(The abort portrait was given by the author to the translator.) Psychopathia Sexualis WITH ESPECIAL BKTEUNCI TO TH» Antipathic Sexual Instinct A MEDICO-FOREN6LC STUDY BY DR. R. v. KRAFFT-EBING P. O. PROr. rtJB PSYCIIIATKIE UND NERVENKIIANKHEITEN AN DB* K. K. ONITRRSITAT WIBN ONLY AUTHORISED ENGLISH ADAPTATION OF THE TWELFTH GERMAN EDITION BY F. J. REBMAN With Author's Portrait as Frontispiece NEW YORK REBMAN COMPANY 141 WEST 36rH STREET All El«hta Reserved, Especially the Right 0* TranslatloB Printed in America PSYCHOPATHIA SEXUALIS PREFACE TO THE FIRST EDITION. FEW people are conscious of the deep influence exerted by sexual life upon the sentiment, thought and action of man in his social relations to others. Schiller, in his essay "Die Weltweisen," touches upon this subject in these memorable words: "So long as philosophy keeps ^together the structure of the Universe so long does it maintain the world's machinery by hunger and love". From the standpoint of the philosopher sexual life takes a subordinate position. Schopenhauer ("Die Welt als Wille und Vorstellung," third edition, vol. ii., p. 586, etc.) considers it peculiar that love has hitherto offered material to the poet only and not also to the philosopher, the scant researches by Plato, Rousseau and Kant always excepted. Whatever Schopenhauer, and after him E. von Hart- mann, the philosopher of the unknown, discuss about sexual relationship, is so thoroughly incorrect and illogical that, so far as science is concerned, empirical psychology and the metaphysics of man's sexual existence are simply virgin soil. Michelet's "L'amour" and Mantegazza's "Physiology of Love" are merely clever causeries, and cannot be considered in the light of scientific research. The poet is the better psychologist, for he is swayed rather by sentiment than by reason, and always treats his subject in a partial fashion. He cannot discern deep shadows, because he is dazed by the blazing light and overcome by the benign heat of the subject Although VI PBEFACE TO THE FIRST EDITION. the "Physiology of Love" provides inexhaustible material for the poetry of all ages and of all peoples, nevertheless the poet will not discharge his arduous task adequately without the active co-operation of natural philosophy and, above all, that of medicine, a science which ever seeks to trace all psychological manifestations t6 their anatomical and physiological sources. In these efforts medicine succeeds, perhaps, in forming a connection between the pessimistic reflections of the philosopher of the stamp of Schopenhauer and Hartmann,1 and the gay and naive creations of the pget. It is not intended to build up in this book a system of the psychology of sexual life, still from the close study of psychopathology there arise most important psychological facts which it behoves the scientist to notice. The object of this treatise is merely to record the various psychopathological manifestations of sexual life in man and to reduce them to their lawful conditions. This task is bj no means an easy one, and the author is well aware of the fact that, despite his (varied) far-reaching experience in psychiatry and criminal medicine, he is yet unable to offer anything but an imperfected system. The importance of the subject, however, demands scientific research on account of its forensic bearing and its deep influence upon the common weal. The medical barrister only then finds out how sad the lack of our knowledge is in the domain of sexuality when he is called upon to express an opinion as to the responsibility of the accused whose life, liberty and honour are at stake. He then begins to appreciate the efforts that have been made to bring light into darkness. 1llartmann's philosophical conception of love ("Philosophy of the Unknown," Berlin, 18(59, p. 583) is: " Love causes more pain than pleasure. Pleasure is only an illusion. Reason would demand the avoidance of love were it not for that fatal sexual instinct. Hence it would be better to be castrated." Schopenhauer expresses the same vi«-w in his work: "Die Welt als Wille und Vorstellung," third edition, vol. ii. p. 586, etc. PUEFACE TO TllK MUST EDITION. Til Certain it is that so fur as sexual crimes are concerned ( -IT- -iieuus ideas prevail, unjust decisions arc given, ;inermet aussi de tout dire". lie appeals to men engaged in serious study in the domains of natural philosophy and medical jurisprudence. A scientific title has been chosen, and technical terms are used throughout the book in order to exclude the lay reader. For the same reason certain portions are written in Latin. VIU PREFACE TO THE TWELFTH EDITION. THIS edition is entirely rewritten and considerably enlarged. The (exceptionally) favourable criticisms which have been accorded in professional circles to former edi- tions are a guarantee that the book* exercises a beneficent influence upon legislation and jurisprudence, and will as- sist in removing erroneous ideas and superannuated laws. Its commercial success is the best proof that large numbers of unfortunate people find in its pages instruction and relief in the frequently enigmatical manifestations of sexual life. The hosts of letters that have reached the author from all parts of the world substantiate this as- sumption. Compassion and sympathy are strongly elicited by the perusal of these letters, which are written chiefly by men of refined thought and of high social and scientific standing. They reveal sufferings of the soul in compari- son to which all the other afflictions dealt out by Fate appear as trifles. May it continue to convey solace and social elevation to its readers. The number of technical terms has been increased, and the Latin language is more frequently made use of than in former editions. May the same kind reception be accorded to this edition which was enjoyed by its predecessors. That it may prove of utility in the service of science, justice and humanity is the wish of the AUTHOR GSAZ. PUBLISHERS' PREFACE. THE publishers sincerely trust that this translation from the Twelfth German Edition of Psychopathia Sexualis by Dr. R. v. Krafft-Ebing will be received with favour by those for whom the book is written, and that ita readers will derive that benefit which the author had in view. Preparing and sifting the material for the Twelfth Edition of this work was the final task of the late author. When he was attacked by the fatal illness which carried him off, the manuscript was all ready for the printer. Dr. Gugl and Dr. Stichl, pupils and for many years collaborators of the author, were entrusted by the family of the deceased with the revision of the proofs. The sale of the book is rigidly restricted to the mem- bers of the medical and legal professions. Any communications intended for the translator should be addressed to "Translator" (Krafft-Ebing), care of Rebman Company, 1123 Broadway, New York. THE PUBLISHERS. CONTENTS PAD* L FRAGMENTS OF A SYSTEM OF PSYCHOLOGY Of SEXUAL LIFE I Force of sexual instinct, 1 — Sexual instinct the basis of ethical sentiments, 2 — Love as a passion, 2 — Historical development of sexual life, 3 — Chastity, 3 — Christianity, 3 — Monogamy, 4 — Position of woman in Islam, 5 — Sen- suality and morality, 5 — Cultural demoralisation of sexual life, 5 — Episodes of the moral decay of nations, 6 — Development of sexual desire; puberty, 7 — Sensuality and religious fanaticism, 7 — Relation between religious and sexual domains, 8— Sensuality and art, 11 — Ideal- isation of first love, 12 — True love, 12 — Sentimentality, 12 — Platonic love, 13— Love and Friendship, 13 — Differ- ence between the love of the mnn and that of the woman, 14 — Celibacy, 15 — Adultery, 16 — Matrimony, 16 — Fond- ness of dress, 16 — Facts of physiological fetichism, 17 — Religious and erotic fetich ism, 18 — Hair, hand, foot of the female as fetiches, 21 — Eye, smell, voice, psychical qualities as fetich, 22. H. PHYSIOLOGICAL FACTS a6 Puberty, 25 — Time limit of sexual life, 26 — Sexual instinct, 26— Localisation, 27 — Physiological development of sexual life, 28 — Erections : Centre of erection, 28 — Sphere of sexuality and olfaction, 32 — Flagellation as a stimu- lant for sexual life, 34 — Sect of flagellants, 35 — " Flagel- lum Salutis" of Paulini, 36 — " Erogenous " (hypersss- thctic) zones, 38 — Control of sexual instinct, 40 — Coitus, 40 — Ejaculation, 41. ffl. ANTHROPOLOGICAL FACTS Primary and secondary sexual characteristics, 42 — Psychical characterintics, 42 — Differentiation of sexes, 42— rOyn«e- comasty, 43 — Development of sexual type, 44 — Eunuchs, 46. XI XII CONTENTS PACK IV. GENEBAL PATHOLOGY (KEUBOLOGICAL AND PSYCHOLOGICAL) 48 Frequency and importance of pathological manifestations, 48 — iScliedule ot Literature, 48 — Sexual neuroses, 49 — In- fluences stimulating the erectile tissues, 49 — Paralysis of the erectile tissues, 50 — Temporary impotence, 50 — Neurosis of the nerve centres of ejaculation, 51 — . Neuroses produced by cerebral causes, 62 — I'aradoxia, i.e., sexual instinct outside the period of anatomical- phyaiological processes, 65 — Sexual instinct in early childhood, 55 — Sexual instinct reappearing in old age, 57 — Sexual perversions in seniles due to impotence or dementia, 57 — Ana's thtivw acxualis, i.e., absence of sexual instinct, 61 — congenital, 61 — acquired, 68 — Hyper- assthesia, i.e., pathologically exaggerated sexual instinct, 69 — Conditions and manifestations of this anomaly, 70 — Partfsthesia or perversion of the sexual instinct, 79 — Perversion and perversity, 79 — Madism, an attempted ex- planation of sadism, 80 — Sadistic lust murder, 88 — An- thropophagy, 95 — Mutilation of corpses, 99 — Maltreat- ment of women by cutting or flogging, etc., 105 — Defile- ment of female persons, 113 — Symbolic sadism, i.e., brutal force employed against female persons, 118 — Ideal sadism, 118 — Sadism practised on any other object, 121--Flogging of boys, 121 — Sadistic acts on animals, 125 — Sadism in woman, 129 — Kleist's " Penthesilea/' 130 — Masochism, 131 — Essence and clinical manifestations of masochism, 132 — Maltreatment and humiliation invited for the purpose of sexual gratification, 134 — Passive flagellation and its relations to masochism, 140 — Fre- quency and practices of masochism, 149 — Symbolic maso- chism, 159 — Ideal masochism, 161 — Jean Jacques Rous- seau, 166 — Masochism in scientific and belletristical literature, 169 — Latent masochism, 171 — Shoe and foot fetichism, 171 — Koprolagnia, ISO-Masochism in woman, 195 — An attempted explanation of masochism, 200 — Sexual bondage, 202 — Masochism and sadism, 213 — Fetichism, definition of, 218 — Cases in which the fetich is a part of the female body, 224 — Hand fetichism, 226 — Bodily defects as fetiches, 234 — Hair fetichism, 239 — Hair despoilers. 241 — The fetich is a part of female attire, 247 — Mania for (theft of) female handkerchiefs, 255 — Shoe fetichism, 260 — The fetich consists of some special fabric, 268 — Fur, silk, velvet, gloves, roses, 274 — /Beast fetichism, 281 — Antipathic sexual instinct, 282 — Acquired sexual inversion in either sex, 286 — Neurotic taint a condition of antipathic sexual instinct, 289 — Grades of acquired perversion, 289 — Simple inversion of sexual instinct, 289 — Eviration and dcfemination, 297 — Insanity among the Scythians, 302 — Mujerados, 303 — Transition to metamorphosis sevualis, 304 — Metamor- phosis sexualis paranoica, 328 — Congenital antipathic sexuality, 335 — Various clinical forms thcroof, 336— -Gen- eral symptoms, 339 — Attempted explanation of this anomaly, 340 — Congenital antipathic sexuality in the male, 350 — Psychical hernnnhroditism, 352 — Homo- sexuality. 304 — Urmngs, ZM—Effeminatirm, 382 — CONTENTS - XIII Androgyny, 389— Congenital antipathic »c*ual\ty in tke female. 395 — Complications of antipathic sexual instinct, 439 — Diagnosis, prognosis and therapy of sexual inver- sion, 443. IV. SPECIAL PATHOLOGY 445 The manifestations of pathological sexual life in the various forms and conditions of mental disturbance, 462 — In- hibition of psychical development, 462 — Acquired mental debility, 466 — Dementia following psychosis or apoplexy, 466 — Or injuries to the head, 466 — Or lues cerebralit, 467 — Dementia paralytica, 468 — Epilepsy, 469 — Periodi- cal dementia, 478 — Ptychopathia seantali* prriodica, 479 — Mania, 481 — Symptoms of sexual excitement in maniacs, 481— -Satyriasis and nymphomania, 482 — Chronic satyriaaia and nymphomania, 486 — Melancholia, 492 — Hysteria, 492 — Paranoia, 494. V. PATHOLOGICAL SEXUAL LIFE BEFORE THE CRIMINAL FOEUM 498 Sexual crimes endanger the common weal, 498 — On the in- crease, 499 — Probable causes, 500 — Clinical researches, 501 — Sexual crimes not properly understood by the law profession, 502 — Points for the proper judgment of sexual crimes, 502 — Conditions for the cessation of responsi- bility, 502 — Points for the paychopathological importance of sexual crimes, 503 — tiexual crime* classified, 503 — Exhibitionists, 604 — Frotteurt, 522— Defilers of statues, 525 — Rape and lust-murder, 526 — Bodily injury, viola- tion of things, cruelty to animals caused by sadism, 633 — Masochism and sexual bondage, 539 — Bodily injury, robbery, theft emanating from fetichism, 543 — Notes on the question of responsibility in sexual offences caused by delusions, 549 — Immorality with persons under the age of fourteen, 552 — Non-psychopathological cases, 552 — Psychopathological cases, 554 — Unnatural abuse, 561 — Violation of animals, sodomy, bestiality, 561 — Zooerasty, 663 — Unnatural sexual relations with persons of the same sex, pederasty, 571 — In relation to sexual inversion, 672 — Necessity to distinguish between pathological and normal conditions of pederasty, 572 — Forensic opinion on congenital sexual inversion nnd when pathologically acquired, 573 — Letter from an timing, 574 — Reasons why legal proceedings against homosexual acts should be •topped, 578 — Cultivated pederasty (not pathological), 685 — Causes of the vice, 585 — Social life of pederasts, 687 — A woman-hater's ball in Berlin, 590 — Various cate- gories of unle loving men, 593 — Pcrdicatio mulierum, •S94 — Amor Irtbini*. 007 — Necrophilia, 611 — Incest, 612 — Violation of wards, C14. INDEX 615 I. FRAGMENTS OF A SYSTEM OF PSYCHOLOGY OF SEXUAL LIFE. THE propagation of the human race is not left to mere accident or the caprices of the individual, but is guaran- teed by the hidden laws of nature which are enforced by a mighty, irresistible impulse. Sensual enjoyment and physical fitness are not the only conditions for the en- forcement of these laws, but higher motives and aims, such as the desire to continue the species or Ihe individu- ality of mental and physical qualities beyond time and space, exert a considerable influence. Man puts himself at once on a level with the beast if he seeks to gratify lust alone, but he elevates his superior position when by curbing the animal desire he combines with the sexual functions ideas of morality, of the sublime, and the beau- tiful. Placed upon this lofty pedestal he stands far above nature and draws from inexhaustible sources material for nobler enjoyments, for serious work and for the realisation of ideal aims. Maudsley ("Deutsche Klinik," 1873, 2, 3) justly claims that sexual feeling is the basis upon which social advancement is developed. Tf man were deprived of sexual distinction and the nobler enjoyments arising therefrom, all poetry and prob- ably all moral tendency would be eliminated from his life. Sexual life no doubt is the one mighty factor in the individual and social relations of man which disclose his powers of activity, of acquiring property, of establishing a homo, of awakening altruistic sentiments towards a person of the opposite sex, and towards his own issue as well as towards the whole human race. 1 2 PSYCIIOPATHIA 8EXDALIS. Sexual feeling is really the root of all ethics, and no doubt of cestheticism and religion. The sublimest virtues, even the sacrifice of self, may spring from sexual life, which, however, on account of its sensual power, may easily degenerate into the lowest passion and basest vice. Love unbridled is a volcano that burns down and lays waste all around it; it is an abyss that devours all — honour, substance and health. It is of great psychological interest to follow up the gradual development of civilisation and the influence exerted by sexual life upon habits and morality.1 The gratification of the sexual instinct seems to be the primary motive in man as well as in beast. Sexual intercourse is done openly, and man and woman are not ashamed of their nakedness. The savage races, e.g., Australasians, Polynesians, Malays of the Philippines are still in this stage (vide Ploss}. Woman is the common property of man, the spoil of the strongest and mightiest, who chooses the most winsome for his own, a sort of instinctive sexual selection of the fittest. Woman is a "chattel," an article of commerce, exchange or gift, a vessel for sensual gratification, an implement for toil. The presence of shame in the manifestations and exercise of the sexual functions, and of modesty in the mutual relations between the sexes are the foundations of morality. Thence arises the desire to cover the nakedness ("and they saw that they were naked") and to perform the act in private. The development of this grade of civilisation is fur- thered by the conditions of frigid climes which necessitate the protection of the whole body against the cold. It is an *Cf. Lombroso, " The Criminal " ; Westermarck, " The History of Marriage "; Ploss, " Das Weib in der Natur- und VOlkerkunde," third edition, vol. ii., p. 413-90. Joseph Miiller, " Das sexuelle Leben der NaturvSlkur," 2 Aufl. 1902; derselbe, "Das sexuelle Leben der alten Kulturvolker, 1902 (Leipzig, Grieben). A SYSTEM OF PSYCHOLOGY OF SEXUAL LIFE. anthropological fact that modesty can be traced to much earlier periods among northern races.1 Another element which tends to promote the refined development of sexual life is the fact that woman ceases to be a "chattel". She becomes an individual being, and, although socially still far below man, she gradually ac- quires rights, independence of action, and the privilege to bestow her favours where she inclines. She is wooed by man. Traces of ethical sentiments pervade the rude sen- sual appetite, idealisation begins and community of woman ceases. The sexes are drawn to each other by mental and physical merits and exchange favours of preference. In this stage woman is conscious of the fact that her charms belong only to the man of her choice. She seeks to hide them from others. This forms the foundation of modesty, chastity and sexual fidelity so long as love endures. This development is hastened wherever nomadic habits yield to the spirit of colonisation, where man establishes a household. He feels the necessity for a companion in life, a housewife in a settled home. The Egyptians, the Israelites, and the Greeks reached this level at early periods, so did the Teutonic races. Its principal characteristics are high appreciation of virginity, chastity, modesty and sexual fidelity in strong contrast to the habits of other peoples where the host places the personal charms of the wife at the disposal of the guest The history of Japan furnishes a striking proof that this high grade of civilisation is often the last stage of moral development, for in that country to within twenty years ago prostitution was not considered to impair in any way the social status of the future wife. Christianity raised the union of the sexes to a sublime position by making woman socially the equal of man and by elevating the bond of love to a moral and religious 'According to Wc«termarck, op. cit., it wag "not the feHinp of shame which sn^ested the garment, but the garment engendered shame. The desiro to make themselves more attractive originated the habit among men and women to cover their nakedness." 4 PSYCIIOPATHIA SEXUAU8. institution.1 Thence emanates the fact that the love of man, if considered from the standpoint of advanced civili- sation, can only be of a monogamic nature and must rest upon a staple basis. Even though nature should claim This assertion may be modified in so far that the symbolical and sacramental character of matrimony was clearly defined only by the Council of Trent, although the spirit of Christianity always tended to raise woman from the inferior position which she occupied in pre- vious centuries and in the Old Testament. The tradition that woman was created from the rib of the sleep- ing man (see Genesis) is one of the causes of delay in this direction, for after the fall she is told " thy will shall be subject to man." Ac- cording to the Old Testament, woman in responsible for the fall of man, and this became the corner-stone of Christian teaching. Thus the social position of woman had to be neglected, as it were, until the spirit of Christianity had conquered tradition and scholastic tenets. It is a remarkable fact that the gospels (barring divorce, Matt, xix. 9) contain not a word in favour of woman. The clemency shown towards the adulteress and the penitent Magdalen do not affect the position of woman in general. The epistles of St. Paul definitely in- sist that no change can be permitted in the position of woman (2 Cor. xi. 3-12; Eph. v. 22, "woman shall be subject to man," and 23, " woman shall fear man "). How much the fathers of the Church are prejudiced against woman on account of Eve's part in the temptation may be easily learned from Tertulllan, " Woman, thou shouldst ever go in mount- ing and sackcloth, thy eyes filled with tears. Thou has brought about the ruin of mankind." St. Jerome has aught but good to say about woman. " Woman is the gate of the devil, the road of evil, th« sting of the scorpion" ("De Cultu Fcminarum," i. 1). Canon law declares: "Man only is created to the image of God, not woman ; therefore woman shall serve him and be his handmaid ". The Provincial Council of Macon (sixth century) seriously dis- cussed the question whether woman had a soul at all. These opinions of the Church had a sympathetic influence upon the peoples who embraced Christianity. Among the converted Ger- manic races the doicer value of woman fell considerably (J. FaU-~e, " Die rittcrliche Gesellschaft," Berlin, 18G2, p. 49. Re the valuation of the two sexes among the Jews, cf. 3 Moses, xxvii. 3-4). Even polygamy, which is distinctly recognised in the Old Testa- ment, (Dcut. xxi. l."j) is nowhere in the New Testament definitely prohibited. In fact many Christian princes (e.g. the Merovingian kings: Chlotar I., Charihort I., Pippin I. and other Prankish nobles) indulged in polygamy without a protest being raised by the Church at the time (Weinhold, "Die deutschen Fraucn itn Mittelalter," ii., p. 15 ; cf. Unger, " Marriage," etc., and Louis Bridel, " La Femme et le Droit," Paris, 1884). A SYSTEM OF PSYCHOLOGY OF SEXUAL LIFE. 5 merely the law of propagation, a community (family or state) cannot subsist without the guarantee that the off- spring thrive physically, morally and intellectually. From the moment when woman was recognised the peer of man, nli. -a monogamy became a law and was consolidated by legal, religious and moral conditions, the Christian nations obtained a mental and material superiority over the poly- .;c races, and especially over Islam. Mohammed strove to raise woman from the position of the slave and mere handmaid of enjoyment, to a higher x.cial and matrimonial grade; yet she remained still far below man, who alone could obtain divorce, and that on the easiest terms. Above all things Islamism excludes woman from public life and enterprise, and stifles her intellectual and moral advancement. The Mohammedan woman is simply a moans for sensual gratification and the propagation of the species ; whilst in the sunny balm of Christian doctrine, blossom forth her divine virtues and her qualities of house- \\ifi-, companion and mother. What a contrast! Compare the two religions and their standard of future happiness. The Christian expects a heaven of spiritual bliss absolutely free from carnal pleasure; the Mohamme- n verging in that one focus, love, i.e., the physical and mental possession of the beloved. 20 PSYCHOPATHIA 8EXUALI8. This fact establishes the existence of physiological fetichism. Without showing a pathological condition the fetich may exercise its power so long as its leading qualities represent the integral parts, and so long as the love en- gendered by it comprises the entire mental and physical personality. "Normal love appears to us as a symphony of tones Max Dessoir (pseudonym Ludwig Brunn)1 in an article "The Fetichism of Love," cleverly says :— "Normal love appears to us as a symphony of tones of all kinds. It is roused by the most varied agencies. It is, so to speak, polytheistic. Fetichism recognises only the tone-colour of a single instrument; it issues forth from a single motive ; it is monotheistic." Even moderate thought will carry the conviction that the term real love (so often misused) can only apply where the entire person of the beloved becomes the phy- sical and mental object of veneration. Of course, there is always a sensual element in love, i.e., the desire to enjoy the full possession of the beloved object, and, in union with it, to fulfil the laws of nature. But where the body of the beloved person is made the sole object of love, or if sexual pleasure only is sought without regard to the communion of soul and mind, true love does not exist. Neither is it found among the disciples of Plato, who love the soul only and despise sexual en- joyment. In the one case the body is the fetich, in the other the soul, and love is fetichism. Instances such as these represent simply transitions to pathological fetichism. This assumption is enhanced by another criterion of true love, viz., the mental satisfaction derived from the sexual act.2 '"Deutsches Montagsblatt," Berlin, 20, 8, 80. * Magnan's " spinal ce"re"bral postgrieur " who finds gratification •with any sort of woman, is only animated by lust. Meretricious love that is purchased cannot be genuine ( Mantegaaea). Whoever coined the adage : " Sublata lucerna nullum discrimen inter feminas," was A SYSTEM OF PSYCHOLOGY OF SEXUAL LIFE. 21 A striking pin-it. -UK-MOM in fetiehism is that among (lie many thiM^s which may serve as fetiches there are some which gain that significance more commonly than I others; for instance, the HAIR, the HAND, the FOOT of \\onian, or the expression of the KYE. This is important in the pathology of fetichism. Woman certainly seems to be more or less conscious of these facts. For she devotes great attention to her hair and often spends an unreasonable amount of time and money upon its cultivation. How carefully the mother looks after her little daughter's hair! What an ( important part the hairdresser plays 1 The falling out of the hair causes despair to many a young lady. The author remembers the case of a vain woman who fell into melancholia on account of this trouble, and finally committed suicide. A favourite subject of conversation among ladies is coiffures. They are envious of each other's luxuriant tresses. Beautiful hair is a mighty fetich with many men. In the legend of the Lorelef, wno lured men to destruction, the "golden hair" which she combs with a golden comb appears as a fetich. Frequently the hand or the foot possesses an attractiveness no less powerful; but in these instances masochistic and sadistic feelings often — though a cynic, indeed. The power to perform love's act is by no means a guarantee of the noblest enjoyment of love. There are urnings who are potent for women — men who do not love their wives, but are nevertheless able to perform the marital " duty ". In the majority of these cases even lustful pleasure is ab- M-nt ; for it is simply an onanistic act rendered possible by the aid of imagination which substitutes another beloved being. This decep- tion may, indeed, superinduce sexual pleasure, but, rudimentary gratification as it is, it can only arise from a psychic trick, just as ' in solitary onaniam voluptuous satisfaction is obtained chiefly with the assistance of fancy. As a matter of fact that degree of orgasm which completes the lustful act is entirely dependent upon the inter- vention of fancy. Wlirre psychic impediments exist (such as indifference, disgust, ion, fear of contagion or impregnation, etc.) the feeling of sexual gratification seems to be wanting altogether. 22 PSYCHOPATHIA SEXUALI8. not always — assist in determining the peculiar kind of fetich. By a transference through association of ideas, gloves or shoes obtain the significance of a fetich. Max Dcssolr^op. c#.7~p6ints out that among the cus- toms 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 role in the legend of Aschenbrodel. The expression of the eye is particularly important as a means of kindling the spark of love. A neuropathic eye frequently affects persons of either sex as a fetich. "Madame, vos beaux yeux me font mourir d'amour." (Moliere). There are many examples showing that odours of the body become fetiches. This fact is taken advantage of in the "Ars amandi" by 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 lavish use of strong scents. Jager, in his "Discovery of the Soul," calls attention to many olfactory sympathies. Cases are known where men have married ugly women solely because their personal odours were exceedingly pleasing. Binet makes it probable that the voice also may act an a fetich. Belot in his novel "Les baigneuses de Trouville" makes the same assertion. Binet thinks that many marriages with singers are due to the fetich of their voices. He also observes that among the singing bird3 the voice has the same sexual significance as odours among the quadrupeds. The birds allure by their song, and the male that sings most beautifully is joined at night by the charmed mate. The pathological facts of masochism and sadism show that mental peculiarities may also act as fetiches but in a wider sense. A SYSTEM OP PS >,Y OF SEXUAL LIKE. Thus the fact of idiosyncrasies is explained, and the old proverb "De gustibus non est disputandum" retains its force. Witli regard to fetichism in woman, science must at least for the present time be content with mere con- jectures. This much seems to be certain, that being a physiological factor, its effects are analogous to those in men, i.e., producing sexual sympathies towards persons of the same sex. Details will come to our knowledge only when medical women enter into the study of this subject. We may take it for granted that the physical as well us the mental qualities of man assume the form of the female fetich. In most cases, no doubt, physical attributes in the male exercise this power without regard to the existence of conscious sensuality. On the other hand it will be found that the mental superiority of man con- stitutes the attractive power where physical beauty is wanting. In the upper "strata" of society this is more apparent, even if we disregard the enormous influence exercised by "blue blood" and high breeding. The possibility that superior intellectual development favours advancement in social position, and opens the way to a brilliant career, does not seem to weigh heavily in the balance of judgment. The fetichism of body and mind is of importance in progeneration ; it favours the selection of the fittest and the transmission of physical and mental virtues. Generally speaking the following masculine qualities impose on woman, viz., physical strength, courage, nubility of mind, chivalry, self-conrufence, even self-assertion, inso- Icncc, }>ravail<>, and a c.>n.-vi..us .-how «.f ma- r the weaker sex. A "Don Juan" impresses many women and elicits admiration, for he establishes the proof of his virile powers, although the inexperienced maiden can in no wise suspect the many risks of lues and chronic urethritis she runs from a marital union with this otherwise interesting rake. 24 PSYCHOPATHIA SEXUALIS. The successful actor, musician, or vocal artiste, the circus rider, the athlete, and even the criminal, often fasci- nate the bread and butter miss as well as the maturer woman. At any rate women rave over them, and inun- date them with love letters. It is a well-known fact that the female heart has pre- dominant weakness for military uniforms, that of the cavalry-man ever having the preference. The hair of man, especially the beard, the emblem of virility, the secondary symbol of generative power — is g predominant feticli with woman. In the measure in which women bestow special care upon the cultivation of their hair, men who seek to attract and please women, cultivate the elegant growth of the beard, and especially that of the moustache. A 0 The eye as well as the voice exert the same charm. Singers of renown easily touch woman's heart. They are overwhelmed with love letters and offers of marriage. Tenors have a decided advantage. Binet (op. cit.) refers to an observation of this charac- ter made by Dumas in his novel "La maison du vent". A woman who falls in love with a tenor-voice loses her virtue. The author has thus far not succeeded in obtaining facts with regard to pathological fetichism in woman. H. PHYSIOLOGICAL FACTS. 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 perpetua- tion of the species (sexual instinct). Sexual desire during the years of sexual maturity is a physiological law. The duration of the physiological pro- cesses 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 sensu- ality 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 oyulation, recognisable in the de- velopment of the body and the occurrence of a periodical flow of blood from the genitals (menstruation), usually begins about the thirteenth to the fifteenth year; in men puberty, recognisable in the deepening of the voice, the appearance of hair on the face and mons veneris, and the occasional occurrence of pollutions, etc., takes place about the fifteenth year. In the inhabitants of tropical countries, • ver, sexual development obtains several years earlier in women — sometimes as early as the eighth year. It is worthy of remark that girla who live in citiea develop about a year earlier than girls living in (lie country, anil that (he larger the town the earlier, ccteris paribus, the development takes place. Heredity, however, has no small influence on libido and sexual power. Thus there are families in which, (25) 26 PSYCIIOPATIII.V SKXUALI8. 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 ex- tinguished. In woman the period of activity of the reproductive glands is shorter than in man, in whom sexual power may last until a great age; ovulation ceases about thirty years after puberty. The^geriodjof^waning activity of the ovaries is called the change of life (climacteriumj meno- pause ) . This biological phase does not represent merely a cessation of functional potency and final atrophy of the reproductive organs, but a transformation of the whole organism. In Middle Europe the sexual maturity of man begins about the eighteenth year, and virility reaches its acme at forty. After that age it slowly declines. The potentia generandi ceases usually at the age of sixty-two, but po- tentia cceundi may be present much longer. 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 periodical in the human male, as it is in animals; it manifests an organic variation of intensity in consonance with the collection and expenditure of semen. In women the degree of sexual desire coincides with the process of ovulation in such a way that libido sexualis is intensified 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. This psycho- sexual centre is nothing more than a junction and crossing of principal paths which lead on the one hand to the sensi- tive motor apparatus of the sexual organs, and on the other hand to those nerve centres of the visual and olfactory organs which are the carriers of that consciousness which distinguishes between the "male" and the "female". Owing to the close relations which exist between thc> PHYSIOLOGICAL FACTS. 27 sexual instinct and the olfactory sense,1 it is to be i> re- sumed that the sexual and olfactory centres lie close together in the cerebral co: The development of M-xiial life has its lv 'ginning in the organic sensations which arise from the maturing reproductive glands. These excite the attention of the individual. Reading and the experiences of every-day life (which, unfortunately, are now-a-days too early and too frequently suggestive), con- vert these notions into clear ideas, which are accent' by organic sensations of a pleasurable character. With this accentuation of erotic ideas through lustful feelings, an impulse to induce them is developed (sexual desire). 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 (hypenrmia, secretion of semen, ovulation), give rise to sexual ideas, images, and impulses. The cerebral cortex, by means of preconceived or re- produced sensual ideas, reacts on the reproductive organs, including hypersemia, production of semen, erection, ejacu- lation. This is effected by means of centres for vasomotor i nervation and ejaculation, which are situated in the lum'nar regions of the cord, and lie close together. Both are reflex centres. The centre .,f erection (Goliz, I'rh-hard} is an inter- mediate station placed between the brain and the genital apparatus. The nervous paths which connect it with the brain probably run through the pcdnnruli crrrhri and the ports. 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 'The olfactory centre is presumed by Ferrier (" Function! of the Brain") to be in the n-jjion of the gyrus uncinntus. Zuckcrkandl (" Uel»T dm IJiorliciTilrnin," 1887), from researches in comparative :m:iti.iny, mnrludri that the olfactory centre haa ita seat in the Hip- I>ocaiiipu8 nmjor. 28 PSYCIIOPATHIA 8EXUALIS. nerves (penis, clitoris and annexa). It ia not directly sub- ordinated to the will. The excitation of this centre is conveyed to the corpora cavernosa by means of nerves (nervi erigentes — Eckhard) running into the first three sacral nerves. The action of the nervi erigentes, which renders erec- tion possible, is inhibitory in so far as it inhibits the ganglionic nervous mechanism in the corpora cavernosa, upon the action of which the smooth muscle-fibres of the corpora cavernosa are dependent (Kolliker and Kohl- rausch). Under the influence of the action of the nervi erigentes, these fibres of the corpora cavernosa become re- laxed, 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 the contraction of the bulbo cavemosus and erector penis muscles, which extend by means of an aponeurosis over the dorsal surface of the penis. The erection-centre is under the influence of both \ exciting and inhibitory innervation arising from the cere- brum. Ideas and sense-perceptions of sexual content , have an exciting effect. According to observations made on men that have been hung, it is evident that the erection-centre may also be aroused by excitation of the1 tract of 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 (tain's, especially myelitis) affecting the lumbar portion1 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) 1Later researches by MUller (Klin. u. experiment. Studien, etc., Deutsche Zeitschr. f. N. heilkunde xxi.) seem to render it more prob- able that the centre of erection does not lie in the conus medullrxns of the spinal cord,, but rather in the sacral ganglia, thus constituting a sympathetic reflex. 1MIY8IOLOOI 29 sensory nerves of the genitals and surrounding parta by fricti«.n ; by irritation of the un-tlia ( g< niOTrtHHO , of the rectum (hemorrhoids, oxyuris), of the bladder (distension with urine, especially in the morning; irritation of cal- culi) ; by distension of the vesieulffi seminales with semen; by hypersemia 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 exerted by irritation of the nervous ganglia which are so abundant in th« 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 inllunir.^ from the brain. In men the fact that will power an«l emotions, (fear of unsuccessful coitus, surprise inter actum sex- ualem, 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 dura- tion 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 point of the sexual mechanism is the cere- bral 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 <1 nate as sexual life, sexual instinct, and sexual desire. This centre is susceptible 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 are dominated by psychical impressions (memory and sensory perceptions, lascivious stories, touch, pressure of the hand, kiss, etc.). Auditory and olfactory perceptions certainly play but a very subordinate role. Under patho- 30 PSYCHOPATHIA SEXUALIS. logical conditions (v. infra}, the latter have a very decided influence in inducing sexual excitement.1 In beasts the influence of olfactory perception on the sexual sense is unmistakable. Al/lmus ("Beitrage zur Physiol. und Pathol. des Olfactorius," "Archiv fiir Psych." xii., II. 1) declares that the sensa 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 perception, and that almost all animals, at the time of rutting, emit a specially distinct odour 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 up. the male was unable to distinguish the female. Again, an experiment by Mantegazza ("Hygiene of Love"), who re- moved the eyes of rabbits and found that the defect con- stituted 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 on their sexual organs, glands which secrete substances having a very strong odour. Althaus also shows that in man there are certain re- lations existing between the olfactory and sexual senses. He mentions Cloquct ("Osphresiologie," Paris, 1826), who calls attention to the sensual pleasure excited by the odour of flowers, and tells how Eichelieu lived in an atmosphere laden with the heaviest perfumes, in order to excite his sexual functions. Zippe ("Wien. Med. Wochenschrift," 1879, No. 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 can- not be doubted that the olfactory sense stands in remote lCf. Albert Hagen, "Die sexuelle Osphresiologie," Charlotten- burg, 1901 (Verlag H. Basdorf), a most interesting monograph on the relations between the olfactory senses and odours and the sexual acts in man. Albert Moll, " Untersuchungen liber libido sexualis," p. 377. (Literature and studies on the olfactory sense as a stimu- lating cause of the sexual instinct.) 1'IIYM' FACTS. 31 with the sexual apparatus. Odours of flov. often occasion pleasurable sensual feelings, and when infers the passage in the 'Song of Solomon,' 'And my hands dropped with myrrh, and my lingers with R\\ smelling myrrh, upon the handles of the lock,' one finds that it did not escape Solomon tti<>n. In the Orient the pleasant perfume* an- esteemed for their relatioi the sexual organ-, and the women's apartments of the Sul- tan are redolent with the fragrance of flo\\ Most, professor in Rostock (cf. ///>/*•), relates: "I learned from a sensual young peasant that ho 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 he the exciting cause of passion- ate love. Ar 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 Conde,- 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 u ball, he wiped his brow with her handkerchief. Professor Jdger, the "discoverer of the soul," refers to the same thing in his well-known book (2nd. ed., 1880, chap, xv., p. 173) ; for he regards the sweat as important in the production of sexual effects, and as being especially seductive.1 One learns from reading the work of Ploss ("Da« Weih"), that attempts to attract a person of the opposite «ex by means of the perspiration, may be discerned in many forms in popular psychology. 'See also further interesting observations on the aphrodiaic ef- fect* of sweat on both sexes. Ftrt, 1'instinct sexuel, p. 127. (Paris, 1899). 32 PSYCHOPATH'IA SEXUALIS. In reference to this, a custom which holds among the natives of the Philippine Islands when they become en- gaged, as reported by Jagor, is remarkable. When it be- comes necessary for an engaged pair to separate, they ex- change articles of wearing-apparel, by means of which each becomes assured of faithfulness. These objects are care- fully preserved, covered with kisses, and smelled. The love of certain libertines and sensual women for perfumes1 indicates a relation between the olfactory and the sexual senses. A case mentioned by Heschl ("Wiener Zeitschrift f. pract. Heilkunde," 22d March, 1861) is remarkable, where the absence of both olfactory lobes was accompanied by imperfectly developed genitals. It was the case of a man aged forty-five, 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, for in the psychoses of both sexes superinduced by mas- turbation, as well as in insanity due to disease of the female organs, or during the climacterium, olfactory hal- lucinations are especially frequent, while in cases where a sexual cause is wanting they are very infrequent. II am inclined to doubt2 that, under normal conditions, olfactory impressions in man, as in animals, p? an im- portant role in the excitation of the sexual centre. On *Cf. Laycock, who ("Nervous Diseases of Women," 1840) found that in women the love for musk and similar perfumes was related to sexual excitement. The following case, reported by Binet, seems to be in opposition to this idea. Unfortunately nothing is said concerning the mental PHY8IOLOOICAI. PACTS. 33 account of the importance of this consensus for the under- rtamling of pathological cases, it is necessary here to thor- oughly consioVr tin- relations existing between the olfactory and srxtial senses. With n •("• rence to these physiological relations it may he mentioned as an interesting fact that there exists a cer- tain histologieal conformity Intwctn the nose and the genitals, f<»r both have KJJKCTILE tissue (likewise the nipple,). Interesting physiological and clinical obeervatiens by J. N. Mackenzie may be found in the "Journal of Medical Science," April, 1884. He finds: (1) that in certain women with normal olfactory organs regularly with men- struation a swelling of the erectile tissue of the nose oc- curs which disappears again with the flooding; (2) that menstruation is at times replaced by epistaxis, which dis- appears when the uterine flow begins, but in some cases always recurs with the menstrual functions; (3) irrita- tions of the nasal organs such as violent sneezing, etc., oc- cur at the_time of sexual excitement; (4) Stimulation of the genital' tracts is occasioned by affections of the nasal organs He, also observe.- that nasal affections in women grovr worse during tho time of menstruation; that venereal ex- cesses produce inflammation of the Schneiderian mem- brane, or intensify it where it already exists. He also points out that masturbators very frequently suffer from nasal disease, are troubled with abnormal sen- sations of olfaction, and are subject to epistaxis. Accord- ing to his experience there are affections of the nose which stubbornly resist all treatment until the concomitant (and causal) genital disease is removed. ehara. <>f the person. In any event, it is certainly confirma- tory of tne relations existing between the olfactory and sexual MOMS: — D., a medical student, was seated on a bench in a public park, rending a book (on pathology). Suddenly a violent erection dis- turbed 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 im- pression made upon him. 3 34 PSYCHOPATHIA SEXUALIS. Other interesting observations and elucidations about the consensus narium et gcnitalium may be found in a book by Fliess recently published r "Die Beziehungen zwisoiim N&se und weiblichen Geschlechtsorganen," Vienna (Deut- icke), 1897. — Cerviset, contribut. a 1'etude du tisses erec- tile des fosses nasales. These de Lyon 1887. Joal, rcvuc mensuelle de laryngologie 1888 Fevr. — Peyer, Miinch. med. Wochenschr, 1889. 4; — Eudriss, Dissertat, Wurz- burg 1892. The sexual sphere of the cerebral cortex may be ex- cited, 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 excite the erec- tion-centre by means of centripetal influence (stimulus resulting from distension of the seminal vesicles ; enlarged Graafian follicles ; any sensory stimulus, however produced, about the genitals; hyperaemia and turgescence of the genitals, especially of the erectile tissue of the corpus cavernosum of the penis and clitoris, as a result of lux- urious, 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).1 This fact is important for the proper 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 mas- turbation. This should be remembered by those who have, the care of children. On account of the dangers to which this form of pun- ishment 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 Mfeibowutw, " De flagiorum usu in re medica," London, 1765: Boileau, "The History of the Flagellants," London, 1783; Doppct, " Aphrodisiaque externe," Paris, 1788; Cooper, " Der Flagellantismus u. d. Flagellanten; Hunscn, Stock u. Peitache in xix. Jahrhundert (Dohrn, Dresden), 2 vola. 1MIY8IOLOGICAL FACTS. ,V» by the sects of flagellants,1 so widespread in the thirteenth and fifteenth centuries. They were accustomed to whip themselves, partly as an atonement and partly to mortify the flesh (in accordance with the principle of chastity pro- mulgated by the Church — i. e., the emancipation of the soul from sensuality). These sects were at first favoured by the Church ; but, since sensuality was only the more excited by flagellation, and this fact became apparent in unpleasant occurrences, the Church was finally compelled to oppose it The fol- lowing facts from the lives of the two heroines of flagella- tion, Maria Magdalena of Pazzi and Elizabeth of Genton, clearly show the significance of flagellation as a sexual ex- citant. The former, the daughter of distinguished parents, was a Carmelite nun in Florence (about 1580), and, by her flagellations, and still more through the results obtained by them, she became quite celebrated, and is mentioned in the "Annals". It was her greatest delight to have her hands bound by the prioress behind her back, and her naked loins whipped 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 ("Ent- ziickungen"). 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 con- tinned. 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 <>f whipping she actually passed into a state of bacchanalian madness. As a rule, she raved when, excited by unusual lCorvin, Hist. Denkmale des ohrist lichen Fanatismus, II., L?ip- tig, 1847; Fofrittmann, Die chriatlicheo Geiaalergoaellachaften, Halle, 1828. 36 PSYCIIOPATIIIA SEXUALI8. flagellation, she believed herself united with her "ideal". This condition was so exquisitely pleasant to her that sho would frequently cry out, "O love, O eternal love, O love, 0 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; reprint, Stuttgart, 1847) :— "There are some nations, viz., the Persians and Rus- sians, where the women regard blows as a peculiar sign of love and favour. Strangely enough, the Russian women are never more pleased and delimited iliaii when they re- ceive hard Mows from their husbands, as John Barclarus relates in a remarkable narrative. A German, named Jordan, went to Russia, and, pleased with the country, 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.' When Jordan adopted the custom his wife began to love him dearly. Similar stories are told by Peter Pcireus, of Erlesund, who adds that husbands, immediately after the wedding, among other indispensable household articles, provide themselves with a whip." On page 73 of this remarkable book, the author says further: "The celebrated Count of Mirandula, John Picus, relates of one of his intimate acquaintances that he was PHYSIOLOGICAL FACTS. 37 an insatiable fellow, but so lazy and incapable of love that he was practically impotent until he had been roughly I handled. The more he tried to satisfy his desire, the heavier the blows he needed, and he could not attain his •'•, unless he had boon whipped till the blood came. For this purpose ho 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. Not being a bad man in other respects he understood and hated his weak- ness." Coelius Rhodigin relates a similar story, as does also the celebrated jurist, Andreas Tiraquell. In the time of the skilful physician, Otten Brunfelsen, there lived in Munich, then the capital of the Bavarian electorate, a de- bauchee who could never perform his (sexual) duties with- out a severe preparatory beating. Thomas Barthelin knew a Venetian, who had to be beaten and driven before he could have intercourse, just as reluctant Cupid was driven by his followers with sprays of hyacinths. & few years ago there was in Liibeck a cheesemonger, living on Mill Street, who, on a complaint to the authorities of unfaith- fulness, was ordered to leave the city. The prostitute with whom he had been, went to the judges and begged on 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 dis- grace, 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 authori- ties, however, he was not only removed from his position, but also severely punished. A reliable friend, a physician in an important city of the kingdom, related to me how a woman of bad character had told a companion, who had been in the hospital a short time before, that she, with 38 PSYCHOPATIIIA SEXUALI8. another woman of like character, had been sent to tho woods by a man who followed them there, cut rods for them, and then exposed his naked buttocks, commanded them to belabour him well. They obeyed, and it is easy to conjecture what he then did with them. Not only men have thus been excited and inflamed to lasciviousness, but (also women, that they too might experience greater in- tensity of pleasure.1 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: Nee prodest agili palinas prtebere Luperco." y In men, as well as in women, erection and orgasm, or leven ejaculation, may be induced by irritation of various other regions of the skin and mucous membrane. These "hyperaesthetic" 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 "Typographical :Anatomy," 1865, Bd. i., p. 552, Hyrtl cites Val. Hildenbrandt, who observed a peculiar anomaly of the sexual instinct in a girl, which he called suctusstupratio. She had her mammae sucked by her lover, and after a while, by constantly pull- ing her nipples, she was enabled 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, No. 21), in an in- teresting article on "Sensuality and Love of Kin," points mt how zealously the nursing mother gives herself to the cursing of the babe, "for love of the weak, undeveloped, helpless being". 'It is a common proceeding for biased and impotents to have themselves whipped. A few years ago mucli noise was made about one such amateur who died whilst being whipped by several women in a house of prostitution at Moscow. (Ibankoic. Archives d' An- tnropol. criminelle. xiv. p. 697). PHYSIOLOGICAL FACTS. 'I'.) It is easy to assume tliat, l.y the side of the ethical motives, tin- fact tliut the sucking may be attend. -d by feelings of physical i»li-asurr phtys a part The remark of I'.ninn. although correct in it>elf, Lut one-sided, that, ac- cording to HouZ' iierienee, among the majority of animals the relations between mother ami offspring are close only during the time of nursim:. ami thereafter in- different, also speaks in favour of this assumption. Bastion found the same thing (blunting of the feeling for the offspring after weaning) among savages. Under pathological conditions, as is shown by Cham- bard, among others, in his thesis for the doctorate, other portions of the body (in hysterical persons) about the mammae and genitals may attain the significance of "hy- peraesthetic" zones. In man, physiologically, the only "hyperaesthetic" zone is the glans penis and perhaps the skin of the external genitals. Under pathological conditions the anus may become a "hyperaesthetic" area. Thus anal automasturbation, which seems to be only too frequent, and passive pederasty would be explained. (Cf. Gamier, "Anomalies sexuelles,*' Paris, p. 514; A. Moll, "Contrare Sexualempfindung," 3rd ed., p. 369; Frigerio, "Archivio di Psichiatria," 1893; Cristiani, "Archivio delle Psicopatie sessuali," p. 182, "au- topederastia in un alienato, affetto da follia periodica".) 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 ac- centuates the feeling of pleasure, by appropriate concep- tions and activity of the imagination ; and the pleasurable sensations are increased to lustful feeling by excitation of the erection centre and the consequent hypersemia of the 40 PSYCHOPATHIA SEXUALIS. genitals (entrance of liquor prostaticus into the urethra, etc.). If circumstances favour the satisfactory performance of the sexual act, the ever-increasing desire is gratified ; if, however, conditions are unfavourable, inhibition occurs, checks the central erectile power, and prevents the sexual act. To civilised man the ready presence of ideas which inhibit sexual desire is of distinct import. 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 impulses and the accompanying organic sen- sations; on the other, upon the power of the inhibitory ideas. Constitution, and especially organic influences, have a marked effect upon the instinctive impulses ; educa- tion and cultivation of self-control counteract the opposing influences. The exciting and inhibitory powers are variable quanti- •ties. For instance, over-indulgence in alcohol is very fatal in this respect, since it awakens and increases libido sexu- alis, while at the same time it weakens moral resistance. THE ACT OF COHABITATION/ The essential condition for the man is sufficient erec- tion. Anjel ("Arch, fur Psych., viii., H. 2) calls atten- tion to the fact that in sexual excitement not alone the erec- tion centre is influenced but the nervous excitement is dis- tributed over 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 eye- balls, dilation of the pupils, cardiac palpitation (resulting from paralysis of the vasomotor nerves of the heart, which arise from the cervical sympathetic, and the resulting dila- tion of the cardiac arteries, and the increased stimulation of the cardiac ganglia induced by the consequent hype- *Cf. Roubavd, " TraiW do Pimpuissance et de la eWrilittf," Paria 1878. Till 41 r:i mia of the canliae walls). The sexual act is accom- panied by a pleasurable feeling, which, in the male, is evoked by the passage of semen through the ductus ejacur II to tho urethra, in consequence of the sensory stimula- tion of the genitals. This pleasurable sensation occurs earlier in the male than in the female, grows rapidly in iisity up to the moment of commencing ejaculation, reaches its acme in the instant of free emission, and disap- pears 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 (geni to-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 semen from the vesicula* semi' nales into the pars membranacea urethras, a reflex effect of stimulation of the glans penis. As soon as the collec- tion of semen, with ever-increasing pleasurable sensation, has reached a sufficient amount to be effectual as a stimu- lus of the ejaculation-centre, this 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). 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 comfort- able feeling of lassitude. III. ANTHROPOLOGICAL FACTS.1 EVERY individual whose sexual development has been in accordance with the normal process, represents physical and metaphysical attributes which, as experience shows, are typical of the sex to which the individual belongs. These sexual characteristics are either primary (sexual glands and organs of propagation) or secondary. The latter are bodily and psychical and are developed only during the period of puberty. Now and then cases of precocious as well as retarded sexual development are reported. As a rule they may be found to be due to abnormal evolutionary conditions in them, chiefly in individuals with a heavy neu- rotic taint. The secondary sexual characteristics differentiate the two sexes ; they present the specific male and female types. The higher the anthropological development of the race, the stronger these contrasts between man and woman, and vice versa. Important somatic secondary sexual characteristics are, the skull, skeleton, pelvis (particularly), facial types, hair, larynx (voice), mammae, thighs, etc. Important psychical characteristics are sexual con- sciousness (i.e., the knowledge of a special sexual indi- viduality as man or woman) and a congruous sexual in- stinct, from both of which a long series of special features and individual peculiarities are evolved, such as psychical dispositions, inclinations, etc. This differentiation of the sexes and the development of sexual types is evidently the result of an infinite suc- 'Bardach, Die Physiologic als Erfahrungswissenschaft, 1826-40; Ploss, Das Weib, 1891, 3d edition; A. Moll, Die contrare Sexualem- pfindung, 3d ed. p. 3; Idem, Untersuchungen fiber die Libido sexualis, 1897-98. (42) ANTHROPOLOGICAL FACTS. 43 cession of intermediary stages of evolution. The primary stage undoubtedly was bi-sexuality, such as still exists in the lowest classes of animal life and also during the first months of foetal existence in man. The type of the present stage of evolution is mono-sexuality, that is to say, a gruous development of the secondary bodily ami psychical sexual characteristics belonging to the respective sexual glands. Observation teaches that the pure type of the man or the woman is often enough missed by nature, that is to say that certain secondary male characteristics are found in woman and vice versa, to wit, men with an inclination for female occupations (embroidery, toilet, etc.), and women with a decided predilection for manly sports (without the inlluencing elements of early education). In both in- stances particular cleverness in the inverted and pro- nounced awkwardness in the originally proper occupation will be noticed. In this class belong castrates, women with a bass voice (abnormal development of the larynx), a narrow pelvis, a beard, undevelopment of the mammae, etc. Of special scientific interest are the cases of GyncB- comasty, i.e., the development of mammae in the male in- dividual, with concomitant inhibited development of the testicles during the period of puberty. Galen described and named this anomaly. Laurent's monograph1 on this sub- ject is worthy of mention. As a rule the gynccomast is slender in build, has a smooth face and stunted testicles, Is devoid of the secondary sexual characteristics of the man, has but little sexual de- sire for the opposite sex, is in short a sort of a man- woman of moral and metaphysical inferiority. It is a remarkable fact that Gynecomasty only occurs in neurotically degenerated families, and must be looked upon as the manifestation of an anatomical and functional ; i oration. 'Laurent, lea bisexual, Paris. 1894; Idem, de l'here\litfi dec gyn&omaates. Annales d. 'hygiene, publ. 1990. 44 PSTCHOPATHIA 8EXUALIS. Castration never produces Gynecomasiy , in which the glandular tissue but rarely develops, whilst the nipple bo- comes erogenous and capable of erection as in woman. Lac- tation has but seldom been observed. With involution even the mammae disappear. The true Gynecomast betrays signs of effemination — the voice is soft and has a high pitch, the hair on the mons veneris is that of a woman, the skin is soft, the pelvis wide, potency though weak is yet heterosexual and libido is wanting. It cannot be denied that in these cases through the interruption of evolutionary processes the sexual characteristics of the man have been replaced by those of the woman and that by this substitu- tion the development also of other physical and psychical sexual characteristics has been influenced in the sense of inversion. The possible combinations, of course, vary greatly. An interesting and important question now arises, viz. : "What determines the development of an individual of that definite sexual type which possesses all the character- istics of a man, or a woman ?" One is tempted to look upon the development of the genital glands as the determining factor which may be recognized even in the apparently bisexual foetus. For the primary sexual characteristics in the form of the sexual organs are present and may be with puberty developed into the secondary sexual characteristics. That the sexual glands are important so far as the sex itself is concerned is hardly open to controversy, but they are not necessarily the determining factor. For we shall see later on that the secondary characteristics (sexual sen- sations, attraction by the physical and psychical properties of the opposite sex, and the instinct to have sexual inter- course with persons of the opposite sex) may be inverted even at the very beginning of sexual development. Again the experience of gynecologists allows of the fol- lowing deductions: Hegar (Nothnagel's Pathologic, xx. Part L, p. 371) points out: (1) that despite of congenital defects and rudimentary ANTHROPOLOGICAL FACTS. 45 development of the ovaries the feminine type may be thor- oughly preserved ; (2) that the female sexual characteristics are relatively independent of the ovaries as is proved by transverse lit rmaphroditism. The old axiom "Propter solum ovari- uin raulier est quod est," therefore falls. The sex-determining moment tun is unknown. ( The form of the sexual glands is therefore not the quali- fying element of sex-determination, but we must look rather to sexual sensations and the sexual instinct. All this directs our attention to the central domains of that nervous plexus which dominates the sexual functions and which renders intermediary sexual gradations between the pure type of man and woman possible, oripheral factors might largely depend on whether the elimination of the sexual glands took place before or after the development of pu- berty ; and again due regard must be given to the fact that the rise of psychical sexual characteristics may have con- siderably preceded physical development. Facts seem to prove that with the loss of the genital glands previous to puberty the development of somatic and psychical sexual characteristics is stunted even unto Asexuality. This is true as to the male and female of the human kind as well as of domestic animals. Matters are different if the injury occurs after this bio- 46 PBYCIIOPATHIA 8EXUALIS. logical phase. Here we are bound to find physical as well as psychical characteristics already existing, but their further development becomes stunted. The manner in which these organs succumb (through illness or surgical interference) is of no import, neither is the sex itself. The only condition needed is that the development of the sec- ondary sexual characteristics had already begun as this is plainly dependent upon central spheres. How far then sexual development will go, depends chiefly upon the con- dition and the developing powers of these central factors; whilst its direction is governed by the biological energy of these bisexually predisposed centres. If the development ran hitherto in heterosexual chan- nels, but was lacking in force, the sex experiences simply a check ; but if the original bisexual predisposition had not yet received a definite sexual direction, and possessed strength, sexual characteristics of the opposite sex and under circumstances even of an inverted nature may un- fold. In most cases there is but a partial development of the characteristics of the opposite sex. Analogous experiences are made in cases in which the sexual glands were lost long after matured puberty. For instance, bearded women are frequently found in the post mortem, minus ovaries (Diet, de med. et de chirurg. prat, art. "ovario"). In a similar manner pheasant hens are found with degenerated ovaries, but with the plumage and voice of the male.1 (Discuss, de la societe zoologique de Londres). It is a well-known fact that many women grow a beard after the climacterium and that the voice drops to a lower register. If the climax be reached very early and vitality remains very strong even another (opposite) sex may be developed. See page 247 and cases 128 and 129. A smart difference may also be found in eunuchs, ac- cording to whether castration took place before or after lCf. Moll, Libido sexualis, p. 335-350, where he gives a large number of cases of perverted sexual characteristics, of a physical as well as psychical nature, even of sexual inversion. ANTIIBOP01 FACT8. 47 hical pulM-rty. In tin- 1; • tlie vita scxualis is Ity no menus a Malik ]>:iLr«- f->r M-xnal fVrling, and sexual in-tinct for the opposite sex are present, although physical and psychical sexual characteristics of the male are stunted and femininism may take its place. In rare cases — apparently in strongly developed bi- sexuality — signs of inverted sexuality may appear (Bedor's case in Cadiz of a eunuch with developed mammae). These facts are not in favour of the exclusive effects exercised by the sexual glands upon the development of the vita sexualis, especially of the psychical sexual character- istics, which no doubt belong to those central spheres which normally come into functional force with arriving puberty a^pd thus determine the essential criterion of the sex (sex- ual instinct). IV. GENERAL PATHOLOGY.1 (NEUROLOGICAL AND PSYCHOLOGICAL.) ANOMALIES of the sexual functions are met with especially in civilised 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 chiefly the signs of an inherited diseased condition of the central nervous system ("functional signs of degeneration"). 'Literature: Parent-Duchatelet, " Prostitution dans la ville de Paris," 1837. Rosenbautn, " Entstehung der Syphilis," Halle, 1839 — also, " Die Lustseuche im Alterthuin," Halle, 1839. Descuret, " La medecine des Passions," Paris, 1800. Caspar, " Klin. Novellen," 1860. Bastion, " Der Mensch in der Geschichte ". Friedlander, " Sit- tengeschichte Roms ". Wiedemeister, " Casarenwahnsinn ". Scherr, " Deutsche Kultur und Sittengeschichte," Bd. i., cap. ix. Jeannel, " Die Prostitution," dcutsch von Miillcr, Erlangen, 1809. ; v. Krafft, " Neue Forschungen auf dcm Gebiete der Psychopathia sexualis," 2 Aufl., Stuttgart, 1891. Taxil, " La Prostitution conteraporaine," Paris, 1884. Frank Lydston, " Philadelph. Med. and Surg. Reports, 1889. Urquhardt, Journal of Mental Science, Jan. 1891. Antonini, " Archiv. di Psichiatria," xxi., 1, 2. Cantat ano, Zcitschr. " La Psi- chiatria," v., 2, 3. Krauss, " Psychologic des Verbrechens," 1884. Kiernan, "Medic. Standard," Nov., 1889. Delcourt, " Le Vice ft Paris," 1889. Lombroso, " L'uomo Delinquente," 2 Aufl., 1878. Toul- mouche, " Annal. d'hygiene," 1868. Giraldds et Horteloup, ibidem, 1876, p. 419. Eulenburg, " Klin. Handb. d. Harn- und Sexualorgane," 1894, 4 Abthl., p. 36. Moll, " Untersuchungen tiber die Libido sex- ualis," 1897; "Archivio delle psicopatie scssuali," Naples (1896) volume unico. Tardicu, " Des attentats aux mceurs," 7 e"dit., 1878. Emminghaus, " Psychopatliol.," pp. 98, 225, 230, 232. Schiile, "Hand- buch der Geisteskrankheiten," p. 114. Marc, "Die Geisteskrankheiten," ii., p. 128. v. Krafft, " Lehrb. d. Psychiatric, 6 Aufl. i., p. 77; " Lehrb. d. ger. Psychopathol.," 3 Aufl., p. 279 ; " Archiv f. Psychi- atric," vii., 2. Morcau, " Des aberrations du sens genesique," Paris, 1880. Kirn, " Allg. Zeitschr. f. Psychiatric," 39, Heft 2 u. 3. Lom- broso, " Geschlechtstrieb und Verbrechen in ihren gcgenseitigen Bozie- hungen". (Goltdammer's "Archiv." Bd. 30). Tamotcsky, "Die krank- haften Erscheinungcn des Geschlechtsainnes," Berlin, 1886. Ball, " La (48) SPINAL NEUROSES. 40 Since the general ivo organs stand in Important func- tional relation to the entire nervous system, and especially to its psychical and somatic functions, the frequency of general neuroses and psychoses arising in sexual (func- tional or organic) disturbances, is easy to understand. SCHEDULE OF THE SEXUAL NEUROSES. I. PERIPHERAL. 1. Sensory. (a) Anaesthesia; (6) Hyperaesthesia ; (c) Neuralgia. 2. Secretory. (a) Aspermia; (6) Polyspennia. 3. Motor. (a) Pollutions (spasm) ; (6) Spermatorrhoea (paralysis) II. SPINAL NEUROSES. 1. Affections of the Erection Centre. (a) Irritation (priapism) arises from reflex action of peripheral sensory irritants (e.g., gonorrhoea) ; directly, from organic irritation of the nerve-tracts leading 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, t. e.t abnormal dura- folie trotique," Paris, 1888. Rtrieux, " Recherches cliniques sur le* anomalies de 1'instinct sexuel," Paris, 1888. Hammond, " Sexual Impotence," 1889. v. Krafft, " Qber sexuale Penrersionen." Leyden'i deutache Klinik, l!»01, vi. v. 8chrenk-\otzing, Die Suggestionathera- I i- 1S92; also, Zeitach. fUr Hypnotism us, vii., H. 1 & 2, viii., H. 1. ( I.iti-ntnr.) Moll, die contrftre Sexualempfindung, 3 Aufl. 1889; also. Intorsurhunt.'.-n ab. d. Libido sexualis, 1897-98. Hirachfeld, Jahrb. f. sexucllc Xwi^-licnstufon, Jahrg. i.-iv. Block, Beitrfige z. Aetiologie >lor Paychopathia sexualis, ii., Tlieil, 1903. Among mof his genitals revealed nothing abnormal vd phimosis. Further cases see V. Krafil, "Arbeiten," iv., p. 178, 179. Hammond ("Sexual Impotence"), even with his wide experience, reports only the following three cases of anaes- thesia sexualis : — Case 6. Mr. W., aged thirty-three; strong, healthy, with normal genitals. He had never experienced libido, and had vainly sought to awaken his defective sexual in* stinct by means of obscene stories and intercourse with prostitutes. On the occasion of such attempts he experi- enced 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 erec- tion. W. had never masturbated, and had had pollutions about once every two months from his seventeenth year. Important interests demanded that he should marry. He had no horror femince, 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 7. X., aged twenty-seven, genitals normal; never felt libido. Mechanical or thermic stimuli easily in- duced erection, but libido sexualis was regularly replaced by 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 e"it us. If, with an erection, he made an attempt at enitus, it disappeared at once. Death in coma during an attack of cerebral hypersemia. 64 PBYCIIOPATHIA 8EXUALJS. Case 8. Mrs. O., normally developed, healthy, men- struated regularly; aged thirty-five; fifteen years marri' <1. 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 experi- ence pleasure in it, but she never had a wish for repetition of cohabitation. In connection with such genuine cases of anaesthesia,1 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 (cf. the tran- sitional case 7). According to Magnan's ingenious classi- fication— 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 mastur- bation before it attains development. These represent the transitional cases from the congenital to the acquired (psychical) anaesthesia sexualis. This danger threatens many masturbators of vitiated constitution. It is psycho- logically 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 fur Psychiatric," vii., are given here as illustrations worthy of consideration: — "No doubt Swift's, the great satirist, was a case of anaesthesia sexualis. Adolf Stern says in his biography of Swift (" Aus dem 18. Jahrhundert; Biographische Bilder und Skizzen," Leipzig, 1874) : " It seems that he was totally devoid of the sensual elements of love ; hia candid cynicism, found in many of his letters, is almost definite proof of this. Whoever properly grasps certain passages in ' Gulli- ver's Travels,' and especially the account which Swift gives of the marriage and progeny of the Houyhnhorses, the noble steeds of the last chapters, can scarcely doubt that this great satirist abhorred marriage, and never felt the impulse which draws the sexes together.'' Practically speaking, the enigmatical side of Swift's character, and several of his works, viz., "Diary to Stella" and "Gulliver's Travels." can only be understood if Swift is considered sexually anaesthetic. CEKEB&AL NEUROSES ANESTHESIA SKXUAJJ8. 65 Case 9. F. J., aged nineteen, student; mother waa nervous, sister epileptic. At the age of four, acute braiu affection, lasting two weeks. As a child he was not affectionate, and was cold towards 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 con- tinual vacillation between religious enthusiasm and ma- terialism — 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 op- posite 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 poi- sons, he attempted suicide with fifty-seven grains of opium, but he was saved and sent to an asylum. Patient was destitute of moral and social feelings. Hia writings disclosed incredible frivolity and vulgarity. His knowledge was of a wide range, but his logic peculiarly distorted. There was no trace of emotionality. He treated everything (even the sublime) with incomparable cynicism and irony. He pleaded for the justification of suicide with false philosophical premises and conclusions, and, as one would speak of the most indifferent affair, he declared that he intended to accomplish it. He regretted that his pen- knife had been taken from him. If he had it, he would open his veins as Seneca did — in the bath. At one time a friend had given him instead of a poison as he sup- posed, a cathartic. Instead of sending him to the other world, it sent him to the water-closet Only the Great Operator could eradicate his foolish and fatal idea with the scythe of death, etc. The patient had a large, rhombic, distorted skull, the 5 66 PSYCHOPATHIA SEXUALI8. left half of the forehead being flatter than the right. The occiput was very straight. Ears far back, widely project- ing, and the external meatus formed a narrow slit. Genitals very lax ; testicles unusually soft and small. Now and then the patient suffered with ononiatomania. He was compelled to think of the most useless problems and give himself up to interminable, distressing and worry- ing thoughts, and became so fatigued that he was no longer capable of any rational thinking. 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 system of Christianity because Christ had been subject to grand delusions and had deceived the world with miracles ( !). After remaining at home some years the sudden occurrence of a maniacal outbreak brought him back to the asylum. He presented a mixture of primordial delirium of persecution (devil, antichrist, persecution, poisoning, persecuting 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 10. E., aged thirty, 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 it off 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, especi "y of those that were pregnant, they being responsible for the misery of the world. He also hated children, and CEREBRAL NEUROSES ANAESTHESIA 8EXUALIS. 67 cursed his father. Ho entertained communistic ideas, and berated the rich aiid the ministry and God, who had allowed him to come into the world so poor, lie declared that it would be better to castrate all children than to allow others to come into the world fated only to endure poverty and misery. He had always had the in- tention, from his fifteenth year, of castrating himself, in order that he might have no part in increasing unhappiness and adding to the number of men. lie hated the female sex because it was a means of procreation. Only twice in his life had he allowed women to practise 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 gratification of it When nature did not help him, he occasionally helped himself by means of masturbation. He was a powerful, muscular man. The formation of the genitals presented no abnormality. On the scrotum and penis were numerous scars, the results of his attempts at self-emasculation, which, he asserted, were not carried out on account of pain. Genu valgum of right leg. No evidence of onanism could be discovered. He was moody, defiant, irritable. Social feelings were absolutely foreign to him. With the exception of imperfect sleep and fre- quent headaches, there were no functional disturbances. From cases of this kind, depending on cerebral causes, there must be distinguished others in which the absence of function arises from an absence of malformation of the generative organs, as in certain hermaphrodites, idiots and cretins. Ultzmann's1 observations show that anaesthesia sexualis is not caused simply by axpcrmia. He shows that even in congenital aspermia the vita sexualis and sexual power may be entirely satisfying; an additional proof that de- '" Ueber mannliche Sterilitlt," Wiener med. Presse, 1878, Nr. 1. '• Ueber Potentia generandi et coSundi," Wiener Klinik, 1885, Heft 1, S. 5. 68 PSYCIIOPATHIA SEXUALIS. fective libido db origine is to be sought for iii cerebral con- ditions. The naturae frigidae of Zacchias are examples of a milder form of anaesthesia. They are met with more fre- quently in women than in men. The characteristic signs of this anomaly are : slight inclination to sexual intercourse, or pronounced disinclination to coitus without sexual equiva- lent, 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 com- plaints from husbands about this. In such cases the wivoa have always proved to be neuropathic ab origine. Some were at the same time hysterical. 2. Acquired Anasthesia. 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 de- pendent upon individual factors. Education and manner of life have a great influence upon the intensity of the vita sexualis. Intense mental activity (hard study), phy- sical exertion, emotional depression, and sexual continence decidedly diminish sexual inclination. Continence at first induces increase, but sooner or later, according to con- stitutional 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 aetivitv of the generative glands and the degree of libido. That this relation is not determined is shown by the cases of sensual women, who, after the climacterinm, 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. CEKEHRAL NEUROSES HTPK&S8THE8IA. 69 On the other hand, however, experience teaches that libido is essentially conditioned by the functions of the generative glands, and that the facts mentioned are ex- ceptional manifestations. As peripheral causes of diminu- tion 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 and abuse of cocaine. 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 remem- bered, 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 or- ganically induced by cortical disease (dementia paralytica in its advanced stages) ; functionally, by hysteria (cen- tral anaesthesia?) and emotional insanity (melancholia, hypochondria). C. Hyperatsthesia (Abnormally Increased Sexual Desire). One of the most important anomalies of sexual life is an abnormal presence of sexual sensations and presenta- tions from which necessarily arise frequent and violent impulses for sexual gratification. No doubt it is the out- come of the education, or rather the breeding of many centuries that the sexual instinct which is indispensable for the preservation of the race and therefore congenital in every normal individual, is not the predominant key in the chord of human sentiments, but rather forms epi- sodes in the physical and psychical life of cultured man with periods of ebb and flood tide; is the generating ele- ment of higher and nobler social and moral sentiments, and leaves room for other spheres of activity, the object of which is the furtherance of interests affecting the indi- vidual as well as society at large. 70 PSYCHOPATHIA SEXUALIS. It is, moreover, a statute of the moral code and of the common law that civilised man satisfy his sexual in- stinct only within the barriers (established in the interests of the community) of modesty and morality, and that man should, under all circumstances, control this instinct so soon as it comes in conflict with the altruistic demands of society. If the normally constituted civilised individual were unable to comply with this rule, family and state would cease to exist as the foundations of a moral, lawful com- munity. Practically speaking the sexual instinct never develops in the normal, sane individual that has not been deprived by intoxication (alcohol, etc.) of his reason or good senses, to such an extent that it permeates all this thoughts and feelings, allowing of no other aims in life, tumultuously, and in rut-like fashion demanding gratification without granting the possibility of moral and righteous counter-pre- sentations, and resolving itself into an impulsive, insatiable succession of sexual enjoyments. For the latter would at once betray a pathological con- dition, which episodically might produce such a high degree of sexual affection, that self-consciousness becomes clouded, sanity impaired, and a true psychical calamity established which would lead to an irresistible impulse to commit sexual acts of violence. Such psycho-sexual extravagances have been but little probed scientifically, though they are of great importance for the criminal forum since the individual so affected can scarcely be held mentally responsible. It is fortunate for society and for the criminal doctor, who is called upon to make the diagnosis, that these cases, in which irresistible hypersensuality leads to the gravest and indisputably path- ological sexual aberrations, are only encountered in that category of human beings whom we class among the de- generates infected with hereditary taint. Alas, their number is by no means small in modern so- ciety, which shows many marks of physical and psychical CEREBRAL NEUROSES H YPER.E8THKBIA. 7l • degeneration, especially in the centres of culture and re- finement. Coupled with perversions of sexual life and sexual im- becility springing from the same degenerated soil, often with the aiding influence of alcohol, the most monstrous and horrible sexual excesses (cf. Sadism) are perpetrated which would disgrace humanity at large, could they be committed by normal man. The commission of these atrocious acts by degenerated and partially defective individuals is the outcome of an ir- resistible impulse or delirium. The mechanism of these actions is indeed the property of psychical degeneration. The special act follows the direction given by the her- editary or acquired impulse and in many instances is de- termined by the relative potency or impotence of the agent. This pathological sexuality is a dreadful scourge for ita victim, for he is in constant danger of violating the laws of the state and of morality, of losing his honor, his freedom and even his life. Alcohol and prolonged sexual abstinence are apt to produce in such degenerated persons at any time powerful sexual affections. Besides these graver manifestations of pathological sex- uality we find also milder and more numerous gradations of hypersexuality, to the lowest of which, perhaps, belong those individuals who, impecunious though they be whilst sexually potent, move in the better classes of society and have no other aim in life than to gratify their sexual de- sires. These are not afflicted with a pathological sexual condition, know to control themselves in a measure, observe the acknowledged rules of decency, do not compromise themselves, but allow no opportunity to pass by without utilizing it to the utmost. Another grade are the apron-} hunters, the Don Juans, whose whole existence is an end- less chain of sensual enjoyment and whose blunted moral I sense does not keep them from seduction, adultery and even incest. Case 11. P., Caretaker, age 53; married; no evi- 72 PSTCHOPATHIA SEXUALIS. dence of hereditary taint; no epileptic antecedents; mod- erate drinker ; no sign of senium precox ; appeared, accord- ing to the statement of his wife during the whole time of their married life covering a period of 28 years, hypersex- ual, extremely libidinous, ever potent, in fact insatiable in his marital relations. During coitus he became quite bestial and wild, trembled all over with excitement and panted heavily. This nauseated the wife who by nature was rather frigid and rendered the discharge of her conjugal duty a heavy burden. He worried her with his jealous behaviour, but he himself soon after the marriage seduced his wife's sister, an innocent girl, and had a child by her. In 1873 he took mother and child to his home. He now had two women, but gave preference to the sister-in-law, which the wife tolerated as a lesser evil. As years went by his libido increased, though his potency decreased. He often resorted to masturbation even immediately after coitus, and with- out in the least minding the presence of the women. Since 1892 he committed immoral acts with a girl of 16 years, who was his ward, i.e., puellam coagere solebat, ut eum masturbaret. He even tried to force her at the point of a revolver to have coitus with him. The same attempts he made on his own illegitimate child, so that both often had to be protected from him. At the clinic he was quiet and well-behaved. His excuse was hypersexuality. He ac- knowledged the wrongfulness of his actions, but said ho could not help himself. The frigidity of the wife had forced him to commit adultery. There was no disturbance of his mental faculties, but the ethical elements were ut- terly wanting. He had several epileptic fits but no signs of degeneration. We must concede that the degree of libido sexualis is subject to rise and fall in the untainted individual, accord- ing to age, constitutional conditions, mode of life and the various influences of health and illness of the body, etc. Sexual desire rapidly increases after puberty, until it reaches a marked degree ; it is strongest from the twentieth to the fortieth year, and then slowly decreases. Married CEREBRAL NEUBO8E8 HYPEBJE8THK8IA. life seems to preserve and control the instinct v Sexual in- tercourse with many persons increases the desire. Since woman has less sexual need than man, a pre- dominating sexual desire in her arouses a suspicion of its pathological significance. 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, se- dentary 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 inclina- tion is post-menstrually increased. At this period, in neu- ropathic women, the excitement may reach a pathological degree. The great libido of consumptives is remarkable, even during the very latest stages of the disease. Sexual hyper- testhesia is in my opinion a functional manifestation of de- generation. Whether it may occur as an acquired, acci- dental, episodical condition in the untainted is worthy of scientific research. 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 period sexual excitement occurs, occasioned by pruritus, and also in cases where there is neuropathic taint. Magnan ("An- nales medico-psychol.," 1885, p. 157) reports the case of a lady who was afflicted in the mornings with attacks of frightful erethismus genitalis, and the case of a man aged fifty-five who was tormented at night by unbearable pri- apism. In each case there was a neurosis. The central origin of sexual excitement can often be traced1 in persons having neurotic taint or hysteria and in 'In individuals in whom intense sexual hyperwstheaia is asso- ciated with acquired irritable weakness of the sexual apparatus, it happens that simply at the sight of a pleasing female figure, without peripheral irritation of the genitals, the psycho-sexual centre may excite into action not only the mechanism of the erection, but alM 74 PSYCIIOPATHIA SEXUALIS. conditions of psychical exaltation. When the cortex and the psycho-sexual centre are in a condition of hypenesthesui (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 conceptions. Magnan (op. cit.) reports the case of a young woman who hud an increasing sexual desire from puberty, and satisfied it by masturbation. Gradually she grew to l>e- come 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 fur Psychiatrie," vii., 2). The two following cases show how powerful, dangerous and painful sexual hypencsthesia may become in those af- flicted with this anomaly : — Case 12. Hypercesthesia sexualis. Masturbatio coram discipulis in schola. Z., 36 years of age, father of seven children, president that of ejaculation. 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 a railway carriage or a drtiwincr-room. Hammond (op. cit., p. 40) describee several cases of this kind that came to him for treatment or subse- quent impotence, and he mentions that these individuals used the tc-rm " 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. CEREBRAL NEUROSES H YPKR.E8THE8IA. 75 of school, confessed that he committed masturbation in school whilst sitting at his desk which, however, pn -venn •«! the act being seen hy tin- pupils as it was encased all arouii(i. Ho drank more than usual on the preceding ini:, had been provoked to an^i-r before going to school, and had ln-en excited by the sight of some very pretty girls attending his lecture. This produced a violent erection and led to masturbation. At'u r the act he became conscious at once of his compromising position, but the thought that the pupils had not noticed his excitement had helped him to regain self-possession. 1 1 is previous conduct being without a blemish, the au- thorities suspected a pathological condition and insisted upon a medical examination by the author. The facts elicited were the following: Z. came from healthy parents. Two close relations were epiletics. At the age of 13 Z. suffered from a severe concussion of tlio brain, which produced an acute dementia lasting three weeks. Since that time frequent spells of irritability and intolerance of alcohol. At the age of 16 awakening of vita sexualis with ab- normal vigor and pronounced sexual emotions. Lascivious literature and pictures of women produced satisfying ejacu- lation. From the age of 18 onward he indulged now and then in coitus. But as a rule the touching of a woman's arm sufficed to produce orgasm and ejaculation. He mar- ried at the age of 24 and indulged in coitus three or four times daily, and besides practised masturbation, coupled with ideal coitus. (See footnote on page 73). With the birth of his fourth child (three years ago) Z. was forced, for economical reasons, to restrain himself from sexual intercourse as he despised anticonceptional means. Tactus feminarum, which produced pollutio diurna, proved unsatisfactory as did also automasturbation. He suffered much from incessant sexual excitement, which at the end of periods of six weeks became so strong that it affected his mind and will power sensibly. Only masturbation 76 PSYCHOPATHIA 8EXITALI8. kept him from committing sexual violence on women. Ho became very irritable and easily flew into passion, yelled and raged about the house and even beat wife and children. It often happened now that at the height of such a spell he would fall over and become unconscious, rattling from the throat in a peculiar manner. After a few minutes he would recover again with complete amnesia of what had happened. An attack of this kind had, however, not pre- ceded the act with which he now stood charged, but had occurred three days afterward. Z. was an intelligent, decent man, most penitent and filled with shame. He understood quite well that he could no longer teach at a girl's school and bewailed his unnatural, unbridled sensuality. He made no attempt to in any way excuse his action, but pointed out that his nervous system had been thor- oughly shaken of late by libido insatiata and overwork (les- sons up to twelve hours daily). Vegetative functions normal ; parietal protuberance of cranium ; genitals large, lax, but normal. Patellar reflexes much exaggerated. In my report I pointed out that Z. suffered from a pathologically exaggerated vita sexualis and most probably from epilepsy, and had committed the act whilst subject to a sexual affection which depressed the power of self-con- trol to a minimum. Further legal proceedings were withdrawn. Z. was pensioned off. Case 13. On llth July, 1884, R., aged thirty-three, 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 in- dulgences. Later, dbusus coitus in matrimonio cum uxore. CEBEBRAL NEUROSES - HYPEILK8THE8IA. 77 Now and then even perverse impulse to commit and t<> administer cantharides to his wife, because her do did not equal his own. His wife died after a short period of married life. Patient's circumstances became straitened, and he had no means to indulge himself sexu- ally. Then masturbation again ; employment of lingua canis to induce ejaculation. At times, priapism and con- ditions approaching satyriasis. He was then driven to masturbate in order to avoid rape. With gradually pre- dominating sexual neurasthenia and hypochondria came beneficial diminution of libido nimia. A particular species of hypercesthesia sexualis may be found in females in whom a most impulsive desire for sexu- al intercourse with certain men imperatively demands gratification. No doubt "unrequited love" for another man may often affect the married woman who does not either psychically or physically (impotentia mariti) experience connubial satisfaction; but the normal, untainted wife guided by ethical reasons knows how to conquer herself. Of course, pathological conditions change the situation. Fetichism must here be considered. Sexual impulse is overpowering, at times periodically recurrent. The very attempt to overcome it produces most painful attacks of worry and anxiety. This pathological want becomes so powerful that all considerations of shame, conventionality and womanly honour simply disappear, and it reveals itself in the most shameless manner even to the husband, whilst the normal woman, endowed with full moral consciousness, knows how to conceal the terrible secret Magnan ("Psychiatr. Vorlesungen") quotes two strik- ing instances from his own experience. One is specially instructive. A young woman, mother of three children, with a blameless past, but daughter of a lunatic, tells her husband one day openly that she is in love with a certain young man and that she would kill herself if her intimate relations with him were interfered with. She begs per- mission to live with him for six months in order to quench 78 PSTCHOPATHIA SEXUALIS. the fire of her passion, when she would return to her family again. Husband and children have no place in her heart with her present love. The husband took her to a foreign country and placed her there under medical treat- ment. This pathological love of married women for other men is a phenomenon in the domain of psychopathia sexualis which sadly stands in need of scientific explanation. The author has had the opportunity of observing five cases be- longing to this category. The pathological conditions were paroxysmal, in one case repeatedly recurrent; but always sharply distinct from the unaffected, healthy period, during which deep sorrow and contrition over the occurrence were manifested. But it was the sorrow over an unavoidable fatality caused by psychically abnormal conditions. Whilst the pathological conditions lasted, absolute in- difference, even hatred, prevailed towards husband and children, and an utter want of understanding the bearings and consequences of the scandalous behaviour, jeopardising the honour and dignity of wife and family, were noticeable. It .is remarkable that in all these cases the husband and relatives had come to the conclusion that the condition was caused by psychopathia, even before they had obtained ex- pert opinion. As against the "non-psycliopathical" but otherwise ab- normally libidinous Messalinas, it is well worthy of note that this sexual aberration is only an episode in the life of the otherwise honourable woman, and that the illicit inter- course was of a strictly monogamic character. This, and particularly the circumstance that the unfortunate woman was not omnium virorum mulier, but only the mistress of one man, establishes a distinct difference from nympho- mania. In three of the cases mentioned above, the grossly sensual momentum was missing, the real motive for marital infidelity was to be found in a fetich-like charm, in mental superior qualities, — in one case the voice of the charmer. In two cases unmistakable proofs of hypercssthesia sexualis and of absolute impotence towards the husband CKRXBRAL NEUROSES PAR.E8TIIEHIA OF FEELING. 79 were found, whilst the merest touch of the other man pro- duced orgasm, and the sexual act the acme of pleasure. Of course, in these latter cases absolute sexual abandonment followed. D. Par&sthesia of Sexual Feeling (Perversion of the Sex- ual Instinct). In this condition there is perverse emotional colouring of the sexual ideas. Ideas physiologically and psycho- logically 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 op- posing ideas with corresponding feelings of disgust ; or the influence of such opposing conceptions may be rendered impossible on account of the absence or loss of all ideas of morality, aesthetics and law. This loss, however, is only too frequently found where the spring well of ethical ideas and feeling* (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 corre- spond with the purpose of nature — i.e., propagation — must be regarded as perverse. The perverse sexual acts resulting from parsesthesia are of the greatest importance clinically, socially, and forensically ; and, therefore, they must here receive careful consideration; all aesthetic and moral dis- gust must be overcome. Perversion of the sexual instinct, as will be seen farther on, is not to be confounded with perversity in the sexual act; since the latter may be induced by conditions other than psycho-pathological. The concrete perverse act, mon- strous as it may be, is clinically ndt decisive. In order to differentiate between disease (perversion) and vice (per- versity), one must investigate the whole personality of the 80 PSYCHOPATHIA SEXUALIS. individual and the original motive leading to the perverse act Therein will be found the key to the diagnosis (v. in- fra}. Partsesthesia may occur in combination with hyperaes- thesia. This association seems to be frequent clinically. Sexual acts are then confidently to be expected. The per- verse direction of sexual activity may be toward sexual satisfaction with the opposite or the same sex. Thus two great groups of perversions of sexual life may be distin- guished. I. Sexual Inclination Toward Persons of the Opposite Sex, with Perverse Activity of the Instinct 1. Sadism.1 Association of Active Cruelty and Violence with Lust. Sadism, especially in its, rudimentary manifestations, seems to be of common occurrence in the domain of sexual perversion. Sadism is the experience of sexual pleasurable sensations (including orgasm) produced by acts of cruelty, bodily punishment afflicted on one's own person or when witnessed in others, be they animals or human beings. It may also consist of an innate desire to humiliate, hurt, wound or even destroy others in order thereby to create sexual pleasure in one's self. Thus it will happen that one of the consorts in sexual heat will strike, bite2 or pinch the other, that kissing de- generates into biting. Lovers and young married couples are fond of teasing each other, they wrestle together "just 'So named from the notorious Marquis de Bade, whose obscene novels treat of lust and cruelty. In French literature the expression " Sadism " has been applied to this perversion. Eulenburg (" Klin. Handb. der Harn und Sexual -organe ") uses the term "active algo- lagnia " in connection with these phenomena. 'Moll, Contr. Sexualempfindung, 3d ed., p. 160; Krafft-Ebing " Arbeit en" iv., p. 106; Idem, Leydcn's German clinic, vi. Sect. 2, p. 137; Eulenburg, Qrenzfragen des Nerven-und Seelenlebent, uci. p. 1. SEXUAL I NCI I N \ ' THE OPPOSITE BEX. 81 for fun," imlulirr in all sorts of horseplay. The transition from these atavistic manifestations, which no doubt be- long to the sphere of physiological sexuality, to the most monstrous acts of destruction of the consort's life can be readily traced. Where the husband forces the wife by menaces and other violent means to the conjugal act, we can no longer describe such as a normal physiological manifestation, but ; must ascribe it to sadistic impulses. It seems probable that this sadistic force is developed by the natural shyness and modesty of woman towards the aggressive manners of the male, especially during the earlier periods of married life and particularly where the husband is hypersexual. Woman no doubt derives pleasure from her innate coyness and the final victory of man affords her intense and refined gratification. Hence the frequent recurrence of these little love comedies. A further development of these sadistic traces may bo found in men who demand the sexual act in unusual places, for this seems to offer an opportunity to him to show his superiority over woman, to provoke her defense and delight in her subsequent confusion and abashment Case 14. One of my patients, hereditarily tainted, a crank, married to an extremely handsome woman of very vivacious temperament, became impotent when he saw her beautiful, pure white skin and her elegant toilet, but was quite potent with any ordinary wench, no matter how dirty (Fetichism). But it would happen that during a lonely walk with her in the country he would suddenly force her to have coitus in a meadow, or behind a shrub. The stronger she refused the more excited he became with per- fect potency. The same would happen in places where there was a risk of being discovered in the act, for instance, in the railway train, in the lavatory of a restaurant. But at home in his own bed he was quite devoid of cupido. In the civilized man of to-day, in so far as he is un- tainted, associations between lust and cruelty are found, ft 82 PSYC1IOPATHIA SKXUALIS. but in a weak and rather rudimentary degree. If such therefore occur and in fact even light atrocious manifesta- tions thereof, they must be attributed to distorted disposi- tions (sexual and motoric spheres). They are due to an awakening of latent psychical dispo- sitions, occasioned by external circumstances which in no wise affect the normal individual. They are not accidental deviations of sentiment or instinct in the sense as given by the modern doctrine of association. Sadistic may often be traced back to early childhood and exist ing a period of life when their revival can by no manner of means be attributed to external impressions, much less to sexual temper. , Sadism must, therefore, like Masochism and the anti- pathic sexual instinct, be counted among the originary anomalies of the vita sexualis. It is a disturbance (a de- viation) in the evolution of psvchosexual processes sprout- ing from the soil of psychical degeneration. That lust and cruelty often occur together is a fact that has long been recognised and is frequently observed. Wri- ters of all kinds have called attention to this phenomenon.1 Blumroder ("Ueber Irresein," Leipzig, 1836, p. 51) saw a man who had several wounds in the pectoral muscle, which a woman, in great sexual excitement, had bitten at the acme of lustful feeling during coitus. The same authoi* ("Ueber Lust und Schmerz," Friedreich's "Magazin fiir Seelenkunde, 1830, ii., 5) calls especial attention to the psychological connection between lust and murder. In re- lation to This, he especially refers to the Indian myths of Siva and Durga (Death and Lust) ; to human sacrifice with voluptuous 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, 1 Cf. also Alfred de Musset's famous verses to the Andalusian girl : — " Qu'elle est superbe en son de"sordre — quand elle tombe les seins nus — Qu'on la voit, bfente, ec tordre — dans un baiser de r&fr» et mordre — En hurlant dea mots inconnus!" SEXUAL INCLINATION T"WAKI> TUB OPPOSITE SEX. 83 1874) also cites numerous . .samples <»f tin- occurrence of a • munler with ^ivatlv increased lust. Hall quotes in hi* "( 'Unique St. Anne" the case of a powerful epileptic who during coitus bit off pieces of his consort's nose and swallowed them. Ferrlnni ( Archiv. delle p.-icopatie sessuali I. 1896, p. 100) speaks of a young man who used to wrestle with his famorata before coitus, bit and pinched her during the t "because he felt otherwise no gratification." One day, however, he hurt the girl too much and she brought an ac- tion against him. On the other hand, when homicidal mania has been ex- ^cited, lust often follows. Lombroso (op.' dt.) alludes to the fact mentioned by Mantegazza, that to the terrors of spoliation and plunder by bandits generally are added those of brutal lust and rape.1 These examples form transitions to the pronounced pathological cases. The examples of the degenerate Ca^ars (Nero, Tiberi- us) 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 Grilles de Rays (Jacob, "Curiosites de 1'histoire de France," Paris, 1858), who was executed in 1440, on account of mutilation and murder, which he had practised for eight years on more than 800 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 joined 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 chil- the excitement of battle the idea of lust forces its way into consciousness. Cf. the description of a battle, by a soldier, by (irillfiarzer: — " And as the signal rang out, the armies met, breast to breast — lu«t of the gods — here, there, the murderous steel slays enemy, <;ivni and taken — death and lift — with wavering change- wildly raging in frenzy" ("Dream a Life," ^ct ».). 84 PSYCHOPATHIA 8EXUALJ8. dren were burned, and only a number of heads of partic- ularly beautiful children were preserved — as memorials. Cf. Eulenburg, op. cit. p. 58, where he gives satisfac- tory proofs of Rays' insanity ; also, in "Die Zukunft, vii., Jahrg. No. 26; — Bossard et Maulle, Gilles de Rays, dit Barbe-Bleu, Paris, 1886 (Champion) ; Michelet, hj^- toire de France, Tome vi., p. 316-326; Bibliotheque de Criminologie, t. xix., Paris, 1899, p. 245. In an attempt to explain the association of lust 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 due to anger. It must further be remembered that love and anger are not only the most intense emotions, but also the only two forms of robust (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 standpoint it is clear how lust impels to acts that otherwise are expressive of anger.1 The one, like the other, is a state of exaltation, an intense excitation of the entire psycho-motor sphere. Thus there arises an im- pulse to react on the object that induces the stimulus, in every possible way, and with the greatest intensity. Juat as maniacal exaltation easily passes to raging destructive- ness, so exaltation of the sexual emotion often induces an impulse to spend itself in senseless and apparently harm- ful acts. To a certain extent these are psychical accom- paniments; but it is not simply an unconscious excitation of innervation of muscles (which also sometimes occurs as blind violence) ; it is a true hyperbole, a desire to exert *8chulz ("Wiener Med. Wochenschrift," No. 49, 1869) reports a remarkable case of a man, aged twenty-eight, who could perform coitus with his wife only after working himself into an artificial fit of anger. •JUCUAL INCLINATION TOWARD THE OPPOSITE SEX. 85 the utmost possible effect upon the individual giving rise to the stimulus. The most intense means, however, is the in- fliction of pain. Through such cases of infliction of pain during the most intense emotion of lust, we approach the cases in which a jeml injury, wound, or death is inflicted on the victim.1 In eases the impulse to cruelty which may accompany the emotion of lust, becomes unbounded in a psychopathic in- Dividual; and, at the same time, owing to defect of moral feeling, all nonnal inhibitory ideas are absent or weak- ened. 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 inter- course of the sexes, the active or aggressive role belongs to man ; woman remains passive, defensive.* It affords man great pleasure to win a woman, to conquer her; and in tho or* amandi, the modesty of woman, who keeps herself on the defensive until the moment of surrender, is an element of great psychological significance and importance. Under normal conditions man meets obstacles which it is his part to overcome, and for which nature has given him an ag- gressive character. This aggressive character, however, under pathological conditions may likewise be excessively developed, and express itself in an impulse to subdue abso- lutely the object of desire, even to destroy or kill it.* 'Concerning analogous acts in rutting animals, vide Lombroso, •The Criminal." '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. •The conquest of woman takes place to-day in the social form of courting, in seduction and deception, etc. From the history of civili sation 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 rendered a woman powerless, were made use ot to obtain loves desire. It is possible that tendencies to such out- breaks of sadism are atavistic In the " JahrbUcher itir Psychologic,'' ii., p. 128, 8cMf«r (Jena) refers to the reports of two ca»e» by A. Payer. In the first 86 PSYCHOPATHIA SKXl'ALIS. 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 out- breaks of sadism occur. Sadism is thus nothing else than an excessive and mon- strous pathological intensification of phenomena, — possible, too, in normal conditions in rudimental forms, — which ac- company 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 in- stinct. What he feels is, as a rule, only the impulse to cruel arid violent treatment of the opposite sex, and the colouring of the idea of such acts with lustful feelings. Thus arises a powerful impulse to commit the imagined deeds. In as far as the actual motives of this instinct are not compre- hended by the individual, the sadistic acts have the char- acter 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 versa; cruel ideas and acts of cruelty cause sexual excitement, and in this way are used by perverse individuals.1 states of great sexual excitement were induced by the sight of bat- tles or of paintings of them; in the second, by cruel torturing of small animals. 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 exist- ing between this side of the masculine character and male sexuality. 1 believe, too, that by unprejudiced observation I can show that, in men who are mentally and physically absolutely normal, the first indefinite and incomprehensible precursors of sexual excitement may be induced by the reading of exciting scenes of the chase and war — t. e., they give rise to unconscious longings for a kind of satisfaction in warlike games (wrestling), in which the fundamental sexual im- pulse to the most perfect and intense contact with a companion is expressed, with the secondary thought of conquest more or less clearly defined." * It sometimes happens that an accidental sight of blood, etc., puts into motion the preformed psychical mechanism of the sadistic individual and awakens the instinct, SEXUAL. IN'CLINA , -1TK 8KZ. 87 A differentiation of original and acquired cases of sad- ism is scarcely possible. Many individuals, tainted ab origine, for a long time do everything to conquer the per- verse instinct If they are potent, they are able for some time to lead a normal vita scxualis, often with the assist- ance of fanciful ideas of a perverse nature. Later, when the opposing motives of an ethical and aesthetic kind have been gradually overcome, and when oft-repeated experience has proved the natural act to give but incomplete satisfac- tion, the abnormal instinct suddenly bursts forth. Owing to this late expression, in acts, of an originally perverse dis- position, the appearances are those of an acquired perver- sion. As a rule, it may be safely assumed that this psycho- pathic state exists ab origine. Sadistic acts vary in monstrousness according to the power exercised by the perverse instinct over the individual thus afflicted, and in accordance with the strength of op- posing ideas that may be present, which nearly always are more or less weakened by original ethical defects, heredi- tary degeneracy, or moral insanity. Thus there arises a long series of forms which begins with capital crime and ends with paltry acts affording merely symbolic satisfaction to the perverse desires of the sadistic individual. Sadistic acts may be further differentiated according to their nature; either taking place after consummated coitus which leaves the libido nimia unsatisfied; or, with diminished virility, being undertaken to merely stimulate the diminished power; or, finally, where virility is abso- lutely wanting, as becoming simply an equivalent for im- possible coitus, and for the induction of ejaculation. In the last two cases, notwithstanding impotence, there is still intense libido; or there was, at least, intense libido in the individual at the time when the sadistic acts became a habit. Sexual hypenesthesia must always be regarded as the basis of sadistic inclinations. The impotence which oc- curs BO frequently in psychopathic and neuropathic indi- viduals here considered, resulting from excesses practised in early youth, is usually dependent upon spinal SS P8YCHOPATHIA 8EXUALIB. Often, too, there is a kind of psychical impotence, super- induced by concentration of thought on the perverse act with simultaneous fading of theidea of normal satisfaction. No matter what the external form of the act may be, the mentally perverse predisposition and instinct of the indi- vidual are essential to an understanding of it. (a) Lust-Murder1 (Lust Potentiated as Cruelty, Murder- ous Lust Extending to Anthropophagy}. The most horrible example, and one which most point- edly shows the connection between lust and a desire to kill, is the case of Andreas Bichel, which Feuerbach published in his "Aktenmassige Darstellung merkwiirdiger Ver- brechen". B. puellas stupratas necavit et dissecuit. With reference to one of his victims, at his examination he expressed him- self 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 beef, and hacked it with an axe into pieces of a size to fit the hole which I had dug 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 strangling prostitutes, post actum, and said : "I am fond of women, but it is sport for me to strangle them after having enjoyed them". A certain Grassi (Lombroso, op. dt., p. 12) was one night seized with sexual desire for a relative. Irritated by her remonstrance, he stabbed her several times in the ab- C/. " Metzger't ger. Arzneiw., herausgegeben von Remer," p 539; " Klein's Annalen," x., p. 176; xviii., p. 311; Heinroth, " Syatem der psych. Med.," p. 270; Never Pitaval, 1855, 23 Th. ("Fall Blaize Ferragc"). SEXUAL INCLINATION TOWARD TIIK OPPOSITE BEX. 89 n with a knife, and also murdered her father and imrl<- who attempted to hold him hack. Immediately there- after lie hastened to visit a prostitute in order to cool in her embrace his sexual passion. But this was not sufficient, for he then murdered his own father and slaughtered sev- eral oxen in the stable. 1 1 cannot be doubted, after the foregoing, that a great number of so-called lust murders depend upon combined hypewesthesia and partrsthcsia sexualis. As a result of this perverse colouring of the feelings, further acts of bestiality with the corpse 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'hygiene publique"), who was examined by Lasegue, Brouardel and Motet, declared to be mentally sound, and executed. Case 15. A four-year-old girl was missing from her parents' home, 15th April, 1880. On 16th April, Menes- clou, 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-charred condition, were taken from the stove. Other parts of the body were found in the water- closet The genitals could not be found. M., when asked their whereabouts, became embarrassed. The circum- stances, as well as an obscene poem found on his person, left no doubt that he had violated the child and then mur- dered her. M. expressed no remorse, asserting that his deed was an unhappy accident. His intelligence was limited. He presented no anatomical signs of degeneration; some- what deaf and scrofulous. Age twenty. Convulsions at the age of nine months. Later he suf- fered from disturbed sleep (enuresis nocturna) ; was nerv- ous, and developed tardily and imperfectly. With puberty he became irritable, showed evil inclinations, was lazy, in- tractable, and in all trades proved to be of no use. He grew 90 PSYCHOPATHIA SEXUALIS. no better even in the House of Correction. He was made a marine, but there, too, he proved useless. When he re- turned 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 a drunkard. 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 con- volutions. Case 16. Alton, a clerk in England, went for a walk out of town. He lured a child into a thicket. After- wards at his office he made this entry in his note-book: "Killed to-day a young girl; it was fine and hot." Tho 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 oc- casionally subject to fits of depression with tcedium vitce. His father had had an attack of acute mania. A near rela- tive suffered from mania with homicidal impulses. A. was executed. Case 17. Jack the Kipper. — On December 1, 1887, July 7, August 8, September 30, one day in the month of October and on the 9th of November, 1888 ; on the 1st of June, the 17th of July and the 10th of September, 1889, the bodies of women were found in various lonely quarters of London ripped open and mutilated in a peculiar fashion. The murderer has never been found. It is probable that he first cut the throats of his victims, then ripped open the abdomen and groped among the intestines. In some in- stances he cut off the genitals and carried them away; in others he only tore them to pieces and left them behind. He does not seem to have had sexual intercourse with his SEXUAL INCLINATION TOWAED THE OPPOSITE SEX. 91 victims, but vary likely the murderous act and subsequent mutilation of the corpse were equivalents for the sexual act. (McDonald, le criminal type, 2 edit., Lyon, 1884 ; — Spitzka, The Journal of Mental and Nervous Diseases, 1§88, December; — Kierman, The Medical Standard, 1888, Nov. and Dec.) Case 18. Vacher, the Ripper. — On the 31st August, 1895, Portalier, seventeen years old, a shepherd, was found naked in the field. The belly was ripped open and the body bore other wounds besides. Examination showed that the victim had been strangled first. On the 4th August, 1897, a tramp, named Vacher, was arrested on suspicion of having committed this crime. lie confessed to it as well as to numerous other acts of a similar nature that had been perpetrated in various parts of France since 1894. He claimed that at the time when he committed the crimes he suffered from temporary insanity and irresistible impulse, in fact, was a madman. Medical examination, however, proved that Vacher was mentis compos when he committed these atrocious deeds, fled after their commis- sion and had a very clear memory of the facts. V. was born in 18G9 of honourable parents and be- longed to a mentally sound family. He never had a severe illness, was from his earliest infancy vicious, lazy and shy of work. When twenty he had immorally assaulted a small child. During his military service he had gained for him- self a very bad reputation and was in 1893 discharged from his regiment on account of "psychical disturbances" (con- fused talk, persecution-mania, threatening language, ex- treme irritability). In 1893 he wounded a girl because she refused to marry him, then made an attempt at suicide (he shot himself through the right ear, which left him deaf on that side and produced facial paralysis). He was sent to an insane asylum and there treated for persecution- mania. On April 1, 1894, he was dismissed as cured. He began to tramp about the country and committed the fol- lowing horrible crimes: On March 20, 1894, he strangled 92 PSYCHOPATHIA SEXUALIS. Delhomme, twenty-one years old, cut her throat, trampled upon her abdomen, tore out a portion of her right breast and then had coitus with the corpse. The same atrocity, but without ravaging the bodies, he committed on Novem- ber 20, 1894, on a girl of the name of Marcel, 13 years of age, and on May 12, 1895, on another girl named Mortureux, 17 years of age. On August 24, 1895, he strangled and then ravaged a lady of the name of Morand, 58 years old, and on the 22d he cut the throat of Allaise, a sixteen year old girl and attempted to rip her abdomen open. On September 29, he committed the same crime — as later on on Portalier — on Palet, a fifteen-year-old boy, but in this instance he also cut off the genitals of the boy and sexually assaulted the corpse. On the 1st of March, 1896, he attempted rape on Deronet, a girl eleven years old, but was scared off by the field police. On the 10th of September, he committed his usual atrocity on a Mrs. Mounier, just married, nine- teen years of age, and on the 1st of October, on Rodier, a shepherdess, fourteen years of age. He cut out her genitals and carried them away. Toward the end of May, 1897, he killed a tramp boy, fourteen years old, named Beaupied, by cutting his throat. The corpse he threw down into a well. On June 18th he murdered a shepherd boy, thirteen years old, named Laurent, and committed pederasty on the corpse. Soon afterward he made an attempt on a Mrs. Plantier, but she was rescued. Unfortunately they allowed him to go unpunished. Lacassagne, Professor of Forensic Medicine in Lyon, Pierrel, Professor of Psychiatry, and Rebatel, specialist on insanity, were the experts in this atrocious murder trial. They found no hereditary taints, no cerebral dis- ease, nor traces of epilepsy. V. was not particularly bright, very irascible from his earliest years, vicious and fond of maltreating animals. No one retained him long in service. He entered a monastery, but was soon dismissed as he began to masturbate his comrades. He could not find em- ployment on account of immorality and ill temper. He SEXUAL INCLINATION TOWABD THE OPPOSITE SEX. 93 was not a drinker. In the army he was feared and shunned. One day when he was disappointed by not be- ing made a corporal, he flew into a passion, attacked his superior and became delirious. He was taken to the in- firmary and thence sent to the insane asylum. His com- rades did not consider him normal. During his spells of rage he was uncontrollable and considered dangerous. He always threatened others with cutting their throats, and was thought capable of doing such an act. He slept badly, constantly dreamed of murder, and often was delirious dur- ing the night, so that no one cared for sleeping near him. At the asylum he was found to suffer from persecution- mania and was considered a dangerous character. Never- theless he was dismissed as cured. Subsequently he became guilty of eleven murdeve, which are acts of sadism, lust murders. They consisted of strangling, cutting of the throat and ripping open of the abdomen, mutilation of the corpse, especially the genitals, eventually gratification of the sexual lust on the corpse. It was definitely proved that V. acted in cold blood, was quite conscious of his actions and suffered from no psychical abnormality. He committed the crimes in various sections of France, traversing the country in every direction. There were no marks of anatomical degeneration. His genitals were normally developed. In confinement he was lazy, irascible and quite intractable. Out of sheer stub- bornness and because he thought he had been slighted, he refused on one occasion all food for a period of seven days. On another occasion he flew into a frightful rage when permission to go to church was refused him. He spoke cynically of his crimes, showed no remorse, insisted that they were the outcome of madness and insanity, played the insane, hoping thus to be sent to an insane asy- lum whence escape is easier. The experts could establish no symptoms of mental disturbance. Resume of the experts: — "V. is neither an epileptic nor subject to an impulsive disease. He is an immoral, 94 PSYCHOPATHIA SEXUALIS. passionate man, who once temporarily suffered from a depressing persecution-mania, coupled with an impulse to suicide. Of this he was cured, a'nd thereafter became re- sponsible for his actions. His crimes are those of an antisocial, sadistic, bloodthirsty being, who considers him- self privileged to commit these atrocities because he was once upon a time treated in an asylum for insanity, and thereby escaped well merited punishment. He is a com- mon criminal and there are no ameliorating circumstances to be found in his favour." — V. was sentenced to death. (Archives d' anthropologie criminelle, xiii., No. 78.) In such cases it may even happen that appetite for the flesh of the murdered victim arises, and in consequence of this perverse colouring of the idea, parts of the body may be eaten. Case 19. Leger, vine-dresser, aged twenty-four. From youth moody, silent, shy of people. He started out in search of a situation. Wandering about eight days in the forest he there caught a girl twelve years old? violated her, mutilated her genitals, tore out her heart, ate of it, drank the blood, and buried 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 (Georgei, "Darstellung der Prozesse Leger, Feldtmann" etc., Darmstadt, 1827). Case 20. Tirsch, hospital beneficiary of Prag, aged fifty-five, always silent, peculiar, coarse, very irritable, grumbling, revengeful, was sentenced to twenty years' imprisonment for violating a girl ten years old. He had attracted attention on account of outbursts of anger from insignificant causes, and also on account of tcedium vitcc. 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 the 8th of July he went about with the SEXUAL 1N< UNA TK'N T THE OPPO-- . 95 intention of killing ono of this hated sex. Vetulam <>• rentem in silvam allcxit, coitum, poposcit, renit<-n(rm pros- travit, jn 108 PSYCHOPATHIA SEXUALIS. Case 26. Z., physician; neuropathic constitution, reacting badly to alcohol. Under ordinary circumstance8 capable of normal coitus, but as soon as he had indulged in wine he found that his increased libido was no longer satisfied by simple coitus. In this condition he was com- pelled to prick the nates puellce, 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 experi- ence complete satiety of his lust. The majority of those afflicted with this form of per- version seem insensible to the normal stimulus of woman. In the first case (25), the assistance of the idea of blood was necessary to obtain erection. The following 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 27. The girl-stabber of Bozen (reported by Demme, "Buch der Verbrechen," Bd. ii., p. 341). In 1829, H., aged thirty, soldier, became the subject of legal investigation. At different times, and in different places, he had wounded girls with pocket-knives or penknives, by stabbing them in the abdomen, preferably in the genitals. He gave as a motive for these acts heightened sexual im- pulse, 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 ex- perienced the same satisfaction as that produced by com- pleted coitus. This was increased by the sight of blood dripping from the knife. In his tenth year the sexual in- stinct became powerfully manifest. At first he yielded 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 BMUAL INCLINATION TOWARD THE OPPOSITE SEX. 109 to practise masturbation on him, and by sodomy. Gradu- ally the thought came to him how pleasurable it would be to stab a young and pretty girl in the genitals, and take delight in the sight of the blood running from the knife. Among his effects were found copies of the object* of phallic cult and obscene pictures painted by himself of Mary's conception, and of the "thought of God injected" into the lap of the Virgin. He was considered a peculiar, very irritable man, shy of people, fond of women, moody and glum. Of shame and regret for his deeds no traces were ever found. He was apparently a person1 who had become impotent through early sexual excesses, and was thus predisposed, by the continuance of intense libido sexualis and heredity, to perversion of sexual life. Case 28. In the "sixties" the inhabitants of Leipzig were frightened by a man who was accustomed to attack young girls on the street, stabbing them in the upper-arm with a dagger. Finally arrested, he was recognised 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. (Wharion, "A Treatise on Mental Unsound- ness," § 623. Philadelphia, 1873.)1 Impotence exists likewise in the next three cases. It may be psychical, however, since the principal tone of the vita sexualis lies in sadistic inclination and the normal ele- ments are distorted : — Case 29. The girl-cutter of Augsburg (reported by lCf. Kraust, " Psychologic des Verbrechens," 1884, p. 188; Dr. Hofer, " Annalen der Staatsarzneikunde," 8 Jahrgang, Heft 2 ; " Schmidt1 't Jahrbucher," Bd. 69, p. 94. 1 According to newspaper reports, in December, 1890, several similar attacks were made in Mainz. A young fellow between four- teen and sixteen years of age pressed against women and girls and stabbed them in the legs with a sharp-pointed instrument. He WM arrested, and seemed to be insane. Further details of the case are not known. 110 PSYCHOPATHIA 8EXUALI8. Demme "Buch der Verbrechen," vii., p. 281). Bartle, wine-merchant. He was subject to lively sexual excite- ment at the age of fourteen, though decidedly opposed to its satisfaction by coitus, his aversion going so far as dis- gust 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, because of lack of opportunity and courage. He disdained masturbation, but now and then had pollutions with erotic dreams of girls who had been cut. At the age of nineteen he for the first time cut a girl. During the act he had a seminal emission and ex- perienced intense pleasure. From that time the impulse grew 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. Up to his thirty-second year he pursued this process of cutting, but was always careful 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 only and not to ejaculation. Then he sought to attain his object by prick- ing the girls with the knife left 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 suffered more pain than when merely cut. In his thirty-seventh year he was detected and arrested. In his lodgings were found a collection of dag- gers, 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 sexual pleasure, with vio- lent excitement. According to his own 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, SEXUAL IN' UK ATION TOWARD THK OPPOSITE SEX. 1 1 I Case 30. During tlii^ month of June, 1896, quite a number of young girls had been stabbed in the genitals in the stnct in broad daylight. On the 2nd of July the per- petrator was caught in the act. V., twenty years of age, was hereditarily heavily tainted ; when fifteen years old he had been sexually excited to a high degree at the sight of a woman's buttocks. From that time on it was this part of the female body which attracted him in a sensuous manner and became the object of his erotic fancies and dreams, ac- companied by pollutions. Soon this was coupled with the lascivious desire to slap, pinch or cut the genitals of women. At the moment when he in his dreams performed this act, pollution took place. Soon he was tempted to transfer his dreams into real practise. For a while he succeeded in mastering his morbid craving, but this produced feelings of anxiety and a copious perspiration would break out from his entire body. When orgasm and erection became very vehement, he would be overcome with fear and confusion to such an extent that the impulse to cut became irresist- ible. At that psychical moment ejaculation would take place, and he felt relieved in body and mind. Magnan in Thoinot's op. cit. p. 451. — For more detailed account see Gamier in Annales d'hygiene publique, 1900, Feb., p. 112.) Case 31. J. IT., aged twenty-six, in 1883 came for consultation concerning severe neurasthenia and hypochon- dria. Patient confessed that he had practised onanism since his fourteenth year, infrequently up to his eighteenth year, but since that time he had been unable to resist the impulse. Up to that time he had no opportunity to ap- proach females, for he had been anxiously cared for and never left alone on account of being an invalid. He had had no real desire for this unknown pleasure, but he acci- dentally learned what it was when one of his mother's maids cut her hand severely on a pane of glass, which she had brokrn while washing windows. While helping to stop the bleeding he could not keep from sucking up the 112 PSYCHOPATHIA SEXUALIS. blood that flowed from the wound, and in this act he ex- perienced extreme erotic excitement, with complete orgasm and ejaculation. From that time on, he sought, in every possible way to see and, where practicable, 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 suc- cess frequently enough, though with some difficulty. In the intervals he practised onanism and manustupration per feminam, which, however, never afforded him com- plete satisfaction, but, on the contrary, caused listlessness and self-reproach. On account of his nervous difficulties he visited many sanatoria, and 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, mono- bromate 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 passion, and spare no pains or money to satisfy his sexual desire in the abnormal manner described. Of special interest for the scientific proof of sadism is a case related by Moll (vide case 29, ninth edition of this work (German) and recently published by Moll himself in his book on "Libido Sexualis," p. 500. 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 de- cidedly timid, and in other respects modest and even ap- prehensive. 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 SEXUAL INCLINATION TOWAKD THE OPPOSITE SKX. 1 I '.I 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 con- tains 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 a 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 ("Viertel- jahrsschr. f. ger. Medicin," N. F. xvii., H. 1), belongs here : — Case 32. A., medical student at Greifswald, accu- satus quod iterum iterumque puellis honestis parentibus naiis in publico genitalia sua ebraj&s dependentia plane nudata quce antea summo amiculo (overcoat) tecta erant, ostenderat. Nonnunquam puellas fugientes secutus casque ad se attractas urina oblivit. HCBC luce clara facia suni; nunquam aliquid hcec faciens loculus est. A. was twenty-three years old, well built, neat in dress, and polite in manners. Indication of cranium progeneum; chronic pneumonia of the apex of the right lung; emphy- sema. Pulse, 60; in excitement not more than 70 to 80. itals normal. Occasional disturbances of digestion, and hardness of the abdomen, vertigo, excessive excitement of sexual desires, early led to onanism. The sexual desire r was directed toward a natural method of satisfac- tion. Occasional attacks of depression, or thoughts of de- precation of self, and of perverse impulses, for which he 8 114 PSYCHOPATHIA 8EXUAOS. 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 was of a nervous temperament, the mother subject to nervous headaches. A brother was subject to epileptic convulsions. From his youth the culprit presented a nervous tem- perament, was inclined to convulsions and attacks of syn- cope, and when severely scolded would fall into a state of momentary stiffness. In 1869 he studied medicine in Ber- lin. In 1870 he went to the war as a hospital assistant. His letters at this time betray peculiar torpidity and soft- ness. On his return home, in 1871, his emotional irrita- bility was noticed at once by those about him. Thereafter frequent complaints of bodily ailments; unpleasantness resulting from a love affair. In November, 1871, he pur- sued his studies diligently in Greifswald. He was con- sidered very gentlemanly. In confinement he was quiet, calm, and sometimes self-absorbed. His acts he attributed to painful sexual excitement, which of late had become excessive. He declared that he had been fully conscious of his perverse acts, and after committing them ; had always 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 — 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 reappearance of sexual instinct, which, under such circumstances, is so often expressed in perverse acts. Thus Tarnowsky reports (p. 76) the follow- ing case : — Case 33. I knew such a patient, who had a woman dressed in a decollete ball-dress lie down on a low sofa in a brightly lighted room. Ipse apud januam alius cubiculi dbscuraii constiiit adspiciendo aliquantulum feminam, ex- citatus in earn insiluit ct excrementa in siniis ejus deposuit. SEXUAL INCLINATION TOWARD THE OPPOSITE SEX. 115 HOBC faciens ejaculationem quondam sc sentire confessua est. An officer of Vienna informed me that men, by means of large sums of money, induce prostitutes to suffer ut illi viri in ora earum spuereni et fasces et urinas in ora exple- rent.1 The following case by Dr. Pascal ("Igiene dell* amore") seems also to belong here: — % Case 34. A man had an inamorata who would allow Iii in to blacken her hands with coal or soot. She then 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 to the clothing of females (e.g., sprinkling them with sulphuric acid, ink, etc.) depend upon a perverse sex- ual impulse; at any rate the mdtive seems to be to inflict an injury, or pain of some sort, and those injured are always females, and the perpetrators males. In crimes of this kind, pains should always be taken to examine into the vita sexualis of the culprits. The case of Bachmann, given below, Case 120, throws a clear light on the sexual nature of such crimes; for, in this case, the sexual motive in the deed is proven. Tatril (" La Corruption," Paris, Noiret, p. 223) makes the same statements. There are also men who demand introductio lingmt mtretricit in onum. 116 PSYCHOPATHIA SEXUALIS. Case 35. B., age twenty-nine, merchant, married, heavily tainted, since his sixteenth year masturbation by means of a pocket electric battery, neurasthenic, impotent at the age of eighteen, for a while absynth drinker on ac- count of unrequited love. One day meeting a nurse-maid wearing a white apron such as his love used to wear, he could not resist the temptation to steal the white apron. He took it home and after masturbating into it burn it with renewed masturbation. Returning to the street he met a woman wearing a white dress. The sight of it produced an impulse to stain the dress with ink. Having done it he went home revelling in the sensual situation thus provoked and again masturbated. At another time strolling about the street he amused himself with cutting the dresses of women with a penknife. He was arrested as a pick-pocket. At other times a stain on a lady's dress caused orgasm and ejaculation in him. He obtained the same results while burning with a cigar a hole into the clothing of women whom he passed. (Magnan, reported by v. Thoinot, at- tentats aux moeurs, p. 434, and by Gamier, annales d' hy- giene publ., 1900, March, p. 237.) Gamier (annales d' hygiene 1900, Feb'y-March) has given these cases of sadism special attention reducing them to fetichism (vide infra}. This is particularly apparent in case 35 in which the fetich consisted in a blue dress cov- ered with a white apron. The personality of the wearer was a matter of indifference, it was the fetich that fas- cinated, the impulse being irresistible. Gamier calls these cases Sadi-Fetichism and points out their social and for- ensic importance, suggesting confinement of such unfor- tunate individuals in an insane asylum. Destructive ac- tions like these towards the fetich which, properly speak- ing, is an object of desire and possession, this sadism on lifeless objects, may be explained by the fact that the fetich awakens sensual sensations coupled in sadistic natures with the pleasure derived from acts of cruelty and destruction. In fetichism, well-developed, the fetich itself — ab- stracted from the personality of the wearer — it dominates SEXUAL INCLINATION TOWARD THE OPPOSITE SEX. 117 per se the whole vita sexualis, brings it into action and may under circumstances awaken kindred regions of a sadistic nature which find gratification in the field of the (imper- sonal) fetich. The sadistic act in itself is often enough an equivalent for coitus rendered impossible by physical and psychical impotence. It may be practised on boys, animals, persons of the same sex, without relation to paedophilia, zoophilia or homosexuality. It is remarkable and seems to prove the connection with lust-cruelty that at the moment of the destroying act against the fetich (cutting off girl's tresses, stabbing women, de- filing ladies' toilets, etc.) orgasm and ejaculation take place in the "sadi-fetichist." A. Moll (Zeitschr. f. Medicinalbeamte) has recently published a case which may be considered classical : — An academically cultured man, age thirty-one years, heavily tainted by heredity, offspring from a marriage be- tween blood-relations, always shy and retired, used to rump about when growing into puberty (17) with the playfel- lows of his sister, girls about eleven years of age, and from the sight of their white underwear became a "laundry fet- ichist." He began to masturbate thinking of girls clad in white garments and manipulating during the act light- coloured pieces of clothing belonging to his female rela- tives. When twenty-three years of age he began coitus with girls dressed in white. At the age of twenty-five he saw a girl's white dress being bespattered with mud. This pro- duced a very strong sexual emotion in him and from that f time on he felt an irresistible impulse to defile the apparel of women, to crush and tear it. This impulse was par- ticularly provoked at the sight of women clad in white. He used liquor ferri sesqui-chlorati or ink and thus produced orgasm and ejaculation. At times he had dreams of white female underwear which were accompanied by pollution at the moment of touching or crushing it. Insanity could not be established. He was mulcted in the sum of 50 marks for unlawfully causing damage to personal property. 118 PSYCHOPATHIA SEXUALIS. (e) Other Kinds of Assault 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 if there is yet sufficient moral resistance, it may happen that the perverse inclina- tion is satisfied by an act that is apparently quite sense- less and silly, but which has nevertheless a symbolic mean- ing for the perpetrator. This seems to be the meaning of the two following cases : — Case 36. (Dr. Pascal, "Igiene dell' amore".) A man was accustomed to go, on a certain day once a month, to an inamorata and cut her "fringe". This gave him the greatest pleasure. He made no other demands on the girl. Case 37. A man in Vienna regularly visited several prostitutes only to lather their faces and then to remove the lather with a razor, as if he were shaving them. He never hurt the girls, but became sexually excited;and ejacu- lated during the procedure.1 . Ideal Sadism. Sadism may eventually manifest itself solely in the im- agination, i.e., in dream pictures which accompany the act of masturbation or accompany the process of pollution in sadistic fancies. That it remains an ideal act only may be due to want of opportunity or courage to put it into practical action or . that latent ethics forbid violence, or it may be that when debility of the centre of ejaculation is pronounced, a vivid sadistic impression suffices to provoke ejaculatory gratifica- tion. In this case sadism is merely an equivalent for coitus. 1 Leo Taxil (op. cit., p. 224) 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. SEXUAL INCLINATION T< >WARD THE OPPOSITE BEX. 119 Case 38. D., agent, age twenty-nine years, family ilv t u i nt cil, masturbation at the age of fourteen, coitus at twenty, but without pronounced libido or satisfaction, hereafter masturbation preferred. At first these acts were accompanied by the thought of a girl whom he could mal- treat and subject to humiliating and infamous actions. Heading of acts of violence on women excited him sex- ually. But he did not like to see blood either on himself or on others. lie hated the sight of a naked woman. He never felt inclined to put his sadistic ideas into ac- tual practice for unnatural sexual intercourse he disliked. He could not account for his sadistic ideas. These statements he made at a consultation for neurasthenia. Case 39. Ideal sadism with "Podex-Fetichisin." 1'.. ni;r twenty-two, of independent means, heavily tainted by heredity, by accident saw the governess chastis- ing his sister (fourteen years of age) ad podicem inter genua. This made a deep impression on him and hence- forth he had a constant desire to see and touch his sister's buttocks. By some clever stratagem he succeeded. When seven years old he became the play-fellow of two small girls, of which one was tiny and lean, the other rather pi ump. He played the role of the father chastising his children. The lean girl he simply spanked over the clothes. The other, however, allowed him to smack her bare bottom (she was then ten years old). This gave him great sexual pleasure and caused erection. One day, after being chastised in this manner the girl asked him to look at her pudenda. But he refused the in- vitation as this view did not interest him in the least. At the age of nine he became acquainted with a boy a little older than himself. One day they came across a pic- ture representing the scene of flagellation in a monk's mon- astery. P. soon persuaded his companion to enact the scene. The latter consented to playing the passive role and found delight in it. This was often repeated. On one occasion P. assumed the passive role but it gave 120 PSYCHOPATHIA SEXUALIS. him no pleasure. This relation between the two con- tinued till they grew up into manhood, and P. always ejac- ulated during the flagellation. He dominated over his friend, who looked upon him as a superior being. Only twice whilst this friendship lasted did P. attempt this pro- cedure on other persons ; once on a nurse-maid whose bare bottom he smacked, and once in the street on a girl, eleven years old, whose cries, however, drove him to hasty flight. He never felt any inclination to masturbation, coitus with girls, nor antipathic sexual sensations. He confined himself to touch the buttocks of women when in a crowd, or of girls whilst mixing with them on the playground, to look under the dresses of women climbing the stairs of an omnibus or watch little girls undressing themselves. He practised "Sadism-Fetichism". His fancy revelled in situations in which he flagellated his younger brother, a nurse-maid or a nun; he invented stories which always ended in a scene of flagellation; answered advertisements such as : "Dame severe demande eleve" and derived the ut- most delight from the correspondence that followed ; made drawings of flagellation scenes, of bare female buttocks, ransacked the libraries for books containing sadistic writ- ings, made abstracts of the whole literature, collected pictures referring to this favourite subject and designed such himself in keeping with the progress he made in developing his perversion. The flights of his fancy rose from the exhibition of the naked buttocks, to smacking, flagellating and even teasing them, even to the murder of the owner. The latter act, however, frightened him. The ever recurring ejaculations finally brought on severe neurasthenia. He never could make up his mind to seek medical advice. At last he found a woman with whom he could have coitus as she permitted him to flagellate her during the act. (Regis, Archives d' anthropologie criminelle, N. 82, July, 1899.) Case 40. Merchant, forty years of age, abnormally SEXUAL INCLINATION TOWARD THE OPPOSITE SEX. 121 early hetero- and hypersexuaiity. From his twentieth year occasionally coitus and faute de mieux masturbation. In consequence of fright (surprise during coitus) psychical impotence. Treatment unsuccessful. This affected his mind and he came near to despair. He now tried imma- ture girls with whom impotence could not put him to shame. His moral will power, still unimpaired, enabled him to resist this impulse, however, and he found satisfac- tion to go with girls legally of age and no longer innocent, but they must in appearance be younger than their years. In such cases his impotence disappeared. One day he saw a lady smiting the face of her daughter, fourteen years old. This produced at once violent erection and orgasm in him. The thought of it had the same result. From that time he found a mighty stimulant in seeing girls, no matter how young, beaten ; even reading or hearing of maltreatment of females had the same result. That the retarded sadism in this case was not acquired but only latent is evident from the fact that it ever existed in an ideal form. It was part of the sensual idea predom- inant in him that he introduced "extremitatem superiorem in vaginam femince usque ad scapulam" and groped about within. [Other cases of ideal sadism see Moll (Libido sex- ualis, pp. 324 and 500) ; Krafft, "Arbeiten," iv. p. 163.] (g) Sadism with Any Other Object — Whipping of Boys. The sadistic acts with females just now described are also practised on other living, sensitive objects, — children and animals. There may be a full consciousness that the impulse is really directed towards women, and that only faute de mieux the nearest attainable objects (pupils) are abused. But the condition of the perpetrator may be such that the impulse to cruel acts enters consciousness accom- panied only by lustful excitement, while its real object (which alone can explain the lustful colouring of such acts) remains latent. The first alternative suffices as an* explanation of the 122 PSYCHOPATIIIA SEXUALIS. cases which Dr. Albert describes (Friedreich's "Blatter f. ger. Med.," p. 77, 1859), — cases "in which lustful teacher* whipped their pupils on the naked buttocks without cause. We must think of the second alternative, the sadistic im- pulse with unconsciousness of its object, when the sight of punishment causes spontaneous sexual excitement in the witness and thus becomes the determining factor in his future vita sexualis, as in the following cases : — Case 41. K., aged twenty-five, 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; later on he became more robust. At the age of eight, while at school, he saw the teacher punish the boys by 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, always calling 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 fright- ened, and tried to overcome his impulse to masturbate ; but he fell into the practice of psychical onanism, which he re- garded 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 pollu- tions, 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 recognised that he was entirely insensible to the charms of the fair sex. The patient was an intelligent man, normally devel- oped, and of aesthetic taste. There was no inclination to SEXUAL INCLINATION TOWARD THE OPPOSITE BEX. 123 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 ex- citants ; and, possibly, hypnotic treatment to ultimately in- duce a return of the vita sexualis to its normal condition. Case 42. Abortive sadism. N., student, came under observation in December, 1890. He had practised mastur- bation from early youth. According to his statements, he became sexually excited when he saw his father whip the children, and, later, when he saw his companions whipped by the teacher. 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 mas- turbate, but he stated with certainty that his sexual in- stinct was first awakened by the punishment of others, and thus he unconsciously came to practise masturbation. 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. lie 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. Up to his fifteenth year his sexual indulgence consisted of masturbation, coupled with such fancies. After that (dancing lessons, association with girls) the early fancies disappeared almost entirely and were accompanied 124: PSYCHOPATHIA 8EXUALIS. 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 was potent, and the act gratified him. He then tried to abstain from masturbation, but was not successful, though he often indulged in coitus, and with more pleasure than he had in masturba- tion. He wished to be freed from masturbation as some- thing vicious. He had coitus once a month, but mastur- bated once or twice every night. He was sexually normal, excepting the masturbation. There was no neurasthenia; genitals normal. Case 43. 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 child- hood of convulsions. The patient was talented, virtuous, and quiet ; but at times he was very disobedient, stubborn, and of violent temper. He had epilepsy, and practised masturbation. One day it was learned that P., with money, induced a comrade of fourteen, B., to allow himself to be pinched in the arms, genitals, and thighs. 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. Gyurlcovechky , "Pathol. und Therapie der mannl. Impotenz.," p. 80, 1889). Case 44. K., fifty years of age, without occupation, heavily tainted, satisfied his perverse sexual feelings ex- clusively on boys of ten to fifteen years of age, whom he seduced to mutual masturbation. At the acme of the sit- uation he would pierce the lobe of the boy's ear. When this, later on, proved ineflicient, he cut off the lobe of a SEXUAL INCLINATION TOWABD THE OPPOSITE SEX. 125 boy's ear. He was arrested and sentenced to five years* imprisonment (Thoinot, op. cit.f p. 452.) That in all these cases of sadistic abuse of boys there can be no thought of a combination of sadism and anti- pathetic sexual instinct, as often occurs (v. infra) in indi- viduals of inverted 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. (h) Sadistic Acts wiih Animals. • In numerous cases, sadistically perverse men, afraid of criminal acts with human beings, or who care only for the sight of the suffering of a sensitive being, make use of the sight of dying animals,1 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 note- worthy in relation to this. According to the evidence of several prostitutes, before the sexual act he was accus- tomed to excite himself by torturing and killing chickens and pigeons and other birds, and, therefore, was called "Hendlherr" (chickenmister). 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 power- fully excited sexually whenever he saw calves slaughtered, and also at the sight of bloody meat. Mantegazza (op. cit. p. 114) relates that among degene- rate Chinese the practice prevails to sodomise geese and at the moment of ejaculation to cut off their heads. 'Dimitri, the son of Ivan the Cruel, derived unspeakable pleas- ure when witnessing the death struggles of sheep, chickens and geese. ( Bibliotheque de Criminologie, xix., p. 278.) 126 PSYCHOPATHIA SEXUALIS. Mantegazza ("Fisiologia del piacere," fifth ed., pp. 394, 395) mentions the case of a man who once saw chick- ens 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 45. C. L., aged forty-two, 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 abnoi- mal 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 missed after the battle of Koniggratz. If, in this case, the capability of normal coitus was much impaired by the predominance of perverse ideas, ill the following it seems to have been entirely repressed: — SEXUAL INCLINATION TOWARD THE OPPOSITE SEX. 127 Case 46. (Dr. Pascal, "Igiene dell' araore ") A gentleman visited prostitutes, had them purchase a living fowl or rabbit, and made them torture the animal. He particularly revelled in the sight of cutting off the heads 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. Interesting is the awakening of sadistic feelings to- ward animals as related in the following case of Fere: — Case 47. B., thirty-seven years of age, tanner, tainted, began masturbation at the age of nine. One day, as he was about to masturbate with another boy at the corner of a street, where the gradient was very steep, a heavily laden dray pulled by four horses came along. The driver yelled at the horses and whipped them. The horses slipped about a good deal and made the sparks fly from the cobble stones. This excited B. very much and he ejaculated as one of the horses fell. Ever afterwards a similar occurrence would have the same effect on him and he went in search of it. If the difficulty was overcome without extra exertion on the part of the horse, or with- out the use of the whip, B. became only excited and he had to resort to masturbation or coitus to find final sat- isfaction. Even after he was married and had children, sadism continued. When one of his children fell ill with chorea, B. had hysterical attacks. (Fere, 1'instinct sexuel, p. 255). The last two sections, g and Ti, 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 to assume sadism 128 PSTCHOPATHIA SEXUALIS. as the motive underlying all the horrors recorded in history or found in certain psychological manifestations among the peoples of the present time. 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 pre- historic conditions, is long afterwards operative; and, in the ideas engendered by civilisation, like that of "the criminal," it finds new objects, so long as 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 horrors and historical enormities may be explained without recourse to sadism (which may often enough have been the motive, but should not be assumed as such, since it is a relatively rare perversion). At the same time, there is still another powerful psychical element to be taken into consideration, which explains the attraction which is still exerted by execu- tions, etc. ; viz., the pleasure which is produced by intense and unusual impressions and rare sights, in contrast to which, in coarse and blunted beings, pity is silent. But undoubtedly there are individuals for whom, in spite 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 follow- ing a dark impulse, occupy themselves with such things, or at least with pictures and notices of them. Still, this is not sadism, so 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. SEXUAL INCLINATION TOWABD TUB OPPOSITE SEX. (t) Sadism in Woman. That sadism — a perversion, though often met with in men — is less frequent in women, may be easily explained. In the first place, sadism, in whirh the need of subju- gation 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 woman than for man. Yet sadism occurs in women, and it can only be explained by the primary constituent ele- ment— the general hyper-excitation of the motor sphere. Only two cases have thus far been scientifically studied. Case 48. 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 widespread legend of the vam- pires, the origin of which may perhaps be referred to such sadistic facts.1 In the second case of feminine sadism, for which P am indebted to Dr. Moll, of Berlin, by the side of the perverse impulse, as so frequently happens, there is anaesthesia in the normal activities of sexual life; and there are also traces of masochism (v. infra). Case 49. Mrs. H., of H., aged twenty-six, came of a family in which nervous or mental diseases are said not to 1 The legend is especially spread throughout the Balkan penin- sula. Among the modern Greeks it has its origin in the myth of the Iamiriehtl. Med., 1893, iv. 2 ( Interessante • von Masochiftten ) . — Bloch, Beitrftge z. Aetiol. d. Psychopi. sexualis, 2 Theil, Dresden. 1903. 132 PSYCHOPATHIA 8EXUAXIS. impotence does not in any way depend upon a horror sexus alterius, but upon the fact that the 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 im- pulse there is still some sensibility 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 per- versions of the sexual instinct, is developed only on the basis of a psychopathic and, for the most part, hereditarily tainted individuality; and as a rule such individuals are given to excesses, particularly masturbation, to which the difficulty of attaining what their fancy creates drives them again and again. I feel justified in calling this sexual anomaly "Maso- chism," because the author Sacher-Masoch frequently made this perversion, which up to his time was quite unknown to the scientific world as such, the substratum of his writ- ings. I followed thereby the scientific formation of the term "Daltonism," from Dalton, the discoverer of colour- blindness. During recent years facts have been advanced which prove that Sacher-Masoch was not only the poet of Maso- chism, but that he himself was afflicted with this anomaly.1 Although these proofs were communicated to me without restriction, I refrain from giving them to the public. I refute the accusation that 'I have coupled the name of a revered author with a perversion of the sexual instinct, which has been made against me by some admirers of the author and by some critics of my book. As a man Sacher-Masoch cannot lose anything in the estimation of his cultured fellow-beings simply because he was afflicted with an anomaly of his sexual feelings. As an author he suffered severe injury so far as the influence and in- trinsic merit of his work is concerned, for so long and 1 Cf. for corroboration Sacher-Magoch, biography by v. Eulenbwg: Grenzfragen des Nerven- und Seelenlebens, 1902, xxix., pp. 46-57. 133 whenever he eliminated his perversion from his literary efforts he was a gift*-! writer, and as such would have achieved real greatness had he been actuated by normally sexual feelings. In this respect he is a remarkable exam- ple of the powerful influence exercised by the vita sexual is — be it in the good or evil sense — <>ver the formation and direction of man's mind. 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 or not, and to what extent, the individual subject to this perversion strives to realise his peculiar fancies; whether or not, he has thus more or less diminished his virility — depends upon the degree of intensity of the perversion in the single case, upon the strength of the opposing ethical and esthetic motives and the relative power of the physical and mental organisation of the affected individual. From the psychopathic point of view, the essential and 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. Whatever has been said with reference to the im- pulsive 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 a gradation of the acts from the most repulsive and monstrous to the silliest, regulated by the degree of intensity of the perverse instinct and the power of the remnants of moral and aesthetic counter- motives. The extreme consequences of masochism, how- ever, are checked by the instinct of self-preservation, and therefore murder and serious injury, which may be com- mitted in sadistic excitement, have here in reality, so far as known, no passive equivalent. But the perverse de- sires of masochistic individuals may in imagination attain these extreme consequences (v. infra, case 50). Moreover, the acts to which masochists resort are in some cases performed in connection with coitus, i.e., as 134 PBYCHOPATHIA SEXUALIS. preparatory measures; in others, as substitutes for coitus when this is impossible. This, too, 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. Case 50. Mr. Z., age twenty-nine, technologist, came for consultation because of fear of tabes. Father nervous, died tabetic. Father's sister insane. Several relatives very nervous and peculiar. On closer examination the patient was found to have sexual, spinal and cerebral asthenia. He presented no symptoms of tabes dorsalis. Questions concerning abuse of the sexual organs brought out a con- fession of masturbation practised since youth. In the course of the examination the following interesting psycho- sexual anomalies were discovered: 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 the one sex or the other. Faute de mieux he practised flagellation on him- self, and, in time, this induced ejaculation. Long before this he had begun to satisfy himself with masturbation, and always during the act revelled in imaginary scenes of whipping. He twice visited brothels to have himself flogged by prostitutes. For this purpose he chose the pret- tiest 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 impor- tant thing. He realised this on the second trial. When he had the "thought of subjection" he was perfectly suc- cessful. In time, by straining his imagination with maso- chistic ideas, he performed coitus without flagellation ; but he found little satisfaction in it, so that he performed MASOCHISM. 135 sexual intercourse in a masochistic way. He found pleas- ure 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 he told stories of such scenes to a pretty girl. 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 did not know how he arrived at this fetichistic idea. Boys' legs with high heels also pleased him; but this charm was purely aesthetic, without any sensual colouring; and he said he had never noticed anything homosexual in himself. The patient referred his fetichism to his partiality for calves (legs). He was charmed by ladies' calves only when elegant shoes were on the feet. Nude legs — feminine nudity in general — did not in the least affect him sexually. A subordinate fetichistic idea for the patient was the human ear. It was a lustful pleasure for him to caress the handsome ears of people. With men this pleasure was slight, but with women it gave him great enjoyment. He also had a weakness for cats. He thought them simply beautiful, and their movements were very attractive to him. The sight of a cat could raise him from a feeling of the deepest depression. Cats seemed to him sacred ; he saw something divine in them! He did not know the reason for this idiosyncrasy. Of late he also frequently had sadistic ideas about punishing boys. In these imaginary flagellations both men and women played a part, but particularly the latter, and then his enjoyment was much more intense. The patient found that, besides what he recognised and felt as masochism, there was something else which he preferred to designate "pageism." While his masochistic fancies and acts were entirely of a coarse, sensual nature, his "pageism" consisted of the 136 PSYCHOPATHIA SEXUALIS. idea of being a page to a beautiful girl. His conception was perfectly chaste, but piquant; his relation to her that of a slave, but absolutely , pure — a mere platonic sub- mission. This revelling in the idea of serving such a "beautiful creature" as a page was coloured by a pleasur- able feeling, but this was in no way sexual. lie experi- enced in it an exquisite feeling of moral satisfaction, in contrast with sensually coloured masochism, and therefore he could but regard it as something of a different nature. At first sight there was nothing remarkable in tho patient's appearance ; but his pelvis was abnormally broad, the ilia were flat, and the pelvis, as a whole, tilted and decidedly feminine. Eyes, neuropathic. He also men- tioned that he often had itching and lustful irritation at the anus, and that there ("erogenous" area) ope digiti, ho could satisfy himself. The patient was 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 designated 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 considera- tion 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 51. Ideal Masochism. Mr. X., technologist, twenty-six years old. Mother of nervous disposition ; suf- fered from neuralgia. In the father's family a case of spinal disease and one of psychosis. A brother suffered from nervousness. Mr. X. had only slight infantile affec- tions ; he learned easily at school, and developed normally. He was of manly appearance, but rather weakly and under medium size. The descent of the right testicle was im- perfect, but could be noticed in the inguinal canal. Penis normally formed, but rather small. At the age of five be felt sexual excitement whilst swinging on the cross-bar with legs crossed, and stretched out at full length, lie repeated the exercise several times, but forgot about the sensation until he grew up to maturer age. He then tried to induce this pleasurable feeling by repeating the exercise, but without success. At the age of seven he took part in a general fight between the pupils of the school which he attended, after which the victors rode on the backs of the vanquished. This impressed X. considerably. He thought the position of the prostrate boys a pleas- ant one, wanted to put himself in their place, imagining how by repeated efforts he could move the boy on his back near his face so that he might inhale the odour of his genitals. These thoughts, coupled with pleasurable feelings, often recurred to him afterwards, although they never occasioned real sensations of lust; in fact, he con- sidered these thoughts sinful and bad, and sought to repulse them. He claimed to have had no knowledge at that time of sexual matters. It is remarkable that the patient up to his twentieth year was periodically troubled with eneuresis nocturna. Up to the time of puberty these masochistic fancies to lie under the thighs of others, boys as well as girls, recurred periodically. Now the objects were chiefly girls, but these exclusively when puberty was completed. Little by little these situations gained a different mean- ing, for soon the culminating point was the consciousness to be absolutely subject to the will and whims of a fully developed girl, coupled with corresponding humiliating acts and attitudes. For instance, X. says : — "I am lying on my back on the floor. The mistress stands over my head with one foot on my breast or she holds my head between her feet so that her genitals are directly in a line with my vision. Or she sits a-straddle "ii my chest or on my face, using my body as a table. If 1 do not obey her commands promptly she locks me up 138 PSYCHOPATHIA 8EXUALIS. in a dark W.C. and leaves the house to find pleasure elsewhere. She introduces me to her friends as her slave and turns me over as such to them as a loan. "She makes me perform the lowest menial work, wait upon her when she arises, in the bath et inter mictionem. At times she uses my face for the latter purpose and makes me drink of the voidance." X. claimed that he never practically put these ideas into effect for fear of not realising the anticipated pleasure. Once only he sneaked into the room of a pretty house- maid ut urinam puellce bibat; but he was too much dis- gusted to carry out the purpose. He stated that he fought in vain against these maso- chistic impulses, considering them of a painful and dis- gusting nature. They were still prevalent. He pointed out particularly that the humiliation connected with these imaginary acts was the principal attraction, and that the pleasure derived from causing pain to others was never associated with them. He preferred as "mistress" a slender maiden of about twenty years of age, with a pretty face, and wearing short light dresses. The ordinary intercourse with young women, dancing, or mixed society, never impressed him. With the period of puberty these masochistic ideas were at times accompanied by pollutions, but only weak emotions of lust. At one time the patient resorted to friction of the glans penis, but he could not induce erection, much less ejaculation, and instead of pleasure he produced disagree- able paralytic feelings. This saved him from masturba- tion. But after the age of twenty he often experienced lustful emotions with ejaculation when performing gym- nastic exercises on the horizontal bar, or when climbing poles or ropes. He never had a desire for sexual inter- course with women or for inverted sexual actions. At the age of twenty-six a friend urged him to coitus, but already on the way to the house "anxiety, restlessness, and decided MASOCHISM. 139 disgust" crept over him. He became so excited, trembled all over, and broke out into a profuse perspiration, that <>uld not command an erection. Repeated attempts -<»d complete failures, but he was able to control his mental and physical excitement a little better than the first time. Libido was never present. Masochistic imaginations gave no assistance, because his mental faculties at such times were "as if paralysed," and he "could not call up those intense imaginary representations which he found necessary for an erection." Thus he gave up all attempts at coitus, partly because libido was absent, and partly on account of his utter want of confidence in success. Only now and then he satisfied his weak sexual desires by the aid of gymnastic exercises. Oc- casionally, however, spontaneous or superinduced maso- chistic fancies (when awake) would cause erection, but never ejaculation. Pollutions occurred at periods of six weeks. The patient was highly intellectual, of refined man- ners, and a little neurasthenic. He complained that when in society the feeling obtruded itself constantly that he was being observed. This caused him worry and embarrass- ment, although he was fully aware that all this was naught but imagination. He loved solitude, for fear that others might find out his sexual abnormality. This impotence did not cause him pain, for he had scarcely any desire. Nevertheless he would consider the cure of his oita sexualis a great boon, since so much depended upon it in social life, and he would be more self- possessed and manlier when among others. \\\< present existence he considered a misery, and his life a burden. Case 52. X., man of letters, aged twenty-eight, tainted. Sexually hypersesthetic from childhood. At the age of six he had dreams of being whipped ad naies by a woman. Upon awakening, intense lustful excitement ; thui 140 PSYCHOPATHIA 8EXUALIS. he came to practise 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 fancies when awake, and indulged in onanism. Three years ago he had an impulse to have himself whipped by a puella. The patient was dis- appointed, for neither erection nor ejaculation occurred. At twenty-seven, another effort, with the thought to en- force erection and ejaculation. This was finally made possible by the following artifice: While coitus was attempted the puella had to tell him how she flogged mercilessly 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, help- less, 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 (infre- quently) dreamed that he was abused, or that he looked on while one puella whipped the other. He never had a real lustful pleasure in coitus. The only things in women that interested him were the hands. Powerful women with big fists were his preference. At the same time, his desire for flagellation was only ideal ; for with his great cutaneous sensitiveness at the most a few strokes were sufficient. Blows from men were repugnant to him. He wished to marry. From the impossibility of asking a decent woman to perform flagellation and the doubt about being potent without flagellation sprang his embarrassment and desire to recover. Passive Flagellation and Masochism. Case 53. D., age thirty-two, sculptor, hereditarily tainted, marks of degeneration, constitutionally neuro- pathic, neurasthenic, weakly in his earlier years. First emotions of sexuality at the age of seventeen; it devel- oped slowly and exclusively in a hetero-sexual, but maso- chistic direction. He craved for floggings at the hands MASOCHISM. 141 of a pretty woman (bu* no hand-fetichisin). He preferred women of haughty and imperious appearance. 'He never •ought to put his masochistic desires into real practice. He could not explain them. On four occasions he tried coitus but without success, He practised masturbation, which caused severe neuras- thenia, accompanied by phobia, whereupon he sought med- ical advice. In three of the foregoing cases for the most part passive flagellation serves him that is subject to this perversion of masochism as an expression of the desired situation of subjection to the woman. The sum<- 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 buttocks.1 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 those dissipated individuals who are not psychically perverse, but physically weakened. It is not difficult to show that masochism is some- thing essentially different from flagellation, and more comprehensive. 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 satis- faction of his peculiar desires. On the other hand, the individual that is weakened and not subject to masochism and who has himself flagellated, desires only a mechanical irritation of his spinal centre.. Whether in a given case it is simple (reflex) flagella- tion or masochism is made clear by the individual's state- ments, and often by the secondary circumstances. The determination depends upon the following facts : — In the first place, the impulse to passive flagellation *C/. tupra, Introduction. 142 PSYCHOPATHIA SEXUALW. exists in the masocbist ab origine. The desire is felt before there has been any experience of the reflex effect, often first in dreams, as, for example, in case 55, v. infra. Secondly, with the masochist, as a rule, flagellation is only one of many and various punishments which come into his mind as fancies and are often realised. In these other punishments and the frequent acts expressing purely sym- bolic humiliations which occur by the side of flagellations, 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 defined disappointment; in fact, always, if the masochist is not successful in his desire to create by means of the prearranged programme the illu- sion 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. In reference to this important point, compare the three foregoing cases and case 58. Between masochism and simple (reflex) flagellation, there is a relation somewhat analogous to that existing between inverted 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 characterised by the con- ditions 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 circum- stances, such as those mentioned above under "secondly' would make it clearly masochistic. This is illustrated in the following two cases : — Case 54. A patient of Tarnowsky's had a person in his confidence rent a house during hia attacks, and instruct MASOCHISM. 143 its personnel (three prostitutes) in what was to be done with him. Whenever he came there he was 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 sub- mit 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 55. X., aged thirty-four, greatly predisposed, suffered with antipathic sexual instinct. For various rea- sons 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 her chemise), and have her tread upon him, whip and beat him. Qua re summa libidine affectus pedem femince lambii quod solum eum libidinosum facere poiest: turn ejaculationem assequitur. Then disgust at the morally debasing situation occurred, and he retired as quickly as possible. Case 56. A gentleman of high standing, age twenty- eight years, would go to a house of prostitution once a month. lie always announced his coming, with a note reading thns: "Dear Peggy, I shall be with you to-mor- row evening between 8 and 9 o'clock. Whip and knout! Kindest regards. . . ." He always arrived at the appointed time carrying a whip, a knout and leather straps. After undressing he had himself bound hand and foot, and then flogged by the girl on the soles of his feet, his calves and buttocks until ejaculation ensued. Other desires or wishes he never ex- 144 PSYCHOPATIIIA SEXUALIS. pressed. The fact that he disdained coitus seems to point to the fact that he resorted to this method simply as a means to gratify his masochistic inclination and not as a ruse to restore potency. Cases occur, however, in which passive flagellation alone constitutes the entire content of the masochistic fancies, without other ideas of humiliation, etc., and without well-defined 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 renders the differential diagnosis certain, if weighed with the circumstance that genuine masochists are perverse from early youth, and that the realisation of their desires is scarcely ever accomplished or proves a disappointment (v. supra, under "thirdly") ; for the whole thing chiefly belongs to the realm of imagination. The following is a case of typical 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 49 in the llth edition only in that there is here no thought of a realisation of the perverse fancies, and that, notwithstanding the perversion of the vita sexualis, normal stimuli are so far effectual that sexual intercourse is really possible under normal conditions. Case 57. "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 disorder. 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, alike whether from the standpoint of master or servant. MASOCHISM. 145 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 being hitched to a waggon 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 desires — i.e., on the way in which they took practi- cal shape. Although these ideas caused erections, yet I have never masturbated in my life, and from my nine- teenth 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 power- ful. 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 to 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 pleasurable comfort which caused erection, but never ejaculation. As a result of the induced sexual excitement, I would immediately seek a woman, preferably one corre- sponding exteriorly with my ideal, and have coitus with her without any actual aid of my fancies, and some- times also without any thought of them during the act. I had, however, also 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 10 146 PSYCHOPATHIA SEXUALIS. abnormal sexually; yet these ideas were certain to occur periodically, and they have remained essentially un- changed. With growing sexual desire, the intervals constantly grew shorter. At the present time the attacks come every two or three weeks. If I previously were to have coitus, the occurrence of the fancies would, perhaps, be postponed. I have never attempted to realise my very definite and characteristic ideas — i.e., to connect them with the world without me — but I have contented myself with revelling in the thoughts, because I was convinced that my ideal would not allow even an approach to realisation. The thought of a comedy with paid pros- titutes always seemed so silly and purposeless, for a per- son hired by me could never take the place of my imagina- tion of a 'crtrel mistress'. I doubt whether there are sadis- tically 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 ever seem only 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 make every effort to obtain my freedom at all hazards. "Yet I have found a way in which to induce, in a certain sense, a realisation. After my sexual desire has been intensely excited by revelling 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 role. After thinking of such a situation for about half an hour, with a constantly re- sulting 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 not even any sympathy whatever MASOCHISM. 147 xith masochistic ideas. But tho next attack is sure to • • sooner or later. I must, however, state that I also have coitus without being prepared by such ideas, especi- ally, 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 aesthetic, and despise any- thing like maltreatment of a human being. Finally, I will not leave un mentioned the fact that the form of address is of importance. In my fancies it is essential that the 'mis- tress' 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 in- clined, 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 ideals. She is gentle, but voluptuous, 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 realisation of the masochistic ideas (i.e., passive flagellation, etc.) be the desired end, then it is in opposi- tion to the fact that the majority of masochists never 148 PSYCHOPATHIA BEXUALI8. attempt realisation; or when this is attempted great disappointment occurs, or at any rate the desired satis- faction is not obtained. "Finally, I should mention that, according to my experience, the number of masochists, especially in big cities, seems to be quite large. The only sources of such information are — since men do not reveal these things — statements by prostitutes, and since they agree on the essential points, certain facts may be assumed as proved. "Thus there is the fact that every experienced prosti- tute keeps 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. These, 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, your chapter on this subject has made a deep 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 guerir'. "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 removed; they come like a streak of lightning, are there, and one does not know whence or how. "But the 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 aesthetic 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 impossi- MASOCHISM. 149 ble? You long for a situation which in reality you can never obtain? This opposing idea has an immediate in- hibitory and undeceiving effect, and breaks the point of the fancy. In fact, since reading your book (early this year) I have actually not revelled in my fancy, though the masochistic tendencies have recurred at regular intervals. "I must also confess that, in spite of its marked patho- logical 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 con- dition as well as ever." The author of the foregoing lines also sends me the following notes : — I. "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 think- ing, 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 ex- cited) 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 this exchange of address (Du and Sie) take place as often as possible. Later, when I had become more mature sexually, such things affected me only when they occurred with a woman, and one relatively older than myself. 150 PSYCHOPATHIA SEXUALIS. II. "Physically and mentally I am in all respects mas- culine. 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, storma at sea, etc.).1 "Again, my masochistic tendencies have nothing femi- nine 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 aim and end of all masochistic ideas. III. "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 not by nature exces- sively sensual. 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 1 This difference of courage in the face of events in nature, on the one hand, and in the face of conflict with will-power, on the other, is certainly remarkable, even though it is the only indication of effeminacy apparent in this case. MASOCHISM. 151 masochistic — e.g., Visaing). Tn spite <»f its manner of ori- gin, tins lil>i'. L" had been separated from her husband, and whom •uml in n. « (1. I lc took her and worked for her with- out any selfish motive, for months. One evening she impatiently demanded sexual satisfaction from him, and almost used violence. Coitus was successful. Z. took tin' woman, lived with her, and indulged in coitus moder- ately, but coitus was more a burden than a pleasure; ions 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 re- gretted 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. 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 a 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 endeavoured to make this situation as pleasant as possible, and easily arranged it so that on the next occasion she said spon- taneously, 'Come, give me a little ride!' Being of tall stature, 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 move- ments of a horse, and loved to have her treat me like a horse, without consideration. She could beat, priok, 154 PSYCIIOPATIIIA SEXUALIS. 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 tli roc-quarters of an hour, without inter- ruption. 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 rested and placed myself again at the disposal of the mistress. When time and circumstances allowed it, I did this three or four times in succession. It sometimes happened that I practised it both in the morning and afternoon. After it I never felt weary or had uncomfort- able feelings, but on such days I had very little appetite. When possible, I liked best to bare my trunk, that I might feel the riding-whip more sharply. 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 said he had not performed coitus in seven years, but he thought he was potent. The riding was a perfect substitute for that "bestial 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 moderately pretty were to address him directly and say, "Come, I want to ride you," he would not be strong enough to withstand the tempta- tion. Z. wished to know whether his abnormality was curable, whether he was unworthy as a vicious man, or an invalid deserving pity.. Even in the foregoing series of cases, with other things, the act of being walked upon has played a role 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, which has caused me to arrange a special group, because it forms the tran- MASOCHISM. 153 sition to another kind of perversion (vide infra (6), is shown in the following classical case of masochism, re- ported by Hammond (op. cit., p. 28) from an observation by Dr. Cox1 of Colorado : — Case 59. X., a model husband, very moral, the father of several children, had times — i.e., attacks — in which he visited brothels, chose two or three of the largest girls, and shut himsolf up with them. He bared the upper portion of his body, lay down on the floor, crossed his hands on his abdomen, closed his eyes, and then had 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 wanted a heavier girl, or some other act still more cruel than this procedure. After two or three hours he had enough. He paid the girls with wine and money, rubbed his blue bruises, dressed himself, paid his bill, and went back to his busi- ness, only to give himself the same strange pleasure again after a few weeks. Occasionally it happened that he had one of the girls stand on his breast, and the others then turn her around until his skin was torn and bleeding from tlio turning of the heels of her shoes. Frequently one of the girls had to stand on him in such a way that one shoe was over the eyes, with its heel pressing on one eye, while the other shoe rested across his neck. In this position he endured the. pressure of a person weighing about l.r>0 pounds for four or five minutes. The author speaks of dozens of similar cases that are known to him. Hammond prrsnnu'*, with reason, that this man had become impotent for intercourse with women ; that in this strange procedure he found an equiva- lent for coitus ; and that, when the heels drew blood, he had pleasant sexual feelings, accompanied by ejaculations. Case 60. X., gentleman belonging to upper class 1 " TransnHions of the Colorado State Medical Society," quoted in the "Alienist and Neurologist," April, 1883, p. 345. 156 PSYCHOPATHIA SEXUALIS. of society ; age sixty-six ; father hypersexual ; two brothers said to be masochists. X. claimed that his masochism dates back to early childhood. At the age of five he asked little girls to undress him and spank his naked bottom. Later on he arranged with other boys or girls in playing teacher with him to flog him. With the age of fifteen he began to imagine that girls ambushed and then beat him. At that time he had no idea as yet of the sexual meaning of such proceedings, in fact he was still unaware of the viia sexualis. His craving for being beaten by women stead- ily increased. At the age of eighteen he learned how to satisfy it and had the first pollution during the act. When nineteen first coitus with complete satisfaction and potency and without masochistic representations. Normal sexual intercourse until he was twenty-one, when a girl suggested a masochistic scene. He accepted, and from that time never had coitus without a masochistic adventure pre- ceding it. He soon recognized the -fact that the stimulus proceeded from the idea to be in the power of a woman rather than from the act of violence itself. He succeeded in making a happy marriage, free from masochistic ideas, but admitted that from time to time he had to seek relief in some masochistic act with a girl, even though he then had grand children. The masochistic scene was always the prelude to coitus. He showed no psychopathic symptoms and was free from other perversions. He pointed out the frequency of masochism and the clever methods often ap- plied by so-called masseuses. According to his experience masochism is of frequent occurrence in England, and English women are easily persuaded to practise it Case 61. L., artist, age twenty-nine; nervous disease and tuberculosis of frequent occurrence in family. Vita sexualis suddenly aroused in him at the age of seven whilst being caned ad podicem ; at ten, masturbation. Dur- ing the act he always thought of some one flagellating him. In later years nocturnal pollutions were always accompa- nied by dreams of flagellation. The wish to be flogged MASOCHISM. 157 was ever present in his mind since he was ten years old. From eleven to eighteen he had inclinations to persons of his own sex, though they never overstepped the bounds of boyish friendship. During this homosexual period he was forever agitated by the desire to be beaten by his companion. At nineteen coitus, but without sufficient erection or gratifying pleasure. His heterosexual inclinations were always towards women older than himself. He was in- different towards young girls. His craving for flagellation increased with the years. At twenty-five he fell violently in love with a woman much older than himself, but marriage he refused. The woman made every effort in her power to win him over to natural sexual intercourse. Although he detested the state of affairs and professed undieing love for the woman he insisted that his sexual feelings for her were only of a masochistic character. Now and then he succeeded in persuading her to flagellate him. His sexual needs being strong he had girls flagellate him. He claimed that flagellation was the only adequate sexual act during which he could experience really pleas- urable ejaculation. Coitus was of minor importance and only on rare occasions did he couple it with the act of flagellation, probably on account of psychical impotence. Nevertheless the two acts affected him in a different manner. Coitus seemed to improve him both mentally and physically, whilst flagellation had bodily exhaustion and moral depression in its wake. He was persuaded that masochism in him was a pathological condition; on that ground he came for advice. His appearance was undeniably masculine, his con- duct decent and beyond criticism. He complained of cerebral neurasthenia (weakness of mind, of will power, absent-mindedness, irritability, shyness, anxiety of mind, pressure in the head, etc.). Genitals normal. Erections only in the morning. He inclined to the belief that if he could find a woman 158 PSYCHOPATHIA BEXUALI8. whom he could love, he might strip off his masochistic in- clination in wedlock. Therapeutic advice: auto-combating of masochistic thoughts, impulses and acts, if necessary, with the aid of hypnotic suggestion; strengthening of the nervous sys- tem, and removing manifestations of irritating weakness by antineurasthenic treatment. The 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 maso- chism the same effect is sought in the passive reception of similar abuse.1 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 62. A middle-aged man, married, and the father of a family, who had always led a normal vita sex- ualis, but who came of a very nervous family, made 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 revelled in the lustfully coloured idea of being stabbed and cut, and even killed, by women with knives. Later on, after the beginning of normal sexual intercourse, these ideas lost completely their per- verse stimulus for him. 1 Instructive instances are given by Seydel, " Vierteljahrsschr. f. ger. Med.," 1893, Heft 2, pp. 275, 276. 159 This case should bo compared with the statements according to \vhirh men find sexual pleasure in being lightly priekod with knives in the hands of women, who at the same time threaten them with death. Such fancies, perhaps, give the key to an understand- ing of the following strange case, for which I am indebted to a communication from Dr. Korber, of Rankau, in Silesia : — Case 63. "A lady makes me the following communi- cation : While still a young and innocent girl, she was married to a man of about thirty years. On their wedding night he forced a bowl with soap into her hands, and without any expression of endearment wanted her to lather his chin and neck (as if for shaving). The inex- perienced 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 was industrious and reliable, but a moody man, with short temper; 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 realisation of ideas of injury or death, or of fancies about knives, like those the man pre- viously mentioned had had in his youth, and by means of which he had been sexually excited and satisfied. The •ct sadistic counterpart to this case, looked upon in the same light, is offered by observation 37, which is a case of symbolic sadism. Symbolic Masochism. At any rate, there is a whole group of masochists who 160 PSYCHOPATH I A SEXDALI8. satisfy themselves with the symbolic representations of situations corresponding with their perversion; a group which corresponds with Group "a" and "e" 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 farther than the idea of being murdered, but in fact not so far, owing to the determining subjective con- ditions). Cases similar to 63 may be here described, in which the acts desired and planned by the masochists have a purely symbolic character, and to a certain extent serve to define the desired situation. Case 64. (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 follow- ing act. The puella had to undress him, tie his hands and feet, bandage his eyes, and draw the curtains of the win- dows. Then she would make her guest sit down on a sofa, and leave him there alone in a helpless position. 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 by the aid of imagination. The following case, in which again a complicated comedy in the sense of masochistic desires is played, is still more peculiar : — Case 65. (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 MASOCHISM. 161 manner. He addressed her as ''Marquise," and she had to call him "ml:ii:iiist8 and fetid 188 PSYOIIOPATHIA 8EXUALIS. He was especially attracted by the feet of well-bred women that were deformed by narrow boots and had not been washed for several days, but he could stomach only "slight, natural deposits, such as one may find upon the feet of clean well-bred ladies, also discolorations from the stockings, whilst sweating feet excited him only in imagin- ation, but in reality disgusted him". "Cruel tortures" also existed for him only in imagination as a means to excitement; he abhorred them and never craved for them in reality. Nevertheless they played a pre-eminent part in his fancy, and he never neglected to instruct the women with whom he kept in masochistic touch how they were to write him threatening letters. From the collection of such letters placed at my disposal by Z. one is given here because it clearly illustrates the line of thought and sentiment : — "Lambitor sudoris pedum mulierum! I take the ut- most delight in conjuring up the moment when you will lick my toes, especially after a long walk. A facsimile of my foot I shall send you soon. It will intoxicate me like nectar when you will lick up my sudor pedum. And if you will not do it voluntarily, I shall force you to it; I shall treat you as my meanest slave. You shall witness how another favoritus sudorem pedum mihi lambit, whilst you shall whine like a dog under the lashes of my servants. I shall declare you outlawed. I shall find the most exquisite pleasure in seeing you in pain, breathing your last under the most cruel tortures, licking my toes in extreme agony. . . . You challenge my cruelty — very well, I shall crush you under my foot like a worm. . . . You ask me for a stocking ? . I shall wear it longer than usual. But I demand that you kiss it and lick it ; that you soak the foot of it in water and then drink the latter. If you do not carry out my pleasure absolutely, I shall chastise you with my riding-whip. I demand uncon- ditional obedience. If you do not obey, I shall have you whipped with the knout, I shall make you walk over a floor well-spiked with sharp nails, I shall have you MASOCHISM. 189 battinaded and cast to the lions in the cage. It will give me th<> utmost delight to see how the wild beasts enjoy your flesh." In spite of such ridiculous tirades, ordered by himself, Z. looked upon them as a means to satisfy his perverse sexuality. These sexual monstrosities, which to him were only a congenital anomaly, he did not consider unnatural, although he admitted them to be disgusting to the nor- mally constituted man. Otherwise he appeared to be a decent sort of a man with rather refined manners, but his otherwise meagre aesthetic sentiments were overbalanced by sensuality which gratified his perverse desires. Z. gave me an insight into his correspondence with the literary champion of masochism, Sacher-Masoch. One of these letters, dated 1888, shows as a heading thf picture of a luxuriant woman, with imperial bearing, only half covered witli furs and holding a riding- whip as if ready to strike. Sacher-Masoch contends that "the passion to play the slave" is widespread, especially among the Germans and Russians. In this letter, the history of a noble Russian is related who loved to be tied and whipped by several beautiful women. One day he found his ideal in a pretty young French woman and took her to his home. According to Sacher-Masoch, a Danish woman yielded her favour to no man until he acted the part of slave to her for a considerable time. Amanlrs coagere solebat, ut pedes suos et podicem lambeant. She had her adorers put in chains and whipped until they obeyed her lambendo pedes. Once she had the "slave" fastened to her bed- posts and thus made him witness her granting the highest favour to another. After the latter left her she had the fcttored "slave" whipped by her servants until he yielded lambere podicem domincB. If these assertions were true which, of course, cannot be accepted from the poet without definite proof, they would constitute remarkable proofs of sadismus femina- rum. At any rate they are psychologically interesting in- 190 PSYCHOPATHIA SEXUAIJS. stances of thoughts and sentiments specific to masochism (my own observations, "Centralblatt fur Krankheiten der Harn- und Sexualorgane," vi., 7). Case 81. Z., aged twenty-four; Russian civil serv- ant; mother neuropathic, father psychopathic. Z. was in- telligent, of refined manners, physically normal, of pleas- ing appearance and aesthetic tastes ; never had a severe ill- ness. Claimed to have been of a nervous disposition from infancy ; had like his mother neuropathic eyes and latterly suffered from cerebral asthenic troubles. Perversio vitce sexualis caused him much worry, bordering on despair, deprived him of self-esteem and tempted him to suicide. What oppressed him was the unnatural desire recurring every four weeks for mictio mulieris in os suum. As cause he gave the following facts, interesting on account of their genetic importance. When six years of age he put his hand by accident sub podicem puellce who sat next to him in school. This caused him pleasure and he repeatedly did so. The memory of these pleasant situations strongly aroused his fancy. Puerum decem annorum serva educatrix libidine mota ad corpus suum appressit et digitum ejus in vaginam intro- duxit. Quum postea fortuitu digito nasum ietigit, odore ejus valde delectatus fuit. This immoral act developed into a lustful fancy which made him believe vinctus inter femora mulieris cumbere, coactus, ut dormiat sub ejus podice et ut bibat ejus urinam. With the thirteenth year these fictions disappeared. At fifteen first coitus, at sixteen second, quite normal and without fanciful representations. Deficiente pecunia et magna libidine perturbatus mas- turbatione earn satiabat. At seventeen perverse ideas recurred. They became more powerful and he struggled against them in vain. At eighteen he yielded to the impulse. Quum mulier qucedam in os ei minxit, maxima voluptate affect us est. He then had coitus with the vile woman. Since then, MASOCHISM. 191 he felt the necessity (,. repent the disgusting act every four weeks. After indulging in this perverse action he was ashamed of himself and disgust overcame him. Ejaculations ac- eompanird the act but seldom, but it produced erections and orgasm and whenever ejaculation missed, he gratified himself with coitus. During the intervals between these excessive impulses hf was quite free from perverse thoughts and desires as well as from ideal masochism and fetichistic relations. Libido during these intervals was but slight and easily gratified in the normal fashion without the assistance of perverse fiction. He often travelled miles from his coun- try seat to the city to satisfy his cravings when these spells came over him. Again and again the patient — refined as he was and disgusted with his own perversity — sought to resist the morbid impulse, but in vain; restlessness, anxiety, trem- ' j»syehiei. £r»t- ihcatmn of - . :ly, but was at «>. rcoine v contempt for himself border' ••ntal struggles enen plained of debility of memory, absent -mimie-. impotence, and cerebral pressure. His last hope was that ni'-dical science might succeed in freeing him from this monstrous affliction and in re-establishing his moral self. Case 82. Masochism — Fetichism — Koprolagnia. B., aged thirty-one, official, family neuropathically tainted, nervous from early childhood, weakly, nocturnal frights. I-'irst pollution at the age of sixteen. At seventeen fell in love with a French woman, twenty-eight years old and anything but pretty. Had a special weakness for her shoes. Whenever he could do so without being observed, he would cover them with kisses. This gave him sensual delights; but it never caused ejaculation. At that time 192 PSYCHOPATHIA SEXUALIS. according to his statement, he had no knowledge of the difference in sexes. He could not understand his weakness for shoes. After he attained the age of twenty-two he had coitus about once a month, but did not derive psychical gratification from the act. One day he met a prostitute in the street whose haughty demeanor, fascinating eye and challenging mien made a peculiar impression on him. He felt an impulse to throw himself at her feet, kiss them, and follow her like a dog or slave. Her "majestic" feet clad in patent leather boots especially captivated him. He trembled with voluptuous excitement. During the night he could not find sleep for the thought of the woman haunted him. He imagined that he was kissing this woman's feet. This fancy superinduced ejaculation. Shy by nature, he now resorted to psychical masturbation, and having a dislike for prostitutes, he shunned henceforth the society of women altogether. He revelled in the thought of the pretty foot of an imperious woman and associated this thought with the olfactory impression he would re- ceive from its proximity. In erotic dreams he would fol- low such wome.ri. T!«l«i. Tvouiu begin 'to 'fail ,ind the woman ug her skirts would show her pretty foot, ankle and calf, encased in a silken stocking. As soon as he grasped and fondled the warm form, so soft and yet so firm, he would ejaculate. On rainy days he used to patrol the streets to see such scenes in reality. If he saw what he came for he would carry away the impression in his memory and it became the object of his nightly dreams and acts of psychical masturbation. To hasten the act he would sniff his own socks, kiss, bite and chew them. His dreams and libidinous ecstasies were also mingled with fancies of a purely masochistic character, e.g., a woman but slightly clad stood in front of him holding a whip in her hand, whilst he knelt at her feet like a slave. She would cut him with the whip, put her foot on his neck, face or mouth, till he consented secretum inter digitos nudos pedis ejus bene clans exsugere. During this mental act he would smell of his own feet, the odor of which was repulsive to MASOCHISM. 193 him when in his normal state. He would vary these prac- tices with acts of "poderfetichism" by using a girl's • Ira were et stercus proprium naribus appositum. At other (ilia's the cunnus feminat would be his fetich and he would practise ideal c mini lingua. For assistance he would use pieces cut from the armpits of a woman's undervest, or stockings, or shoes. After six years, during which neu- rasthenia had increased whilst the imaginative power had waned, he lost all power to accomplish these act* of psychical onanism and came down to the level of a common masturbator. He, later on, be- came acquainted with a girl of a similar masochistic ten- dency, and coitus became possible for both, but always by having recourse to some masochistic situation. But the old fetichistic fascinations reappeared and he found greater pleasures in appeasing this perverse appetite than in coitus, which he performed only honoris causa. The end of this cynical sexual existence was a marriage — after his mistress had forsaken him — with a woman who had the same perverse inclinations as himself. They had chil- dren, but found sexual gratification chiefly in masochistic marital acts. (Centralblatt fur Krankheiten der Harn- und Sexual organe, vi., 7.) Other cases of Cantarano's (loc. cit.) belong here (mic~ iio even dcfcecatio puellce ad linguam viri ante actum) con- sumption of confects smelling like faces, in order to be- come potent; and also the following case, likewise com- municated to me by a physician : — "A Russian prince, who was very decrepit, was ac- customed 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 ate marchpane exclu- sively. Ut libidinosus fiat et ejaculate possit excrementa feminw ere excipit. A Brazilian physician tells me of 13 194 PSYC1IOPATHIA SEXUALIS. several cases of defcecatio feminae in os viri that have como 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 way and swallowed with pleasure ; and oscula ad nates and even ad anum are indulged in. Dr. Moll (op. cit.f p. 135) reports the same thing of a man affected with inverted sexuality. The perverse desire to practise cunnilingus, which is very wide-spread, probably has its root frequently in masochistic impulses. Evidently the case quoted by Cantarano ("La Psichia- tria," v., p. 207) belongs here also, in which coitus is preceded by morsus et succio of the woman's toes which have not been washed for some time. Also a case quoted by me in the eighth edition of this book, cf. ibid., case 68. Stefanowsky ("Archives de 1'Anthropologie crimi- nelle," 1892, vol. vii.) knows of a Russian merchant qui valde delectatus fuit bibendo ae quce puella lupanarii jusso suo in vas spuerunt. Neri, "Archivio delle psicopatie sessuali," p. 198 : Workman, aged twenty-seven, heavily tainted, tic in the face, troubled with phobia (especially agoraphobia) and alcoholism. Summa ei fit voluptas, si meretrices in os ejus faces et urinas deponunt. Vinum supra corpus scortorum effusum defluens ore ad meretricis cunnum adposito excipit. Valde delectatur, si, sanguinem menstrualem ex vagina ef- fluentem sugere potest. He is fetichist of ladies' gloves and slippers, osculatur calceos sororis, cujus pedes sudorc ma- dent. Libido cjus turn dcmun maxime satiatur, si a puellis insultatur, immo vero verberatur, ut sanguis exeat. Dum verberatur, genibus nixus veniam et clementiam pueUa expetit, deinde masturbare incipit. Pelanda ("Archivio di Psichiatria," x., fascicolo 3, 4) relates the following case : — Case 83. W., aged forty-five, predisposed, was given to masturbation at the age of eight. A decimo sexto anno MASOCHISM. 195 lihidines suas bibendo recentem feminarum urinam satia- rit. Tanta erat voluptas urinam bibentis ut nee aliquid olfaceret nee saperei, hcec faciens. After drinking he al- ways experienced disgust and ill-feeling, and made firm •it inns 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 practised fellatio. The patient suffered from epileptic insanity. Still older cases belong here, which Tardieu ("Etude medico-legale sur les attentats aux moeurs," p. 206) ob- served in senile individuals. He describes as "Renifleurs" persons "qui in sccretos locos nimirum theatrorum porticos convenientes quo complures femince ad micturiendum fes- tinani, per nares urinali odore excitati, illico se invicem polluunt". The "Stercoraires" that Taxil ("La prostitu- tion contemporaine") mentions are, in relation to this subject, unique. Eulenburg relates further monstrous facts belonging to this section. Cf. Zulzer's "Klin. Handbuch der Ham- und Sexualorgane," iv., p. 47. (d) Masochism in Woman. In woman voluntary subjection to the opposite sex is a physiological phenomenon. Owing to her passive role in procreation and long-existent social conditions, ideas of subjection are, in woman, normally connected with the idea of sexual relations. They form, so to speak, the harmonics which determine the tone-quality of feminine feeling. Any one conversant with the history of civilisation knows in what a state of absolute subjection woman was always kept until a relatively high degree of civilisation was reached;1 and an attentive observer of life may still 1 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 stand- 196 PSYCHOPATHIA SEXUALIS. easily recognise how the custom of unnumbered genera- tions, in connection with the ^-passive role 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 behaviour, though loudly reprehended, is often accepted with secret satisfaction.2 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 ele- ments,— 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. 199). It may, how- ever, be held to be established that, in woman, an inclina- tion 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 improve the opportunity by the dis- play of his power (as the ladies of the middle ages did towards the love-serving knights), but prefers to realise solid advantages. The barbarian has his wife plough for him, and the civilised lover speculates about her dowry; she willingly endures both. Cases of pathological increase of this instinct of sub- jection, in the sense of feminine masochism, are probably ing (cf. Schultze, "Das hofische 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 (v. infra, p. 198). 2 Cf. Lady Milford's words in Schiller's " Kabale und Liebe": "We women can only ehoose between ruling and serving; but the highest pleasure power affords is but a miserable substitute, if the grater joy of being the slaves of a man we love is denied ua!" (Act II./ Scene I.). 197 enough, but custom represses their manifesta- ti-'ii. Manv Noting women like nothing better than to kii« el U-t'oro their husbands or lovers. Among the lower classes of Slavs it is said that the wives feel hurt if they are not beaten by their husbands. A Hungarian official informs me that the peasant women of the Soinogyer Comitate 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.1 Intrinsic and extraneous restraints — modesty and custom — naturally constitute in woman insurmountable obstacles to the expression of per- verse sexual instinct. Thus it happens that, up to the present time, but two cases of masochism in woman have been scientifically established. Case 84. Miss X., twenty-one years of age; her mother was a morphia maniac and died some years ago from nervous disorders. Her uncle (mother's side) was also a morphia-eater. One brother of the girl was neurasthenic, another a masochist (wished to be beaten with a cane by proud, noble ladies). Miss X. had never had a severe ill- ness, but at times suffered from headaches. She considered If to !be physically sound, but periodically insane, vix., when she was haunted by the fancies which she thus described : — Since her earliest youth she fancied herself being whipped. She simply revelled in these ideas, and had the most intense desire to be severely punished with a rattan cane. This desire, she claimed, originated from the fact that at the age of five a friend of her father's took her for fun I8eydel, " Vierteljahresschr. f. gor. Mcd.," 1893, vol. ii., quotes an an • f iu:i-<><-|iism the patient of Dicffenbach, who repeat- edly and purposely dislocated her arm in order to experience lustful sensations when it was being reduced, anaesthetics not being known th.U. 198 PSYCIIOPATHIA 8EXUALIS. across his knees, pretending to whip her. Since then she had longed for the opportunity of being caned, but to her great regret her wish was never realised. At these periods she imagined herself as absolutely helpless and fettered. The mere mention of the words "rattan cane" and "to whip" caused her intense excitement Only for the last two years she associated these ideas with the male sex. Previously she only thought of a severe school-mistress or simply a hand. Now she wished to be the slave of a man whom she loves; she would kiss his feet if he would only whip her. She did not understand that these manifestations were of a sexual nature. A few quotations from her letters are characteristic as bearing upon the masochistic character of this case: — "In former years I seriously contemplated going into a lunatic asylum whenever these ideas worried me. I fell upon this idea whilst reading how the director of an insane asylum pulled a lady by the hair from her bed and beat her with a cane and a riding-whip. I longed to be treated in a similar manner at such an institute, and have therefore unconsciously associated my ideas with the male sex. I liked, however, best to think of brutal, uneducated female warders beating me mercilessly. "Lying (in fancy) before him, he puts one foot on my neck whilst I kiss the other. I revel in the idea of being whipped by him; but this changes often, and I fancy quite different scenes in which he beats me. At times I take the blows as so many tokens of love — he is at first extremely kind and tender, and then, in the excess of his love, he beats me. I fancy that to beat me for love's sake gives him the highest pleasure. Often I have dreamed that I was his slave — but, mind you, not his female slave ! For instance, I have imagined that he was Robinson- and I the savage that served him. I often look at the pictures in which Robinson puts his foot on the neck of the savage. 1 now find an explanation of these strauee fancies : I look MASOCHISM. 199 upon woman in general as low, far below man; but I am : \\i-e extremely proud and quite indomitable, whence it arises that I think as a man (who is by nature proud and superior). This renders my humiliation before the man I love the more intense. I have also fancied myself to be his female slave; but this does not suffice, for after all every woman can be the slave of her husband. Case 85. Miss v. X., aged thirty-five ; of greatly pre- disposed family. For some years she had been in the ini- tial stages of paranoia pcrsecutoria. This sprang from cerebro-spinal neurasthenia, the origin of which was found to be sexual hyperexcitation. With twenty-four she was given to masturbation. As a result of disappointment in an engagement, she began to practise 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 revelled in the idea, and never attempted any actual reali- sation of my fancies, which 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. 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 who is conceived in imagination's whipping her, is explained by the circumstance that the masochistic desire was here present in the mind of a child before the psychical vita gexualis had developed and the instinct for the male had 200 PSYCHOPATHIA SEXUALIS. been awakened. Antipathic sexual instinct . is here ex- pressly excluded. Case 86. A physician in the General Hospital of Vienna had his attention drawn to a girl who used to call on the medical assistants of the institution. When meet- ing one of them she would express great delight at meeting a medical man and ask him to at once undertake a gyneco- logical examination on her. She said she would make re- sistance, but he must take no notice of that, on the contrary ask her to be calm and proceed with the examination. If X. consented, the scene would be enacted as she desired. She would resist, and thus work herself up into a high state of sexual excitement. If the medical man refused to pro- ceed any further she would beg him not to desist. It was quite evident that the examination was only requested for the purpose of inducing the highest possible degree of orgasm. When the medical man refused coitus she felt deeply offended, but begged him to let her come again. Money she never accepted. It is apparent that orgasm was not induced by the mere palpation of the genitals, but the exciting cause undoubt- edly lay in the act of force, which was always demanded, and which became the equivalent of coitus. It is evidently a manifestation belonging in the province of masochism in woman. An Attempt to Explain Masochism. The facts of masochism are certainly among the most interesting in the domain of psychopathology. An attempt at explanation must first seek to distinguish in them the essential from the unessential. The distinguishing charac- teristic 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), witli the awakening and accompaniment of lustful sexual feel- ings to the degree of orgasm. From the foregoing it is MASOCHISM. 201 that the particular manner in which this relation of subjection or domination is expressed (v. supra), whether !y in 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 un- doubtedly frequent; and it is this that comes most fre- quently under observation and almost exclusively makes u j> the series of observed cases. The reason for this has been previously stated. 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 ex- cited. It is entirely physiological that playful taps and light blows should be taken for caresses,1 Like the lover's pinch, which hurts and is desired. — Anthony and Cleopatra, v., 2. From here the step is not long to a state where the wish xperience 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 ever a r ;i'ly means for producing intense bodily impressions. Just as in sadism the sexual emotion leads to a state of exaltation in which the excessive motor excitement im- plicates neighbouring nervous tracts, so in masochism an ecstatic state arises, in which the rising flood of a single 1 Analogous facts are found in the animal kingdom. Pulmonata Cuv., for instance, possess a small calcareous staff which lies hidden in a special pouch of the body, but is at the time of mating pro- jected and used as a means of sexual excitement, producing, beyond doubt, pain. 202 PSYCHOPATHIA SEXUALI8. 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, yet, J)y no means lies within the domain of sexual perversion. I here refer to the very prevalent fact that in in- numerable instances, which occur in all varieties, one in- dividual becomes dependent on another of the opposite sex, in a very extraordinary and remarkable manner, — even to the loss of all independent will-power; a depend- ence which forces the party in subjection to acts and suffering which greatly prejudice personal interest, and often enough lead to offences against both morality and law. This dependence, however, differs from. the manifesta- tions 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 equili- brium. The difference is one of intensity, not of quality, as in masochistic manifestations. This dependence of one person upon another of the opposite sex — abnormal but not perverse, a phenomenon possessing great interest when .regarded from a forensic standpoint — I designate "sexual bondage";1 for the rela- tions and circumstances attending it have in all respects the character of bondage. The will of the ruling2 indi- 1 Cf. the author's article, " tiber geschlechtliche Horigkeit und Masochismus," in the " Psychiatrist-he Jahrbticher," Bd. x., p. 169 et teq., where this subject is treated in detail, and particularly from the forensic standpoint. * The expressions " slave " and " slavery," though often used metaphorically under such circumstances, are avoided here because they are the favourite expressions of masochism, from which this " bondage " must be strictly differentiated. The expression " bondage " is not to be construed to mean J. 8. 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. Besides it has reference to either sex. MASOCHISM. 203 virtual dominates that of the person in subjection, just as the master's does that of bondsmen. This "sexual bondage," as has been said, is certainly an abnormal phenomenon. It hegins with the first devia- tion 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 content, amiable, and inclined to sexual inter- course, 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.1 The motive of the dominant individual is egotism which finds unlimited room for action. The manifestations of sexual bondage are various in form, and the cases are very numerous.2 At every step in life we find men that have fallen into sexual bondage. Among married men, hen-pecked husbands belong to this i 1 Perhaps the moat 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 estab- lished, 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. 1 Sexual bondage, of course, plays a rdle in all literature. 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 Albt Pr^vott, " Manon Lescault." An excellent description of feminine " bondage " is that of " Leone Leoni," by George Sand. But first of all comes Klcitt'a Kllthchen von Heilbronn," who himself called it the counterpart of (sadistic) " Penthesilea." Halm't "Griseldis'* and many other similar poema also belong here. 204 PSYCHOPATHIA SEXUALIS. 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, moot 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 "bond- age" 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 oftener her first thought, but always takes at least the second place. But, what is still more important, man ruled by this impulse easily satisfies it in embraces for which he finds unlimited opportunities. 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 MASOCHISM. 205 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 illu- sions of a maiden; the seducer, and the man who com- promises 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 diffi- culties of her position. It was necessary to give the subject of "sexual bond- age" here brief consideration, for in it may be clearly discerned 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 subjec- tion of the individual affected with this abnormality to a person of the opposite sex, and of domination of the former by the latter.1 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 pathologi- cal ; 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 1 Cases may occur in which the sexual bondage is expressed in the same acts that are common in masochism. When rough men beat 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, 206 PSYCHOPATHIA SEXUALI8. opposed to self-interest, and often to custom and law. The motive, in obedience to which the subordinated indi- vidual 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 per- formed at the command of the ruling individual, to sat- isfy 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 under- lying 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 them- selves. 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 tyrannised is for a long time closely associated with the Jwtful thought of the beloved person, the lustful emotion MASOCHISM. 207 is finally transferred to the tyranny itself, and the trans- formation to perversion is completed. This is the manner in which masochism may be acquired by cultivation.1 Thus a mild degree of masochism may arise from "bondage" — become acquired; but genuine, complete, deep-rooted masochism, with its feverish longing for sub- jection from the time of earliest youth, is congenital. The explanation of the origin of the perversion — in- frequent though it be— of fully developed masochism is 1 It is highly 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," " henpecked," 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 practises 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 on the same lines at does the masochitt, viz., to intensify the idea of his dependence (his ultimate aim), he 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 ( cf. Grillparzer, " Ottokar," act v. : " To rule is sweet, almost as sweet as to obey") the poetry of love is filled with similar phrases nnd 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 rever- ence for women as " mistresses " in society and in individual love- rolatinns; 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 sys- tematic, poetical development of the " bondage " of love. Certain extreme manifestations, like the deeds and sufferings of Vlrich von Lichtemtein or Pierre Vidal in the Rprviee 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 demon- strate the natural transformation of one phenomenon into the other. 208 PSYCHOPATHIA SEXUALIS. most probably to be found in the assumption that it arises from the more frequent abnormality of "sexual bondage,'' through which, now and then, this abnormality is heredi- tarily transferred to a psychopathic individual in such a manner that it becomes transformed into a perversion. It has been previously shown how a slight displacement of the psychical elements under consideration may effect this transition. Whatever effects associating habits may have on possible cases of acquired masochism, the same effects are produced by the varying tricks of heredity upon orig- inal masochism. No new eleme'nt is thereby added to "bondage," but on the contrary the very element is deleted which cements love and dependence, and thereby distin- guishes "bondage" from masochism and abnormality from perversion. It is quite natural that only the instinctive element is transmitted. This transition from abnormality into perversion, through hereditary transference, takes place very easily where the psychopathic constitution of the descendant presents the other factor of masochism, — i.e., what has been previously called its main root, — the tendency of sexually hyperrcsthetic natures to assimilate all impres- sions coming from the beloved person with the sexual im- pression. 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 from the basis of psychopathic predis- position, in so far as its sexual hypersesthesia intensifies first all the physiological accessories of the vita sexualis and, finallv, only its abnormal accompaniments, to the pathological degree of perversion.1 1 If it he 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 ruls-* is a* MASOCHISM. 209 At any rate, masochism, as a ci.nircnital sexual per- •itutes a functional sign of degeneration in (almost exclusively) hereditary taint ; and this clinical deduction is continual in my cases of masochism and -in. It is easy to demonstrate that the peculiar, hically anomalous direction of the vita sexualis resented in masochism 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 contend. 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 observations, from case 50, 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 role, as in cases 50 and 52. Case 58 is particularly instructive in relation to this; for in this instance there can be no thought of a sexually stimulating effect by punishment received in youth. More- over, 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 from purely psychical elements, on confronting it with sadism (v. infra), is con- vincingly demonstrated. That passive flagellation occurs inheritance of the " bondage " of feminine ancestry. Thus it comes into a relation — though distant — with antipathic sexual instinct, as a transference to the male of a perversion really belonging to the female. It must, however, be emphasised that " bondage " also plays no unimportant role in the masculine vita scxualis, and that masochism in man may also be explained without any such transference of feminine elements. It must also be remembered here that masochism, a» well aa its counterpart, sadism, occurs in irregular combinatiog with antipathic sexual instinct. 14 210 rsYciiorATiiiA SEXUALIS. 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 render 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, we must in these acts (as well as in flagellation in masochists, having like significance) seek to ascertain the relation in which 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 what causes physical pain is here simply perceived as physical pleas- ure; for 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), in the preoccupation of consciousness with lustful emotion, the idea of mal- treatment remains merely a symbol, without its quality of pain. To a certain extent there is overcompensation of physical pain in the 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 colouring in the sensoriuiu of sensory impressions, a kind of hallucination of bodily pleasure takes place, with a vague localisation of the ob- jectively projected sensation. In the self-torture of religious enthusiasts (fakirs, howling dervishes, religious flagellants) there is an analo- gous state, only with a difference in the quality of pleas- MASOCHISM. 211 uru!>lo frclin^. Ilm- the coiiccjition of martyrdom is apperccivcd without its pain; for consciousness is filial \\ith tin- plcasnrably colon PM! idea of serving God, atoning for sins, deserving heaven, etc., through martyrdom. In order to give masochism its proper place in the sphere of sexual perversion, we must proceed from the fact that it is a manifestation of psychical characteristics of the feminine type transcending into pathological con- ditions, in so far as its determining marks are suffering, subjection to the will of others, and to force. Among peoples of a lower class of culture the subjection of woman is extended even to brutality. This flagrant proof of de- pendence is felt by woman even with sensual pleasure and accepted as a token of love. It is probable that the woman of high civilisation looks upon the role of being over- shadowed by the male consort as an acceptable situation which forms a portion of the lustful feeling developed in the sexual act. The daring and self-confident demeanor of man undoubtedly exercises a sexual charm over woman. It cannot be doubted that the masochist considers himself in a passive, feminine role towards his mistress and that his sexual gratification is governed by the success his il- lusion experiences in the complete subjection to the will of the consort. The pleasurable feeling, call it lust, re- sulting from this act differs per se in no wise from the feeling which woman derives from the sexual act. The masochistically inclined individual seeks and finds an equivalent for his purpose in the fact that he endows in his imagination the consort with certain masculine psy- chical sexual characteristics — i.e., in a perverse manner, in so far as the sadistic female partner constitutes his ideal. From this emanates the deduction that masochism is, properly speaking, only a rudimentary form of antipathic soxiial instinct. It is a partial effemination which has only apperceived the secondary sexual characteristics of the psychical vita sexualis. This assumption is supported by the fact that hetero- 212 PSYCHOPATHIA SEXUALIS. sexual masochists consider themselves merely as individ- uals endowed with feminine feelings.1 Observation shows that they really possess feminine traits of character.2 This renders it intellfgible that the masochistic element is so fre- quently found in homosexual men.3 In the woman masochist also these relations to an- tipathic sexual instinct are to be found. Cf., case 84. Moll quotes a typical case of homosexuality in a woman afflicted with passive flagellantism and koprolagnia : Case 87. Miss X., age twenty-six. At the age of six cunnilingus mutuus; then up to seventeen deficiente occasione solitary masturbation. Since then cunnilingus with various female friends, at times playing the passive, at others the active role, always producing ejaculation in herself. For years koprolagnia. Maxime delectata fuit lambendo anum feminarum amatarum, lambendo san- guinem menstrualem amicae. The same effect had ver- bera amicae delectae nudae et robustae ad nates. The thought of performing koprolagnia in corpore viri was repulsive to her. Satisfaction in cunnilingus viri she only obtained when she imagined that the act was performed by a woman, not by a man. Coitus cum viro she dis- dained. Erotic dreams were always of a homosexual na- ture and were confined to active or passive cunnilingus. Inter osculationem mutuam maximam offert voluptatem *Cf. cases 57 and 58. a Cf. case 70 in Schrenck-Notzing; case 20 in F6r6, 1'instinct sexuell, p. 262. 1 Cf. case 67 in Schrenck-Notzing; Atoll, Contr. Sexualempfindung, 3rd edition, p. 265 (gentleman who pestered an officer with letters in which he begged him to be allowed to clean his boots) ; ibidem, p. 281 (gentleman who was agitated by two wishes, viz.: (1) to be a woman that he might have coitus with the man he loved, (2) to be maltreated by the same) ; ibidem, case 17; ditto, p. 283 (man who finds satis- faction in the act with another man only when the latter rubs his back with a hard brush till the blood flows) ; p. 284 (koprolagnia) ; p. 317; v. Krafft, Psycop. sexual., 6th edit., case 43; 8th edit., cases 46, 114, 115; item, Jahrb. f. Psychiatric, xii., pp. 339 and 351; item, "Arbeiten," iv., p. 134. MASOCHISM AND SADISM. 213 raorsus consortis, by preference in the lobe of the ear, causing pain and subsequent swelling. X. always had leaning to male occupations, loved to be among moil as one of their own. From her tenth to her fifteenth year she worked in the brewery of a relative, if possible clad in trousers and a leather apron. She was bright, intelligent and good-natured, and felt quite happy in her perverse, homosexual existence. She smoked ami drank beer. Female larynx (Dr. Flatau), small, badly developed breasts, large hands and feet. (Dr. Moll, intern. (Vntralblatt f. Physiol. und Patholog. der Harn- und Sex- ual-organe. iv. 3). Masochism and Sadism. The perfect counterpart of masochism is sadism. While in the former there is a desire to suffer and bo 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 role become the object of tin desire of the masochist in the passive role. 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 in case 62, — of course, only in fancy, — its passive counterpart. Under favouring conditions, both perversions may occur with a normal vita sexualis; in both, the acts in which they express themselves are preparatory to coitus or substi- tutes for it.1 *Of course, both have to contend with opposing ethical and esthetic motives in foro intcrno. After these have been overcome, active sadism immediately conies in conflict with the law. This is not the case with ninsodrism, which accounts for the greater fre- quency of masochistic acts. But the instinct of self-preservation and fear of pain prevent the realisation of the latter. The practical significance of masochism lies only in its relations to psychical impotence; while that of sadism lies beyond this, and is principally forensic. 214: P8YCHOPATHIA SEXUALIS. But the analogy does not exist-simply in external man- ifestations; it also extends to the intrinsic character of both perversions. Both are to be regarded as original psychopathies in mentally abnormal individuals, who, in particular, are affected with psychical hypercesthcsia sexu- alis, 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. In masochism, as shown above, these elements lie in the fact (1) that in the state of sexual emotion every impression produced by the con- sort, independently of the manner of its production, is, per se, attended with lustful pleasure, which, when accom- panied by hypercesthesia sexualis, may go so far as to overcompensate all painful sensation; and in the fact (2) that "sexual bondage," dependent on mental factors — in themselves not perverse — may, under pathological condi- tions, become a perverse, pleasurable desire for subjection to the opposite sex, which — even if its inheritance from the female side need not be presupposed — represents a pathological degeneration of the character (really belong- ing to woman) of the instinct of subordination, physiolo- gical in woman. In harmony with this, there are, likewise, two constit- uent 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 ex- tent 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 in- dividuals sexually hypersesthetic, may degenerate into a craving to inflict pain; and the fact (2) that, under path- ological conditions, man's active role of winning woman may become an unlimited desire for subjugation. Thus masochism and sadism represent perfect counter- parts. It is also in harmony with this that the individuals affected with these perversions regard the opposite perver- MASOCHISM AND SADISM. 215 sion in the other sex as their ideal, as shown by case 57, 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 association of related ideas, as Bintt, in his 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 re- lated 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 ele- ments and phenomena of masochism and sadism, and as a resume 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, be- cause 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. Sadism and masochism are the results of associations, just the same as all complicated manifestations of psychi- cal life are associations. For psychic life consists, after the production of the simplest elements of consciousness, simply of associations and disassociations of these ele- ments. The chief point gained by this analysis is that sadism and masochism are not merely the results of accidental 216 PSYCHOPATIIIA SEXUALI8. associations, occasioned by chance.or an opportune coinci- dence, but results of associations springing from causes existing under normal circumstances, easily produced under certain conditions — e.g., sexual hyperaesthesia. An abnormally intensified sexual instinct spreads in every direction. It reaches into adjacent spheres, and amalga- mates with their contents, thus producing the pathological associations which are the real essence of both these per- versions.1 Of course, this need not always be so, for there are cases of hyperaesthesia without perversion. But these cases of pure hypercesthesia sexualis — at least, those of striking intensity — seem to be of rarer occurrence than those of perversion. The cases in which sadism and masochism occur simul- taneously in one individual are interesting, but they pre- 1 Schrenck-Notzing, who in his explanation of all perversions lays particular stress upon the " occasional momentum," gives prefer- ence to the theory of acquired perversions over the congenital, and allows the manifestations of sadism and masochism only a subordi- nate position. Although he admits that many cases can only be explained on the assumption of congenital predisposition, yet he contends that circumstances or a timely coincidence control their acquirement (op. cit. p. 170). His arguments are based upon observations. Quoting two cases of psychopathia sexualis (29 and 37 of the seventh edition) he con- tends that the accidental sight of a girl bleeding or a boy being •whipped coinciding with a strong sexual emotion may be sufficient cause for continued pathological associations. Against this it may, however, be decisively held that in every hyperaesthetic individual early and strong sexual emotions have often coincided with numerous heterogeneous things, whilst the patho- logical associations are always coupled with but few definite (sadistic and masochistic) things. Numerous pupils indulge in sexual emotions or gratifications during lessons in grammar and mathe- matics in the class-room, as well as elsewhere, without thereby con- tracting perverse associations. From this clearly follows that the sight of a whipping or similar scenes may provoke pathological associations already present but latent, but that it cannot produce them. Moreover, the aroused sexual instinct is not associated with the numerous indifferent things that are ever present, but only with such as normally excite disgust. The same argument refers to the opinion of Binet, who also seeks to explain these manifestations by accidental associations. MASOCHISM AND SADISM. 217 sent some difficulties of explanation. Such cases are, for instance, No. 47 of the seventh edition, also Nos. 57 and t the present, but especially No. 29 of the ninth edi- tion. Fnua 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 bo observed, with more or less clear- ness, 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 maltreat- ment, coloured with lustful pleasure, either in an active or passive sense, have become deeply imbedded in such an individual. Occasionally the imagination is tempted to try the same ideas in an inverted role. There may even be realisation of this inversion. Such attempts in imagination and in acts, are, however, usually soon aban- doned as inadequate for the original inclination. Masochism and sadism also occur in combination with antipathic sexual instinct, #nd, in fact, in association with all forms and degrees of this perversion. The individual of inverted sexuality may be a sadist as well as a masochist (cf. cases 55 of the present and 49 of the seventh edition and numerous cases in the subsequent series of cases of sexual inversion). Wherever a sexual perversion has developed on the basis of a neuropathic individuality, sexual hypersesthesia, 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 218 rSYCIIOPATIIIA SEXUALIS. appearance at any point in the dojnain of sexual aberra- tion.1 Fetichism. — The Association of Lust with the Idea of Certain Portions of the Female Person, or with Cer- tain Articles of Female Attire. In the considerations concerning the psychology of the normal sexual life in the introduction to this work 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. In- 1 Every attempt to explain the facts of either sadism or maso- chism owing to the close connection of the two phenomena demon- strated here, must also be suited to explain the other perversion. An attempt to offer an explanation of sadism, by J. O. Kiernan (Chicago) (vide "Psychological Aspects of the Sexual Appetite," Alienist and Neurologist, St. Louis, April, 1891 ) meets this require- ment, 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, Cicnkowsky) which conceives the so-called con- jugation, 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 atavistic rebound. This explanation of sadism would, of course, also explain masochism; for if the origin of sexual intercourse is to be sought in cannibalistic process, then both the survival of one sex and the destruction of the other would fulfil 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 (cf. Weismann, "Die Bedeutung der sexuellcn Fortpflanzung fdr die Selectionstheorie," p. 51, Jena, 1886). FETICH ISM. 219 deed, the especial power of attraction possessed by certain forms and peculiarities for many men — in fact, the ma- jority— may be regarded as the real principle of individ- ualism in love. This preference for certain particular physical char- acteristics 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 Famour," "Revue Philosophique," 1887) and Lombroso (Introduction to the Italian edition of the second edition of this work), I have called "fetich- ism" ; 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. By the side of this physiological fetichism, however, there is, in the psycho-sexual sphere, an undoubted patho- logical, erotic fetichism, of which there is already a numer- ous series of cases presenting phenomena having great clinical and psychiatric interest, and, under certain cir- cumstances also, 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 iVtirliism is connected, through grad- ual transitions, with physiological fetich ism, 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 im- pression made l»y a part of the person of the opposite sex, so that all other impressions fade and become more or less 220. PSYCHOPATHIA SEXUALI8. indifferent. Therefore, the body-fetichist is not to be re- garded 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 distinguish- ing 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 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 sub- jective 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 cer- tain portion of the body that has no direct relation to sex (as have the mammae and external genitals) — a peculiarity to be emphasised — 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 manipula- tion 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 still possible or not. Fetichism of inanimate objects or articles of dress, how- ever, in all cases, may well be regarded as a pathological phenomenon, since its object, falls without the circle of normal sexual stimuli. But even here, in the phenomena, FETICHISM. 221 there is a certain outward correspondence with processes of the normal psychical rita sexualis; the inner connection and meaning of pathological fetichism, however, are en- tirely 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 pathologi- cal fetichist has no such relations. The fetich constitutes the entire content of his idea. When he becomes aware of its presence, sexual excitement occurs, and the fetich makes itself felt.1 According to all observations thus far made, patho- logical fetichism seems to arise only on the basis of a psychopathic constitution that is for the most part heredi- tary, or on the basis of existent mental disease. Thus it happens that it not infrequently appears com- bined with the other (original) sexual perversions that arise on the same basis. Not infrequently fetichism occurs in the most various forms in combination with inverted 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 per- versions (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 na- ture; it is not congenitally perfect, as we may well assume sadism and masochism to be. While in the sexual perversions described in the pre- ceding chapters we have met only cases of a congenital type, here we meet only acquired cases. Aside from the fact that often in fetichism the causative circumstance of iln Zola't "Th6r£se Uaquin," where the lover repeatedly kisses his mistress's boot, the case is quite different from that of shoe- and boot- fi'tirhists, who, at the sight of every boot worn by a lady, or even .'!"iic, are thrown into sexual excitement, even to the extent of ejacu- lation. 222 PSYCHOPATHIA 8EXUA1.IS. its acquirement is traced, yet the physiological conditions are wanting, which in sadism and masochism, by means of sexual hyperaesthesia, are intensified to perversions, and justify the assumption of congenital origin. In fetichism, every case requires an event which affords the ground for the perversion. As has been said, it is, of course, physiological in sexual life to be partial to one or another of woman's charms, and to be enthusiastic about it; but concentration of the entire sexual interest on such partial impression is here the essential thing; and for this concentration there must be a particular reason in every individual affected. There- fore, 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 must be sought for in the time of early youth, and, as a rule, occurs in connec- tion with the first awakening of the vita sexualis. This first awakening is associated with some partial sexual im- pression (since it is always a thing standing in some rela- tion to woman),1 and stamps it for life as the principal object of sexual interest. The circumstances under which the association arises are usually forgotten; the result of the association alone is retained. The general predisposi- tion to psychopathic states and the sexual hypersesthesia of such individuals are all that is original here.2 1 Cf. " Arbeiten," iv., p. 172. Case of ring fetichism; p. 174, mourning crape fetichism in homosexual persons. '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 hyper- rcsthesia 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 chastisement could excite sexually even a very excitable individual, if the physio- logical relationship of lust and cruelty had not been developed into original sadism in an abnormally excitable individual. As the sadistic and masochistic associations are performed in the mind of the subject from homogeneous elements in adjacent spheres, in the same measure la the possibility of fetichistic associations prepared FETICHI8M. 223 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 indcbito, 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 scxualis, or occur parallel 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 pre- paratory act The great practical importance which attaches to the facts of fetichism, in accordance with what has been said, lies in two factors. In the first place, pathological fetich- ism is not infrequently a cause of psychical impotence.1 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 the idiosyncrasies of the object and thus easier understood. In nearly every instance it is impressions of parts of the female form (including garments) that are in question. Fetichistic association which originated only by mere accident can only be traced in a few special cases. 1 When young husbands who have associated much with prosti- tutes feel impotent in the face of the chastity of their young wives — a thing of frequent occurrence — 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. pp. 48, 49) reports a very similar interesting case. Of course, in such cases, a bad conscience and hypochcadriacal fear of impotence play an important part. 224 PSYCHOPATHIA SEXUALIS. by means of concentration of his "fancy upon his fetich. In this perversion, and in the difficulty of its adequate gratification, just as in the other perversions of the sexual instinct, lie conditions favouring psychical and physical onanisra, which again reacts deleteriously on the constitu- tion 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 aesthetic motives, shrink from the realisation of their perverse de- sires. 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 eye, the hand, the foot and the hair of woman frequently become fetiches, so, in the pathological domain, the same portions of the body become the sole objects of sexual interest. This ex- clusive 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 patho- logical. Case 88. (Binet, op. cit.) X., aged thirty-four, teacher in a gymnasium. In childhood he suffered from FBTICHISM. 225 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 vivid sexual desires revolved around 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 recognised 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. Nose fetichism is but seldomly met with. The follow- ing rare bit of poetry comes to me from England : — "Oh! sweet and pretty little nose, so charming unto me; Oh, were I but the sweetest rose, I'd give my scent to thee. Oh, make it full with honey sweet, that I may suck it all; T'would be for me the greatest treat, a real festival. How sweet and how nutritious your darling nose does seem; It would be more delicious, than strawberries and cream." Hand-fetichists are very numerous. The following case is not really pathological. It is given here as a transi- tional one : — Case 89. B., of neuropathic family, very sensual mentally intact. At the sight of the hand of a beautiful young lady he was always charmed and felt sexual excite- ment to the extent of erection. It was his delight to kiss and press such hands. As long as they were covered with gloves he felt unhappy. By pretexts he tried to get hold of such hands. He was indifferent to the foot. If the beautiful hands were ornamented with rings, his lust was increased. Only the living hand, not its image, caused him this lustful excitement. It was only when he was 15 226 rsYCHOPATiiiA SEXUALIS. exhausted sexually by frequent coitus that the hand lost 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 25, a man may be partial to the female hand as a result of sadistic impulses; and that, according to case 52, the same thing may be due to masochistic desires. Thus such cases have more than one meaning. But it docs by no means follow 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, they disappeared; but here the assumption of the origin of the fetichism in an accidental association meets every requirement: — Case 90. A case of hand-fetichism, communicated by Albert Moll. P. L., aged twenty-eight, a merchant in 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 sub- ject for any length of time ; on the other hand, from child- hood he had a great inclination for music. His tem- perament was always nervous. In August, 1890, he came to me complaining of head- ache 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 dim-to] questions did the patient make the following statements FETICHI8M. 227 concerning his sexual life. As far as he could remember, tin- Ix-giiining 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 strongly accentuated erections. Led astray by an- other boy, L. learned to masturbate at the age of seven or eight. "Being of a very excitable nature," said L., "I practised 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 practising 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 com- |i;iiiions 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-fellow impelled him to practise mutual onanism with him. 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 plea- sure. Another early event which L. remembered is inter- esting. One day his favourite companion, N., who prac- tised 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 onan- isra was directly combined with a struggle between both parties, in which N. was always conquered. The struggle was finally ended in N.'s being compelled to allow L. to practice onanisrn on him. L. assured me that this kind of masturbation had given him, as well as N., especial pleas- ure. In this way L. continued to practice masturbation very frequently until his eighteenth year. Warned by a friend, he then Ix-iran to struggle with all his might against this evil habit. He became more and more successful, and 228 PSYCHOPATHIA SEXUALIS. finally, after the first performance of coitus, he stopped the practice of onanism entirely. But this was only ac- complished in his twenty-second year. It now seemed incomprehensible to the patient — and he said he was filled with disgust at the thought — 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 was even unpleasant to him. He had lost all inclination for men, and felt attracted by women exclusively. It must be mentioned, however, that although L. had a decided inclination for the female sex, he presented an abnormal phenomenon. The essential thing in woman that excited him was the sight of her beautiful hands ; L. was far more impressed when he touched a beautiful female hand than he would have been had he seen its possessor in a state of complete nudity. The extent to which L.'s preference for beautiful female hands went 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 con- ceive a deeper interest in the lady, but he was not able even to touch her. L. believed that there was 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, induced the puella to 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. FETICH ISM. The preference for the hand was still so great that the patient had greater pleasure when his genitals were touched l»v it thnt when he performed e<>itus in vaginam. Yet, the patient preferred to perform the latter, because it seen KM 1 to him to be natural, while the former seemed abnormal. The touch of a beautiful female hand on his body imme- diately caused him to have erection; he thought that kiss- ing and other contacts do not exert nearly so strong an influence. It was only of late years that the patient had performed coitus frequently, but it had always been very difficult for him to determine to do it. Moreover, in coitus, he did not find the complete satisfaction he sought. How- ever, when he found himself near a woman whom he would like to possess, sometimes, at mere sight of her, his sexual excitement became so intense that ejaculation resulted. L. said expressly that during this process he did not in- tentionally touch or press his genitajs; ejaculation under such circumstances afforded him much more pleasure than he experienced in actual coitus.1 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 to the normal man. The patient's dreams were of events of his school-days, when, besides the mutual onan- ism described, he had ejaculations whenever he became anxiously excited. When, for example, the teacher dic- tated an extemporaneous exercise, and L. was unable to follow in translation, ejaculation often occurred.1 The pollutions that now occurred occasionally, at night, were 1 Great sexual hypertesthesia. 'This is also seximl hypersesthesia. Any intense excitement affects the sexual sphere (Rinet'a " Dynamogeiiie g4n£rale"). Con- cerning this Dr. Moll communicates the following case: " A similar thing is described by Mr. E., aged twenty-seven; merchant. While at school, and afterward, he often had ejaculation with pleasurable feeling when he was seized with a spell of intense anxiety. Besides, almost every other physical or mental pain exerted a similar influence. E., as he stated, had a normal sexual instinct, but suffered with nervous impotence." 230 PSTCIIOPATHIA SEXUALIS. only accompanied by dreams that had the same or u similar subject — i.e., the events at school just mentioned. On account of his unnatural feeling and sensibility the patient thought he was incapable of loving a woman permanently. Treatment of the patient's perversion was not possible. This case of hand-fetichism certainly does not depend on masochism or sadism, but is to be explained simply on the ground of early indulgence in mutual onanism. Neither is there antipathic 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 that of woman. In hand fetichists, who according to Binet, are numer- ous, 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. 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 foot when covered. This assumption is certainly correct with regard to those who have grown up in large cities, and easily explains the scarcity of foot-fetichism,1 which will be elucidated by the following cases. Case 91. Foot-fetichism. Acquired inverted sexuality. 1 Exceptions are the cases of latent masochism in the form of Koprolagnia in which case the fetichistic stimulus is not to be found in the clean naked foot but e contra, cf. case 8G. FETICH ISM. 231 Mr. X., civil servant, twmt v-nine years of age; mother neuropathic, father diabetic. Had good mental qualities, was of nervous disposition, but never suffered from nervous disease, showed no signs of degeneration. Patient distinctly recalled tiiat even at the age of six he became sexually excited when he saw the naked feet of women, and was impelled to follow them, or watch them when at work. At the age of fourteen he slipped one night into the room where his sister slept and kissed her foot. At the age of eight he began spontaneously to masturbate, think- ing all the while of the naked feet of women. \Vlien sixteen he often took shoes and stockings of servant girls to bed with him; and whilst fingering them excited himself into masturbation. At the age of eighteen he began sexual intercourse with persons of the opposite sex. He had full power, and coitus satisfied him without the aid of a fetich. For males he had not the slightest sexual inclination, neither had the feet of men any attraction for him. At the age of twenty-four a great change came over his sexual feelings and his physical condition. Patient became neurasthenic and began to experience sexual inclination to males. No doubt excessive mastur- bation brought about neurosis and inverted sexuality to which he was led by -libido nimia remaining unsated by coitus, and by the sight (accidental or otherwise) of female As neurasthenia (at first sexualis) increased, a rapid cessation of libido, power and gratification, with regard to women set in. Parallel with this, inclination towards his own sex developed and his fetichism was transferred to males. With the age of twenty-five he had coitus cum muliere but rarely, and without satisfaction. He had lost nearly all interest in the foot of woman. The craving to have sexual intercourse wfth men grew daily stronger. When he was transferred to a large city he found the long- 232 PSYCHOPATIIIA SEXUALI8. wished-for opportunity and actually revelled with intense passion in this unnatural love. He ejaculated during these acts with the utmost volup- tuousness. By-and-by the sight of a sympathetic man, especially if he were barefooted, sufficed him. His nocturnal pollutions had now for their object intercourse with men, and, to be sure, in the fetichistic sense (feet). Shoes did not interest him. The naked foot was his charm. He often felt impelled to follow men in the street, hoping to find occasion for taking off their shoes. As a substitute he went barefooted himself. At times he was driven to walk along the street in his bare feet, thereby experiencing the most intense lustful feelings. If he resisted, agony, trembling, and palpitation of the heart set in. Often at nights he yielded to this impulse for hours, even in stormy, rainy weather, not minding the many risks and personal dangers to which he exposed himself by so doing. He would carry the shoes in his hand, became sexually excited, and only found satisfaction in spontaneous, or induced ejaculation. He felt envious of navvies and the poor who could go barefoot without attracting attention. His happiest moments were the time which he spent in an hydropathic establishment, a la Kneipp, where he was allowed to go barefoot with the other men under treatment. An awkward affair, the result of his perverse sexual practices sobered him. He sought safety from his un- natural sexual existence by consulting a physician who sent him to me. The patient did his utmost to abstain from masturba- tion and perverse connection with men. He underwent treatment for neurasthenia in an hydropathic institute, regained some interest in the gentle sex — his foot-fetich- ism serving as a bridge — had once, with a degree of plea- sure, coitus with a barefooted peasant girl who acceded to his wishes, and later on visited puellas a few times but without gratification. Then he turned again to persons FETICHISM. 233 of his own sex, backslided totally, felt irresistibly drawn to tramps and farm labourers, whom he paid for the favour to kiss their feet. An attempt to rescue the unfor- tunate man by suggestive treatment was wrecked on the impossibility to remove an enervation which was beyond therapeutic aid. Case 92. Fool-fetichism with continued hetero-sex- uality. Mr. Y., fifty years of age, bachelor, belonged to high society. Consulted a physician on account of "ner- vous" troubles. Tainted, from childhood nervous, very sensitive to cold and heat, troubled with delusions which assumed the character of transient dementia persecutoria. For instance, when he sat in a restaurant he imagined that everybody stared at him, talked about, and made fun of him. As soon as he rose this feeling left him and he no longer believed his fancies. He never felt settled for any length of time, and moved about from one place to another. At times it happened that he engaged rooms at a hotel, but never went there on account of his peculiar delusions. He never had much libido. All his sentiments were heterosexual. Now and then he found gratification in coitus which he claimed to have been normal. Y. admitted that his sexual life was peculiar from early youth. Neither women nor men excited him sexually, but the sight of female feet, be they of children or grown- up women, would do so. All other parts of the female body had no attraction for him. If by chance he could see the naked feet of female gipsies or tramps he could gaze at them by the hour and was driven by a "terrible" impulse terere genitalia propria ad pedes illarum. Thus far he had successfully resisted this impulse. What annoyed him most was to see these feet covered with dirt He would like to see them well washed and clean. He could not say how this fetichism originated in him (from a communication of Professor Forel). 234 PSYCHOPATHIA SEXUALIS. Moll in his recent researches in libido sexualis, p. 288, relates a most interesting case -x>f foot-fetichism which resembles case 91 above, in so far as the patient by force of the fetich became homosexual. Shoe-fetichism also finds its place in the following group of dress-fetich ism ; however, on account of its demonstrable masochistic character in the majority of cases, it has been, for the most part, described already above. Besides the eye, hand and foot, the mouth and ear often play the role of a fetich. Among others, Moll (op. cit.) mentions such cases. (Cf. Belot's romance, "La Bouche de Madame X.," which, B. states, rests upon actual ob- servation. ) The following remarkable case comes under my per- sonal observation : — Case 93. A gentleman of very bad heredity con- sulted me concerning impotence that was driving him al- most 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 become fetiches. Case 94. X., twenty-eight years of age; family heavily tainted ; neurasthenic ; want of self-confidence and frequent depression of mind, with fits of suicidal inten- tions, which he had great trouble to ward off. The smallest worries threw him out of temper, and filled him with despair. He was an engineer in a factory in Russian- Poland, a man of robust frame, without signs of degenera- tion. He complained of a peculiar mania, which caused FETICH ISM. him to doubt his sanity. Since his seventeenth year ho became sexually excited at the sight of physical defect* in women, especially lameness and disfigured feet. He was not conscious of the original associative connection be- tween his libido and these defects in women. Ever since puberty he had been under the bane of this fetichism, which was painful to himself. Normal women had no attraction for him. If a woman, however, was afflicted with lameness or with contorted or disfigured feet, she exercised a powerful sensual influence over him, no matter whether she was otherwise pretty or ugly. In his dreams, accompanied by pollutions, the forms of halting women were ever before him. At times he could not resist the temptation to imitate their gait, which caused vehement orgasm, with lustful ejaculation. lie claimed to have strong libido, and suffered intensely when his sexual desire remained unsatisfied. Despite these facts, he had «>ims for the first time when he was twenty-two years of age, and then but five times. He felt, however, not the slightest satisfaction in spite of complete ability. !!•• thought it would cause him intense pleasure if he had the chance to mate with a halting woman. At any rate, be could never marry any other than a lame woman. Since his twentieth year the patient manifested fetich- ism for garments. It often sufficed him to put on female stockings, shoes and drawers. He I* night such wearing apparel at times and, putting it on secretly, became lust- fully excited and ejaculated. Garments which had been worn by women had no attraction for him. He would fain prefer to wear female garb, so as to keep up sensual emotions, but had not yet dared to do so for fear of being detected. His i-lln SCJT nulls was reduced ;<> these practices. He was definite in asserting that In- n»ver was addicted to mas- turbation. Quite recently lie had been, in consequence of his neurasthenic afflictions, much troubled with pollutions. Case 95. Z., gentleman, family tainted. Even iu 236 PSYCHOPATHIA SEXUALI8. early childhood always felt great ..sympathy with the lame and the halt. He used to limp about the room on two brooms in lieu of crutches, or when unobserved, go limping about the streets; but at that time no sexual significance was coupled with the idea. Gradually the thought super- vened that he would like "as a pretty lame child" to meet a pretty girl who would express sympathy with his afflic- tion. Sympathy from men he disdained. Z. was brought up in a rich man's house by a private tutor, and claimed that he was unaware of the difference in sexes up to his twentieth year. His feelings were confined to the idea of being pitied by a pretty girl for being lame, or extending the same sympathy himself to a lame girl. Gradually erotic emotions associated themselves with this fancy and at the age of twenty he succumbed to a temptation and masturbated for the first time. This act he practised henceforth very often. Neurasthenia sexualis supervened and an irritable weakness took hold of him to such an extent that the very sight of a girl with a halting gait induced ejaculation. When masturbating, or in his erotic dreams, the idea of the limping girl was always the con- trolling element. The personality of the halting girl was a matter of indifference to Z., his interest being solely centered in the limping foot. He never had coitus with a girl thus afflicted. He never felt an inclination for doing so and did not think he could be potent under the circum- stances. His perverse fancies only revolved around mas- turbation against the foot of a halting female. At times he anchored his hope on the thought that he might succeed in winning and marrying a chaste lame girl, that, on ac- count of his love for her, she would take pity on him and free him of his crime by "transferring his love from the soul of her foot to the foot of her soul." He sought de- liverance in this thought. His present existence was one of untold misery. Case 96. Mr. V., thirty years, civil servant ; parents neuropathic. Since his seventh year he had for a play- mate a lame girl of the same age. FETICH ISM. 237 At the age of twelve, being of a nervous disposition and hyporsexually inclined, the boy began spontaneously to masturbate. At that period puberty set in, and it lies beyond doubt that the first sexual emotions towards the other sex were coincident with the sight of the lame girl. For ever after only halting women excited him sexu- ally. His fetich was a pretty lady who, like the companion of his childhood, limped with the left foot Always heterosexual but abnormally sensual he sought early relations with the opposite sex, but was absolutely impotent with women who were not lame. Virility and gratification were most strongly elicited if the puella limped with the left foot, but he was successful also if the lameness was in the right foot. As, in consequence of his fetichism the opportunities for coitus occurred but seldom, he resorted to masturbation, but found it a dis- gusting and miserable substitute. His sexual anomaly rendered him very unhappy, and he was often near com- mitting suicide, but regard for his parents prevented him. This moral affliction culminated in the desire for marriage with a sympathetic lame lady, but since he could not love the soul of such a wife, but only her defect of lameness, he considered such a union a profanation of matrimony and an unbearable, ignoble existence. On this account he had often thought of resignation and castration. When V. came to me for advice I obtained, in my examination of him, only negative results as regards signs of degeneration, nervous disease, etc. I enlightened the patient on the subject, and told him that it was difficult, if not absolutely impossible, for medical science to obliterate a fetichism so deeply rooted by old associations, but expressed the hope that if he made a limping maid happy in wedlock he himself would find happiness also. Descartes, who himself ("Traite des Passions," cxxxvi.) expresses some opinions concerning the origin of 238 PSYCHOPATUIA SEXUALIS. peculiar affections in associations of ideas, was alwavA partial to cross-eyed women, because the object of his first love had such a defect (Binet, op. cit.). Lydston ("A Lecture on Sexual Perversion," Chicago, 1890) reports the case of a man who had a love affair with a woman whose right lower extremity had been am- putated. After separation from her he searched for other women with a like defect A negative fetich! A peculiar variety of body fetichism may be found in the following case (strongly complicated with sadistic ele- ments), in which fine white virgin skin is the fetich, and sadism leads to lustful acts of cruelty (as an equivalent to coitus), even to anthropophagy (cf. p. 95 ei seq.), for which the deeply degenerated and probably epileptic pa- tient seeks to find a substitute in automutilation and auto- phagy. Case 97. L., labourer, was arrested because he had cut a large piece of skin from his left forearm with a pair of scissors in a public park. He confessed that for a long time he had been craving to eat a piece of the fine white skin of amaiden, and that for this purpose he had been lying in wait for such a vic- tim with a pair of scissors ; but, as he had been unsuccess- ful, he desisted from his purpose and instead had cut his own skin. His father was an epileptic, and his sister was an imbe- cile. Tip to his seventeenth year he suffered from enuresis nociuma, was dreaded by everybody on account of his rough and irascible nature, and dismissed from school because of his insubordination and viciousness. He began onanism at an early age, and read with preference pious books. His character showed traits of superstition, proneness to the mystic, and showy acts of devotion. When thirteen his lustful anomaly awoke at the sight of a beautiful young girl who had a fine white skin. The impulse to bite off a piece of that skin and eat it became ntnciiiBic. 239 paramount with him. Xo other parts of the female body excited lam. He nrv< -r had any desire for sexual inter- course, and never attempted such. Hi hoped to achieve his end easier with the aid of scissors than with his teeth, for which reason he always carried a pair with him for years. On several occasions his efforts were nearly successful. Since the previous year he found it most difficult to bear his failures any longer, when he decided upon a substitute — viz., each time when he had unsuccessfully pursued a girl he would cut a piece of skin from his own arm, thigh or abdomen and 'eat it. Imagining that it was a piece of the skin of the girl whom he had pursued, he would whilst masticating his own skin obtain orgasm and ejaculation. Many extensive and deep wounds and numerous scars were found on his body. During the act of self-mutilation, and for a long time afterwards, he suffered severe pains, but they were over- compensated by the lustful feelings which he experienced whilst eating the raw flesh, especially if the latter dripped with blood, and when he succeeded in his illusion that it was cutis virginis. The mere sight of a knife or scissors sufficed to provoke this perverse impulse, which threw him into a state of anxiety, accompanied by profuse per- spiration, vertigo, palpitation of the heart, craving for cutis femince. lie must, with scissors in hand, follow the woman that attracted him, but he did not lose conscious- ness or self-control, for at the acme of the crisis he took from his own what was denied him from the body of the girl. During the whole crisis he had erection and orgasm, and at the very moment when he began to chew the piece of his skin ejaculation set in. After that he felt greatly relieved and comforted. L. was quite conscious of the pathological aspect of his condition. Of course, this dangerous character was sent to an insane asylum, where he attempted suicide (Magnan "Psychiatrische Vorlesungen"). An interesting category is formed by the hair-fetich- 240 PSYCHCWATHIA SEXUALIS. ists. The transition from "admirer of woman's hair" within physiological limits to pathological fetichism is easy. The beginning of the pathological series is formed by those cases in which the hair of a woman simply makes a sensual impression and incites to cohabitation. Then fol- low those in which virility is only possible with a woman who possesses this individual fetich. Possibly various senses (sight, smell, hearing, crepitant sounds, also touch as with velvet- and silk-fetichists, vide infra) are drawn into activity in this hair-fetichism as they receive lustful impulses. The end of the series is formed by those whom the hair of woman suffices even when severed from the body — so to speak, no longer a part of the living body, but only matter, even a mercantile article — to excite libido and sensual gratification by way of physical or psychical onan- ism, eventually under contact of the genitals with the fetich.1 An interesting instance of a hair-fetichist belong- ing to the second category is related by Dr. Gemy, under the title of "Historic des peruques aphrodisiaques," in "La Medecine Internationale," September, 1894. Case 98. A lady told Dr. Gemy that in the bridal night and in the night following her husband contented himself with kissing her, and running his fingers through the wealth of her tresses. He then fell asleep. In the third night Mr. X. produced an immense wig, with enormously long hair, and begged his wife to put it on. As soon as she had done so, he richly compensated her for his neglected marital duties. In the morning he showed again extreme tenderness, whilst he caressed the wig. When Mrs. X. re- moved the wig she lost at once all charm for her husband. l Gamier ( Sadi-fetichism, Annal. d'hyg.) knew a degenerate whose fetich was the hair of the Mons Veneris. His greatest delight was to tear them out with his teeth. He collected specimens and used them for renewed sexual gratification by biting and chewing them. He bribed housemaids of hotels to let him search the beds in which ladies had slept for such hairs. Whilst searching for them he be- came erotically excited and trembled with happiness when he made a successful find. FETICIIIBM. 241 Mrs. X. recognised this as a hobby, and readily yielded to the wishes of her husband, whom she loved dearly, and whose libido depended on the wearing of the wig. It was remarkable, however, that a wig had the desired effect only for a fortnight or three weeks at a time. It had to be made of thick, long hair, no matter of what colour. The result of this marriage was, after five years, two children, and a collection of seventy-two wigs. The following case, observed by Magnan and reported by Thoinot (op. cit. p. 419), is that of a man with anti- pathic sexual instinct, to whom the actual existence of the fetich was a conditio sine qua non of potency. Case 99. X., aged twenty, inverted sexually. Only loved men with a large bushy mustache. One day he met a man who answered his ideal. He invited him to his home, but was unspeakably disappointed when this man removed an artificial mustache. Only when the vis- itor put the ornament on the upper lip again, he exercised his charm over X. once more and restored him to the full possession of virility. In those cases in which the female hair as mere mat- ter possesses the properties of a fetich, it not uncom- monly happens that the fetichist seeks to possess himself of woman's hair by unlawful acts. • These form the group of hair-deepoilers, of no slight importance from the foren- sic aspect.1 Case 100. A hair-despoiler. P., aged forty, artistic, locksmith, single. His father was temporarily insane, and his mother was very nervous. He was well de- veloped and intelligent, but was early affected with tic and delusions. He had never masturbated. He loved 1 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 Midlists, for in a few cases such acts are done for the purpose of gain — i. e.t the stolen hair is not a fetich. 16 242 PSYCHOPATHIA SEXUAL1S. platonically, and often busied himself with matrimonial plans. He had coitus with prostitutes but rarely, and 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 forc- ibly cut off a young girl's hair. He was arrested with the hair in his hand and a pair of scissors 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, as- sorted in packets. P. had already been once arrested, on 15th December, 1886, under similar circumstances, but was released for lack of evidence. P. stated that, for the last three years, when he was alone in his room at night, he felt ill, anxious, excited and dizzy, and then was 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 sexual pleasure, became more and more powerful in him. He wondered that previously, even in the most intimate inter- course 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 sensuous 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 yracuisM. 243 end, he felt himself possessed by a supernatural power and unable to give up his booty. If he could not attain tin- object of his desire, ho became greatly depressed, hurried IK .mo, and there revelled in his collection of hair. II*- combed and fondled it, and thus had intense orgasm, satisfying himself by masturbation. Hair exposed in tin; show-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 was in such a state of ex* <-i i finent that he had only imperfect apperception and subsequent recollection of what he had done. When he touched the hair with the scissors he had erection, and, at the instant of cutting it off, ejaculation. Since his mis- fortune, about three years ago, he had weakness of mem- ory, was easily exhausted mentally, and troubled by sleep- lessness and night-terrors. P. deeply regretted 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 heredi- tarily 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 over- powering abnormal sexual feeling. Pardon; asylum for insane (Voisin, Socquet, Motet, "Annales d'hygiene," April, 1890). Following this case is a similar one, which also de- serves attention, for it has been well studied, and may be called almost classical ; and it places also the fetich, as well as the original associative awakening of the idea, in a clear light 244 PSYCHOPATHIA BEXUALIS. Case 101. A hair-despoilcr, E., aged twenty-five. Maternal aunt, epileptic; brother had convulsions. Was fairly healthy as a child, and learned quite easily. At the age of fifteen he had an erotic feeling of pleasure, with erection, at the sight of one of the village beauties combing her hair. Until that time persons of the oppo- site 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 ever excited him in- tensely. 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 in the army. During this time hair was not dangerous for him, because not very accessible; but he dreamed sometimes of female heads with the hair braided or flowing. Occasional coitus with women, but without their hair being effective as a fetich. Once more in Paris, he again dreamed as beforej 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 mas- turbation. 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 twenty-five 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. After spending some time in the asylum, he improved so far that female hair no longer excited him. Set at liberty, ho thought of going to his native place, where the women wear their hair done up (Magnan, "Archiv. de 1'anthro- pol. criminelle," v., No. 28). A third case is the following, which is likewise suited to illustrate the psychopathic nature of such phenomena; FETICHI8M. and the remarkable means which induced a cure are worthy of note: — Case 102. Hair-fetichism. Mr. X., between thirty and fortv \vars old; of the higher class of society; single. Came of a healthy family, but from childhood had been nervous, vacillating and peculiar; since his eighth year he had 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. lie allowed this quietly, because this girl's hair pleased him so well. When about ten years old, he began to have erotic feelings at the sight of female hair that pleased him. Gradually these feelings occurred spontaneously, and memory-pictures of girl's hair were always immediately associated with them. At the age of eleven he was taught to masturbate by school-mates. The associative connec- tion of sexual feelings and a fetichistic idea were already established, and always appeared when the patient in- dulged in evil practices with his companions. With ad- vancing years, the fetich grew more and more powerful. Even false hair began to excite him, but he always pre- ferred 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 mas- turbated. After his fourteenth year he became so power- fully 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 ex- perienced intense desire to kiss such hair, particularly to suck it. To touch such hair afforded him but little sat- isfaction ; 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 toedium vitce. Then he would attempt to re- lieve himself, imagining fantastic "hair-adventures" and 246 I'SYCliOPATIlIA SEXUALIS. masturbating. Not infrequently, in the street and in crowds, he could not keep from imprinting a kiss on ladies' heads, lie 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, lie 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 him- self in coitus with puellis. lie induced powerful erection by kissing their tresses, but could not induce ejaculation, and coitus did not satisfy him. At the same time, his favourite idea was coitus with kissing of hair; but even this did not satisfy him, because it did not induce ejacu- lation. 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 Aineri- FETICH IBM. 2 1 7 can new-papers, several cities in the United States were tr<>ul>lrj 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 recognised. Culture and fashion have, to a certain extent, endowed woman with artificial sexual characteristics, the removal of which, when woman is seen unattired, in spite of the normal sexual effect of this sight, may exert an opposite influence.1 It should not be overlooked that female dress often shows a tendency to emphasise and exaggerate certain sexual peculiarities, — secondary sexual characteristics (bosom, waist, hips). In most individuals the sexual instinct awakes long before there is any possi- bility or opportunity of intimate intercourse, and the early desires of youth are concerned with the ordinary appear- ance 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 rts attain to a normal /•//f a unman as she exposed In T charms by raiding her skirts in wet weather. The obscure instin.-t, not yet conscious of its object, then became directed to the wet garments, ' as in other Lovers of female handkerchiefs are frequent, and, therefore, important forensically. As to the frequency «>f handkerchief -fetichism, it may be remarked that the handkerchief is the one article of feminine attire which, outside of intimate association, is most frequently dis- playi •(!, and which, with its warmth from the person and specific odours, may by accident fall into the hands of rs. The frequency of early association of lustful feel- ings 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 110. A baker's assistant, aged thirty-two, sin- ^|f, previously of good repute, was discovered stealing a handkerchief from a lady. In sincere remorse, he con- fessed that he had stolen from eighty to ninety such hand- kerchiefs. He had cared only for handkerchiefs, and, indeed, only for those belonging to young women attractive to him. In his outward appearance the culprit presented nothing peculiar. He dressed himself with much taste. His conduct was peculiar, anxious, depressed and unman- ly, and lie often lapsed into whining and tears. Lack of self-reliance, weakness of comprehension, and slowness of ••ption and reflection were noticeable. One of his sis- ters was epileptic. He lived in good circumstances ; never had a severe1 illness; was well developed. In relating his history, he showed weakness of memory and lack of clear- ness ; calculation was hard for him, though when young he learned and comprehended easily. His anxious, uncertain <>f mind gave rise to a suspicion of onanism. The culprit confessed that he had been given to this practice >sively since his nineteenth year. For some years, as 256 PSYCHOPATHIA SEXUALIS. a result of his vice, he had suffered with depression, lassi- tude, trembling of the limbs, pain, in the back, and disincli- nation 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 sex- ual intercourse with women, and could not bring himself to indulge in it. Of late, however, he had thought of mar- riage. With great remorse and in a weak-minded way, he now confessed that six months ago, 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 cceundi, 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 resist the impulse. During the act he was uneasy, 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 mas- turbation, and referred the abnormal impulses to a per- verse sexual impulse, calling attention to the presence of an interesting and well-known physiological connection between olfactory and sexual senses. The inability to resist the pathological impulse was recognised. X. was not punished (Zippe, "Wiener Med. Wochenschrift," 1879, No. 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, 446 ladies' handkerchiefs FETICIII8M. 257 were found. I !<• stated that In- had avready burned two bundles of them. In the course of tin examination, it was further shown that X. had been punished with im- prisonment for fourteen days in 1883 for stealing twenty- D handkerchiefs, and aguin 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 an imbecile and constitutionally neuro- pathic. X. had married in 1879, and embarked in an independent business, and in 1881 he made an assign- ment Soon af ^er 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 said he had been sexually excited by the sight of handkerchiefs belonging to women since puberty. He could not recall the exact cir- cumstances of this fetichistic association. The sexual excitement occasioned by the sight of a lady with » handkerchief hanging out of her pocket had constantly increased. This had repeatedly caused erection, but nevef ejaculation. After his twenty-first year, he said, 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 been. In the act he had true orgasm. If he could not gain possession of the handkerchief he 17 258 PSYCIIOPATIIIA 8EXUALIS. desired, he would become painfully excited, tremble ant! sweat all over. He kept separate the handkerchiefs of ladies particularly pleasing to him, and revelled in tlr> sight of them, taking great pleasure in it. The odour of them also gave him great delight, though he states that it was really the odour peculiar .to the linen, and not the perfume, which excited him sensually. He had mastur- bated but very seldom. X. complained of no physical ailments except occa- sional 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 were mild neurasthenic symptoms, anomalies of the distri- bution of blood, and unequal pupils. It was proved that X. had committed his crimes in obedience to an abnormal, irresistible impulse. Pardon. Case 111. Z. began *o masturbate at the age of twelve. From that time he could not see a woman's handkerchief without having orgasm and ejaculation. He was irresistibly compelled to possess himself of it. At that time he was a choir boy and used the handkerchiefs to masturbate with in the bell-tower close to the choir. But he chose only such handkerchiefs as had black and white borders or violet stripes running through them. At fifteen he had coitus. Later on he married. As a rule, he was only potent when he wound such a handkerchief around his penis. Often he preferred coitus inter femora femince where he had placed a handkerchief. Wherever he espied a handkerchief he did not rest until he came in possession of it. He always had a number of them in his pockets and around his genitals (Rayneau, annales medico- psychol., 1895). Such cases of handkerchief-fetichism, where an abnor- mal individual is driven to theft, are very numerous. They also occur in combination with inverted sexuality, as is FETICHI8M. 259 proved l>y the following ca^c, which I borrow from page ' of Dr. Moll's frequently cit«l work: — * Case 112. Handkerchief- fclichism in a case of an- tijxiilii'- srj-iinl instinct. K., agod thirty-eight; mechanic; a powerfully built man. He made numerous com- plaints, — weakness of the legs, pain in the back, headache, want of pleasure in work, etc. The complaints gave the decided impression of neurasthenia with tendency to hypochondria. Only after the patient had been under Dr. Moll's treatment for 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 Dr. Moll. He had never practised 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 role. The handkerchiefs of handsome men particularly excited him sexually. His greatest delight was to masturbate in men's handkerchiefs. For this reason he often took his friends* handkerchiefs. In order to save himself from detection, he always left one of his own handkerchiefs with his friends 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 that handkerchiefs did. •On page 1y. He Ix-^jin 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 j »en is witli her shoes, and thus ejaculation with great lust- ful feeling was immediately induced. After separation from the governess he went to puellas, whom he made ••rni the same manipulation. This was usually suffi- cient for satisfaction. Only seldom did he resort to coitus 262 PSYCHOPATHIA SEXUALJS. 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 role; and of gratifica- tion with women's shoes appositos 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 became accessory: a prostitute's shoe that was elegant and chic; starched petticoats, and black hose, if possible. Nothing else in woman interested him. Pie was absolutely indiffer- ent to the naked foot. Women have not the slightest psy- chic 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 over him that when he saw a lady in 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 this state of severe neurasthenia. Shoes displayed in shops, and, of late, even advertise- ments 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 recognised 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 fol- lowed the advice of the physicians. He was cruelly dis- appointed in the hope which the authority of the physi- cians 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 FETIC1II8M. 263 prostitute with the required chic. lie 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 ejacu- lated tardily, for he had to force himself to coitus; and after a few weeks this artifice failed, because his imagina- tion failed. lie felt unspeakably miserable, and would have preferred to make an end of himself. lie 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. lie 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 ejacula- tion would occur immediately. In absolute despair, the patient came for consultation. He deeply regretted that, against his inner conviction, he had followed the un- fortunate 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 pre- sented no remarkable symptoms*. Genitals perfectly nor- mal. Prostate somewhat large. 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 criven up to such ideas. When he was on his estate, he often suddenly had to go a distance 264 P8YCHOPATHIA SEXUALIS. of ten. miles to the city, to satisfy his fetichism at shoe- shops 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, proved abortive on account of the mental excitement of the unfortunate man, who was exclusively controlled by the thought that he had made his wife un- happy. Case 114. X., aged twenty-four, from a badly taint- ed family (mother's brother and grandfather insane, one sister epileptic, another sister subject to migraine, parents of excitable temperament). During dentition he had convulsions. At the age of seven he was taught to mas- turbate by a servant-girl. X. first experienced pleasure in these manipulations cum ilia puella fortuito pede calce- olo tecto penem tetigit. Thus, in the predisposed boy, an association was established, as a result of which, from that time on, merely the sight of a woman's shoes, and, finally, merely the idea of them, sufficed to induce sexual excite- ment and erection. He now masturbated while looking at women's shoes, or while calling them up in imagination. The shoes of the schoolmistress excited him intensely, and in general he was affected by shoes that were partly con- cealed 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 revelled in the memory of shoe-scenes with his former school-mistress, and thus had erections, orgasms, 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. FETICH ISM. 205 else in a woman could excite him; the thought itus filled him with horror. Men did not interest him in any way. At the age of eighteen he opened a shop, and, among other things, dealt in ladies' shoes. He was »-.\rit» •y pollutions On account of his natural shyne.-s lie did not resort to coitus until later in life, and then he could only succeed in it with a woman • ••I in silk. He much preferred to mix with crowds in the street and there t<»uch the silk gowns of ladies, which always produced ejaculation accompanied by powerful -in.- and intense lustful feelings. What gratified him more than Ix-ing with the prettiest woman was to put on a silk petticoat when going to bed. The forensic medical opinion declared him to be a heavily tainted subject who gave way to abnormal desires under the strain of morbid impulses. Pardon (Dr. Gamier, "Annales d'hygiene publique," 3e serie, xxix., 5). The following case of kid-glove- fetichism is peculiarly adapted to show the origin of fetichistic associations as well as the enormous influence permanently exercised by such an association, although itself based upon a psychico- physical and morbid predisposition. Case 122. Mr. Z., an American, thirty-three years of age, manufacturer, for eight years enjoying a happy married life, blessed with offspring; consulted me for a peculiar troublesome glove-fetichism. He despised him- self on account of it, and said it brought him well nigh to the verge of despair and even insanity. He claimed to come of thoroughly sound parents, but since infancy had been neuropathic and very excitable. By nature he was very sensual, whilst his wife was very frigid. At the age of nine, he was seduced by schoolmates to practise masturbation, which gratified him immensely, and he yielded to it with passion. One day when sexually excited he found a small bag of chamois skin, lie stripped it over his membrum and experienced thereby great sensual pleasure. After that 278 PSYCHOPATHIA SEXUALI8. he used it for onanistic manipulations, put it around his scrotum and carried it about with him day and night. This aroused in him an unusual interest for leather in general, but particularly for kid gloves. With puberty this centered entirely in ladies' kid gloves, which simply fascinated him. If he touched his penis with one such glove it produced erection and even ejaculation. Men's gloves did not excite him in the least, although he loved to wear them. In consequence, nothing about woman attracted him but her kid gloves. These were his fetich. They must be long, with many buttons, and if worn out, dirty and saturated with perspiration at the finger-tips, they were preferable. Women wearing such, even if ugly and old, had a particular charm for him. Ladies with silk, or cotton gloves did not attract him. He always looked at her gloves first when meeting a lady. As for the rest he took very little interest in the female sex. When he could shake hands with a lady gloved with kid, the contact with the soft, warm leather would cause erection and orgasm in him. Whenever he could get hold of such a glove he would at once retire to a lavatory, wrap it around his genitals and masturbate. Later on when visiting brothels he would beg the puella to put on long gloves provided by himself for that purpose, which act alone would excite him so much that ejaculation ensued forthwith. Z. became a collector of ladies' kid gloves. He would hide away hundreds of pairs in various places. These he would count and gloat over in his spare time, "as a miser would over his gold," place them over his genitals, bury his face in a pile of them, put one on his hand and then masturbate. This gave him more intense pleasure than coitus. He made covers for his penis of them, or suspensories, wearing them for days. He preferred black, soft leather^ FETICHISM. 279 He would fasten ladies' kid gloves around his waist in such a fashion that they would, apron-like, hang down over his genitals. After marriage this fetichism grew worse. As a rule he was only virile when he put a pair of his wife's gloves during coitus by her head so that he could kiss them. The acme of pleasure was when he could persuade his wife to put on kid gloves and thus touch his genitals previous to cohabitation. Z. felt very unhappy on account of this fetichism, and made repeated but vain attempts to free himself of the curse. Whenever he came across the word, or the picture of a glove in novels, fashion-plates, advertisements, etc., he was simply fascinated. At the theatre his eyes were riveted on the hands of the actresses. He could scarcely tear himself away from the show-windows of glove-dealers. He often would stuff long gloves with wool or some such material to make them resemble arms and hands. Then he would make tritus membri inter brachia talia arti- ficialia, until he had achieved his object. It was his habit to take ladies' kid gloves to bed with him and wrap them around his penis until he could feel them like a large leathern priapus between his legs. In the larger towns he bought from the cleaners ladies* gloves which had not been called for, but preferred those most soiled and worn. Twice he admitted to have yielded to the temptation to steal such gloves, although in every other respect he was absolutely correct. When in a crowd he must touch ladies' hands whenever possible. At his office he allowed no opportunity to pass without shaking hands with ladies, in order to fool for "at least a second the soft, warm leather". His wife must wear as much as possible kid gloves or such made v£ <-^o.m* desk. Not an hour passed in which he did not toucB 280 PSYCHOPATHIA SEXUALI8. and stroke them. When especially excited (sexually) he put such a glove in his mouth and chewed it. Other articles of the female toilet, likewise other parts of the female body besides the hand, did not attract him. Z. felt much depressed about this anomaly. He felt ashamed to look into the innocent eyes of his children, and prayed God to protect them from this curse of their father. The object of fetichism may also be found in a thing which only by sheer accident stands in relation to the body of woman, as may be gathered from the following instance related by Moll. It proves, moreover, how by the merely accidental association of an apperception with a parallel sexual emotion — based, of course, upon a special psychic process — the object of such apperception may become a fetich which in its turn may some day disappear again. The theory of association in connection with original perverse manifestations (based on organo-psychical mo- tives) seems here quite acceptable. The same may be said of the data relating to masochism and sadism. Case 123. B., thirty years of age, apparently un- tainted, refined and sensitive ; great lover of flowers ; liked to kiss them, but without any sensual motive or sensual excitement ; rather of natura frigida; did not before twen- ty-one practise onanism, and subsequently only at periods. When twenty-one he was introduced to a young lady who wore some large roses on her bosom. Ever since then large roses dominated over his sexual feelings. He in- cessantly bought roses; kissing them would produce erec- tion. He took them to bed with him although he never touched his genitals with them. His pollutions henceforth were accompanied by dreams of roses. He would dream of roses of fairy-like beauty and, inhaling their fragrance, have ejaculation. He became secretly engaged to his "lady of roses," but the platonic relations grew colder, and when the .' III8M. 281 engagement was broken off tlio rose-fetirlii.-m suddenly ami prniianrntly 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, — abnormally 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 exhibit more or less a reflex spinal character. The existence of innocence, or of sexual neutrality, is the more remarkable, since very early in education, employ- ment, dress, etc., the child undergoes a differentiation from children of the opposite sex. These impressions remain, however, devoid of psychical significance, because they apparently are stripped of sexual meaning ; 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 differen- tiation of form belonging to each sex, which goes hand in hand with it (in the boy as well as in the girl), rudi- Jments of a mental fppling ftf>rrp?pnmling with the sex jure developed ; jind in this of c"iir-e, education and external influences in p-neral have a powerful .-tTecr upon the individual, who now begins to observe. If the sexual development is normal and undisturbed, a definite character, corresponding with the sex, is devel- 284 PSYCHOPATIIIA 8EXUALI8. oped. Certain well-defined inclinations and reactions in intercourse with persons of the opposite sex arise; and it is psychologically worthy of note with what relative rapidity each individual psychical type corresponding with the sex is evolved. While modesty, for instance, during childhood, is essentially but an uncomprehended and incomprehensible exaction of education and imitation, expressed but im- perfectly in the innocence and naivete of the child; in the youth and maiden it becomes an imperative require- ment of self-respect; and, if in any way it is offended, intense vaso-motor reaction (blushing) and psychical emotions are induced. If the original constitution is favourable and normal, and factors injurious to the psycho-sexual development exercise no adverse influence, then a psycho-sexual \ personality is developed which is so unchangeable and ! corresponds so completely and harmoniously with the sex / of the individual in question, that subsequent loss of the generative organs (as by castration), or the climacterium or senility, cannot essentially alter it. This, however, must not be taken as a declaration that the castrated man or woman, the youth and the aged man, the maiden and the matron, the impotent and the potent man, do not differ essentially from each other ill their psychical existence. An interesting and important question for what follows is, whether the peripheral influences of the generative fglands (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, have a great influence on physical and psycho-sexual development, so that the latter is stunted and assumes a type more closely resembling the opposite sex (eunuchs, certain viragoes, etc.), betokens their great importance in this respect. That the physical processes taking place in the genital ANTIPATHIC SEXUALITY. 285 organs are only co-operative, and not the exclusive factors, in the process of development of the psycho-sexual char- acter, 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 anom- aly of central conditions, — in an abnormal psycho-sexual constitution. This constitution, as far as its anatomical and functional foundation is concerned, is as yet unknown. Since, in nearly all such cases, the individual tainted with antipathic sexual instinct displays a neuropathic predispo- sition 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 inverted sexuality appears spontaneously, without external cause, with the development of sexual life, as an individual manifestation \of an abnormal form of the vita sexualis, having the force of a congenital phenomenon ; or it develops iipon a sexuality the beginning of which was normal, as a result of very definite injurious influences, and thus appears as an ac- quired anomaly. Upon what conditions this enigmatical phenomenon of acquired homo-sexual instinct depends, remains still unexplained, and is a mere matter of hypo- thesis. 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 any rate, bi-sexuality, which, for its manifestation, re- quires the influence of accidental exciting causes to rouse it from its dormant state. In so-called antipathic sexual instinct there are degrees of the phenomenon which quite correspond with the de- grees 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 286 PSYCHOPATHIA SEXUAIIS. cases, the whole psychical personality, and even the bodily sensations, are transformed so as to correspond with the sexual inversion; 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 accord- ance with these clinical facts. A. Homo-sexual Feeling as an Acquired Manifestation in Both Sexes. The determining factor 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, without being dependent upon perversion, often come under observation. This is. espe- cially true with reference to sexual acts between persons of the same sex, particularly in pederasty. Here paroes- thesia sexualis is not necessarily at work; but hyperaes- thesia, with physical or psychical impossibility for natural sexual satisfaction. Thus we find homo - sexual intercourse in impotent masturbators or debauchees, or faute de mieux in sensual men and women under imprisonment, on ship-board, in garrisons, bagnios, boarding-schools, etc. There is an immediate return to normal sexual inter- course as soon as the 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, HOMO-SEXUAL FEELING IN BOTH SEXES. 287 thus (Irjirnvcd, reaches the age of maturity, there is wanting in liiiu that aesthetic, ideal, pure and free impulse which draws the opposite sexes together. The glow of sensual sensibility wanes, and the inclination toward the opposite sex is weakened. This defect influences the morals, the character, fancy, feeling and instinct of tho youthful masturbator, male or female, in an unfavourable manner, even causing, under certain circumstances, the desire for the opposite sex to sink to nil; so that masturba- tion is preferred to the natural mode of satisfaction. Sometimes the development of the nobler sexual feel- ings toward the opposite sex suffers, on account of hypo- chrondriacal fear of infection in sexual intercourse; or on account of an actual infection ; or as a result of a faulty education which points out such dangers and exaggerates them. Again (especially in females), fear of the result of coituj^Jj^regmmfiy), or abhorrence of men, by reason of physical or moral defects, may direct into perverse chan- inels an instinct that makes itself felt with abnormal in- tensity. On the other hand, premature 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, etc.), while, at the same time, it maintains imagin- ation and libido in continuous excitement. Almost every masturbator at last reaches a point \vhere, 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 sexnalis. The moral and mental conditions are here the most unfavourable possible. The pure glow of sexual feeling is destroyed ; the fire of sexual instinct is wanting, and self- confidence is lost ; 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 288 PSYCHOPATH 1 A SKXUALIS. eensual feeling, or he is lacking in the physical strength necessary to accomplish the act. This fiasco has a fatal effect, and leads to absolute psychical impotence. A bad conscience and the memory of past failures prevent suc- cess in any further attempts. The ever present libido sexualis, however, demands satisfaction, and this moral and mental perversion separates further and further from woman. For various reasons, however, (neurasthenic complaints, hypochondriacal fear of results, etc.), the individual is also kept from masturbation. At times, under such cir- cumstances, bestiality is resorted to. Intercourse with the same sex is then near at hand, — as the result of seduction or of the feelings of friendship which, on the level of patho- logical sexuality, easily associate themselves with sexual feelings. Passive and mutual onanism now become the equivalent of the avoided act. If there is a seducer, — which, un- fortunately often happens, — then the cultivated pederast is produced, — i.e., a man who performs quasi acts of onan- ism with persons of his own sex, and, at the same time, feels and prefers himself in an active role corresponding with his real sex; who is mentally indifferent not only to persons of the opposite sex, but also to those of his own. Sexual aberration reaches this degree in the normally constituted, untainted, mentally healthy individual. No case has yet been demonstrated in which perversity has been transformed into perversion — i.e., into an inversion of the sexual instinct.1 1 Gamier ("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 unfaith- fulness 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 waa 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 ever so much like a female, HOMO-SEXUAL FEELING 1 289 With l\ ma.-turhation, abstinence, or other Gradually, in contact with persons of the same sex, sexual excitation by them is induced. Related ideas are coloured with lustful feelings, and awaken corresponding desires. This decidedly degenerate reaction is the begin- ning of a process, of physical and mental transformation, a description <>f which is attempted in what follows, and which is one of the most interesting psychological phenom- ena that have been observed. This metamorphosis pre- sents different stages, or degrees. 1. Degree: Simple Reversal of Sexual Feeling. This degree is attained when a person exercises an \aphrodisiac effect over another person of the same sex 'who reciprocates the sexual feeling. Character and in- Btinct, however, still correspond with the sex of the indi- and a female like a male, but they will not become homo-sexual. The natural disposition is the determining condition; not education nn>l oth-r mSndcntal circumstances, I :•'.<• m ut 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, a ixl 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 Mtting and standing increased, and which was made worse by catching cold. But I had no suspicion what- ever 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 deport- ment, 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; per- haps, also, I seemed to myself, on account of my uncom- monly white skin, more like that of a girl. The skin of my face and hands, particularly, was very sensitive. Girls liked my society; and, though I should have pre- ferred to have been with them constantly, I avoided them when I could ; for I had to exaggerate in order not to ap- pear feminine. In my heart I always envied them. I was particularly envious when one of my young girl friends got l"ii<: 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 should 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. While 308 PSYCHOPATHIA SEXUALIS. 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 envi- ous, and only too gladly would have put myself in her place in the beautiful garments and lovely form. Never- theless, 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 petti- coats. 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 practised 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 im- pressed 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 runno mutatum maluisse. To her astonish- ment, the girl had to treat me as a girl, and did it will- ingly; but she treated me as if I were she (she was still HOMO-SEXUAL FKELINO IN BOTII SEXES. 309 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 at- tempted suicide. Without any cause I once did not sleep for 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 bragga- docio when it was necessary. I soon overcame my aversion to foul odours and blood, and even liked them. Only some things I could not look at without nausea. I was want- ing 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, 310 PSYC1IOPAT11IA SEXUALIS. 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 ever made, 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 satis- fied 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 him- self 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 t^vo ye»rs were child- MO-SEXUAL FEELING IN BOTH SEXES. 311 leas. After a difficult pregnancy, during which time I lay at the point of death in the enemy's own country, my wife gave birth to our first boy in a difficult labour, — a boy still afflicted with a melancholy nature. Then came a second, who is very quiet; a third, full of peculiarities; a fourth, a fifth; and all have the predisposition to neuras- thenia. 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 endure. I studied and operated; and I experimented with many drugs and methods of cure, always on myself. I left the regulation of the house t<> 1 1 iv \\ife, as she understood housekeeping 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 also difficult for mo. I should have much preferred to have the other role. When I had to deliver my wife, it almost hroke 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 anaemic 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 dia- phragm 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, con.-tant pain in the back, and the like. Yet, with the strength of despair, I fought against these com- plaints, which impressed me as being female or effeminate, until three years ago, when a severe attack of arthritis completely broke me down. "lint In-fore this terrible attack of gout occurred, in lir, to lessen the pain of gout, T had taken hot baths, ;i> near the temperature of the Ixuly as possible. On one of tl i-ion< it happened that I suddenly changed, and seemed to be near death. I sprang with all my 312 rSYCIIOPATHIA SEXUALIS. remaining strength out of the bath ; I had felt exactly like a woman with libido. This happened 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 hashish poison- ing. 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 potato instead of a head; my wife had the full moon on her thorax. 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 com- pletely changed into a woman; and when, on standing and walking, I felt vulva and mammas I When at last I raised myself out of bed, I felt that a complete trans- formation had taken place in me. During my illness 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, for I had a stroke of paralysis which HOMO-SEXUAL FEELING IN BOTH SEXES. 313 would certainly have killed me had I been of my fonnor disposition ; but now I was reconciled, for I 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 anaemic 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 by the gout, influenza ruined entirely. "Present condition: I am tall, slightly bald, and the beard is growing gray. I begin to stoop. Since having influenza I have lost about one-fourth 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 per- ceptibly. 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 7/^2 to 724 in size. I also wear a corset without annoyance. My weight varies between 168 and 184 pounds. Urine without albumen or sugar, but it con- tains an excess of uric acid. But when 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 consti- pation. Sleep is poor, — for weeks at a time only of two or three hours' duration. 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 314 PSYCIIOrATHIA SEXUALIS. unbearable cutaneous itching for the last two years; but during the last few weeks this 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 pecu- liarities 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 awakening in the morning, I am confused for a few moments, as if I were seeking for myself; then the impera- tive 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 IH>M<> srxi'Al I I I • i.IWO IN BOTH SEXES. 3 1 r> •. frd ill. ir sensations; l>ut this, indeed, does- not r them. The most unpl»-aastie," in the " Diction, med. et de chirurgic."— Coutagnc, " Lyon medical," 1880, Nos. 35, 36. — Blunter, " Amcric. Journ. of Insanity," July, 1882. — F. Krafft, " Zeitschr. f Psychiatric," No. 38. — niumerutock, art. " Contrlre Sexualompfindung," " Realcn- cyclop. d. ge«. Heilkunde," 2 Aufl. vi. — Brouardel, " Gar. des hopiteaux," 1887.— Krirtc, " Inaugural dissert.," WQrzburg, 1888.— Wo/man, art. " Paederastie," " Realencyclop. d. ges. Heilkunde," 2 336 PSYCHOPATHIA SEXUALI8. sexual glands perform their functions properly, and the sexual type is completely differentiated. Feeling, thought, will, and the whole character, in leases of the complete development of the anomaly, corre- •spond 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 role in which they feel themselves to be. Anthropologically and clinically, this abnormal mani- festation 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, Aufl. xv. — Tarnowsky, " Die krankhaften Ercheinungen des Ge- schlechtsinnes," Berlin, 1886. — Magnan, " Stance de I'acadfimie de m&iecine du 13 Janvier," 1885, idem, "Annales medico psychol.," 1886 ( " Anomalies du sens genital " ; " Discussion sur la f olie h6r6d- itaire"). — Scrieux, " Recherches cliniques sur les anomalies de 1'instinct sexuel," Paris, 1886. — Chevalier, " L'inversion sexuelle," Lyon, Paris, 1893. — Ladame, " Revue de 1'hypnotisme," Sept., 1889. — Peyer, ""Munch, med. Wochenschrift," 1890, No. 23.— Lewin, " Neurolog. Centralblatt," 1891, No. 18.— 7. Schrenck-Xotzing, " Die Suggestions-therapie," etc., Stuttgart. — Eulenburg, op. cit., p. 66, " Homo-sexuelle Parerosie." — Raffalovich, " Die Entwickelung der Homo-sexualitfit," Berlin, 1895, — 4dem, " Uranisme et Unisexualite"," Paris, 1886. — V. Schrenck-Notzing, " Klin. Zeit- und Streitfragen," ix. 1 (Wien, 1895). — Laupts, "Perversion et perversity sexuelles," Paris, 1896. — Legrain, " Des anomalies de 1'instinct sexuel," etc., Paris, 1896. HOMO-SEXUAL FEELING AS ABNORMAL MANIFESTATION. 337 the cause must be sought in the brain (androgyny and gynandry). The first definite communications1 concerning this enigmatical phenomenon • of Nature are made by Casper ("Ueber Nothzucht und Paderastie," Casper's "Viertel- jahrsschrift," 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 (peder- asty) 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 perver- sion 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, declared, in numerous articles, under the nom-de-plume 1 Dr. Moll, of Berlin, called my attention to the fact that in Moritz'a " Magazin f. Erfahrungsseelenkunde," vol. viii., Berlin, 1791, references are made to antipathic sexual instinct in man. In fact, two biographies of men are there reported who manifested an enthusiastic love for persons of their own sex. In the second case, which is par- ticularly 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 con- genital (psycho-sexual hermaphrodisia?) or acquired antipathic sexual instinct. 338 PSYCHOPATHIA SKXl'ALIS. "Numa Numantius,1 that the sexual mental life was not connected with the bodily sex; tha.t there were male in- dividuals that felt like women toward men (anima mulie- bris in corpore virili inclusa). lie 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. Psychiatric," 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 owe thanks to Westphal ("Archiv f. Psychiatric," ^ ii., p. 73) 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 antipathic sexual instinct. At the same time, he began a series of cases, which up to this time has numbered about 200, those reported in this monograph not being included. Westplial leaves it undecided as to whether antipathic 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 desig- nated this peculiar sexual feeling as a functional sign of degeneration, and as a partial manifestation of a neuro- (psycho-) pathic state, in most cases hereditary, — a supposition which has found renewed confirmation in a 1MVindex, Inclusa, Vindicta, Formatrix, Ara spei, Gladius furena" (Leipzig, H. Matthes, 1864 and 1865); Ulrtchs, " Kritische Pfeile," 1879, in Commission, by H. Cronlein, Stuttgart, Augusten- strasse, 5. HOMOSEXUAL FEELING AS ABNORMAL MANIFESTATION. 339 consideration of additional cases. The following pecu- liarities may bo given as the signs of this neuro- (psycho-) I>athic taint : — 1. The sexual life of individuals thus organized mani- fests 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 antipathic sexual feeling are found other functional, and in many cases anatomical, evidences of degeneration. 4. Neuroses (hysteria, neurasthenic, epileptoid states, etc.) co-exist. Almost invariably the existence of tem- porary or lasting neurasthenia may be proved. As a rule, this is constitutional, having its root in congenital condi- tions. 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 sex- ualis, which manifests itself essentially in irritable weak- ness 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 ejacu- lation. Frequently this is accompanied by an abnormally powerful feeling of lustful pleasure, which may be so in- tense as to suggest a feeling of "magnetic" currents pass- ing through the body. 5. In the majority of cases, psychical anomalies (bril- liant endowment, in art, especially music, poetry, etc., by the side of bad intellectual powers or original eccentricity) are present, which may extend to pronounced conditions of mental degeneration (imbecility, moral insanity). 340 PSYCHOPATHIA SEXUALI8. In many urnings, either temporarily or permanently, insanity of a degenerative character (pathological emo- tional 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 ahd blood relations has been possible, neurosis, psychoses, degenerative signs, etc., have been found in the families.1 The depth of congenital antipathic sexual 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 congeni tally 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 antipathic sexual feeling points directly to anomalies of the cerebral organisation of the affected individuals. The very fact that in these cases, with few exceptions, the sexual glands are found quite normal, anatomically and functionally, seems to favour this assumption. This enigmatical manifestation in the nature of man has led to many attempts of explanation. Among lay persons, it is called vice; in the language 1 Tarnowsky (op. cit., p. 34) records a case which shows that antipathic 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. Mod." ) , in which the perversion of the sexual desires stood in causal relation with an arrest of psychical development, caused by traumatism. HOMO-SEXUAL FEELING AS ABNORMAL MANIFESTATION. ..f the law, crime. Those tainted with it, although recog- nising it as an abnormality, claim for it the same rights and privileges that are accorded to normal (hetero-sexual) love, on account of its being based upon a freak of nature. From Plato down to Ulrichs, in antipathic sexual circles, this standpoint is maintained. Plato's "Banquet," chap- ters viii. and ix., are quoted for that purpose, viz.: "There is no Aphrodites without an Eros. But there are two goddesses. The older Aphrodites came into existence without a mother; being the daughter of Uranos she is called Urania. The younger Aphrodites is the daughter of Zeus and Diana and is called Pandemos. The Eros of the former must, therefore, be Uranos, that of the latter Pandemos. With the love of Eros Pandemos the ordinary human beings love; Eros Uranos did not choose a female but a male; this is the love for boys. Whoever is inspired with this love turns to the male sex." From many other places in the classics the impression may be won that Uranic love attained a higher position even than her sister. More recent explanations of the homo- sexual instinct have emanated from philosophers, psycho- logists and natural scientists. One of the most peculiar explanations is advanced by Schopenhauer ("Die Welt als Wille und Vorstellung"), who seriously contends that nature seeks to prevent old men (i.e., over fifty years of age) from begetting children, since experience teaches that these never turn out good. For this purpose nature in her wisdom has turned the sexual instinct in old men toward their own sex! The great philosopher and thinker evidently was not aware that sexual inversion, as a rule, exists ab origine, and that pederasty, occurring in the senium, is only sexual per- versity, but by no means proves the presence of perversion. Binet attempts to explain these peculiar manifestations from a psychological standpoint, thinking (with Condillac) to reduce them — together with other bizarre psychical phenomena — to the law of association of ideas (i.e., association of ideas with sentiments in statu nascendi). 342 PSYCHOPATHIA SEXUALIS. This clever psychologist assumes that the instinct not as yet sexually differentiated is determined by the coin- cidence of a vivid sexual emotion with the simultaneous sight or contact of a person of the opposite sex. In this manner a mighty association is created, which takes root by repeating itself, whilst the original associative process is forgotten or becomes latent. Even to-day v. Schrenck-Notzing and others lean to this opinion, in their efforts to explain the inverted sexual instinct (chiefly when acquired; ; but it cannot withstand serious criticism. Psychological forces are insufficient to explain manifesta- tions of so thoroughly degenerated a character (vide infra). Chevalier ("Inversion Sexuelle," Paris, 1893) rightly demurs against Binet that these attempts at psychological explanations explain neither the precocity of homo-sexual impulses, i.e., such as have existed long before sexual feelings were associated with imagination, nor the aver- sion towards the opposite sex, nor early appearance of secondary psychico-sexual manifestations. Nevertheless, Binet's subtle remark that the lasting presence of such associations is only possible in predisposed (tainted) indi- viduals is worthy of note. Neither do the explanations attempted by physicians and naturalists prove anything to satisfaction. Gley ("Revue philosophique," January, 1884) maintains that those afflicted with inverted sexual instinct have a female brain ( !) but masculine sexual glands, and that an existing morbid condition of the brain determines the sexual life, whilst e contra and normally the sexual glands influence the sexual cerebral functions. Magnan ("Annales med. psychol.," 1885, p. 458) also speaks of a female brain in the body of a man and vice versa. Ulrichs ("Memnon," 1868) comes closer to the point when he speaks of an anima muliebris virili corpori innati, and thus seeks to explain congenital effeminatio. According to Mantegazza (op. cit. 1886, p. 106), anatomical anomalies exist in such persons in so far as the natural plextts of the genital nerves terminates in the rectum, thus misdirecting thither all 0-8EXUAI >i;\!\[ l-ATION. 343 s. But surelv nadir is guilty of such errors or "sallux". NYiiln-r does slit- burden a masculine body with a female brain. The author of this hypothesis, otherwise so acute, quite overlooks the fact that the individuals given to sexual inversion, as a rule, abhor the use of the anus — viz., pederasty. Mantegazza, reverts, as a support for his hypothesis, to the communications which he received from a well-known prominent author, who assured him that he was not as yet satisfied in his own mind whether he derived greater pleasure from coitus than from defalcation. Even if we admit the correctness of this statement, it would only prove that its author was sexually abnormal, and that he derived but a minimum of pleasure from coitus. Moreover, one would come to the conclusion that the mucous membrane of his rectum was, in some abnormal manner, erogenous. Bernhardi ("Der Uranismus," Berlin, 1882) casually found in five effeminati ("Pathici") absence of spermato- zoa, in four cases not even sperm crystals, and thought to find the solution of this "enigma of many thousand years" in the assumption that the pathicux was a "monster of the feminine sex, having nothing else in common with the male than the male genitals, which in some cases are even only imperfectly developed". This author could not even base his contention upon an autopsy, which, no doubt, would have eventually established a case of hermaphrodit- ism. Those practising active viraginity and gynandry he styles as "monsters of masculine gender in opposition to which the passive tribade is as perfect a woman as the active paedicator is a perfect man". The author of this book has made an attempt to utilise facts of heredity for an explanation of this anomaly. Proceeding from the experience that manifestations of sexual perversion are frequently found in the parents, he suspects that the various grades of congenital sexual inversion represent various grades of sexual anomaly inherited by birth, acquired by ascendency, or otherwise 344 PSYCHOPATH IA SEXUALI8. developed. In this connection, the law of progressive heredity must also be considered.^ All attempts at explanation made hitherto on the ground of natural philosophy or psychology, or those of a merely speculative character are insufficient. Later researches, however, proceeding on embryo- logical (onto- and phylogenetic) and anthropological lines seem to promise good results. Emanating from Frank Lydston ("Philadelphia Med. and Surg. Recorder," September, 1888,) and Kiernan ("Medical Standard," November, 1888), they are based (1) on the fact that bisexual organisation is still found in the lower animal kingdom, and (2) on the supposition that mono-sexuality gradually developed from bisexuality. Kiernan assumes in trying to subordinate sexual inversion to the category of hermaphroditism that in individuals thus affected retrogression into the earlier hermaphrodisic forms of the animal kingdom may take place at least functionally. These are his own words: "The original bisexuality of the ancestors of the race, shown in the rudimentary female organs of the male, could not fail to occasion functional, if not organic reversions, when mental or physical manifestations were interfered with by disease or congenital defect. It seems certain that a feminily functionating brain can occupy a male body and vice versa. Chevalier (op. cit., p. 408) proceeds from the original bisexual life in the animal kingdom, and the original bisexual predisposition in the human foetus. According to him the difference in the gender, with marked physical and psychical sexual character, is only the result of endless processes of evolution. The psycho- physical sexual difference runs parallel with the high level of the evolving process. The individual being must also itself pass through these grades of evolution; it is originally bisexual, but in the struggle between the male and female elements either one or the other is conquered, and a monosexual being is evolved which corresponds with the type of the present stage of evolution. But traces of HOMO-SEXUAL FEELING AS ABNORMAL MANIFESTATION. 345 the conquered srxualitv remain. Under certain circum- stances, these caracteres sexuels latcnts may gain Darwin's signification, i.e., they may provoke manifestations of i-tecl sexuality. Chevalier does not, however, look upon such processes as a retrogression (atavism), in the sense of Lombroso's opinion and that of others, but rather considers them with Lacassagne as disturbances in the present stage of evolution. If the structure of this opinion is continued, the fol- lowing anthropological and historical facts may be evolved : — 1. The sexual apparatus consists of (a) the sexual glands and the organs of reproduction; (6) the spinal centres, which act either as a check or a stimulus upon (a) ; (c) the cerebral regions, in which the psychical processes of the vita sexualis are enacted. Since the original predisposition of (a) is of a bisexual character, the same must be claimed for (6) and (c). 2. The tendency of nature in the present stage of evolution is the reproduction of monosexual individuals, and the law of experience teaches that that cerebral centre is normally developed which corresponds with the sexual glands ("Law of the Sexual Homologous Development"). 3. This destruction of antipathic sexuality is at present not yet completed. In the same manner in which the processus vermiformis in the intestinal tube points to former stages of organisation, so may also be found in the sexual apparatus — in the male as well as in the female — residua, which point to the original onto- and phylogenetic bisexuality, not to speak of hormaphrodisic malformations, which may be looked upon merely as partial excesses of development, or disturbances in the formation of the sexual organisation, and especially of the external genitals. The residua referred to are, in the male, the utriculus masculinus (remnants of the "Miillersche Gange") and the nipple, fn woman the paroophoron (remnants of the ori/r;utaiices, f«»r the same reasons \\hieh may lead normal individuals to avoid coitus, onanism, fautc de mieux, is indulged in. In urnings with nervous systems congenitally irritable, or injured by onauism (irritable weakness of the ejacu- lation 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 ereciionem, 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 remark- able, that the adequate sexual act with persons of the same sex gives them a feeling of great satisfaction and accession of strength, while satisfaction by solitary onan- ism, or by enforced coitus with a woman, affects them in an unfavourable way, making them miserable and increas- ing their neurasthenic symptoms. As to the frequency1 of the occurrence of the anomaly, it is difficult to reach a just conclusion, since those affected with it not often break from their reserve; and in criminal cases the urning with perversion of sexual instinct is usual- ly 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. 'That inversion of the sexual instinct is not uncommon is proved, among other things, by the circumstances that it is frequently the subject in novels. The neuropathic foundation of this sexual perversion does not escape tlie writers. This theme is treated in m literature in " Fridolin's hcimliche Eho," by Wilbrand; in " Brick-a-Braek odcr Lie-lit im Schatton," by Emcrich Graf Stadion; also by Raldtiin Grnllrr, " Prinz Klotz." The oldest urning romance is probably that publish***! by 1'etroniut at Rome, under the Empire. under the title " Satyricon." 352 PSYCHOPATH I A SEXUALIS. Ulrichs ("Kritische Pfeilc," p. 2, 1880) declares that, on an average, there is one person affected with antipathic sexual instinct to every 200 mature men, or to every 800 of the population; and that the percentage among the Mag- yars 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 inhab- itants), fourteen urnings. He further declares that he is acquainted with at least eighty in a city of 60,000 inhabi- tants. It is to be presumed that this man, otherwise worthy of belief, makes no distinction between the congen- ital and the acquired anomaly. I. Psychical Hermaphroditism.1 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 homo-sexuality is primary, and, in time and intensity, forms the most strik- ing 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 antipathic « 1 Cf. author's work, " Ueber psychosexuales Zwitterthum," in the " Internationales Centralblatt f. d. Physiologic u. Pathologic der Harn- und Sexualorgane," Bd. i., Heft 2. PSYCHICAL !I1:«>1>1TI8M. 353 sexual instinct. This is especially to be feared as a result of the influences of masturbation (JIM a- in ac<|iiired in- version of tin- sexual in.-iinct) and its neurasthenia and conseqm-nt exacerbations; and, further, it is to be found as a consequence of unfavourable experiences in sexual intercourse with persons of the opposite sex (defective feel- ing of pleasure in coitus, failure in coitus on account of \\( akness of erection and premature ejaculation, infection). On the other hand, it is possible that aesthetic and ethical sympathy with persons of the opposite sex may favour the development of hetero-sexual desires. Thus it happens that the individual, according to the predomi- nance of favourable or unfavourable influences, experiences now hetero-sexual, now homo-sexual, feeling. It seems to me probable that such hermaphrodites from constitutional taint are rather numerous.1 Since they attract very little attention socially, and since such secrets of married life are only exceptionally brought to the knowl- edge of the physician, it is at once apparent why this in- teresting and practically important transitional group to the group of absolute inverted sexuality has thus far escaped scientific investigation. Many cases of frigiditas uxoris and marili 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 thera- peutics (v. infra). The differential diagnosis from acquired antipathic sexual instinct may present difficulties; for, in such cases, so 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- 1This idea ia supported by the statement* 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 had also " relations " with men. 23 354 PSYCHOPATH I A SEXUALIS. sexual impulses consists in passive and mutual onanism and coitus inter femora. Case 134. Antipathic sexual instinct with sexual sat- isfaction in hetero-sexual intercourse. Mr. Z., aged thirty- six, consulted me 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 also neuropathic; father's brother an idiot. Patient's mother and her family were healthy and normal mentally. The patient had three sisters and one brother, the latter being subject to moral insanity. Two sisters were healthy, and enjoying 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 illness, except coxitis, as a result of which he limped 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 occupa- tions. He had a certain interest for female toilettes, orna- ments, and occupations. From the time of puberty the patient noticed in himself an inexplicable inclination toward male persons. Youths- of the lowest classes were most attractive to him. Cavalry men especially excited his interest. He experienced a lustful desire to press him- self 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 t>ver 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 PSYCHICAL IIERMAIMIBODITISM. 355 lower classes, wearing tight, brown trousers, were espec- ially dangerous for him. His greatest pleasure would be to embrace such a man and press himself to 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 gen- itals 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 had never noticed any inclination for women. He did not avoid them, even danced with them on occasion, but he never felt the slightest sensual excitation under such circum- stances. At the age of twenty-eight the patient was neuras- thenic 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 death-scenes, of being attacked by dogs, etc. After these, as before, he suffered with great libido serualis. 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 thor- oughly satisfy his libido, he determined to frequent broth- els. 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 preat pleasure in hearing men tell stories of their sexual relations with the opposite sex. Ideas of flagellation would al*o oonr1 to him while in a brothel, but the retention of such fancies was not easen- 356 PSYCHOPATH! A SEXTTALIS. tial for the performance of coitus. He considered sexual intercourse with prostitutes only a' remedy against the de- sire for masturbation and men, — a kind of safety-valve to prevent compromising himself with some man. The patient wished to marry, but feared not only that he could have no love for a decent woman, but also that he might be impotent for intercourse with her. Hence his thought and need of medical advice. The patient was very intelligent, and, in all respects, was of masculine appearance. In dress and manner he pre- sented nothing that would attract attention. Gait, voice and frame, — the pelvis especially, — masculine in character. Genitals of normal development. The normal growth of hair for a male was abundant. The patient's relatives and friends had not the slightest suspicion of his sexual anomalies. In his inverted sexual fancies he had never felt himself in the role of a woman toward a man. For some years he had been entirely free from neurasthenic troubles. The question as to whether he considered himself a subject of congenital sexual inversion he could not answer. It seems probable that there was a congenital weak inclina- tion for the opposite sex, with a greater one for the same sex, which, as a result of early masturbation in conse- quence of the homo-sexual instinct, was still more weak- ened, but not reduced to nil. With the cessation of mas- turbation, 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 eliminate this delicate point. Fortunately, the patient confined himself to the ques- tion 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; moreover that he could at all times improve his power by exercising his imagination in the right direction. PSYCHICAL HZBMAPHBODITI81C. 357 The main object was to strengthen .the sexual inclina- tion for the opposite sex, which was defective, but not ab- solutely 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 hyp- notic suggestion, (removal of homo-sexual desires by sug- gestion) ; by the excitation and exercise of normal sexual desires and impulses; by complete abstinence from mas- turbation, and eradication of the remnants of the neuras- thenic condition of the nervous system by means of hydro- therapy, and possibly general faradisation. Case 135. V., age twenty-nine, official ; father hypo- chondriac, mother neuropathic; four other children nor- mal; one sister homo-sexual. V. was very talented, learned easily and had a most excellent religious education. Very nervous and emo- tional. At the age of nine he began to masturbate of his own accord. When fourteen he recognised the danger of this practice and fought with some success against it; but he began to rave about male statuary, also about young men. When puberty set in, he took slight interest in women. At twenty, first coitus cum rauliere, but though potent, he derived no satisfaction from it^ Afterwards only faute de mieux (alxnit six times) hetero-sexual inter- course. He admitted to have had very frequently intercourse with men (masturbatio mutua, coitus inter femora, inter- dum in os). He took either the active or passive role. At the consultation he was in despair and wept bitterly. He abhorred his sexual anomaly, and said that he had des- perately battled against it, but without success. In woman he found only moderate animal satisfaction, psychical gratification being totally absent. Yet he craved for the happiness of family life. Excepting an abnormally broad pelvis (100 cm.) there was nothing in his character or personal appearance that lacked the qualities of the masculine type. 358 PSYCIIOPATIIIA SEXUALIS. Case 136. K., age 30; in the family on his mother's side there were several cases of insanity. Both parents were neurasthenic, irritable and excitable, and lived unhappily together. K. had from his early childhood sympathy only for men, chiefly for male servants. Pollutions at the age of fourteen, often coupled with homo-sexual dreams. Descriptions of bullfights and tortures of animals greatly excited him sexually. When fifteen he began, of his own accord, auto-mas- turbation. At the age of twenty-one, homo-sexual inter- course with men (only mutual masturbation). Off and on psychical onanism associated with thoughts of men. His inclinations to women were of a transient nature. When pressed to enter wedlock he could not decide in its favour. He never had coitus cum muliere partly because he had no confidence in his virility, and partly from fear of infection. For years he was highly neurasthenic, which rendered him for whole periods psychically unfit for any kind of work. He was listless and devoid of energy, but in struc- ture and personal appearance masculine. Genitals normal. Advice: Treatment for neurasthenia, energetic combat with homo-sexual desires, society of ladies, eventually coi- tus condomatus. Wedlock, when suited, as His station in life demanded it. After four months K. returned. He had conscien- tiously acted upon the medical advice, was successful in coitus, dreamed of women, disdained the idea of sexual relations with men, but during the heated season still ex- perienced homo-sexual impulses (due to exacerbation of neurasthenia, superinduced by the hot weather). He hoped to marry at an early date, and anticipated much happiness from the married state. Case 137. Psychical liermaphroditism. Hetero-sex- .MAi'iiuoi.rr 359 ual feeling early interfere! with by masturbation, but epi- sodically vi TV intense. ll<»m<> -sexual feeling ab orirjiiic erse (sexual excitation by men's boots). Mr. X., of high social position, aged twenty-eight, came to me in September, 1887, in a despairing mood, to con- sult me on account of a perversion of his vita scxualis, which made life seem almost unbearable to him, and which had repeatedly brought him near to suicide. The patient came of a family in which neuroses and psychoses had been of frequent occurrence. In the father's family there had been marriage between first cousins for three generations. The father was said to have been a healthy man, and to have lived morally in marriage. However, his father's preference for fine-looking servants seemed remarkable to the son. The mother's family was described as eccentric. The mother's grandfather and great-grandfather die.d mel- ancholic; her sister was insane; a daughter of the grand- father's brother was hysterical, and had nymphoraania. Only three of the mother's twelve brothers and sisters married. Of these, one brother was homo-sexual, and al- ways nervous as a result of excessive masturbation. The patient's mother was said to have been a bigot of small mental endowment, nervous, irritable, and inclined to mel- ancholia. Patient had a sister and a brother. The brother was neuropathic and frequently melancholic; and, though mature had never shown the slightest trace of sexual inclinations. The sister was an acknowledged beauty, and nmeh sought by gentlemen. This lady was married, but ehildless, as reported, owing to the impotence of her hus- band. She had always been indifferent to the attentions shown her by men. but was charmed by female beauty, and actually in love with some of her female friends. With respect to himself, the pntiont asserted that when four years old he dreamed of handsome jockeys wearing shining boots. He never dreamed of women when he grew older. His niirhtly pollutions were always induced by "boot-dreams". From his fourth year be had a peculiar 360 PSYCHOPATIIIA SEXUALI9. 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, how- ever, he had sensually coloured ideas — such as being his servant's servant, and drawing off his boots; 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, 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 characterised himself as a clever, quiet, strong- willed, but superficial man. He asserted that he was a passionate hunter and rider, and that he had never had any inclination for feminine pursuits. In the society of ladies he had always been reserved; dancing always tired him. He never had an interest in any lady of high social position. As for women, only the buxom peasant girls, such as are the models of painters in Rome, had taken his fancy. He had, however, never felt any sexual interest even in such representatives of the female sex. At thb theatre and circus only male performers had attracted him ; but, at the same time, they 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 PSYCHICAL HEEMAPIIEODITISM. 361 were handsome men. Men of his own position, wearing ever so fine boots, were absolutely indifferent to him. With reference to his sexual inclinations, the patient was still uncertain whether he felt these more toward the opposite sex or his own. He was inclined to think that originally he had more inclination for women, but that this sympathy was, in any case, very weak. He stated with certainty that the sight of a naked man made no impres- sion on him, and that the sight of male genitals was even repugnant to him. As for woman, this was not exactly the case; but even the most beautiful feminine form did not excite him sexually. 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 get 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 pleasur- able feeling. Patient felt no impulse to intercourse with women, always requiring some external cause — i.e., per- suasion. Left to himself his vita sexualis consisted in rev- elling in ideas about boots, and in corresponding dreams coupled with pollutions. As the impulse to kiss his ser- vant's boots, to draw them off, etc., became more and more connected with these dreams and ideas the patient deter- mined to use every means to rid himself of this disgust- ing 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 sexual perversion. He went home, and tried to win the girl's favour. He asserted that at that time he was deeply in love with this person, and that the sight of her, 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. rSYCIIOPATlIIA SEXUALIS. 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 rape. It is remarkable that on this single occasion he had a pleas- urable 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 the decline of virility — i.e., when it was main- tained only with ideas about boots — libido for the opposite sex decreased. The patient's slight libido and weak in- clination for women were 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 them- selves 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 mentally brighter and fresher, as a result of masturbation. In time, however, symptoms of sexual, and later on of general neurasthenia, with spinal irritation, appeared. He then temporarily 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 practised masturbation, which pro- PSYCHICAL 1 1 1: K M A P 1 1 Id iDITISlf. <1 him from the impulse to kiss and blacken, etc., ser- vants' boots. At the saint- tim«-, ho felt his sexual position keenly. He again occasionally attempted coitus, and was successful in it as soon as he thought of blackened boots. After continued abstinence from masturbation, he was at times successful in coitus without any artificial an I. The patient said that his sexual needs wore intense. If no ejaculation had taken place for a long time, he be- came congestive, psychically much excited, and tormented by repugnant images of boots, so that he was forced to have coitus, or, preferably, to masturbate. During the past year his moral position became most painfully complicated by the fact that, as the last of a wealthy line of high position, and at the importunate de- sire of his parents, he must marry. The bride was of rare beauty, and mentally in perfect sympathy with him; but, as a woman, she was as indifferent to him as any other. J'sthetically she satisfied him "as any work of art would" ; in his eyes, she was simply ideal. To honour her in a platonic way would be happiness worth striving for; but to possess her as a wife was a painful thought. He was certain beforehand that with her he would be impotent, save with the help of ideas of boots. To use such means, however, was in opposition to his respect and his moral and aesthetic feelings for the lady. Were he to soil her with such thoughts, she would lose, in his eyes, all her aesthetic value; and then he would become impotent for her, and she would become repugnant to him. The patient considered his position one of despair, and confessed that he had of late been repeatedly near suicide. He was a man of much intelligence, and decidedly of masculine appearance, with abundant growth of beard, deep voice, and normal genitals. The eye had a neuro- pathic 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 364' P8YCHOPATHIA SEXUALIS. 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 to 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 any- thing like adequate libido for woman. In this deplorable situation, he was now compelled by circumstances to marry in three months. 2. Homo-Sexual Individuals, or Urnings. In contradistinction from the preceding group of psycho-sexual hermaphrodites, there are here predominant, i ob origine, sexual desires and inclinations for persons of the same sex exclusively; but, in contrast with the follow- ing group, the anomaly is limited to the vita sexualis, and , does not more deeply and seriously affect 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 the more so as these individuals, at the same time, and as a rule, are subject to hypercesthesia sex- ualis; for which reason, their love for their own sex is emotional and passionate. The urning loves and deifies the male object of his affections, just as the normal man idealises the woman he loves. He is capable of the greatest sacrifice for him, and experiences the pangs of unhappy, often unrequited, love ; he suffers from the disloyalty of the beloved object, and is subject to jealousy, etc. The attention of the male-loving man is given only to HOMO-SEXUAL INDIVIDUALS. 365 male dancers, actors, athletes, statues, etc. The sight of female charms i.-. indifferent t.. him, if not repulsive. A naknl woman is disgusting to him, while the sight of male hips, etc., affords him infinite pleasure. I'.odily contact with a sympathetic man induces a thrill of delight; and, since such individuals are in most cases :illv neurasthenic (congenitally or from onanism or enforced abstinence from sexual intercourse), under such circumstances ejaculation is very easily induced, which evm 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 comfort. Should the urning be able to force himself to coitus, in which, as a rule, dis- gust has the effect of an inhibitory character, and makes the act possible, then his feeling is something like that of a man compelled to take disgusting food or drink. How- ever, experience teaches that not infrequently urnings be- longing to this group marry, either from ethical or social considerations. Such unfortunates are relatively potent, in so far 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. It makes them, for days after, nervous and miserable. If such urnings, by means of powerful stimulation of their fancy, or under the influence of alcoholic drink, or by erections induced by an overfilled bladder, etc., are not enabled to overcome the inhibitory feelings and ideas, then they are entirely impotent; while the mere touch of a man may induce intense 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, is to him the greatest of pleasures. The male urniiii?, if he possess higher culture, is not opposed to non-sexual intercourse with woman, when by 366 PSYCHOPATHIA SEXUALJ8. mind and refinement they make conversation charming. It is only woman in her sexual role that he abhors. In this degree of sexual degeneration, character and occupation correspond with the sex which the individual represents. Sexual perversion remains an isolated anom- aly of the mental being of the individual, deeply affecting the social existence. In ace rdance with this, these indi- viduals feel themselves during the sexual act in the same role which would naturally be theirs in hetero-sexual inter- course. However, transitions to group 3 occur, inasmuch as sometimes the passive role which corresponds with homo- sexual feeling is thought of or desired, or at least forms the subject of dreams. Moreover, leanings to occupations and tendencies of taste are manifested which do not cor- respond 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 orig- inal anomaly, superinduced by perverse sexual activity (masturbation), and analogous to the signs of progressive degeneration observed in acquired sexual inversion. Regarding the manner of sexual satisfaction, it must be stated that with many male urnings, the mere embrace is sufficient to induce ejaculation, subject as they are to irritable weakness of the sexual apparatus. In cases of sexual hyperaesthesia, and of parsesthesia of the moral sense, great pleasure is afforded by intercourse with persons of the lowest condition. On the same basis, desire to commit pederasty (active, of course) and other similar aberrations occur, though it is but seldom, and apparently only in cases of moral defect and by reason of libido mimia in individuals especially passionate, that active pederasty is indulged in. The sexual desire of mature urnings, in contradistinc- tion to 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 HOMO-SEXUAL INDIVIDUALS. 367 material, and in case of violent passion, does the urning become dangerous to boys. Case 138. Z., age thirty-six, wholesale merchant; parents were said to have been healthy ; physical and men- tal development normal; irrelevant children's disease?; at fourteen onanism of his own accord; began to rave about boys of his own age when fifteen. Never took the slight- est notice of the opposite sex. At twenty-four he went for the first time to a brothel, but took to flight when he saw the nude female figure. At twenty-five sexual intercourse with men of his own stamp (fervent embraces with ejaculation, at times mutual masturbation). For business reasons, and with a view to cure his abnor- mal passion, he married at the age of twenty-eight a lady endowed with many physical and mental charms. By the aid of imagination (thinking of intercourse with a hand- some young man), Z. succeeded in being potent with his wife, whom at heart he loved passionately. This strain, however, superinduced neurasthenia. When a child was 'born he gradually withdrew from his wife, who was any- how endowed with a frigid nature, chiefly because he was haunted by the fear of procreating offspring afflicted with Jiis own anomaly. Homo-sexual feelings and thoughts began to sway him again, which he sought to eradicate by means of mastur- bation. He fell in love with a handsome young man, but over- came the weakness at the cost of his own health as the severe struggle brought on a pronounced attack of cerebral neurasthenia. lie came to me for advice, as his homo- sexual tendency had become too powerful to be resisted any longer. He was afraid that his secret affliction might be discovered, thus rendering his position in society impossi- ble. Like many of his fellow-sufferers he had taken to drink. Although he found that alcohol relieved his nerv- 368 PSYCHOPATHIA SKXTTALIS. ou8 disorders (physical weakness, psychical inertness and depression), his libido was increased. Z. was a man of refined thought, mentally well en- dowed, in appearance masculine and normal. He deeply deplored his position and loathed his weakness to auto- masturbation (at times also mutual). Mutual kisses and embraces satisfied him. Morally, he said, he had sunk so low that he would feign abandon him- self to this perverse passion were it not for the considera- tion he had for his wife and child. My advice was to strenuously combat these homo-sexual impulses, perform his marital duties whenever possible, eschew alcohol and masturbation, which increases homo- sexual feelings and kills the love for woman, and undergo treatment for neurasthenia. If he could not find relief and the situation became unbearable he must confine him- self to kisses and embraces with the male. Case 139. V., age thirty-six, merchant; mother psychopathic ; sister healthy ; brother neuropsychopathic. V. was early drawn to persons of his own sex, at first to school- and playmates; with the advent of puberty to achilts ; never to persons of the opposite sex whose charms had no interest for him. At the age of six he felt annoyed at not being a girl. Dolls and girls' games he always pre- ferred. At twelve a schoolmate seduced him to masturbate. His dreams (with pollutions when virile) were exclusively of an homo-sexual character. He practised mutual mas- turbation with men, coitus inter femora, exceptionally succio membri alterius. He had felt a pronounced position as to the active or passive role in the act. Rarely and only faute de mieux coitus cum muliere. He was potent when he thought during the act of a man, but never expe- rienced real pleasure. The sexual act with a woman ap- peared to him as a miserable substitute for the homo-sexual act. During recent years intimate relations with a young man. HOMO-SEXUAL INDIVIDUALS. 369 V. acknowledged the abnormality of his vita sexualis. ituls normal. Secondary physical and psychical sexual characteristics thoroughly masculine. No patholog- ical conditions. Arrested for having committed mutual masturbation, he was tried, found guilty and sent to prison. He felt his sentence keenly, but only because it brought dishonour to him and his family. He could not help feeling and acting in his abnormal manner. Case 140. H., age thirty, member of high society; mother neuropathic. When a boy he felt drawn 4o his schoolmates. At the age of fourteen a playmate older than himself committed paedicatio on him. He liked it, but nevertheless felt pangs of conscience and never allowed the act to be repeated again. Later on he practised mutual masturbation. As neurasthenia increased it sufficed when he embraced and pressed a companion to himself to produce ejaculation. He confined himself to this method when seeking satisfaction. He never had a liking for persons of the other sex and was unconscious of his anomaly. At twenty he made some at- tempts, apud puellas, in order to cure his vita sexualis. Up to that time he had looked upon his abnormal prac- tices merely as a youthful aberration. He was potent in coitus, but derived no gratification from it, for which rea- son he turned to man again. His weakness was for young men eighteen to twenty years of age. He had no sympathy for men older than that. He never played a well defined role in his relations with other men, but his social situa- tion affected him keenly. He was forever haunted by the fear of detection, and said he could never survive the shame of it. There was nothing in habits or behaviour Avhich betrayed antipathic sexual instinct. Genitals nor- mal. No signs of degeneration. He had no faith in ever changing his abnormal sexuality. For women he had no taste whatsoever. Case 141. Y., age forty, manufacturer; father neu- 24 370 PSYCHOPATHIA SEXUALIS. ropatliic; died of cerebral apoplexy; mother's family with taint of insanity; two other children of the family, though sexually normal, were constitutionally neuropathic. At eight masturbation of his own accord. At fifteen he felt drawn to other handsome boys of his own age, of whom he seduced several to masturbation. With puberty he was attracted by youths seventeen to twenty years of age, but they must be beardless arid have pretty, soft and girl-like features. Girls had no charm for him. He soon recognized the pathological character of his vita sexualis; but he considered his method of satisfying his abnormal needs as in accordance with nature and felt no remorse. To touch a woman was loathsome to him. He had twice attempted coitus, but without success. In like manner, he looked upon auto-masturbation as a filthy act. He averred that he had honestly striven to strip off this dreadful impulse, which made an outcast of him before the whole world. But all his efforts were in vain, for he felt forced by nature to seek satisfaction in his own manner. He always played the active rule and confined himself en- tirely to acts not proscribed by the law of the land. Yet he became involved in some affair, lost his position, which was one of confidence and good remuneration, became a vagabond until he decided to cross the ocean and begin a new life. Being clever and honourable he succeeded. When first I met Y., he was in despair and firmly con- templated suicide, especially since a medical man had failed with hypnotic treatment, on account of Y. not reacting to suggestion. He was inclined to neurasthenia. Penis small. No pathological symptoms. Masculine in every respect. Case 142. T., age thirty-four; merchant; mother neuropathic and weakly; father healthy. At the age of nine a schoolmate taught him how to masturbate. He practised mutual masturbation with his brother, who slept with him in the same bed; once receptio membri in os. On one occasion, when yet a boy, it happened quod Iambi t HOMO-SEXUAL INDIVIDUALS. 371 locum quo prius mile* urinaverat At fourteen first love for a schoolmate of ten. At the age of seventeen lie took a dislike to handsome young men, and centred his affection in decrepid old nn n. One night he heard his aged father "give a groan of sexual satisfaction." This excited him immensely as he imagined his father performing the marital act. Since that time the picture of old men performing the homo- sexual act enlivened his dreams (with pollution), and was • •nt in his mind during masturbation. The older, the more decrepid and feeble the old man was, when he saw such, the stronger his sexual excitement would be even unto ejaculation. At twenty-three he sought a cure with a prostitute ; but erection failed him, and he made no other attempts. Young men and boys left him callous. At twenty-nine he conceived a violent love for an old man whom he accompanied for years on his daily walks. Intimate relations were, however, precluded. But he often had ejaculations on these walks. To free himself of this humiliating situation he once more went to a prostitute, but it proved a fiasco. lie now fell upon the idea to hire a decrepid old man, take him along and make him have coitus whilst he looked on. This caused erection in him, and he was able to have coitus himself. The act, however, gave him no pleasure, but he felt psychically relieved, especially when he was potent in the absence of the old man. But this did not last long. He became sexually and generally neurasthenic, depressed, shy and impotent, and gave himself up to psychical onanism coupled with thoughts of old men in homo-sexual situations. T. was masculine in appearance, and presented no special marks beyond his heavy sexual neurasthenia. Case 143. Z., age twenty-eight, merchant; father very nervous and irritable; mother hysteropathic. He was himself constitutionally nervous, suffered from enure- Bis to his eighteenth year, and was a frail boy. Proper physical development really began only when he waa 372 PSYC1IOPATHIA 8EXUALI8. twenty years of age. The first sexual emotions he experi- enced when, a boy of eight, he witnessed other boys being caned ad podicem. Although he felt compassion for the boys, he yet had a feeling of lustful pleasure pervading his whole body. Some time afterwards he was late for school and on the way the anticipation of a caning ad podicem excited him so much that for a short time he could not move and had a violent erection. At eleven he fell in love with a "beautiful, blond boy who had wondrously lovely, intelligent and lustrous eyes." It gave him immense pleasure to see this boy home, and he often craved for kisses and caresses from him. But he recognized the unbecoming nature of this desire, and did not allow the boy to have an inkling of them. At that time he met a girl once, two years his junior, who pleased him so much that he covered her with kisses. This, however, remained a solitary episode. At thirteen he was seduced to onanism. But he did not cultivate the habit, as he found protection in his "more refined feelings for young men" and disdained to "drag his pure, divine love" in the gutter. At seventeen he became desperately enamored with a companion "with lovely brown eyes, noble features and dark complexion". He suffered untold tortures through this unhappy love for two and one-half years, when he was separated from his companion. If ever he were to meet him again, the old fire would be certain to flare up anew. On two other occasions he fell in love with com- rades, but not so violently as in the first instance. At twenty he had coitus, but derived no pleasure from the act. He continued his relations with women for the purpose of avoiding masturbation, to appear potent and to mask his homo-sexual tendency. Although he had no horror feminsp, women did not excite him. "A woman is a work of art, a statue." Endowed with a strong will power he was able to mas- ter his abnormal inclination! But his sexual position ap- peared to him unsatisfactory, especially as he looked upon MO-SEXUAL INDIVIDUALS. 373 coitus as a coarsely sensual enjoyment, and erection became difficult In the n.iisultation no abnormal signs could be de- tected, lie app< an (1 to be virile and mentally sound. Case 144. P., age thirty-seven ; mother very nervous, suffered from migraine. As a boy he was subject to attacks of hysteria gravis. Was always drawn to handsome young men and became highly excited when he could see their genitals. With puberty he practised mutual masturbation with men; but they must be about twenty-five to thirty years old. He played the female role in the sexual act. He loved with the whole intensity of woman, and only posed as a man like an actor on the stage. Other boys sneered at him on account of his girlish ways and habits. In the hope of correcting his vita sexualis he married. He forced himself to coitus with the wife and produced po- tency by imagining her to be a young man. They had one child. But he himself became neurasthenic, his imag- ination waned and he became potent. For two years he avoided coitus, resumed his homo-sexual practices and was apprehended by the police in the act of mutual mas- turbation with a young man. He pleaded that prolonged sexual abstinence had un- duly excited him when he saw the genitals of a man and in his confusion he had yielded to the impulse. There was no amnesia. Thoroughly virile. Decent appearanee. Genitals normal. Short imprisonment. Case 145. N., aged forty-one, unmarried. Father and mother near relatives, but both psychically normal. An uncle on the father's side was insane. N.'s brothers \\( TO hyper- and hetero-sexual. At the age of nine he felt strong inclinations to other boys. At fifteen mutual mas- turbation and coitus inter femora. At sixteen a love affair with a young man. His homo- sexual love developed, so he clailned, just as the love affairs between man and woman do in novels. 374 PSYCIIOPATUIA SEXUALI8. Only handsome young men of the age of twenty to twenty-four attracted him. His erotic dreams were solely homo-sexual. He played the female role, also in actual intercourse with men. His soul was of feminine character, so he said. He never cared for boys' games, only for cooking and girls' work. Manly sports and smoking and drinking he dis- dained. He led a varied life, served as cook in a foreign country and gave great satisfaction; but he lost his place because he entered upon a love-affair with the son of his employer. At twenty-two he recognized the abnormality of his sexual position. He became alarmed and began to fre- quent brothels to cure himself of his perverse habits, but erection absolutely failed him. When his family discovered the true state of affairs he became confused with shame and made an attempt on his own life. But he recovered, went abroad (cast out by his family), disgusted with himself and his unhappy life. His only hope was that with old age relief would come. He came for medical advice to find "honour and rest." The secondary physical sexual characteristics were quite nor- mal and of the masculine type. Genitals normal. He thought of castration or entering a monastery. Advice: Suggestive treatment. Case 146. On a summer evening, at twilight, X. Y., a physician of a city in North Germany, was detected by a watchman while committing a misdemeanour with a countryman in a field. He was practising masturbation on him, and then mentulam alius in os suum immisit. X. escaped legal prosecution by flight. The authorities dis- missed 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 correspond- ence of a perverse sexual character, which showed that he had had perverse intercourse for years with all classes of people. \CO-SEXCAI. I/CIMVIDUALS. 375 X. came of a neurotic family. Ilia paternal grand- father died by suicide while insane. Ilia father waa a weak, peculiar man. One brother masturbated at the age of two. A cousin was sexually perverse, and practised I > kimwlcdgo overcame the trouble that I had had in supposing that I was alone in my abnormality. This young man had an extensive ac- quaintance 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 attract- ive 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 Numantius). "When, later, I took up the study of medicine, and associated with many normal youths, I was often in a posi- tion where I was compelled to visit public prostitutes. After having consorted to no purpose with various pros- titutes, 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 per- sons 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 cele- brated 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 in- jections of morphine several times daily, which were sud- 378 PSYCHOPATHIA SEXUALIS. denly discontinued, and which I practised 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 recommen- dations, 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, of which, only after three relapses, I was able to rid myself (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 travelled for a few weeks in order to improve my health, the perverse im- pulses 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 should be compelled to leave Ger- many, 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 ac- quaintances. Since I was exclusively drawn toward strong, HoUO-BEXUAL INDIVIDUALS. 879 youthful and masculine individuals, and they were very seldom inelim-d i» vit 'Id to my wishes, 1 was compelled to buy them. Since my desire was limited to persons of the lower classes, I was always able to tiiul such as were purchasable with money. I hope that the following state- is will not awaken your repugnance. At first I in- tended 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: — ' T< -ne juvcnis in os recepto, ita ut commovendo ore meo effecerhn, ut is quern cupio, semen ejaculaverit, in periiui-um exspuo, femora comprimi jubeo et meuin adversus et intra femora compressa immitto. 1 him luec Hunt, necesse est, ut juvenis me, quantum potest, amplectatur. Quae prius me fccisse narravi, eandem mihi afferunt voluptatem, acsi ipse ejaculo. Ejaculationem in aiiuin iiuinittendo vel manu terendo assequi, mihi nequaquam amoenum est. "Sed inveni, qui penem meum receperint atque ea facientes, quae supra exposui, effecerint, ut libidines mea plane sint saturate?. "Concerning my person, I must still mention the fol- lowing: I am 180 centimetres tall, of masculine appear- ance, 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 very favourably critiei--ed by my friends. The story has several problems taken from the life of urn ings in the >ul»ject-matter. "Aiiioni: the large number of fellow-sufferers that are personally known to me, I have naturally been in a poei- 380 PSYCHOPATHIA SEXTJALIS. tion 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 spontaneous 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 'Sel- cher-Fanny'. Both of them never missed an opportunity during the carnival time, to show themselves in very fan- tastic 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 occa- sionally 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 in whom 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 rec- ommendation 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 tnmor as lanre as a fist. One case of primary affection of the soft palate I saw in Vienna, in a young man who used to frequent fancy-dress balls in girl's HOMO-SEXUAL INDIVIDUALS. 381 attire, and entice young men; lie would then pretend that he was menstruating, and thus induce tin- 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 antipathic sexuality that I have seen, I have found anything concerning the inter- course of pederasts among themselves, I venture to com- municate something concerning it in conclusion: — "As soon as individuals that are affected with inverted 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 them- selves 'aunts'; in Vienna, 'sisters'; and two very mascu- line public prostitutes in Vienna, whom I accidentally became acquainted with, and who lived in a perverse sex- ual relation with each other, told me that for the corre- sponding condition in women the name 'uncle' was used. Since I became 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 ulmm I suspected. In my own town of 30,000 inhabitants I personally know about 120 '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 'reason- able' or 'unreasonable'. My acquaintances are often as- tounded 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 382 PSYCHOPATHIA 8EXUALJS. 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 condi- tion were to be changed ; and, moreover, since the congeni- tal condition, according to my own and all other experi- ence, cannot be influenced, 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 offence, when this can be proved at the same time, shall be punishable." 3. Effemination. There are various transitions from the foregoing cases to those making up this category, characterised 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 are fully developed cases in which males are females in feeling; and vice versa 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; he develops tastes in female toilettes, and even becomes 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 persons, art, belle-lettres, etc., even to the extent of giving himself entirely to the cultivation of the beautiful. Since woman possesses parallel inclinations, he prefers to move in the society of women. If he can assume the role 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 — modesty, sweet- ness, taste for aBsthetics, poetry, etc. Efforts to approach the female appearance in gait, attitude and attire are fre- quently seen. EFFEMINATIOW. 383 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. Thus they feel themselves to be antagonistic to persons of their own sex constituted like themselves, as 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 wlu'ch occurs in normal sexual life also occurs here, when rivalry is threatened; and, indeed, since they are, as a rule, hvpersesthetic sexually, this jealousy is often boundless. In cases of completely developed inverted sexuality, hetero-sexual love is looked upon as a thing absolutely in- comprehensible; 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 cases transitional to the third category were able, with the aid of imagination which made the female in question assume the role of man, to have coitus for the time being; but the act, which yielded no gratification, was a great sacri- fice, and afforded no pleasure. In homo-sexual intercourse effeminated man feels him- self in the act always as a woman. The means of indul- gence, where there is irritable weakness of the ejaculation centre, are simply succubus, or passive coitus inter femora; in other cases, passive masturbation, or ejaculaiio viri di- lecti in ore. Some 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 dis- gust 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. Case 147. E., aged thirty-one, son of an inveterate drunkard. No other taint in the family. Grew up in a village. At the age of six he began to feel happy when 384 PSYCHOPATH IA 8EXUALIS. in the company of men with beards. At the age of eleven he began to blush whenever he met a handsome man, and dared not look at them. He was at ease when in the com- pany of women. He wore girl's garments up to his sev- enth year, and was very unhappy when he was deprived of them. Occupation in the kitchen and about the house he liked best. Ilis school time passed without events. Now and then he had intimate liking for a certain school- mate, but this wore off. Dreams of men with beards clad in blue clothes became more frequent. He joined an athletic society that he might converse with men, liked to go to balls, not on account of the girls, who were a matter of indifference to him, but to see the fine men, thinking all the time that he was in the embrace of one of them. He felt lonely, however, and dissatisfied, and gradually became conscious of being quite unlike the other young fellows. All his thoughts and aims were to find a man who could love him. At seventeen he was seduced by another man to mutual masturbation. Delight, shame and fear were the reaction. He recognized the abnormality of his sexual feelings, be- came depressed, came near committing suicide. He finally became reconciled with his abnormal position and craved for men, but being shy by nature he found but little op- portunity. He felt uneasy when girls sought his company. When twenty-six he went to live in a large city and now found plenty of opportunities for homo-sexual intercourse. For some time he lived with another man of his own age as husband and wife. He felt happy in the role of woman. Sexual gratification was obtained by mutual masturbation and coitus inter femora. He was a skilful workman, well liked, and in appear- ance and behaviour masculine. Genitals normal. No signs of degeneration. His younger brother was also homo-sexual. Two sisters, who both died young, avoided men, never EFF KM i: NATION. 385 cared for work in the kitchen, but preferred that in the stable, and were skilful in all handicrafts of m< n. Case 148. C., age twenty-eight, gentleman of lei- sure; father neuropathic; mother very nervous. One brother suffered from paranoia, another was psychically degenerated. Three younger members of the family were normal. C. was neuropathically tainted; slight convulsive tic. As long as he can remember he felt drawn to male per- sons, at first only to his schoolmates. When puberty set in he fell in love with male teachers, who used to visit at the house of his parents. He felt himself in the female role. His dreams, with pollutions, were always about men. He was gifted in music and poetry and loved the theatre. For science, especially mathematics, he had no talents and passed his final examinations only with difficulty. Psychic- ally, he declared, he was a woman. Loved to play with dolls and concerned himself by preference with woman's affairs, disdaining all the pursuits of men. He liked best the society of young girls, because they were sympathetic and had an affinity of soul. When in the company of men he was shy and confused like a maiden. He never smoked, and disliked alcoholic drinks. He feign would have liked to spend his time in cooking, knitting and em- broidering. He had no libido. Sexual intercourse with men only a few times, although his ideal was to play the role of the woman on such occasions. Coitus cum muliere he abhorred. After reading "Psychopathia Sexualis," he became alarmed, was afraid of coming in conflict with the police and avoided sexual relations with men. But pollu- tions became very frequent, and neurasthenia supervened. He came for medical advice. C. had an abundant beard, and was of a decidedly mas- culine type, excepting soft features and a remarkably fine skin. (Irnitals normal, except a deficient dcscensus of one of the testicles. In his behaviour, gait, and appearance nothing unusual, though he had the illusion that everybody 25 386 PSYCHOPATIIIA SEXUALM. noticed his abnormal sexual proclivity. He shunned soci- ety for that reason. Lascivious talk made him blush like a maiden. Once when someone turned the topic of con- versation on antipathic sexual instinct, he fainted. Music brought on a heavy perspiration all over his body. Upon. closer acquaintance he showed psychical femininity; he was as timid as a girl, and without a vestige of independ- ence. Nervous restlessness, convulsive tic, numerous neu- rasthenic complications put on him the stamp of a consti- tutionally tainted neuropathic individual. Case 149. B., waiter, forty-two years of age, un- married, was sent to me by his own physician (with whom he had fallen in love), as a case of sexual inversion. B. gave readily in modest language an account of his vita anteacta and especially sexualis. He seemed pleased to obtain at last an authentic explanation of his abnormal state which he had always considered a disease. B. possessed no knowledge of his grandparents. The father was of an irascible, excitable nature, a drinker, and of strong sexual wants. After begetting twenty-four chil- dren with the same woman, he obtained a divorce, and after that had three children by his housekeeper. The mother was a healthy woman. Of the twenty-four children only six are now among the living, several of whom suffer from nervous affections, but are sexually nor- mal, except one sister who for ever runs after the men. B. claimed to have always been delicate and sickly. His vita sexualis awoke at the age of eight. He began to masturbate and derived much pleasure from penem aliorum puerorum in os arrigere. At the age of twelve he began to fall in love with men, preferring those in the thirties and with moustache. His sexual needs at that period were extraordinary and erections and pollutions were frequent. He masturbated daily, thinking of some man whom he loved. His ambition was always penem viri in os arrigere, which thought caused ejaculation ac- companied by the utmost lust. But only twelve times ZFFEMINATION. 387 tnus far had he been successful in this. He never felt nausea at the penis of others if they were sympathetic; on the contrary. Active as well as passive pederasty dis- gusted him thoroughly and he never accepted such offers. During the perverse act he played the role of woman. His love for sympathetic men was boundless. He could do any- thing for the man whom he thus loved, and when beholding him he trembled with excitement and lustful feelings. When nineteen he was several times lured by his com- panions to a brothel, but coitus did not please him and only at the moment of ejaculation did he experience a sort of gratification. lie could only be virile with woman when he thought of her during the act as the man whom he loved. He much rather would have preferred the woman to allow him immissio penis in os; but she refused. Faute de mieux he indulged in coitus; twice even he was a father. The younger of the two children, now a girl of eight, has already begun masturbation and mutual onan- ism, which fact troubled him very much. Was there no remedy for this? Patient said that towards men he always felt himself to be of feminine type (this also during sexual intercourse). His idea was that this sexual perversion originated from the fact that his father when begetting him wished to beget a girl. The other children of the family always teased him on account of his girlish ways and manners. To sweep the rooms and wash the dishes were ever pleasant occupations for him. His housework was always much admired and praised because he was cleverer than the girls. Whenever he could he would don girl's attire. At the Mardi-cjras balls he always wore the female mask. He made a capital coquette on account of his female nature. Drinking, smoking, manly sports and occupations never suited him, but he was passionately fond of sewing and was often upbraided on account of his weakness for dolls when a boy. When at the circus or the theatre his atten- tion was only drawn to the male performers. He had an 388 PSYCHOPATHIA SEXUALIS. irresistible desire to loiter about W.C's. in order to get a look at the men's genitals. Female charms never attracted him. Coitus was only possible when aided by the thought of a beloved man. Nocturnal pollutions were always produced by lascivious dreams about men. Despite numerous sexual excesses B. had never suf- fered from neurasthenia sexualis; neither were there symp- toms of neurasthenia of any kind. Features delicate ; sparse side whiskers and moustache, which began to grow only when he was twenty-eight. His external appearance, excepting a light, swinging gait, did not indicate female nature. He observed that he was often teased on account of his womanish carriage. His manners were highly modest. Genitals large, well devel- oped, quite normal, with abundance of hair; pelvis mas- culine. Cranium rachitic, slightly hydrocephalic ; parietal bones rather bulging. Countenance exceptionally small. Patient said he was easily provoked to wrath. Case 150. Taylor had occasion to examine a certain Eliza Edwards, aged twenty-four. It was discovered that she was of masculine sex. E. had worn female clothing from her fourteenth year, and had 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 gen- itals were fixed in an upward position by an artful band- age. The condition of the anus indicated passive peder- asty (Taylor, "Med. Jurisp." 1873, ii., p. 473). Case 151. 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 anti- pathic sexual feeling. One day, through the indiscretion of a prostitute, the following scandal became public: About once a week X. ANDROGYNY. 389 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 4 male person (a servant of the house). This man's father was heriditarily tainted, had been insane several times, and was afflicted with hypercesthesia and parcesthesia sex- ualis. 4. Androgyny. » Forming direct transitions from the foregoing groups are those individuals of antipathic sexuality in whom not only the character and all the feelings are in accord with the abnormal sexual instinct, but also the frame, the feat- ures, voice, etc.; so that the individual approaches the opposite sex anthropologically, and in more than a psychi- cal and psycho-sexual way. This anthropological form of the cerebral anomaly apparently represents a very high de- gree of degeneration ; but that this variation is based on an entirely different ground than the teratological manifesta- tion of hermaphroditisrn, in an anatomical sense, is clearly shown by the fact that thus far, in the domain of inverted 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 marked. There is yet wanting a sufficient record of cases belong- ing to this interesting group of women in masculine attire with masculine genitals. 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.). 390 P8YCHOPATIIIA 8EXTTALIS. In persons belonging to the fourth group, and in cer- tain ones in the third, forming transitions to the fourth, there seems to be a feeling of shame (sexual) toward per- sons of the same sex, and not toward those of the opposite sex. Case 152. Androgyny. Mr. v. H., aged thirty, sin- gle; of neuropathic mother. Nervous and mental diseases were said not to have occurred in the patient's family, and his only brother was said to be mentally and physically completely normal. The patient developed tardily physi- cally, and, therefore, spent much of his time at the sea- shore and climatic resorts. From childhood he was of neu- ropathic constitution, and, according to the statements of his relatives, unlike other boys. His disinclination for masculine pursuits and his preference for feminine amuse- ments were early remarked. Thus he avoided all boyish games and gymnastic exercises, while doll-play and femi- nine occupations were particularly pleasing to him. Sub- sequently 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 pollution occurred, became more frequent, and finally took place during the day; so that the patient grew weak, and manifested various ner- vous disturbances. Symptoms of neurasthenia spinalis made their appearance, and lasted for some years, but they became milder with the decrease in the number of pollu- tions. Onanism was denied, but was very probable. An indolent, effeminate, dreamy habit of thought had become more and more noticeable ever since puberty. All efforts to induce the patient to take up an earnest pursuit in life were in 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 ANDROGYNY. 391 an actual incapability to take care of money, and his own confession that ho 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 persever- ance. 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. Pre- posterous acts, senseless journeys, waste of money and debts repeatedly occurred 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 intracta- ble, and never did well when 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 was asserted that he had sexual intercourse with women, and was able to perform the act of coitus normally; but, partly on account of in- crease 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 was not quite clear; he was r..Tiv(.j,,us of an inclination toward the male sex, but con- fessed, only in a shame-faced way, that he had certain 392 PSYCHOPATHIA SEXUALIS. pleasurable feelings of friendship for masculine individ- uals, which, however, were not accompanied by any sensual feelings. The female sex he did 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 at- tempting to have sexual intercourse with youths, gave him the lie. His external appearance also, habitus, form, gestures, manners and dress were remarkable, and decidedly recalled the feminine form and characteristics. The patient, how- ever, was over middle height, but thorax and pelvis were decidedly of feminine form. The body was rich in fat; the skin was well groomed, delicate and soft. This im- pression of a woman in masculine dress was further in- creased by a thin growth of hair on the face, which was shaven, with the exception of a small moustache; by the mincing gait; the shy, effeminate mannel%; 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 made undoubted the feminine form of the body. The external genitals were well developed, though the left testicle had remained in the canal ; the growth of hair on the mons veneris was thin, and the latter was unusually rich in fat and prominent. The voice was high, and without masculine timbre. The occupation and manner of thought of v. H. were decidedly feminine. He had a boudoir and a well-supplied toilet-table, at which he spent many hours in all kinds of arts for beautifying himself. He abhorred the chase, AWDBOOYNT. 393 practice with arms, and such masculine pursuits, and called himself an aesthete; spoke with preference of his paintings and attempts at poetry. He was interested in feminine occupations, in which — e.g., embroidery — he engaged, and called his greatest pleasure. He could spend his life in an artistic and esthetic circle of ladies and gentlemen, in conversation, music and aesthetics. His conversation was preferably about feminine things, — fashions, needlework, cooking and household work. The patient was well nourished, but anaemic. He was of neuropathic constitution, and presented symptoms of neurasthenia, which were maintained by a bad manner of life, lying abed, living in-doors, and efferainateness. He complained of occasional pain and pressure in the head, and had habitual constipation. He was easily fright- ened ; complained 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 felt tired and relaxed ; he was sensitive to pressure over the spinous processes of the dorsal vertebrae, as also to pressure along accessible nerves. He felt peculiar sympathies and antipathies towards certain persons, and, when he met people for whom he had an antipathy, he fell into a condition of peculiar fear and confusion. His pollutions, though later on they occurred but seldom, were pathological, in that they occurred by day, and were un- accompanied by any sensual excitement Opinion. • 1. Mr. v. H., according to all observations and reports, was mentally an abnormal and defective person, and that, in fact, ab origine. His antipathic sexual instinct repre- sented a part of his abnormal physical and mental condi- tion. 2. This condition, in that it was congenital, was in- curable. There existed defective organisation of the high- est cerebral centres, which rendered him incapable of 394 PSYCIIOPATHIA SEXUALJS. leading an independent life, and of obtaining a position in life. His perverse sexual instinct prevented him from exercising normal sexual functions ; and this was attended by all the social consequences of such an anomaly, and the danger of satisfaction of perverse impulses arising out of his abnormal organisation, with consequent social and legal conflicts. Fear of the latter, however, could not be great, since the (perverse) sexual impulse of the patient was weak. 3. Mr. v. H., in the legal sense of the word, was not irresponsible, and neither fit for, or in need of, treatment in a hospital for the insane. It was possible for him — though but an overgrown child, and incapable of personal independence — to live in society, even under the care and guidance of normal individuals. To a certain extent, it was possible for him to respect the laws and restrictions of society, and to judge his own acts; but, with respect to possible sexual errors and conflicts with criminal laws, it must be emphasised that his sexual instinct was abnormal, having its origin in organic pathological conditions; and this circumstance should have been eventually used in his favour. On ac- count of his notorious lack of independence, he could not be discharged from parental care or guardianship, inas- much as otherwise he would be ruined financially. 4. Mr. v. H. was also physically ill. He presented signs of slight anaemia and of neurasthenia spinalis. A rational regulation of his manner of life and a tonic regimen, and, if possible, hydro-therapeutic treatment, seemed necessary. The suspicion that this trouble had its origin in early masturbation should be entertained, and the possibility of the existence of spermatorrhoea, that is of importance etiologically and therapeutically, was proba- ble. (Personal case. Zeilschr. f. Psychiatric.) CONGENITAL SEXUAL INVERSION IN WOMAN. 395 CONGENITAL SEXUAL INVERSION IN WOMAN.* Science in its present stage has but few data to fall back on, so far as the occurrence* of homosexual instinct in woman is rono-rued as compared with man. It would not be fair to draw from this the conclusion that sexual inversion in woman is rare, for if this anomaly is really a manifestation of functional degeneration, then degenerative influences will prevail alike in the female as well as in the male. The causes of apparent infrequency in woman may be found in the following facts: (1) It is more difficult to gain the confidence of the sexually perverse woman; (2) this anomaly, in so far as it leads to sexual intercourse, inter feminas, does not fall (in Germany at any rate) under the criminal code, and therefore remains hidden from public knowledge; (3) sexual inversion does not affect woman in the same manner as it does man, for it does not render woman impotent; (4) because woman (whether sexually inverted or not) is by nature not as sensual and certainly not as aggressive in the pursuit of sexual needs as man, for which reason the inverted sexual intercourse 'Literature: Hanelock Ellis, "Alienist and Neurologist," April, 1895 ; Moll, " Contriire Sexualempfindung," second edition, p. 322. — Moll, Contrfire Sexualempfindung, 3rd ed., p. 504. — Moraglia, Neue Forschungen aus d. Gehiet der weiblichen Criminalitat. — v. Krafft, Jahrb. f. sexuclle Zwischenstufen, Hi., p. 20. •Observations: (1) Westphal, "Arch. f. Psych.," ii., p. 73;— (2) Oock, op. cit., No. 1.;— (3) Wite, "The Alienist and Neurol- ogist," January, 1883; — (4) Cantarano, "La Psichiatria, 1883," p. 201; — (5) Berieux, op. cit., obs. 14;— (6) Kiernan, op. cit.; — (7) MAller, Friedreich't " Bliltter f. gor. Mt-d.," 1891, Heft 4.;— (8-19) Moll, " ContrRre Sexualempfindung," 2 Aufl. Beob., 18, 19, 20, 21, 22, 23;— (20) Meyhdfer, " Zeitsch. f. Medicinalbeamte," v., 16;— (21 22) Zuccarelli, " Inversione congenita in due donne," Napoli, 1888; — (23-33) it oil, " Untrrsuchungen liber Libido sexualis," Fftlle 10-12, 40-44, 47, 50, 57; — (34-36) Uavelock Ellit, op. cit.;— (37) Penta • Vrto, " Ardiiv. delle psichopatie sexuali," p. 33; — (38) Penta, ibid., p. 04. — (39-40) Ftrc, 1'instinct sexuelle, observ. 15, p. 242, observ. 22, p. 291.— (41) Case Urban of the 18th century, reported by Moll, Contr. Sexualempfindung, 3rd ed. p. 533. — (42-43) v. Krafft, Jahr- bOdier fUr texuelle Zwischenstufen, iii., p. 27 and 29. 396 PSTCHOPATHIA SEXUALIS. among women is less noticeable,, and by outsiders is considered mere friendship. Indeed, there are cases on record (psychical hermaphroditism, even homosexuality) in which the causes of frigiditas uxoris remain unknown even to the husband. Certain passages in the Bible,1 the history of Greece ("Sapphic Love"), the moral history of ancient Rome and of the Middle Ages,2 offer proofs that congressus in- tersexualis feminarum took place at all times, the same as it is practised now-a-days in the harem, in female prisons, brothels and young ladies' seminaries (vide infra, amor lesbicus). Still it must be admitted that many of these cases are to be reduced to causes of perversity and not per- version.8 The chief reason why inverted sexuality in woman is still covered with the veil of mystery is that the homo- sexual act so far as woman is concerned, does not fall under the law. I cannot lay sufficient stress upon the fact that sexual acts between persons of the same sex do not necessarily constitute antipathic sexual instinct. The latter exists only when the physical and psychical secondary sexual characteristics of the same sex exert an attracting influ- ence over the individual and provoke in him or her the impulse to sexual acts. 1 Paul, Epist. ad Rom. * Ploss, op. cit. ' It is a remarkable fact that in fiction, lesbic love is frequently used as the leading theme, viz., Diderot, " La Religieuse " ; Balzac, " La fille aux yeaux d'or " ; Th. Gautier, " Mademoiselle de Maupin " ; Feydeau, "La Comtesse de chalis"; Flaubert, "Salammbo"; Belot, "Mademoiselle Giraud, ma femme"; Rachilde, "Monsieur Venus." The heroines of these (lesbic) novelles appear to the beloved persons of the same sex in the character and the rdle of a man; their love is most intense. The oldest case of sexual inversion recorded thus far in Germany is one of viraginity dating as far back as the beginning of the eighteenth century. It is that of a woman who was married to another woman cohabiting with the consort by means of a leathern priapus. Vide Dr. Miiller in Friedreich'a " Blatter f. ger. Med.," 1891, Heft 4. CONGENITAL SEXUAL INVERSION IN WOMAN. 397 I have through long experience gained the impression that inverted sexuality occurs in woman as frequently as in man. But the chaster education of the girl deprives the sexual instinct of its predominant character; seduction to mutual masturbation is less frequent; the sexual in- stinct in the girl begins to develop only when she is, with the advent of puberty, introduced to the society of the other sex, and is thus naturally led primarily into hetero- sexual channels. All these circumstances work in her favour, often serve to correct abnormal inclinations and tastes, and force her into the ways of normal sexual in- tercourse. We may, however, safely assume that many cases of frigidity or anaphrodisia in married women are rooted in undeveloped or suppressed antipathic sexual instinct. The situation changes when the predisposed female is also tainted with other anomalies of an hypersexual char- acter and is led through it or seduced by other females to masturbation or homosexual acts. In these cases we find situations analogous to those which have been described as existing in men afflicted with "acquired" antipathic sexual instinct. As possible sources from which homosexual love in woman may spring, the following may be mentioned: 1. Constitutional hypersexuality impelling to auto- masturbation. This leads to neurasthenia and its evil consequences, to anaplimdisia in the normal sexual inter- course so long as libido remains active. 2. Hypersexuality also leads faute de mieux to homo- sexual intercourse (inmates of prisons, daughters of the higher classes of society who are guarded so very care- fully in their relations with men, or are afraid of im- pregnation,— this latter group is very numerous). Fre- quently female servants are the seducers, or lady friends with perverse sexual inclinations, and lady teachers in seminaries. 3. Wives of impotent husbands who can only sexually excite, but not satisfy, woman, thus producing in her 398 PSTCHOPATHIA SEXUALI8. libido insatiata, recourse to masturbation, pollutiones fem- inw, neurasthenia, nausea for coitus/ and ultimately disgust with the male sex in general. 4. Prostitutes of gross sensuality who, disgusted with the intercourse with perverse and impotent men by whom they are used for the performance of the most revolting sexual acts, seek compensation in the sympathetic embrace of persons of their own sex. These cases are of very fre- quent occurrence. Careful observation among the ladies of large cities soon convinces one that homosexuality is by no means a rarity. Uranism may nearly always be suspected in fe- males wearing their hair short, or who dress in the fashion of men, or pursue the sports and pastimes of their male acquaintances; also in opera singers and actresses, who appear in male attire on the stage by preference. So far as the clinical aspect is concerned I may be brief, for this anomaly shows the same qualifications alike in man and woman, mutatis mutandis, and runs through the same grades. Psychico-hermaphrodisic and many homosexual women do not betray their anomaly by ex- ternal appearances nor by mental (masculine) sexual characteristics. Remarkable, however, it is that Dr. Flatau (Moll, op. cit., p. 334) in examining the larynx of twenty-three homosexual women found in several of them a decidedly masculine formation. In the transition to the subsequent grade, i.e., that of viraginity (analogous to effeminatio in the male) strong preference for male garments will be found. In dreams, but also in the ideal or real homosexual function, the individual in question plays an indifferent sexual role. Where viraginity is fully developed, the woman so acting assumes definitely the masculine role. In this grade modesty finds expression only towards the same but not the opposite sex. In such cases the sexual anomaly often manifests itself by strongly marked characteristics of male sexuality. The female urning may chiefly be found in the haunts CONGENITAL, SEXUAL INVERSION IN WOMAN. 399 of boys. She is (ho rival in their play, preferring the nx-kin^-horse, playing at soldiers, etc., to dolls and other girlish occupations. The toilet is neglected, and rough boyish manners are affected. Love for art finds a sub- stitute in the pursuits of the sciences. At times smoking and drinking are cultivated even with passion. Perfumes and sweetmeats are disdained. The con- sciousness of being a woman and thus to be deprived of the gay college life, or to be barred out from the military career, produces painful reflections. The masculine soul, heaving in the female bosom, finds pleasure in the pursuit of manly sports, and in manifestations of courage and bravado. There is a strong desire to imitate the male fashion in dressing the hair and in general attire, under favourable circumstances even to don male attire and impose in it Arrests of women in men's clothing are by no means of rare occurrence, A case of a woman who for years successfully posed as a man (hunter, soldier, etc.,) is related by Mutter in Friedreich's "Blatter"; another by Wise (op. cit.) and others. The ideals of such viragines are certain female char- acters who in the past or the present have excelled by virtue of genius and brave and noble deeds. Gynandry represents the extreme grade of degenerative homosexuality. The woman of this type possesses of the feminine qualities only the genital organs ; thought, senti- ment, action, even external appearance are those of the man. Often enough does one come across in life such characters, whose frame, pelvis, gait, appearance, coarse masculine features, rough deep voice, etc., betray rather the man than the woman. Moll (op. cit. p. 331) has given many interesting items about the mode of life led by these men-women, and about the way in which they satisfy their sexual needs. Mutatis mutandis, the situation is the same as with the man-loving man. These creatures seek, find, recognise, 400 PSYCHOPATHIA SEXUALIS. love one another, often live together as "father" and "mother" in pseudo marriage. Suspicion may always be turned toward homosexuality when one reads in the advertisement columns of the daily papers: "Wanted, by a lady, a lady friend and companion". Numerous psychical hermaphrodites of the female gender, and even homosexualists, enter upon matrimony with men partly on account of being ignorant of their own anomaly, and partly because they wish to be pro- vided for. Some of these marriages linger on in a way, the husband, perhaps, being psychically sympathetic, thui rendering the marital act possible to the unhappy wife. But in most cases, when one or two children have been born, she seeks under all kinds of pretexts to avoid the connubial duty. More frequently, however, incompatibility wrecks these unions. Homosexual intercourse continues after marriage just the same as with the homosexual man. When viraginity prevails marriage is impossible, for the very thought of coitus cum viro arouses disgust and horror. The intersexual gratification among these women seems to be reduced to kissing and embraces, which seems to satisfy those of weak sexual instinct, but produces in sexually neurasthenic females ejaculation. Automasturbation, faute de mieux, seems to occur in all grades of the anomaly the same as in men. Strongly sensual individuals may resort to cunnilingus or mutual masturbation. In grades 3 and 4 the desire to adopt the active role towards the beloved person of the same sex seems to in- vite the use of the priapus. Case 153. Psychical hermaphroditism. Mrs. X., twenty-six years of age, suffered from neurasthenia. She was hereditarily tainted, suffered periodically from delu- sions. She had been married seven years, had two healthy children, a boy of six and a girl of four years. Success in CONGENITAL SEXUAL INVERSION IN WOMAN. 401 gaining the confidence of the patient. She confessed that she always inclined more to persons of her own sex, and that, although she esteemed and liked her husband, sexual intercourse disgusted her. Since the birth of the younger of the two children she had prevailed upon him to give it up altogether. When at the seminary she interested her- self in other young ladies in a manner which she could only describe as love. At times, however, she also found her- self drawn to certain gentlemen, and especially of late her virtue had been sorely tried by an admirer to whose advances she was afraid she might succumb, for which reason she avoided being alone with him. But such episodes were only of a quite transient character as com- pared with her passionate liking for persons of her own sex. Her whole desire was to be kissed and embraced by them and have the most intimate intercourse with them. She suffered much from nervousness because she could not always realise these desires. The patient is not aware of this inclination to persons of the same sex being of a sexual character, for beyond kissing, embracing, or fondling them she would not know what to do with them. Patient thought herself to be of a sensual nature. It was likely that she was addicted to masturbation. She considered her sexual perversion as "unnatural, morbid." There was nothing in the behaviour or the manners or the external appearance of this lady which in the least betrayed her anomaly. Case 154. Psychical hermaphrodUism. Mrs. M., forty-iour years of age, claimed to be an instance illus- trating the fact that in one and the same human being, be it man or woman, the inverted as well as the normal di- rection of sexual life may be combined. The father of this lady was very musical, generally possessed considerable talents for art, was a great admirer of the gentle sex, and himself of exceptional beauty. He died, after repeated apoplectic attacks, with dementia in an asylum. His 2G 402 PSYCIIOPATHIA SEXUALIS. brother was neuropsychopathic, as a child was afflicted with somnambulism, and later on with hypercesthesia sexualis. Although married and father of several married sons, he fell desperately in love with Mrs. M., then eighteen years of age, and attempted to abduct her. Her grandfather (on the paternal side) was very ec- centric and a well known artist, who had originally studied theology, but for love of the dramatic art became a mimic and singer. He was given to excess in Baccho et Venere, extravagant and fond of splendour, and died at the age of forty-nine from apoplexia cerebri. Her mother's father and her mother both died of pulmonary phthisis. She had eleven brothers and sisters, but only six sur- vived. Two brothers died at the age of sixteen and twenty of tuberculosis. One brother was suffering from laryngeal phthisis. Four living sisters the same as Mrs. M. were physically like unto the father, very nervous and shy. Two younger sisters were married and in good health, and both had healthy children. Another one, a maiden, was suffering from nervous affection. Mrs. M. was the mother of four children, mostly deli- cate and neuropathic. There was nothing of importance in the history of the patient's childhood. She learned easily, had gifts for poetry and aesthetics, was somewhat affected, loved to read novels and sentimental literature, was of neuropathic % constitution and very sensitive to changes of temperature, the slightest draught would make her flesh creep. It is noteworthy, however, that one day when ten years of age she fancied her mother did not love her. Thereupon she put a lot of sulphur matches in her coffee and drank it to make herself ill, in order to draw her mother's love to herself. Puberty began without difficulty at the age of eleven, with subsequent regular menses. Even previous to that period sexual life had awakened, which ever since was very potent. The first sentiments and emotions lay in vthe homosexual direction. She conceived a passionate, CONGENITAL SEXUAL INVERSION IN WOMAN. 403 though platonie, affection for a young lady, wrote love- songs and sonnets to her, and never was happier than \\licn, upon one occasion, she could admire the "charms "f her beloved" in the bath, or when she could gaze upon the- neck, shoulders and breasts of this lady whilst dressing. She could resist only with difficulty the desire to touch these physical charms. When a girl she was deeply in love with Raphael's and Quido Reni's Madonnas. She was irresistibly impelled to follow pretty girls and ladies by the hour, no matter how inclement the weather might be, admiring their air of refinement and watching for a chance of showing them a favour, giving them flowers, etc. The patient asserted that up to her nineteenth year she had not the slightest knowledge of the difference of sexes, since she had been brought up by a prudish old maiden aunt like a nun in a cloister. In consequence of this crass ignorance she fell a victim to a man who loved her passionately and insidiously betrayed her virtue. She became the wife of this man, gave birth to a child, and led an "eccentrically" sexual life with him, but felt sat- isfied with the sexual intercourse. A few years later she became a widow. Since then her affections again turned to persons of her own sex, the principal reason for which was, the patient averred, the fear of the results of sexual intercourse with man. At the age of twenty-seven she entered upon a second marriage with a man of infirm constitution. It was not a love match. Thrice she became a mother, and fulfilled all the conditions of maternity; but her health ran down, and during the latter years her dislike for coitus ever increased, chiefly on account of her husband's infirmity, although her desire for sexual gratification remained strong. Three years after her second husband's death, she dis- covered that her daughter by the first husband, now nine years of age, was given to masturbation and going into decline. She read an article about this vice in the Ency- clopcedia, and now could not resist the temptation to try 404 PSYCHOPATHIA SEXUALI8. it herself and thus became an onanist. She hesitated to give a full account of this period of .her life. She stated, however, that she became sexually so excited that she had to send her two daughters away from home in order to preserve them from something "terrible". The 'two boys could remain at home. Patient became neurasthenic ex masturbatione (spinal irritation, pressure in the head, languor, mental constipa- tion, etc.) at times even dysthymic, with worrying tcedium vita. Her sexual inclinations turned now to woman, now to man. But she controlled herself, suffered much from her abstinence, especially since she resorted to mastur- bation on account of her neurasthenic afflictions only at the last instance. At the age of forty-four — still having regular periods — the patient suffered from a violent pas- sion for a young man with whom, on account of her avoca- tion, she was bound to be in constant contact. The patient did not offer anything extraordinary in her external appearance, though graceful of build, she was slight of form. Pelvis decidedly feminine, but arms and legs large, and of pronounced masculine type. Female boots did not really fit her, and she had quite crippled and malformed her feet by forcing them into narrow shoes. Genitals quite normal. Excepting a descensus uteri with hypertrophy of the vaginal portion, no changes were noticeable. She still claimed to be essentially homo- sexual, and declared that her inclination and desire for the opposite sex were only periodical and grossly sensual. Al- though she had strong sexual feelings towards the man aforementioned, yet her greatest and noblest pleasure she found in pressing a kiss upon the soft cheek of a sweet girl. This pleasure she enjoyed often, for she was the "favourite aunt" among these "dear creatures," to whom she rendered the services of the "cavalier" unstintingly, always feeling herself in the role of the man. Case 155. Homosexuality. Miss L., fifty-five years CONUKMTAL SEXUAL INVERSION IN WOMAN. 405 of age. No information about her father's family. The I >a rents of her mother were described as irascible, ca- pricious and nervous. One brother of her mother was an epileptic, another eccentric and mentally abnormal. Mother was sexually hypenesthetic, and for a long time a messalina. She was considered to be psychopathic and died at the age of sixty-nine of cerebral disease. Miss L. developed normally, had only slight illnesses in childhood, and was mentally well endowed, but of a neuropathic constitution, emotional, and troubled with numerous fads. At the age of thirteen, two years previous to her first menstruation, she fell in love with a girl-friend ("a dreamy feeling, quite pure of sensuality"). Her second love was for a girl older than herself who was a bride; this was accompanied by tantalising sensual desires, jealousy, and an "undefined consciousness of mys- tical impropriety". She was refused by this lady and now fell in love with a married woman, who was a mother and twenty years her senior. As she controlled her sensual emotions, this lady never even divined the true reason of this enthusiastic friendship which lasted for twelve years. Patient described this period as a veritable martyrdom. Since she was twenty-five she had begun to mastur- bate. Patient seriously thought that, perhaps, by marriage she might save herself, but her conscience objected, for her children might inherit her weakness, or she might make a sincere husband unhappy. At the age of twenty-seven she was approached with direct proposals by a girl who denounced abstinence as alisurd, and plainly described the homosexual instinct \\hich ruled her and was very impetuous in her demands. She suffered the caresses of the girl, but would not con- sent to sexual intercourse, as sensuality without love dis- gusted her. Mentally and bodily dissatisfied the years fled by, leaving the consciousness of a spoiled life. Now and then she became enthusiastic about ladies of her acquaintance, 406 PSYCHOPATHIA SEXUALIS. but controlled herself. She also rid herself from mastur- bation. When she was thirty-eight years of age she became acquainted with a girl nineteen years her junior, of ex- ceptional beauty, who came from a demoralized family, and had been at an early age seduced by her cousins to mutual masturbation. It could not be ascertained whether this girl A. was a case of psychical hermaphrodism or of acquired sexual inversion. The former hypothesis seems the likelier of the two. The following is taken from an autobiography of Miss Jj. '• "Miss A., my pupil, began to show me her idolatrous love. She was sympathetic to the highest degree. Since I knew that she was entangled in a hopeless love affair with a dissolute fellow and continued intimate intercourse with demoralised female cousins, I decided not to repulse her. Compassion and the conviction that she was surely drifting into moral decay determined me to suffer her advances. "I did not consider her affection as dangerous, as I did not think it possible that (considering her love affair) in ONE soul two passions (one for a man and another for a woman) could exist simultaneously. Moreover, I was certain of my power of resistance. I kept, therefore, Miss A. about me, renewed my moral resolutions, and con- sidered it to be my duty to use her love for me for en- nobling her character. The folly of this I soon found out. One day whilst I lay asleep Miss A. took occasion to satisfy her lust on me. Although I woke up just in time, I did not have the moral strength to resist her. I was highly excited, intoxicated as it were — and she pre- vailed. "What I suffered immediately after this occurrence beggars description. Worry over the broken resolutions, which to keep I had made such strenuous efforts, fear of detection and subsequent contempt, exuberant joy at last to be rid of the torturing watcbings and longings of the CONGENITAL SEXUAL INVERSION IN WOMAN. 407 single state, unspeakable sensual pleasure, wrath against tin- evil companion, mingled with feelings of the deepest tenderness towards her. Miss A. calmly smiled at my excitement, and with caresses soothed my anger. "1 accepted the situation. Our intimacy lasted for years. We practised mutual masturbation, but never to excess or in a cynical fashion. "Little by little this sensual companionship ceased. Miss A.'s tenderness weakened; mine, however, remained as before, although I felt no longer the same sensual cravings. Miss A. thought of marriage, partly in order to find a home, but especially because her sensual desires had turned into the normal paths. She succeeded in finding a husband. I sincerely hope she will make him happy, but I doubt it. Thus I have the prospect before me to linger on the same joyless, peaceless life as it ever was in youthful days. "It is with sadness that I remember the years of our loving union. It does not disturb my conscience to have had sexual intercourse with Miss A., for I succumbed to her seduction, having honestly endeavoured to save her from moral ruin and to bring her up an educated and moral being. In this I honestly think I have succeeded after all. Besides, I rest in the thought that the moral code is established only for normal humans, but is not binding for anomalies. Of course, the human being who is endowed by nature with sentiments of refinement, but whose constitution is abnormal and outside the conven- tionalities of society, can never be truly happy. But I experienced a sad tranquillity and felt happy when I thought Miss A. to be so too. "This is the history of an unhappy woman who, by the fatal caprice of nature, is deprived of all joy of life and made a victim of sorrow." The author of this woeful story was a lady of great refinement. But she had coarse features, a powerful but throughout feminine frame.* She passed through the climacterium without trouble, and since then had been 408 PSYCHOPATHIA SEXUALIR. entirely free from sensual worry. Sexually she had never played a defined role towards the, woman she loved; for men she never felt the slightest inclination. Her statements about the family relations and the health of her paramour, Miss A., establish a heavy taint beyond doubt. The father died in an insane asylum, the mother was deranged during the period of her climac- terium, neuroses were of frequent occurrence in the family, and Miss A. herself suffered at times heavily from hystero- pathy, with hallucinations and delirium. Case 156. Homosexuality. S. J., age thirty-eight, governess. Came to me for medical advice on account of nervous trouble. Father was periodically insane, and died from cerebral disease. Patient was an only child. She suffered early from anxiety and alarming fancies, e.g., that she would wake up in a coffin after it had been fastened down; that she would forget something when going to confession, and thus receive holy communion unworthily. Was often troubled with headaches, very excitable, easily startled, but notwithstanding had a great desire to see exciting things such as funerals, etc. From the earliest youth she was subject to sexual excitement, and spontaneously practised masturbation. At the age of fourteen she began to menstruate. Her periods were often accompanied by colicky pains, intense sexual excitement, neuralgia and mental depression. With the age of eighteen she gave up masturbation successfully. The patient never experienced an inclination towards a person of the opposite sex. Marriage to her only meant to find a home. But she was mightily drawn to girls. At first she considered this affection merely as friendship, but she soon recognised from the intensity of her love for girl friends and her deep longings for their constant society that? it meant more than mere friendship. To her it is inconceivable that a girl could love a man, although she can comprehend the feeling of man toward woman. She always took the deepest interest in pretty CONGENITAL SEXUAL INVERSION IN WOMAN. 409 girls and ladies, the sight of whom caused her intense • "input. Her desire was ever to embrace and kiss these dear creatures. She never dreamed of men, always of girls only. To revel in looking at them was the acme of pleasure. Whenever she lost a "girl friend" she felt in despair. Patient claimed that she never felt in a defined role, even in her dreams, towards her girl friends. In appear- ance she was thoroughly feminine and modest. Feminine pelvis, large mammse, no indication of beard. Case 157. Homosexuality. Mrs. R., aged thirty-five, of high social position, was brought to me in 1886 by her husband for advice. Father was a physician; 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 were 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 had been subject to habitual headache. With the exception of measles, she had no illness. She was gifted, 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 asserted that she had always had sympathy only for her own sex, and found only an sesthetic interest in men. She never had any taste for female work, As a little girl, she preferred to play with boys. She said she remained well until her twenty-seventh year. Then, without external cause, she became depressed and considered herself a bad, sinful person, had no plea- sure in anything, and was sleepless. During this time of illness she was also troubled with delusions: she must 410 PSYCHOPATHIA SEXUALIS. think of her death and that of 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 mada 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 ; hers 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 be- came ill with symptoms of hystero-neurasthenia (dyspep- sia, spinal irritation, and tonic spasmodic attacks; attacks of hemiopia with migraine and transitory aphasia; pruritus pudendi ei am). In February, 1886, these symp- toms disappeared. In March she became acquainted with her present husband, whom she married 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 6th April, she read the sentence, "Death misses no one." Like a flash of lightning in a clear sky, the former delusions of death returned. She was forced to meditate on the most horrible manner of death for herself and those about her, and constantly imagined 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 6th June, 1886. She was deeply de- pressed morally by it. She 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 behaviour of his wife. She was friendly toward him, and suffered CONGENITAL SEXUAL INVERSION IN WOMAN. 411 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 insepar- able. The husband saw that this friendly relation was a peculiar one, and hastened their departure. lie had an opportunity of ascertaining, 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 delusions 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, anosmia, et 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 tin- physicians, she had been better; but she thought of the future with horror. She esteemed her husband, and l<>\itliing else." After the husband forbade her lover the house, there was interchange of letters with such expres- sions 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 was pre- sumable that mutual masturbation was the means of sexual 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 housekeeper, and also a governess for the children. The patient fell in love with both, who, at least, allowed caresses, and profited ma- terially 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 be- came manifest She thought the Russian lady a nihilist; that she was magnetised by her; and she presented formal persecutory delusions. She fled, was caught in an Italian city, and placed in a hospital, where she soon became quiet. Again she worried 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 harsh 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 lover, 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 exalta- 416 PSYCIIOPATHTA SEXUALIS. tion disappeared. The patient became quiet, and made a desperate attempt at suicide; after it she was in great an- guish of mind with toedium vitce. The perverse sexual feeling grew less and less noticeable as tuberculosis pro- gressed. The patient died of phthisis in the beginning of 1885. The examination of the brain presented nothing unu- sual so far as architecture and arrangement of convolu- tions were concerned. Weight of brain 1150 grammes. Skull slightly asymmetrical. No anatomical signs of de- generation. External and internal genitals without anom- aly. Case 160. (Homo-sexuality in Transition to Vira- ginity.) Mrs. v. T., wife of a manufacturer; age twenty- six; married only a few months; was brought by her husband for consultation because after a banquet she had fallen upon the neck of a lady guest, covered her profusely with kisses and caressed her like a lover, thus causing a scandal. Mrs. T. said that she had before their marriage ex- plained to her husband her antipathic sexual feelings, and had told him that she esteemed him solely for his mental qualities. She accepted her conjugal duties merely as a matter of unavoidable necessity. Her only condition was that she should be incubus. In this position she obtained a sort of gratification, for she imagined his body to be that of a beloved woman in succubus. Her brother was neuropathic, of feminine type, suf- fered from hysteria, and was very weak in his sexual needs; one of his sisters, it was said, bought her conjugal rights from her husband for a sum of money, giving him full liberty to find sexual satisfaction elsewhere. The mother was hyper-sexual, and known as a Messalina. She made her daughter sleep in the same bed with her till she reached the age of fourteen. At fifteen v. T. was sent to a girl's school. Being extraordinarily bright, she learned quickly and soon dominated over all the other girls in her form. COMM-.MTAL SEXUAL INVERSION IX WOMAN. 417 At the ago of seven she IKK! a i»v<-ltieul trauma when a friend of the family exhibits! him.-eh' l.rfuiv lier. Menses began at twelve, were regular and without in rvoiiv enm-omitants. At that age she began already to be powerfully drawn to other girls. Although for several years she never associated these yearnings with sexual feel- ings, she yet looked upon them as an anomaly. She only felt bashful when undressing in the presence of persons of her own sex. At twenty the sexual instinct awoke. At once she turned to girls for gratification, avoiding men entirely. She had sensual love affairs with girls by the scores. When she returned home from school, having no Mipervision and plenty of money, she found it easy to give her passion full sway. She always felt like a man towards woman. Masturbatio feminro dilectae was the common occurrence in her orgies, until a female cousin taught her the mysteries of Lesbian love. She now coupled the act with etinuiliugus. She always played the active role, and never allowed others to satisfy themselves on her own body. Homo-sexual woman she disdained. She gave preference to unmarried women of high standing endowed with men- tal gifts, of voluptuous, Diana-like figure, but of modest and retiring disposition. (Sensual women she did not care for.) Whenever she met such a woman, she would be- come erotically so excited that she fell upon her person like a hungry wild beast. She said that at such momenta everything appeared to her in a reddish gleam, and con- sciousness was obliterated for the time being. Her nerves were easily unstrung, and she could not master her feel- ings. At the age of twenty-three she became acquainted with a young woman who, to all appearances, was not homo- Mi, but very hypersexual, and could not find sexual satisfaction on account of impotence in her husband. The relations with this woman stimulated T.'s homo-sexuality to a very high pitch and increased her sexual needs. She furnished an apartment away from home, where she had regular orgies cum digito et lingua, sometimes for hours, 27 418 PSYCHOPATHIA 8EXUALIS. until she herself collapsed in a state of exhaustion. She had a love affair with a dressmaker's model with whom she had herself photographed in man's attire, visited, in the same costume, with her places of amusement and was finally arrested on one of these occasions. She escaped with a warning and gave up male attire out-of-doors. A year before her marriage she had a period of melan- cholia. At that time she meditated suicide, and wrote a farewell letter to an intimate lady friend, a sort of con- fession, from which a few passages are given: "I was born a girl, but a misdirected education forced my fiery imagination early into the wrong direction. At twelve I had a mania to pose as a boy and court the atten- tion of ladies. I recognised this abnormal impulse as a mania, but, like fate, it grew with the years. The power to rid myself of it was lost. It was my hashish, my happi- ness, and grew into an overpowering passion. I felt like a man, forced to play the active role. My exuberant dis- position, tierce sensuousness and deep-rooted perverse in- stinct gradually forged me into the chains of Lesbian love. I took a certain interest in man, but a single touch by a woman made my whole nervous system tremble. I have suffered untold tortures in the bane of this passion. "The reading of French novels and lascivious compan- ions taught me all the tricks of perverse erotics, and the latent impulse became a conscious perversity. Nature has made a mistake in the choice of my sexuality and I must do a life-long penance for it, for the moral power to suffer the unavoidable with dignity is lost. Irresistibly I have been drawn into the maelstrom of passion and shall be swallowed up by it "I languished for your sweet body. I was jealous of your Victor as one rival is of the other. In my jealousy I suffered the tortures of hell. I hated that man unto death. I cursed my fate that made me a woman. I was satisfied to play a stupid comedy before you, to endow you with an artificial membrum. It only increased the heat of my passion. Courage failed me to tell you the CONGENITAL SEXUAL INVERSION IN WOMAN. 419 (ruth, because it would have been so miserable and ludi- crous. Now you know all. You will not despise me, though; you will only feel what I have suffered. All my joys resemble more a momentary intoxication than the real gold of happiness. It was all but an illusion. I have fooled life and life has fooled me. We are quits. I say good-bye. Think sometimes in the hour of happiness of your poor, comical fool who loved you truly and so well . . . The vita sexualis of this woman contained also traces of masochism and sadism. If the woman whom she wor- shipped had chided or even struck her, it would have been a delight, — so she claimed — and at the time of sex^ial ex- citement she felt more like biting than kissing the object of her love. She was highly cultured and intellectual, felt her false position painfully, but rather on account of her family than her own self. She looked upon it all as fate, over which she had no control. She bewailed it and declared herself ready to do anything to rid herself of this perversion and become a true wife and good mother, for she would take good care that her child were brought up in the right way. She would do everything to reconcile her husband and perform her marital duties, but she could not bear his moustache, and she must first rid herself of her un- fortunate impulsive passion. The physical and psychical secondary sexual charac- teristics were partly masculine, partly feminine. Her love for sport, smoking and drinking, her preference for clothes cut in the fashion of men, her lack of skill in and liking for female occupations, her love for the study of obtuse and philosophical subjects, her gait and carriage, severe features, deep voice, robust skeleton, powerful mus- cles and absence of adipose layers bore the stamp of the masculine character. The pelvis also (small hips), dis- tantia spinarum 22cm., cristarum 26, trochanterum 31, ap- proached the masculine figure. Vagina, uterus, ovaries normal, clitoris rather large. Mammae well developed, hair on mons veneris female. 420 PSYCHOPATHIA SF.XTTALIS. I sent her to an hydropathic establishment, where an experienced colleague succeeded in a few months to free this patient by means of hydro- and suggestive treatment, from her homo-sexual affliction. She became a decent, sexually at least, neutral person. The relatives with whom she lived afterwards for a considerable time found her be- haviour absolutely correct. Case 161. Viraginity. Miss N"., twenty-five years of age. Parents supposed to be healthy. Her brothers and sisters were all neuropathic. Three of her sisters were married. She was very talented, especially in the fine arts. Even in her earliest childhood she preferred playing at soldiers and other boys' games; she was bold and torn- boyish, and tried even to excel her little companions of the other sex. She never had a liking for dolls, needle- work or domestic duties. Puberty at fifteen. She soon foil in love with young ladies, but only in a platonic fash- ion, for she was a "respectable girl." For several years since then her libido was very strong. She could hardly restrain herself. Her dreams were of a lascivious character, only about females, with herself in the role of man. She was desperately in love with a woman of forty, whom she tor- mented with her jealous conduct. Miss N. was indifferent to men. She could safely live with a man in the same room, whilst towards persons of her own sex she was most bashful. She was quite conscious of her pathological condition. Masculine features, deep voice, manly gait, without beard, small mammse; cropped her hair short, and made the impression of a man in woman's clothes. Case 162. Viraginity. C. R., maid-servant, aged twenty-six, 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 on account of delusions of persecution, she came under the observation CONGENITAL SEXUAL INVEK8ION IN WOMAN. 421 of tbe authorities. On this occasion it was ascertained that R. was affected with sexual inversion. Concerning her parents and relatives, there was no in- formation 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 irregrtlar and abnormally ex- cessive. 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 im- print 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 pre- ferred 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 per- secutions, the patient had often gone about in male attire and played the part of a man. She did this with such (natural) skill that, as a rule, she was able to deceive peo- ple concerning her sex. 422 PSYCHOPATHIA SEXUALIS. 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 lieu- tenant ; and in August of the same year, dressed as a male servant, she fled to Switzerland through delusions of per- secution. There she found service in a merchant's family and fell in love with the daughter of the house, "the beau- tiful Anna," who, on her side, not recognising the sex of R., fell in love with the handsome young man. Concerning this episode the patient made the follow- ing 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 role 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 apostrophises 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 my 'flower/ for if she should die I 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 occa- sion, 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 em- braced and kissed in the same way. R. was a tall, slim, stately person, of feminine form in all respects, but masculine features. Cranium regular; no anatomical signs of degeneration. Genitals normal and indicative of virginity. R. made the impression of a mor- ally pure and modest person. All the circumstances in- dicated that she had only indulged in platonic love. Eye CONGENITAL SEXUAL INVERSION IN WOMAN. 423 and appearance were indicative of a neurasthenic person. Severe hysteria, occasional cataleptoid attacks, with vision- ary and delirious states. The patient was very easily brought into a state of somnambulism by hypnotic influ- ence, and in this condition was susceptible to all possible suggestions. (Personal case. "Friedreich's Blatter," 1881, Heft i.) Case 163. Viraginity. Miss O., twenty-three years of age. Mother constitutionally and heavily hysteropathic. Mother's father insane. Father's family untainted. Father died early of pneumonia. Patient was brought to me by her trustee because she ran away recently from home in male attire in order to rove through the world and become an "artiste". Very gifted in music. For several years she attracted much attention by her bold, mannish behaviour, and by wearing her hair and attire in male fashion. Since she was thirteen she was demonstrative in her love for girl friends, whom she often wearied with fervent embraces. She did not seek to conceal her passionate fondness for persons of her own sex. Claimed that since her thir- teenth year she was fully conscious of the fact that she could love only women. She felt as a man towards woman ; though she looked like a man, and would much rather wear men's clothes. A short time ago she seriously asked a relative who was in the police department to obtain permission for her to go about in male attire. Her erotic dreams dealt only with intimate intercourse with female friends. She never took the slightest interest in men, and never thought of marriage. She felt quite happy in her abnormal sexual condi- tion, and did not recognise it as pathological. She could not comprehend that her sexual instinct differed from that of other women. The circumference of the head was 51 cm. Frame quite feminine; but the feet were exceptionally large and 424 PSYCIIOPATHIA SEXUALIS. more of masculine type. Carriage, attitude and gait quite masculine. Female voice. Monthly periods regular since her thirteenth year. Case 164. (Viraginity.) On the 5th of October, 1898, the police brought to my clinic W., age thirty-six, a charwoman, for examination as to her sanity. She had engaged herself to a young girl under the pretext that she was a man and belonged to an aristocratic family. Exam- ination proved this to be a classical case of original para- noia. When she was five she imagined that the couple with whom she lived were only her foster parents, at eighteen that she came from a distinguished family, at twenty-nine that her father was a king, her mother a countess. Circumference of cranium 53 cm., parietal bones slightly bulging. Ears abnormally small, of uneven size, misformed, the right lobe joined groin-like to the cheek, the left properly developed. Palate very narrow and steep. Teeth carious, many missing (Rachitis). Stat- ure medium size, willowy. Chest strongly arched. Waist and region of hips smaller than in the normal. A promi- nent gynecologist examined the pelvic regions and found a small pelvis, narrow at the inferior outlet, in form almost typically masculine. Ilium less inclined than in the nor- mal. The hard lines and severe features of the face gave it a rather masculine appearance. Her hair was cut short. Gait and bearing masculine. Skin very rough, adipose layers sparse, mamma stunted. Genitals normal, hymen intact. She was loath to speak of her vita sexualis, but wanted an explanation why she had no desire for men and only for persons of her own sex. "Her genitals could not be right." Menses from the age of sixteen, but the flow of blood came but seldom, and even then very sparsely. With the advent of puberty inclinations to persons of her own sex. She never was sensual. Her sexual ideas were always about the female sex in general, never concentrated on an individual. In this wise she had lived with another CONGENITAL SEXUAL INVERSION IN WOMAN. 425 girl of her own age; but their relations had been those of sisters; sexual acts had never taken place between them. She felt towards other women as a man does; she loathed the idea of sexual intercourse with a man. When a child she preferred playing with boys. "When playing at "rob- bers" she would be the captain and chose a girl for her wife, but without any sexual moment. At sixteen she thought she possessed the qualities of a man. She was then in a convent and there learned from a woman mas- turbation. The thought of this woman was always pres- ent when she masturbated, and acted as a sexual stimulus. Later on she thought of other females during the act, but without decided individuality. At thirty-three she became neurasthenic, gave up the practice successfully. She bewailed the fact that she was not born a man, as she hated feminine things and dress generally. "Would much, rather have been a soldier. Sweetmeats she disdained, preferring a cigar. She was a bright, intelligent person. Larynx and voice feminine. She became convinced that she could not marry a woman and upon promise to conquer her perverse sexual inclina- tions she was dismissed. Case 165. Miss X., aged thirty-eight, consulted me late in the fall of 1881, on account of severe spinal irri- tation 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 fam- ily 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 devel- oped, with predominating spinal irritation and sleepless- ness. 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 426 PSYCHOPATHIA SEXUALlS. months in the hospital relieved the latter, and considerably improved the neurasthenic neurosis, in the treatment of which general faradisation exerted a remarkably favour- able influence. Even at the first meeting, the patient produced a re- markable 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 gar- ment of masculine cut that reached well down over her gown, and boots with high heels. She had coarse, some- what 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 decid- edly feminine form of the pelvis. During the long time that she was observed, there were never signs of erotism. When questioned concerning her attire, she would only respond that the style she chose suited her better. Gradu- ally 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. 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 of 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, she had worn her hair short, and parted it on the side, as men do. She as- serted that she was never sexually excited in the company of men, but that her friendship and self-sacrifice for sym- pathetic ladies was unbounded; while from that time she also experienced repugnance for gentlemen and their so- ciety. Her relatives reported that, before 1872, the patient CONGENITAL SEXUAL INVERSION IN WOMAN. 427 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, 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 unfaithful- ness. Moreover, since her illness, 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 investigation showed that the patient had a love-relation, which was not purely platonic, with the lady described in case 159; and that she wrote her affectionate letters like those of a lover to his beloved. In 1887 I again saw the patient in a sanatorium, where she had been placed on account of hystero-epileptic attacks, spinal irritation, and morphinism. The inverted sexual feeling existed un- changed, 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 "exhaus- tion," in August, 1889. The autopsy showed, in the vege- tative 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 oedematous, but no atro- phied brain, 1175 grammes. The meuinges delicate, easily 428 PSYCHOPATHIA SEXUALIS. removed. Cortex pale. Convolutions broad, not numer- ous, regularly arranged. Nothing abnormal in cerebellum and great ganglia. Case 166. Gynandry.1 History: On 4th November, 1889, the father-in-law of a certain Countess V., com- plained that the latter had swindled him out of 800f., under the pretence 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 the 6th Sept., 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. came of an ancient, noble and highly respected family of Hungary, in which there had been eccentricity and family peculiarities. A sister of the maternal grand- mother 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. When anything was 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, 1 Cf. the expert medical opinion of this case, by Dr, in " Friedreich't Blatter f. ger. Med.," 1891, Heft 1. CONGENITAL SEXUAL INVERSION IN WOMAN. 429 A fourth great-aunt during two years did not leave In r room, and neither washed herself nor combed her hair; ilicn she again made her appearance. AH these ladies were, nevertheless, intellectual, finely educated and amiable. >.'s mother was nervous, and could not bear the light of the moon. She inherited many of the peculiarities of her father's family. 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 were unusually talented; the females were de- cidedly narrow-minded and domesticated. S.'s father had a high position, which, however, on account of his eccen- tricity 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 when the son was sent to a higher school at the age of fifteen. 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. Surolta 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 430 PSYCUOrATHIA SEXUALI8. young gentleman. She early became independent and visited cafes, 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 skilful fencer. She felt herself drawn particularly toward actresses, or others of similar position, and, if possible, toward those who were not very young. She asserted that she never had any inclination for a young man, and that she had felt, from year to year, an increasing dislike for young men. "I preferred to go into the society of ladies with ugly, ill-favoured men, so that none of them could put me ill 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 enthu- siasm for the beautiful sex." During the last ten years S. had lived almost con- stantly away from her relatives, in the guise of a man. She had had many liaisons with ladies, travelled 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; con- stancy 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 that 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 proved fatal to S., caused her to CONGENITAL SEXUAL INVERSION IN WOMAN. 431 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 still looked upon herself as a divorced wife, and regarded herself as the Countess V.! That S. also had the power to excite passion in other women was 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 be- come 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 arbour, by a pseudo- priest, in Hungary. S., with her friend, forged the mar- riage certificate. The pair lived happily, and, without the interference of the father-in-law, this false marriage, probably, would have lasted much longer. It is remark- able 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 432 PSYCHOPATHIA SEXUALIS. 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, how- ever, as haemorrhoidal) ; 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., 26th August, 1889, speaks in favour 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 was 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 CONGENITAL SEXUAL INVERSION IN WOMAN. 433 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 declara- tion 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 28 434 PSYCHOPATHIA SEXUALIS. 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 Siecle* ! 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-Worth, blending in harmonious mel- ancholy, gave tidings of rest and peace, she wrote: "For that poor soul, for this poor heart that beats for thee till the last breath". Personal examination: The first meeting which the experts had with S. was in a measure, a time of embarrass- ment to both sides; for them, because perhaps S.'s some- what 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 tho experts to realise 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 accused 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 asserted that in her thirteenth year she first felt a trace of sexual feeling, which expressed itself in kisses, embraces, and caresses, with sexual pleasure, and this on the occasion of her elopement with the red-haired English girl from the Dres- CONGENITAL SEXUAL INVERSION IN WOMAN. 435 den institute. At that time feminine forms exclusively appeared to her in dream-pictures, and ever since, in sensual dreams, she felt herself in the situation of a man, and occasionally, also, at such times, experienced ejacu- lation. She knew 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 recognised 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 com- panion,— 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, H»T 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 hf-r statement that, on the occasions of Marie's absence, she had sought those places on which Marie's head waa accustomed to repose, and smelled them, in order to ex- perience the delight of inhaling the odour of her hair. 436 PSYCHOPATHIA SEXUALIS. Among women, those who were beautiful, or voluptuous, or quite young, did not particularly interest her. The physical charms of women she made subordinate. As by magnetic attraction, sli3 felt herself drawn to those between twenty-four and thirty. She found her sexual satisfaction exclusively in corpore femincs (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 was religious, had a lively interest in all that is noble and beautiful, — men excepted, — and was very sensi- tive to the opinion others entertained of her morality. She deeply regretted that in her passion she made Ma- rie unhappy, and regarded her sexual feelings as perverse, and such a love of one woman for another, among normal individuals, as morally reprehensible. She had great literary talent and an extraordinary memory. Her only weakness was her great frivolity and her incapability to manage money and property reasonably. But she was conscious of this weakness, and did not care to talk about it. She was 153 centimetres tall, of delicate build, thin, but remarkably muscular on the breast and thighs. Her gait in female attire was awkward. Her movements were powerful, not unpleasing, though they were somewhat masculine and lacking in grace. She greeted one with a firm pressure of the hand. Her whole carriage was decided, firm and somewhat self-conscious. Her glance was 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 was not the slightest trace of beard, in spite of all shaving experi- ments. The hips did not correspond in any way with those of a female. Waist wanting. Pelvis so slim and CONGENITAL SEXUAL INVERSION IN WOMAN. 437 so little prominent, that a line drawn from the axilla to the- corresponding knee was straight — not curved inward by a waist or outward by the pelvis. The skull slightly oxycephalic, and in all its measurements below the aver- age of the female skull by at least one centimetre. Cireu inference of the head 52 centimetres; occipital half circumference, 24 centimetres; line from ear to ear, over the vertex, 23 centimetres; anterior half-circumfer- ance, 28.5 centimetres; line from glabella to occiput, 30 centimetres; ear-chin line, 26.5 centimetres; long diam- eter, 17 centimetres; greatest lateral diameter, 13 centi- metres; diameter at auditory incut i, 12 centimetres; zygo- matic diameter, 11.2 centimetres. Upper jaw strikingly projecting, its alveolar process projecting beyond the under jaw about 0.5 centimetre. Position of the teeth not fully normal ; right upper canine not developed. Mouth remark- ably small; ears prominent; lobes not differentiated, pass- ing over into the skin of the cheek. Hard palate, narrow and high ; voice rough and deep ; mammre 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 touching each other almost completely ; labia minora having a cock's-comb-like form, and projecting under the labia majora. Clitoris small and very sensitive. Frenulum delicate; perineum very narrow; introitus vaginae narrow ; mucous membrane normal. Hymen want- ing (probably congenitally) ; likewise the carunculsc myrti- formes. Vagina so narrow that the insertion of a mem- brum virile would be impossible, also very sensitive; cer- tainly coitus had not taken place. Uterus felt, through the rectum, to be about the size of a walnut, immovable and retroflected. Pelvis generally narrowed (dwarf -pelvis), and of de- cidedly masculine type. Distance between anterior su- perior spines 22.5 centimetres (instead of 26.3 centi- metres). Distance between the create of the ilii, 26.5 438 PSYCHOPATHIA SEXTJALIS. centimetres (instead of 29.3 centimetres) ; between the tro- chanters, 27.7 centimetres (31) ; the external conjugate diameter, 17.2 centimetres (19 to 20); therefore, the in- ternal conjugate, presumably, 7.7 centimetres (10.8). On account of narrowness of the pelvis, the direction of the thighs 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 ano- malies 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 was 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," 20th August, 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 CON KtJAL INVEB8ION IN WOMAN. 439 mouth at onco attract attention. It is certain that he r actually regarded himself as a woman. Complications of Antipathic Sexual Instinct. Moreover, in individuals afflicted with sexual inver- sion, in themselves, the perverse sexual feeling and inclina- tion may be complicated with other perverse manifesta- tions. Thus here, with reference to the activity of the in- stinct, 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 anti- pathic sexual feeling, acts of lustful sadistic 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. 160; 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 melan- cholic mother. His brother indulged in abnormal sexual pleasures, and committed suicide. Z. was a congenital urning, and in habitus and occupa- tion masculine. There was phimosis. Mentally, he was a weak, perverse, socially useless man. He had horror femince, 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 of his perverse instinct, and sought satisfaction in mutual onanism, with frequent desire for pederasty. Similar sadistic feelings of this kind, in those afflicted with antipathic sexual instinct, are found in some of the roing histories (rf. oases 128 and 129 of this edition, and case 96 of the sixth edition; also Moll, "Contr. Sex- ualempfindung," second edition, p. 189; v. Krafft, "Jahrb. 440 PSYCIIOPATIIIA SEXUALIS. f. Psychiatric," xii., pp. 357 and 389; Moll, "Unter- siichungen iiber Libido sexualis," clases 26 and 27). As examples of perverse sexual satisfaction dependent on antipathic sexual instinct, may be mentioned the Greek, who, as Athendus 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 incision. Cases 92, 110 and 115 (eighth edition) show that fetichism may also occur with antipathic sexual instinct ; moreover a case of shoe-fetichism related by me in "Jahr- biicher f. Psychiatric," xii., 1 ; Moll, op. cit., second edi- tion, p. 179 ; Gamier, "Les Fetichistes," p. 98. The following case, taken from Gamier, is a classical example of boot-fetichism. At times masochism forms a complication of sexual inversion Cf. Moll, second edition, p. 172 (case 12) and p. 190; Hem, "Internat. Centralbl. f. d. Physiol. and Pathol. der Harn- und Sexualorgane," iv., Heft 5 (homosexuality in a woman with passive flagel- lantism and koprophagia) ; v. Krafft, case 43 in sixth edition of this book, also case 137 of this edition and 114 of eighth edition; ditto "Jahrbiicher fur Psychiatric," xii., p. 339 (homosexuality, abortive masochism), p. 351 (psych, hermaphrod. masochism). Case 167. Homosexuality. X., twenty-six years of age, of the upper class, was arrested for having prac- tised masturbation in a public park. By heredity heavily tainted ; skull abnormal ; was peculiar from earliest youth ; psychically abnormal ; at the age of ten he began to show a peculiar interest in patent leather shoes; began to mas- turbate at thirteen, but in order to procure ejaculation he had to fasten his eyes upon patent leather shoes. He never felt any inclination towards woman, and when, at the age of twenty-one, he once attempted coitus at a CONGENITAL HDP \l. I N v I.KM« >.\ IN WOMAN. -Ill brothd driivid no satisfaction from the act. With the twenty-fourth year his lu»ii»uH-xual instinct began to assert itself more and more. But he felt himself drawn only to young men who wore elegant clothes and patent leather boots. Thinking of such nun, he masturbated. II is ideal was to live with such a man and practice mutual masturbation. Unable to realise his wishes, he would introduce a ball into his anus, and moving it in and out fancy himself to have coitus with his ideal young man wearing patent leather boots. Simultaneously he would masturbate. During this imitation of passive pederasty he would wear drawers made of red silk. For some time he was wont to stick notices on public buildings to this effect: "My nates are at the disposal of handsome gentle- men who wear patent leather boots". Whilst writing such notices and looking at his own patent leather shoes, he would have an erection. Since his sixteenth year, when young men began to interest him, he had eyes only for their patent leather boots. He loved to loiter about the show-windows of boot shops and the drilling-grounds of the military school, where he had opportunity for ad- miring the officers in their patent leather boots. One day he bought a pair for himself and became quite in- toxicated by gazing at them. The very smell of them was sufficient to excite him very much sexually. He finally put them on, that in them he might make con- quests; but he was not successful. Now he used them for another purpose. He would masturbando ejaculate into them. The most intense lustful pleasure he derived when he put, during this act, one of the shoes to his anus or inter femora, rubbing it about there. When one day X. found a defect on the uppers of one of these shoes, which he always saved most carefully, he was very de- jected. He looked upon himself as a person who has just discovered the first wrinkle in the face of his beloved. One day when in the park he thought that a young man made advances to him according to his own desire; he was highly elated, and could not resist to expose hi» per- 442 PSYCHOPATH I A SKXUALIS. son. He was arrested, but not sentenced. He was sent to an insane asylum (Gamier, "Les Fetichistes," p. 114). In general, the acquired cases are characterised in that :— 1. The homo-sexual instinct appears as a secondary factor, and always may be referred to influences (mas- turbatic 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 aesthetic sense. 2. The homosexual instinct, so long as inversio sexualis has not yet taken place, is looked upon, by the individual affected, as vicious and abnormal, and yielded to only faute de mieux. 3. The heterosexual instinct long remains predominant, and the impossibility to satisfy it gives pain. It weakens in proportion as the homosexual feeling gains in strength. On the other hand, in congenital cases : — (a) The homosexual 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. (&) The heterosexual instinct fails completely, or, if it should make its appearance in the history of the indi- vidual (psycho-sexual hermaphroditism), it is still but an episodical phenomenon which has no root in the mental constitution, and is essentially, but a means to satisfaction of sexual desire. The differentiation of the above groups of congenital inverted sexuality from one another, and from the cases in which the anomaly is acquired, will, after the foregoing, present no difficulties. » The jjrognQjSJs of the cases of acquired antipathic sexual | instinct is, at all events, much more favourable than that of the congenital cases. In the former, the occurrence of effemination — the mental inversion of the individual, in ANTIPATHIC SEXUAL IWBTIWOT. 443 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, thought possible (vide the case of Schrenk- Notzing) in that of the timings. 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 expe- rience 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 children. In many schools and academies masturbation and vice are actually cultivated. At present much too little atten- tion 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 made a mystery to the developing youth, and not the slight- est 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 help- less, unprotected innocent into dangerous by-paths. Diagnosis, Prognosis and Therapie of Antipathic kxual Instinct The diagnosis of antipathic sexual instinct is of great clinical and. particularly, forensic, import. At the first 444 PSTCHOPATHIA 8EXTTALIS. glance, it opens some difficulties, since the symptoms are rather of a subjective nature and the perverse acts offer so many aspects which may mean perversion as well as perversity. Much depends on the veracity of the patient, and that leaves in many cases much to be desired. Auto- biographies are to be taken cum grano sails, and should be discounted. Nevertheless the expert will soon be able to weed out exaggeration and untruth. Antipathic sexual instinct is such a complicated psychical anomaly that only the experienced specialist can quickly distinguish between truth and fiction. True knowledge is easiest ascertained from those who despair of their existence, meditate suicide (which fre- quently is found in those who have cultured minds and realise the anomaly of their position), but as a last resort come to the medical man for advice; also from those who are confronted with legal proceedings, or who through cir- cumstances are forced into marriage and doubt their virility. These patients have an urgent need for help, and will tell the truth. In strong contrast to these really un- fortunate beings stand those, generally of but little ethical and intellectual value, who seek to enrich medical knowledge by fatuous gossip about their disease. Every case of genuine homosexuality has its etiology, its concom- itant physical and psychical symptoms, its reactions upon the whole psychical being, and must be reduced to an ab- normal sexual instinct which is diametrically opposed to the physical sex of the affected individual, as it can be explained upon that basis only. The diagnosis is to be found in the anamnesis, the aetiology, the vita anteacta, the psycho-sexual development of the case. To form a clear opinion it behooves to judge the case from the stand- point of the anthropological clinical history of its devel- opment, and to collect synthetically all the various details. The opinion will then be as definitely established as in any other clinical case. The first important point based upon ripe experience is the fact that antipathic sexual instinct as an anomaly ANTIPATHIC SEXUAL INSTINCT. 445 of sexual life is only found in individuals who are tainted, as a rule, hereditarily. In foro particular stress should be laid upon this point. In all cases in which anamnesis has been proved, this taint will be readily found. Per &e, thi* proof is of no value, for perversity also grows in this soil. But it assumes importance when the same frailty is found to exist in several members of the same family or appears in the form of other perversions of the sexual life either in the individual himself under consideration, or in other members of his family. Often enough the patient pre- sents other psychical or neurotic anomalies, even psychical diseases, defects or such like. They are so frequent and numerous that one is often led to doubt whether the man- ifestation under observation belongs in the sphere of neu- ropathia or that of psychopathia. These neurotic and psychopathic manifestations de- mand a most careful scrutiny as to their meaning. Not uncommonly they are signs of taint or degeneration of equivalent value with antipathic sexual instinct, or they may be reactions emanating from external defects to which tainted individuals are more subject than normal man is, often indirectly depending on antipathic sexual instinct on the ground of psychical conflicts in which these unfor- tunates are frequently implicated by virtue of their sexual perversions ; or they may be found to spring from the im- perfect or perverse gratification of their sexual needs (onanism). Certain it is that these persons are, as a rule, also abnormal so far as character is concerned. They are neither man nor woman, a mixture of both, with secondary psy- chical and physical characteristics of the one as well as the other sex, which grow out of the interfering influences of a bisexual predisposition and disturb the development of a well defined and complete being. But this peculiarity is only found in fully developed cases. A psychical disease per se is not a necessary adjunct to antipathic sexual in- stinct. All nations and all eras have produced perverse 446 PSYCHOPATHIA SKXUALIS. men, whose renown and greatness adorn the history of their mother country or that of the world. This abnormality must not be looked upon as a patho- logical condition or as a crime, but the development of the vita sexualis with its reacting effects upon the mind and the moral sense; it may proceed with the same harmony and satisfying influence as in the normally disposed, a fur- ther argument in favour of the assumption that antipathic sexual instinct is an equivalent for heterosexuality. If ethical and intellectual defects are present, they may be looked upon merely as complicated anomalies resulting from the taint. An important factor is precocity in sexual life, which together with its antithesis, i.e., retarded puberty, is the distinguishing mark of a degenerated constitution. It is quite another thing when the vita sexualis takes an inverted course at an early period, particularly at a time when evil influences or bad examples cannot be at work. For in- stance, when little boys prefer male adults to their female relations, or show a predilection for girls' games and oc- cupations or particular skill in sewing, knitting, embroid- ering, etc., or inclination for female toilet, find pleasure in wearing girls' clothing, choose girls' characters in private theatricals or in masquerades and betray great cleverness in impersonating the female character, etc. Homosexual acts (mutual masturbation, etc.) previous to puberty are no proof of antipathic sexuality. They may spring from hypersexuality, precocity or some exter- nal influences. They do not necessarily lead to inverted sexuality, only then when the individual is predisposed. It is at the time of puberty that the vita sexualis is devel- oped and receives its direction for the rest of life. An unconscious desire for sexual union, often enough stimu- lated by individuals of the same sex, brings the playmates together, tickling and other tactile irritations — quite apart from the genuine sexual instinct — lead to acts of mastur- bation in corpore virili, but they are not coupled with psy- chical feelings in the sense of homosexual acts. The same ANTIPATHIC SEXUAL INSTINCT. 447 analogous manifestations may be observed in young ani- mals. But rarely antipathic sexuality develops from these horseplays. Puberty teaches the youthful sinner to know his true sex soon enough. From the sexual instinct, baaed upon a series of physical and psychical attractions, ema- nates the sexual leaning to persons of the opposite gender, and the earlier homosexual encounters are remembered with shame and confusion. But the homosexual act com- mitted after puberty has set in, is the decisive step in the wrong direction. The stadium of sexual differentiation covers sometimes a long period and often reaches far be- yond that of physical sexual development. Of great value in diagnosing a case is to ascertain the dream-life and that of sleep in the patient. The true status of the sexual instinct is here often pitifully por- trayed. Nocturnal pollutions are found to be coloured (a) in cases of psychical herinaphroditism predominantly, (b) in all the other grades of the anomaly exclusively in the sense of homosexuality. In cases of effeminatio (viragin- ity) they are accompanied by dream-pictures delineating the passive (in man) or the active (in woman) role in the sexual act The presence of physical or psychical abnormal char- acteristics may aid diagnosis if they are coupled with other more distinctive signs. By themselves they prove nothing, as they are also found in individuals not tainted, for in- stance, in gyn&ecomasts, bearded women, etc., etc. In the well-pronounced cases of antipathic sexual in- stinct (effeminatio and viraginity) the physical and psy- chical characteristics of inverted sexuality are so plentiful that a mistake cannot occur. They are simply men in women's garb, and women in men's attire, especially if they have full freedom of action. Psychically they consider themselves to belong to the opposite sex. We have seen women urnings in the army, and men urnings among the waitresses in restaurants. They act, walk, gesticulate and behave in every way exactly as if they were persons of the 448 PSYCHOPATHIA 8EXUAI.I8. f i sex which they simulate. I have known malo urnmgs who excelled woman in wiles, loquacity, coquetry, etc., etc. In pronounced cases hashfulness and timidity in the presence of persons of his own sex will be observed in the homosexual individual. That urnings know each other instinctively is a fable. They recognize one another by their gait, natural shyness and by signs just the same as normal persons of opposite sexes do if they go adventure hunting. The higher grades of homosexuality show horror fem- inse to the extent of absolute impotence. Imagination sometimes assists in producing erection and rendering coi- tus possible. Diagnosis is definitely established when abso- lute proof is at hand that a homosexual person is perma- nently attracted by a person of the same sex and led to a sexual act with that person, the act granting full satisfac- tion to the sexual instinct, whilst similar attractions do not exist in persons of the opposite sex, and if the disgust for persons of the opposite sex is insuperable. The distinction between congenital and acquired (or rather retarded) homosexuality is considered to be of theo- retical and therapeutical value. Some authors claim that congenital homosexuality does not exist, but that this anomaly is acquired from oth- ers. But I cannot accept their arguments, for they do not explain the presence of the distinguishing symptoms so often found in the earliest years of the individuals af- flicted, i.e., at a period in which external influences may be considered to be absolutely excluded. Case 1 68. Taken from Moll, "Libido Sexualis," case 69, p. 726. A young man, thirty-four years of age, was from age seventeen drawn to young men, and had no liking for girls. He was an effeminated character, had a girl's nickname, and played with dolls. When drunk he allowed men to masturbate him. When sober, however, he would not permit it, because he thought it stupid. ANTIPATHIC SEXUAL INSTINCT. 449 To parents and teachers, the experiences detailed in this and numerous other scientific works on masturbation, present valuable suggestions. Educators are often too "naive" in their views, and their power of observation is too limited to notice the sexual abuses rampant among the boys entrusted to their care and practised even during lesson time. In a few excep- tional cases they have even become seducers of boys. Everything that is calculated to unduly further the devel- opment of the vita sexualis — such as prolonged sitting on the form, the use of alcoholic drinks, etc. — should be strictly avoided. A boy with inverted sexuality should be rigidly excluded from all public educational institutions for boys and sent to a hospital for nervous disorders. Boys should not be permitted to sleep together at home. Swim- ming lessons and bathing en masse should be under the careful and strict supervision of a competent person. Neither should "a child with antipathic sexual instinct be placed under the isolated tuition of a tutor or private master, for frequently the first object of homosexual love is the instructor at home. Care should be taken that tainted children are not caressed and fondled by persons of the same sex. Flagellatio ad podicem should never be permitted. The best place for children that are perversely (sex- ually) inclined is the public school where co-education of the sexes prevails. An early preference for games, occu- pations and pastimes of the opposite sex should be strongly discountenanced and interdicted. Masturbation should be carefully watched in both sexes. Early signs of antipathic sexual instinct should at once be noticed, and hypnotic and (suggestive treatment applied, for there is more hope for (eradicating the evil in its earlier stages than when the in- dividual so tainted has already been lost in the quagmire of sexual perversion. The lines of treatment, when antipathic sexual instinct exists, are the following: — 29 450 P8YCHOPATHIA 8EXDALI8. 1. Prevention of onanism and removal of other influ- ences injurious to the vita sexualis. 2. Cure of the neurosis (neurasthenia sexualis and tmi- versalis') arising out of the unhygienic conditions of the vita sexualis. 3. Mental treatment, in the sense of combating homo- sexual, and encouraging heterosexual, feelings and im- pulses. The momentum of the treatment lies in fulfilling the third indication, particularly with reference to onanism. Only in very few cases, where acquired antipathic sexual instinct has not progressed far, can the fulfilment of 1 and 2 be sufficient, as a case fully reported by the author in the "Irrenfreund," 1885, No. 1, proves. Cf. case 128, ninth edition of this book. As a rule, physical treatment, even though it be rein- forced morally by good advice with reference to the avoid- ance of masturbation, the repression of homosexual feel- ings and impulses, and the encouragement of heterosexual desires, will not prove sufficient, even in cases of acquired sexual inversion. Here a method of mental treatment — hypnotic sugges- tion— is all that can really benefit the patient. I know of but one case in which auto-suggestion proved successful, cf. case 129, ninth edition. As a rule, only suggestion coming from a second per- son, and that by means of hypnosis, promises success. In such cases, the object of post hypnotic suggestion is to remove the impulse to masturbation and homosexual feelings, and to encourage heterosexual emotions 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 proves impossi- ble, since the subject is often excited, embarrassed, and in no condition to concentrate the thoughts. By reason of the great benefit that can be given to such unfortunates, and with Ladame's case in view (v. ANTIPATHIC SEXUAL INSTINCT. 451 infra), in all such cases, everything should be done to force hypnosis — the only means of salvation. The result, in the three following cases, was satisfactory : — Case 160. Antipathic sexual instinct acquired through masturbation. Mr. X., merchant, aged twenty- nine. 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 irri- table, "melancholic," and indifferent to women. When a child, patient had scarlet fever with delirium. Up to 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 elev- enth year, and at that time he learned masturbation from other boys, and practised mutual onanism with them. At the age of thirteen or fourteen, ejaculation for the first time. Patient had felt no evil results of onanism until the last three months. At school he learned easily, but was troubled with head- aches. After the age of twenty, pollutions, in spite of daily practice of onanism. With pollutions occurred "pro- creative" dreams, as man and wife might perform the act In his seventeenth year he was seduced into mutual onan- ism by a man having a love for men. He found satisfac- tion 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. Tie felt satisfaction only when he played the passive role — when manustupration was prac- tised on him. When the act was once completed, he had no respect for the individual. If it happened that, later, 452 PSYCHOPATHIA SEXUALIS. 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 practised on him. When he himself practised onanism, he always thought of pleasing men practising onanism on him dur- ing 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. 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 sexual relations with a woman. At the theatre, as well as in the circus and ballet, the feminine figure had always interested him. In mu- seums, masculine and feminjjia statues had affected him equally. ff Patient was a great smoker, a beer-drinker, loved male society, and was an athlete and skater. Anything dandi- fied was repugnant to him, and he had never felt any de- sire 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 practised without evil effects, now began to disclose its bad results. Since July, 1889, he had suffered with neuralgia of the testicles. Tlie pain occurred particularly at night; and ANTIPATHIC SEXUAL INSTINCT. 453 tt night there was also trembling (increased reflex excita- bility). 1> was not refreshing, and he would wake up with pain in the testicles. He was inclined, now, to indulge more frequently in onanism. lie was afraid of the con- sequences 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 was tall, powerful, well nourished, and had a thick growth of beard. Skull and skeleton normal. Knee- jerks very prompt ; deep reflexes in upper extremities much increased. Pupils dilated, equal, and acted promptly. Carotids of equal calibre; hyperaesthesia urethra; cords and testicles not sensitive ; genitals normal. The patient was calmed, and given hope for the future, provided that he gave up onanism and attempted to trans- fer his sexual desires from persons of his own sex to females. Hip-baths (24° to 20° R.^ ; extr. Secal. cornut. aquos., 0.5; antipyrin, 1.0 (pro die) ; pot. brom. 4.0 (evenings), were ordered. H 13th December. To-day the patient came, in a dis- t turbed 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 of my own sex, and shall never again think men handsome. 454 PSYCHOPATHIA SEXUALJ8. 3. I shall and will become well again, fall in love with a virtuous woman, be happy, and make her happy. 14th December. 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. 18th December (fourth sitting), somnambulism oc- curred; the impulse to onanism and interest in men dis- appeared. At the eighth sitting "complete virility" was added to the above suggestions. The patient felt himself morally elevated and physically strengthened. The neuralgia of the testicles had disappeared. He now found that he was without sexual feeling. He now believed himself free from masturbation and inverted sexual inclination. After the eleventh sitting he thought 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 oppor- tunity for sexual intercourse, and I have found pleasure in it. I look calmly on my happy future." Other cases successfully treated by suggestion may be found in Wetterstrand, Der Hypnotismus und seine An- wendung in der praktischen Medicin, 1891, p. 52 u. ff. ; — Berriheim, "Hypnotisme," Paris, 1891, etc., p. 38. The foregoing details of the successful results of hyp- notic suggestion, in cases of acquired sexual inversion, make it seem possible that those unfortunates who are afflicted with congenital perversion may be helped in some degree by the same means. Of course the proposition is different as regards cases ANTirvillH si.MM. INSTINCT. 455 of a congenital anomaly. To correct a morbid psycho- sexual existence is a most ilitiinilt proMcm. The most favourable cases are those of psychosexual hermaphroditism in which at least rudimentary hetero; sexual feelings may be strengthened by suggestion and brought into active practice. Case 170. Mr. von X., aged twenty-five, landed proprietor, lit- came "I a neuropathic, irascible father, who was said to have been sexually normal. His mother was nervous, as were her two sisters. Maternal grand- mother was nervous, and maternal grandfather a roue, much given to venery. Patient was like his mother, and an only child. From birth ho was weak, suffered much with migraine, and was nervous. lie passed through sev- eral illnesses. At fifteen he began masturbation, without having been taught. Until his seventeenth year 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 praetised coitus inter femora riri. He abhorred pederasty. Lascivious dreams were concerned only with men. In circus and theatre males alone interested him. The inclin- ation 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 to travel about. In London he iM into a "blackmailing scrape," but suc- ceeded in escaping to his home. 456 PSYCHOPATHIA SEXUALIS. He profited in no way by this bitter experience, and again- showed disgraceful inclinations toward men. Pa- tient was sent to me to be cured of his fatal peculiarity (December, 1888). Tall, stately, robust, well-nourished, of masculine build ; large, well-formed genitals. Gait, voice, and attitude masculine. Pronounced masculine pas- sions. He smoked but little, and only cigarettes; drank little, and was fond of confectionery. He loved music, arts, aesthetics, flowers, and moved in ladies' society by preference. He wore a moustache, the face being other- wise cleanly shaved. His garments were in nowise re- markable. He was a soft, blase fellow, and a do-nothing. He would lie in bed mornings, and could scarcely be made to rise before noon. He said he had never regarded his inclination toward his own sex as abnormal. He looked upon it as congenital ; but, taught by his evil experiences, he wished to be cured of his perversion. He had little faith in his own will. He had tried to reform, but always lapsed into masturbation, which he found injurious, inas- much as it caused (slight) neurasthenic symptoms. There was no moral defect. Intelligence was a little below the average. Careful education and aristocratic manners were apparent. The exquisite neuropathic eye betrayed a ner- vous constitution. The patient was not a complete and hopeless urning. He had heterosexual feelings, his sen- sual inclinations toward the opposite sex, however, were manifested but weakly and infrequently. When nineteen, he was first taken to a brothel by friends. He experienced no horror femince, had efficient erections, and some pleas- ure in coitus, but not the instinctive delight he experienced while embracing men. Since then, patient asserted that he had had coitus six times, twice sua sponte. He gave the assurance that he was always capable of it, but he did it only faute de mieux, as he did masturbation, when the sexual impulse troubled him, as a substitute for intercourse with men. He had thought of the possibility of finding a sympathetic lady and ANTIPATHIC SIXUAL INSTINCT. 457 marrying her. He would regard marital cohabitation and abstinence from intercourse with men as hard duties. Since there were rudiments of heterosexual 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 influ- ence in hypnosis. The fulfilment of this hope seemed doubtful, because the famous //onsen had tried several times, in vain, to hypnotise 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 pro- cedure 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 easily yielded to sug- gestions of all kinds; indeed, contractures were induced by stroking him. He was awakened by counting three. Awakened, patient had amnesia for all the events of the hypnotic state. Hypnosis was induced every second or third day for the communication of hypnotic suggestions. At the same time, moral and hydro-therapeutic measures were employed. The hypnotic suggestions were as follows: 1. I abhor onanism, because it makes me weak and miserable. 2. I no longer have inclination toward men; for love for men is against religion, nature and law. 3. I fool an inclination toward woman; for woman is lovely and desirable, and created for man. •During the sittings the patient always repeated ver- batim these suggestions. After the fourth sitting it was noticeable, that, when taken into society, he paid court to ladies. Shortly aftor that, when a famous priraa-donna Bang, he was all enthusiasm for her. Some days later the jxatient sought the address of a brothel. 458 PSYCHOPATHIA SEXUALIS. Yet he preferred the society of young gentlemen; but the most careful watching failecl-to reveal anything sus- picious. 17th February. Patient asked to be allowed to in- dulge in coitus, and was very well satisfied with his expe- rience with one of the demi-mondes. 16th March. Up to this time, hypnosis twice a week. The patient always passed into deep somnambulism by simply being looked at, and, at request, repeated the sug- gestions. He was susceptible to all kinds of post-hypnotic suggestion, and, in the waking state, knew not the least of the influences exerted on him in the hypnotic state. In the hypnotic condition he always gave the assurance that he was free from onanism and sexual feeling for men. Since he gave the same answers in hypnosis — e.g., that on such and such a date he practised onanism for the last time, and that he was too much under the will of the physician to be able to lie — his assertions deserved belief; the more, since he looked well and was free from all neu- rasthenic symptoms, and, in the society of men, not the slightest suspicion rested on him. An open, free, and manly bearing was developed. Moreover, since, of his own will, he now and then in- dulged in coitus with pleasure, and occasional pollutions were induced by lascivious dreams which concerned women, there could be no doubt of the favourable change of his vita sexualis; and it was presumable that the hyp- notic suggestions had developed into auto-suggestive in- clinations, which directed his feelings, thoughts and will. Probably the patient will always remain a natura frigida; but he more often spoke of marriage, and of his intention to win a wife as soon as he had become acquainted with a sympathetic lady. Treatment was stopped. (Author's own case, "Internat. Centralbl. fiir die Physiol. und Pathol. der Harn- und Sexualorgane" Band i.) In July, 1889, I received a letter from his father, tell- ing me of his son's good health and conduct. On 24th May, 1890, by chance, I met my former ANTir. \THIC SEXUAL INSTINCT. 459 patient, while on a journey. His bright, healthful appear- ance allowed the most favourable 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 mar- riage, I hypnotised 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 fte suggestions he had received in December, 1888 — an excellent example of the possible duration and power of post-hypnotic suggestion. Other cases may be found in the eighth. edition, casea 137, 138, 140, 141 ; and ninth edition, case 133, of thii book. The cases quoted by the author, as well as those given by Ladame, in which suggestion removed the homosexual instinct, or, at least, neutralised it (as a protection from shame and law), seem to afford a proof that even the gravest cases of congenital sexual inversion may be bene- fited by the application of hypnotism. Weiterstrand (cf. Schrenck, op. cit.t case 49) Bern- heim (cf. Schrenck, case 51), Muller (cf. Schrenck, case 53), Schrenck (op. cit., cases 66, 67), report even complete success in displacing the homosexual by the heterosexual instinct coupled with virility. Schrenck (op. cit., cases 62, 63) succeeded also in cases of effeminatio. But only when hypnotism produces deep somnambu- lism, decided and lasting results may be hoped for, which, after all, are nothing more than suggestive training, not a real cure. They are marvellous "artefacta" of hypnotic science practised on abnormal human beings, but by no means "transformations" (cf. Schrenck) of a psychosexual existence. Very instructive in this respect is a case related by Schrenok, the representative of which after effected "cure" says of himself: "I am ever conscious of a certain insu- 460 PSYCHOPATHIA SEXUALIB. perable coercion winch does not rest upon moral principles, but must, as I believe, be referable directly to treatment". At any rate such "cures" afford no proof whatsoever against the assumption of original conditionality of sexual inversion. It is necessary here to warn the reader against illusions about the true value of hypnotic therapy. Attempts have been repeatedly made to question the right of the medical adviser to treat cases of antipathic sexuality. The advice given to the unfortunates so af- flicted was to become reconciled with their anomaly and to eschew homosexual intercourse. In some cases in which the libido was weak or the sense of morality was not en- tirely blunted, success has been achieved. It was pointed out to these unfortunate beings that there are many other dreadful afflictions, such as trigeminus neuralgia or malign tumours, which man must bear with resignation. This view involves, however, a defective knowledge of the meaning and bearing of antipathic sexual instinct, in so jfar as this affliction means nothing more or less than a [hopeless existence, a life without love, an undignified comedy before human society, and moral and psychical marasmus if the advice is adopted; on the other hand, eventual loss of social position, civic honour and liberty are involved. Castration is out of the question, because it is difficult to justify such an operation, for the antipathic sexual in- stinct with its psychical tortures, cannot be extirpated by this process even though the libido sexualis be diminished. To confine such people in an insane asylum is a mon- strous idea. Justification for it can only then exist if the perverse individual suffers also from a psychosis which renders confinement imperative. Another objection which has been made against treat- ment is that the weal and welfare of society is jeopardized in so far as an opportunity is given to tainted individuals to propagate their perversions. This objection appears comical in the face of the fact ANTIPATHIC SEXUAL INSTINCT. 461 that no one has yet thought of prohibiting tin- marriage of the congenital libertine or habitual drunkard. M\ perience teaches me that the sexual perverts in general by no means constitute tin' worst type of degeneration. The progeny of individuals thus tainted, which 1 have had occasion to observe, has offered no pronounced manifesta- tions of neuropathic constitution or taint. Psychopathia sexualis is not often met with as a family failing or a mark of heredity. The number of cases which have been really cured of tin.- anomaly will always be limited, because many of these unfortunates refrain from taking into their confidence even the medical man. Others despair beforehand of the effi- ciency of treatment, whilst some who practise homosexual intercourse and find satisfaction in it, hesitate to exchange their method for something uncertain. Again others de- mur for fear of becoming potent, and thus transmitting their own weakness to the offspring. Others present psy- chical impedimenta which s<"'in insurmountable, or they do not react to hypnotic influence or suggestion, thus ren- dering treatment futile. If an individual afflicted with antipathic sexual in- stinct, for ethical, social or any other reasons, demands treatment, surely it cannot be denied him. It is the sacred duty of every medical man to give advice and aid to the best of his ability and knowledge whenever it is asked for. The health and welfare of the patient must ever be para- mount to that of society at large. Hygiene and prophy- laxis enable him at all times to recompense the community for any damage he may have done in an isolated case. Moreover in the majority of cases the patient is quite satisfied when he becomes sexually neutral, and under these circumstances medical skill has rendered a signal ser- vice to both society and the individual himself. IV.— SPECIAL PATHOLOGY. THE MANIFESTATIONS OF ABNORMAL SEXUAL LIFE IN THE VABIOU8 FOBM8 AND STATES OF MENTAL DISTURBANCE. ABBEST OF MENTAL DEVELOPMENT. SEXUAL life in idiots is, generally speaking, 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 either impotence or sterility. Even in idiots of low grade, sexuality is not prominent. In rare cases it is manifested with a certain periodicity, and then with greater intensity. It may then find expression in sudden impulses, and be violently satisfied. Perversions of the sexual instinct do not seem to 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 mur- derous assault on the persons attacked. It is to be ex- pected that idiots should not exercise choice, and even 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 Blatter," 1858, p. 50). I have repeatedly had occasion to give opinions in cases of attempts to rape little girls. 462 ARREST OF MENTAL DEVELOPMENT. 463 Oiraud ("Annal. m6d. psych.," 1885, No. 7) also re- ports a case of this kind. Consciousness of the significance of the act is always wanting; but an instinctive know- ledge that such obscene acts are not publicly permitted is often present, and causes the 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 per- version of the sexual instinct are infrequent The most frequent manner of satisfying the sexual desire is onanism. The weak-minded seldom make sexual attacks on adults of the opposite sex. Sexual satisfaction with animals is frequently at- tempted. 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 unrestricted manifestation of sexual instinct, which comprises open masturbation, exhibition of the genitals, attacks on children and those of the same sex, and sodomy. Oiraud ("Annal. med. psycho!.," 1855, No. 1) hag reported a whole series of immoral attacks on children* : — 1. H., aged seventeen, 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 sig- nificance of the act 2. L., aged twenty-one; imbecile; degenerate. While 1 For numerous case*, "r. Ufnkf'$ Zeitschr.," xxiii., "Erglnzungs- heft," p. 147; Combe*, "Annal. meU psychol.," 1866; Ltmow, " Zweifelh. Geisteazustlnde," p. 389 ; Ca*j>cr-IAman. " Lehrb., 7, Aufloge," Fall 295 ; Bartelt, " Fricdreich'i Blatter f. gerichtl. lied.," 1890, Heft 1. 464 PSYCHOPATHIA SEXUALI8. 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 immission was unsuccessful, 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. 3. G., aged twenty-one, microcephalic, imbecile, had masturbated since his sixth year, and practised active and passive pederasty. He had repeatedly tried to per- form pederasty with boys, and attacked little girls. He was absolutely without an understanding of his acts. His sexual desires were manifested periodically and in- tensely, as in animals.1 4. B., aged twenty-one; 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 wrenched his penis, and he then left her and quietly went on with his work. B. had a deformed, microcephalic skull, and had no sense of the significance of his act. Emminghaus (op. cit., p. 234) reports the case of an exhibitionist : — Case 171. A man, aged forty, married, had for six- teen years been accustomed to exhibit himself in parks, at dusk, to little girls and servants, and drew their atten- tion 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 172. X., of tainted family ; imbecile ; defective 1 Other cases of pederasty, v. Catper, "Klin. Novellen," Fall 5; Combe*, "Annul. m6d. psychol.," July, 1866. ARREST OF MENTAL DEVELOPMENT. 465 and pervertc'd in inirllivt, feeling and will. For help and protection lie 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 mani- festations of inverted sexual instinct No onanism re- ported (Sander, "Archiv f. Psych.," p. 655). Case 173. Pederasty with a child. On 8th April, 1884, at ten o'clock, A. M., while X. was sitting in the street, holding a boy of eighteen months on her lap, a cer- tain Vallario approached and took the child from X., say- ing 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 forty- five, mason, defective morally and intellectually, dolicho- microcephalic ; narrow, deformed facial bones; the halves of the face and the ears asymmetrical ; brow low and re- treating; genitals normal. V. showed general diminution of cutaneous sensibility, was imbecile, and had no ideas. He lived in the present, had no ambition, and did nothing of his own will. He had no desires and no emotional feel- ing. ,He had never had coitus. Nothing more could be ascertained about his vita sexualis. Proofs of intellectual and moral idiocy, due to microcephaly; the crime was ascribed to a perverse, uncontrollable sexual impulse. Sent to an asylum (Virgilio, "II 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.1 »F. Bander, " Vierteljahrsschr. f. ger. M«L," xriit, p. 11; Coiper, "Klin. Novellen," Fall 27. 30 466 PSYCHOPATHIA SEXUALIS. 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 pro- cesses 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. I. Dementia Consecutive to Psychoses. Casper ("Klin. Novellen," Fall 31) reports a case that belongs here. It is that of a physician, aged thirty-three, 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 Geisteszustande," is an analogous case (dementia after melancholia; offence against morals by exhibition). 2. Dementia After Apoplexy. Case 174. B., aged fifty-two. 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 STATES OP ACQUIRED MENTAL WKAKNXM. -M>7 from repeated apoplexies. B., who, up to this time, had been well-behaved, Bays 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 un- skilful attempt at suicide. He often cried childishly. His moral and intellectual energy in opposing his sexual impulses was certainly much weakene'd. No sentence (Qiraud, "Ann. med. Psychol.," March, 1881). 3. Dementia After Apoplexy of Head. Case 175. 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, irascible, 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 hemi- sphere had bands of cicatricial tissue running through it, and was one-third smaller than the other (Friedreich'g "Blatter," 1885, Heft 6). 4. Acquired Mental Weakness, Probably Resulting from Lues. Case 176. 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. 468 P8YCHOPATHIA SEXUALIS. X., formerly healthy, and of blameless life, was in- fected 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 thirty-seven, showed no trace of lues when examined. The paralysis of the left abducens was still present. The left eye was amblyopic. He was mentally weak. Concerning the trial that was before him, he said it was nothing but a harmless misunderstanding. Indi- cations 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, "Jahrbiicher fur 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 per- verse. 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, las- civiousness in intercourse with the opposite sex, thoughts of marriage, frequenting of brothels, etc.), which is char- acteristic 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 EPILEPSY. 469 striking enough. As the mental weakness increases, such patients become criminal by reason of exhibition, mastur- bation in the streets and attempts at immoral acts with children. If conditions of mental excitement come on, attempts at rape are commit tinl, 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 rnoeurs") ; Mendel ("Progres- sive Paralyse der Irren," 1880, p. 123) ; Westphal ("Arch, f. Psvrh., vii., p. 622) ; and a case by Petrucci ("Annal. med. 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 needs 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 water- ing-place. A similar case is reported by Dr. Regis ("De la dynamic ou exaltation fonctionnelle au debut de la paral. gen.," 1878). Cases reported by Tarnowsky (op. cit., p. 82) show that also pederasty find 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, iu 4:70 PSYCHOPATIIIA SEXUALJS. 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. Perver- sion 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 out- break may induce an abnormal excitation of the sexual instinct.1 Besides, in the exceptional mental states of epileptics, they are unable to resist their impulses, by reason t>f 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. After a time he comes to himself, and has no recollection 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 shame- lessly, but during the intervals was above reproach. Simon ("Crimes et delits," p. 220) mentions an epilep- tic girl of twenty-three, well educated, and of the best morals, who, in attacks of vertigo, would shout out ob- *Arndt ("Lehrb. d. Psych," p. 410) especially emphasises the passionate element in epileptics : " I have known epileptics who behaved in a most sensual way toward their mothers, and others who were suspected by their fathers of 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. EPILEPSY. 1 7 1 scene words, then raise her dress, make lascivious move- ments, and try to tear open IUT undofgannentai 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 atti- tudes, 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 177. W., of good heredity, previously healthy; before and after the attack, sound mentally, quiet, kind, temperate. On 13th April, 1877, he had no appetite. On the 14th, in the presence of his wife and children, he de- manded 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 recollection of the events of his attack (Kowalewsky, "Jahrbiicher f. Psych.," 1879). Another case, examined by Caspar ("Klin. Novellen," p. 267), may be attributed to epilepsy (latent). A respect- able man attacked four women, one after another, in the open street (one 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 : — 472 PSYCHOPATHIA SEXUALIS. Case 178. L., an official, aged forty; a kind husband and father. During four years lie had offended public morals twenty-five times, for which he had to endure long imprisonment. In the first seven complaints he was accused of expos- ing his genitals to girls from eleven to thirteen years old, while passing them on horseback, 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, 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 remem- brance of the crime of which he was accused. Observa- tion showed further and more violent attacks of epileptic vertigo. L. was not sentenced. In 1875 paretic dementia developed with rapidly fatal results (Westphal, "Arch. f. Psych.," vii., p. 113). Case 179. A rich man of twenty-six had lived for a year with a girl with whom he was very much in love. He cohabited but rarely, but was never perverse. Twice during the year, after excessive indulgence in alcohol, he had had epileptic attacks. One evening after EPILEPSY. 473 dinner, at which he had taken much wine, he hurried to tin- 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. lie left the boy and raped the maid ; after that he went to bed and slept twelve hours. When he awoke, he had an indistinct remem- brance of intoxication and coitus. Thereafter there were repeated epileptic attacks (Tarnowsky, op. cit.t p. 52). Case 180. X., of high social position, led a dissolute life for some time, and had epileptic attacks. He be- came 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 remembrance of the events, and could give no explanation of his acts (Tarnowsky, op. cii., p. 53). Case 181. Z., aged twenty-seven; 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. Pug- liese, "Arch, di Psich.," viii., p. 622). Case 182. V., aged, sixty; physician; violated chil- dren. Sentenced to imprisonment for two years. Dr. Marandon later on proved the existence of epileptoid attacks of apprehensiveness, dementia, erotic and hypo- chondriacal delusions and occasional attacks of fear (Lacas- sagne, "Lyon. med.," 1887, No. 51). Case 183. On 4th August, 1878, H., aged about 474 PSYCHOPATHIA SEXUALI8. fifteen, was picking gooseberries with several little girls and boys as her companions. Suddenly she threw L., aged ten, to the ground and exposed her, and ordered A., aged eight, and O., aged five, 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 was suspected to be epileptic. For three months H., after seizures, had frequently done strange things, and afterward had no remembrance of them. H. seemed to have been deflowered. Mental defect was not apparent. She said she had no remembrance of the act of which she was accused. According to her mother's testimony, she had an epileptic attack on the morning of 4th August, and she had been, on that account, told by her mother not to leave the house (Piirkhauer ', "Friedreich's Blatter f. ger. Med.," 1879, H. 5). Case 184. Immoral acts of an epileptic in states of abnormal unconsciousness. — T., revenue collector; aged fifty-two ; married. He was charged of being guilty of im- morality with boys for the past seventeen years, by practis- ing masturbation on them, and by inducing them to carry- out the act on himself. The accused, a respected officer, was overcome by the terrible crime attributed to him, and declared that he knew nothing of the deeds of which he was accused. His mental integrity was^ questionable. His family physician, who had known him twenty years, emphasised his peculiar, retiring disposition and his mercurial moods. His wife asserted 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 window. T. knew nothing of these attacks. Other witnesses testified to strange changes of mood and peculiarities of character. A physician reported EPILEPSY. 475 the observation of occasional attacks of vertigo and con- vulsions in him. TVs grandfather was insane; his father was affected with chronic alcoholism, and of late years had had epilep- tiform 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 auro-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 latent epilepsy) ; the jury disagreed, and 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 remembrance of them. Soon T. was arrested again 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 in- creased. T. was noticed to have repeated epileptoid con- vulsions (tonic convulsion with tremor and loss of con- sciousness) (Auzouy, "Annal. med. psychol., 1874, Nov.; Legrand du Saulle, "Etude mcd. legale," etc., p. 99). The following cases of immoral acts with children, ob- served by the author and reported in "Friedreich's Blat- 476 PSYCHOPATHIA BEXUALIS. ter," will serve to conclude this group,1 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 185. P., aged forty-nine; 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 25th May, 1883. D. testified: "I was in the meadow with G. and my sister J., aged three. P. called us into his shop and fastened the door. Turn nos exosculabatur, linguam in os meum demittere tentabat faciemque mihi lambebal ; sustulit me in gremium, bracas aperuit, vestes meas sublevavit, digitis me in genitalibus titillabat et merabro vulvam meam fricabat ita ut humida fierem. When I cried, he gave me twelve kreuzers, and threatened to shoot me if I exposed him. At last he tried to persuade me to come again the next day." G. testified : "P. nates et genitalia D . . se exosculatus, iisdem me conatibus aggressus est. Deinde filiolum quoque tres annos natum in manus acceptum osculatus est nudatumque parti suee virili appressit. Postea quae nobis essent nomina interrogavit ac censuit, genitalia D. .se meis multo esse majora. Quin etiam nos impulit, ut membrum suum intueremur, manibus comprehendere- mus et videremus, quantopere id esset erectum." At his examination, 29th May, 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 irre- sponsible condition. Besides, he had suffered for years lCf. also Liman, " Zweifelhafte Geisteszustande," Fall 8; Lastgue, " Exhibitionists, Union mfid.," 1877 ; Ball and Chambard, "Art. Somnambulisme" ("Diet, des scienc. m6d.," 1881). EPILEPSY. 477 with weakness in his bead as result of an injury. On 22nd June he knew nothing of the events of 25th May, and nothing of his examination on 29th May. This amnesia was shown also on cross-examination. P. came of a family affected with cerebral disease; a brother was epileptic. P. was formerly a drinker. Years before he had actually received an injury to his head. Since then, from time to time, he had attacks of mental disturbance, introduced by moroseness, irritability, ten- dency to alcoholic excesses, apprehension, and delusions of persecution sufficient to induce threats and deeds of vio- lence. At the same time ho would have auditory hyperacs- thesia, vertigo, headache and cerebral congestion, — all this, with great mental confusion and amnesia for the whole period of the attack, which sometimes lasted 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 in- clined 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 remembrance. Soon after this, being sent to hospital, he gave the im- pression 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, indus- trious, good-natured man, and had never shown any sex- ual excitement; and, until this time, never sexual incli- nations, 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 478 PSYCHOPATHIA SEXUALI8. brought on headache and confusion. The medical exami- nation 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 was free from the sensations that started from the scar, he seemed kind, free, willing and open, though he was mentally weak and cloudy. P. was not sentenced (vide "Friedreich's Blatter" 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. £. Psych."), shows that it then may also be perverted: — Case 186. Catherine W., aged sixteen; she had not yet menstruated ; previously healthy. Father very irascible. Seven weeks before admission (3rd December, 1872), melancholic depression and irritability. 27th November, maniacal outbreak, lasting two days; thereafter, melan- cholic. 6th December, normal condition. 24th December (twenty-eight days after the first maniacal attack), silent, shy, depressed. 27th December, exaltation (jolly, laughing, etc.), with violent love for an attendant (female). 31st December, suddenly melan- cholic catalepsy, which disappeared after two hours. 20th January, 1873, new attack like the previous one. A simi- lar one on 18th February, with traces of menses. The patient had no recollection whatever for what occurred in the paroxysms, and blushed scarlet with astonishment and shame when told about them. PERIODICAL INSANITY. 479 Tin n-aftiT ilirru were abortive attacks, which entirely disappeared, to give place to the normal mental condition in . I une. In a case reported by Goclc ("Arch. f. Psych." v.), which was probably circular insanity, in a man of very bad heredity, during the state of exaltation there was manifestation of sexual feeling for men. In this case, however, the patient thought himself a girl, and it is ques- tionable whether the sexual inclination was induced by the delusion or by an antipathic sexual instinct In connection with these cases of abnormal manifesta- tion 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 dipso- mania, while in the intervals the sexual instinct is neither intense nor perverse. Quite a genuine case of such periodical psychopathia sexualis, connected with the process of menstruation, is the following reported by Anjel ("Arch. f. Psych." xv., Heft 2) :— Case 187. A quiet lady, near the climacterium. 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 disturb- ance, a hystero-epileptic attack, with post-epileptic insanity of several weeks' duration. Thereafter there was sleep- lessness 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 spoke openly of this impulse, and asked to be watched, as she was not to be trusted. In the intervals she anxiously avoided all talk of it, was very modest, and in nowise passionate sexually. 480 PSYCHOPATIIIA SEXUALI8. With reference to the still imperfectly known cases of periodical psychopathic, scxualis of this kind Tarnowsky (op. cit., p. 38) has made valuable contributions, though his cases were not all of a periodic nature. 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 parox- ysmal 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 in- somnia, and thoughts and impulses to commit the perverse sexual acts, with anxious confusion and an increasing im- pulse 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 Tarnow- sky, 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., Heft 2), is one of the most topical of the convulsive-like occurrence of sexual excitement : — Case 188. A gentleman of high social position, aged forty-five ; generally respected and beloved ; heredity good ; very moral; married fifteen years. Previously sexually normal, the father of several healthy children, and living in happy matrimony. Eight years ago he had a sudden fright. For some weeks thereafter he had a feeling of apprehension of 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 MANIA. 481 live- t«. ti-n years, evrn for his own daughters. He would beg his wife to guard tin- children. For days at a time, while in this state, he would shut himself in his room. iously he was compelled to pass school-girls on the t, and he found a peculiar pleasure in exposing his genitals before them, by acting as if about to urinate. For fear of exposure, he shut himself in his room, morose, incapable of movement, and torn by feelings of fear. Consciousness seemed to" be undisturbed. The at- tacks lasted from eight to fourteen days. The cause of their return was not clear. Improvement was sudden; there was great desire for sleep, and, after this was satis- fied, he was well again. In the interval there was nothing abnormal. Anjel assumed an epileptic foundation, and considered the attacks to be the psychical equivalents of epileptic convulsions. Mania. With the general excitation that here exists in the psy- chical organ, the sexual sphere is likewise often implicat- ed. 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, frivol- ity, and lasciviousness in speech, and frequenting of brotln-ls, arc ohserved; in women, inclination for the so- ciety of men, personal adornment, perfumes, talk of mar- riage and scandals, suspicion of the virtue of other women ; or there is manifested the reli^i-ms equivalent — pilgrim- ages, missionary work, desire to become a monk or the 31 482 PSYCHOPATIIIA SEXUALIS. 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 faeces; 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 shame- less masturbation and sexual attacks on women. Nymphomania and Satyriasis.1 The description of these conditions is simply an annex to the attempt made on page 69 to explain hypercesthesia sexualis, in so far as we take into consideration temporary sexual affects emanating therefrom, no matter whether they are occasioned by abstinence or are of a permanent char- acter. They may become so predominant that they com- pletely sway the field of imagination and desire, and im- peratively demand the relief of the affect in the correspond- ing sexual act. In acute and severe cases, ethics and will- power lose their controlling influence entirely, while in chronic and milder cases restraint is still possible to a certain degree. At the acme of paroxysm hallucinations, delirium and benumbed consciousness make* their appear- ance, and often continue during a prolonged period. •Literature: Bienville, Traite" de la nymph., Amsterdam, 1771; Louyer-Villermay, art. nymphomanie, diet, des sciences med., xxx., p. 563; Magnet, diet, en 60 vol. (vol xxxvi., p. 580) ; Meyer Alexit, des rapporta conjugaux, Paris, 1882, 7 6d. ; Guibout, traite clinique des malad. des femmes, Paris, 1886; Icard, la femine pendant la pgriode menstruelle, 1890; Marc, die Geisteskrankheiten, (ibersetzt von Ideler, ii., p. 138; Ideler, Grundriss der Seelenheilkunde, ii., p. 488; Foville, diet, de me'd. et de chirurch. pratique; Legrand du Saulle, la folie devant des tribun., 1864; Hall, la folie e"rotique, 1888; Moreau, aberrations du sens ggnlsique, 1884; Thoinot, attentats aux inoeurs, p. 487; Legrand du Saulle, les hyste'riques, 1883. NYMPHOMANIA AND 8ATTRIA8I8. 483 Such cases have led to the classification of nympho- mania as a proper psychical disease. But this is an error, for nymphoinania is only a syndrome within the sphere of psychical degeneration. As such it may manifest itself as an acute paroxysmic condition, analogous to dipsomania, frequently coinciding with menstrual phases, recurring either in stated periodical cicles, or at irregular intervals. Or it may be a complication or combination of other condi- tions and appear episodically in dementia senilis, climac- teric psychosis, mania in degenerates, and delirium acutum ("acute deadly nymphomania" ). Moreau (op. cit.) reports an interesting case. A young girl became suddenly a nymphomaniac when forsaken by her betrothed ; she revelled in cynical songs and expres- sions, and lascivious attitudes and gestures. She refused to put on her garments, had to be held down in bed by muscular men ( !) and furiously demanded coitus. In- somnia, congestion of the facial nerves, a dry tongue, and rapid pulse. Within a few days lethal collapse. Louyer-Villermay (op. cit.) : Miss X., aged thirty; modest and decent, was suddenly seized with an attack of nymphomania, unlimited desire for sexual gratification, obscene delirium. Death from exhaustion within a few days. Cf. three other cases with deadly result by Maresch, Psychiatr. Centralblatt, 1871. Chronic Nymphomania is more frequently met with, but seems to occur only in individuals psychically degener- ated. It is the result of sexual hyperaesthesia and exacer- bations thereof reaching even to the state of sexual affects which manifest themselves in impulsive acts, or, in milder cases, are complicated with delusions. These, however, need not by necessity lead to involuntary acts, in as much as ethical considerations may counterbalance the milder forms of sexual excitement and, moreover, recourse to soli- tary masturbation as a means of temporary relief is here always possible. Tlipso milder cases of nymphomania claim our sym- pathy not less that thoee unfortunate women who by lire- 484 P8YCIIOPATHIA SEXUALIS. sistible impulses are forced to sacrifice feminine honour and dignity, for they are fully conscious of their painful situa- tion, they are a toy in the grip of a morbid imagination which revolves solely around sexual ideas and grasps even the most distant points in the sense of an aphrodisiac. Even in their sleep they are pursued by lascivious dreams. In the daytime the slightest cause will produce a crisis in which a veritable erithismus cerebralis sexnalis, coupled with painful sensations (pressure, vibration, pulsation, etc.,) in the genitals torments them. Temporary relief comes in time in the shape of neurasthenia gcnitalis, which reacts promptly on the centre of ejaculation and readily causes pollutions in lascivious dreams, or some erotic crisis when awake. Full gratification, however, they cannot find any more than those of their unfortunate fellow-sufferers who abandon themselves to men. This anaphrodisia ex- plains to a large extent the persistence of the sexual affect, i.e., that nymphomania which heaps crisis upon crisis. Neurasthenia sexualis, which inhibits orgasm and sensual gratification, no doubt, fully explains this anaphro- disia which restrains the beneficent assuagement of sexual emotions, yet maintaining an incessant craving (libido in- saiiata}, forces the woman, morally devoid of all power of resistance, to auto-masturbation or psychical onanism, and eventually as a Messalina to prostitution in which to find satisfaction and relief with one man after another. This neurasthenia is often caused by an abnormally early and powerful sexual instinct, which prescribes onan- ism; or it may be reduced to enforced continence with strong coexisting sexual appetite. Case 189. Mrs. V., from earliest youth mania for men.- Of good ancestors, highly cultured, good-natured, very modest, blushed easily, but always the terror of the family. Quando quidem sola erat cum homine sexus alte- rium, negligens, utrum infans sit an vir, an senex, utrum pulcher an teter, statim corpus nudavit et vehement or libidines suas satiari rogavit vel vim vel manus ei injecit. NYMPHOMANIA AND 8ATYRIA8I8. 485 Marriage was resorted to as a cure. Maritum quam max- ime amavit, neque tanien sibi teinperare potuit quin a quolibet viro, si solura apprehenderat, seu verso, seu mer- cennario, seu discipulo coitum exposceret. Nothing could cure her of this failing. Even when she was a grandmother, she still remained a Messalina. Puerum quondam duodecim annos natum in cubiculum allectum stuprare voluit. He tore himself away and fled, and his brother gave her a severe punishment. But it was all in vain. When sent to a convent she was a model of good conduct and committed not the slightest act of indiscretion. But the moment she returned home, she resumed her perverse practices. The family sent her away, giving her a small allowance. She worked hard to earn the money she needed for "buying her lovers." In look- ing at the trim, neat matron of sixty-five years of age, with her modest manners and a most amiable disposition, no one could ever suspect how shamelessly needy in her sexual life she was even then. At last she was sent to an insane asylum, where she lived till May, 1858, when in her seventy-third year, she succumbed to a stroke of cerebral apoplexy. Her beha- viour at the asylum when under surveillance, was beyond reproach; but if left to herself she utilized every oppor- tunity in the same old fashion even to within a few daya before her death. No other signs of mental anomaly could be detected in her. (Trelat, "folie lucide.") Case 190. Chronic nymphomania. Mrs. E., age forty-seven. An uncle on father's side insane. Father Buffered from self-conceit and was given to sexual excess. A brother of the patient died from acute cerebral inflam- mation. Always nervous, eccentric, erotic, began coitus at the age of ten. Married at nineteen. Although her husband was virile, she maintained a number of male friends. Fully conscious of the abominable nature of her conduct, she was powerless in restraining her insatiable ap- petite. She kept up appearances, however. Later on she 486 PSYCIIOPATHIA SEXUALJS. claimed that she had suffered from a "monomania for men." She had six confinements. One day she was thrown from a carriage and sustained concussion of the brain. This caused melancholia and paranoia persecutoria. With approaching climacterium the menses became frequent and very profuse, but the libido gradually disappeared. Slight degree of descensus uteri and prolapsus ani. Chronic conditions of nymphomania are apt to weaken public morality and lead to offences against decency. Woe unto the man who falls into the meshes of such an insatia- ble Messalina, whose sexual appetite is never appeased. Heavy neurasthenia and impotence are the inevitable con- sequences. These unfortunate women disseminate the spirit of lewdness, demoralize their surroundings, become a danger to boys, and are liable to corrupt girls also, for there are homosexual nymphomaniacs as well.1 By expos- ing their feminine charms, even by exhibition, they lure men. Nymphomaniacs endowed with the world's riches purchase lovers. In many instances they resort to prosti- tution. The conditions of Satyriasis in men are analogous to nymphomania. It is a central disturbance, either of an acute character or chronic. In the acute stage it may lead to hallucinations of erotic content, and where compensa- tion of the sexual affect is rendered impossible, to furious mania, delirium acutum. This pathological sexual affect, stigmatised by abnormal intensity and duration, fills the whole psychical life. Oc- currences of the commonest and most indifferent nature are taken as sensual hints or suggestions. The lustful colouring of thoughts, ideas or natural perceptions by the senses is strongly exaggerated. At the acme of the crisis the patient is in a "rut-like" condition, in which conscious- ness is clouded and a general physical excitement, similar to that during coitus (cf. p. 40) pervades the whole 1 Thoinot, attentats aux moeurs, p. 498. NTMPHOMANIA AND 8ATYBIA8I8. 487 frame. Ejaculation may be concatenated with a renewed phase of orgasm in which the genital organs retain a per- manent turgescence (priapism). The individual afflicted with satyriasis is forever exposed to the peril of commit- ting rape, thus becoming a common danger to all persons of the opposite sex. Faute de mieux he resorts to mastur- bation and sodomy. Luckily satyriasis is a rare disease. It is not due to poisoning with cantharides, as some claim, which only produces priapism, that is to say, though at first causing erotic .-vn-ations and erection, after repeated doses it produces the opposite effect Analogous with nymphomania chronica mitis condi- tions of a mild satyriasis exist in men, (chiefly after Abusus Veneris) who suffer from neurasthenia sexualis ex mastur- batione and subsequent impotence, yet are the slaves of an insatiable libido. The imagination — the same as in acute cases — is highly excited and consciousness is com- pletely filled with obscene pictures and situations. The \vln»le train of thought, the entire realm of desire in these men is directed to sexual matters. Impotence and anaphro- disia assisted by perverse fancies lead them to the worst perversities possible in the sexual act and render them particularly dangerous to children. They give offence by exhibition, by masturbation and by sexual acts with per- sons of the other sex in public. They are lascivious in speech and revel in filthy language, etc. Satyriasis mitis is often observed in the incipient stages of dementia paralitica and senilis. Case 191. Satyriasis. Delir. acuium ex abstinentia. On the 29th of May, 1882, F., age twenty-three, unmar- ried, cobbler, was received at the psychiatric clinic at Graz. Father irascible, mother neuropathic, uncle on mother's side insane. Patient never had a severe illness, was not addicted to fir ink, but sexually very needy. Five days previously he was attacked with an acute psychical disease. In broad dajlight, and in the presence of two witnesses, he made 488 PSYCHOPATIIIA SEXUALIS. two separate attempts at rape, went into a fit of delirium, raving about obscene matters when arrested, constantly masturbated, and became a raving maniac with violent motoric irritability and fever. Treatment with ergotine brought relief. On January 5th, 1888, he was again arrested in a fit of raving mania. On the 4th, he had been morose, irrita- ble, squeamish, sleepless. He became furious when he was foiled in two assaults on women. On the 6th his con- dition became very much aggravated, heavy delirium acu- tum (disturbance of consciousness, jactation, crinching of teeth, facial contortions and other motoric manifestations, temperature 40.7°). Masturbation as if by instinct. Re- covery under treatment with ergotine till the llth of January. When restored to health again he gave some interesting details about his illness. His sexual needs were always very great. Coitus at sixteen. Continence caused headaches, great psychical irritability, dislike for work, laziness, sleeplessness. Hav- ing no opportunity for coitus he resorted to masturbation, once or twice daily. For two months he had had no sexual intercourse. As sexual excitement increased, masturbation failed as a means of compensation, but the desire for coitus became more vehement than ever. At the acme of the attack his memory failed him. - In his normal state he was a decent man and looked upon his state as a pathological condition which filled him with alarm for the future. Case 192. On the afternoon of 7th July, 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 neighbouring village of St. Ruprecht, attempted a rape on an old woman, aged seventy, whom he found alone in a house. He was seized by the neighbours and arrested by the local police. At his hearing he declared that he had tried to find the pound, HYMI'IIOMAXIA AND 8ATYRU8IB. 43d in order to satisfy his sexual desire with a bitch. Tie said that he often suffered with such sexual excitement. 1 It- 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 whom he wished to go, had confused him and made him ill. Shame and remorse were not shown. Ilia 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 ac- cused 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. ( \ was forty-five years old, married, father of one child. He did not know what diseases his parents or other mem- bers of his family 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, dated from that injury. The bone was here somewhat depressed. The overlying skin was united to the bone. Pressure at this point caused pain, which radiated along the lower branch of the trigeminus. This spot was also at times spontaneously painful. In his youth he suffered "fainting spells"; before puberty, pnefamonia, 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 f<>r men, though it was entirely platonic. He began to masturbate at the age of fourteen ; first intercourse at sev- enteen. Then the earlier manifestations of inverted sexual feeling disappeared entirely. At that time he passed through a peculiar acute j>-\vli<>pathic condition, which he ribed as a kind of clairvoyance. From fifteen, haemor- rhoids, with symptoms of abdominal plethora. When ho 4dO PSYCHOPATHIA 8EXUALI8. had profuse hsemorrhoidal haemorrhage, which occurred usually every three or four weeks, he was better. At other times he was constantly in a condition of painful sex- ual excitement, which he satisfied partly by means of onan- ism and partly by coitus. Every woman he met excited him ; even when he was among female relatives he was im- pelled to make indecent proposals. Sometimes it was possi- ble for him to master his desire ; sometimes he was driven to indecent acts. If, after these, he was ejected from the house, 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 period- icity in this sexual excitement was recognisable. Until 1861 he committed excesses in venery and was several times infected with gonorrhoea 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, ac- companied by great sexual excitement. He said that in- testinal catarrh and anxiety were the cause of his illness at that time. Thereafter he was well, but he suffered much on ac- count 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 ab- dominal plethora. Something that he remembered in medical reading made him think that in his case the gan- glionic 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 as well as bitches. From the middle of June until 7th of July, he had no oppor- 1TTMPHOMANIA AND 8ATYRIA8I8. 401 tunity 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 ab- sence. The heat and the noise of the train confused him, and he could no longer hold out against his sexual excite- ment and the pressure of blood in his abdomen. Every- thing 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 him- self in the water; everything appeared as in 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 were undisturbed, but he was, nevertheless, a congenitally peculiar man, with a character weak and devoid of energy. The facial expression had something lascivious and peculiar about it. He suffered with hemorrhoids. The genitals pre- sented nothing abnormal. The cranium was narrow and retreating at the forehead. Body large and well nourished. With the exception of diarrhrea, there was no disturbance of the vegetative functions. Case 193. For three years farmer D., universally respected, married, aged thirty-five, had manifested states of sexual excitement with increasing frequency and severity, which during the past year had become true paroxysms of satyriasis. It was impossible to discover hereditary or other organic causes. D. was compelled a* times, when his sexual excitement was excessive, to per- form the sexual act from ten to fifteen times in twenty- 492 PSTCHOPATHIA SEXUALIS. four hours, without deriving any feeling of satisfaction. Gradually he developed a condition of general nervous hyper-irritability (erethisme general) with increased emo- tional irritability to the extent of pathological outbreaks of anger, and impulse to over indulgence in alcohol, which induced symptoms of alcoholism. His attacks of satyri- asis 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 of these attacks, in which the extreme irritability even led to outbreaks of maniacal rage, was entirely want- ing. 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 dis- appeared (Lentz, Bulletin de la societe de med. mentale de Belgique, No. 21). Melancholia. The thoughts and feelings of melancholiacs are not favourable for the excitation of sexual desires. At the same time, these patients sometimes masturbate. In my experience such cases have always been hereditarily pre- disposed 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 ICTMPHOMANIA AMD SATYBIA8IS. 493 occur here, with sudden changes and peculiar activity; and, on an hereditary ate basis and in moral inilxrility, they may appear in the most perverse forms. The abnormal change and inversion of the il fivling are never without effect upon the patient's disposition. The following case, reported by Giraud, is one of this nature worthy of repetition: — Case 194. Marianne L., of Bordeaux. At night, while the household was asleep under the influence of narcotics which she had administered, she had given the rhildren of the house to her lover for sexual enjoyment, and made them witness immoral acts. It was found that L. \vas hysterical (hemiansesthesia and convulsive attacks), but before her illness she had been a moral, trustworthy person. Since her illness she had become a shameless pros- titute, and lost all moral sense. In the hysterical the sexual sphere is often abnormally excited. This excitement may be intermittent (men- strual ?). Shameless prostitution, even in married women, may result. In a milder form the sexual impulse ex- presses itself in onanisra, going about in a room naked, smearing the person with urine and other filthy things, or wearing male attire, etc. Schiile ("Klin. Psychiatric," 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 cites known cases in which, on the wed- ding-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, un- 494 PSYCHOrATHIA 8EXUALI8. founded accusations against men for immoral acts,1 hallu- cinations of coitus,2 etc. Occasionally frigidity may occur, with absence of lust- ful feeling — due, for the most part, to genital anaesthesia. 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 experi- ence, 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 in- tense and, under certain circumstances, perverse sexual in- stinct 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 aesthetically. Under certain circumstances, the enthusiasm is for an imaginary person, a portrait, or a statue. A love for the opposite sex that is weak and purely mental also, often has its basis in weakness of the genitals due to long-continued masturbation; and, under the guise of virtuous admiration for a beloved person, great lascivi- ousness and sexual perversion are often concealed. Epi- sodically, especially in women, violent sexual excitement may occur as a nymphomania. For the most part, paranoia religiosa rests upon sexual- ity which manifests itself in a sexual impulse abnormally 1 Vide case of Merlac, in the author's " Lehrb. d. ger. Psycho- pathol.," 2 Aufl., p. 322; Morel, " Traite" dea malad. mentales," p. 687 ; Legrand, " La f olie," p. 337 ; Process La Ronciere, in " Annal. d'hyg.," 1 Serie, iv.; 3 Serie, xxii. 1 The iucubui in the witch-trials of the middle ages depended on them. PARANOIA. early ami intcnso. The libido finds satisfaction in mas- turbation 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. 10 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. med. psychol.") has reported a case of immorality with a little girl by a religious paranoiac, aged forty-three, who was temporarily erotic. Here, also, belongs a case of incest (Liman, "Vierteljahrsschr. f. ger. Med."). Case 195. 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 1800 years old. He would be a bridge between the Old and the New Testament." 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 196. A woman of thirty had, under promise of money and food, 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 delu- sions of persecution, and thought she was under the secret influence of her seducer, who impelled her to sexual acts. 496 PSYCJIOPATHIA SEXUALIS. 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 (Kiissner, "Berl. klin. Wochenschrift"). Case 197. Immoral Acts With Children — Paranoia. On the 26th of May, X., aged forty-six, railway official, was arrested in the act of sucking the penis of a boy eight years of age in the public highway. On the way to prison he committed the same offence on a fellow prisoner, who was riding in the same vehicle with him; and again on another prisoner. He was sent to the psychiatric ward of the hospital, where he made similar attempts. lie was then isolated. The medical examination proved paranoia persecutoria, developed from constitutional neurasthenia. X. was heav- ily tainted by heredity. His illusion was that the admin- istration under which he had served were persecuting him and tried to force him to resume his former duties. He had noticed that persons who were friendly to him, especially his superiors, tried to show him a way in which he could rid himself of this fear of persecution. They did so by putting a finger in their mouth and sucking it. Still plainer were the suggestions of his chums who, pointing to a dog, i.e., meaning himself, would speak of "licking." This started the idea in him that if he could be appre- hended in the act of licking somebody's genitals, his su- periors would become disgusted with him and dismiss him from service, in which way he would regain his freedom. For a long time he could not muster up courage enough to commit such an act, but the idea became so strong that at first he resorted to cunnilingus with prostitutes, who in- vited him with cunning looks to this delectable feast. As these women, however, refused to denounce him to the authorities, he attacked boys and girls — the sex was im- material— who, he fancied, invited him by gestures to the act. He could not understand, however, why he should PARANOIA. 497 come in conflict with the police by committing an act which was suggested to him by his superiors in office, — and all this in spite of the continued persecution of the railway administration. It is strange 'that X. should have had recourse to such an abominable and nauseating sexual act and not to theft or some other act of dishonesty, unless it is explained on the ground of an increasing neurasthenia, coupled with a perversion of the sexual instinct and subsequent impotence. He was always hypersexual, with an heterosexual predis- position, suffered for years from neurasthenia sexualis, and derived no satisfaction from coitus. As in time erec- tion became difficult, he had consulted several physicians, who advised abstinence. His excessive libido rendered it difficult to follow this advice, and impotence prevented coitus. This suggested cunnilingus, which granted a cer- tain amount of sexual gratification and at times even pro- duced ejaculation. This also compensated him for the nausea he experienced during the act and paved the way to his folly on children. He claimed that in this act he found sexual satisfac- tion, but the chief object for it always was to rid himself of persecution by his superiors. This passion calmed down under treatment at the hospital, and he became a decent man when put under domestic supervision. Cullerre ("Perversions sexuelles chez les persecutes," in "Annal. medico-psychol.," March, 1886) has reported similar cases, — the case of a patient who, suffering with paranoia sexualis persccutoria, 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 ped- erasty,— a thing he abhorred. In a similar case the perse- cutor impelled to onanism and pederasty. V. PATHOLOGICAL SEXUALITY IN ITS LEGAL ASPECTS.1 THE laws of all civilised nations punish those who com- mit 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 corn- batted, 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 civilisation.* This is particularly the case with immoral acts with chil- dren under the age of fourteen. Casper {Clinical novels), drew attention to this de- plorable fact early in the sixties of the 19th century. As a criminal physician (Berlin) he had fifty-two cases of crimes against morality under observation from 1842-57, but during the decade of 1852-1861 the number rose to 138. *B. Weitbrod, "Die Sittlichkeitsverbrechen vor dem Gesetz," Berlin, 1891; Dr. Pasquale Penta, "1 pervertimenti sessuali nell'- uomo," Napoli, 1893; Seydel, "Die Beurtheilung der perversen Sex- ualvergehen in foro," " Vierteljahrsachr. fUr.ger. Med.," 1893, Heft 2; Viazzi, " reati sesauali " (" Biblioteca antropologico-giuridica ") ; Archivio di Psichiatria, vol. xix., fasc. 1., " Strafgesetzbticher und Unzuchtsdelikte." — v. Schrenk-Noteing, Archiv f. Kriminalanthropol. Bd. 1, H. 1. *Cf. Casper, "Klin. Novellen"; Lombroso, " Qoltdammer3* Archiv," Bd. xxx.; Oettingen, "Moralstatistik," p. 494. 498 PATHOLOGICAL SEXUALITY IN ITS LEGAL ASPECTS. 499 According to the "Comptea rendus de la justice crimi- nelle en France/' during the period of 1826-1840, "a//> n- tats aux mocurs" formed only 20 per cent, of the criminal proceedings, whilst from 1856-60 the average rose to 53 per cent. Sexual atrocities on children were but 1-13 of all cases tried before the criminal forum from 1826-30, but 1-3 during the period of 1856-60. Oettingen ("Moralstatistik") quotes 136 cases of stup- rum on children committed in France in 1826, but 805 in 1867. Moreau ("Aberrations du sens genesique") quotes, for the year 1872, 682 cases of immoral attacks on children in France, for the year 1876 their number was 875. In England similar delicts on children numbered 167 for the period 1830-34, and 1395 for the period 1855-57. In Prussia, according to Oettingen, sexual attempts were in the proportion of 325 :925 ; sexual crimes in the proportion of 1477:2945. Ortloff also finds ("die straf- baren Handlungen") a considerable increase in immoral offences on children under the age of fourteen. We are indebted to Thoinot for interesting statistics of moral offences dealt with by the criminal courts of France (at- tentats aux moeurs et perversions des sens genital, 1898, Paris). Sexual criminal cases seem to have been on the wane in France. There were in 1860 830 (2.3 to a population of 100,000) offenders sentenced; in 1892 only 679 (1.7 to a population of 100,000). The proportion of crimes committed on adults and children was in 1860 180 :650 (1 :3.6), whilst in 1892 it rose to 78 :601 (1 :7.7). In 1885 it reached the highest point, viz. : 1 :9.5. 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 pun- ishing 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 nervous condition of later 500 PSYCI10PAT1IIA SEXUALIS. generations, in that it begets defective individuals, excites the sexual instinct, leads to sexual abuse, and, with con- tinuance of lasciviousness associated with diminished sex- ual power, induces perverse sexual acts. It will be clearly seen from what follows how such an opinion is justified, especially with respect of the increas- ing number of sexual crimes committed on children. The relative increase of sexual delicts on children seems to point to an advance in the physical decadence (impotence) and psychical degeneration of the adult popu- lation. This view seems to be supported by Tardieu, Brouardel and Bernard, who find that attacks on children are more frequent in large cities, whilst those on adults, especially rape, occur more often in the country. The statistical facts compiled by Tardieu and Brouar- del, according to which the proportion of sexual offences on children is in ratio with the age of the offender, i.e., the older the criminal the younger the victim, and the circum- stance that acts of immorality by very old men are only committed on children, seem to demonstrate that impotentia cceundi and moral decay (dementia senilis) are the funda- mental causes of these horrible crimes. It is at once evident, from the foregoing, that neuro- pathic, and even psychopathic, states are largely determin- ate for the commission of sexual crimes. Here nothing less than the responsibility of many of the men who com- mit such crimes is called in question. Psychiatry cannot be denied the credit of having re- cognised 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 psycho-pathology. Law is, in this, opposed to Medicine, and is constantly in danger of passing judgment on in- dividuals who, in the light of science, are not responsible for their acts. Owing to this superficial treatment of acts that deeply PATHOLOGICAL 8EXUALITT IN ITS LEOAL ASPECTS. 501 rn the interests and welfare of society, it becomes very easy for justice to treat a delinquent, who is as dan- gerous to society as a murderer or a wild beast, as a crimi- nal, 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 per- petrator, is always in danger of injuring not only import- ant interests of society (general morality and safety), but also those of the individual (honour). 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 hero 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 per so indicate perversion of in- stinct. At any rate, the most monstrous and most 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 it to be part of an existing general neuropathic or psychopathic condi- tion. The species facti is important ; but it, too, allows 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 accord- ance with the manner in which it is done. Periodical recurrence of the act under identical circum- stances, and an impulsive manner in carrying it out, give rise to weighty presumptions that it is of pathological sig- nificance. The decision, however, must follow after re- ferring the act to its psychological motive (abnormalities of thought and feeling), and after showing this elementary 502 PSYCHOPATHIA SEXUALIS. 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 occa- sioned 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 anthropo- logical 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 charged with 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 moral- ity, and at the same time remove the conditions necessary to the existence of responsibility, under the following cir- cumstances : — 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 (&) the fact that they have been lost (states of acquired mental weakness). 2. When the sexual desire is increased (states of psy- chical exaltation), consciousness simultaneously clouded PATHOLOGICAL ST \ I \ I ITV I X ITS LEGAL ASPECTS. 503 and tin- nii-ntiil mechanism too much disturbed to allow the opposing ideas, virtually present, to exert their in- fluence. B, When the sexual instinct is perverse (states of psychical degeneration). It may, at the same time, be so intensified as to be irresistible. 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 condi- tion, 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 dis- ease, will recognize the circumstances which ameliorate the heinousncss 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 commit- ted 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, peder- asty, amor Icsbicus, and bestiality may have a psycho- pathological basis. In case of lust-murdor — in as far as its ulterior object goes beyond the murder itself — and likewise in cases of mutilation of corpses, psychopathic conditions are probable, 504 PSYCIIOPATIIIA SEXUALIS. Exhibition and mutual masturbation seem to indicate the probable existence of pathological conditions. Mas- turbation of another and passive onanism may occur in connection with senile dementia and inverted sexual feel- ing, but also with mere sensuality. Cunnilingus and fellare (penem in os mulieris arri- qere) 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. Pcedicaiio 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 neces- sary that the sexual acts threatened with punishment as sexual crimes be considered by jurists from the standpoint 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 physio- logical psychology. 1. Offence Against Morality in the Form of Exhibition.1 (Austrian Statutes, §516; Abridgment, §195. German Statutes, §183.) In man's present condition of civilisation, 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. 1 Boisticr et Lachaux, " Perversions sexuelles a forme obse'dante," " Archives de Neurologic," 1893, October; Schafer, " Vierteljahrsschr. f. gerichtl. Med.," 3 Folge, x., 1.— Thoinot, attentata aux moeurs, 1898, p. 366-398;— Seiffer, Arch. f. Psych. Bd. 31, H. 1 and Z.- Cramer, Die Beziehungen des Exhib. zum §51. des deutsch. Stfgsb., Zeitschr. f. Psych. 54, p. 481. — Bassenge, Der Exhibitionismus, Inaug.- Dissert., Berlin, 1896. — Eoche, Neurolog. Centralbl., 1896, 2. OFFENCE AGAINST MORALITY. 505 Tin1 presumption is justifiable that an individual who has in this way offended public decency and his own self- respect was incapable of (idiots) or had lost the feelings of morality (states of acquired mental weakness) ; or that he 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, whom in some in- stances they even pursue, 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 calls the virility of these individuals in question. Thus there are various categories of exhibi- tionists. The first category includes acquired 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 resistance 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 cases1 fall in this category. lLa»(guc, "Union MAdicale,"l877, May; Laugier, " Annal. d'hy gi«ne publ.," 1878, No. 106; Pelande, " Pornopatha," " Archivio di Psichiatria," viii. ; Hchurhardt, " Zeitschr. f. Medicinalbeamte," 1890, Heft 6. — Duchateau, Bulletin de la Boci6t£ de m&leoinc de Gand, 1897, Febr.-March. — Gamier, Annal. m(klico.-p«ychol. 1894, Jan.-Feb. — \\gouruux, ibidem. — Moppc, Vierteljahr»»chr. f. gerichtl. Med., 3. 506 PSYCHOPATHIA SEXUALIS. They are those of individuals afflicted with senile demen- tia, paretic dementia, or mental defects due to alcoholism, epilepsy, etc. Case 198. Z., high official, aged sixty; widower, father of a family. He gave offence 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 (Lasegue, op. cit.). Case 199. Z., aged seventy-eight; seaman. He had repeatedly exhibited his genitals on children's play- grounds and in the neighbourhood 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 previously he had suffered a severe head-injury, which left a deep scar, indenting the bone. Pressure on this scar caused pain ; at the same time his face would flush, his expression become fixed, and he would grow som- nolent, with convulsive movements in the right upper extremity (apparently epileptoid state in connection with cortical disease). Moreover, 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 sixty. At the age of fifty-eight he Folge xx., 2. — Leppmann, Die Sachverstiindigenthatigkeit, p. 101. — Rayneau, Annal. me'd.-pych. 1895, May-June. — von Schrenk-Notzing, Arch. f. Criminalanthropol. Bd. i., H. 2 and 3, Fall 4 u. 5. — Struts- mann, Vierteljahra. f. geriehtl. Med., 3. Folge, 10 Bd. OFFENCE AOAIN8T MORALITY. 507 began to exhibit himself to women and children. In the asvlum at Verona, for a long time thereafter, he was lascivious, and also attempted fellatio. 2. A drinker, aged sixty-six, suffering with folie cir- culaire. His exhibition was first noticed in church during divine service. His brother was likewise an exhibitionist. 3. A drinker, predisposed, aged forty-nine. He was always very excitable sexually; in an asylum on account of chronic alcoholism. lie exhibited himself whenever he saw a woman. 4. A man, aged sixty-four; married ; father of fourteen children. Great predisposition. Rachitic, microcephalic IK ':'.d. For years he had been an exhibitionist, in spite of repented punishment. Case 200. X., merchant, born in 1833 ; single. He had repeatedly exhibited himself to children, or even urinated at the same time; once, under these circum- stances, he had kissed a little girl. Twenty years pre- viously X. had had a severe attack of mental disease, lasting two years, in which he was 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 prcecox and mental weakness. Penis small ; phi- mosis; testicles atrophic. Proof of mental disease; par- doned (Dr. Scliuchardt, op. cit.}. Such cases recall the lasciviousness of youthful, sexu- ally excited 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 epilep- tics.1 This category is essentially to be distinguished from 1 Instructive <-nse reported by Uoraclli, " Bolleiino della R. Accademia medica di Geneva," vol. ix. (1804), fasc. 1. 508 PSYCHOPATIIIA 8EXUALIS. the foregoing, because a conscious motive for the exhibition is wanting; and it appears much more like an impulsive act which, without any consideration of external circum- stances, is performed as if it were an abnormal organic necessity. At the time of the act there is always a state of im- perfect 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 conscious- ness, he regrets and abhors it if there is not permanent mental weakness. The prime motive in this state of imperfect conscious- ness, as with other impulsive acts, is a feeling of appre- hensive 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 epi- leptics may be understood from the discussion on p. 468. 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 track has been established in the path of motivity. The feeling of anxiety, with the state of imperfect con- sciousness, 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 201. K., a subordinate official, aged twenty- nine; of neuropathic family; living in happy marriage; father of one child. He had repeatedly, especially at dusk, exhibited himself to servant-girls. K. was tall, slim, pale, nervous and hasty in manner. There was imperfect mem- ory of the crimes. Since childhood there had been fre- quent severe congestive attacks, with intense flushing of the face, a rapid, tense pulse, and a fixed, absent stare. At- OFFENCE AGAINST MORALITY. 509 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. stated that he had al- ways 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 IK- 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 was 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 extenuat- ing circumstances (Dr. Schuchardt, op. cit.). Case 2O2. L., aged thirty-nine; single; tailor. His father was probably a drinker; he had two epileptic brothers, one of whom was insane. The patient himself had slight epileptic attacks, and from time to time states of imperfect consciousness, in which he ran about aim- lessly, and thereafter did not know where he had been. lie was considered a moral man, but he was now accused of having exhibited and played with his genitals in a strange house five or six times. His remembrance of these acts was very imperfect. On account of repeated desertion from the army (pro- bably likewise in epileptic states of imperfect conscious- ness), L. had been severely punished. In imprisonment he became insane with "epileptic insanity," was sent to the Charite, and from there discharged "cured". As far as the criminal acts were concerned, cynicism and wanton- ness could be excluded. That they were committed in a state of imperfect consciousness was probable from the fact 510 PSYCHOPATHIA SEXUAUS. among other things, that to the policeman who arrested him, the "imbecile" appeared to be in a remarkably cloudy state of mental consciousness (Liman, "Vierteljahrsschrift f. ger. Med.," N. F. xxxviii., Heft 2.) Case 203. L., aged thirty-seven. From 15th October to 2nd November, he had many times given offence by exhibiting himself to girls in daylight in 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 with his exposed penis on the window so that the children and servant-girls 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 demonstra- tion 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 (at- tacks of insanity?). Besides, he was often remarkable on account of his changeable, quarrelsome character, occa- sional excitement and inconstancy. L.'s brother died of paralysis. He himself presented no degenerative signs; no epileptic antecedents. At the time of observation he was neither insane nor mentally weakened. He behaved himself very well, and expressed great regret for his sexual crimes, which he explained in this wise: though not a drinker, he occasionally had an im- pulse to drink. Soon after beginning, congestion of the head, vertigo, restlessness, anxiety and oppression came on. He then passed into a dreamy state. An irresistible impulse now forced him to expose himself; and he then experienced a feeling of relief and breathed more easily. When he had once exposed himself, he knew nothing OFFENCE AGAINST MORALITY. 511 more of what he did. 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 con- sciousness he had but an obscure, 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, with- out 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 aim- lessly in a neighbouring 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 were perfectly normal (Dr. Hotzen, "Friedreich's Blatter," 1890, Heft 6). A clinical group that very nearly approaches the epi- leptic exhibitionists is made up of certain neurasthenic individuals, in whom, likewise, there may occur attacks (epileptoid ?) of imperfect consciousness1 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 204. Dr. S., academic teacher, had aroused public indignation by being seen repeatedly running about in the Zoological Garden at Berlin, before ladies and chil- dren, with his genitals hanging out. S. admitted this, but denied all thought or consciousness of causing public offence, and excused himself by saying that his running about with exposed genitals afforded him relief from ner- vous excitement. Mother's father was insane, and died by suicide; his mother was constitutionally neuropathic, a somnambulist, and had been temporarily insane. He I 1 Cf. v. Krafft, " Ucber tranaitoriachea Irresein bei Neurasthen- ischen," " Irrenfreund," 1883, No. 8; and "Wiener klin. Wochen- •chr.," 1891, No. 50. 512 PSYCHOPATHIA 8EXUALIS. was neuropathic, had been a somnambulist, and had had continuous aversion to sexual intercourse with females. In his youth he practised onanism. He was a neuras- thenic man, shy, torpid and easily became embarrassed and confused. He was sexually always much excited. Fre- quently he dreamed that he was running about with ex- posed genitals, or that, dressed only in a shirt, he hung from a horizontal bar 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. In his waking state also 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 lie 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. No doubt 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 {Liman, "Vierteljahrsschrift fiir gerichtl. Med.," N. F. xxx. viii., Heft 2). Case 205. X., aged thirty-eight ; married ; father of one child. Always sullen and silent. Suffered frequently with headache. Very neurasthenic, though not insane. He was troubled much at night by pollutions. He had 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 1'an- thropologie criminelle," iii., p. 256). OFFENCE AGAINST MOKA1.1TY. 513 In the following case the exhibition seems subsidiary to tlu- impulsive desire to satisfy sudden, intense libido by means of masturbation : — Case 206. R., coachman, aged* forty-nine; Vienna; married since 18@6; childless. Father neuropathic and given to sexual excesses; died of cerebral disease. lie presented no degenerative signs. At the age of twenty-nine he suffered a severe concus- sion by falling from a height. Up to that time the vita scxualis had been normal. Since then, however, every three or four months he had 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, preceded this. In the intervals he was sexually cold, and had but very infrequent desire for his wife, who, moreover, for five years had been, sick and incapable of cohabitation. He gave the assurance that, as a young man, he never masturbated, and that, in the intervals between his attacks, he had never thought of satisfying himself sexually in this way. The impulse to masturbate during the attack was al- ways excited by certain feminine charms — short cloak, pretty foot and ankle, elegant appearance. Age made no difference; even little girls excited him. The impulse was sudden and unconquerable. R. described 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 sper- matic 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. lie regarded it as a terrible affliction. Defence showed that R. had been punished six times for 33 514 PSYCHOPATH I A SEXUALIS. similar offences — exhibition and masturbation in the open street. Although an examination into his mental condi- tion by experts was demanded by his counsel, the court refused it on the ground that the proceedings had raised no doubt as to his responsibility. On 4th November, 1889, R., while in his worst condi- tion, 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 too excited. There was immediate exhibition, masturbation in front of a house — great scandal and immediate arrest. R. was not weak-minded, and had no ethical defect. He bemoaned his fate, deeply regretted his act, and feared new attacks. He regarded his condition as abnormal — as a fate against which he thought he was powerless. He thought himself still virile. Penis abnormally large. Cremasteric reflex present; patellar reflex increased. Weakness of the sphincter of the bladder, that had existed for some years. Various neurasthenic difficulties. The opinion showed that R. was subject to the influ- ence of abnormal conditions, and had acted impulsively. Patient was sent to an asylum, from which he was dis- charged 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 exhibition- ists that are in a neurotic (epileptic or neurasthenic) state of benumbed consciousness, apparently the clinical and for- ensic side of this phenomenon is still unexhausted; in addition to these, there is another class, the represent- atives of which, owing to deep hereditary taint (hereditary degenerative neurosis?), are impelled to periodical and very impulsive exhibition. With reference to these conditions of psychopafhia OFFENCE AGAINST MORALITY. 515 scxualis periodica(cf. "Periodical Insanity,") in which the accidentally awakened impulse to exhibition is but a par- tial manifestation of a clinical whole, like in dipsomania periodica the craving for drink, Magnan,1 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 realisation of the impulse, gives place to a feeling of relief. These facts, and, no less, the clinical picture of de- generacy that, for the most part, is referable to injurious conditions that are hereditary, or that exercise an in- jurious effect on the development of brain in early years (rachitis, etc.,) are, medico-legally, of decisive importance. Case 207. G., aged twenty-nine, waiter in a cafe. 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. had very nervous parents. His father was mentally unstable and very irascible. His mother was at times in- sane, and suffered with severe neurotic affection. G. had always had nervous twitching of the face, and constant alternation of causeless depression, with tcedium vita, and periods of elation. At the ages of ten and fifteen, for slight cause, he wished to commit suicide. When ex- cited, he had similar twitching of the extremities. He presented 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 1 " Recherche* sur les Centres Nerveux," 2% s4rie, Paris, 1893. 516 PSYCHOPATHIA SEXUAXIS. solitary and mutual masturbation, and, on one occasion, he had practised onanism witfi a girl. From that time, working in a cafe, the female customers had excited him BO intensely that ejaculation was often induced. He suf- fered 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 him- self at his window, and also exposed himself naked to female neighbours living opposite. In 1883 he married for love. 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. In one of these attacks he had recently exhibited him- self before ladies in two streets of Paris (12th May, 1887). Since then he was fighting a desperate battle against these morbid impulses which had now become almost per- manent, and when at their height made him morose and confused, and caused him to weep all night. In spite of all efforts he backslided again and again. Opinion: Proof of hereditary degeneration with delusions and irresistible impulses ("perversion delirante du sens genital"). Par- don (Magnan, "Arch, de 1'anthropologie criminelle," v., No. 28). Case 208. B., aged twenty-seven; of neuropathic mother and alcoholic father. He had one brother who was a drinker; and a hysterical sister. Four blood rela- tions on paternal side were drunkards, one female cousin is hysterical. After his eleventh year, onanisra, solitary or mutual. After his thirteenth year, impulses to exhibition. He at- tempted 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. OFFENCE AGAINST MORALITY. 517 After his s