Ages stands unexplained.

Footnote 76:

  Comp. Lady Milford’s words in Schiller’s “Kabale und Liebe”: “We women
  can only choose between ruling and serving; but the highest pleasure
  power affords is but a miserable substitute, if the greater joy of
  being the slaves of a man we love is denied us!”

Footnote 77:

  Anthony and Cleopatra, v. 2.

Footnote 78:

  Comp. the author’s article, “über geschlechtliche Hörigkeit und
  Masochismus,” in the Psychiatrischen Jahrbücher, Bd. x, p. 169 _et
  seq._, where this subject is treated in detail, and particularly from
  the forensic stand-point.

Footnote 79:

  The expressions “slave” and “slavery,” though often used
  metaphorically under such circumstances, are avoided here because they
  are the favorite expressions of masochism, from which this “bondage”
  must be strictly differentiated.

  The expression “bondage” is not to be construed to mean J. S. Mill’s
  “Bondage of Woman.” What Mill designates with this expression are laws
  and customs, social and historical facts. Here, however, we always
  speak of facts having peculiar individual motives that even conflict
  with prevalent customs and laws.

Footnote 80:

  Perhaps the most important element is, that by the habit of submission
  a kind of mechanical obedience, without consciousness of its motives,
  which operates with automatic certainty, may be established, having no
  opposing motives to contend with, because it lies beyond the threshold
  of consciousness; and it may be used by the dominant individual like
  an inanimate instrument.

Footnote 81:

  Sexual bondage, of course, plays a _rôle_ in all literatures. Indeed,
  for the poet, the extraordinary manifestations of the sexual life that
  are not perverse form a rich and open field. The most celebrated
  description of masculine “bondage” is that by Abbé Prévost, “Mano
  Lescault.” An excellent description of feminine “bondage” is that of
  “Leone Leoni,” by George Sand. But first of all comes Kleist’s
  “Käthchen von Heilbronn,” who himself called it the counterpart of
  (sadistic) “Penthesilea.” Halm’s “Griseldis” and many other similar
  poems also belong here.

Footnote 82:

  Cases may occur in which the sexual bondage is expressed in the same
  acts that are common in masochism. When rough men whip their wives,
  and the latter suffer for love, without, however, having a desire for
  blows, we have a pseudo form of bondage that may simulate masochism.

Footnote 83:

  It is very interesting, and dependent upon the nature of bondage and
  masochism, which essentially correspond in external effects, that to
  illustrate the former certain playful, metaphorical expressions are in
  general use; such as “slavery,” “to bear chains,” “bound,” “to hold
  the whip over,” “to harness to the triumphal car,” “to lie at the
  feet,” “hen-pecked,” etc.,—all things which, literally carried out,
  form the objects of the masochist’s desire. Such similes are
  frequently used in daily life and have become trite. They are derived
  from the language of poetry. Poetry has always recognized, within the
  general idea of the passion of love, the element of dependence in the
  lover, who practices self-sacrifice spontaneously or of necessity. The
  facts of “bondage” have also always presented themselves to the
  poetical imagination. When the poet chooses such expressions as those
  mentioned, to picture the dependence of the lover in striking similes,
  _he proceeds exactly as does the masochist_, who, to intensify the
  idea of his dependence (his ultimate aim), creates such situations in
  reality. In ancient poetry, the expression “domina” is used to signify
  the loved one, with a preference for the simile of “casting in chains”
  (_e.g._, Horace, Od. iv, 11). From antiquity through all the centuries
  to our own times (comp. Grillparzer, “Ottokar,” Act v: “To rule is
  sweet, almost as sweet as to obey”), the poetry of love is filled with
  similar phrases and similes. The history of the word “mistress” is
  also interesting. But poetry reacts on life. It is probable that the
  courtly chivalry of the Middle Ages arose in this way. In its
  reverence for women as “mistresses” in society and in individual
  love-relations; its transference of the relations of feudalism and
  vassalage to the relation between the knight and his lady; its
  submission to all feminine whims; its love-tests and vows; its duty of
  obedience to every command of the lady,—in all this, chivalry appears
  as a systematic, poetical development of the “bondage” of love.
  Certain extreme manifestations, like the deeds and suffering of Ulrich
  von Lichtenstein or Pierre Vidal in the service of their ladies; or
  the practice of the fraternity of the “Galois” in France, whose
  members sought martyrdom in love and subjected themselves to all kinds
  of suffering,—these clearly have a masochistic character, and
  demonstrate the natural transformation of one phenomenon into the
  other.

Footnote 84:

  If it be considered that, as shown above, “sexual bondage” is a
  phenomenon observed much more frequently and in a more pronounced
  degree in the female sex than in the male, the thought arises that
  masochism (if not always, at least as a rule) is an inheritance of the
  “bondage” of feminine experience. Thus it comes into a relation—though
  distant—with contrary sexual instinct, as a transference to the male
  of a perversion really belonging to the female. This conception of
  masochism as a rudimentary contrary sexual instinct, as a partial
  effemination, here affecting only the secondary sexual character of
  the vita sexualis (a theory still more unconditionally expressed in
  the sixth edition of this work) finds its support in the statements of
  the subjects of Case 44 and Case 50, who present other features of
  effemination, and give as their ideal a relatively old woman who seeks
  and wins them; and, further, in the fact that the (potent) masochist
  prefers the _rôle_ of succubus, as shown by statements referring to
  this.

  It must, however, be emphasized that “bondage” also plays no
  unimportant _rôle_ in the masculine vita sexualis, and that masochism
  in man may also be explained without any such transference of feminine
  elements. It must also be remembered here that masochism, as well as
  its counterpart, sadism, occurs in irregular combination with contrary
  sexual instinct.

Footnote 85:

  Of course, both have to contend with opposing ethical and æsthetic
  motives _in foro interno_. After these have been overcome and sadism
  appears, it immediately comes in conflict with the law. This is not
  the case with masochism; which accounts for the greater frequency of
  masochistic acts. But the instinct of self-preservation and fear of
  pain oppose the realization of the latter. The practical significance
  of masochism lies only in its relations to psychical impotence; while
  that of sadism lies beyond that, and is principally forensic.

Footnote 86:

  Every attempt to explain the facts of either sadism or masochism,
  owing to the close connection of the two phenomena demonstrated here,
  must also be suited to explain the other perversion. An attempt to
  offer an explanation of sadism, by J. G. Kiernan (Chicago) (_vide_
  “Psychological Aspects of the Sexual Appetite,” Alienist and
  Neurologist, St. Louis, April, 1891) meets this requirement, and for
  this reason may be briefly mentioned here. Kiernan, who has several
  authorities in Anglo-American literature for his theory, starts from
  the assumption of several naturalists (Dallinger, Drysdale, Rolph,
  Cleukowsky) which conceives the so-called conjugation, a sexual act in
  certain low forms of animal life, to be cannibalism, a devouring of
  the partner in the act. He brings into immediate connection with this
  the well-known facts that at the time of sexual union crabs tear limbs
  from their bodies and spiders bite off the heads of the males, and
  other sadistic acts performed by rutting animals with their consorts.
  From this he passes to lust-murder and other lustful acts of cruelty
  in man, and assumes that hunger and the sexual appetite are, in their
  origin, identical; that the sexual cannibalism of lower forms of
  animal life has an influence in higher forms and in man, and that
  sadism is an example of atavism.

  This explanation of sadism would, of course, also explain masochism;
  for if the origin of sexual intercourse is to be sought in
  cannibalistic processes, then both the survival of one sex and the
  destruction of the other would fulfill the purpose of nature, and thus
  the instinctive desire to be the victim would be explained. But it
  must be stated in objection that the basis of this reasoning is
  insufficient. The extremely complicated process of conjugation in
  lower organisms, into which science has really penetrated only during
  the last few years, is by no means to be regarded as simply a
  devouring of one individual by another (comp. Weismann, Die Bedeutung
  der Sexuellen Fortpflanzung für die Selectionstheorie, p. 51, Jena,
  1886).

Footnote 87:

  In Zola’s “Therese Raquin,” where the lover repeatedly kisses his
  mistress’s boot, the case is quite different from that of shoe- and
  boot-fetichists, who, at the sight of every boot worn by a lady, or
  even alone, are thrown into sexual excitement, even to the extent of
  ejaculation.

Footnote 88:

  Though Binet (_op. cit._) declares that every sexual perversion,
  without exception, depends upon such an “accident acting on a
  predisposed subject” (where, under predisposition, only hyperæsthesia
  in general is understood), yet such an assumption for other
  perversions than fetichism is neither necessary nor satisfactory. For
  example, it is not clear how the sight of another’s punishment could
  excite sexually even a very excitable individual, if the physiological
  relationship of lust and cruelty had not been developed into
  _original_ sadism in an abnormally excitable individual.

Footnote 89:

  When young husbands who have associated much with prostitutes feel
  impotent in the face of the chastity of their young wives—a thing that
  frequently occurs—the condition may be regarded as a kind of
  (psychical) fetichism in a wider sense. One of my patients was never
  potent with his beautiful and chaste young wife, because he was
  accustomed to the lascivious methods of prostitutes. When he now and
  then attempted coitus with puellis he was perfectly potent. Hammond
  (_op. cit._) reports a very similar interesting case. Of course, in
  such cases, a bad conscience and hypochondriacal fear of impotence
  play an important part.

Footnote 90:

  A kind of rudimentary sadism in L. and masochism in N.

Footnote 91:

  Great sexual hyperæsthesia. Comp. note on p. 50.

Footnote 92:

  This is also sexual hyperæsthesia. Any intense excitement affects the
  sexual sphere (Binet’s “dynamogénie générale”). Concerning this, Dr.
  Moll communicates the following case: “A similar thing is described by
  Mr. E., aged 27; merchant. While at school, and afterward, he often
  had ejaculation with pleasurable feeling when he was seized with a
  feeling of intense anxiety. Besides, almost every other physical or
  mental pain exerted a similar influence. E., as he states, has a
  normal sexual instinct, but suffers with nervous impotence.”

Footnote 93:

  Phila. Med. and Surg. Rep., Sept. 7, 1889.

Footnote 94:

  This case was originally reported by Dr. A. R. Reynolds, Chicago
  (Western Med. Reporter, Nov., 1888).

Footnote 95:

  Moll (_op. cit._ p. 131) reports: “A man, X., becomes intensely
  excited sexually whenever he sees a woman with the hair in a braid;
  loose hair, no matter how beautiful, cannot produce this effect.”

  Of course, it is not justifiable to consider all hair-despoilers
  fetichists, for in a few cases such acts are done for the purpose of
  gain,—_i.e._, the stolen hair is not a fetich.

Footnote 96:

  Magnan (Arch, de Neurologie, vol. xxxiii, No. 69, 1892) gives the
  details of a case of sexual perversion in a degenerate individual,
  where the elements of fetichism and sadism were combined, and _faute
  de mieux_ the sadistic impulse found satisfaction in self-mutilation.
  The perverse impulse began at the age of six; the sight of a boy or
  girl with a delicate, white skin awakened in him sexual appetite, with
  a desire to bite and eat a piece of the skin. While caressing a horse,
  the impulse to bite the soft skin of its nostrils arose, and afterward
  the memory of this became associated with the act of onanism. Later,
  he began to prick himself with pins, knives, etc., while masturbating.
  The desire to bite and eat skin was also provoked by the sight of
  shining blades, like those of scissors. He was always able to resist
  the impulse to attack young girls; but the struggle was hard, and for
  eight months he hesitated before venting his passion on his own
  person. He was finally arrested in the act of cutting a large piece of
  skin from his arm with scissors. Asked the motive of his
  self-mutilation, he stated that for several hours he had been
  following a young girl who had a fine, white skin, and was burning
  with desire to cut out a piece of it and eat it. On his person there
  were many scars of previous mutilations. The impulse was devoid of
  natural sexual desire. Chewing the piece of skin provoked
  ejaculation.—TRANS.

Footnote 97:

  The frequent changes of style of dress which fashion dictates may be
  referred to a physiological law. The reaction of the nervous system to
  a constant stimulus diminishes in proportion to the duration of the
  action of the stimulus. Constant association with nudity removes its
  power to excite sexually. Owing to this, the savage endeavors to
  attract attention by changing his physical peculiarities; he dresses
  his hair in some remarkable way, or paints his body; then he tattooes
  his skin, or performs striking self-mutilation, such as
  half-castration and circumcision (comp. Westermarck, _op. cit._, p.
  205). Finally, mutilation is replaced by movable appendages, upon
  which ornaments are worn; and thus there is afforded opportunity for
  _change_, in obedience to the unconscious physiological requirement,
  which is called a “_taste_ for change.” Undoubtedly, woman’s desire
  for changes of fashion is primarily dependent upon man’s desire to be
  pleased; and her function in this direction has certainly been
  transferred from him to her by civilization (comp. p. 16).—TRANS.

Footnote 98:

  Comp: Goethe’s remarks about his adventure in Geneva (“Briefe aus der
  Schweiz,” 1. Abtheil., Schluss).

Footnote 99:

  The fact that the partly-veiled form is often more charming than when
  it is perfectly nude, is, as far as object goes, similar, but quite
  different psychically. This depends upon the effect of contrast and
  expectation, which are common phenomena, and in no sense pathological.

Footnote 100:

  On page 124 (_op. cit._) Dr. Moll writes concerning this impulse in
  hetero-sexual individuals: “The passion for handkerchiefs may go so
  far that the man is entirely under their control. A woman tells me: ‘I
  know a certain gentleman, and when I see him at a distance I only need
  to draw out my handkerchief so that it peeps out of my pocket, and I
  am certain that he will follow me as a dog follows its master. Go
  where I please, this gentleman will follow me. He may be riding in a
  carriage or engaged in important business, and yet, when he sees my
  handkerchief he drops everything in order to follow me,—_i.e._, my
  handkerchief.’”

Footnote 101:

  Garnier (Anomalies Sexuelles, Paris, pp. 508, 509) reports two cases
  (Cases 222 and 223) that are apparently opposed to this assumption,
  particularly the first, in which despair about the unfaithfulness of a
  lover led the individual to submit to the seductions of men. But the
  case itself clearly shows that this individual never found pleasure in
  homo-sexual acts. In Case 223, the individual was effeminated _ab
  origine_, or was at least a psychical hermaphrodite.

  Those who hold to the opinion that the origin of homo-sexual feelings
  and instinct is found to be exclusively in defective education and
  other psychological influences are entirely in error.

  An untainted male may be raised never so much like a female, and a
  female like a male, but they will not become homo-sexual. The natural
  disposition is the determining condition; not education and other
  accidental circumstances, like seduction. There can be no thought of
  contrary sexual instinct save when the person of the same sex exerts a
  psycho-sexual influence on the individual, and thus brings about
  libido and orgasm,—_i.e._, has a psychical attraction. Those cases are
  quite different in which, _faute de mieux_, with great sensuality and
  a defective æsthetic sense, the body of a person of the same sex is
  used for an onanistic act (not for coitus in a psychical sense).

  In his excellent monograph, Moll shows very clearly and convincingly
  the importance of original predisposition in contrast with exciting
  causes (comp. _op. cit._, pp. 156–175). He knows “many cases where
  early sexual intercourse with men was not capable of inducing
  perversion.” Moll significantly says, further: “I know of such an
  epidemic (of mutual onanism) in a Berlin school, where a person who is
  now an actor shamelessly introduced mutual onanism. Though I now know
  the names of very many urnings in Berlin, yet I could not ascertain,
  even with anything like probability, that among all the scholars of
  that school at that time there was one that had become an urning; but,
  on the other hand, I have quite certain knowledge that many of those
  scholars are now normal sexually, in feeling and intercourse.”

Footnote 102:

  Comp, author’s Experimental Study in the Domain of Hypnotism, 1889. G.
  P. Putnam’s Sons, New York.

Footnote 103:

  Comp. Sprengel, “Apologie des Hippokrates,” Leipzig, 1792, p. 611;
  Friedreich, “Literärgeschichte der psych. Krankheiten,” 1830, p. 31;
  Lallemand, “Des pertes séminales,” Paris, 1836, i, p. 581; Nysten,
  “Dictionn. de médecine,” xi édit., Paris, 1858, Art. “éviration et
  Maladie des Scythes”; Marandon, “De la maladie des Scythes”; “Annal.
  médico-psychol.,” 1877, Mars, p. 161; Hammond, American Journal of
  Neurology and Psychiatry, August, 1882.

Footnote 104:

  The following description of the “bote” is taken from Dr. J. G.
  Kiernan’s article on “Responsibility in Sexual Perversion,” read
  before the Chicago Medical Society, March 7, 1892: “In accordance with
  the well-known physiological law, that too frequent excitation of a
  nerve exhausts the reaction of that nerve to that excitant, sexual
  excess exhausts the normal reaction, whence it occurs that abnormal
  stimulus is required and the vice type of sexual perversion results.
  Such vice types crop up among savages. Dr. A. B. Holder (N. Y. Med.
  Jour., 1889) describes a sexual pervert called the ‘bote’ by the
  Montana and the ‘burdach’ by the Washington Indians. Such a pervert is
  found among all the tribes of the Northwest. Like all other sexual
  perverts, these ‘botes’ can recognize each other. Dr. Holder has found
  that the ‘bote’ wears the squaw dress, parts his hair like a squaw,
  and assumes feminine speech and manners. Their features are often
  masculine. In childhood feminine dress and manners are assumed, but
  not until puberty do ‘bote’ practices result. These consist in taking
  the male organ of the active party in the lips of the ‘bote,’ who
  experiences the sexual orgasm at the same time. A ‘bote’ examined by
  Dr. Holder was a splendidly formed fellow, of prepossessing face, in
  perfect health, active in movement, and happy in disposition. By
  offering payment, he induced him to submit himself, though with
  considerable reluctance, to a thorough examination. He was five feet
  eight inches high, weighed one hundred and fifty-eight pounds, and had
  a frank, intelligent face,—being an Indian, of course beardless. He
  was thirty-three years of age, and had worn woman’s dress for
  twenty-eight years. His dress was the usual dress of the Indian
  female, consisting of four articles,—a single dress or gown of half a
  dozen yards of cloth, made loose with wide sleeves, and skirt reaching
  to the ankles, the skirt and body of one piece, very much like the
  ‘Mother Hubbard’ _negligée_ worn by ladies; a beaded belt loosely
  confining this at the waist; stockings from government annuity goods,
  and buckskin moccasins extending above the ankles. The hair,
  twenty-four or twenty-six inches long, was parted in the centre and
  allowed to hang loose in two masses behind the shoulders. Since among
  the Sioux and some other tribes it is usual for men to wear their hair
  in this way, it is well to observe that in this tribe (Absaroke) the
  men usually wear the hair in long braids, and always part it on the
  side and ‘roach’ the front. His skin was smooth and free from hair,
  there being absolutely none on the legs, arms, or breast, or in the
  arm-pits. This is of no special significance, as male and female
  Indians are both free from hair on these parts of the body. The mammæ
  were as rudimentary as those of the male. When he removed his dress he
  threw his thighs together so as to completely conceal the organs,
  whether male or female; such a movement is made by timid women under
  examination,—a movement usually successful in the female, owing to the
  non-projecting character of the genitals and to the rotundity of the
  thighs; but not usually easy, for the reverse reasons, in the male. In
  this the ‘bote’—either from the conformation of the thighs, which had
  the feminine rotundity, or from skill acquired by habit—succeeded
  completely. When he separated his thighs, male organs came into view,
  in size perhaps not quite so large as the physique of the man would
  indicate, but in position and shape altogether normal. The penis was
  flaccid. The ‘bote’ in habits very closely resembles a class described
  by Hippocrates among the Scythians of Caucasus, called by the Greeks
  anandreis, a word strikingly similar in meaning to ‘bote.’”—TRANS.

Footnote 105:

  Bibliography (besides works mentioned hereafter): Tardieu, Des
  attentats aux moeurs, 7 édit., 1878, p. 210.—Hofmann, Lehrb. d. ger.
  Med., 3 Aufl., pp. 172, 850.—Gley, Revue philosophique, 1884, Nr.
  1.—Magnan, Annal. med.-psychol., 1885, p. 458.—Shaw and Ferris,
  Journal of Nervous and Mental Disease, 1883, April.—Bernhardi, Der
  Uranismus, Berlin (Volksbuchhandlung), 1882.—Chevalier, De l’inversion
  de l’instinct sexual, Paris, 1885.—Ritti, Gaz. hebdom. de médecine et
  de chirurg., 1878, 4. Januar.—Tamassia, Rivista sperim, 1878, pp.
  97–117.—Lombroso, Archiv. di Psichiatr., 1881.—Charcot et Magnan,
  Archiv. de neurologie, 1882, Nr. 7, 12.—Moll, Die conträre
  Sexualempfindung, Berlin, 1891 (numerous bibliographic
  references).—Chevalier, Archives de l’anthropologie criminelle, vol.
  v, No 27; vol. vi, No. 31.—Reuss, “Aberrations du sens générique,”
  Annales d’hygiène publique, 1886.—Saury, Étude clinique sur la folie
  héréditaire, 1886.—Brouardel, Gaz. des hôpiteaux, 1886 and
  1887.—Tilier, L’instinct sexuel chez l’homme et chez les animaux,
  1889.—Carlier, Les deux prostitutions, 1887.—Lacassagne, art.
  “Pédérastie,” in the Diction. encyclopédique.—Vibert, art.
  “Pédérastie,” in the Diction. méd. et de chirurgie.

Footnote 106:

  Dr. Moll, of Berlin, called my attention to the fact that in Moritz’s
  Magazin f. Erfahrungsseelenkunde, vol. viii, Berlin, 1791, there are
  references to contrary sexual instinct in man. In fact, there two
  biographies of men are reported who manifested an enthusiastic love
  for persons of their own sex. In the second case, which is
  particularly noteworthy, the patient himself explains his aberration
  by the fact that, as a child, he was caressed only by grown persons,
  and, as a boy of ten or twelve years, only by his school-fellows.
  “This, and the want of association with persons of the opposite sex,
  in me, caused the natural inclination toward the female sex to be
  entirely diverted to the male sex. I am still quite indifferent to
  women.”

  It cannot be determined whether such a case is one of congenital
  (psycho-sexual hermaphroditism?) or acquired contrary sexual instinct.
  The oldest case of contrary sexual instinct, that has thus far been
  proved in Germany, is that of a woman who was married to another, and
  gratified herself sexually with a leathern priapus. A case of
  viraginity, historically and legally interesting, derived from the
  legal proceedings, which took place early in the eighteenth century,
  is reported by Dr. Müller (Alexandersbad), in Friedrich’s Blätter f.
  ger. Medicin, 1891, part iv.

Footnote 107:

  “Vindex, Inclusa, Vindicta, Formatrix, Ara spei, Gladius furens,
  kritische Pfeile,” Leipzig (Otto u. Kadler), 1864–1880.

Footnote 108:

  In male individuals: (1) Casper, Klin. Novellen, p. 36 (Lehrb. d. ger.
  Med., 7 Aufl., p. 176); (2) Westphal, Archiv f. Psych., ii. p. 73; (3)
  Schminke, _id._, iii, p. 225; (4) Scholz, Vierteljahrsschr. f. ger.
  Med., xix; (5) Gock, Arch. f. Psych., v., p. 564; (6) Servaes, _id._,
  vi, p. 484; (7) Westphal, _id._, vi, 620; (8, 9, 10) Stark, Zeitsch.
  f. Psychiatrie, Bd. 31; (11) Liman (Casper’s Lehrb. der ger. Med., 6
  Aufl., p. 509), p. 291; (12) Legrand du Saulle, Annal. méd.-psychol.,
  1876, May; (13) Sterz, Jahrb. f. Psychiatrie, iii, Heft 3; (14) Krueg,
  Brain, 1884, Oct.; (15) Charcot et Magnan, Arch. de neurolog., 1882,
  Nr. 9; (16, 17, 18) Kirn, Zeitschr. f. Psych., Bd. 39, p. 216; (19)
  Rabow, Erlenmeyer’s Centralb., 1883, Nr. 8; (20) Blumer, Americ.
  Journ. of Insanity, 1882, July; (21) Savage, Journal of Mental
  Science, 1884, October; (22) Scholz, Vierteljahrsschr. f. ger. Med.,
  N. F. Bd. 43, Heft. 7; (23) Magnan, Ann. méd. psychol., 1885, p. 461;
  (24) Chevalier, De l’inversion de l’instinct sexuel, Paris, 1885, p.
  129; (25) Morselli, La Riforma medica, iv, March; (26) Leonpacher,
  Friedreich’s Blätter, 1888, H. 4; (27) Holländer, Allg. Wiener Med.
  Zeitg., 1882; (28) Kreise, Erlenmeyer’s Centralblatt, 1888, Nr. 19;
  (29, 30, 31, 32) v. Krafft, Psychopathia sexualis, 3 Aufl., Beob. 32,
  36, 42, 43; (33) Golenko, Russ. Archiv f. Psychiatrie, Bd. ix, H. 3
  (v. Rothe, Zeitschr. f. Psychiatrie); (34) v. Krafft, Internationales
  Centralblatt f. d. Physiol, u. Pathologie der Harn-u. Sexualorgane,
  Bd. 1, H. 1; (35) Cantarano, La Psichiatria, 1887, v., p. 195; (36)
  Sérieux, Recherches cliniques sur les anomalies de l’instinct sexuel,
  Paris, 1888, obs. 13; (37–42) Kiernan, The Medical Standard, 1888, 7
  cases; (43–46) Rabow, Zeitschr. f. klin. Medicin, Bd. xvii, Suppl.;
  (47–51) v. Krafft, Neue Forschungen, Beob. (1, 3, 4, 5, 8); (52–61) v.
  Krafft, Psychopath. Sexualis, 5 Aufl., Beob. 53, 61, 64, 66, 73, 75,
  78, 84, 85, 87; (62–65) v. Krafft, Neue Forschungen, 2 Aufl., Beob. 3,
  4, 5,6; (66, 67) Hammond, Sexual Impotence; (68–71) Garnier, Anomalies
  sexuelles, 1889, Obs. 227, 228, 229, 230; (72) Müller, Friedreich’s
  Blätter, 1891; (73–87) v. Krafft, Psychopathia Sexualis, 6 Aufl.,
  Beob. 78, 81, 82, 84, 85, 86, 87, 89, 93, 94,96, 97, 98, 101, 102.

  In female individuals: (1) Westphal, Arch. f. Psych., ii, p. 73; Gock,
  _op. cit._, Nr. 1; (3) Wise, The Alienist and Neurologist, 1883,
  January; (4) Cantarano, La Psichiatria, 1883, p. 201; (5) Sérieux,
  _op. cit._, obs. 14; (6) Kiernan, _op. cit._

Footnote 109:

  Tarnowsky (_op. cit._, p. 34) records a case which shows that contrary
  sexual feeling, as a concomitant manifestation with neurotic
  degeneration, may also affect the descendants of parents having no
  neurotic taint. In this instance, lues of the parents played a part,
  as in a similar case of Scholz (Vierteljahrsschr. f. ger. Med.), in
  which the perversion of the sexual desires stood in causal relation
  with an arrest of psychical development, caused by traumatism.

Footnote 110:

  This supposition is overthrown by the result of the post-mortem of my
  case (118), where the brain-weight was 1150 grammes, and of Case 130,
  where it was 1175 grammes.

Footnote 111:

  That inversion of the sexual instinct is not infrequent is proved,
  among other things, by the circumstance that it is frequently a
  subject in novels. Chevalier (_op. cit._) points out in French
  literature, besides the novels of Balzac, like “La Passion au Desert”
  (treating of bestiality) and “Sarrazine” (treating of the love of a
  woman for a eunuch), Diderot’s “La Religieuse” (a story of one given
  to _amor lesbicus_); Balzac’s “La Fille aux Yeux d’Or” (_amor
  lesbicus_); Th. Gautier’s “Mademoiselle de Maupin”; Feydeau’s “La
  Comtesse de Chalis”; Flaubert’s “Salammbo,” etc. Belot’s “Mademoiselle
  Giraud, Ma Femme” may also be mentioned (now translated into English).
  It is interesting that the heroines of these (Lesbian) novels appear
  in the character and _rôle_ of the husband of a lover of the same sex,
  and that their love is extremely passionate. Moreover, the neuropathic
  foundation of this sexual perversion does not escape the writers. This
  theme is treated, in German literature, in “Fridolin’s heimliche Ehe,”
  by Wilbrand; in “Brick and Brack Oder Licht in Schatten,” by Emerich
  Graf Stadion. The oldest urning’s romance is probably that published
  by Petronius at Rome, under the Empire, under the title Satyricon.

Footnote 112:

  Comp. author’s work, “Ueber psychosexuales Zwitterthum,” in the
  internationalen Centralblatt f. d. Physiologie u. Pathologie der Harn
  und Sexualorgane, Bd. i, Heft 2.

Footnote 113:

  This idea is supported by the statements of an unmarried urning which
  Dr. Moll, of Berlin, kindly communicated to me. He could report a
  number of cases of his acquaintance, in which married men at the same
  time had “relations” with men.

Footnote 114:

  Later it became known that a near relative died insane, and, further,
  that eight of his parent’s children had died of acute or chronic
  hydrocephalus at ages ranging from one to fifteen.

Footnote 115:

    “Thou art like any flower, so sweet, so beautiful, so pure,” etc.

Footnote 116:

           “Lowering like the heavens, frowns the world on me,
           Yet blest or cursed will be the fate I meet.
           With trusting heart, dear friend, I think of thee!
           God keep thee, dear! it would have been too sweet!
           God keep thee, dear! such happiness was not to be!”

Footnote 117:

  Comp. the expert medical opinion of this case, by Dr. Birnbacher, in
  Friedreich’s Blätter f. ger. Med., 1891, H. 1.

Footnote 118:

  With reference to prophylaxis, the following words, which were written
  to me by the subject of Case 88 of the sixth edition, are noteworthy:
  “If it were only possible that—not as among the Spartans, where the
  weaklings were allowed to perish for the sake of perfect selection, in
  accordance with the Darwinian idea—our contrary sexual instincts might
  be recognized early in youth; and if it were only possible that, at
  this time of life, the worst of all diseases could be cured by
  suggestion! Probably cure could be more easily effected in youth than
  later.”

Footnote 119:

  For numerous cases, _v._ Henke’s Zeitschr., xxiii.—Ergänzungsheft, p.
  147.—Combes, Annal. méd. psychol., 1866.—Liman, Zweifelh.
  Geisteszustände, p. 389.—Casper-Liman, Lehrb., 7. Auflage, Fall
  295.—Bartels, Friedreich’s Blätter f. gerichtl. Med., 1890, Heft 1.

Footnote 120:

  Other cases of pederasty, _v._ Casper, Klin. Novellen, Fall 5; Combes,
  Annal. méd. psychol.

Footnote 121:

  V. Sander, Vierteljahrsschr. f. ger. M., xviii, p. 31.—Casper, Klin.
  Novellen, Fall 27.

Footnote 122:

  Arndt (Lehrb. d. Psych., p. 410) especially emphasizes the passionate
  element in epileptics: “I have known epilepsy that expressed itself in
  a most sensual way toward the mother, and that that rested under a
  suspicion on the part of fathers, concerning sexual intercourse with
  the mothers.” But when Arndt declares that, wherever there is a
  peculiarity of the sexual life, thought of an epileptic element should
  come into consideration, he is in error.

Footnote 123:

  Comp. also Liman, Zweifelhafte Geisteszustände, Fall 6.—Lasègue,
  Exhibitionists, Union méd., 1877.—Ball and Chambert, Art.
  Somnambulisme (Dict. des scienc. méd., 1881).

Footnote 124:

  Comp. the interesting cases of Marc-Ideler, ii, p. 137.—Ideler,
  “Grundriss der Seelenheilkunde,” ii, pp. 488–492.

Footnote 125:

  _Vide_ Fall Merlac, in the author’s Lehrb. d. ger. Psychopathol., 2
  Aufl., p. 322.—Morel, Traité des malad. mentales, p. 687.—Legrand, La
  folie, p. 337.—Process La Roncière, in Annal. d’hyg., 1. Serie, iv; 3.
  Serie, xxii.

Footnote 126:

  The incubus in the witch-trials of the Middle Ages depended on them.

Footnote 127:

  Comp. Casper, Klin. Novellen.—Lombroso, Goltdammer’s Archiv, Bd.
  xxx.—Oettingen, Moralstatistik, p. 494.

Footnote 128:

  Lasègue, Union Médicale, 1877, May.—Laugier, Annal d’hygiène publ.,
  1878, No. 106.—Pelanda, “Pornopaths,” Archivio di Psichiatria,
  viii.—Schuchardt, Zeitschr. f. Medicinalbeamte, 1890, Heft 6.

Footnote 129:

  Comp. v. Krafft, “Ueber transitorisches Irresein bei
  Neurasthenischen,” Irrenfreund, 1883, No. 8.

Footnote 130:

  Dr. Moll calls this perversion (?) mixoscopia (from μιξις,
  cohabitation; and σκεπτειν, to look). His assumption that it is
  related to masochism, in that there is a stimulus for the _voyeur_ in
  suffering at seeing a woman in the possession of another, does not
  seem to me to be justified. For further details, _vide_ Moll, “Die
  conträre Sexualempfindung,” p. 137.

Footnote 131:

  Annal. médico-psychol., 1849, p. 515; 1863, p. 57; 1864, p. 215; 1866,
  p. 253.

Footnote 132:

  Comp. the cases of Tardieu, Attentats, p. 182–192.

Footnote 133:

  Comp. Haltzendorff, Psychologie des Mords.

Footnote 134:

  Tardieu, Attentats, Case 51, p. 188.

Footnote 135:

  Masochism may, under certain circumstances, attain forensic
  importance. Modern criminal law no longer recognizes the principle,
  “volenti non fit injuria”; and the present Austrian statute, in § 4,
  says expressly: “Crimes may also be committed on persons who demand
  their commission on themselves.”

  As Herbst (Handb. d. österr. Strafrechts., Wien, 1878, p. 72) remarks,
  there are, nevertheless, crimes conditioned by the absence of assent
  on the part of the injured individual, which cease to be such as soon
  as the injured individual has given consent,—_e.g._, theft, rape.

  But Herbst also enumerates here the limitation of personal freedom
  (?).

  Of late a decided change of views on this point has taken place. The
  German criminal law regards the consent of a man to his own death of
  such importance that a very different and much milder punishment is
  inflicted under such circumstances (§ 216); and it is the same in
  Austrian law (Austrian Abridgment, § 222). The so-called double
  suicide of lovers was the act considered. In bodily injury and
  deprivation of freedom, the consent of the victim must also receive
  consideration at the hands of the judge. Certainly a knowledge of
  masochism is of importance in making a judgment of the probability of
  asserted consent.

Footnote 136:

  According to Austrian law, this crime should fall under § 411, as
  _slight_ bodily injury; according to the German criminal law, it is
  bodily injury (comp. Liszt, p. 325).

Footnote 137:

  Cases, _vide_ Friedreich’s Blätter f. ger. Anthropologie, iii, p. 77.

Footnote 138:

  Cases, Maschka, Handb., iii, p. 175.—Casper, Vierteljahrsschr., 1852,
  Bd. i.—Tardieu, Attentats.

Footnote 139:

  Comp. Kirn, Allg. Zeitschr. f. Psych., 39, p. 217.

Footnote 140:

  I follow the usual terminology in describing bestiality and pederasty
  under the general term sodomy. In Genesis (chap. xix), whence this
  word comes, it signifies exclusively the vice of pederasty. Later,
  sodomy was often used synonymously with bestiality. The moral
  theologians, like St. Alphons of Liguori, Gury, and others, have
  always distinguished correctly, _i.e._, in the sense of Genesis,
  between sodomia, _i.e._, concubitus cum persona ejusdem sexus, and
  bestialitas, _i.e._, concubitus cum bestia (comp. Olfus,
  Pastoralmedicin, p. 78).

  The jurists brought confusion into the terminology by establishing a
  “Sodomia ratione sexus” and a “S. ratione generis.” Science, however,
  should assert itself as _ansilla theologiæ_, and return to the correct
  usage.

Footnote 141:

  For interesting histories, _vide_ Krauss, Psychol. d. Verbrechens, p.
  180.—Maschka, Hdb. iii, p. 188.—Hofmann, Lehrb. d. ger. Med., p.
  180.—Rosenbaum, Die Lustseuche.

Footnote 142:

  How difficult, unpleasant, and dangerous for the jurist judgment of
  these “coitus-like” acts for the establishment of the objective fact
  of the crime may be is well shown by an article on the
  punishableness of male intercourse, in the Zeitschr. f. d. gesammte
  Strafrechtswissenschaft., Bd. vii, Heft 1, as well as by a similar
  one in Friedreich’s Blätter f. ger. Medicin, 1891, Heft 6. _Vide_,
  further, Moll, Conträre Sexualempfindung, p. 223 _et seq._, and
  Bernhardi, Der Uranismus, Berlin, 1882.

Footnote 143:

  For interesting histories and notes, _v._ Krause, Psychol. des
  Verbrechens, p. 174.—Tardieu, Attentats.—Maschka, Handb., iii, p. 174.
  This vice seems to have come through Crete from Asia to Greece, and,
  in the times of classic Hellas, to have been wide-spread. From there
  it spread to Rome, where it flourished luxuriantly. In Persia and
  China (where it is actually tolerated) it is wide-spread, as it also
  is in Europe. (Comp. Tarnowsky _et al._)

Footnote 144:

  Lombroso (Der Verbrecher, p. 20 _et seq._) shows that also, in case of
  animals, intercourse with the same sex occurs where normal indulgence
  is impossible.

Footnote 145:

  Comp. Tardieu, Attentats, p. 198.—Martineau, Deutsche Med. Zeitung,
  1882, p. 9.—Virchow’s Jahrb., 1881, i, p. 533.—Coutagne, Lyon Médical,
  Nos. 35, 36.

Footnote 146:

  Comp. Mayer, Friedreich’s Blätter, 1875, p. 41.—Kraussold, Melancholie
  und Schuld, 1884, p. 20.—Andronico, Archiv di psich. scienze penali ed
  anthropol. crim., vol. iii, p. 145.

Footnote 147:

  Comp. Maschka, Hdb., iii, p. 191 (good historical notes).—Legrand, La
  folie, p. 521.

Footnote 148:

  _Vide_ Westermarck, History of Human Marriage, chap. xiv. McMillan &
  Co., 1891.

------------------------------------------------------------------------

_September, 1893._

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                          INDEX TO CATALOGUE.


                                                                    PAGE

 Annual of the Universal Medical Sciences                         27, 28


                                ANATOMY.

 Practical Anatomy—Boenning                                            4

 Structure of the Central Nervous System—Edinger                       8

 Charts of the Nervo-Vascular System—Price and Eagleton               17

 Synopsis of Human Anatomy—Young                                      26


                              BACTERIOLOGY.

 Bacteriological Diagnosis—Eisenberg                                   8


                          CLINICAL CHARTS, ETC.

 Improved Clinical Charts—Bashore                                      3

 Symptom Register & Case Rec’d—Straub                                 25


                         DOMESTIC HYGIENE, ETC.

 Cholera—Vought                                                       15

 The Daughter:t Her Health, Education, and Wedlock—Capp                7

 Consumption:t How to Prevent it—Davis                                 5

 Plain Talks on Avoided Subjects—Guernsey                              9

 Heredity, Health, and Personal Beauty—Shoemaker                      22


                              ELECTRICITY.

 Practical Electricity in Medicine and Surgery—Liebig and Rohé        12

 Electricity in the Diseases of Women—Massey                          13

 International System of Electro-Therapeutics                         11


                                 FEVER.

 Fever:t its Pathology and Treatment—Hare                             10

 Hay Fever—Sajous                                                     15


                               GYNECOLOGY.

 Lessons in Gynecology—Goodell                                         9


                       HEART, LUNGS, KIDNEYS, ETC.

 Diseases of the Heart, Lungs, and Kidneys—Davis                       7

 Diseases of the Heart and Circulation in Children—Keating and        12
   Edwards

 Diabetes:t its Cause, Symptoms, and Treatment—Purdy                  17


                                HYGIENE.

 Climatology of Southern California—Remondino                         18

 Text-Book of Hygiene—Rohé                                            19


                    MATERIA MEDICA AND THERAPEUTICS.

 Hand-Book of Materia Medica, Pharmacy, and Therapeutics—Bowen         4

 Ointments and Oleates—Shoemaker                                      22

 Materia Medica and Therapeutics—Shoemaker                            21

 International Pocket Medical Formulary—Witherstine                   25


                             MISCELLANEOUS.

 History of the Life of D. Hayes Agnew, M.D., LL.D.—Adams             29

 Book on the Physician Himself—Cathell                                 5

 Oxygen—Demarquay and Wallian                                          7

 Record-Book of Medical Examinations for Life-Insurance—Keating        9

 The Medical Bulletin, Monthly                                         2

 Physician’s Interpreter                                              13

 Circumcision—Remondino                                               18

 Medical Symbolism—Sozinskey                                          23

 International Pocket Medical Formulary—Witherstine                   25

 The Chinese:t Medical, Political, and Social—Coltman                  6

 Psychopathia Sexualis—Krafft-Ebing                                   29

 Universal Medical Journal                                            26

 A Practical Manual of Diseases of the Skin—Rohé                      19


                       NERVOUS SYSTEM, SPINE, ETC.

 Spinal Concussion—Clevenger                                           6

 Structure of the Central Nervous System—Edinger                       8

 Epilepsy:t its Pathology and Treatment—Hare                          10

 Lectures on Nervous Diseases—Ranney                                  30


                               OBSTETRICS.

 Eclampsia—Michener and others                                        15

 Obstetric Synopsis—Stewart                                           24


                              PHYSIOGNOMY.

 Practical and Scientific Physiognomy—Stanton                         30


                       PHYSIOLOGY AND EMBRYOLOGY.

 Physiology of Domestic Animals—Smith                                 23


                    SURGERY AND SURGICAL OPERATIONS.

 Tuberculosis of the Bones & Joints—Senn                              20

 Circumcision—Remondino                                               18

 Principles of Surgery—Senn                                           20


                      SWEDISH MOVEMENT AND MASSAGE.

 Swedish Movement and Massage Treatment—Nissen                        15


                            THROAT AND NOSE.

 Journal of Laryngology and Rhinology                                 12

 Hay Fever—Sajous                                                     15

 Diseases of the Nose and Throat—Ivins                                10


                           VENEREAL DISEASES.

 Syphilis To-day and in Antiquity—Buret                                4

 Neuroses of the Genito-Urinary System in the Male—Ultzmann           24


                               VETERINARY.

 Age of Domestic Animals—Huidekoper                                   11

 Physiology of Domestic Animals—Smith                                 23


                    VISITING-LISTS AND ACCOUNT-BOOKS.

 Medical Bulletin Visiting-List or Physicians’ Call-Record            14

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                               _BOENNING_

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                                _BURET_


SYPHILIS In Ancient and Prehistoric Times.

WITH A CHAPTER ON THE RATIONAL TREATMENT OF SYPHILIS IN THE NINETEENTH
CENTURY.

By DR. F. BURET, Paris, France. Translated from the French, with the
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The subject throughout is treated in a clear, concise manner, and
readers will find many things which are historically new.

In order to give some idea of the contents of this first volume, the
following are cited as among the subjects treated:—

In What does Syphilis Consist? Origin of the Word Syphilis. The Age of
Syphilis. Syphilis in Prehistoric Times. _Tchoang._—Syphilis Among the
Chinese 5000 Years Ago. _Kasa._—Syphilis in Japan in the Ninth Century
B.C. Syphilis Among the Ancient Egyptians, 1400 B.C. Syphilis Among the
Ancient Assyrians and Babylonians. Syphilis Among the Hebrews in
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                                 _CAPP_

           The Daughter: Her Health, Education, and Wedlock.

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By WILLIAM M. CAPP, M.D., Philadelphia. This is just such a book as a
family physician would advise his lady patients to obtain and read. It
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It is complete in one beautifully printed (large, clear type) 12mo
volume of 150 pages.

  Handsomely bound in Extra Cloth, price, post-paid, in the United
    States and Canada, $1.00, net; Great Britain, 5s. 6d; France, 6 fr.
    20.

               In Paper Cover (Unabridged), 50 cts., net.

In the 144 pages allotted to him he has compressed an amount of homely
wisdom on the physical, mental, and moral development of the female
child from birth to maturity which is to be found elsewhere in only the
great book of experience. It is, of course, a book for mothers, but is
one so void of offense in expression or ideas that it can safely be
recommended for all whose minds are sufficiently developed to appreciate
its teachings.—_Philadelphia Public Ledger._

Many delicate subjects are treated with skill and in a manner which
cannot strike any one as improper or bold. The absolute ignorance in
which most young girls are allowed to exist, even until adult life, is
often productive of much misery, both mental and physical. Quite a
number of books written by physicians for popular use have been prepared
in such a way that the professional man can read between the lines
strong bids for popular favor, etc. These objectionable features will
not be found in Dr. Capp’s _brochure_, and for this reason it is worthy
the confidence of physicians.—_Medical News._


                               _CATHELL_

                     Book on the Physician Himself

   AND THINGS THAT CONCERN HIS REPUTATION AND SUCCESS. A NEW (TENTH)
                    EDITION, AUTHOR’S LAST REVISION.

By D. W. CATHELL, M.D., Baltimore, Md. This is the author’s final
revision of one of the most useful, successful, and popular medical
books ever published. It has been wisely and carefully revised
throughout. The well-known charming style of the author is preserved
intact, while the practical value of the book is truly enhanced by the
addition of much of the author’s gathered wisdom not introduced into any
previous edition. The volume has been brought to perfection, as far as
human effort can achieve, and though enlarged to 350 _Royal Octavo
Pages_ the price has not been increased.

 Handsomely Bound in Extra Cloth, price, in the United States and Canada,
 post-paid, $2.00, net; in Great Britain, 11s. 6d.; in France, 12 fr. 40.

“The Physician Himself” interested me so much that I actually read it
through at one sitting. It is brimful of the very best advice possible
for medical men. I, for one, shall try to profit by it.—_Prof. William
Goodell, Philadelphia._

It is marked with good common sense and replete with excellent maxims
and suggestions for the guidance of medical men.—_The British Medical
Journal._

We advise our readers to buy it. It will give them food for thought and
show them how to and how not to achieve reputation and success.—_The
Medical Age._

We cannot too strongly commend it to the attention of every young
doctor. Many a lesson is pleasantly and gently taught in its pages which
cannot otherwise be learned unless by bitter experience.—_Canada Medical
Record._

Of course, one reason for its occult power is that it is written with
admirable grace and precision, besides presenting the ups and downs of a
physician’s life in such a natural and perfect way. The book will help
any one who will read it. It tells you how to begin practice; leads you
into medical ethics properly, and, carefully studied, the pages of this
book will be of great benefit to the young and old.—_Charlotte Medical
Journal._

This book is evidently the production of an unspoiled mind and the fruit
of a ripe career. I admire its pure tone and feel the value of its
practical points. How I wish I could have read such a guide at the
outset of my career!—_Prof. James Nevins Hyde, Chicago, Ill._

“The Physician Himself” is useful alike to the tyro and the sage—the
neophyte and the veteran. It is a _headlight_ in the splendor of whose
beams a multitude of our profession shall find their way to
success.—_Prof. J. M. Bodine, Dean University of Louisville._

We have read one of the former, and smaller, editions through very
carefully, and know of no work in medical literature more profitable for
perusal and possession.—_Denver Medical Times._

This book will do a world of good, a good that will be far-reaching and
constant, and the fact that it has reached its tenth edition proves
toward a higher and yet higher teaching, that “the elevation of the
profession” is a consistent and timely aim.—_Chicago Clinical Review._

                              _CLEVENGER_

                           Spinal Concussion.

 SURGICALLY CONSIDERED AS A CAUSE OF SPINAL INJURY, AND NEUROLOGICALLY
   RESTRICTED TO A CERTAIN SYMPTOM GROUP, FOR WHICH IS SUGGESTED THE
 DESIGNATION ERICHSEN’S DISEASE, AS ONE FORM OF THE TRAUMATIC NEUROSES.

By S. V. CLEVENGER, M.D., Consulting Physician Reese and Alexian
Hospitals; Late Pathologist County Insane Asylum, Chicago, etc.

Special features consist in a description of modern methods of diagnosis
by Electricity, a discussion of the controversy concerning hysteria, and
the author’s original pathological view that the lesion is one involving
the spinal sympathetic nervous system.

_Every Physician and Lawyer should own this work._

In one handsome Royal Octavo Volume of nearly 400 pages, with thirty
Wood-Engravings.

  Price, post-paid, in United States and Canada, $2.50, net; in Great
                    Britain, 14s.; in France, 15 fr.

This work really does, if we may be permitted to use a trite and
hackneyed expression, “fill a long-felt want.” The subject is treated in
all its bearings; electro-diagnosis receives a large share of attention,
and the chapter devoted to illustrative cases will be found to possess
especial importance.—_Medical Weekly Review._


                               _COLTMAN_

 THE CHINESE: Their Present and Future; Medical, Political, and Social.

By ROBERT COLTMAN, JR., M.D., Surgeon in Charge of the Presbyterian
Hospital and Dispensary at Teng Chow Fu; Consulting Physician of the
American Southern Baptist Mission Society, etc.

Beautifully printed in large, clear type, illustrated with Fifteen Fine
Engravings on Extra Plate Paper, from photographs of persons, places,
and objects characteristic of China.

In one Royal Octavo volume of 212 Pages. Handsomely bound in Extra
Cloth, with Chinese Side Stamp in gold.

  Price, post-paid, in United States and Canada, $1.75, net; in Great
                  Britain, 10s.; in France, 12 fr. 20.

The Chinaman is a source of absolute curiosity to the American, and
anything in regard to his relationship to the medical profession will
prove more than usually attractive to the average doctor. Such is the
case with the work before us. It is difficult to put it aside after one
has begun to read it.—_Memphis Med. Monthly._

Dr. Coltman has written a very readable book, illustrated with
reproductions of photographs taken by himself.—_Boston Med. and Surg.
Journal._

Attached to a number of hospitals and dispensaries, he has had ample
opportunity to observe the medical aspect of the Chinese. The most
prevalent diseases are such as affect the alimentary tract and eye
troubles. Renal troubles are also frequent. Skin diseases are abundant
and syphilis is far from infrequent. Erysipelas is rare and enteric
fever infrequent. Cholera appears in epidemics and is then frightfully
fatal. Leprosy, of course, is common, and the author states that it
cannot be contagious, as is supposed by many, or it would assume a
terrible prevalence in China, where lepers are permitted to go about
free.

We will not further mention the subjects discussed in this excellent
book. The style of the author is very interesting and taking, and much
information is given in an entertaining manner. The political situation
is very intelligently handled in its various bearings. The
photo-engravings are handsome and well-executed, the book in general
being gotten up in a very artistic manner. We can heartily commend this
work not only to physicians, but to intelligent lay readers.—_St. Louis
Medical Review._


                                 _DAVIS_

         CONSUMPTION: How to Prevent it and How to Live with it.

 ITS NATURE, CAUSES, PREVENTION, AND THE MODE OF LIFE, CLIMATE, EXERCISE,
                FOOD, AND CLOTHING NECESSARY FOR ITS CURE.

By N. S. DAVIS, JR., A.M., M.D., Professor of Principles and Practice of
Medicine, Chicago Medical College; Physician to Mercy Hospital, Chicago;
Member of the American Medical Association, etc.

This plain, practical treatise thoroughly discusses the prevention of
Consumption, Hygiene for Consumptives, gives timely suggestions
concerning the different climates and the important part they play in
the treatment of this disease, etc., etc.,—all presented in such a
succinct and intelligible style as to make the perusal of the book a
pleasant pastime.

12mo. 143 pages. Handsomely bound in Extra Cloth.

 Price, post-paid, in United States and Canada, 75 Cents, net; in Great
                     Britain, 4s.; in France, 5 fr.

The questions of heredity, predisposition, prevention, and hygienic
treatment of consumption are simply and sensibly dealt with. The
chapters on how to live with tuberculosis are excellent.—_Indiana
Medical Journal._

The author is very thorough in his discussion of the subject, and the
practical hints which he gives are of real worth and value. His
directions are given in such a manner as to make life enjoyable to a
consumptive patient, and not a burden, as is too frequently the
case.—_Weekly Medical Review._


                          _By the Same Author_

               Diseases of the Lungs, Heart, and Kidneys.

By N. S. DAVIS, JR., A.M., M.D.

_The Nature, Pathological Anatomy, Symptoms, Causes, Diagnosis, and
Treatment_ of the diseases of these important organs are comprehensively
discussed in this conveniently arranged volume. Special and careful
attention is given to Treatment, while nothing else is slighted. _No. 14
in the Physicians’ and Students’ Ready-Reference Series._ 12mo. 359
pages. Extra Dark-Blue Cloth.

    Price, in United States and Canada, post-paid, $1.25, net; Great
                  Britain, 6s. 6d.; France, 7 fr. 75.

The author evidently knows how to put “multum in parvo” without omitting
anything essential to a clear understanding of the subject
discussed.—_St. Louis Medical Era._

It requires close thought, carefully and judiciously applied, to write a
book as this one is written. A systematic treatise on the Diseases of
the Lungs, Heart, and Kidneys, and their co-ordinate relation and
sympathy, presenting many of the main points of dependence of one upon
the other. This Dr. Davis has succeeded in doing to a nice degree,
handing the student a book worthy of most serious study.—_Medical Free
Press._


                              _DEMARQUAY_

  On Oxygen. A Practical Investigation of the Clinical and Therapeutic
          Value of the Gases in Medical and Surgical Practice,

    WITH ESPECIAL REFERENCE TO THE VALUE AND AVAILABILITY OF OXYGEN,
               NITROGEN, HYDROGEN, AND NITROGEN MONOXIDE.

By J. N. DEMARQUAY, Surgeon to the Municipal Hospital, Paris, and of the
Council of State; Member of the Imperial Society of Surgery, etc.
Translated, with notes, additions, and omissions, by SAMUEL S. WALLIAN,
A.M., M.D., ex-President of the Medical Association of Northern New
York; Member of the New York County Medical Society, etc.

Royal Octavo, 316 pages; illustrated with 21 Wood-Cuts.

    Price, post-paid, in United States and Canada, Cloth, $2.00, net;
 Half-Russia, $3.00, net. In Great Britain, Cloth, 11s. 6d.; Half-Russia,
      17s. 6d. In France, Cloth, 12 fr. 40; Half-Russia, 18 fr. 60.

This is a handsome volume of 300 pages, in large print, on good paper,
and nicely illustrated. Although nominally pleading for the use of
oxygen inhalations, the author shows in a philosophical manner how much
greater good physicians might do if they more fully appreciated the
value of fresh-air exercise and water, especially in diseases of the
lungs, kidneys, and skin. We commend its perusal to our readers.—_The
Canada Medical Record._


                              _EISENBERG_

                       Bacteriological Diagnosis.

                TABULAR AIDS FOR USE IN PRACTICAL WORK.

By JAMES EISENBERG, Ph.D., M.D., Vienna. Translated and augmented, with
the permission of the author, from the second German Edition, by NORVAL
H. PIERCE, M.D., Surgeon to the Out-Door Department of Michael Reese
Hospital; Assistant to Surgical Clinic, College of Physicians and
Surgeons, Chicago, Ill.

Nearly 200 pages. In one Royal Octavo volume, handsomely bound in Cloth
and in Oil-Cloth (for laboratory use).

 Price, post-paid, in the United States and Canada, $1.50, net; in Great
                  Britain, 8s. 6d.; in France, 9 fr. 35.

This book is a novelty in Bacteriological Science. It is a work of great
importance to the teacher as well as to the student. It will be of
inestimable value to the private worker, and is designed throughout as a
practical guide in laboratory work. It is arranged in a tabular form, in
which are given the specific characteristics of the various
well-established bacteria, so that the worker may, at a glance, inform
himself as to the identity of a given organism.

There is also an appendix, in which is given, in a concise and practical
form, the technique employed by the best laboratories in the cultivation
and staining of bacteria; the composition and preparation of the various
solid, semi-solid, and fluid media, together with their employment; a
complete list of stains and reagents, with formulæ for same; the methods
of microscopic examination of bacteria, etc., etc., etc.


                               _EDINGER_

    Twelve Lectures on the Structure of the Central Nervous System.

                      FOR PHYSICIANS AND STUDENTS.

By DR. LUDWIG EDINGER, Frankfort-on-the-Main. Second Revised Edition.
With 133 Illustrations. Translated by WILLIS HALL VITTUM, M.D., St.
Paul, Minn. Edited by C. EUGENE RIGGS, A.M, M.D., Professor of Mental
and Nervous Diseases, University of Minnesota; Member of the American
Neurological Association.

The illustrations are exactly the same as those used in the latest
German edition (with the German names translated into English), and are
very satisfactory to the Physician and Student using the book.

The work is complete in one Royal Octavo Volume of about 250 pages,
bound in Extra Cloth.

 Price, post-paid, in the United States and Canada, $1.75, net; in Great
                   Britain, 10s.; in France, 12 fr. 20.

One of the most instructive and valuable works on the minute anatomy of
the human brain extant. It is written in the form of lectures, profusely
illustrated, and in clear language.—_The Pacific Record of Medicine and
Surgery._

Since the first works on anatomy, up to the present day, no work has
appeared on the subject of the general and minute anatomy of the central
nervous system so complete and exhaustive as this work of Dr. Ludwig
Edinger. Being himself an original worker, and having the benefits of
such masters as Stilling, Weigeit, Geilach, Meynert, and others, he has
succeeded in transforming the mazy wilderness of nerve-fibres and cells
into a district of well-marked pathways and centres, and by so doing has
made a pleasure out of an anatomical bugbear.—_The Southern Medical
Record._

Every point is clearly dwelt upon in the text, and where description
alone might leave a subject obscure clever drawings and diagrams are
introduced to render misconception of the author’s meaning impossible.
The book is eminently practical. It unravels the intricate entanglement
of different tracts and paths in a way that no other book has done so
explicitly or so concisely.—_Northwestern Lancet._


                               _GOODELL_

                         LESSONS IN GYNECOLOGY.

By WILLIAM GOODELL, A.M., M.D., etc., Professor of Clinical Gynecology
in the University of Pennsylvania.

This exceedingly valuable work, from one of the most eminent specialists
and teachers in gynecology, embraces all the more important diseases and
the principal operations in the field of gynecology, and brings to bear
upon them all the extensive practical experience and wide reading of the
author. It is an indispensable guide to every practitioner who has to do
with the diseases peculiar to women. THIRD EDITION. With 112
Illustrations. Thoroughly revised and greatly enlarged. Royal octavo,
578 pages.

  Price, in United States and Canada, Cloth, $5.00; Full Sheep, $6.00.
  Discount, 20 per cent., making it, net, Cloth, $4.00; Sheep, $4.80.
 Postage, 27 cents extra. Great Britain, Cloth, 22s. 6d.; Sheep, 28s.,
                     post-paid. France, 30 fr. 80.

It is too good a book to have been allowed to remain out of print, and
it has unquestionably been missed. The author has revised the work with
special care, adding to each lesson such fresh matter as the progress in
the art rendered necessary, and he has enlarged it by the insertion of
six new lessons.—_Amer. Jour. of Obstet._

Extended mention of the contents of the book is unnecessary; suffice it
to say that every important disease found in the female sex is taken up
and discussed in a common-sense kind of a way. We wish every physician
in America could read and carry out the suggestions of the chapter on
“the sexual relations as causes of uterine disorders—conjugal onanism
and kindred sins.” The department treating of nervous counterfeits of
uterine diseases is a most valuable one.—_Kansas City Medical Index._


                               _GUERNSEY_

                    Plain Talks on Avoided Subjects.

By HENRY N. GUERNSEY, M.D., formerly Professor of Materia Medica and
Institutes in the Hahnemann Medical College of Philadelphia; author of
Guernsey’s “Obstetrics,” including the Disorders Peculiar to Women and
Young Children; Lectures on Materia Medica, etc. The following Table of
Contents shows the scope of the book:

CONTENTS.—Chapter I. Introductory. II. The Infant. III. Childhood. IV.
Adolescence of the Male. V. Adolescence of the Female. VI. Marriage: The
Husband. VII. The Wife. VIII. Husband and Wife. IX. To the Unfortunate.
X. Origin of the Sexes. In one neat 16mo volume, bound in Extra Cloth.

 Price, post-paid, in the United States and Canada, $1.00; Great Britain,
                          6s.; France, 6 fr. 20.


                               _KEATING_

                  Record-Book of Medical Examinations

                          FOR LIFE-INSURANCE.

Designed by JOHN M. KEATING, M.D.

This record-book is small, compact, complete, and embraces all the
principal points that are required by the different companies. It is
made in two sizes, viz.: No. 1, covering one hundred (100) examinations,
and No. 2, covering two hundred (200) examinations. The size of the book
is 7 x 3¾ inches, and can be conveniently carried in the pocket.

                                          U. S. and   Great
                                           Canada.   Britain. France.
 No. 1. For 100 Examinations, in Cloth,   $ .50, net 3s. 6d.  3 fr. 60
 No. 2. For 200 Examinations, in Full
   Leather, with Side Flap,                1.00, net 6s.      6 fr. 20


                                 _HARE_

                 Epilepsy: Its Pathology and Treatment.

 BEING AN ESSAY TO WHICH WAS AWARDED A PRIZE OF FOUR THOUSAND FRANCS BY
    THE ACADEMIE ROYALE DE MEDECINE DE BELGIQUE, DECEMBER 31, 1889.

By HOBART AMORY HARE, M.D., B.Sc., Professor of Materia Medica and
Therapeutics in the Jefferson Medical College, Phila.; Physician to St.
Agnes’ Hospital and to the Children’s Dispensary of the Children’s
Hospital; Laureate of the Royal Academy of Medicine in Belgium, of the
Medical Society of London, etc.; Member of the Association of American
Physicians.

_No. 7 in the Physicians’ and Students’ Ready-Reference Series._ 12mo.
228 pages. Neatly bound in Dark-Blue Cloth.

    Price, post-paid, in United States and Canada, $1.25, net; Great
                  Britain, 6s. 6d.; France, 7 fr. 75.

The task of preparing the work must have been most laborious, but we
think that Dr. Hare will be repaid for his efforts by a wide
appreciation of the work by the profession; for the book will be
instructive to those who have not kept abreast with the recent
literature upon this subject. Indeed, the work is a sort of dictionary
of epilepsy—a reference guide-book upon the subject.—_Alienist and
Neurologist._

It is representative of the most advanced views of the profession, and
the subject is pruned of the vast amount of superstition and nonsense
that generally obtains in connection with epilepsy.—_Medical Age._

Every physician who would get at the gist of all that is worth knowing
on epilepsy, and who would avoid useless research among the mass of
literary nonsense which pervades all medical libraries, should get this
work.—_The Sanitarian._


                          _By the Same Author_

                  Fever: Its Pathology and Treatment.

     BEING THE BOYLSTON PRIZE ESSAY OF HARVARD UNIVERSITY FOR 1890.
 CONTAINING DIRECTIONS AND THE LATEST INFORMATION CONCERNING THE USE OF
             THE SO-CALLED ANTIPYRETICS IN FEVER AND PAIN.

By HOBART AMORY HARE, M.D., B.Sc., etc., etc.

_No. 10 in the Physicians’ and Students’ Ready-Reference Series._ 12mo.
Neatly bound in Dark-Blue Cloth.

Illustrated with more than 25 new plates of tracings of various fever
cases, showing beautifully and accurately the action of the
Antipyretics. The work also contains 35 carefully prepared statistical
tables of 249 cases showing the untoward effects of the antipyretics.

 Price, post-paid, in the United States and Canada, $1.25, net; in Great
                   Britain, 6s. 6d.; France, 7 fr. 75.

The author has done an able piece of work in showing the facts as far as
they are known concerning the action of antipyrin, antifebrin,
phenacetin, thallin, and salicylic acid. The reader will certainly find
the work one of the most interesting of its excellent group, the
_Physicians’ and Students’ Ready-Reference Series_.—_The Dosimetric
Medical Review._


                                _IVINS_

                    Diseases of the Nose and Throat.

              A TEXT-BOOK FOR STUDENTS AND PRACTITIONERS.

By HORACE F. IVINS, M.D., Lecturer on Laryngology and Otology in the
Hahnemann Medical College of Philadelphia; Laryngological Editor of “The
Journal of Ophthalmology, Otology, and Laryngology”; Member of the
American Institute of Homœopathy, of the Homœopathic Medical Society of
the State of Pennsylvania, etc.

ROYAL OCTAVO, 507 PAGES. WITH 129 ILLUSTRATIONS, CHIEFLY ORIGINAL,
including Eighteen (18) colored figures from Drawings and Photographs of
Anatomical Dissections, etc.

 Price, in United States, Extra Cloth, $4.00, net; Half-Russia, $5.00,
  net. Canada (duty paid), Cloth, $4.40, net; Half-Russia, $5.50, net.
   Great Britain, Cloth, 22s. 6d.; Sheep or Half-Russia, 28s. France,
               Cloth, 24 fr. 60; Half-Russia, 30 fr. 30.


                               _HUIDEKOPER_

                       Age of the Domestic Animals.

 BEING A COMPLETE TREATISE ON THE DENTITION OF THE HORSE, OX, SHEEP, HOG,
 AND DOG, AND ON THE VARIOUS OTHER MEANS OF DETERMINING THE AGE OF THESE
                                 ANIMALS.

By RUSH SHIPPEN HUIDEKOPER, M.D., Veterinarian (Alfort, France);
Professor of Sanitary Medicine and Veterinary Jurisprudence, American
Veterinary College, New York; Late Dean of the Veterinary Department,
University of Pennsylvania.

Royal Octavo, 225 pages, bound in Extra Cloth. Illustrated with 200
Engravings.

 Price, post-paid, in the United States and Canada, $1.75, net; in Great
                   Britain, 10s.; in France, 12 fr. 20.

This work presents a careful study of all that has been written on the
subject from the earliest Italian writers. The author has drawn much
valuable material from the ablest English, French, and German writers,
and has given his own deductions and opinions, whether they agree or
disagree with such investigators as Bracy Clark, Simonds (in English),
Girard, Chauveau, Leyh, Le Coque, Goubaux, and Barrier (in German and
French).

  The literary execution of the book is very satisfactory, the text is
  profusely illustrated, and the student will find abundant means in the
  cuts for familiarizing himself with the various aspects presented by
  the incisive arches during the different stages of life. Illustrations
  do not always illustrate; these do.—_Amer. Vet. Review._

  Although written primarily for the veterinarian, this book will be of
  interest to the dentist, physiologist, anatomist, and physician. Its
  wealth of illustration and careful preparation are alike
  commendable.—_Chicago Med. Recorder._

  It is profusely illustrated with 200 engravings, and the text forms a
  study well worth the price of the book to every dental
  practitioner.—_Ohio Journal of Dental Sciences._


             International System of Electro-Therapeutics.

         FOR STUDENTS, GENERAL PRACTITIONERS, AND SPECIALISTS.

Chief Editor, HORATIO R. BIGELOW, M.D., Permanent Member of the American
Medical Association; Fellow of the British Gynæcological Society; Fellow
of the American Electro-Therapeutic Association; Member of the
Philadelphia Obstetrical Society; Member of the Société
d’Electro-Thérapie; Author of “Gynæcological Electro-Therapeutics” and
“Familiar Talks on Electricity and Batteries,” etc. Assisted by upward
of Thirty Eminent Specialists in Europe and America as Associate
Editors.

The character of this work is such that the publishers confidently
expect it will stand unrivalled, and be the _vade mecum_ of the
profession, as well as the standard text-book in all the colleges upon
this important branch of medical science.

It will be handsomely and clearly printed, thoroughly illustrated with
engravings, colored drawings, and plates where these will elucidate the
text, and at the close of the volume there will be a full reference
index.

COMPLETE IN ONE ROYAL OCTAVO VOLUME OF ABOUT 900 PAGES.

  Price, in United States, Extra Cloth, $5.50, net; Sheep, $6.50, net;
   Half-Russia, $7.00, net. In Canada (duty paid), Cloth, $6.00, net;
  Sheep, $7.25, net; Half-Russia, $7.75, net. In Great Britain, Cloth,
 32s.; Sheep, 37s. 6d.; Half-Russia, 40s. In France, Cloth, 34 fr. 70.;
               Sheep, 40 fr. 45; Half-Russia, 43 fr. 30.

WILL BE PUBLISHED IN OCTOBER, 1893.


             Journal of Laryngology, Rhinology, and Otology.

 AN ANALYTICAL RECORD OF CURRENT LITERATURE RELATING TO THE THROAT, NOSE,
               AND EAR. ISSUED ON THE FIRST OF EACH MONTH.

Edited by DR. NORRIS WOLFENDEN, of London, and DR. JOHN MACINTYRE, of
Glasgow, with the active aid and co-operation of Drs. Dundas Grant,
Barclay J. Baron, and Hunter Mackenzie. Besides those specialists in
Europe and America who have so ably assisted in the collaboration of the
Journal, a number of new correspondents have undertaken to assist the
editors in keeping the Journal up to date, and furnishing it with
matters of interest.

 Price, 13s. or $3.00 per annum, Strictly in Advance. Single copies, 1s.
                  3d. (30 Cents). Sample Copy, 25 Cents.


                          _KEATING and EDWARDS_

                  Diseases of the Heart and Circulation

 IN INFANCY AND ADOLESCENCE. WITH AN APPENDIX ENTITLED “CLINICAL STUDIES
                       ON THE PULSE IN CHILDHOOD.”

By JOHN M. KEATING, M.D., Obstetrician to the Philadelphia Hospital, and
Lecturer on Diseases of Women and Children; Surgeon to the Maternity
Hospital; Physician to St. Joseph’s Hospital; Fellow of the College of
Physicians of Philadelphia, etc.; and WILLIAM A. EDWARDS, M.D.,
Instructor in Clinical Medicine and Physician to the Medical Dispensary
in the University of Pennsylvania; Fellow of the College of Physicians:
formerly Assistant Pathologist to the Philadelphia Hospital, etc.

Illustrated by Photographs and Wood-Engravings. About 225 pages. Octavo.
Bound in Cloth.

 Price, post-paid, in the United States and Canada, $1.50, net; in Great
                  Britain, 8s. 6d.; in France, 9 fr. 35.

  Drs. Keating and Edwards have produced a work that will give material
  aid to every doctor in his practice among children. The style of the
  book is graphic and pleasing, the diagnostic points are explicit and
  exact, and the therapeutical resources include the novelties of
  medicine as well as the old and tried agents.—_Pittsburgh Med.
  Review._

  It is not a mere compilation, but a systematic treatise, and bears
  evidence of considerable labor and observation on the part of the
  authors. Two fine photographs of dissections exhibit mitral
  stenosis and mitral regurgitation; there are also a number of
  wood-cuts.—_Cleveland Medical Gazette._


                           _LIEBIG and ROHÉ_

             Practical Electricity in Medicine and Surgery.

By G. A. LIEBIG, JR., PH.D., Assistant in Electricity, Johns Hopkins
University; Lecturer on Medical Electricity, College of Physicians and
Surgeons, Baltimore; Member of the American Institute of Electrical
Engineers, etc.; and GEORGE H. ROHÉ, M.D., Professor of Obstetrics and
Hygiene, College of Physicians and Surgeons, Baltimore; Visiting
Physician to Bay View and City Hospitals; Director of the Maryland
Maternité; Associate Editor “Annual of the Universal Medical Sciences,”
etc.

Profusely illustrated by Wood-Engravings and Original Diagrams, and
published in one Royal Octavo volume of 383 pages, bound in Extra Cloth.

 Price, post-paid, in the United States and Canada, $2.00, net; in Great
                 Britain, 11s. 6d.; in France, 12 fr. 40.

  Any physician, especially if he be a beginner in electro-therapeutics,
  will be well repaid by a careful study of this work by Liebig and
  Rohé. For a work on a special subject the price is low, and no one can
  give a good excuse for remaining in ignorance of so important a
  subject as electricity in medicine.—_Toledo Medical and Surgical
  Reporter._

  The entire work is thoroughly scientific and practical, and is really
  what the authors have aimed to produce, “a trustworthy guide to the
  application of electricity in the practice of medicine and
  surgery.”—_New York Medical Times._

  In its perusal, with each succeeding page, we have been more and more
  impressed with the fact that here, at last, we have a treatise on
  electricity in medicine and surgery which amply fulfills its purpose,
  and which is sure of general adoption by reason of its thorough
  excellence and superiority to other works intended to cover the same
  field.—_Pharmaceutical Era._


                                _MASSEY_

                 Electricity in the Diseases of Women.

     WITH SPECIAL REFERENCE TO THE APPLICATION OF STRONG CURRENTS.

By G. BETTON MASSEY, M.D., Physician to the Gynæcological Department of
the Howard Hospital; late Electro-therapeutist to the Philadelphia
Orthopædic Hospital and Infirmary for Nervous Diseases, etc. SECOND
EDITION. Revised and Enlarged. With New and Original Wood-Engravings.
Handsomely bound in Dark-Blue Cloth. 240 pages. 12mo. _No. 5 in the
Physicians’ and Students’ Ready-Reference Series._

This work is presented to the profession as the most complete treatise
yet issued on the electrical treatment of the diseases of women, and is
destined to fill the increasing demand for clear and practical
instruction in the handling and use of strong currents after the recent
methods first advocated by Apostoli. The whole subject is treated from
the present stand-point of electric science _with new and original
illustrations_, the thorough studies of the author and his wide clinical
experience rendering him an authority upon electricity itself and its
therapeutic applications. The author has enhanced the practical value of
the work by including _the exact details_ of treatment and results in a
number of cases taken from his private and hospital practice.

 Price, post-paid, in the United States and Canada, $1.50, net; in Great
                  Britain, 8s. 6d.; in France, 9 fr. 35.

  A new edition of this practical manual attests the utility of its
  existence and the recognition of its merits. The directions are
  simple, easy to follow and to put into practice; the ground is well
  covered, and nothing is assumed, the entire book being the record of
  experience.—_Journal of Nervous and Mental Diseases._

  It is only a few months since we noticed the first edition of this
  little book; and it is only necessary to add now that we consider it
  the best treatise on this subject we have seen, and that the
  improvements introduced into this edition make it more valuable
  still.—_Boston Medical and Surgical Journ._

  The style is clear, but condensed. Useless details are omitted, the
  reports of cases being pruned of all irrelevant material. The book is
  an exceedingly valuable one, and represents an amount of study and
  experience which is only appreciated after a careful reading.—_Medical
  Record._


                        Physicians’ Interpreter.

  IN FOUR LANGUAGES (ENGLISH, FRENCH, GERMAN, AND ITALIAN). SPECIALLY
                  ARRANGED FOR DIAGNOSIS BY M. VON V.

The object of this little work is to meet a need often keenly felt by
the busy physician, namely, the need of some quick and reliable method
of communicating intelligibly with patients of those nationalities and
languages unfamiliar to the practitioner. The plan of the book is a
systematic arrangement of questions upon the various branches of
Practical Medicine, and each question is so worded that the only answer
required of the patient is merely Yes or No. The questions are all
numbered, and a complete Index renders them always available for quick
reference. The book is written by one who is well versed in English,
French, German, and Italian, being an excellent teacher in all those
languages, and who has also had considerable hospital experience. Bound
in Full Russia Leather, for carrying in the pocket. Size, 5 × 2¾ inches.
206 pages.

 Price, post-paid, in the United States and Canada, $1.00, net; in Great
                    Britain, 6s.; in France, 6 fr. 20.

  Many other books of the same sort, with more extensive vocabularies,
  have been published, but, from their size, and from their being
  usually devoted to equivalents in English and one other language only,
  they have not had the advantage which is pre-eminent in
  this—convenience. It is handsomely printed, and bound in flexible red
  leather in the form of a diary. It would scarcely make itself felt in
  one’s hip-pocket, and would insure its bearer against any ordinary
  conversational difficulty in dealing with foreign-speaking people, who
  are constantly coming into our city hospitals.—_New York Medical
  Journal._

  This little volume is one of the most ingenious aids to the physician
  which we have seen. We heartily commend the book to any one who, being
  without a knowledge of the foreign languages, is obliged to treat
  those who do not know our own language.—_St. Louis Courier of
  Medicine._


      The Medical Bulletin Visiting-List or Physicians’ Call Record.

 ARRANGED UPON AN ORIGINAL AND CONVENIENT MONTHLY AND WEEKLY PLAN FOR THE
                 DAILY RECORDING OF PROFESSIONAL VISITS.


                 Frequent Rewriting of Names Unnecessary.

This Visiting-List is arranged so that the names of patients need be
written but ONCE a month instead of FOUR times a month, as in the
old-style lists. By means of a new feature, a simple device consisting
of STUB OR HALF LEAVES IN THE FORM OF INSERTS, the first week’s visits
are recorded in the usual way, and the second week’s visits are begun by
simply turning over the half-leaf without the necessity of rewriting the
patients’ names. This very easily understood process is repeated until
the month is ended and the record has been kept complete in every detail
of VISIT, CHARGE, CREDIT, etc., and the labor and time of entering and
transferring names at least THREE times in the month has been saved.
There are no intricate rulings; not the least amount of time can be lost
in comprehending the plan, for it is acquired at a glance.

                    THE THREE DIFFERENT STYLES MADE.

The No. 1 Style of this List provides space for the DAILY record of
seventy different names each month for a year; for physicians who prefer
a List that will accommodate a larger practice we have made a No. 2
Style, which provides space for the daily record of 105 different names
each month for a year, and for physicians who may prefer a Pocket
Record-Book of less thickness than either of these styles we have made a
No. 3 Style, in which “The Blanks for the Recording of Visits in” have
been made into removable sections. These sections are very thin, and are
made up so as to answer in full the demand of the largest practice, each
section providing ample space for the DAILY RECORD OF 210 DIFFERENT
NAMES for two months; or 105 different names daily each month for four
months; or seventy different names daily each month for six months. Six
sets of these sections go with each copy of NO. 3 STYLE.

             SPECIAL FEATURES NOT FOUND IN ANY OTHER LIST.

In this NO. 3 STYLE the PRINTED MATTER, and such matter as the BLANK
FORMS FOR ADDRESSES OF PATIENTS, Obstetric Record, Vaccination Record,
Cash Account, Birth and Death Records, etc., are fastened permanently in
the back of the book. The addition of a removable section does not
increase the thickness more than an eighth of an inch. This brings the
book into such a small compass that no one can object to it on account
of its thickness, as its bulk is VERY MUCH LESS than that of any
visiting-list ever published. Every physician will at once understand
that as soon as a section is full it can be taken out, filed away, and
another inserted without the least inconvenience or trouble. _Extra or
additional sections will be furnished at any time for 15 cents each or
$1.75 per dozen._ This Visiting-List contains calendars, valuable
miscellaneous data, important tables, and other useful printed matter
usually placed in Physicians’ Visiting-Lists.

Physicians of many years’ standing and with large practices pronounce it
THE BEST LIST THEY HAVE EVER SEEN. It is handsomely bound in fine,
strong leather, with flap, including a pocket for loose memoranda, etc.,
and is furnished with a Dixon lead-pencil of excellent quality and
finish. It is compact and convenient for carrying in the pocket. Size, 4
× 6⅞ inches.

                           IN THREE STYLES.                  NET PRICES.
 No. 1.   Regular size, to accommodate 70 patients daily
            each month for one year,                               $1.25
 No. 2.   Large size, to accommodate 105 patients daily each
            month for one year,                                    $1.50
 No. 3.   In which the “Blanks for Recording Visits in” are
            in removable sections,                                 $1.75
          Special Edition for Great Britain, without printed
            matter,                                              4s. 6d.

   _N. B.—The Recording of Visits in this List may be Commenced at any
                         time during the Year._


                               _MICHENER_

 Hand-Book of Eclampsia; OR, NOTES AND CASES OF PUERPERAL CONVULSIONS.

By E. MICHENER, M.D.; J. H. STUBBS, M.D.; R. B. EWING, M.D.; B.
THOMPSON, M.D.; S. STEBBINS, M.D. 16mo. Cloth.

 Price, 60 cents, net; in Great Britain, 4s. 6d.; in France, 4 fr. 20.


                                _NISSEN_

                   A MANUAL OF INSTRUCTION FOR GIVING

                Swedish Movement _and_ Massage Treatment

By PROF. HARTVIG NISSEN, late Director of the Swedish Health Institute,
Washington, D.C.; late instructor in Physical Culture and Gymnastics at
the Johns Hopkins University, Baltimore, Md.; Instructor of Swedish and
German Gymnastics at Harvard University’s Summer School, 1891, etc.,
etc.

This excellent little volume treats this very important subject in a
practical manner. Full instructions are given regarding the mode of
applying the Swedish Movement and Massage Treatment in various diseases
and conditions of the human system with the greatest degree of
effectiveness. This book is indispensable to every physician who wishes
to _know how_ to use these valuable handmaids of medicine.

Illustrated with 29 Original Wood-Engravings. In one 12mo volume of 128
Pages. Neatly bound in Cloth.

 Price, post-paid, in the United States and Canada, $1.00, net; in Great
                    Britain, 6s.; in France, 6 fr. 20.

  The present volume is a modest account of the application of the
  Swedish Movement and Massage Treatment, in which the technique of the
  various procedures are clearly stated as well as illustrated in a very
  excellent manner.—_North American Practitioner._

  This manual is valuable to the practitioner, as it contains a terse
  description of a subject but too little understood in this country....
  The book is got up very creditably.—_N. Y. Med. Journal._


                                 _SAJOUS_

 HAY FEVER And Its Successful Treatment by Superficial Organic Alteration
                      of the Nasal Mucous Membrane.

By CHARLES E. SAJOUS, M.D., formerly Lecturer on Rhinology and
Laryngology in Jefferson Medical College; Chief Editor of the Annual of
the Universal Medical Sciences, etc. With 13 Engravings on Wood. 103
pages. 12mo. Bound in Cloth, Beveled Edges.

 Price, post-paid, in the United States and Canada, $1.00, net; in Great
                    Britain, 6s.; in France, 6 fr. 20.


                                _STRAUB_

                   Symptom Register and Case Record.

Designed by D. W. Straub, M.D.

Giving in plain view, on one side of the sheet 7½ × 10½ inches, the
Clinical Record of the sick, including Date, Name, Residence,
Occupation, Symptoms, Inspection (Auscultation and Percussion), History,
Respiration, Pulse, Temperature, Diagnosis, Prognosis, Treatment
(special and general), and Remarks, all conveniently arranged, and with
ample room for recording, at each call, for four different calls, each
item named above, the whole forming a clinical history of individual
cases of great value to every Practitioner.

 Published in stiff Board Tablets of 50 sheets each, at 50 cts. net per
 tablet, and in Book-form, flexible binding, with Alphabetical Marginal
                        Index, at 75 cts., net.


     Physician’s All-Requisite Time- and Labor-Saving Account-Book.

  BEING A LEDGER AND ACCOUNT-BOOK FOR PHYSICIANS’ USE, MEETING ALL THE
                  REQUIREMENTS OF THE LAW AND COURTS.

Designed by WILLIAM A. SEIBERT, M.D., of Easton, Pa.

Probably no class of people lose more money through carelessly kept
accounts and overlooked or neglected bills than physicians. Often
detained at the bedside of the sick until late at night, or deprived of
even a modicum of rest, it is with great difficulty that he spares the
time or puts himself in condition to give the same care to his own
financial interests that a merchant, a lawyer, or even a farmer devotes.
It is then plainly apparent that a system of bookkeeping and accounts
that, without sacrificing accuracy, but, on the other hand, ensuring it,
at the same time relieves the keeping of a physician’s book of half
their complexity and two-thirds the labor, is a convenience which will
be eagerly welcomed by thousands of overworked physicians. Such a system
has at last been devised, and we take pleasure in offering it to the
profession in the form of The Physician’s All-Requisite Time- and
Labor-Saving Account-Book.

There is no exaggeration in stating that this Account-Book and Ledger
reduces the labor of keeping your accounts more than one-half, and at
the same time secures the greatest degree of accuracy. We may mention a
few of the superior advantages of The Physician’s All-Requisite Time-
and Labor-Saving Account-Book, as follows:—

  =_First_=—Will meet all the requirements of the law and courts.

  =_Second_=—Self-explanatory; no cipher code.

  =_Third_=—Its completeness without sacrificing anything.

  =_Fourth_=—No posting; one entry only.

  =_Fifth_=—Universal; can be commenced at any time of the year, and can
    be continued indefinitely until every account is filled.

  =_Sixth_=—Absolutely no waste of space.

  =_Seventh_=—One person must needs be sick every day of the year to
    fill his account, or might be ten years about it and require no more
    than the space for one account in this ledger.

  =_Eighth_=—Double the number and many times more than the number of
    accounts in any similar book; the 300–page book contains space for
    900 accounts, and the 600–page book contains space for 1800
    accounts.

  =_Ninth_=—There are no smaller spaces.

  =_Tenth_=—Compact without sacrificing completeness; every account
    complete on same page—a decided advantage and recommendation.

  =_Eleventh_=—Uniform size of leaves.

  =_Twelfth_=—The statement of the most complicated account is at once
    before you at any time of month or year—in other words, the account
    itself as it stands is its simplest statement.

  =_Thirteenth_=—No transferring of accounts, balances, etc.

To all physicians desiring a quick, accurate, and comprehensive method
of keeping their accounts, we can safely say that no book as suitable as
this one has ever been devised. A descriptive circular showing the plan
of the book will be sent on application.

                _NET PRICES, SHIPPING EXPENSES PREPAID._
                                         Canada     Great
                              In U.S. (duty paid). Britain.   France.

 No. 1. 300 Pages, for 900
   Accounts per Year, Size
   10×12, Bound in ¾-Russia,
   Raised Back Bands, Cloth
   Sides,                       $5.00        $5.50     28s.   30 fr. 30.

 No. 2. 600 Pages, for 1800
   Accounts per Year, Size
   10×12, Bound in ¾-Russia,
   Raised Back-Bands, Cloth
   Sides,                        8.00         8.80     42s.    49 fr. 40


                          _PRICE and EAGLETON_

               Three Charts of the Nervo-Vascular System.

  PART I.—THE NERVES.     PART II.—THE ARTERIES. PART III.—THE VEINS.

A New Edition, Revised and Perfected. Arranged by W. HENRY PRICE, M.D.,
and S. POTTS EAGLETON, M.D. Endorsed by leading anatomists. Clearly and
beautifully printed upon extra durable paper.

  PART I. The Nerves.—Gives in a clear form not only the Cranial and
    Spinal Nerves, showing the formation of the different Plexuses and
    their branches, but also the complete distribution of the
    SYMPATHETIC NERVES.

  PART II. The Arteries.—Gives a unique grouping of the Arterial system,
    showing the divisions and subdivisions of all the vessels, beginning
    from the heart and tracing their CONTINUOUS distribution to the
    periphery, and showing at a glance the terminal branches of each
    artery.

  PART III. The Veins.—Shows how the blood from the periphery of the
    body is gradually collected by the larger veins, and these
    coalescing forming still larger vessels, until they finally trace
    themselves into the Right Auricle of the heart.

It is therefore readily seen that “The Nervo-Vascular System of Charts”
offers the following superior advantages:—

1. It is the only arrangement which combines the Three Systems, and yet
each is perfect and distinct in itself.

2. It is the only instance of the Cranial, Spinal, and Sympathetic
Nervous Systems being represented on one chart.

3. From its neat size and clear type, and being printed only upon one
side, it may be tacked up in any convenient place, and is always ready
for freshening up the memory and reviewing for examination.

 Price, post-paid, in United States and Canada, 50 cents, net, complete;
             in Great Britain, 3s. 6d.; in France, 3 fr. 60.

  For the student of anatomy there can possibly be no more concise way
  of acquiring a knowledge of the nerves, veins, and arteries of the
  human system. It presents at a glance their trunks and branches in the
  great divisions of the body. It will save a world of tedious reading,
  and will impress itself on the mind as no ordinary _vade mecum_, even,
  could. Its price is nominal and its value inestimable. No student
  should be without it.—_Pacific Record of Medicine and Surgery._

  These are three admirably arranged charts for the use of students, to
  assist in memorizing their anatomical studies.—_Buffalo Med. and Surg.
  Jour._


                                _PURDY_

             Diabetes: Its Cause, Symptoms _and_ Treatment

By CHAS. W. PURDY, M.D. (Queen’s University), Honorary Fellow of the
Royal College of Physicians and Surgeons of Kingston; Member of the
College of Physicians and Surgeons of Ontario; Author of “Bright’s
Disease and Allied Affections of the Kidneys;” Member of the Association
of American Physicians; Member of the American Medical Association;
Member of the Chicago Academy of Sciences, etc.

CONTENTS.—Section I. Historical, Geographical, and Climatological
Considerations of Diabetes Mellitus. II. Physiological and Pathological
Considerations of Diabetes Mellitus. III. Etiology of Diabetes Mellitus.
IV. Morbid Anatomy of Diabetes Mellitus. V. Symptomatology of Diabetes
Mellitus. VI. Treatment of Diabetes Mellitus. VII. Clinical
Illustrations of Diabetes Mellitus. VIII. Diabetes Insipidus;
Bibliography.

12mo. Dark Blue Extra Cloth. Nearly 200 pages.

     _No. 8 in the Physicians’ and Students’ Ready-Reference Series._

 Price, post-paid, in the United States and Canada, $1.25, net; in Great
                  Britain, 6s. 6d.; in France, 7 fr. 75.

  This will prove a most entertaining as well as most interesting
  treatise upon a disease which frequently falls to the lot of every
  practitioner. The work has been written with a special view of
  bringing out the features of the disease as it occurs in the
  United States. The author has very judiciously arranged the little
  volume, and it will offer many pleasant attractions to the
  practitioner.—_Nashville Journal of Medicine and Surgery._

  While many monographs have been published which have dealt with the
  subject of diabetes, we know of none which so thoroughly considers its
  relations to the geographical conditions which exist in the United
  States, nor which is more complete in its summary of the
  symptomatology and treatment of this affection. A number of tables,
  showing the percentage of sugar in a very large number of alcoholic
  beverages, adds very considerably to the value of the work.—_Medical
  News._


                              _REMONDINO_

                        History of Circumcision.

 FROM THE EARLIEST TIMES TO THE PRESENT. MORAL AND PHYSICAL REASONS FOR
 ITS PERFORMANCE; WITH A HISTORY OF EUNUCHISM, HERMAPHRODISM, ETC., AND
        OF THE DIFFERENT OPERATIONS PRACTICED UPON THE PREPUCE.

By P. C. REMONDINO, M.D. (Jefferson), Member of the American Medical
Association; of the American Public Health Association; Vice-President
of California State Medical Society and of Southern California Medical
Society, etc.

In one neat 12mo volume of 346 pages. Handsomely bound in Extra
Dark-Blue Cloth, and illustrated with two fine wood-engravings, showing
the two principal modes of Circumcision in ancient times. _No. 11 in the
Physicians’ and Students’ Ready-Reference Series._

  Price, post-paid, in United States and Canada, $1.25, net; in Great
    Britain, 6s. 6d.; in France, 7 fr. 75.

  A Popular Edition (unabridged), bound in Paper Covers, is also issued.
    Price, 50 Cents, net; in Great Britain, 3s.; in France, 3 fr. 60.

Every physician should read this book; he will there find, in a
condensed and systematized form, what there is known concerning
Circumcision. The book deals with simple facts, and it is not a
dissertation on theories. It deals, in plain, pointed language, with the
relation that the prepuce bears to physical degeneracy and disease,
bases all its utterances on what _has_ occurred and on what _is_ known.
The author has here gathered from every source the material for his
subject, and the deductions are unmistakable.

  This is a very full and readable book. To the reader who wishes to
  know all about the antiquity of the operation, with the views pro and
  con of the right of this appendage to exist, its advantages, dangers,
  etc., this is the book.—_The Southern Clinic._

  The operative chapter will be particularly useful and interesting to
  physicians, as it contains a careful and impartial review of all the
  operative procedures, from the most simple to the most elaborate,
  paying particular attention to the subject of after-dressings. It is a
  very interesting and instructive work, and should be read very
  liberally by the profession.—_The Med. Brief._

  The author’s views in regard to circumcision, its necessity, and its
  results, are well founded, and its performance as a prophylactic
  measure is well established.—_Columbus Med. Journal._


                          _By the Same Author_

                  The Mediterranean Shores of America.

    SOUTHERN CALIFORNIA: ITS CLIMATIC, PHYSICAL, AND METEOROLOGICAL
                              CONDITIONS.

By P. C. REMONDINO, M.D. (Jefferson), etc.

Complete in one handsomely printed Octavo volume of nearly 175 pages,
with 45 appropriate illustrations and 2 finely executed maps of the
region, showing altitudes, ocean currents, etc. Bound in Extra Cloth.

  Price, post-paid, in United States and Canada, $1.25, net; in Great
    Britain, 6s. 6d.; in France, 7 fr. 75.

  Cheaper Edition (unabridged), bound in Paper, post-paid, in United
    States and Canada, 75 Cents, net; in Great Britain, 4s.; in France,
    5 fr.

Italy, of the Old World, does not excel nor even approach this region in
point of salubrity of climate and all-around healthfulness of
environment. This book fully describes and discusses this wonderfully
charming country. The medical profession, who have long desired a
trustworthy treatise of true scientific value on this celebrated region,
will find in this volume a satisfactory response to this long-felt and
oft-expressed wish.


                                 _ROHÉ_

                         Text-Book of Hygiene.

 A COMPREHENSIVE TREATISE ON THE PRINCIPLES AND PRACTICE OF PREVENTIVE
                 MEDICINE FROM AN AMERICAN STAND-POINT.

By GEORGE H. ROHÉ, M.D., Professor of Obstetrics and Hygiene in the
College of Physicians and Surgeons, Baltimore; Member of the American
Public Health Association, etc.

Every Sanitarian should have Rohé’s “Text-Book of Hygiene” as a work of
reference.

Second Edition, thoroughly revised and largely rewritten, with many
illustrations and valuable tables. In one handsome Royal Octavo volume
of over 400 pages, bound in Extra Cloth.

  Price, post-paid, in United States, $2.50, net; Canada (duty paid),
          $2.75, net; Great Britain, 14s.; France, 16 fr. 20.

  One prominent feature is that there are no superfluous words; every
  sentence is direct to the point sought. It is, therefore, easy
  reading, and conveys very much information in little space.—_The
  Pacific Record of Medicine and Surgery._

  It is unquestionably a work that should be in the hands of every
  physician in the country, and medical students will find it a most
  excellent and valuable text-book.—_The Southern Practitioner._

  The first edition was rapidly exhausted, and the book justly became an
  authority to physicians and sanitary officers, and a text-book very
  generally adopted in the colleges throughout America. The second
  edition is a great improvement over the first, all of the matter being
  thoroughly revised, much of it being rewritten, and many additions
  being made. The size of the book is increased one hundred pages. The
  book has the original recommendation of being a handsomely-bound,
  clearly-printed octavo volume, profusely illustrated with reliable
  references for every branch of the subject matter.—_Medical Record._

  The wonder is how Professor Rohé has made the book so readable and
  entertaining with so much matter necessarily condensed. Altogether,
  the manual is a good exponent of hygiene and sanitary science from the
  present American stand-point, and will repay with pleasure and profit
  any time that may be given to its perusal.—_University Medical
  Magazine._


                          _By the Same Author_

              A Practical Manual of Diseases of the Skin.

By GEORGE H. ROHÉ, M.D., Professor of Materia Medica, Therapeutics, and
Hygiene, and formerly Professor of Dermatology in the College of
Physicians and Surgeons, Baltimore, etc., assisted by J. WILLIAMS LORD,
A.B., M.D., Lecturer on Dermatology and Bandaging in the College of
Physicians and Surgeons; Assistant Physician to the Skin Department in
the Dispensary of Johns Hopkins Hospital.

In one neat 12mo volume of over 300 pages bound in Extra Dark-Blue
Cloth. _No. 13 in the Physicians’ and Students’ Ready-Reference Series._

 Price, post-paid, in the United States and Canada, $1.25, net; in Great
                  Britain, 6s. 6d.; in France, 7 fr. 75.

The PRACTICAL character of this work makes it specially desirable for
the use of students and general practitioners.

The nearly one hundred (100) reliable and carefully prepared Formulæ at
the end of the volume add not a little to its practical value.

All the various forms of skin diseases, from Acne to Zoster
(alphabetically speaking), are succinctly yet amply treated of, and the
arrangement of the book, with its excellent index and unusually full
table of contents, goes to make up a truly satisfactory volume for ready
reference in daily practice.


                                 _SENN_

                         Principles of Surgery.

By N. SENN, M.D., PH.D., Professor of Practice of Surgery and Clinical
Surgery in Rush Medical College, Chicago, Ill.; Professor of Surgery in
the Chicago Polyclinic; Attending Surgeon to the Milwaukee Hospital;
Consulting Surgeon to the Milwaukee County Hospital and to the Milwaukee
County Insane Asylum.

This work, by one of America’s greatest surgeons, is thoroughly
COMPLETE; its clearness and brevity of statement are among its
conspicuous merits. The author’s long, able, and conscientious
researches in every direction in this important field are a guarantee,
of unusual trustworthiness, that every branch of the subject is treated
authoritatively, and in such a manner as to bring the greatest gain in
knowledge to the practitioner and student.

In one Royal Octavo volume, with 109 fine Wood-Engravings and 624 pages.

                            United       Canada     Great
                           States.    (duty paid). Britain.   France.
 Price, in Cloth,          $4.50, net   $5.00, net 24s. 6d.    27 fr. 20
 Price, in Sheep or
   ½-Russia,                5.50, net    6.10, net     30s.    33 fr. 10

  STEPHEN SMITH, M.D., Professor of Clinical Surgery Medical Department
  University of the City of New York, writes: “There has long been great
  need of a work on the principles of surgery which would fully
  illustrate the present advanced state of knowledge of the various
  subjects embraced in this volume. The work seems to me to meet this
  want admirably.”

  FRANK J. LUTZ, M.D., St. Louis, Mo., says: “It seems incredible that
  those who pretend to teach have done without such a guide before, and
  I do not understand how our students succeeded in mastering the
  principles of modern surgery by attempting to read our obsolete
  text-books. American surgery should feel proud of the production, and
  the present generation of surgeons owe you a debt of gratitude.”

  The work is systematic and compact, without a fact omitted or a
  sentence too much, and it not only makes instructive but fascinating
  reading. A conspicuous merit of Senn’s work is his method, his
  persistent and tireless search through original investigations for
  additions to knowledge, and the practical character of his
  discoveries.—_The Review of Insanity and Nervous Diseases._

  After perusing this work on several different occasions, we have come
  to the conclusion that it is a remarkable work, by a man of unusual
  ability.—_The Canada Medical Record._

  The work is exceedingly practical, as the chapters on the treatment of
  the various conditions considered are based on sound deductions, are
  complete, and easily carried out by any painstaking surgeon.—_Medical
  Record._

  The book throughout is worthy of the highest praise. It should be
  adopted as a text-book in all of our schools.—_University Medical
  Magazine._


                          _By the Same Author_

                 Tuberculosis of the Bones and Joints.

By N. SENN, M.D., PH.D.

Illustrated with upwards of One Hundred (100) Engravings and Plates,
many of them colored. Royal Octavo. Over 500 pages.

                           United       Canada      Great
                          States.    (duty paid).  Britain.    France.
 Price, Extra Cloth,      $4.00, net   $4.40, net 22s. 6d.     24 fr. 60
 Price, Sheep or
   ½-Russia,               5.00, net    5.50, net 28s.         30 fr. 30

To get an idea of the scope of the work read the following titles of
chapters: History. Proofs which Establish the Tubercular Nature of the
So-called Strumous Disease of Bones and Joints. Bacillus Tuberculosis.
Histology of Tubercle. Histogenesis of Tubercle. Caseation. Tubercular
Abscess. Topography of Bone and Joint Tuberculosis. Bone Tuberculosis.
Etiology of Bone Tuberculosis. Symptoms and Diagnosis of Tubercular Bone
Affections. Prognosis of Tubercular Disease of Bone. Treatment of
Tuberculosis of Bone. Tuberculosis of Joints. Special Points in the
Pathology of Synovial Tuberculosis. Etiology; Symptoms and Diagnosis,
Prognosis. Treatment of Tuberculosis of Joints. Local Treatment.
Tuberculin Treatment. Treatment of Tuberculosis of Joints by
Parenchymatous and Intra-articular Injections. Operative Treatment.
Resection. Atypical and Typical Resection. Immediate and Remote Results
of Resection. Amputation. Post-Operative Treatment. Tuberculosis of
Special Bones. Tuberculosis of the Bones of the Trunk. Tuberculosis of
Pelvic Bones, Scapula, Clavicle, Sternum, and Ribs. Tuberculosis of
Joints of Upper Extremity. Tuberculosis of Hip-Joint. Tuberculosis of
Knee-Joint. Tuberculosis of Ankle-Joint and Tarsus.

  All these subjects are handled in the author’s simple, direct, and
  vigorous style, and always with the practical side of the question
  kept in view, and leave nothing necessary or desirable untouched.
  We know of no book of equal learning, thoroughness, and utility
  upon the common and important class of cases composed under
  Tuberculosis of Bones and Joints. The illustrations are numerous
  and good, and the printing and other details of issuing a book
  have been attended to with an enterprise and ambition creditable
  to the publishers.—_Cleveland Medical Gazette._


                              _SHOEMAKER_

                    Materia Medica and Therapeutics.

     WITH ESPECIAL REFERENCE TO THE CLINICAL APPLICATION OF DRUGS.

By JOHN V. SHOEMAKER, A.M., M.D., Professor of Materia Medica,
Pharmacology, Therapeutics, and Clinical Medicine, and Clinical
Professor of Diseases of the Skin in the Medico-Chirurgical College of
Philadelphia; Physician to the Medico-Chirurgical Hospital; Member of
the American Medical Association, of the Pennsylvania and Minnesota
State Medical Societies, the American Academy of Medicine, the British
Medical Association; Fellow of the Medical Society of London, etc.

Second Edition. Thoroughly revised. In two volumes. Royal Octavo. Nearly
1100 pages.

Volume I is devoted to pharmacy, general pharmacology, and therapeutics,
and remedial agents not properly classed with drugs.

Volume II is wholly taken up with the consideration of drugs, each
remedy being studied from three points of view, viz.: the Preparations,
or Materia Medica; the Physiology and Toxicology, or Pharmacology; and,
lastly, its Therapy. Each volume is thoroughly and carefully indexed
with clinical and general indexes, and the second volume contains a most
valuable and exhaustive table of doses extending over several
double-column octavo pages.

THE VOLUMES MAY BE PURCHASED SEPARATELY.

                                 VOL. I.

                            United       Canada     Great
                           States.    (duty paid). Britain.   France.
 Extra Cloth,              $2.50, net   $2.75, net     14s.    16 fr. 20
 Sheep,                     3.25, net    3.60, net     18s.    20 fr. 20


                                VOL. II.

                            United       Canada     Great
                           States.    (duty paid). Britain.   France.
 Extra Cloth,              $3.50, net   $4.00, net     19s.    22 fr. 40
 Sheep,                     4.50, net    5.00, net     25s.    28 fr. 60

The well-known practical usefulness of this eminently standard work is
now greatly increased by the very recent and accurate information it
gives, from a clinical stand-point, concerning the new and useful drugs
introduced to the medical profession since the issue of the first
edition, two years ago; so that it is thoroughly abreast of the progress
of therapeutic science, and hence really indispensable to every student
and practitioner.

                     REVIEWS OF THE FIRST EDITION.

  The value of the book lies in the fact that it contains all that is
  authentic and trustworthy about the host of new remedies which have
  deluged us in the last five years. The pages are remarkably free from
  useless information. The author has done well in following the
  alphabetical order.—_N. Y. Med. Record._

  In perusing the pages devoted to the special consideration of drugs,
  their pharmacology, physiological action, toxic action, and therapy,
  one is constantly surprised at the amount of material compressed in so
  limited a space. The book will prove a valuable addition to the
  physician’s library.—_Occidental Med. Times._

  It is a meritorious work, with many unique features. It is richly
  illustrated by well-tried prescriptions showing the practical
  application of the various drugs discussed. In short, this work makes
  a pretty complete encyclopædia of the science of therapeutics,
  conveniently arranged for handy reference.—_Med. World._


                               _SHOEMAKER_

                  Heredity, Health, and Personal Beauty.

 INCLUDING THE SELECTION OF THE BEST COSMETICS FOR THE SKIN, HAIR, NAILS,
                   AND ALL PARTS RELATING TO THE BODY.

By JOHN V. SHOEMAKER, A.M., M.D., Professor of Materia Medica,
Pharmacology, Therapeutics, and Clinical Medicine, and Clinical
Professor of Diseases of the Skin in the Medico-Chirurgical College of
Philadelphia; Physician to the Medico-Chirurgical Hospital, etc., etc.

The health of the skin and hair, and how to promote them, are discussed;
the treatment of the nails; the subjects of ventilation, food, clothing,
warmth, bathing; the circulation of the blood, digestion, ventilation;
in fact, all that in daily life conduces to the well-being of the body
and refinement is duly enlarged upon. To these stores of popular
information is added a list of the best medicated soaps and toilet
soaps, and a whole chapter of the work is devoted to household remedies.
The work is largely suggestive, and gives wise and timely advice as to
when a physician should be consulted. _This is just the book to place on
the waiting-room table of every physician, and a work that will prove
useful in the hands of your patients._

Complete in one handsome Royal Octavo volume of 425 pages, beautifully
and clearly printed, and bound in Extra Cloth, Beveled Edges, with side
and back gilt stamps and in Half-Morocco Gilt Top.

  Price, in United States, post-paid, Cloth, $2.50; Half-Morocco, $3.50,
    net. Canada (duty paid), Cloth, $2.75; Half-Morocco, $3.90, net.
    Great Britain. Cloth. 14s.; Half-Morocco. 19s. 6d. France. Cloth. 15
    fr.; Half-Morocco, 22 fr.

The book reads not like the fulfillment of a task, but like the
researches and observations of one thoroughly in love with his subject,
fully appreciating its importance, and writing for the pleasure he
experiences in it. The work is very comprehensive and complete in its
scope.—_Medical World._

The book before us is a most remarkable production and a most
entertaining one. The book is equally well adapted for the laity or the
profession. It tells us how to be healthy, happy, and as beautiful as
possible. We can’t review this book; it is different from anything we
have ever read. It runs like a novel, and will be perused until finished
with pleasure and profit. Buy it, read it, and be surprised, pleased,
and improved.—_The Southern Clinic._

This book is written primarily for the laity, but will prove of interest
to the physician as well. Though the author goes to some extent into
technicalities, he confines himself to the use of good, plain English,
and in that respect sets a notable example to many other writers on
similar subjects. Furthermore, the book is written from a thoroughly
American stand-point.—_Medical Record._

This is an exceedingly interesting book, both scientific and
practical in character, intended for both professional and lay
readers. The book is well written and presented in admirable form by
the publisher.—_Canadian Practitioner._


                              _SHOEMAKER_

       Ointments and Oleates: Especially in Diseases of the Skin.

By JOHN V. SHOEMAKER, A.M., M.D., Professor of Materia Medica,
Pharmacology, Therapeutics, and Clinical Medicine, and Clinical
Professor of Diseases of the Skin in the Medico-Chirurgical College of
Philadelphia, etc., etc.

The author concisely concludes his preface as follows: “The reader may
thus obtain a conspectus of the whole subject of inunction as it exists
to-day in the civilized world. In all cases the mode of preparation is
given, and the therapeutical application described seriatim, in so far
as may be done without needless repetition.”

SECOND EDITION, revised and enlarged. 298 pages. 12mo. Neatly bound in
Dark-Blue Cloth. _No. 6 in the Physicians’ and Students’ Ready-Reference
Series._

 Price, post-paid, in the United States and Canada, $1.50, net; in Great
                  Britain, 8s. 6d.; in France, 9 fr. 35.

It is invaluable as a ready reference when ointments or oleates are to
be used, and is serviceable to both druggist and physician.—_Canada
Medical Record._

To the physician who feels uncertain as to the best form in which to
prescribe medicines by way of the skin the book will prove valuable,
owing to the many prescriptions and formulæ which dot its pages, while
the copious index at the back materially aids in making the book a
useful one.—_Medical News._


                                _SMITH_

                  Physiology of the Domestic Animals.

   A TEXT-BOOK FOR VETERINARY AND MEDICAL STUDENTS AND PRACTITIONERS.

By ROBERT MEADE SMITH, A.M., M.D., Professor of Comparative Physiology
in University of Pennsylvania; Fellow of the College of Physicians and
Academy of the Natural Sciences, Philadelphia; of American Physiological
Society; of the American Society of Naturalists, etc.

This new and important work, the most thoroughly complete in the English
language on this subject, treats of the physiology of the domestic
animals in a most comprehensive manner, especial prominence being given
to the subject of foods and fodders, and the character of the diet for
the herbivora under different conditions, with a full consideration of
their digestive peculiarities. Without being overburdened with details,
it forms a complete text-book of physiology adapted to the use of
students and practitioners of both veterinary and human medicine. This
work has already been adopted as the Text-Book on Physiology in the
Veterinary Colleges of the United States, Great Britain, and Canada. In
one Handsome Royal Octavo Volume of over 950 pages, profusely
illustrated with more than 400 Fine Wood-Engravings and many Colored
Plates.

                            United       Canada     Great
                           States.    (duty paid)  Britain.   France.
 Price, Cloth              $5.00, Net   $5.50, Net     28s.    30 fr. 30
 Price, Sheep,              6.00, net    6.60, net     32s.    36 fr. 20

A. LIAUTARD, M.D., H.F.R.C., V.S., Professor of Anatomy, Operative
Surgery, and Sanitary Medicine in the American Veterinary College, New
York, writes:—“I have examined the work of Dr. R. M. Smith on the
‘Physiology of the Domestic Animals,’ and consider it one of the best
additions to veterinary literature that we have had for some time.”

E. M. READING, A.M., M.D., Professor of Physiology in the Chicago
Veterinary College, writes:—“I have carefully examined the ‘Smith’s
Physiology,’ published by you, and like it. It is comprehensive,
exhaustive, and complete, and is especially adapted to those who desire
to obtain a full knowledge of the principles of physiology, and are not
satisfied with a mere smattering of the cardinal points.”


Dr. Smith’s presentment of his subject is as brief as the status of the
science permits, and to this much-desired conciseness he has added an
equally welcome clearness of statement. The illustrations in the work
are exceedingly good, and must prove a valuable aid to the full
understanding of the text—_Journal of Comparative Medicine and Surgery._

Veterinary practitioners and graduates will read it with pleasure.
Veterinary students will readily acquire needed knowledge from its
pages, and veterinary schools, which would be well equipped for the work
they aim to perform, cannot ignore it as their text-book in
physiology.—_American Veterinary Review._

Altogether, Professor Smith’s “Physiology of the Domestic Animals” is a
happy production, and will be hailed with delight in both the human
medical and veterinary medical worlds. It should find its place,
besides, in all agricultural libraries.—PAUL PAQUIN, M.D., V.S., in the
_Weekly Medical Review_.

The author has judiciously made the nutritive functions the strong point
of the work, and has devoted special attention to the subject of foods
and digestion. In looking through other sections of the work, it appears
to us that a just proportion of space is assigned to each, in view of
their relative importance to the practitioner.—_London Lancet._


                              _SOZINSKEY_

    Medical Symbolism. Historical Studies in the Arts of Healing and
                                Hygiene.

By THOMAS S. SOZINSKEY, M.D., Ph.D., Author of “The Culture of Beauty,”
“The Care and Culture of Children,” etc.

12mo. Nearly 200 pages. Neatly bound in Dark-Blue Cloth. Appropriately
illustrated with upward of thirty (30) new Wood-Engravings. _No. 9 in
the Physicians’ and Students’ Ready-Reference Series._

    Price, post-paid, in United States and Canada, $1.00, net; Great
                    Britain, 6s.; France, 6 fr. 20.

He who has not time to more fully study the more extended records of the
past, will highly prize this little book. Its interesting discourse upon
the past is full of suggestive thought.—_American Lancet._

Like an oasis in a dry and dusty desert of medical literature, through
which we wearily stagger, is this work devoted to medical symbolism and
mythology. As the author aptly quotes: “What some light braines may
esteem as foolish toyes, deeper judgments can and will value as sound
and serious matter.”—_Canadian Practitioner._

In the volume before us we have an admirable and successful attempt to
set forth in order those medical symbols which have come down to us, and
to explain on historical grounds their significance. An astonishing
amount of information is contained within the covers of the book, and
every page of the work bears token of the painstaking genius and erudite
mind of the now unhappily deceased author.—_London Lancet._


                               _STEWART_

                          Obstetric Synopsis.

By JOHN S. STEWART, M.D., formerly Demonstrator of Obstetrics and Chief
Assistant in the Gynæcological Clinic of the Medico-Chirurgical College
of Philadelphia: with an introductory note by WILLIAM S. STEWART, A.M.,
M.D., Professor of Obstetrics and Gynæcology in the Medico-Chirurgical
College of Philadelphia.

By students this work will be found particularly useful. It is based
upon the teachings of such well-known authors as Playfair, Parvin, Lusk,
Galabin, and Cazeaux and Tarnier, and contains much new and important
matter of great value to both student and practitioner.

With 42 Illustrations. 202 pages. 12mo. Handsomely bound in Dark-Blue
Cloth. _No. 1 in the Physicians’ and Students’ Ready-Reference Series._

 Price, post-paid, in the United States and Canada, $1.00, net; in Great
                     Britain, 6s.; France, 6 fr. 20.

DELASKIE MILLER, M.D., Professor of Obstetrics, Rush Medical College,
Chicago, Ill., says:—“I have examined the ‘Obstetric Synopsis,’ by John
S. Stewart, M.D., and it gives me pleasure to characterize the work as
systematic, concise, perspicuous, and authentic. Among manuals it is one
of the best.”


It is well written, excellently illustrated, and fully up to date in
every respect. Here we find all the essentials of Obstetrics in a
nutshell, Anatomy, Embryology, Physiology, Pregnancy, Labor, Puerperal
State, and Obstetric Operations all being carefully and accurately
described.—_Buffalo Medical and Surgical Journal._

It is clear and concise. The chapter on the development of the ovum is
especially satisfactory. The judicious use of bold-faced type for
headings and italics for important statements gives the book a pleasing
typographical appearance.—_Medical Record._

This volume is done with a masterly hand. The scheme is an excellent
one. The whole is freely and most admirably illustrated with well-drawn,
new engravings, and the book is of a very convenient size.—_St. Louis
Medical and Surgical Journal._


                               _ULTZMANN_

         The Neuroses of the Genito-Urinary System in the Male.

                     WITH STERILITY AND IMPOTENCE.

By DR. R. ULTZMANN, Professor of Genito-Urinary Diseases in the
University of Vienna. Translated, with the author’s permission, by
GARDNER W. ALLEN, M.D., Surgeon in the Genito-Urinary Department, Boston
Dispensary.

Full and complete, yet terse and concise, it handles the subject with
such a vigor of touch, such a clearness of detail and description, and
such a directness to the result, that no medical man who once takes it
up will be content to lay it down until its perusal is complete,—nor
will one reading be enough.

Professor Ultzmann has approached the subject from a somewhat different
point of view from most surgeons, and this gives a peculiar value to the
work. It is believed, moreover, that there is no convenient hand-book in
English treating in a broad manner the Genito-Urinary Neuroses.

SYNOPSIS OF CONTENTS.—First Part—I. Chemical Changes in the Urine in
Cases of Neuroses. II. Neuroses of the Urinary and of the Sexual Organs,
classified as: (1) Sensory Neuroses; (2) Motor Neuroses; (3) Secretory
Neuroses. Second Part—Sterility and Impotence. The treatment in all
cases is described clearly and minutely.

Illustrated. 12mo. Handsomely bound in Dark-Blue Cloth. _No. 4 in the
Physicians’ and Students’ Ready-Reference Series._

 Price, post-paid, in the United States and Canada, $1.00, net; in Great
                    Britain, 6s.; in France, 6 fr. 20.

This book is to be highly recommended, owing to its clearness and
brevity. Altogether, we do not know of any book of the same size which
contains so much useful information in such a short space.—_Medical
News._

Its scope is large, not being confined to the one
condition,—neurasthenia,—but embracing all of the neuroses, motor and
sensory, of the genito-urinary organs in the male. No one who has read
after Dr. Ultzmann need be reminded of his delightful manner of
presenting his thoughts, which ever sparkle with originality and
appositeness.—_Weekly Med. Review._

It engenders sound pathological teaching, and will aid in no small
degree in throwing light on the management of many of the difficult and
more refractory cases of the classes to which these essays especially
refer.—_The Medical Age._


                                _VOUGHT_

                 A Chapter on Cholera for Lay Readers.

      HISTORY, SYMPTOMS, PREVENTION, AND TREATMENT OF THE DISEASE.

By WALTER VOUGHT, Ph.B., M D., Medical Director and Physician-in-Charge
of the Fire Island Quarantine Station, Port of New York; Fellow of the
New York Academy of Medicine, etc.

Illustrated. 12mo. 106 pages. Flexible Cloth.

 Price, post-paid, in the United States and Canada, 75 cents, net; Great
                       Britain, 4s.; France, 5 fr.

By complying with and conforming to (and this is perfectly practicable)
the instructions so clearly, fully, and yet briefly given in this little
volume, absolute security against the disease is assured.

It is written by so experienced and competent an authority—one who has
had actual hand-to-hand conflict with an extensive epidemic—and in such
a clear, succinct style, as to be easily comprehended and made available
by every individual and household.

The following CONDENSED TABLE OF CONTENTS shows the scope and
completeness of the work: Definition; History of Cholera; Cholera in
America; Causes of the Disease; The Disease in Human Beings; The Germ in
the Body; The Disease in Epidemic Form; Symptoms; The Diagnosis of the
Disease; Prognosis; Treatment; Prevention; Method of Handling an
Outbreak of Cholera on Shipboard; Quarantine; Disinfection.

A very thorough and conveniently arranged index adds greatly to the
practical usefulness of the book.


                             _WITHERSTINE_

               The International Pocket Medical Formulary

                       ARRANGED THERAPEUTICALLY.

By C. SUMNER WITHERSTINE, M.S., M.D., Associate Editor of the “Annual of
the Universal Medical Sciences”; Visiting Physician of the Home for the
Aged, Germantown, Philadelphia; Late House-Surgeon Charity Hospital, New
York.

More than 1800 formulæ from several hundred well-known authorities. With
an Appendix containing a Posological Table, the newer remedies included;
Important Incompatibles; Tables on Dentition and the Pulse; Table of
Drops in a Fluidrachm and Doses of Laudanum graduated for age; Formulæ
and Doses of Hypodermatic Medication, including the newer remedies; Uses
of the Hypodermatic Syringe; Formulæ and Doses for Inhalations, Nasal
Douches, Gargles, and Eye-Washes; Formulæ for Suppositories; Use of the
Thermometer in Disease; Poisons, Antidotes and Treatment; Directions for
Post-Mortem and Medico-Legal Examinations; Treatment of Asphyxia,
Sun-stroke, etc.; Antiemetic Remedies and Disinfectants; Obstetrical
Table; Directions for Ligations of Arteries; Urinary Analysis; Table of
Eruptive Fevers; Motor Points for Electrical Treatment, etc.

This work, the best and most complete of its kind, contains about 275
printed pages, besides extra blank leaves judiciously distributed
throughout the book, affording a place to record and index favorite
formulæ. Elegantly printed, with red lines, edges, and borders; with
illustrations. Bound in leather, with side-flap.

The alphabetical arrangement of the diseases and a thumb-letter index
render reference rapid and easy.

As a _student_, the physician needs it for study, collateral reading,
and, for recording the favorite prescriptions of his professors, in
lecture and clinic; as a _recent graduate_, he needs it as a reference
hand-book for daily use in prescribing; as an _old practitioner_, he
needs it to refresh his memory on old remedies and combinations, and for
information concerning newer remedies and more modern approved plans of
treatment.

No live, progressive medical man can afford to be without it.

    Price, post-paid, in United States and Canada, $2.00, net; Great
                 Britain, 11s. 6d.; France, 12 fr. 40.


                                _YOUNG_

                       Synopsis of Human Anatomy.

   BEING A COMPLETE COMPEND OF ANATOMY, INCLUDING THE ANATOMY OF THE
                     VISCERA, AND NUMEROUS TABLES.

By JAMES K. YOUNG, M.D., Instructor in Orthopædic Surgery and Assistant
Demonstrator of Surgery, University of Pennsylvania; Attending
Orthopædic Surgeon, Out-Patient Department, University Hospital, etc.

While the author has prepared this work especially for students,
sufficient descriptive matter has been added to render it extremely
valuable to the busy practitioner, particularly the sections on the
Viscera, Special Senses, and Surgical Anatomy.

The work includes a complete account of Osteology, Articulations, and
Ligaments, Muscles, Fascias, Vascular and Nervous Systems, Alimentary,
Vocal, and Respiratory and Genito-Urinary Apparatus, the Organs of
Special Sense, and Surgical Anatomy.

In addition to a most carefully and accurately prepared text, wherever
possible, the value of the work has been enhanced by tables to
facilitate and minimize the labor of students in acquiring a thorough
knowledge of this important subject. The section on the teeth has also
been especially prepared to meet the requirements of students of
dentistry.

Illustrated with 76 Wood-Engravings. 390 pages. 12mo. Bound in Extra
Dark-Blue Cloth. _No. 3 in the Physicians’ and Students’ Ready-Reference
Series._

 Price, post-paid, in the United States and Canada, $1.40, net; in Great
                  Britain, 8s. 6d; in France, 9 fr. 25.

  Every unnecessary word has been excluded, out of regard to the very
  limited time at the medical student’s disposal. It is also good as a
  reference-book, as it presents the facts about which he wishes to
  refresh his memory in the briefest manner consistent with
  clearness.—_New York Medical Journal._

  As a companion to the dissecting table, and a convenient reference for
  the practitioner, it has a definite field of usefulness.—_Pittsburgh
  Medical Review._

  The book is much more satisfactory than the “remembrances” in vogue,
  and yet is not too cumbersome to be carried around and read at odd
  moments—a property which the student will readily appreciate.—_Weekly
  Medical Review._


                     The Universal Medical Journal

                      (_Formerly THE SATELLITE_).

 A MONTHLY MAGAZINE OF THE PROGRESS OF EVERY BRANCH OF MEDICINE IN ALL
                          PARTS OF THE WORLD.

Edited by CHARLES E. SAJOUS, M.D., Editor-in-Chief of THE ANNUAL OF THE
UNIVERSAL MEDICAL SCIENCES, and C. SUMNER WITHERSTINE, M.S., M.D.,
Associate Editor.

 Subscription Price, in the United States of America, $2.00 per year; in
       other countries of the Postal Union, 8s. 6d. or 10 fr. 50c.

Subscribers to THE ANNUAL OF THE UNIVERSAL MEDICAL SCIENCES will now
receive THE UNIVERSAL MEDICAL JOURNAL _free_, as formerly they did THE
SATELLITE. THE UNIVERSAL MEDICAL JOURNAL contains 32 pages of Text,
Original Articles (a New Feature), Clinical Notes, and Correspondence by
eminent foreign and American physicians, etc. _The Best Time to
Subscribe is—Now!_ It is improved in appearance, matter, style, size.


               Annual of the Universal Medical Sciences.

    A YEARLY REPORT OF THE PROGRESS OF THE GENERAL SANITARY SCIENCES
                         THROUGHOUT THE WORLD.


                   Issue of 1893 Ready in June, 1893.

Edited by CHARLES E. SAJOUS, M.D., formerly Lecturer on Laryngology and
Rhinology in Jefferson Medical College, Philadelphia, etc., and Seventy
Associate Editors, assisted by over Two Hundred Corresponding Editors
and Collaborators in America, Europe, Asia, and Africa. IN FIVE ROYAL
OCTAVO VOLUMES OF ABOUT 500 PAGES EACH, bound in Cloth and Half-Russia,
Magnificently Illustrated with Chromo-Lithographs, Engravings, Maps,
Charts, and Diagrams. Being intended to enable any physician to possess,
at a moderate cost, a complete Contemporary History of Universal
Medicine, edited by many of America’s and Europe’s ablest teachers, and
superior in every detail of print, paper, binding, etc.

SOLD ONLY BY SUBSCRIPTION, OR SENT DIRECT ON RECEIPT OF PRICE, SHIPPING
EXPENSES PREPAID.

 Subscription Price per Year (including the “UNIVERSAL MEDICAL JOURNAL”
 for one year): In U. S., 5 vols., Cloth, $15.00; Half-Russia, $20.00.
 Canada (duty paid), Cloth, $16.50; Half-Russia, $22.00. Great Britain,
     Cloth, £4 7s.; Half-Russia, £5 15s. France, Cloth, 93 fr. 95;
                        Half-Russia, 124 fr. 35.

The UNIVERSAL MEDICAL JOURNAL is a Monthly Magazine of the Progress of
Every Branch of Medicine in All Parts of the World, Edited by the Chief
Editor of the ANNUAL and C. SUMNER WITHERSTINE, M.S., M.D., Associate
Editor. Supplied to subscribers to the ANNUAL free of charge; to all
others, $2.00 per year in advance.

   EDITORIAL STAFF OF THE “ANNUAL OF THE UNIVERSAL MEDICAL SCIENCES.”

          CONTRIBUTORS TO SERIES 1888, 1889, 1890, 1891, 1892.

        EDITOR-IN-CHIEF, CHARLES E. SAJOUS, M.D., PHILADELPHIA.


                       SENIOR ASSOCIATE EDITORS.

  AGNEW, D. Hayes, M.D., LL.D., Philadelphia, series of 1888, 1889.

  BALDY, J. M., M.D., Philadelphia, 1891, 1892.

  BARTON, J. M., A.M., M.D., Philadelphia, 1889, 1890, 1891, 1892.

  BARUCH, Simon, M.D., New York, 1892.

  BIRDSALL, W. R., M.D., New York, 1889, 1890, 1891, 1892.

  BOOTH, J. A., M.D., New York, 1892.

  BROWN, F. W., M.D., Detroit, 1890, 1891, 1882.

  BRUEN, Edward T., M.D., Philadelphia, 1889.

  BRUSH, Edward N., M.D., Philadelphia, 1889, 1890, 1891.

  CATTELL, H. W., M.D., Philadelphia, 1892.

  COHEN, J. Solis-, M.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

  COHEN, S. Solis-, M.D., Philadelphia, 1892.

  CONNER, P. S., M.D., LL.D., Cincinnati, 1888, 1889, 1890, 1891, 1892.

  CURRIER, A. F., A.B., M.D., New York, 1889, 1890, 1891, 1892.

  DAVIDSON, C. C., M.D., Philadelphia, 1888.

  DAVIS, N. S., A.M., M.D., LL.D., Chicago, 1888, 1889, 1890, 1891,
    1892.

  DELAFIELD, Francis, M.D., New York, 1888.

  DELAVAN, D. Bryson, M.D., New York, 1888, 1889, 1890, 1891, 1892.

  DOLLEY, C. S., M.D., Philadelphia, 1892.

  DRAPER, F. Winthrop, A.M., M.D., New York, 1888, 1889, 1890, 1891,
    1892.

  DUDLEY, Edward C., M.D., Chicago, 1888.

  ERNST, Harold C., A.M., M.D., Boston, 1889, 1890, 1891, 1892.

  FORBES, William S., M.D., Philadelphia, 1888, 1889, 1890.

  GARRETSON, J. E., M.D., Philadelphia, 1888, 1889.

  GASTON, J. McFadden, M.D., Atlanta, 1890, 1891, 1892.

  GIHON, Albert L., A.M., M.D., Brooklyn, 1888, 1889, 1890, 1891, 1892.

  GOODELL, William, M.D., Philadelphia, 1888, 1889, 1890.

  GRAY, Landon Carter, M.D., New York, 1890, 1891, 1892.

  GRIFFITH, J. P. Crozer, M.D., Philadelphia, 1889, 1890, 1891, 1892.

  GUILFORD, S. H., D.D.S., Ph.D., Philadelphia, 1888.

  GUITERAS, John, M.D., Ph.D., Charleston, 1888, 1889.

  HAMILTON, John B., M.D., LL.D., Washington, 1888, 1889, 1890, 1891.

  HARE, Hobart Amory, M.D., B.Sc., Philadelphia, 1888, 1889, 1890, 1891,
    1892.

  HENRY, Frederick P., M.D., Philadelphia, 1889, 1890, 1891, 1892.

  HOLLAND, J. W., M.D., Philadelphia, 1888, 1889.

  HOLT, L. Emmett, M.D., New York, 1889, 1890, 1891, 1892.

  HOOPER, Franklin H., M.D., Boston, 1890, 1891, 1892.

  HOWELL, W. H., Ph.D., M.D., Ann Arbor, 1889, 1890, 1891, 1892.

  HUN, Henry, M.D., Albany, 1889, 1890.

  INGALS, E. Fletcher, A.M., M.D., Chicago, 1889, 1890, 1891.

  JAGGARD, W. W., A.M., M.D., Chicago, 1890.

  JOHNSTON, Christopher, M.D., Baltimore, 1888, 1889.

  JOHNSTON, W. W., M.D., Washington, 1888, 1889, 1890, 1891, 1892.

  KEATING, John M., M.D., Philadelphia, 1889.

  KELSEY, Charles B., M.D., New York, 1888, 1889, 1890, 1891, 1892.

  KEYES, Edward L., A.M., M.D., New York, 1888, 1889, 1890, 1891, 1892.

  KNAPP, Philip Coombs, M.D., Boston, 1891, 1892.

  KYLE, D. Braden, M.D., Philadelphia, 1892.

  LAPLACE, Ernest, A.M., M.D., Philadelphia, 1890, 1891, 1892.

  LEE, John G., M.D., Philadelphia, 1888.

  LEIDY, Joseph, M.D., LL.D., Philadelphia, 1888, 1889, 1890, 1891.

  LONGSTRETH, Morris, M.D., Philadelphia, 1888, 1889, 1890.

  LOOMIS, Alfred L., M.D., LL.D., New York, 1888, 1889.

  LYMAN, Henry M., A.M., M.D., Chicago, 1888.

  MCGUIRE, Hunter, M.D., LL.D., Richmond, 1888.

  MANTON, Walter P., M.D., F.R.M.S., Detroit, 1888, 1889, 1890, 1891,
    1892.

  MARTIN, H. Newell, M.D., M.A., Dr.Sc., F.R.S., Baltimore, 1888, 1889.

  MATAS, Rudolph, M.D., New Orleans, 1890, 1891, 1892.

  MEARS, J. Ewing, M.D., Philadelphia, 1888, 1889, 1890, 1891.

  MILLS, Charles K., M.D., Philadelphia, 1888.

  MINOT, Chas. Sedgwick, M.D., Boston, 1888, 1889, 1890, 1891, 1892.

  MONTGOMERY, E. E., M.D., Philadelphia, 1891, 1892.

  MORTON, Thos. G., M.D., Philadelphia, 1888, 1889.

  MUNDE, Paul F., M.D., New York, 1888, 1889, 1890, 1891, 1892.

  O’DWYER, Joseph, M.D., New York, 1892.

  OLIVER, Charles A., A.M., M.D., Philadelphia, 1889, 1890, 1891, 1892.

  PACKARD, John H., A.M., M.D., Philadelphia, 1888, 1889, 1890, 1891,
    1892.

  PARISH, Win. H., M.D., Philadelphia, 1888, 1889, 1890, 1892.

  PARVIN, Theophilus, M.D., LL.D., Philadelphia, 1888, 1889.

  PEIRCE, C. N., D.D.S., Philadelphia, 1888.

  PEPPER, William, M.D., LL.D., Philadelphia, 1888.

  RANNEY, Ambrose L., M.D., New York, 1888, 1889, 1890.

  RICHARDSON, W. L., M.D., Boston, 1888, 1889.

  ROCKWELL, A. D., A.M., M.D., New York, 1891, 1892.

  ROHÉ, Geo. H., M.D., Baltimore, 1888, 1889, 1890, 1891, 1892.

  SAJOUS, Chas. E., M.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

  SAYRE, Lewis A., M.D., New York, 1890, 1891, 1892.

  SEGUIN, E. C., M.D., Providence, 1888, 1889, 1890, 1891.

  SENN, Nicholas, M.D., Ph.D., Milwaukee, 1888, 1889.

  SHAKSPEARE, E. O., M.D., Philadelphia, 1888.

  SHATTUCK, F. C., M.D., Boston, 1890.

  SMITH, Allen J., A.M., M.D., Philadelphia, 1890, 1891, 1892.

  SMITH, J. Lewis, M.D., New York, 1888, 1889, 1890, 1891, 1892.

  SPITZKA, E. C., M.D., New York, 1888.

  STARR, Louis, M.D., Philadelphia, 1888, 1889, 1890, 1891, 1892.

  STIMSON, Lewis A., M.D., New York, 1888, 1889, 1890, 1891, 1892.

  STURGIS, F. R., M.D., New York, 1888.

  SUDDUTH, F. X., A.M., M.D., F.R.M.S., Minneapolis, 1888, 1889, 1890,
    1891, 1892.

  THOMSON, William, M.D., Philadelphia, 1888.

  THOMSON, Win. H., M.D., New York, 1888.

  TIFFANY, L. McLane, A.M., M.D., Baltimore, 1890, 1891, 1892.

  TURNBULL, Chas. S., M.D., Ph.D., Philadelphia, 1888, 1889, 1890, 1891,
    1892.

  TYSON, James, M.D., Philadelphia, 1888, 1889, 1890.

  VAN HARLINGEN, Arthur, M.D., Philadelphia, 1888, 1889, 1890, 1891,
    1892.

  VANDER VEER, Albert, M.D., Ph.D., Albany, 1890.

  VICKERY, H. F., M.D., Boston, 1892.

  WHITE, J. William, M.D., Philadelphia, 1889, 1890, 1891, 1892.

  WHITTAKER, Jas. T., M.D., Cincinnati, 1888, 1889, 1890, 1891, 1892.

  WHITTIER, E. N., M.D., Boston, 1890, 1891, 1892.

  WILSON, James C., A.M., M.D., Philadelphia, 1888, 1889, 1890, 1891,
    1892.

  WIRGMAN, Chas., M.D., Philadelphia, 1888.

  WITHERSTINE, C. Sumner, M.S., M.D., Philadelphia, 1888, 1889, 1890,
    1891, 1892.

  WYMAN, Walter, M.D., Washington, 1892.

  YOUNG, Jas. K., M.D., Philadelphia, 1891, 1892.

                         JUNIOR ASSOCIATE EDITORS.

  BALDY, J. M., M.D., Philadelphia, 1890.

  BLISS, Arthur Ames, A.M., M.D., Philadelphia, 1890, 1891, 1892.

  CATTELL, H. W., M.D., Philadelphia, 1890, 1891.

  CERNA, D., M.D., Ph.D., Philadelphia, 1891, 1892.

  CLARK, J. Payson, M.D., Boston, 1890, 1891, 1892.

  CRANDALL, F. M., M.D., New York, 1891, 1892.

  COHEN, Solomon Solis-, A.M., M.D., Philadelphia, 1890, 1891.

  CRYER, H. M., M.D., Philadelphia, 1889.

  DEALE, Henry B., M.D., Washington, 1891.

  DOLLEY, C. S., M.D., Philadelphia, 1889, 1890, 1891.

  DOLLINGER, Julius, M.D., Philadelphia, 1889.

  DORLAND, W. A., M.D., Philadelphia, 1891, 1892.

  ESHNER, A. A., M.D., Philadelphia, 1892.

  FREEMAN, Leonard, M.D., Cincinnati, 1891, 1892.

  FULLER, Eugene, M.D., New York, 1892.

  GOODELL, W. Constantine, M.D., Philadelphia, 1888, 1889, 1890.

  GOULD, Geo. M., M.D., Philadelphia, 1889, 1890.

  GREENE, E. M., M.D., Boston, 1891, 1892.

  GRIFFITH, J. P. Crozer, M.D., Philadelphia, 1888.

  HOAG, Junius, M.D., Chicago, 1888.

  HOWELL, W. H., Ph.D., B.A., Baltimore, 1888, 1889.

  HUNT, William, M.D., Philadelphia, 1888, 1889.

  JACKSON, Henry, M.D., Boston, 1891, 1892.

  KIRK, Edward C., D.D.S., Philadelphia, 1888.

  LLOYD, James Hendrie, M.D., Philadelphia, 1888.

  MCCARTHY, N. I., Philadelphia, 1892.

  MCDONALD, Willis G., M.D., Albany, 1890.

  PENROSE, Chas. B., M.D., Philadelphia, 1890.

  POWELL, W. M., M.D., Atlantic City, 1889, 1890, 1891, 1892.

  QUIMBY, Chas. E., M.D., New York, 1889.

  RAU, Leonard S., M.D., New York, 1892.

  SAYRE, R. H., M.D., New York, 1890, 1891, 1892.

  SMITH, Allen J., A.M., M.D., Philadelphia, 1889, 1890.

  STENGEL, Alfred, M.D., Philadelphia, 1892.

  VICKERY, H. F., M.D., Boston, 1891, 1892.

  WARFIELD, Ridgely B., M.D., Baltimore, 1891, 1892.

  WARNER, F. M., M.D., New York, 1891, 1892.

  WEED, Charles L., A.M., M.D., Philadelphia, 1888, 1889.

  WELLS, Brooks H., M.D., New York, 1888, 1889, 1890, 1891.

  WOLFF, Lawrence, M.D., Philadelphia, 1890.

  WYMAN, Walter, A.M., M.D., Washington, 1891.

                      ASSISTANTS TO ASSOCIATE EDITORS.

  BARUCH, S., M.D., New York, 1888.

  BEATTY, Franklin T., M.D., Philadelphia, 1888.

  BROWN, Dillon, M.D., New York, 1888.

  BUECHLER, A. F., M.D., New York, 1888.

  BURR, Chas. W., M.D., Philadelphia, 1891.

  COHEN, Solomon Solis-, M.D., Philadelphia, 1889.

  COOKE, B. G., M.D., New York, 1888.

  COOLIDGE, Algernon, Jr., M.D., Boston, 1890.

  CURRIER, A. F., M.D., New York, 1888.

  DANIELS, F. H., A.M., M.D., New York, 1888.

  DEALE, Henry B., M.D., Washington, 1890, 1891, 1892.

  ESHNER, A. A., M.D., Philadelphia, 1891.

  GOULD, George M., M.D. Philadelphia, 1888.

  GRANDIN, Egbert H., M.D., New York, 1888, 1889.

  GREENE, E. M., M.D., Boston, 1890.

  GUITERAS, G. M., M.D., Washington, 1890.

  HANCE, I. H., A.M., M.D., New York, 1891, 1892.

  KLINGENSCHMIDT, C. H. A., M.D., Washington, 1890.

  KRAMER, S. P., M.D., Cincinnati. 1892.

  MARTIN, Edward, M.D., Philadelphia, 1891, 1892.

  MCKEE, E. S., M.D., Cincinnati, 1889, 1890, 1891, 1892.

  MYERS, F. H., M.D., New York, 1888.

  PACKARD, F. A., M.D., Philadelphia, 1890.

  PRITCHARD, W. B., M.D., New York, 1891, 1892.

  SANGREE, E. B., A.M., M.D., Philadelphia, 1890, 1892.

  SEARS, G. G., M.D., Boston, 1890.

  SHULTZ, R. C., M.D., New York, 1891, 1892.

  SOUWERS, Geo. F., M.D., Philadelphia, 1888.

  TAYLOR, H. L., M.D., Cincinnati, 1889, 1890.

  VANSANT, Eugene L., M.D., Philadelphia, 1888.

  VICKERY, H. F., M.D., Boston, 1890.

  WARNER, F. M., M.D., New York, 1888, 1889, 1890.

  WELLS, Brooks H., M.D., New York, 1888.

  WENDT, E. C., M.D., New York, 1888.

  WESTCOTT, Thompson S., M.D., Philadelphia, 1892.

  WILDER, W. H., M.D., Cincinnati, 1889.

  WILSON, C. Meigs., M.D., Philadelphia, 1889.

  WILSON, W. R., M.D., Philadelphia, 1891, 1892.


                   THE BIOGRAPHY OF A GREAT SURGEON.

                             HISTORY OF THE

                  Life of D. HAYES AGNEW, M.D., LL.D.

By J. HOWE ADAMS, M.D.

This fascinating life history of one of the world’s greatest surgeons is
_now ready_.

Dr. J. Howe Adams, the author, has been for many years a member of Dr.
Agnew’s family, has had the valuable aid of Mrs. Agnew, and also access
to documents and papers of unusual value and interest that would have
been denied to most writers; so that the biography here presented is
written, as it were, from the inside, and thus made doubly interesting
and valuable as the narrative of the career of an eminent physician,
surgeon, and benefactor of mankind. Royal Octavo, 376 pages, handsomely
printed, with Portraits and other illustrations.

 Price, in United States, Extra Cloth, $2.50 net: Half-Morocco, Gilt Top,
      $3.50 net, post-paid. In Canada (duty paid), Cloth, $2.75 net;
 Half-Morocco, $3.90 net. Great Britain, Cloth, 14s.; Half-Morocco, 19s.
             6d. France, Cloth, 15 fr.; Half-Morocco, 22 fr.

 SOLD ONLY BY SUBSCRIPTION, OR SENT DIRECT ON RECEIPT OF PRICE, SHIPPING
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      THE ONLY COMPLETE AND EXHAUSTIVE EXPOSITION OF THE SUBJECT.

                         Psychopathia Sexualis,

  WITH ESPECIAL REFERENCE TO CONTRARY SEXUAL INSTINCT: A MEDICO-LEGAL
                       STUDY OF SEXUAL INSANITY.

By DR. R. VON KRAFFT-EBING, Professor of Psychiatry and Neurology,
University of Vienna. Authorized Translation of the Seventh Enlarged and
Revised German Edition, by CHARLES GILBERT CHADDOCK, M.D., Professor of
Nervous and Mental Diseases, Marion-Sims College of Medicine, St. Louis;
Fellow of the Chicago Academy of Medicine; Corresponding Member of the
Detroit Academy of Medicine; Associate Member of the American
Medico-Psychological Association, etc.

Professor von Krafft-Ebing’s study of the psychopathology of the sexual
life easily supersedes all previous attempts to treat this important
subject scientifically, and it is sure to commend itself to members of
the medical and legal professions as a scientific explanation of many
social and criminal enigmas to which no work in English offers a
solution.

GENERAL SCHEME OF THE BOOK.—I. Fragment of a Psychology of the Sexual
Life; the Sexual Instinct; Sensuality and Morality; True Love, etc. II.
Physiological Facts; Sexual Maturity; Control of the Sexual Instinct,
etc. III. General Pathology; Importance of Pathological Manifestations;
Sexual Perversion. IV. Special Pathology; Abnormal Sexual Manifestations
in Mental Diseases; Insanity. V. Pathological Sexuality Before the
Criminal Court; Frequency of Sexual Crimes; Increase; Loss of
Responsibility.

One Royal Octavo Volume. 432 pages.

                             United      Canada     Great
                             States   (duty paid). Britain.   France.
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                                 _RANNEY_

                      Lectures on Nervous Diseases.

 FROM THE STAND-POINT OF CEREBRAL AND SPINAL LOCALIZATION, AND THE LATER
   METHODS EMPLOYED IN THE DIAGNOSIS AND TREATMENT OF THESE AFFECTIONS.

By AMBROSE L. RANNEY, A.M., M.D., Professor of the Anatomy and
Physiology of the Nervous System in the New York Post-Graduate Medical
School and Hospital; Professor of Nervous and Mental Diseases in the
Medical Department of the University of Vermont, etc.; Author of “The
Applied Anatomy of the Nervous System,” “Practical Medical Anatomy,”
etc., etc.

It is now generally conceded that the nervous system controls all of the
physical functions to a greater or less extent, and also that most of
the symptoms encountered at the bedside can be explained and interpreted
from the stand-point of nervous physiology.

Profusely illustrated with original diagrams and sketches in color by
the author, carefully selected wood-engravings, and reproduced
photographs of typical cases. One handsome royal octavo volume of 780
pages.

 SOLD ONLY BY SUBSCRIPTION, OR SENT DIRECT ON RECEIPT OF PRICE, SHIPPING
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  Great Britain, Cloth, 32s.; Sheep, 37s. 6d.; Half-Russia, 40s. France,
       Cloth, 34 fr. 70; Sheep, 40 fr. 45; Half-Russia, 43 fr. 30.

  We are glad to note that Dr. Ranney has published in book form his
  admirable lectures on nervous diseases. His book contains over seven
  hundred large pages, and is profusely illustrated with original
  diagrams and sketches in colors, and with many carefully selected
  wood-cuts and reproduced photographs of typical cases. A large amount
  of valuable information, not a little of which has but recently
  appeared in medical literature, is presented in compact form, and thus
  made easily accessible. In our opinion, Dr. Ranney’s book ought to
  meet with a cordial reception at the hands of the medical profession,
  for, even though the author’s views may be sometimes open to question,
  it cannot be disputed that his work bears evidence of scientific
  method and honest opinion.—_American Journal of Insanity._


                               STANTON’S

                 Practical and Scientific Physiognomy;

                                   OR

                           How to Read Faces.

By MARY OLMSTED STANTON. Copiously illustrated. Two large Royal Octavo
volumes. 1220 pages.

The author, MRS. MARY O. STANTON, has given over twenty years to the
preparation of this work. Her style is easy, and, by her happy method of
illustration of every point, the book reads like a novel and memorizes
itself. To physicians the diagnostic information conveyed is invaluable.
To the general reader each page opens a new train of ideas. (This book
has no reference whatever to phrenology.)

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------------------------------------------------------------------------




                          TRANSCRIBER’S NOTES


 1. P. 416, changed “petits jusus” to “petits jesus”.
 2. Silently corrected typographical errors and variations in spelling.
 3. Archaic, non-standard, and uncertain spellings retained as printed.
 4. Enclosed italics font in _underscores_.
 5. Superscripts are denoted by a caret before a single superscript
      character, e.g. M^r.

*** END OF THE PROJECT GUTENBERG EBOOK 64931 ***